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Ferri A, Sutcliffe KL, Catling C, Newnham E, Levett KM. Antenatal education - Putting research into practice: A guideline review. Midwifery 2024; 132:103960. [PMID: 38461784 DOI: 10.1016/j.midw.2024.103960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Revised: 02/05/2024] [Accepted: 02/25/2024] [Indexed: 03/12/2024]
Abstract
PROBLEM Antenatal care guidelines used in Australia are inconsistent in their recommendations for childbirth and parenting education (CBPE) classes for preparation of women and parents for pregnancy, childbirth, and early parenting. BACKGROUND Clinical practice guidelines in maternity care are developed to assist healthcare practitioners and consumers to make decisions about appropriate care. The benefit of such guidelines relies on the translation and quality of the evidence contained within them. In the context of antenatal care guidelines, there is a potential evidence-practice gap with regard to CBPE. AIMS This review aims to appraise the quality of Australian antenatal care guidelines in their recommendations for CBPE for women and partners. METHODS Publicly available Australian antenatal care guidelines were identified including local health district websites and professional organisations pertaining to maternity care. Guidelines were reviewed independently, and the quality was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool. FINDINGS Five guidelines were included in the review and appraised using AGREE II. With the exception of the Department of Health Pregnancy Care Guidelines, guidelines scored poorly across all six domains. When appraised according to specific CBPE recommendations for rigour of development, presentation, and applicability; all guidelines received low scores. DISCUSSION Prenatal services remain largely unregulated across the board, with no systematic approach to make recommendations for CBPE and guidelines lacking in rigour with regard to CBPE. CONCLUSION Within the guidelines reviewed there was a lack of evidence-based recommendations provided for educators or consumers regarding childbirth and parenting education.
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Affiliation(s)
- Alessia Ferri
- National School of Medicine, Auburn Clinical School, University of Notre Dame Australia, NSW, Australia.
| | - Kerry L Sutcliffe
- National School of Medicine, Auburn Clinical School, University of Notre Dame Australia, NSW, Australia
| | - Christine Catling
- Collective for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, Australia
| | - Elizabeth Newnham
- School of Nursing & Midwifery, University of Newcastle, NSW, Australia
| | - Kate M Levett
- National School of Medicine, Auburn Clinical School, University of Notre Dame Australia, NSW, Australia; Collective for Midwifery, Child and Family Health, University of Technology Sydney, Broadway, Australia; NICM Health Research Institute, and THRI, Western Sydney University, Australia
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2
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Shurong Z, Li M, Jie X. Decision-making experiences and the need for decision aids in women considering vaginal birth after cesarean: A qualitative meta-synthesis. Birth 2024; 51:3-12. [PMID: 37766494 DOI: 10.1111/birt.12764] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2020] [Revised: 07/21/2023] [Accepted: 08/05/2023] [Indexed: 09/29/2023]
Abstract
AIMS This study aims to comprehensively explore the decision-making requirements of women contemplating vaginal birth after cesarean (VBAC). DESIGN & METHODS A meta-synthesis approach was employed for this study. Using an integrative methodology, we conducted a systematic assessment of women's experiences and needs related to VBAC decision-making. A comprehensive search was conducted across The Cochrane Library, PubMed, EMBASE, Ovid Medline, SCOPUS, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Wan Fang databases to identify pertinent studies between 2000 and 2022. Furthermore, the reference lists of the included studies were thoroughly examined. RESULTS Fifteen studies were incorporated, from which seven themes emerged: emotional changes, preference for vaginal birth, unmet information needs, influences on decision-making, decision-making autonomy, aligning information provision with decision-support needs, and the requirement for support systems. Two primary syntheses were constructed on the decision-making process and the need for decision-making aids, respectively. CONCLUSION Women opting for VBAC experienced emotional shifts during their decision-making process in pregnancy. There remains a need for an enhanced decision-making tool to guide them in their choice. Recommendations for implementation in VBAC decision aids include facilitating women's involvement in decision-making, satisfying their information needs, and delivering appropriate emotional support.
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Affiliation(s)
- Zhou Shurong
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
| | - Mengyuan Li
- Peking University School of Nursing, Beijing, China
| | - Xiang Jie
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Department of obstetrics Nursing, West China Second University Hospital, Sichuan University/West China School of Nursing, Sichuan University, Chengdu, China
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3
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Dencker A, Lyckestam Thelin I, Smith V, Lundgren I, Nilsson C, Li H, Ladfors L, Elfvin A. Neonatal outcomes associated with mode of subsequent birth after a previous caesarean section in a first pregnancy: a Swedish population-based register study between 1999 and 2015. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001519. [PMID: 36053602 PMCID: PMC9289021 DOI: 10.1136/bmjpo-2022-001519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 06/23/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To investigate neonatal outcomes within 28 days in the subsequent birth in women who gave birth to their first baby by caesarean section (CS). DESIGN AND SETTING National retrospective population-based register study. A cohort of 94 451 neonates who were born in Sweden between 1999 and 2015 as a second child to a mother who had her first birth by emergency or planned caesarean. METHODS Data were retrieved from the national registers held by Statistics Sweden and the National Board of Health and Welfare. Logistic regression was used to calculate unadjusted and adjusted ORs (aOR) with 95% CIs for each outcome. MAIN OUTCOME MEASURES Neonatal infection, neonatal asphyxia/respiratory distress, neonatal hospital care and neonatal death within 28 days. RESULTS Emergency CS and instrumental vaginal birth were associated with a doubled risk of neonatal infection (aOR 2.0) and planned CS with a decreased risk (aOR 0.7) compared with spontaneous vaginal birth. Compared with spontaneous vaginal birth, an increased risk of birth asphyxia and/or respiratory distress was identified with all other modes of birth (aOR 2.2-3.2). Emergency CS and instrumental vaginal birth, but not planned CS, were associated with neonatal hospital care (aOR 1.8 and 1.7) and an increased mortality rate during the neonatal period (aOR 2.9 and 3.2), compared with spontaneous vaginal birth. CONCLUSIONS In childbirth following a previous birth by CS, spontaneous vaginal birth appears to confer better neonatal outcomes within 28 days after birth overall than other modes of birth.
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Affiliation(s)
- Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden
| | - Ida Lyckestam Thelin
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.,Munkebäck Antenatal Clinic, Västra Götalandsregionen, Gothenburg, Sweden
| | - Valerie Smith
- The School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Ingela Lundgren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Goteborg, Sweden.,Institute of Health and Care Sciences, UiT The Arctic University of Norway, Tromso, Norway
| | - Christina Nilsson
- Munkebäck Antenatal Clinic, Västra Götalandsregionen, Gothenburg, Sweden
| | - Huiqi Li
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, Goteborg, Sweden
| | - Lars Ladfors
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, Goteborg, Sweden
| | - Anders Elfvin
- Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg Sahlgrenska Academy, Gothenburg, Sweden.,Department of Pediatrics, Sahlgrenska University Hospital, Goteborg, Sweden
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Incorporation of randomized controlled trials into organizational guidelines for obstetricians and gynecologists. Eur J Obstet Gynecol Reprod Biol X 2022; 14:100142. [PMID: 35098104 PMCID: PMC8783086 DOI: 10.1016/j.eurox.2022.100142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/23/2021] [Accepted: 01/08/2022] [Indexed: 11/22/2022] Open
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Yang M, Yue W, Han X, Hu C, Sun X, Luo J. Postpartum care indications and methodological quality:a systematic review of guidelines. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:2261-2275. [PMID: 34306970 PMCID: PMC8288832 DOI: 10.1007/s10389-021-01629-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 06/18/2021] [Indexed: 10/25/2022]
Abstract
Background The coverage of postpartum care is not ideal, and has not been used very well due to not enough attention being paid to the puerperal women and newborns, especially in developing countries. Practice guidelines on postpartum care provide beneficial practice guidance and help to reduce maternal mortality. However, little is known about the credibility and consistency of those guidelines. This systematic review was conducted to summarize main postpartum care indications and appraise methodological quality of guidelines. Methods Seven literature databases and guideline development institutions and organizations of obstetrics and maternity care were searched. Two reviewers independently assessed guideline quality using the AGREE II instrument, and synthesized consistent and non-consistent recommendations using the content analysis approach. Results Twenty-nine guidelines were included and a total of eight postpartum care indications were identified. Most guidelines focused on care indications and interventions including exclusive breastfeeding, maternal nutrition, home visit, infant or newborn care and sexuality, contraception, and birth spacing. However, indications such as pain or weight management, pelvic floor muscle training, abdominal rehabilitation, and mental health got less attention. Additionally, the overall quality of all involving postpartum care guidelines is relatively good and acceptable. Conclusions Guidelines developed by NICE, RANO, and WHO indicated higher methodological quality. For postpartum care indications, most guidelines are incomplete. Variation in practice guidelines for postpartum care recommendations exists. In the future, implementation research into shared decision-making, as well as further high-quality research to broaden the evidence base for postpartum care indications is recommended. Supplementary Information The online version contains supplementary material available at 10.1007/s10389-021-01629-4.
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Affiliation(s)
- Ming Yang
- School of Nursing, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou, Guangdong China
| | - Wei Yue
- School of Nursing, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou, Guangdong China
| | - Xinrui Han
- School of Nursing, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou, Guangdong China
| | - Chunhong Hu
- Department of Spleen and Stomach, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong China
| | - Xiaoning Sun
- School of Nursing, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou, Guangdong China
| | - Jianghe Luo
- School of Nursing, Guangzhou University of Chinese Medicine, No. 232, Waihuan East Road, Guangzhou University City, Panyu District, Guangzhou, Guangdong China
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Morris S, Geraghty S, Sundin D. Breech presentation management: A critical review of leading clinical practice guidelines. Women Birth 2021; 35:e233-e242. [PMID: 34253466 DOI: 10.1016/j.wombi.2021.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/23/2021] [Accepted: 06/29/2021] [Indexed: 10/20/2022]
Abstract
PROBLEM Clinical practice guidelines are designed to guide clinicians and consumers of maternity services in clinical decision making, but recommendations are often consensus based and differ greatly between leading organisations. BACKGROUND Breech birth is a divisive clinical issue, however vaginal breech births continue to occur despite a globally high caesarean section rate for breech presenting fetuses. Inconsistencies are known to exist between clinical practice guidelines relating to the management of breech presentation. AIM The aim of this review was to critically evaluate and compare leading obstetric clinical practice guidelines related to the management of breech presenting fetuses. METHODS Leading obstetric guidelines were purposively obtained for review. Analysis was conducted using the International Centre for Allied Health Evidence (iCAHE) Guideline Quality Checklist and reviewing the content of each guideline. FINDINGS Antenatal care recommendations and indications for Caesarean Section were relatively consistent between clinical guidelines. However, several inconsistencies were found among the other recommendations in terms of birth mode counselling, intrapartum management and the basis for recommendations. DISCUSSION Inconsistencies noted in the clinical practice guidelines have the potential to cause issues related to valid consent and create confusion among clinicians and maternity consumers. CONCLUSION Clinical practice guidelines, which focus on the risks of a Vaginal Breech Birth without also discussing the risks of a Caesarean Section when a breech presentation is diagnosed, has the potential to sway clinician attitudes and impact birth mode decision-making in maternity consumers. To respect pregnant women's autonomy and fulfil the legal requirements of consent, clinicians should provide balanced counselling.
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Affiliation(s)
- Sara Morris
- Edith Cowan University; King Edward Memorial Hopsital.
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Coates D, Makris A, Catling C, Henry A, Scarf V, Watts N, Fox D, Thirukumar P, Wong V, Russell H, Homer C. A systematic scoping review of clinical indications for induction of labour. PLoS One 2020; 15:e0228196. [PMID: 31995603 PMCID: PMC6988952 DOI: 10.1371/journal.pone.0228196] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 01/10/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS 68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive evidence. CONCLUSIONS While for some indications, IOL is clearly recommended, a number of common indications for IOL do not have strong supporting evidence. Overall, few RCTs have evaluated the various indications for IOL. For conditions where clinical equipoise regarding timing of birth may still exist, such as suspected macrosomia and elevated BMI, researchers and funding agencies should prioritise studies of sufficient power that can provide quality evidence to guide care in these situations.
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Affiliation(s)
- Dominiek Coates
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Angela Makris
- Department of Medicine, Western Sydney University, Sydney, Australia
- Women’s Health Initiative Translational Unit (WHITU), Liverpool Hospital, Liverpool, Australia
| | - Christine Catling
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Amanda Henry
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
- Department of Women’s and Children’s Health, St George Hospital, Sydney, Australia
- The George Institute for Global Health, UNSW Medicine, Sydney, Australia
| | - Vanessa Scarf
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Nicole Watts
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Deborah Fox
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
| | - Purshaiyna Thirukumar
- School of Women’s and Children’s Health, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Vincent Wong
- Liverpool Diabetes Collaborative Research Unit, Ingham Institute of Applied Research Science, University of New South Wales, Liverpool, Australia
| | - Hamish Russell
- South Western Sydney Local Health District, Sydney, Australia
| | - Caroline Homer
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Australia
- Maternal and Child Health Program, Burnet Institute, Victoria, Australia
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Wu Y, Kataria Y, Wang Z, Ming WK, Ellervik C. Factors associated with successful vaginal birth after a cesarean section: a systematic review and meta-analysis. BMC Pregnancy Childbirth 2019; 19:360. [PMID: 31623587 PMCID: PMC6798397 DOI: 10.1186/s12884-019-2517-y] [Citation(s) in RCA: 70] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 09/20/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Evidence for the relationship between maternal and perinatal factors and the success of vaginal birth after cesarean section (VBAC) is conflicting. We aimed to systematically analyze published data on maternal and fetal factors for successful VBAC. METHODS A comprehensive search of Medline, Embase, and the Cumulative Index to Nursing and Allied Health Literature, from each database's inception to March 16, 2018. Observational studies, identifying women with a trial of labor after one previous low-transverse cesarean section were included. Two reviewers independently abstracted the data. Meta-analysis was performed using the random-effects model. Risk of bias was assessed by the Newcastle-Ottawa Scale. RESULTS We included 94 eligible observational studies (239,006 pregnant women with 163,502 VBAC). Factors were associated with successful VBAC with the following odds ratios (OR;95%CI): age (0.92;0.86-0.98), obesity (0.50;0.39-0.64), diabetes (0.50;0.42-0.60), hypertensive disorders complicating pregnancy (HDCP) (0.54;0.44-0.67), Bishop score (3.77;2.17-6.53), labor induction (0.58;0.50-0.67), macrosomia (0.56;0.50-0.64), white race (1.39;1.26-1.54), previous vaginal birth before cesarean section (3.14;2.62-3.77), previous VBAC (4.71;4.33-5.12), the indications for the previous cesarean section (cephalopelvic disproportion (0.54;0.36-0.80), dystocia or failure to progress (0.54;0.41-0.70), failed induction (0.56;0.37-0.85), and fetal malpresentation (1.66;1.38-2.01)). Adjusted ORs were similar. CONCLUSIONS Diabetes, HDCP, Bishop score, labor induction, macrosomia, age, obesity, previous vaginal birth, and the indications for the previous CS should be considered as the factors affecting the success of VBAC.
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Affiliation(s)
- Yanxin Wu
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
| | - Yachana Kataria
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA
| | - Zilian Wang
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China.
| | - Wai-Kit Ming
- Department of Obstetrics and Gynecology, The First Affiliated Hospital, Sun Yat-sen University, No. 58 Zhongshan Road 2, Guangzhou, 510000, People's Republic of China.
| | - Christina Ellervik
- Department of Laboratory Medicine, Boston Children's Hospital and Harvard Medical School, 300 Longwood Avenue, Boston, MA, 02215, USA.
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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Induction of labour indications and timing: A systematic analysis of clinical guidelines. Women Birth 2019; 33:219-230. [PMID: 31285166 DOI: 10.1016/j.wombi.2019.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Revised: 06/04/2019] [Accepted: 06/05/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND There is widespread and some unexplained variation in induction of labour rates between hospitals. Some practice variation may stem from variability in clinical guidelines. This review aimed to identify to what extent induction of labour guidelines provide consistent recommendations in relation to reasons for, and timing of, induction of labour and ascertain whether inconsistencies can be explained by variability guideline quality. METHOD We conducted a systematic search of national and international English-language guidelines published between 2008 and 2018. General induction of labour guidelines and condition-specific guidelines containing induction of labour recommendations were searched. Guidelines were reviewed and extracted independently by two reviewers. Guideline quality was assessed using the Appraisal of Guidelines for Research and Evaluation II Instrument. FINDINGS Forty nine guidelines of varying quality were included. Indications where guidelines had mostly consistent advice included prolonged pregnancy (induction between 41 and 42 weeks), preterm premature rupture of membranes, and term preeclampsia (induction when preeclampsia diagnosed ≥37 weeks). Guidelines were also consistent in agreeing on decreased fetal movements and oligohydramnios as valid indications for induction, although timing recommendations were absent or inconsistent. Common indications where there was little consensus on validity and/or timing of induction included gestational diabetes, fetal macrosomia, elevated maternal body mass index, and twin pregnancy. CONCLUSION Substantial variation in clinical practice guidelines for indications for induction exists. As guidelines rated of similar quality presented conflicting recommendations, guideline variability was not explained by guideline quality. Guideline variability may partly account for unexplained variation in induction of labour rates.
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Coates D, Homer C, Wilson A, Deady L, Mason E, Foureur M, Henry A. Indications for, and timing of, planned caesarean section: A systematic analysis of clinical guidelines. Women Birth 2019; 33:22-34. [PMID: 31253513 DOI: 10.1016/j.wombi.2019.06.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 06/12/2019] [Accepted: 06/13/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND There has been a worldwide rise in planned caesarean sections over recent decades, with significant variations in practice between hospitals and countries. Guidelines are known to influence clinical decision-making and, potentially, unwarranted clinical variation. The aim of this study was to review guidelines for recommendations in relation to the timing and indications for planned caesarean section as well as recommendations around the process of decision-making. METHOD A systematic search of national and international English-language guidelines published between 2008 and 2018 was undertaken. Guidelines were reviewed, assessed in terms of quality and extracted independently by two reviewers. FINDINGS In total, 49 guidelines of varying quality were included. There was consistency between the guidelines in potential indications for caesarean section, although guidelines vary in terms of the level of detail. There was substantial variation in timing of birth, for example recommended timing of caesarean section for women with uncomplicated placenta praevia is between 36 and 39weeks depending on the guideline. Only 11 guidelines provided detailed guidance on shared decision-making. In general, national-level guidelines from Australia, and overseas, received higher quality ratings than regional guidelines. CONCLUSION The majority of guidelines, regardless of their quality, provide very limited information to guide shared decision-making or the timing of planned caesarean section, two of the most vital aspects of guidance. National guidelines were generally of better quality than regional ones, suggesting these should be used as a template where possible and emphasis placed on improving national guidelines and minimising intra-country, regional, variability of guidelines.
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Affiliation(s)
- Dominiek Coates
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, NSW, Australia; Maridulu Budyari Gumal, The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia; School of Women's and Children's Health, UNSW Medicine, UNSW, Australia.
| | - Caroline Homer
- University of Technology Sydney, Faculty of Health, Centre for Midwifery and Child and Family Health, NSW, Australia; Burnet Institute, Victoria, Australia
| | - Alyssa Wilson
- Maridulu Budyari Gumal, The Sydney Partnership for Health, Education, Research and Enterprise (SPHERE), Australia
| | - Louise Deady
- South Eastern Sydney Local Health District, District Offices, Sutherland Hospital Locked Bag 21, Taren Point, NSW 2229, Australia.
| | - Elizabeth Mason
- South Eastern Sydney Local Health District, District Offices, Sutherland Hospital Locked Bag 21, Taren Point, NSW 2229, Australia.
| | - Maralyn Foureur
- Hunter New England Nursing and Midwifery Research Centre, Australia; University of Newcastle, Faculty of Health and Medicine, Australia.
| | - Amanda Henry
- School of Women's and Children's Health, UNSW Medicine, UNSW, Australia; Department of Women's and Children's Health, St. George Hospital, Sydney, Australia; The George Institute for Global Health, UNSW Medicine, Australia
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Trollope H, Leung JPY, Wise M, Farquhar C, Sadler L. An evaluation of the objective quality and perceived usefulness of maternity clinical practice guidelines at a tertiary maternity unit. Aust N Z J Obstet Gynaecol 2018; 58:660-666. [PMID: 29505660 DOI: 10.1111/ajo.12789] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Accepted: 01/25/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Compliance with maternity clinical practice guidelines developed by National Women's Health has been found to be low at audit. OBJECTIVE To explore the reasons for poor compliance with maternity guidelines by evaluating the quality of a sample of National Women's Health guidelines using a validated instrument and assessing local guideline users' perceptions of and attitudes toward guidelines. DESIGN Five independent reviewers evaluated the quality of 10 purposively selected guidelines for adherence to the Appraisal of Guidelines Research & Evaluation (AGREE) II instrument standards. A self-administered questionnaire for staff was undertaken regarding views of and barriers to guideline use. RESULTS None of the guidelines attained a score over 50% for the following domains: stakeholder involvement, rigour of development, applicability, editorial independence. The highest scoring domain was clarity of presentation (mean 69%). All guidelines scored the minimum possible for editorial independence. Survey respondents had positive attitudes toward guidelines, believed that their use could improve quality of care within the service, and felt that encouragement from senior staff members and peers would encourage their use. Accessibility was the most commonly cited of many barriers identified. CONCLUSION The National Women's Health guidelines evaluated in this study cannot be considered to be high quality, and could be improved by reporting on methodology of the development process. Although poor guideline development may contribute to failure of the local maternity guidelines, it appears that accessibility is a major barrier to their use and implementation.
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Affiliation(s)
- Helena Trollope
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Joyce Pui Yee Leung
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Michelle Wise
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand
| | - Cynthia Farquhar
- Department of Obstetrics and Gynaecology, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Women's Health, Auckland District Health Board, Auckland, New Zealand
| | - Lynn Sadler
- Women's Health, Auckland District Health Board, Auckland, New Zealand
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12
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McLaughlin K, Foureur M, Jensen ME, Murphy VE. Review and appraisal of guidelines for the management of asthma during pregnancy. Women Birth 2018; 31:e349-e357. [PMID: 29475603 DOI: 10.1016/j.wombi.2018.01.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2017] [Revised: 01/05/2018] [Accepted: 01/11/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Asthma affects 12.7% of pregnancies in Australia. Poorly controlled asthma is associated with increased maternal and infant morbidity and mortality. Optimal antenatal management of asthma during pregnancy has the potential to reduce complications relating to asthma. Evidence-based clinical practice guidelines help to translate health research findings into practice and when implemented can improve health outcomes. National and International guidelines currently provide recommendations for optimal asthma care in pregnancy. AIM To appraise the existing asthma in pregnancy guidelines with respect to their evidence for recommendations, consistency of recommendations and appropriateness for clinical practice. METHOD The Appraisal of Guidelines for Research and Evaluation (AGREE II) tool was used to appraise four English language asthma in pregnancy guidelines, published or updated between 2007 and 2016. The recommendations, range and level of evidence was analysed. RESULTS Two of the four guidelines scored highly in most domains of the appraisal. Many of the recommendations made in the appraised guidelines were consistent. Due to the lack of randomised controlled trials involving pregnant women with asthma, most recommendations were evidenced by consensus and expert opinion rather than high quality meta-analysis, systematic reviews of randomised controlled trials. CONCLUSION The recommended antenatal asthma management was generally consistent among the guidelines but lacked clarity in some areas which then leave them open to interpretation. More randomised controlled trials involving pregnant women with asthma are required to fortify the recommendations made and asthma management guidelines should be included in Australian Antenatal Care Guidelines as they currently are not.
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Affiliation(s)
- Karen McLaughlin
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre GrowUpWell™, Hunter Medical Research Institute and University of Newcastle, Callaghan, NSW, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Megan E Jensen
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre GrowUpWell™, Hunter Medical Research Institute and University of Newcastle, Callaghan, NSW, Australia
| | - Vanessa E Murphy
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia; Priority Research Centre GrowUpWell™, Hunter Medical Research Institute and University of Newcastle, Callaghan, NSW, Australia.
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Torigoe I, Shorten A. Using a pregnancy decision support program for women choosing birth after a previous caesarean in Japan: A mixed methods study. Women Birth 2018; 31:e9-e19. [DOI: 10.1016/j.wombi.2017.06.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/11/2017] [Accepted: 06/02/2017] [Indexed: 11/17/2022]
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Tsai HT, Wu CH. Vaginal birth after cesarean section-The world trend and local experience in Taiwan. Taiwan J Obstet Gynecol 2017; 56:41-45. [PMID: 28254224 DOI: 10.1016/j.tjog.2016.03.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2016] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE The trend of increasing cesarean section rates had evoked worldwide attention. Many approaches were introduced to diminish cesarean section rates. Vaginal birth after cesarean section (VBAC) is a route of delivery with diverse agreements. In this study, we try to reveal the world trend in VBAC and our experience of a 10-year period in a medical center in northern Taiwan. MATERIALS AND METHODS This is a retrospective study of all women who underwent elective repeat cesarean delivery or trial of labor after cesarean (TOLAC) following primary cesarean delivery by a general obstetrician-gynecologist in the Tamshui Branch of MacKay Memorial Hospital (Taipei, Taiwan) between 2006 and 2015. We excluded cases of preterm labor, two or more cesarean deliveries, and major maternal diseases. We compared the characteristics and outcomes between these groups. RESULTS We included 400 women with subsequent pregnancies who underwent elective repeat cesarean delivery or TOLAC during the study period. Among the study population, 112 women were excluded and 11 underwent repeat VBAC. A total of 204 (73.65%) cases underwent elective repeat cesarean delivery and 73 (26.35%) chose TOLAC. The rate of successful VBAC among the women who chose TOLAC was 84.93%. CONCLUSION With respect to maternal and fetal safety, and success rates and adverse effects of VBAC, the results of this study are promising and compatible with the global data. It shows that a trial of VBAC can be offered to pregnant women without contraindications with high success rates.
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Affiliation(s)
- Hsiu-Ting Tsai
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Chia-Hsun Wu
- Department of Obstetrics and Gynecology, MacKay Memorial Hospital, Taipei, Taiwan.
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Bonzon M, Gross MM, Karch A, Grylka-Baeschlin S. Deciding on the mode of birth after a previous caesarean section – An online survey investigating women's preferences in Western Switzerland. Midwifery 2017; 50:219-227. [DOI: 10.1016/j.midw.2017.04.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 04/15/2017] [Accepted: 04/17/2017] [Indexed: 12/17/2022]
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Foureur M, Turkmani S, Clack DC, Davis DL, Mollart L, Leiser B, Homer CSE. Caring for women wanting a vaginal birth after previous caesarean section: A qualitative study of the experiences of midwives and obstetricians. Women Birth 2016; 30:3-8. [PMID: 27318563 DOI: 10.1016/j.wombi.2016.05.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Revised: 05/30/2016] [Accepted: 05/31/2016] [Indexed: 10/21/2022]
Abstract
PROBLEM One of the greatest contributors to the overall caesarean section rate is elective repeat caesarean section. BACKGROUND Decisions around mode of birth are often complex for women and influenced by the views of the doctors and midwives who care for and counsel women. Women may be more likely to choose a repeat elective caesarean section (CS) if their health care providers lack skills and confidence in supporting vaginal birth after caesarean section (VBAC). AIM To explore the views and experiences of providers in caring for women considering VBAC, in particular the decision-making processes and the communication of risk and safety to women. METHODS A descriptive interpretive method was utilised. Four focus groups with doctors and midwives were conducted. FINDINGS The central themes were: 'developing trust', 'navigating the system' and 'optimising support'. The impact of past professional experiences; the critical importance of continuity of carer and positive relationships; the ability to weigh up risks versus benefits; and the language used were all important elements. The role of policy and guidelines on providing standardised care for women who had a previous CS was also highlighted. CONCLUSION Midwives and doctors in this study were positively oriented towards assisting and supporting women to attempt a VBAC. Care providers considered that women who have experienced a prior CS need access to midwifery continuity of care with a focus on support, information-sharing and effective communication.
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Affiliation(s)
- Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Sabera Turkmani
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Danielle C Clack
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Deborah L Davis
- University of Canberra, Australian Capital Territory (ACT), Australia; The ACT Government, Health Directorate, Australia
| | - Lyndall Mollart
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia
| | - Bernadette Leiser
- Central Coast Local Health District, Holden Street, Gosford, New South Wales, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, New South Wales, Australia.
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Beckmann M, Cooper C, Pocock D. INFORMed choices: Facilitating shared decision-making in health care. Aust N Z J Obstet Gynaecol 2015; 55:294-7. [DOI: 10.1111/ajo.12343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2014] [Accepted: 03/19/2015] [Indexed: 01/29/2023]
Affiliation(s)
- Michael Beckmann
- Department of Obstetrics and Gynaecology; Mater Health Services; Brisbane Queensland Australia
- Mater Research Institute, University of Queensland; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Catherine Cooper
- Mater Education Centre; Mater Health Services; Brisbane Queensland Australia
| | - Daniel Pocock
- Clinical Safety and Quality Unit; Mater Health Services; Brisbane Queensland Australia
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Bantan N, Abenhaim HA. Vaginal births after caesarean: What does Google think about it? Women Birth 2015; 28:21-4. [DOI: 10.1016/j.wombi.2014.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Revised: 10/09/2014] [Accepted: 10/11/2014] [Indexed: 10/24/2022]
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Culture-based versus risk-based screening for the prevention of group B streptococcal disease in newborns: A review of national guidelines. Women Birth 2014; 27:46-51. [DOI: 10.1016/j.wombi.2013.09.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2013] [Revised: 09/28/2013] [Accepted: 09/28/2013] [Indexed: 11/18/2022]
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Toohill J, Gamble J, Creedy DK. A critical review of vaginal birth rates after a primary Caesarean in Queensland hospitals. AUST HEALTH REV 2014; 37:642-8. [PMID: 24160447 DOI: 10.1071/ah13044] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2013] [Accepted: 08/11/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION For women with a lower uterine incision without indication for repeat Caesarean section (CS), vaginal birth for their next pregnancy is a safe option. Although these women should be encouraged to consider vaginal birth after a Caesarean section (VBAC) it is not consistently supported in practice. There is relatively little information on the extent to which maternal preference, birthing decisions and outcomes match best available evidence. AIM To describe current VBAC rates for women in Queensland, Australia and compare this to safe, achievable VBAC rates reported in national and international studies. METHOD Perinatal data from 2004 to 2011 were reviewed to determine current VBAC rates following a primary CS for women birthing in Queensland. These were compared with VBAC rates reported in the literature. RESULTS Queensland has a high overall CS rate and high repeat CS rate compared with the national average. In 2010, Queensland VBAC rates for next birth following primary CS were 14% (range 13-21% public sector, 7-11% private hospitals). This is substantially lower than achievable Australian rates of 24% and international rates. CONCLUSION Low VBAC rates reflect low numbers of women commencing labour in a pregnancy subsequent to a primary CS. There is unexplained variation in VBAC rates between maternity facilities. Clinical reviews to support evidence-based practice are warranted.
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Affiliation(s)
- Jocelyn Toohill
- Griffith Health Institute, Griffith University, Meadowbrook, Qld 4131, Australia
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Konheim-Kalkstein Y, Barry MM, Galotti K. Examining influences on women’s decision to try labour after previous caesarean section. J Reprod Infant Psychol 2014. [DOI: 10.1080/02646838.2013.875133] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Horey D, Kealy M, Davey MA, Small R, Crowther CA. Interventions for supporting pregnant women's decision-making about mode of birth after a caesarean. Cochrane Database Syst Rev 2013:CD010041. [PMID: 23897547 DOI: 10.1002/14651858.cd010041.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Pregnant women who have previously had a caesarean birth and who have no contraindication for vaginal birth after caesarean (VBAC) may need to decide whether to choose between a repeat caesarean birth or to commence labour with the intention of achieving a VBAC. Women need information about their options and interventions designed to support decision-making may be helpful. Decision support interventions can be implemented independently, or shared with health professionals during clinical encounters or used in mediated social encounters with others, such as telephone decision coaching services. Decision support interventions can include decision aids, one-on-one counselling, group information or support sessions and decision protocols or algorithms. This review considers any decision support intervention for pregnant women making birth choices after a previous caesarean birth. OBJECTIVES To examine the effectiveness of interventions to support decision-making about vaginal birth after a caesarean birth.Secondary objectives are to identify issues related to the acceptability of any interventions to parents and the feasibility of their implementation. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 June 2013), Current Controlled Trials (22 July 2013), the WHO International Clinical Trials Registry Platform Search Portal (ICTRP) (22 July 2013) and reference lists of retrieved articles. We also conducted citation searches of included studies to identify possible concurrent qualitative studies. SELECTION CRITERIA All published, unpublished, and ongoing randomised controlled trials (RCTs) and quasi-randomised trials with reported data of any intervention designed to support pregnant women who have previously had a caesarean birth make decisions about their options for birth. Studies using a cluster-randomised design were eligible for inclusion but none were identified. Studies using a cross-over design were not eligible for inclusion. Studies published in abstract form only would have been eligible for inclusion if data were able to be extracted. DATA COLLECTION AND ANALYSIS Two review authors independently applied the selection criteria and carried out data extraction and quality assessment of studies. Data were checked for accuracy. We contacted authors of included trials for additional information. All included interventions were classified as independent, shared or mediated decision supports. Consensus was obtained for classifications. Verification of the final list of included studies was undertaken by three review authors. MAIN RESULTS Three randomised controlled trials involving 2270 women from high-income countries were eligible for inclusion in the review. Outcomes were reported for 1280 infants in one study. The interventions assessed in the trials were designed to be used either independently by women or mediated through the involvement of independent support. No studies looked at shared decision supports, that is, interventions designed to facilitate shared decision-making with health professionals during clinical encounters.We found no difference in planned mode of birth: VBAC (risk ratio (RR) 1.03, 95% confidence interval (CI) 0.97 to 1.10; I² = 0%) or caesarean birth (RR 0.96, 95% CI 0.84 to 1.10; I² = 0%). The proportion of women unsure about preference did not change (RR 0.87, 95% CI 0.62 to 1.20; I² = 0%).There was no difference in adverse outcomes reported between intervention and control groups (one trial, 1275 women/1280 babies): permanent (RR 0.66, 95% CI 0.32 to 1.36); severe (RR 1.02, 95% CI 0.77 to 1.36); unclear (0.66, 95% CI 0.27, 1.61). Overall, 64.8% of those indicating preference for VBAC achieved it, while 97.1% of those planning caesarean birth achieved this mode of birth. We found no difference in the proportion of women achieving congruence between preferred and actual mode of birth (RR 1.02, 95% CI 0.96 to 1.07) (three trials, 1921 women).More women had caesarean births (57.3%), including 535 women where it was unplanned (42.6% all caesarean deliveries and 24.4% all births). We found no difference in actual mode of birth between groups, (average RR 0.97, 95% CI 0.89 to 1.06) (three trials, 2190 women).Decisional conflict about preferred mode of birth was lower (less uncertainty) for women with decisional support (standardised mean difference (SMD) -0.25, 95% CI -0.47 to -0.02; two trials, 787 women; I² = 48%). There was also a significant increase in knowledge among women with decision support compared with those in the control group (SMD 0.74, 95% CI 0.46 to 1.03; two trials, 787 women; I² = 65%). However, there was considerable heterogeneity between the two studies contributing to this outcome ( I² = 65%) and attrition was greater than 15 per cent and the evidence for this outcome is considered to be moderate quality only. There was no difference in satisfaction between women with decision support and those without it (SMD 0.06, 95% CI -0.09 to 0.20; two trials, 797 women; I² = 0%). No study assessed decisional regret or whether women's information needs were met.Qualitative data gathered in interviews with women and health professionals provided information about acceptability of the decision support and its feasibility of implementation. While women liked the decision support there was concern among health professionals about their impact on their time and workload. AUTHORS' CONCLUSIONS Evidence is limited to independent and mediated decision supports. Research is needed on shared decision support interventions for women considering mode of birth in a pregnancy after a caesarean birth to use with their care providers.
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Affiliation(s)
- Dell Horey
- Faculty of Health Sciences, La Trobe University, Bundoora, Australia.
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Homer CSE, Besley K, Bell J, Davis D, Adams J, Porteous A, Foureur M. Does continuity of care impact decision making in the next birth after a caesarean section (VBAC)? a randomised controlled trial. BMC Pregnancy Childbirth 2013; 13:140. [PMID: 23819882 PMCID: PMC3717054 DOI: 10.1186/1471-2393-13-140] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Accepted: 06/18/2013] [Indexed: 11/10/2022] Open
Abstract
Background Caesarean section (CS) has short and long-term health effects for both the woman and her baby. One of the greatest contributors to the CS rate is elective repeat CS. Vaginal birth after caesarean (VBAC) is an option for many women; despite this the proportion of women attempting VBAC remains low. Potentially the relationship that women have with their healthcare professional may have a major influence on the uptake of VBAC. Models of service delivery, which enable an individual approach to care, may make a difference to the uptake of VBAC. Midwifery continuity of care could be an effective model to encourage and support women to choose VBAC. Methods/Design A randomised, controlled trial will be undertaken. Eligible pregnant women, whose most recent previous birth was by lower-segment CS, will be randomly allocated 1:1 to an intervention group or control group. The intervention provides midwifery continuity of care to women through pregnancy, labour, birth and early postnatal care. The control group will receive standard hospital care from different midwives through pregnancy, labour, birth and early postnatal care. Both groups will receive an obstetric consultation during pregnancy and at any other time if required. Clinical care will follow the same guidelines in both groups. Discussion This study will determine whether midwifery continuity of care influences the decision to attempt a VBAC and impacts on mode of birth, maternal experiences with care and the health of the neonate. Outcomes from this study might influence the way maternity care is provided to this group of women and thus impact on the CS rate. This information will provide high level evidence to policy makers, health service managers and practitioners who are working towards addressing the increased rate of CS. Trial registration This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12611001214921
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Affiliation(s)
- Caroline S E Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology, Level 7, 235-253 Jones St, Broadway, Sydney, NSW, Australia.
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Quelles sont les recommandations d’organisation et d’information en cas de proposition de tentative de voie basse pour utérus cicatriciel ? ACTA ACUST UNITED AC 2012; 41:782-7. [DOI: 10.1016/j.jgyn.2012.09.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Abstract
Malpractice fears are believed to influence various aspects of obstetrical practice. They seem to have contributed in small part to the rising primary caesarean section rate, but have also played a considerable role in the downtrend in vaginal birth after caesarean statistics. The rising vaginal birth after caesarean section rate between 1981 and 1995 was interrupted by a spate of lawsuits associated with broadened indications for vaginal birth after caesarean section in conjunction with requirements for immediate clinician availability. These factors dramatically reduced the availability of hospitals and clinicians willing to offer vaginal birth after caesarean section. This reversal, however, has not diminished the demand for vaginal birth after caesarean section from various stakeholders in the name of patient autonomy, clinician beneficence and optimal care. Nevertheless, as long as stringent requirements remain for clinician attendance during vaginal birth after caesarean section, and as long as the spectre of preventable error and the lingering dread of lawsuits retain their hold on obstetrical practice, caesarean section trends are unlikely to change.
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Chen MM, Hancock H. Women's knowledge of options for birth after Caesarean Section. Women Birth 2012; 25:e19-26. [DOI: 10.1016/j.wombi.2011.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Revised: 07/22/2011] [Accepted: 08/04/2011] [Indexed: 10/17/2022]
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Eden KB, Denman MA, Emeis CL, McDonagh MS, Fu R, Janik RK, Broman AR, Guise J. Trial of Labor and Vaginal Delivery Rates in Women with a Prior Cesarean. J Obstet Gynecol Neonatal Nurs 2012; 41:583-98. [DOI: 10.1111/j.1552-6909.2012.01388.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Lundgren I, Begley C, Gross MM, Bondas T. 'Groping through the fog': a metasynthesis of women's experiences on VBAC (Vaginal birth after Caesarean section). BMC Pregnancy Childbirth 2012; 12:85. [PMID: 22909230 PMCID: PMC3506503 DOI: 10.1186/1471-2393-12-85] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2012] [Accepted: 07/30/2012] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Vaginal birth after Caesarean section (VBAC) is a relevant question for a large number of women due to the internationally rising Caesarean section (CS) rate. There is a great deal of research based on quantitative studies but few qualitative studies about women's experiences. METHOD A metasynthesis based on the interpretative meta ethnography method was conducted. The inclusion criterion was peer-review qualitative articles from different disciplines about women's experiences of VBAC. Eleven articles were checked for quality, and eight articles were included in the synthesis. RESULTS The included studies were from Australia (four), UK (three), and US (one), and studied women's experience in relation to different aspects of VBAC; decision-making whether to give birth vaginally, the influence of health professionals on decision-making, reason for trying a vaginal birth, experiences when choosing VBAC, experiences of giving birth vaginally, and giving birth with CS when preferring VBAC. The main results are presented with the metaphor groping through the fog; for the women the issue of VBAC is like being in a fog, where decision-making and information from the health care system and professionals, both during pregnancy and the birth, is unclear and contrasting. The results are further presented with four themes: 'to be involved in decision about mode of delivery is difficult but important,' 'vaginal birth has several positive aspects mainly described by women,' 'vaginal birth after CS is a risky project,' and 'own strong responsibility for giving birth vaginally'. CONCLUSION In order to promote VBAC, more studies are needed from different maternity settings and countries about women's experiences. Women need evidence-based information not only about the risks involved but also positive aspects of VBAC.
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Affiliation(s)
- Ingela Lundgren
- Institute of Health and Care Sciences at the Sahlgrenska Academy, University of Gothenburg, Box 457, S-405 30, Gothenburg, Sweden
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, Dublin 2, Ireland
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Terese Bondas
- Faculty of Professional Studies, University of Nordland, Bodo, Norway
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Horey D, Davey MA, Small R, Kealy M, Crowther CA. Interventions for supporting women with decisions about mode of birth in a pregnancy after caesarean birth. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2012. [DOI: 10.1002/14651858.cd010041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Harris SR, Schmitz KH, Campbell KL, McNeely ML. Clinical practice guidelines for breast cancer rehabilitation: syntheses of guideline recommendations and qualitative appraisals. Cancer 2012; 118:2312-24. [PMID: 22488705 DOI: 10.1002/cncr.27461] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Despite strides in early detection and management of breast cancer, the primary treatments for this disease continue to result in physical impairments for some of the nearly 3 million people diagnosed annually. Over the past decade, evidence-based clinical practice guidelines (CPGs) have been developed with goals of preventing and ameliorating these impairments. However, translation of these guidelines into clinical practice needs to be accelerated. METHODS Relevant health science databases (2001-2011) were searched to identify CPGs on breast cancer rehabilitation for the following impairments: upper extremity restrictions, lymphedema, pain, fatigue, chemotherapy-induced peripheral neuropathy, treatment-related cardiotoxicity, bone health, and weight management. RESULTS Recommendations from 19 relevant CPGs were first summarized by impairment within tables; commonalities across guidelines, within each impairment, were then synthesized within the article. The CPGs were rated using the Appraisal of Guidelines for Research and Evaluation II (AGREE II); wide variability was noted in rigor of development, clarity of presentation, and stakeholder involvement. The most rigorous and comprehensive of those rated was the adult cancer pain guideline from the Scottish Intercollegiate Guidelines Network. CONCLUSIONS Based on a large body of evidence published in recent years, including randomized trials and systematic reviews, there is an urgent need for updating the guidelines on upper extremity musculoskeletal impairments and lymphedema. Furthermore, additional research is needed to provide an evidence base for developing rehabilitation guidelines on management of other impairments identified in the prospective surveillance model, eg, arthralgia.
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Affiliation(s)
- Susan R Harris
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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Brown SD, Ecker JL, Ward JR, Halpern EF, Sayeed SA, Buchmiller TL, Mitchell C, Donelan K. Prenatally diagnosed fetal conditions in the age of fetal care: does who counsels matter? Am J Obstet Gynecol 2012; 206:409.e1-11. [PMID: 22340943 DOI: 10.1016/j.ajog.2012.01.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2011] [Revised: 12/21/2011] [Accepted: 01/19/2012] [Indexed: 10/14/2022]
Abstract
OBJECTIVE We sought to characterize practices and attitudes of maternal-fetal medicine (MFM) and fetal care pediatric (FCP) specialists regarding fetal abnormalities. STUDY DESIGN This was a self-administered survey of 434 MFMs and FCPs (response rate: MFM 60.9%; FCP 54.2%). RESULTS For Down syndrome (DS), congenital diaphragmatic hernia (CDH), spina bifida: MFMs were more likely than FCPs to support termination (DS 52% vs 35%, P < .001; CDH 49% vs 36%, P < .001; spina bifida 54% vs 35%, P < .001), and consider offering termination options as highly important (DS 90% vs 70%, P < .001; CDH 88% vs 69%, P < .001; spina bifida 88% vs 70%, P < .001). For DS only, MFMs were less likely than FCPs to think that pediatric specialist consultation should be offered prior to a decision regarding termination (54% vs 75%, P < .001). MFMs reported report higher termination rates among patients only for DS (DS 51% vs 21%, P < .001). CONCLUSION MFM and FCP specialists' counseling attitudes differ for fetal abnormalities.
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Vaginal birth after cesarean delivery: a common-sense approach. Obstet Gynecol 2011; 118:1176-1177. [PMID: 22015892 DOI: 10.1097/aog.0b013e318234a066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Cox KJ. Providers' perspectives on the vaginal birth after cesarean guidelines in Florida, United States: a qualitative study. BMC Pregnancy Childbirth 2011; 11:72. [PMID: 21992871 PMCID: PMC3203084 DOI: 10.1186/1471-2393-11-72] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2011] [Accepted: 10/12/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Women's access to vaginal birth after cesarean (VBAC) in the United States has declined steadily since the mid-1990s, with a current rate of 8.2%. In the State of Florida, less than 1% of women with a previous cesarean deliver vaginally. This downturn is thought to be largely related to the American College of Obstetricians and Gynecologists (ACOG) VBAC guidelines, which mandate that a physician and anesthesiologist be "immediately available" during a trial of labor. The aim of this exploratory qualitative study was to explore the barriers associated with the ACOG VBAC guidelines, as well as the strategies that obstetricians and midwives use to minimize their legal risks when offering a trial of labor after cesarean. METHODS Semi-structured interviews were conducted with 11 obstetricians, 12 midwives, and a hospital administrator (n = 24). Interviews were recorded and transcribed verbatim, and thematic analysis informed the findings. RESULTS Fear of liability was a central reason for obstetricians and midwives to avoid attending VBACs. Providers who continued to offer a trial of labor attempted to minimize their legal risks by being highly selective in choosing potential candidates. Definitions of "immediately available" varied widely among hospitals, and providers in solo or small practices often favored the convenience of a repeat cesarean delivery rather than having to remain in-house during a trial of labor. Midwives were often marginalized due to restrictive hospital policies and by their consulting physicians, even though women with previous cesareans were actively seeking their care. CONCLUSIONS The current ACOG VBAC guidelines limit US obstetricians' and midwives' ability to provide care for women with a previous cesarean, particularly in community and rural hospitals. Although ACOG has proposed that women be allowed to accept "higher levels of risk" in order to be able to attempt a trial of labor in some settings, access to VBAC is unlikely to increase in Florida as long as systemic barriers and liability risks remain high.
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Affiliation(s)
- Kim J Cox
- College of Nursing, University of New Mexico, Albuquerque, NM 87131-0001, USA.
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Catling-Paull C, Johnston R, Ryan C, Foureur MJ, Homer CS. Non-clinical interventions that increase the uptake and success of vaginal birth after caesarean section: a systematic review. J Adv Nurs 2011; 67:1662-76. [DOI: 10.1111/j.1365-2648.2011.05662.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Affiliation(s)
- Amanda Burls
- Department of Primary Health Care, University of Oxford, Old Road Campus, Headington, Oxford OX2 7LF, UK.
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Affiliation(s)
- Liz Baxter
- Corbar Birth Centre, Buxton, Stockport NHS Foundation Trust,
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