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Figa Z, Zemeskel AG, Alemu A, Abebe M. Evidence-based intrapartum care practice and associated factors among obstetrics workers in Ethiopia, systematic review and meta-analysis. SAGE Open Med 2024; 12:20503121241261210. [PMID: 39086555 PMCID: PMC11289799 DOI: 10.1177/20503121241261210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2024] [Accepted: 05/24/2024] [Indexed: 08/02/2024] Open
Abstract
Background Evidence-based practice is defined as using the best available research and clinical evidence by incorporating patients' values and preferences for their health needs. The use of evidence-based intrapartum care practices is an essential tool to improve the quality of obstetrics care. Objective The primary objective of this study was to determine the prevalence of evidence-based intrapartum care and associated factors among obstetrics care providers in Ethiopia. Method Important articles were retrieved from universally accepted and used databases, including Cochran, PubMed, HINARI, Google Scholar, Web of Science, African OnLine, and repositories of Ethiopian Universities. We extracted articles by using a standard JOANNA Briggs Institute data extraction sheet. To determine the existence of heterogeneity in studies, I 2 statistics and Cochran Q tests were used. The publication bias of the included studies was checked using Egger's test and a Funnel plot. Result A total of 2035 obstetrics care providers were involved in this systematic review and meta-analysis. The estimated overall rate of evidence-based intrapartum care practice in Ethiopia was 54.45% (95% CI: 43.06, 65.83); I 2 = 96.6%, p < 0.001). The studies with a sample size greater than 300 count for 47.25% (95% CI: 36.14, 65.83). Whereas obstetrics care providers have a decent knowledge of intrapartum care evidence 3.31 times, a positive attitude toward evidence 3.34 times, training 2.21 times, and work experience ⩾5 years 3.31 times associated with the practice of evidence-based intrapartum care. Conclusion The overall practice of evidence-based intrapartum care among obstetrics workers in Ethiopia is estimated to be low. Therefore, there should be a focused effort on training and disseminating protocols and guidelines to enhance knowledge and foster a positive attitude among obstetrics care providers. Additionally, the Ethiopian government should prioritize the implementation of the 2021 to 2025 National Health Equity Strategic Plan to achieve its objective of improving the quality of health services.
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Affiliation(s)
- Zerihun Figa
- Department of Midwifery, Dilla University College of Health and Medical Science, Dilla, Ethiopia
| | - Addisu Getinet Zemeskel
- Department of Midwifery, Dilla University College of Health and Medical Science, Dilla, Ethiopia
| | - Asrat Alemu
- Department of Midwifery, Dilla University College of Health and Medical Science, Dilla, Ethiopia
| | - Mesfin Abebe
- Department of Midwifery, Dilla University College of Health and Medical Science, Dilla, Ethiopia
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Zbiri S, Rozenberg P, Milcent C. Staff Resources in Public and Private Hospitals and Their Implication for Medical Practice: A French Study of Caesareans. Healthcare (Basel) 2024; 12:1007. [PMID: 38786416 PMCID: PMC11120882 DOI: 10.3390/healthcare12101007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/07/2024] [Accepted: 05/08/2024] [Indexed: 05/25/2024] Open
Abstract
This study aimed to investigate the effect of hospital staffing resources on medical practice in public versus private hospitals. We used exhaustive delivery data from a French district of 11 hospitals over an 11-year period, from 2008 to 2018, including 168,120 observations. We performed multilevel logistic regression models with hospital fixed or random effects, while controlling for factors known to influence obstetric practice. We found that hospital staff ratios of obstetricians and that of midwives affected caesarean rates, but with different effects depending on the hospital sector. In public hospitals, the higher the ratio of obstetricians and that of midwives, the lower the probability of planned caesareans. In private hospitals, the higher the ratio of obstetricians, the greater the probability of planned caesareans. Indeed, in public hospitals, obstetricians and midwives, both salaried employees, do not have financial or organizational incentives to perform more caesareans. In private hospitals, obstetricians, who are independent doctors, may have such incentives. Our results underline the importance of having an adequate supply of health professionals in healthcare facilities to ensure appropriate care, with specific regard to the different characteristics of the public and private sectors.
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Affiliation(s)
- Saad Zbiri
- Research Unit 7285 RISCQ, UVSQ, Paris-Saclay University, 78180 Montigny-le-Bretonneux, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, American Hospital of Paris, 92200 Neuilly-sur-Seine, France
- UVSQ, Inserm, Team U1018, Clinical Epidemiology, CESP, Paris Saclay University, 78180 Montigny-le-Bretonneux, France
| | - Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Centre for Scientific Research (CNRS), 75014 Paris, France
- Paris School of Economics (PSE), 75014 Paris, France
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Sánchez-Romero J, Ruiz-Boluda I, Juan-Pérez A, Pérez-Buendía J, Motos-Garrido M, Blanco-Carnero JE, Nieto-Díaz A. Interval between balloon removal and oxytocin administration in cervical ripening with double-balloon in singleton pregnancies: An observational study. Int J Gynaecol Obstet 2024; 165:778-785. [PMID: 38009593 DOI: 10.1002/ijgo.15267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 10/29/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE To analyze the influence of the resting interval after removal of a double-balloon for cervical ripening and oxytocin administration on the time to onset of active labor in singleton pregnancies. METHODS A retrospective cohort study of women who required a cervical ripening with double-balloon was conducted between January 2019 and December 2022. We collected data for cervical ripening balloon insertion and removal, oxytocin administration, suspicious or pathological cardiotocographic trace, mode of delivery, maternal and neonatal complications, neonatal outcomes. Proportional hazards model comparing resting interval between double-balloon cervical ripening removal and oxytocin administration. RESULTS A total of 403 singleton pregnancies were recruited and 213 pregnant women experienced a rest of 12 h between cervical balloon removal and oxytocin administration (resting group). Oxytocin was administered immediately after balloon removal in 190 women (non-resting group). Median insertion-to-active labor interval and insertion-to-delivery interval were significantly shorter in the non-resting group: 18.5 versus 24.0 h, HR 2.59 (CI 95%: 1.97-3.41) and 24.0 versus 29.0 h, HR 2.38 (CI 95%: 1.85-3.05) respectively. Bishop score change and mode of delivery between were similar in both groups. No differences in maternal nor neonatal complications between both groups were found. CONCLUSIONS Oxytocin administration immediately after removal of a double-balloon for cervical ripening compared with 12 h delayed interval resulted in a shortened time from insertion to active labor onset and to delivery interval without increasing maternal or neonatal adverse outcomes.
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Affiliation(s)
- Javier Sánchez-Romero
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
- Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, Murcia, Spain
| | - Inmaculada Ruiz-Boluda
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Almudena Juan-Pérez
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Judit Pérez-Buendía
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
| | - Mónica Motos-Garrido
- Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, Murcia, Spain
| | - José Eliseo Blanco-Carnero
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
- Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, Murcia, Spain
| | - Aníbal Nieto-Díaz
- Department of Obstetrics and Gynecology, "Virgen de la Arrixaca" University Hospital, Murcia, Spain
- Department of Obstetrics and Gynecology, Pediatrics and Surgery, University of Murcia, Murcia, Spain
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Schreiber H, Cohen G, Shalev-Ram H, Heresco L, Daykan Y, Arbib N, Biron-Shental T, Markovitch O. Vacuum-assisted delivery outcomes: is advanced maternal age a factor? Arch Gynecol Obstet 2024; 309:1281-1286. [PMID: 36867307 DOI: 10.1007/s00404-023-06983-0] [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: 01/18/2023] [Accepted: 02/14/2023] [Indexed: 03/04/2023]
Abstract
PURPOSE This study evaluated age-related maternal outcomes of vacuum-assisted vaginal deliveries (VAD). METHODS This retrospective cohort study included all nulliparous women with singleton VAD in one academic institution. Study group parturients were maternal age ≥ 35 years and controls < 35. Power analysis revealed that 225 women/group would be sufficient to detect a difference in the rate of third- and fourth-degree perineal tears (primary maternal outcome) and umbilical cord pH < 7.15 (primary neonatal outcome). Secondary outcomes were maternal blood loss, Apgar scores, cup detachment, and subgaleal hematoma. Outcomes were compared between groups. RESULTS From 2014 to 2019, 13,967 nulliparas delivered at our institution. Overall, 8810 (63.1%) underwent normal vaginal delivery, 2432 (17.4%) instrumental, and 2725 (19.5%) cesarean. Among 11,242 vaginal deliveries, 10,116 (90%) involved women < 35, including 2067 (20.5%) successful VAD vs. 1126 (10%) women ≥ 35 years with 348 (30.9%) successful VAD (p < 0.001). Rates of third- and fourth-degree perineal lacerations were 6 (1.7%) with advanced maternal age and 57 (2.8%) among controls (p = 0.259). Cord pH < 7.15 was similar: 23 (6.6%) study group and 156 (7.5%) controls (p = 0.739). CONCLUSION Advanced maternal age and VAD are not associated with higher risk for adverse outcomes. Older, nulliparous women are more likely to undergo vacuum delivery than younger parturients.
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Affiliation(s)
- Hanoch Schreiber
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel.
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Gal Cohen
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Hila Shalev-Ram
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lior Heresco
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yair Daykan
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nissim Arbib
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ofer Markovitch
- Department of Obstetrics and Gynecology, Meir Medical Center, 59 Tchernichovsky St., 44281, Kfar Saba, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lorthe E, Severo M, Hamwi S, Rodrigues T, Teixeira C, Barros H. Obstetric Interventions Among Native and Migrant Women: The (Over)use of Episiotomy in Portugal. Int J Public Health 2024; 69:1606296. [PMID: 38577390 PMCID: PMC10991787 DOI: 10.3389/ijph.2024.1606296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Accepted: 02/28/2024] [Indexed: 04/06/2024] Open
Abstract
Objective: Episiotomy, defined as the incision of the perineum to enlarge the vaginal opening during childbirth, is one of the most commonly performed surgical interventions in the world. We aimed to determine if migrant status is associated with episiotomy, and if individual characteristics mediate this association. Methods: We analyzed data from the Bambino study, a national, prospective cohort of migrant and native women giving birth at a public hospital in mainland Portugal between 2017 and 2019. We included all women with vaginal delivery. The association between migrant status and episiotomy was assessed using multivariable multilevel random-effect logistic regression models. We used path analysis to quantify the direct, indirect and total effects of migrant status on episiotomy. Results: Among 3,583 women with spontaneous delivery, migrant parturients had decreased odds of episiotomy, especially those born in Africa, compared to native Portuguese women. Conversely, with instrumental delivery, migrant women had higher odds of episiotomy. Disparities in episiotomy were largely explained by maternity units' factors, and little by maternal and fetal characteristics. Conclusion: Our results suggest non-medically justified differential episiotomy use during childbirth and highlight the importance of developing evidence-based recommendations for episiotomy use in a country with a high frequency of medical interventions during delivery.
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Affiliation(s)
- Elsa Lorthe
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Unit of Population Epidemiology, Department of Primary Care Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Milton Severo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Sousan Hamwi
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Teresa Rodrigues
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Department of Gynecology and Obstetrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Cristina Teixeira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Polytechnic Institute of Bragança, Bragança, Portugal
| | - Henrique Barros
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Departamento de Ciências de Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Boujenah J, Carbonne B. [New cervical dilation curves during labour: Is there a benefit in moving from the statistical model to reality?]. GYNECOLOGIE, OBSTETRIQUE, FERTILITE & SENOLOGIE 2023; 51:484-486. [PMID: 37414341 DOI: 10.1016/j.gofs.2023.06.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 06/29/2023] [Accepted: 06/30/2023] [Indexed: 07/08/2023]
Affiliation(s)
- Jeremy Boujenah
- Département d'obstétrique, GH Diaconesses Croix Saint-Simon, Paris, France; Centre médical du château, Vincennes, France; Centre hospitalier Princesse Grace, Monaco, Monaco.
| | - Bruno Carbonne
- Centre médical du château, Vincennes, France; Centre hospitalier Princesse Grace, Monaco, Monaco
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Giaxi P, Gourounti K, Vivilaki V, Zdanis P, Galanos A, Antsaklis A, Lykeridou A. Implementation of the Robson Classification in Greece: A Retrospective Cross-Sectional Study. Healthcare (Basel) 2023; 11:healthcare11060908. [PMID: 36981564 PMCID: PMC10048284 DOI: 10.3390/healthcare11060908] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 03/08/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
Cesarean sections have become the most commonly performed operations around the world. The World Health Organization recommended the use of the Robson classification system as a universal standard to establish a joint control system in healthcare facilities. The aim of this study was to implement the Robson classification for the first time in Greece to identify trends in cesarean births and examine the groups of women who are the main contributors to the increasing rates. Moreover, the indicators for cesarean sections will be evaluated as per the Robson classification. In the sample analysis, we included the records of 8572 women giving birth in one private health facility in Greece. A total of 8572 women gave birth during the study period, of which 5224 (60.9%) were cesarean section births and 3348 (39.1%) were vaginal births. In our study, according to the Robson classification, the largest contributors to the overall CS rate were as follows: (a) nulliparous women with a single cephalic term pregnancy, who were either labor induced or delivered by cesarean section before labor-Group 2 (34.6%); (b) multiparous women with a single cephalic term pregnancy and at least one previous cesarean section-Group 5 (30.7%); (c) women with a single cephalic preterm pregnancy-Group 10 (11.7%); (d) women with multiple pregnancies-Group 8 (7.0%). Our study is expected to assist policymakers in Greece in planning further interventions for each subgroup of women in order to reduce the overall CS rate and unnecessary CSs.
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Affiliation(s)
- Paraskevi Giaxi
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Kleanthi Gourounti
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Victoria Vivilaki
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Panagiotis Zdanis
- Department of Midwifery, University of West Attica, 12243 Athens, Greece
| | - Antonis Galanos
- Laboratory for Research of the Musculoskeletal System, School of Medicine, National and Kapodistrian University of Athens, 15784 Athens, Greece
| | - Aris Antsaklis
- IASO, General Maternity and Gynecology Clinic, 15123 Athens, Greece
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Ray CL, Lelong N, Cinelli H, Blondel B, Lelong N, Cinelli H, Blondel B, Regnault N, Demiguel V, Lebreton E, Salanave B, Fresson J, Vilain A, Deroyon T, Raynaud P, Rey S, Chemlal K, Rabier-Thoreau N. Results of the 2021 French National Perinatal Survey and trends in perinatal health in metropolitan France since 1995. J Gynecol Obstet Hum Reprod 2022; 51:102509. [PMID: 36410664 DOI: 10.1016/j.jogoh.2022.102509] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/04/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To report results of the 2021 French National Perinatal Survey (ENP) in metropolitan France and assess trends in the main indicators of perinatal health, medical practices, and risk factors in France since 1995. POPULATION AND METHOD All the samples included all women giving birth at a gestational age of at least 22 weeks of gestation and/or to an infant weighing at least 500 grams in all maternity units in metropolitan France during one week in 1995 (N=13 048), 2003 (N=14 324), 2010 (N=14 546), 2016 (N=12 553), and 2021 (N=12 088). The data came from postpartum interviews of the women at the hospital and their medical records. Comparisons between surveys showed trends over time. RESULTS Between 1995 and 2021, maternal characteristics changed. Maternal age and the frequency of women with obesity rose: in 2021, 24.6% of women were 35 years or older (21.1% in 2016, 19.2% in 2010, 15.9% in 2003 and 12.4% in 1995) and 14.4% were obese (11.8% in 2016, 9.9% in 2010 and 7.4% in 2003). Some antenatal prevention behaviors that improved in 2021 were not smoking during the third trimester, acid folic administration before pregnancy, and vaccination against influenza. The percentage of women with an early prenatal appointment ("4th month appointment"), implemented to facilitate screening of maternal vulnerability during pregnancy, has continued to rise. The percentage of women receiving prenatal care by midwives has risen markedly (39.0% in 2021 versus 11.7% in 2016). Serum screening for Down syndrome continues to increase (91.8% of women in 2021). The rate of induction of labor has risen significantly (20.2% in 1995 and 25.8% in 2021). The mode of delivery has not varied significantly since 2003; in 2021, the cesarean rate was 21.4% and the instrumental vaginal delivery rate 12.4%. Episiotomy was increasingly rare, among both primiparous and multiparous women (16.5% and 2.9% in 2021, respectively). The prevalence of coronavirus (SARS-CoV2) infection during pregnancy was 5.7%. Preterm live births increased regularly, slightly but significantly over the 1995-2016 period and then remained stable between 2016 and 2021 (7.0%). In 2021, 56.3% of women exclusively breastfed during their hospital stay, a modest increase in comparison with 2016 (54.6%). CONCLUSION Routine national perinatal surveys highlight positive trends over time in some preventive practices, decreases in some medical interventions consistent with national guidelines, and the increasing role of midwives in prenatal care. Nonetheless, some indicators remain less than optimal and require more detailed analyses.
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Affiliation(s)
- Camille Le Ray
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France; Maternité Port-Royal, Groupe hospitalier Paris Centre, AP-HP, Université Paris Cité, FHU Prema, 75014 Paris.
| | - Nathalie Lelong
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
| | - Hélène Cinelli
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
| | - Béatrice Blondel
- Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOPé), CRESS, INSERM, INRAE, Université Paris Cité, 75014 Paris, France
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Abou-Dakn M, Schäfers R, Peterwerth N, Asmushen K, Bässler-Weber S, Boes U, Bosch A, Ehm D, Fischer T, Greening M, Hartmann K, Heller G, Kapp C, von Kaisenberg C, Kayer B, Kranke P, Lawrenz B, Louwen F, Loytved C, Lütje W, Mattern E, Nielsen R, Reister F, Schlösser R, Schwarz C, Stephan V, Kalberer BS, Valet A, Wenk M, Kehl S. Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020). Geburtshilfe Frauenheilkd 2022; 82:1143-1193. [PMID: 36339636 PMCID: PMC9633231 DOI: 10.1055/a-1904-6546] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 07/16/2022] [Indexed: 11/06/2022] Open
Abstract
Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.
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Affiliation(s)
- Michael Abou-Dakn
- Klinik für Gynäkologie und Geburtshilfe, St. Joseph Krankenhaus, Berlin-Tempelhof, Berlin, Germany,Correspondence Prof. Dr. med. Michael Abou-Dakn Klinik für Gynäkologie und GeburtshilfeSt. Joseph Krankenhaus
Berlin-TempelhofWüsthoffstraße 1512101
BerlinGermany
| | - Rainhild Schäfers
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany,Prof. Dr. Rainhild Schäfers Hochschule für GesundheitDepartment für Angewandte
GesundheitswissenschaftenGesundheitscampus 6 – 844801
BochumGermany
| | - Nina Peterwerth
- Hochschule für Gesundheit Department für Angewandte Gesundheitswissenschaften Bochum, Bochum, Germany
| | - Kirsten Asmushen
- Gesellschaft für Qualität in der außerklinischen Geburtshilfe e. V., Storkow, Germany
| | | | | | - Andrea Bosch
- Duale Hochschule Baden-Württemberg Angewandte Hebammenwissenschaft, Stuttgart, Germany
| | - David Ehm
- Frauenarztpraxis Bern, Bern, Switzerland
| | - Thorsten Fischer
- Dept. of Gynecology and Obstetrics Paracelcus Medical University, Salzburg, Austria
| | - Monika Greening
- Hochschule für Wirtschaft und Gesellschaft, Hebammenwissenschaften – Ludwigshafen, Ludwigshafen, Germany
| | | | - Günther Heller
- Institut für Qualitätssicherung und Transparenz im Gesundheitswesen, Berlin, Germany
| | - Claudia Kapp
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Constantin von Kaisenberg
- Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Medizinische Hochschule Hannover, Hannover, Germany
| | - Beate Kayer
- Fachhochschule Burgenland, Studiengang Hebammen, Pinkafeld, Austria
| | - Peter Kranke
- Klinik und Poliklinik für Anästhesiologie, Intensivmedizin, Notfallmedizin und Schmerztherapie, Universitätsklinikum Würzburg, Würzburg, Germany
| | | | - Frank Louwen
- Frauenklinik, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christine Loytved
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Wolf Lütje
- Institut für Hebammen, Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften ZHAW, Winterthur, Switzerland
| | - Elke Mattern
- Deutsche Gesellschaft für Hebammenwissenschaft e. V., Edemissen, Germany
| | - Renate Nielsen
- Ev. Amalie Sieveking Krankenhaus – Immanuel Albertinen Diakonie Hamburg, Hamburg, Germany
| | - Frank Reister
- Frauenklinik, Universitätsklinikum Ulm, Ulm, Germany
| | - Rolf Schlösser
- Klinik für Kinder- und Jugendmedizin, Universitätsklinikum Frankfurt, Frankfurt am Main, Germany
| | - Christiane Schwarz
- Institut für Gesundheitswissenschaften FB Hebammenwissenschaft, Lübeck, Germany
| | - Volker Stephan
- Deutsche Gesellschaft für Kinder- und Jugendmedizin e. V., Köln, Germany
| | | | - Axel Valet
- Frauenklinik Dill Kliniken GmbH, Herborn, Germany
| | - Manuel Wenk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie Kaiserwerther Diakonie, Düsseldorf, Germany
| | - Sven Kehl
- Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Germany
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Duration of second stage of labor and factors associated with prolonged second stage: A national population-based study in France. Eur J Obstet Gynecol Reprod Biol 2022; 273:12-19. [PMID: 35436643 DOI: 10.1016/j.ejogrb.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 03/07/2022] [Accepted: 04/09/2022] [Indexed: 11/21/2022]
Abstract
OBJECTIVES Prolonged second stage of labor could be associated with an increase in maternal and neonatal morbidity. However, in France, no consensual definition of prolonged 2nd stage of labor exists and therefore factors associated with prolonged second stage have not yet been studied. From national population-based data, we aimed at defining the prolonged 2nd stage of labor in France and identifying its associated factors for women with epidural. STUDY DESIGN From the French national perinatal survey of 2016, we included all women who reached 2nd stage of labor and delivered at term of a singleton infant in cephalic presentation. We studied the distribution of the duration of the 2nd stage according to parity and defined prolonged 2nd stage as the 90th percentile. Among women with epidural, factors associated with a prolonged 2nd stage of labor were then explored by univariate and multilevel multivariable analysis, to take the cluster effect into account. The proportional change of variance was estimated for each multivariate model. RESULTS Among the 8154 women included, 3574 were nulliparous and 4580 multiparous. Prolonged second stage was defined as a duration of more than 89.6 min and 30.6 min for nulliparous and multiparous women without epidural; and respectively 185.7 min and 120.1 min for women with epidural analgesia. The factors associated with prolonged 2nd stage of labor were respectively for nulliparous and multiparous women, macrosomia (aOR 1.74 [1.03-2.94] and ORa 2.52 [1.69-3.76]), prenatal preparation classes (aOR 1.47 [1.04-2.08] and aOR 1.56 [1.21-2.01]), a prolonged 1st stage (aOR 1.47 [1.14-1.87] and aOR 1.52 [1.19-1.95]) and delivery in a public maternity unit (aOR 2.68 [1.50-4.78] and aOR 3.12 [1.88-5.17]). Women's characteristics accounted for 3.4% of the variance and maternity organizational characteristics for 26.1%. CONCLUSION In France, prolonged 2nd stage of labor can be defined as a 2nd stage exceeding 3 h in nulliparous and 2 h in multiparous women with epidural analgesia. The identification of its associated factors allows determining a target population of women at risk of prolonged 2nd stage and improve their 2nd stage's management.
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Cesar JA, Marmitt LP, Mendoza-Sassi RA. Episiotomy in Southern Brazil: prevalence, trend, and associated factors. Rev Saude Publica 2022; 56:26. [PMID: 35476104 PMCID: PMC9004702 DOI: 10.11606/s1518-8787.2022056003908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 08/24/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To identify and analyze the prevalence, trend, and factors associated with episiotomy in Rio Grande, in the state of Rio Grande do Sul, Southern Brazil. METHODS A single, standardized questionnaire was applied to all pregnant women, residents in the municipality of Rio Grande, who had children in local hospitals between January 1 and December 12 of the years 2007, 2010, 2013, 2016 e 2019. Demographic and socioeconomic characteristics were investigated, as well as the assistance received during pregnancy and delivery. Chi-square test was used to compare proportions and Poisson regression with robust variance adjustment was used for multivariable analysis. Prevalence ratio (PR) was used as effect measure. RESULTS Among the 12,645 births that occurred in the five years, 5,714 (45.2%) were vaginal delivery. Of these mothers, 2,930 (51.3%; 95%CI: 50.0%–52.6%) underwent episiotomy. Over this period, the episiotomy rate decreased from 70.9% (68.4–73.5) in 2007 to 19.4% (17.1–21.7) in 2019. Adjusted analysis showed a high PR of episiotomy occurrence among women who were young (PR = 2.23; 95%CI: 1.89–2.63), had higher education (PR = 1.21; 95%Cl: 1.03–1.42), had a higher family income (PR = 1.25; 95%CI: 1.10–1.41), were primiparous (PR = 3.41; 95%CI: 2.95–3.95), had prenatal care in the private sector (PR = 1.25; 95%CI: 1.07–1.46), had oxytocin-induced labor (PR = 1.18; 95%CI:1.09–1.27), underwent forceps (PR = 1.32; 95%CI: 1.16–1.50), and whose newborn weighed 4,000 g or more (PR = 1.43; 95%CI: 1.14–1.80). CONCLUSION Although the prevalence of episiotomy fell sharply within the studied period, its occurrence is more likely among women at lower risk of birth complications.
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Affiliation(s)
- Juraci A Cesar
- Universidade Federal do Rio Grande. Faculdade de Medicina. Programa de Pós-graduação em Saúde Pública. Rio Grande, RS, Brasil
| | - Luana P Marmitt
- Universidade do Oeste de Santa Catarina. Programa de Pós-Graduação em Biociências e Saúde. Flor da Serra, SC, Brasil
| | - Raúl A Mendoza-Sassi
- Universidade Federal do Rio Grande. Faculdade de Medicina. Programa de Pós-graduação em Saúde Pública. Rio Grande, RS, Brasil
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12
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Milcent C, Zbiri S. Supplementary private health insurance: The impact of physician financial incentives on medical practice. HEALTH ECONOMICS 2022; 31:57-72. [PMID: 34636088 DOI: 10.1002/hec.4443] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 09/17/2021] [Accepted: 09/28/2021] [Indexed: 06/13/2023]
Abstract
In the French diagnosis-related group (DRG)-based payment system, both private and public hospitals are financed by a public single payer. Public hospitals are overcrowded and have no direct financial incentives to choose one procedure over another. If a patient has a strong preference, they can switch to a private hospital. In private hospitals, the preference does come into play, but the patient has to pay for the additional cost, for which they are reimbursed if they have supplementary private health insurance. Do financial incentives from the fees received by physicians for different procedures drive their behavior? Using French exhaustive data on delivery, we find that private hospitals perform significantly more cesarean deliveries than public hospitals. However, for patients without private health insurance, the two sectors differ much less in terms of cesareans rate. We determine the impact of the financial incentive for patients who can afford the additional cost. Affordability is mainly ensured by the reimbursement of costs by private health insurance. These findings can be interpreted as evidence that, in healthcare systems where a public single payer offers universal coverage, the presence of supplementary private insurance can contribute to creating incentives on the supply side and lead to practices and an allocation of resources that are not optimal from a social welfare perspective.
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Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research, Paris, France
| | - Saad Zbiri
- EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
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13
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Obstetrics at odds with evolution: The consequences of interrupting adaptive birthing consciousness. NEW IDEAS IN PSYCHOLOGY 2021. [DOI: 10.1016/j.newideapsych.2021.100903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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14
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Marmitt LP, Cordeiro MF, Cesar JA. Trend and Inequality in Episiotomy in Southern Brazil, 2007-2016: Evidence of Reduced Abusive Practice. Matern Child Health J 2021; 26:1231-1238. [PMID: 34839433 DOI: 10.1007/s10995-021-03291-4] [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] [Accepted: 11/20/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This study aimed to measure the prevalence, to describe the trend over time, and to evaluate socioeconomic inequalities in the occurrence of episiotomies in 2007, 2010, 2013, and 2016 in the municipality of Rio Grande, in Southern Brazil. METHODS We included all women who had vaginal delivery in each of the studied years. All the information was obtained through a questionnaire applied at maternity wards within 48 h after delivery. The outcome consisted of episiotomy. A chi-square test was used to evaluate the linear trend. Absolute and relative inequalities were assessed from household income and schooling of the women through the Slope Index of Inequality and Relative Index of Inequality, respectively. RESULTS This study included 4,521 parturients. The episiotomy rate in the period fell from 71.0% (95%CI: 68.4-73.5) in 2007 to 40.1% (95%CI: 37.3-42.8) in 2016, and it was more frequent among women with higher income and higher schooling. We observed a reduction in the rate of episiotomy in all income and schooling levels, and this was more evident among women in the lowest socioeconomic levels. Absolute inequality declined, while relative inequality remained unchanged. CONCLUSIONS FOR PRACTICE Despite the significant reduction in the rate of episiotomy, its occurrence remains high. Women with higher income and education, therefore with lower risk for complications during childbirth, were the most frequently submitted to this procedure. Routine use of episiotomy must be reevaluated, especially among pregnant women with better socioeconomic status.
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Affiliation(s)
- Luana P Marmitt
- Universidade Federal do Rio Grande (FURG), Rua General Osorio, Rio Grande, RS, 96201-900, Brazil.
- Universidade do Oeste de Santa Catarina (Unoesc), Rua Getúlio Vargas, 2125-Bairro Flor da Serra, Joaçaba, SC, 89600-000, Brazil.
| | - Marcos F Cordeiro
- Universidade do Oeste de Santa Catarina (Unoesc), Rua Getúlio Vargas, 2125-Bairro Flor da Serra, Joaçaba, SC, 89600-000, Brazil
| | - Juraci A Cesar
- Universidade Federal do Rio Grande (FURG), Rua General Osorio, Rio Grande, RS, 96201-900, Brazil
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van den Berg LMM, Gordon BBM, Kleefstra SM, Martijn L, van Dillen J, Verhoeven CJ, de Jonge A. Centralisation of acute obstetric care in the Netherlands: a qualitative study to explore the experiences of stakeholders with adaptations in organisation of care. BMC Health Serv Res 2021; 21:1233. [PMID: 34774037 PMCID: PMC8590329 DOI: 10.1186/s12913-021-07269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022] Open
Abstract
Background In the past decade, acute obstetric care (AOC) has become centralised in many high-income countries. In this qualitative study, we explored how stakeholders in maternity care perceived and experienced adaptations in the organisation of maternity care in areas in the Netherlands where AOC was centralised. Methods A heterogenic group of fifteen maternity care stakeholders, including patients, were purposively selected for semi-structured interviews. An inductive thematic analysis was used. Results Three main themes were identified: (1) lack of involvement. (2) the process of making adaptations in the organisation of maternity care. (3) maintaining quality of care. Stakeholders in this study were highly motivated to maintain a high quality of maternity care and therefore made adaptations at several organisational levels. However, they felt a lack of involvement during the planning of centralisation of AOC and highlighted the importance of a collaborative process when making adaptations after centralisation of AOC. Conclusions Regions with AOC centralisation plans should invest time and money in change management, encourage early involvement of all maternity care stakeholders and acknowledge centralisation of AOC as a professional life event with associated emotions, including a feeling of unsafety. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07269-4.
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Affiliation(s)
- Lauri M M van den Berg
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Bernardus Benjamin Maria Gordon
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Sophia M Kleefstra
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Lucie Martijn
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Maxima Medical Centre, Department of Obstetrics and Gynecology, De Run 4600, Veldhoven, Netherlands.,Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, NG7 2RD, Nottingham, UK
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
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Quibel T, Rozenberg P, Bouyer C, Bouyer J. Variation between hospital caesarean delivery rates when Robson's classification is considered: An observational study from a French perinatal network. PLoS One 2021; 16:e0251141. [PMID: 34415907 PMCID: PMC8378683 DOI: 10.1371/journal.pone.0251141] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 04/20/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION WHO has recommended using Robson's Ten Group Classification System (TGCS) to monitor and analyze CD rates. Its failure to take some maternal and organizational factors into account, however, could limit the interpretation of CD rate comparisons, because it may contribute to variations in hospital CD rates. OBJECTIVE To study the contribution of maternal socioeconomic and clinical characteristics and hospital organizational factors to the variation in CD rates when using Robson's ten-group classification system for CD rate comparisons. METHODS This prospective, observational, population-based study included all deliveries at a gestational age > 24 weeks at the 10 hospitals of the French MYPA perinatal network in the Paris area. CD rates were calculated for each TGCS group in each hospital. Interhospital variations in these rates were investigated with hierarchical logistic regression models to quantify the variation explained by differences in patient and hospital characteristics when the TGCS is considered. Variations in CD rates between hospitals were estimated with median odds ratios (MOR) to express interhospital variance on the standard odds ratio scale. The percentage of variation explained by TGCS and maternal and hospital characteristics was also calculated. RESULTS The global CD rate was 24.0% (interhospital range: 17-32%). CD rates within each TGCS group differed significantly between hospitals (P<0.001). CD was significantly associated with maternal age (>40 years), severe preeclampsia, and two organizational factors: hospital status (private maternities) and the deliveries per staff member per 24 hours. The MOR in the empty model was 1.27 and did not change after taking the TGCS into account. Adding maternal characteristics and hospital organizational factors lowered the MOR to 1.14 and reduced the variation between hospital CD rates by 70%. CONCLUSION Maternal characteristics and hospital factors are needed to address variation in CD rates among the TGCS groups. Therefore, comparisons of these rates that do not consider these factors should be interpreted carefully.
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Affiliation(s)
- Thibaud Quibel
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
- EA 7285, Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Patrick Rozenberg
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
- EA 7285, Research Unit "Risk and Safety in Clinical Medicine for Women and Perinatal Health", Versailles-Saint-Quentin University (UVSQ), Montigny-le-Bretonneux, France
| | - Camille Bouyer
- Department of Gynecology and Obstetrics, Intercommunal Hospital Centre of Poissy-Saint-Germain-en-Laye, Poissy, France
- Réseau de Périnatalité Maternité en Yvelines et Périnatalité Active (MYPA), Saint-Germain-en-Laye, France
| | - Jean Bouyer
- Université Paris-Saclay, UVSQ, Inserm, CESP, Villejuif, France
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Induction of labour as compared with spontaneous labour in low-risk women: A multicenter study in Catalonia. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100648. [PMID: 34332215 DOI: 10.1016/j.srhc.2021.100648] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 06/26/2021] [Accepted: 07/19/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare birth and neonatal outcomes in low-risk women undergoing induced labour with those undergoing spontaneous onset. METHODS This retrospective multicentre study included 30 public maternity hospitals in Catalonia between 2016 and 2017. The study population consisted of 5,717 women. RESULTS Of the 5,717 births, 75.8% had spontaneous onset and 24.2% had an induction. Induced labour was more likely at week 41 of gestation and in nulliparous women. Induced labour increased the likelihood of undergoing caesarean section (adjusted OR [ORa], 2.59; 95% confidence interval [CI], 2.11-3.16), assisted vaginal birth (ORa, 1.70; 95% CI, 1.46-1.98), epidural analgesia (ORa, 2.64; CI, 2.14-3.27), postpartum haemorrhage (ORa, 1.56; 95% CI, 1.14-2.15) and episiotomy (ORa, 1.26; 95% CI, 1.08-1.47). Induced labour was also associated with not performing skin-to-skin contact with the mother (ORa, 0.47; 95% CI, 0.39-0.58) and with not performing early breastfeeding (ORa, 0.49; 95% CI, 0.39-0.61). CONCLUSIONS The frequency of labour inductions among low-risk women exceeds the level recommended by scientific organisations in Catalonia and Spain, and is associated with adverse birth outcomes such as increased caesarean section rates, assisted vaginal births, and episiotomy rates. It is also associated with the failure to perform early skin-to-skin contact with the mother and failure to initiate early breastfeeding.
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18
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Kearney L, Craswell A, Massey D, Marsh N, Nugent R, Alexander C, Smitheram C, McLoughlin A, Ullman A. Peripheral intravenous catheter management in childbirth (PICMIC): A multi-centre, prospective cohort study. J Adv Nurs 2021; 77:4451-4458. [PMID: 34118163 DOI: 10.1111/jan.14933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 04/06/2021] [Accepted: 05/24/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Childbirth is a normal, physiological process, yet intervention is common. Arguably the most common intervention is the insertion of a peripheral intravenous catheter; however, there are few studies guiding best practice. This study aimed to describe current intravenous catheter insertion practice, explore clinician decision-making during insertion and perceptions of women. METHODS This prospective, observational cohort study recruited 101 women and clinicians from two Australian regional hospitals. Data collection incorporated non-participant observation, brief interview and chart review. Variables measured included pain score, insertion attempts, catheter gauge and dwell time. RESULTS Childbearing women were, on average, aged 31 with body mass index (BMI) above 28. Women reported a mean pain score of 3.3/10 at 24 h for catheter insertion and 12% reported bruising. An 18-gauge catheter was considered more painful than a 16-gauge, and multiple attempts did not increase perceived average pain score. Association between failed first attempts and higher BMI was not established. Participant clinicians were predominantly midwives, who selected and placed 18-gauge catheters mostly in hand or wrist (66%). Decision-making about site, catheter gauge, dressing and attempts varied. Thirty-four per cent attempted two to three times, despite regular practise. Confidence to reliably insert determined catheter gauge and almost half clinician participants cited hospital policy and preferred non-dominant arm as key reasons for the location of PIVC. CONCLUSIONS Regular use of a large-gauge catheter is counter intuitive when placed in the small veins of the hand with extension tubing. More research is needed to promote best practice around gauge selection, site and women's experience.
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Affiliation(s)
- Lauren Kearney
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia.,Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Alison Craswell
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Debbie Massey
- School of Nursing, Midwifery and Paramedicine, University of the Sunshine Coast, Sippy Downs, QLD, Australia
| | - Nicole Marsh
- Royal Brisbane Women's Hospital, Metro North Hospital and Health Service, Herston, QLD, Australia
| | - Rachael Nugent
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Catherine Alexander
- Caboolture Hospital, Metro North Hospital and Health Service, Caboolture, QLD, Australia
| | - Carmel Smitheram
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Anthea McLoughlin
- Sunshine Coast Hospital and Health Service, Birtinya, QLD, Australia
| | - Amanda Ullman
- School of Nursing, Midwifery and Social Work, University of Queensland, Brisbane, QLD, Australia.,Children's Health Queensland, Brisbane, QLD, Australia
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Determinants of the use of nonpharmacological analgesia for labor pain management: a national population-based study. Pain 2021; 161:2571-2580. [PMID: 32569092 DOI: 10.1097/j.pain.0000000000001956] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Besides neuraxial analgesia, nonpharmacological methods are also proposed to help women coping with pain during labor. We aimed to identify the individual and organizational factors associated with the use of nonpharmacological analgesia for labor pain management. Women who attempted vaginal delivery with labor analgesia were selected among participants included in the 2016 National Perinatal Survey, a population-based cross-sectional study. Labor analgesia was studied as neuraxial analgesia alone, nonpharmacological analgesia alone, and neuraxial and nonpharmacological analgesia combined. The associations were studied using multilevel multinomial logistic regression. Among the 9231 women included, 62.4% had neuraxial analgesia alone, 6.4% had nonpharmacological analgesia alone, and 31.2% had both. Nonpharmacological analgesia alone or combined with neuraxial analgesia were both associated with high educational level (adjusted odds ratio 1.55; 95% confidence interval [CI], 1.08-2.23 and 1.39; 95% CI, 1.18-1.63), antenatal preference to deliver without neuraxial analgesia, and public maternity unit status. Nonpharmacological analgesia alone was more frequent among multiparous women, and in maternity units with an anesthesiologist not dedicated to delivery unit (1.57; 95% CI, 1.16-2.12) and with the lowest midwife workload (2.15; 95% CI, 1.43-3.22). Neuraxial and nonpharmacological analgesia combined was negatively associated with inadequate prenatal care (0.70; 95% CI, 0.53-0.94). In France, most women who had nonpharmacological analgesia during labor used it as a complementary method to neuraxial analgesia. The use of nonpharmacological analgesia combined with neuraxial analgesia mainly depends on the woman's preference, but also on socioeconomic factors, quality of prenatal care, and care organization.
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Schantz C, Lhotte M, Pantelias AC. [Moving beyond the ethical tension of caesarean section on maternal request]. SANTE PUBLIQUE 2021; 32:497-505. [PMID: 33723955 DOI: 10.3917/spub.205.0497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION In a legal context focused on the right and autonomy of the patient, some women wish to be able to choose their mode of childbirth. As midwives are primary care-givers for pregnant women with a physiological pregnancy, we wanted to find out whether it was ethically acceptable for them to accompany a woman in her decision to have a caesarean section.Purpose of research: This survey is an ancillary study of the CESARIA research program validated by the Comité de Protection des Personnes Sud Méditerranée IV and declared to the CNIL. Thirty-seven semi-directive interviews were conducted with midwives and women. RESULTS The majority of women and midwives share a vision of childbirth as “natural” and consider the request for caesarean section as a pathology. When formulated, this request places midwives in a situation of ethical tension. On the one hand, midwives wish to refer women to vaginal birth as the norm, and this choice embodies the ethical principles of beneficence and non-maleficence. On the other hand, midwives express a desire to respect patient choice and freedom, illustrating the ethical principle of respect for autonomy. CONCLUSIONS The ethical issue of caesarean section on demand lies not so much in the decision to accept or not to accept a caesarean section but rather in listening to the request. Taking into consideration a medical indication more broadly than the simple obstetrical indication makes it possible to ethically support these requests while respecting the pregnant woman’s autonomy.
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Girault A, Blondel B, Goffinet F, Le Ray C. Frequency and determinants of misuse of augmentation of labor in France: A population-based study. PLoS One 2021; 16:e0246729. [PMID: 33561131 PMCID: PMC7872232 DOI: 10.1371/journal.pone.0246729] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/25/2021] [Indexed: 11/24/2022] Open
Abstract
Introduction While use of augmentation of labor (AL) is appropriate for labor dystocia, it is frequently used inadequately and unnecessarily. The objective was to assess at a national level, the frequency and determinants of misuse of augmentation of labor (AL). Material and methods Women of the French perinatal survey of 2016 with a singleton cephalic fetus, delivering at term after a spontaneous labor were included. “Misuse of AL” was defined by artificial rupture of the membranes (ROM) and/or oxytocin within one hour of admission and/or duration between ROM and oxytocin of less than one hour. Women, labor and maternity unit’s characteristics were compared between the “misuse of AL” and “no misuse of AL” groups by bivariate analysis. To identify the determinants of misuse of AL, a multivariable multilevel logistic regression was performed taking into account the data’s hierarchical structure (first level: women, second level: maternity units). Results Among the 7196 women included, 1524 (21.2%) had a misuse of AL. The determinants of misuse of AL were middle school educational level (reference high school), aOR = 1.21; 95%CI[1.01–1.45], gestational age at delivery ≥41weeks (reference 39–40 weeks), aOR = 1.19; 95%CI[1.00–1.42], cervical dilation ≥6cm at admission (reference <3cm), aOR = 1.39; 95%CI[1.10–1.76], epidural analgesia aOR = 1.63; 95%CI[1.35–1.96], delivery in a private hospital (reference public teaching hospital), aOR = 2.25; 95%CI[1.57–3.23]; and maternity units with <1000 deliveries/year and 1000–1999 deliveries/year (reference ≥3000 deliveries/year), respectively aOR = 1.52; 95%CI[1.11–2.08] and aOR = 1.42; 95%CI[1.05–1.92]. Less than 3% of the variance was explained by women characteristics, and 24.17% by the maternity units’ characteristics. Conclusions In France, one spontaneous laboring woman among five is subject to misuse of AL. The misuse is mostly explained by maternity unit’s characteristics. The determinants identified in this study can be used to implement targeted actions in small and private maternity units.
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Affiliation(s)
- Aude Girault
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
- * E-mail:
| | - Béatrice Blondel
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
| | - François Goffinet
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
| | - Camille Le Ray
- INSERM UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (Epopé), Center for Epidemiology and Statistics, FHU PREMA, Université de Paris, Paris, France
- Maternité Port Royal, AP-HP, Hôpital Cochin, FHU PREMA, Paris, France
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Diguisto C, Le Gouge A, Arthuis C, Winer N, Parant O, Poncelet C, Chauleur C, Hannigsberg J, Ducarme G, Gallot D, Gabriel R, Desbriere R, Beucher G, Faraguet C, Isly H, Rozenberg P, Giraudeau B, Perrotin F. Cervical ripening in prolonged pregnancies by silicone double balloon catheter versus vaginal dinoprostone slow release system: The MAGPOP randomised controlled trial. PLoS Med 2021; 18:e1003448. [PMID: 33571294 PMCID: PMC7877637 DOI: 10.1371/journal.pmed.1003448] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 01/13/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Prolonged pregnancies are a frequent indication for induction of labour. When the cervix is unfavourable, cervical ripening before oxytocin administration is recommended to increase the likelihood of vaginal delivery, but no particular method is currently recommended for cervical ripening of prolonged pregnancies. This trial evaluates whether the use of mechanical cervical ripening with a silicone double balloon catheter for induction of labour in prolonged pregnancies reduces the cesarean section rate for nonreassuring fetal status compared with pharmacological cervical ripening by a vaginal pessary for the slow release of dinoprostone (prostaglandin E2). METHODS AND FINDINGS This is a multicentre, superiority, open-label, parallel-group, randomised controlled trial conducted in 15 French maternity units. Women with singleton pregnancies, a vertex presentation, ≥41+0 and ≤42+0 weeks' gestation, a Bishop score <6, intact membranes, and no history of cesarean delivery for whom induction of labour was decided were randomised to either mechanical cervical ripening with a Cook Cervical Ripening Balloon or pharmacological cervical ripening by a Propess vaginal pessary serving as a prostaglandin E2 slow-release system. The primary outcome was the rate of cesarean for nonreassuring fetal status, with an independent endpoint adjudication committee determining whether the fetal heart rate was nonreassuring. Secondary outcomes included delivery (time from cervical ripening to delivery, number of patients requiring analgesics), maternal and neonatal outcomes. Between January 2017 and December 2018, 1,220 women were randomised in a 1:1 ratio, 610 allocated to a silicone double balloon catheter, and 610 to the Propess vaginal pessary for the slow release of dinoprostone. The mean age of women was 31 years old, and 80% of them were of white ethnicity. The cesarean rates for nonreassuring fetal status were 5.8% (35/607) in the mechanical ripening group and 5.3% (32/609) in the pharmacological ripening group (proportion difference: 0.5%; 95% confidence interval (CI) -2.1% to 3.1%, p = 0.70). Time from cervical ripening to delivery was shorter in the pharmacological ripening group (23 hours versus 32 hours, median difference 6.5 95% CI 5.0 to 7.9, p < 0.001), and fewer women required analgesics in the mechanical ripening group (27.5% versus 35.4%, difference in proportion -7.9%, 95% CI -13.2% to -2.7%, p = 0.003). There were no statistically significant differences between the 2 groups for other delivery, maternal, and neonatal outcomes. A limitation was a low observed rate of cesarean section. CONCLUSIONS In this study, we observed no difference in the rates of cesarean deliveries for nonreassuring fetal status between mechanical ripening with a silicone double balloon catheter and pharmacological cervical ripening with a pessary for the slow release of dinoprostone. TRIAL REGISTRATION ClinicalTrials.gov NCT02907060.
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Affiliation(s)
- Caroline Diguisto
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, France
- Université de Paris, CRESS, INSERM, INRA, Paris, France
- * E-mail:
| | | | - Chloé Arthuis
- Department of Obstetrics and Gynecology, University Hospital of Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, France
| | - Norbert Winer
- Department of Obstetrics and Gynecology, University Hospital of Nantes, NUN, INRAE, UMR 1280, PhAN, Université de Nantes, France
| | - Olivier Parant
- Pôle de gynécologie obstétrique, hôpital Paule-de-Viguier, CHU de Toulouse, Toulouse, France
| | - Christophe Poncelet
- Department of Obstetrics and Gynecology, Rene DUBOS Hospital, Cergy-Pontoise, France
- Université Paris 13, Sorbonne Paris Cité, UFR SMBH, Bobigny, France
| | - Celine Chauleur
- Department of Gynecology and Obstetrics, University Hospital of Saint-Etienne, Saint-Etienne, France
- INSERM, SAINBIOSE, U1059, Dysfonction Vasculaire et Hémostase, Université Jean-Monnet; CIC1408, Saint-Etienne, France
| | - Jacob Hannigsberg
- CHU Brest, Hôpital Morvan, service de gynécologie-obstétrique, Brest, France
| | - Guillaume Ducarme
- Department of Obstetrics and Gynecology, Centre Hospitalier Departemental, La Roche sur Yon, France
| | - Denis Gallot
- Pôle femme et enfant, CHU Estaing, 1, place Lucie-et-Raymond-Aubrac, Clermont-Ferrand, France, Team Translational approach to epithelial injury and repair, UMR6293 CNRS-Université Clermont Auvergne, U1103 Inserm, GReD, Clermont-Ferrand, France
| | - Rene Gabriel
- Service de Gynécologie-Obstétrique, Hôpital Maison Blanche, Reims Cedex, Université de Reims Champagne Ardennes, France
| | - Raoul Desbriere
- Hôpital Saint Joseph, Department of Obstetrics and Gynecology, Marseille, France
| | - Gael Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, Caen, France
| | - Cyrille Faraguet
- Service de Gynécologie Obstétrique, Centre Hospitalier de Chartre, France
| | - Helene Isly
- Service de Gynécologie Obstétrique, Centre Hospitalier Universitaire de Rennes, France
| | - Patrick Rozenberg
- Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
- Versailles St-Quentin University, research unit EA 7285. Montigny-le-Bretonneux, France
| | - Bruno Giraudeau
- Université de Tours, France
- INSERM CIC1415, CHRU de Tours, Tours, France
| | - Franck Perrotin
- Pôle de gynécologie obstétrique, médecine fœtale, médecine et biologie de la reproduction, centre Olympe de Gouges, CHRU de Tours, Tours, France
- Université de Tours, France
- INSERM U1253 Imaging and Brain (iBrain), Tours, France
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Clesse C, Cottenet J, Lighezzolo-Alnot J, Goueslard K, Scheffler M, Sagot P, Quantin C. Episiotomy practices in France: epidemiology and risk factors in non-operative vaginal deliveries. Sci Rep 2020; 10:20208. [PMID: 33214621 PMCID: PMC7677317 DOI: 10.1038/s41598-020-70881-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 07/28/2020] [Indexed: 02/08/2023] Open
Abstract
Episiotomy use has decreased due to the lack of evidence on its protective effects from maternal obstetric anal sphincter injuries. Indications for episiotomy vary considerably and there are a great variety of factors associated with its use. The aim of this article is to describe the episiotomy rate in France between 2013 and 2017 and the factors associated with its use in non-operative vaginal deliveries. In this retrospective population-based cohort study, we included vaginal deliveries performed in French hospitals (N = 584) and for which parity was coded. The variable of interest was the rate of episiotomy, particularly for non-operative vaginal deliveries. Trends in the episiotomy rates were studied using the Cochran-Armitage test. Hierarchical logistic regression was used to identify variables associated with episiotomy according to maternal age and parity. Between 2013 and 2017, French episiotomy rates fell from 21.6 to 14.3% for all vaginal deliveries (p < 0.01), and from 15.5 to 9.3% (p < 0.01) for all non-operative vaginal deliveries. Among non-operative vaginal deliveries, epidural analgesia, non-reassuring fetal heart rate, meconium in the amniotic fluid, shoulder dystocia, and newborn weight (≥ 4,000 g) were risk factors for episiotomy, both for nulliparous and multiparous women. On the contrary, prematurity reduced the risk of its use. For nulliparous women, breech presentation was also a risk factor for episiotomy, and for multiparous women, scarred uterus and multiple pregnancies were risk factors. In France, despite a reduction in episiotomy use over the last few years, the factors associated with episiotomy have not changed and are similar to the literature. This suggests that the decrease in episiotomies in France is an overall tendency which is probably related to improved care strategies that have been relayed by hospital teams and perinatal networks.
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Affiliation(s)
- Christophe Clesse
- Centre for Psychiatry, Wolfson Institute of Preventive Medicine, Barts & The London School of Medicine & Dentistry, Queen Mary, University of London, Old Anatomy Building Charterhouse Square, London, EC1M 6BQ, UK.,Interpsy Laboratory (EA 4432), Universite de Lorraine - Campus Lettres Et Sciences Humaines, Nancy, France.,Majorelle Polyclinic, Nancy, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | | | - Karine Goueslard
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France
| | - Michele Scheffler
- Obstetricial Gynecologist, Endocrinologist, Gynecologist, The FNCGM (National Federation of Gynecology Medical Colleges), Cabinet de Gynécologie Médicale Et Obstétrique, 21 avenue Foch, 54000, Nancy, France
| | - Paul Sagot
- Department of Obstetrics and Gynecology, University Hospital, Dijon, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), University Hospital, University of Burgundy and Franche-Comté, Dijon, France. .,Inserm, CIC 1432, Clinical Investigation Center, Clinical Epidemiology/Clinical Trials Unit, Dijon University Hospital, Dijon, France. .,Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France.
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Martín-Arribas A, Vila-Candel R, O’Connell R, Dillon M, Vila-Bellido I, Beneyto MÁ, De Molina-Fernández I, Rodríguez-Conesa N, González-Blázquez C, Escuriet R. Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228394. [PMID: 33202745 PMCID: PMC7696735 DOI: 10.3390/ijerph17228394] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 11/08/2020] [Accepted: 11/11/2020] [Indexed: 11/16/2022]
Abstract
Background: In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. Methods: A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016–2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.
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Affiliation(s)
- Anna Martín-Arribas
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Faculty of Medicine, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain;
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Valencia, Spain
- Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), 46020 Valencia, Spain
- Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain
- Correspondence:
| | - Rhona O’Connell
- School of Nursing and Midwifery, University College Cork, T12 YN60 Cork, Ireland;
| | - Martina Dillon
- Cork University Maternity Hospital, Wilton, T12 YE02 Cork, Ireland;
| | - Inmaculada Vila-Bellido
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | - M. Ángeles Beneyto
- Verge dels Lliris Hospital, Poligon de Caramanxel s/n, 03804 Alcoi, Spain; (I.V.-B.); (M.Á.B.)
| | | | | | | | - Ramón Escuriet
- GHenderS Research Group, School of Health Sciences Blanquerna, Universitat Ramon Llull, Carrer Padilla 326, 08025 Barcelona, Spain; (A.M.-A.); (R.E.)
- Catalan Health Service, Government of Barcelona, 08028 Catalonia, Spain
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25
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Bittencourt SDDA, Vilela MEDA, Marques MCDO, Santos AMD, Silva CKRTD, Domingues RMSM, Reis AC, Santos GLD. Labor and childbirth care in maternities participating in the "Rede Cegonha/Brazil": an evaluation of the degree of implementation of the activities. CIENCIA & SAUDE COLETIVA 2020; 26:801-821. [PMID: 33729338 DOI: 10.1590/1413-81232021263.08102020] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022] Open
Abstract
Using a judgment framework, this article analyzes the degree of implementation of the best practices in labor and childbirth care contained in the guidelines of the Rede Cegonha (RC) across Brazil. The study eligibility criteria were public and mixed hospitals located in a health region with a RC action plan in place in 2015, resulting in a total of 606 facilities distributed across the country. Three different data collection methods were used: face-to-face interviews with managers, health professionals and puerperal women; document analysis; and on-site observation. The framework was built around the five guidelines of the Labor and Childbirth component of the RC. Degree of implantation was rated as follows: adequate; partially adequate and inadequate. The performance of maternity facilities was rated as partially adequate for all guidelines except for hospital environment, which was rated as inadequate. A huge variation in degree of implementation was observed across regions, with the South and Southeast being the best-performing regions in most items. The results reinforce the need for an ongoing evaluation of the actions developed by the RC to inform policy-making and the regulation of labor and childbirth care.
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Affiliation(s)
| | | | | | | | | | - Rosa Maria Soares Madeira Domingues
- Laboratório de Pesquisa Clínica em DST/Aids, Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Ana Cristina Reis
- Escola Politécnica Joaquim Venâncio, Fiocruz. Rio de Janeiro RJ Brasil
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Anna MA, Olga CV, Rocío CS, Isabel SP, Xavier ET, Pablo RC, Montserrat PA, Cristina GB, Ramon E. Midwives' experiences of the factors that facilitate normal birth among low risk women in public hospitals in Catalonia (Spain). Midwifery 2020; 88:102752. [PMID: 32521407 DOI: 10.1016/j.midw.2020.102752] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/16/2020] [Accepted: 05/06/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Normal birth has major benefits for women and infants. Nevertheless, during the last few decades, the advancement in technology and an increasing domination of obstetrician-led childbirths have resulted in the medicalization of childbirth. Midwives are interested in amending this trend and aim to support women to achieve the best possible birth experience for them. OBJECTIVE This study aimed to explore midwives' experiences on the facilitators and barriers of normal birth in conventional obstetric units. DESIGN A descriptive qualitative study. Three focus groups were audio recorded and transcribed verbatim. Recurrent themes were identified and formulated. Feedback from data were analysed using thematic analysis. Investigator triangulation was used during the analysis. SETTING Midwives from eleven different public hospitals in Catalonia participated in the study. PARTICIPANTS A purposive sample of 33 midwives participated in the focus groups. FINDINGS Midwives identified several factors that complicated their task of facilitating normal birth. Barriers included: (1) inadequate institutional support; (2) existing obstetrician-led practices, (3) lack of evidence-based practice and (4) midwives' lack of awareness of professional competencies. Factors facilitating normal birth included: (1) midwives' positive perceptions of normal birth, (2) midwives' additional effort and (3) women's awareness of normal birth. KEY CONCLUSIONS Midwives wishing to promote normal birth in obstetric units face a number of challenges and often feel unsupported. Nonetheless, the midwives perceive the increasing women's demand for normal births as an opportunity to implement changes in such a way that women are involved in the decision-making process and midwives act as their advocates. IMPLICATIONS FOR PRACTICE There is a need to increase the midwifery workforce and enhance regulations and funding strategies to support their practice as well as normal birth. Policy makers in settings without well-functioning midwife-led care should consider implementing this model after successfully scaling up of the number of midwives and ensuring an effective midwifery training.
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Affiliation(s)
- Martin-Arribas Anna
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.; School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Canet-Velez Olga
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain..
| | - Casañas Sanchez Rocío
- Escola Superior d'Infermeria del Mar (ESIM), Universidad Pompeu Fabra (UPF), Carrer Dr. Aiguader 80, 08003 Barcelona, Spain.; Centre d'Higiene Mental Les Corts, CHM Salut Mental Barcelona, Carrer de Numància 103 Baixos, 08029 Barcelona, Spain..
| | - Salgado Poveda Isabel
- Vall d'Hebron University Hospital, Carrer Vall d'Hebron 119-129, 08035 Barcelona, Spain..
| | - Espada-Trespalacios Xavier
- Obstetric care area. Hospital General de Granollers, Avinguda Francesc Ribas s/n, 08402 Granollers, Bacelona, Spain..
| | - Rodriguez Coll Pablo
- Maternal and Child Healthcare Department. Fundació Sanitària de Mollet, Ronda Pinetons 8, 08100 Mollet del Vallès, Bacelona, Spain..
| | | | - González-Blázquez Cristina
- Faculty of Medicine, Nursing Department,Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain..
| | - Escuriet Ramon
- School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain..
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PoleSat_2018: an optimized, automated, geomatics IT tool based on a gravitational model: strategic decision support in hospital catchment area planning. SN APPLIED SCIENCES 2020. [DOI: 10.1007/s42452-020-2735-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
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Saucedo M, Bouvier-Colle MH, Blondel B, Bonnet MP, Deneux-Tharaux C. Delivery Hospital Characteristics and Postpartum Maternal Mortality: A National Case-Control Study in France. Anesth Analg 2020; 130:52-62. [PMID: 31283618 DOI: 10.1213/ane.0000000000004290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The variability in resources for managing critical events among maternity hospitals may impact maternal safety. Our main objective was to assess the risk of postpartum maternal death according to hospitals' organizational characteristics. A secondary objective aimed to assess the specific risk of death due to postpartum hemorrhage (PPH). METHODS This national population-based case-control study included all 2007-2009 postpartum maternal deaths from the national confidential enquiry (n = 147 cases) and a 2010 national representative sample of parturients (n = 14,639 controls). To adjust for referral bias, cases were classified by time when the condition/complication responsible for the death occurred: postpartum maternal deaths due to conditions present before delivery (n = 66) or during or after delivery (n = 81). Characteristics of delivery hospitals included 24/7 on-site availability of an anesthesiologist and an obstetrician, level of perinatal care, number of deliveries annually, and their teaching and profit status. In teaching and other nonprofit hospitals in France, obstetric care is organized on the principle of collective team-based management, while in for-profit hospitals, this organization is based mostly on that of "one woman-one doctor." Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for postpartum maternal death. RESULTS The risk of maternal death from prepartum conditions was lower for women who gave birth in for-profit compared with teaching hospitals (aOR, 0.3; 95% CI, 0.1-0.8; P = .02) and in hospitals with <1500 vs ≥1500 annual deliveries (aOR, 0.4; 95% CI, 0.1-0.9; P = .02). Conversely, the risk of postpartum maternal death from complications occurring during or after delivery was higher for women who delivered in for-profit compared with teaching hospitals (aOR, 2.8; 95% CI, 1.3-6.0; P = .009), as was the risk of death from PPH in for-profit versus nonprofit hospitals (aOR, 2.8; 95% CI, 1.2-6.5; P = .019). CONCLUSIONS After adjustment for the referral bias related to prepartum morbidity, the risk of postpartum maternal mortality in France differs according to the hospital's organizational characteristics.
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Affiliation(s)
- Monica Saucedo
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Marie-Hélène Bouvier-Colle
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Béatrice Blondel
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
| | - Marie-Pierre Bonnet
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France.,Department of Anesthesiology and Critical Care, Hôpital Armand Trousseau, Hôpitaux Universitaires Est Parisien, Assistance Publique des Hôpitaux de Paris, Paris, France
| | - Catherine Deneux-Tharaux
- From the Inserm UMR 1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team (EPOPé), Centre for Epidemiology and Statistics Sorbonne Paris Cité (CRESS), DHU Risks in Pregnancy, Paris Descartes University, Paris, France
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Balcik Colak M, Ozturk Can H. Effects of the time of pregnant women's admission to the labor ward on the labor process and interventions. Health Care Women Int 2020; 42:563-579. [PMID: 32027224 DOI: 10.1080/07399332.2020.1716763] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Our aim to conduct the study was to investigate the effects of the time of pregnant women's admission to the labor ward on the labor process and interventions. This study is a two-group, prospective, analytical study. Groups were determined according to their cervical dilation levels. The data were collected using the Labor Process Form, and analyzed using the Statistical Package for the Social Sciences version. Within this context, the rates of amniotomy, induction with oxytocin, episiotomy, and cesarean section in the participants who presented to the hospital in the latent phase of labor were higher.
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Affiliation(s)
| | - Hafize Ozturk Can
- Midwifery Department, Ege University Faculty of Health Sciences, Izmir, Turkey
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Rousseau A, Azria E, Baumann S, Deneux‐Tharaux C, Senat MV. Do obstetricians apply the national guidelines? A vignette‐based study assessing practices for the prevention of preterm birth. BJOG 2019; 127:467-476. [DOI: 10.1111/1471-0528.16039] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2019] [Indexed: 01/20/2023]
Affiliation(s)
- A Rousseau
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
- EA 7285 Versailles Saint Quentin University Montigny le Bretonneux France
| | - E Azria
- Maternity Unit Notre Dame de Bon Secours Paris Saint Joseph Hospital Paris Descartes University Paris France
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - S Baumann
- Midwifery Department Versailles Saint Quentin University Montigny‐le‐Bretonneux France
| | - C Deneux‐Tharaux
- National Institute for Health and Medical Research (INSERM) Unit 1153 Obstetrical Perinatal and Paediatric Epidemiology Research Team (EPOPé) Center for Epidemiology and Statistics Sorbonne Paris Cité DHU Risks in Pregnancy Paris University Paris France
| | - MV Senat
- Department of Obstetrics and Gynaecology Bicêtre Hospital AP‐HP Kremlin Bicêtre France
- Paris Sud Paris Saclay University Le Kremlin Bicêtre France
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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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Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Factors related to episiotomy practice: an evidence-based medicine systematic review. J OBSTET GYNAECOL 2019; 39:737-747. [DOI: 10.1080/01443615.2019.1581741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Christophe Clesse
- Interpsy Laboratory (EA4432), Université de Lorraine, Nancy, France
- Hospital Centre of Jury-les-Metz – Route d’Ars Laquenexy, Jury-Lesmetz, France
- Polyclinic Majorelle, Nancy, France
| | | | | | | | - Michèle Scheffler
- Polyclinic Majorelle, Nancy, France
- Cabinet de Gynécologie Médicale et Obstétrique, Nancy, France
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Abstract
OBJECTIVE To investigate the association of caesarean section rates with the health system characteristics in the public hospitals of Kosovo. DESIGN Cross-sectional survey. SETTING Five largest public hospitals in Kosovo. PARTICIPANTS 859 women with low-risk deliveries who delivered from April to May 2015 in five public hospitals in Kosovo. OUTCOME MEASURES The prespecified outcomes were the crude and adjusted OR of births delivered with caesarean section by health system characteristics such as delivery by the physician who provided antenatal care, health insurance status and other. Additional prespecified outcomes were caesarean section rates and crude ORs for delivery with caesarean in each public hospital. RESULTS Women with personal monthly income had increased odds for caesarean (OR 1.55, 95% CI 1.06 to 2.27), as did women with private health insurance coverage (OR 3.44, 95% CI 1.20 to 9.85). Women instructed by a midwife on preparation for delivery had decreasing odds (OR 0.32, 95% CI 0.19 to 0.51) while women having preference for a caesarean had increasing odds for delivery with caesarean (OR 3.84, 95% CI 1.96 to 7.51). The odds for caesarean increased also in the case of delivery by a physician who provided antenatal care (OR 2.06, 95% CI 1.16 to 3.67) and delivery during office hours (OR 2.36, 95% CI 1.37 to 4.05), while delivery at the University Clinical Centre of Kosovo decreased the odds for caesarean (OR 0.46, 95% CI 0.24 to 0.90). CONCLUSIONS We found that several health system characteristics are associated with the increase of caesarean sections in a low-risk population of delivering women in public hospitals of Kosovo. These findings should be explored further and addressed via policy measures that would tackle provision of unnecessary caesareans. The study findings could assist Kosovo to develop corrective policies in addressing overuse of caesareans and may provide useful information for other middle-income countries.
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Affiliation(s)
- Ilir Hoxha
- Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
- Action for Mother and Children, Prishtina, Kosovo
| | | | - Mrika Aliu
- Action for Mother and Children, Prishtina, Kosovo
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - David C Goodman
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
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Hernández-Martínez A, Martínez-Galiano JM, Rodríguez-Almagro J, Delgado-Rodríguez M, Gómez-Salgado J. Evidence-based Birth Attendance in Spain: Private versus Public Centers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050894. [PMID: 30871065 PMCID: PMC6427791 DOI: 10.3390/ijerph16050894] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 03/07/2019] [Accepted: 03/09/2019] [Indexed: 12/17/2022]
Abstract
The type of hospital (public or private) has been associated with the type of clinical practice carried out. The purpose of this study was to determine the association between the type of hospital (public or private) and delivery attendance with practices based on the recommendations by the World Health Organization (WHO). A cross-sectional study with puerperal women (n = 2906) was conducted in Spain during 2017. The crude Odds Ratios (OR), adjusted (aOR) and their 95% confidence intervals (CI) were calculated through binary logistic regression. For multiparous women in private centers, a higher rate of induced labor was observed (aOR: 1.49; 95% CI: 1.11⁻2.00), fewer natural methods were used to relieve pain (aOR: 0.51; 95% CI: 0.35⁻0.73), and increased odds of cesarean section (aOR: 2.50; 95% CI: 1.81⁻3.46) were found as compared to public hospitals. For primiparous women in private centers, a greater use of the epidural was observed (aOR: 1.57; 95% CI: 1.03⁻1.40), as well as an increased likelihood of instrumental birth (aOR: 1.53; 95% CI: 1.09⁻2.15) and of cesarean section (aOR: 1.77; 95% CI: 1.33⁻2.37) than in public hospitals. No differences were found in hospitalization times among women giving birth in public and private centers (p > 0.05). The World Health Organization birth attendance recommendations are more strictly followed in public hospitals than in private settings.
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Affiliation(s)
| | - Juan Miguel Martínez-Galiano
- Department of Nursing, University of Jaén, Campus de Las Lagunillas s/n, Building B3 Office 266, 23071 Jaén, Spain.
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | | | - Miguel Delgado-Rodríguez
- Consortium for Biomedical Research in Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
- Division of Preventive Medicine and Public Health, University of Jaen, 23071 Jaen, Spain.
| | - Juan Gómez-Salgado
- Department of Nursing, Faculty of Nursing, University of Huelva, 21071 Huelva, Spain.
- Espíritu Santo University, Guayaquil 092301, Ecuador.
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Hoxha I, Braha M, Syrogiannouli L, Goodman DC, Jüni P. Caesarean section in uninsured women in the USA: systematic review and meta-analysis. BMJ Open 2019; 9:e025356. [PMID: 30833323 PMCID: PMC6443081 DOI: 10.1136/bmjopen-2018-025356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/14/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the odds of caesarean section (CS) for uninsured women in the USA and understand the underlying mechanisms as well as consequences of lower use. STUDY DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of deliveries by CS of uninsured women as compared with privately or publicly insured women. The prespecified secondary outcome was the crude OR of deliveries by CS of uninsured women as compared with insured women. RESULTS 12 articles describing 16 separate studies involving more than 8.8 million women were included in this study. We found: 0.70 times lower odds of CS in uninsured as compared with privately insured women (95% CI 0.63 to 0.78), with no relevant heterogeneity between studies (τ2=0.01); and 0.92 times lower odds for CS in uninsured as compared with publicly insured women (95% CI 0.80 to 1.07), with no relevant heterogeneity between studies (τ2=0.02). We found 0.70 times lower odds in uninsured as compared with privately and publicly insured women (95% CI 0.69 to 0.72). CONCLUSIONS CSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuse.
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Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
| | - Medina Braha
- International Business College Mitrovica, Mitrovica, Kosovo
| | | | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
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Cesarean delivery rate and staffing levels of the maternity unit. PLoS One 2018; 13:e0207379. [PMID: 30485335 PMCID: PMC6261590 DOI: 10.1371/journal.pone.0207379] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 10/30/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate whether staffing levels of maternity units affect prelabor urgent, elective, and intrapartum cesarean delivery rates. METHODS This population-based retrospective cohort study covers the deliveries of the 11 hospitals of a French perinatal network in 2008-2014 (N = 102 236). The independent variables were women's demographic and medical characteristics as well as the type, organization, and staffing levels for obstetricians, anesthesiologists, and midwives of each maternity unit. Bivariate and multivariate analyses were conducted with multilevel logistic models. RESULTS Overall, 23.9% of the women had cesarean deliveries (2.4% urgent before labor, 10% elective, and 11.5% intrapartum). Independently of individual- and hospital-level factors, the level of obstetricians, measured by the number of full-time equivalent persons (i.e., 35 working hours per week) per 100 deliveries, was negatively associated with intrapartum cesarean delivery (adjusted odds ratio, aOR 0.55, 95% confidence interval, CI 0.36-0.83, P-value = 0.005), and the level of midwives negatively associated with elective cesarean delivery (aOR 0.79, 95% CI 0.69-0.90, P-value < 0.001). Accordingly, a 10% increase in obstetrician and midwife staff levels, respectively, would have been associated with a decrease in the likelihood of intrapartum cesarean delivery by 2.5 percentage points and that of elective cesarean delivery by 3.4 percentage points. These changes represent decreases in intrapartum and elective cesarean delivery rates of 19% (from 13.1% to 10.6%) and 33% (from 10.3% to 6.9%), respectively. CONCLUSION Staffing levels of maternity units affect the use of cesarean deliveries. High staffing levels for obstetricians and midwives are associated with lower cesarean rates.
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Duvillier C, Rousseau A, Bouyer C, Goffinet F, Rozenberg P. Facteurs organisationnels associés à la réalisation d’une césarienne dans une population à bas risque. ACTA ACUST UNITED AC 2018; 46:706-712. [DOI: 10.1016/j.gofs.2018.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Indexed: 10/28/2022]
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Milcent C, Zbiri S. Prenatal care and socioeconomic status: effect on cesarean delivery. HEALTH ECONOMICS REVIEW 2018; 8:7. [PMID: 29525909 PMCID: PMC5845483 DOI: 10.1186/s13561-018-0190-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/02/2018] [Indexed: 05/23/2023]
Abstract
Cesarean deliveries are widely used in many high- and middle-income countries. This overuse both increases costs and lowers quality of care and is thus a major concern in the healthcare industry. The study first examines the impact of prenatal care utilization on cesarean delivery rates. It then determines whether socioeconomic status affects the use of prenatal care and thereby influences the cesarean delivery decision. Using exclusive French delivery data over the 2008-2014 period, with multilevel logit models, and controlling for relevant patient and hospital characteristics, we show that women who do not participate in prenatal education have an increased probability of a cesarean delivery compared to those who do. The study further indicates that attendance at prenatal education varies according to socioeconomic status. Low socioeconomic women are more likely to have cesarean deliveries and less likely to participate in prenatal education. This result emphasizes the importance of focusing on pregnancy health education, particularly for low-income women, as a potential way to limit unnecessary cesarean deliveries. Future studies would ideally investigate the effect of interventions promoting such as care participation on cesarean delivery rates.
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Affiliation(s)
- Carine Milcent
- Paris-Jourdan Sciences Economiques, French National Center for Scientific Research, Paris, France
| | - Saad Zbiri
- EA 7285, Versailles Saint Quentin University, Montigny-le-Bretonneux, France
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Barasinski C, Debost-Legrand A, Lemery D, Vendittelli F. Practices during the active second stage of labor: A survey of French midwives. Midwifery 2018; 60:48-55. [PMID: 29494852 DOI: 10.1016/j.midw.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE the principal objective of our study was to describe the practices reported by French midwives during the active second stage of labor (expulsion phase). DESIGN this cross-sectional Internet survey questioned French midwives who attended at least one childbirth in 2013. SETTING this open survey was posted on a website from June 15 through December 1, 2014. PARTICIPANTS 1496 midwives from 377 maternity units participated in the study. MEASUREMENTS AND FINDINGS the midwives most often reported suggesting horizontal positions during the active second stage (supine with footholds, lithotomy, lithotomy with knees turned in, or lateral positions). Non-horizontal positions were more often proposed by midwives in level I units (p<0.0001). Almost half the midwives responding (46.4%), especially those working in level III units (51.1%, p = 0.006), advised Valsalva pushing. The mean maximum pushing time was 35.3 minutes±12.8 minutes. Nearly all the midwives favored the 'hands on' technique at childbirth (91.4%), and 24% reported using warm compresses on the perineum at childbirth. KEY CONCLUSION most midwives advised horizontal positions for childbirth. The practices of French midwives differed as a function of where they worked. The midwives, especially those in level III facilities, reported that they cannot always ensure 'physiological childbirth'. IMPLICATIONS FOR PRACTICE the practices of French midwives must become more evidence-based. The development of professional guidelines for midwives in France appears essential. This study also helps to prioritise national training for midwives.
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Affiliation(s)
- Chloé Barasinski
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France.
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique; et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
| | - Françoise Vendittelli
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique; et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
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Jang W, Flatley C, Greer RM, Kumar S. Comparison between public and private sectors of care and disparities in adverse neonatal outcomes following emergency intrapartum cesarean at term - A retrospective cohort study. PLoS One 2017; 12:e0187040. [PMID: 29149182 PMCID: PMC5693444 DOI: 10.1371/journal.pone.0187040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 10/10/2017] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Perinatal outcomes may be influenced by a variety of factors including maternal demographics and medical condition as well as socio-economic status. The evidence for disparities in health outcomes stratified by type of care (public or private) is lacking. The aim of this study was to investigate short term neonatal outcomes following category 1 and 2 emergency cesareans at term between publicly and privately funded women at a single major tertiary centre in Australia. Category 1-immediate threat to life (maternal or fetal); Category 2-maternal or fetal compromise that is not immediately life-threatening. METHODS This was a retrospective, cross sectional study of 61355 term singleton babies born at the Mater Mother's Hospital in Brisbane, Australia in 2007-2014. We collected data from the hospital's maternity database and compared maternal demographics, indications for cesarean and neonatal outcomes for publicly and privately funded women. RESULTS Over the study period there were 32477 public and 28878 private, term singleton births. Compared to the publicly funded cohort, privately insured women were older, had lower BMI, were of Caucasian ethnicity, Australian born, nulliparous, had shorter labors and had lower rates of hypertensive disorders and diabetes. The most common indications for category 1 and category 2 cesareans in combination were non-reassuring fetal status followed by failure to progress in labor and malpresentation. For both category 1 and 2 cesareans, neonatal outcomes (Apgar score <7 at 5 minutes, abnormal cord gases, Neonatal Critical Care Unit admission rates, rates of severe respiratory distress and jaundice) were significantly worse in the publicly funded compared to the privately insured cohort Multivariate analyses controlling for maternal age, ethnicity, country of birth, parity, hypertension, diabetes mellitus, gestational age at birth and length of labour confirmed that private insurance status was highly protective for the perinatal outcomes of Apgar score <7 at 5 minutes (aOR 0.26, 95% CI 0.13-0.55), admission to NCCU (OR 0.51, 95% CI 0.30-0.92) and respiratory distress (aOR 0.60, 95% CI 0.41-0.86). CONCLUSION Birth in the private health sector was inversely associated with adverse neonatal outcomes following category 1 and 2 cesareans.
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Affiliation(s)
- Woonji Jang
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
| | - Christopher Flatley
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
| | - Ristan M. Greer
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
| | - Sailesh Kumar
- Mater Research Institute—University of Queensland, South Brisbane, Queensland, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, Australia
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Huet J, Beucher G, Geoffroy L, Morello R, Benoist G, Dreyfus M. Intervention of the obstetrician during childbirth in a supposedly low-risk population and influence of parity. J Gynecol Obstet Hum Reprod 2017. [PMID: 28643664 DOI: 10.1016/j.jogoh.2017.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Compare obstetrician intervention and calling rates during labour and delivery between low-risk and high-risk women and study the influence of parity on these rates. MATERIAL AND METHODS Descriptive retrospective study conducted on 227 patients in a university maternity unit (level 3 university hospital maternity unit) between 1st and 30th January 2014. The low- and high-risk populations were characterised according to the French National Authority for Health (HAS) and NICE guidelines. The obstetrician intervention criteria were: Caesarean section, instrumental vaginal delivery, artificial delivery/uterus examination and postpartum haemorrhage. The obstetrical team also had to call the obstetrician in case of foetal heart rate abnormalities, scalp blood pH measurement, third and/or fourth degree perineal tears, labour dystocia, or any other severe event occurring during labour or delivery. RESULTS In univariate analysis, the obstetrician intervention rates were respectively 44.5% and 34.4% in the high- and low-risk groups (P=0.13). The obstetrician calling rates were similar between the two groups. Using logistic regression model including parity, the obstetrician intervention rate became significantly higher in the "high-risk" group (OR 2.044, 95% CI 1.129-3.703, P=0.018). In the low-risk population, the intervention rate was significantly increased for nulliparous women compared with multiparas (47.5% versus 9.7%, P<0.001, OR=8.2, CI 95% 2.2 to 46.9). CONCLUSION One third of the women defined as low-risk patients appear to need an obstetrician intervention during labour and delivery, with a major influence of parity.
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Affiliation(s)
- J Huet
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France; Université de Caen, 14000 Normandie, France.
| | - G Beucher
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France
| | - L Geoffroy
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France
| | - R Morello
- Unité de biostatistique et recherche clinique, CHU de Caen, 14033 Caen, France
| | - G Benoist
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France; Université de Caen, 14000 Normandie, France
| | - M Dreyfus
- Service de gynécologie obstétrique et médecine de la reproduction, CHU de Caen, 14033 Caen, France; Université de Caen, 14000 Normandie, France
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Hoxha I, Syrogiannouli L, Luta X, Tal K, Goodman DC, da Costa BR, Jüni P. Caesarean sections and for-profit status of hospitals: systematic review and meta-analysis. BMJ Open 2017; 7:e013670. [PMID: 28213600 PMCID: PMC5318567 DOI: 10.1136/bmjopen-2016-013670] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE Financial incentives may encourage private for-profit providers to perform more caesarean section (CS) than non-profit hospitals. We therefore sought to determine the association of for-profit status of hospital and odds of CS. DESIGN Systematic review and meta-analysis. DATA SOURCES MEDLINE, EMBASE and the Cochrane Database of Systematic Reviews from the first year of records through February 2016. ELIGIBILITY CRITERIA To be eligible, studies had to report data to allow the calculation of ORs of CS comparing private for-profit hospitals with public or private non-profit hospitals in a specific geographic area. OUTCOMES The prespecified primary outcome was the adjusted OR of births delivered by CS in private for-profit hospitals as compared with public or private non-profit hospitals; the prespecified secondary outcome was the crude OR of CS in private for-profit hospitals as compared with public or private non-profit hospitals. RESULTS 15 articles describing 17 separate studies in 4.1 million women were included. In a meta-analysis of 11 studies, the adjusted odds of delivery by CS was 1.41 higher in for-profit hospitals as compared with non-profit hospitals (95% CI 1.24 to 1.60) with no relevant heterogeneity between studies (τ2≤0.037). Findings were robust across subgroups of studies in stratified analyses. The meta-analysis of crude estimates from 16 studies revealed a somewhat more pronounced association (pooled OR 1.84, 95% CI 1.49 to 2.27) with moderate-to-high heterogeneity between studies (τ2≥0.179). CONCLUSIONS CS are more likely to be performed by for-profit hospitals as compared with non-profit hospitals. This holds true regardless of women's risk and contextual factors such as country, year or study design. Since financial incentives are likely to play an important role, we recommend examination of incentive structures of for-profit hospitals to identify strategies that encourage appropriate provision of CS.
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Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | | | - Xhyljeta Luta
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Kali Tal
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, New Hampshire, USA
| | - Bruno R da Costa
- Institute of Primary Health Care, University of Bern, Bern, Switzerland
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, Department of Medicine, University of Toronto, Canada
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Miller S, Abalos E, Chamillard M, Ciapponi A, Colaci D, Comandé D, Diaz V, Geller S, Hanson C, Langer A, Manuelli V, Millar K, Morhason-Bello I, Castro CP, Pileggi VN, Robinson N, Skaer M, Souza JP, Vogel JP, Althabe F. Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. Lancet 2016; 388:2176-2192. [PMID: 27642019 DOI: 10.1016/s0140-6736(16)31472-6] [Citation(s) in RCA: 638] [Impact Index Per Article: 79.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/23/2016] [Accepted: 07/11/2016] [Indexed: 12/29/2022]
Abstract
On the continuum of maternal health care, two extreme situations exist: too little, too late (TLTL) and too much, too soon (TMTS). TLTL describes care with inadequate resources, below evidence-based standards, or care withheld or unavailable until too late to help. TLTL is an underlying problem associated with high maternal mortality and morbidity. TMTS describes the routine over-medicalisation of normal pregnancy and birth. TMTS includes unnecessary use of non-evidence-based interventions, as well as use of interventions that can be life saving when used appropriately, but harmful when applied routinely or overused. As facility births increase, so does the recognition that TMTS causes harm and increases health costs, and often concentrates disrespect and abuse. Although TMTS is typically ascribed to high-income countries and TLTL to low-income and middle-income ones, social and health inequities mean these extremes coexist in many countries. A global approach to quality and equitable maternal health, supporting the implementation of respectful, evidence-based care for all, is urgently needed. We present a systematic review of evidence-based clinical practice guidelines for routine antenatal, intrapartum, and postnatal care, categorising them as recommended, recommended only for clinical indications, and not recommended. We also present prevalence data from middle-income countries for specific clinical practices, which demonstrate TLTL and increasing TMTS. Health-care providers and health systems need to ensure that all women receive high-quality, evidence-based, equitable and respectful care. The right amount of care needs to be offered at the right time, and delivered in a manner that respects, protects, and promotes human rights.
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Affiliation(s)
- Suellen Miller
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA.
| | - Edgardo Abalos
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | | | - Agustin Ciapponi
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniela Colaci
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Daniel Comandé
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Virginia Diaz
- Centro Rosarino de Estudios Perinatales (CREP), Rosario, Argentina
| | - Stacie Geller
- Center for Research on Women and Gender, University of Illinois, Chicago, IL, USA
| | - Claudia Hanson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Ana Langer
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Victoria Manuelli
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
| | - Kathryn Millar
- Maternal Health Task Force, Harvard T H Chan School of Public Health, Boston, MA, USA
| | - Imran Morhason-Bello
- University of Ibadan, Ibadan, Nigeria; London School of Hygiene & Tropical Medicine, London, UK
| | - Cynthia Pileggi Castro
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Vicky Nogueira Pileggi
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Pediatrics, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | | | | | - João Paulo Souza
- GLIDE Technical Cooperation and Research, Ribeirão Preto, SP, Brazil; Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Joshua P Vogel
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Fernando Althabe
- Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Bittencourt SDDA, Domingues RMSM, Reis LGDC, Ramos MM, Leal MDC. Adequacy of public maternal care services in Brazil. Reprod Health 2016; 13:120. [PMID: 27766964 PMCID: PMC5073989 DOI: 10.1186/s12978-016-0229-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background In Brazil, hospital childbirth care is available to all, but differences in access and quality of care result in inequalities of maternal health. The objective of this study is to assess the infrastructure and staffing of publicly financed labor and birth care in Brazil and its adequacy according to clinical and obstetric conditions potentially associated with obstetric emergencies. Methods Nationwide cross-sectional hospital-based study “Birth in Brazil: national survey into labor and birth” conducted in 2011–2012. Data from 209 hospitals classified as public (public funding and management) or mixed (public or private funding and private management) that generate estimates for 1148 Brazilian hospitals. Interview with hospital managers provided data for the structure adequacy assessment covering four domains: human resources, medications, equipment for women emergency care and support services. We conducted analysis of the structure adequacy rate according to type of hospital (public or mixed), availability of ICU and the woman obstetric risk using the X2 test to detect differences in categorical variables with the level of statistical significance set at p <0.05. Results Global rate of adequacy of 34.8 %: 42.2 % in public hospitals and 29.0 % in mixed hospitals (p < 0.001). Public and mixed hospitals with ICU had higher scores of adequacy than hospitals without ICU (73.3 % × 24.4 % public hospitals; 40.3 % × 10.6 % mixed hospitals). At a national level, 32.8 % of women with obstetric risk were cared for in hospitals without ICU and 29.5 % of women without risk were cared for in hospitals with ICU. Inequalities were observed with the North, Northeast and non-capital regions having the lower rates of hospitals with ICU. Conclusions The majority of maternity wards across the country have a low rate of adequacy that can affect the quality of labor and birth care. This holds true for women at high obstetric risk, who suffer the possibility of having their care compromised by failures of hospital infrastructure, and for women at low obstetric risk, who may not receive the appropriate care to support the natural evolution of their labor when in a technological hospital environment.
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Affiliation(s)
| | | | | | - Márcia Melo Ramos
- Subsecretaria de Vigilância, Fiscalização Sanitária e Controle de Zoonose, Secretaria Municipal de Saúde, Rio de Janeiro, Brazil
| | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sérgio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
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Chuilon AL, Le Ray C, Prunet C, Blondel B. L’épisiotomie en France en 2010 : variations des pratiques selon le contexte obstétrical et le lieu d’accouchement. ACTA ACUST UNITED AC 2016; 45:691-700. [DOI: 10.1016/j.jgyn.2015.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Revised: 10/13/2015] [Accepted: 10/22/2015] [Indexed: 10/22/2022]
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Nippita TA, Trevena JA, Patterson JA, Ford JB, Morris JM, Roberts CL. Inter‐hospital variations in labor induction and outcomes for nullipara: an Australian population‐based linkage study. Acta Obstet Gynecol Scand 2016; 95:411-9. [DOI: 10.1111/aogs.12854] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/18/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Tanya A. Nippita
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St Leonards NSW Australia
- Sydney Medical School‐Northern, University of Sydney St Leonards NSW Australia
- Department of Obstetrics and Gynecology Royal North Shore Hospital Northern Sydney Local Health District St Leonards NSW Australia
| | - Judy A. Trevena
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St Leonards NSW Australia
| | - Jillian A. Patterson
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St Leonards NSW Australia
- Sydney Medical School‐Northern, University of Sydney St Leonards NSW Australia
| | - Jane B. Ford
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St Leonards NSW Australia
- Sydney Medical School‐Northern, University of Sydney St Leonards NSW Australia
| | - Jonathan M. Morris
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St Leonards NSW Australia
- Sydney Medical School‐Northern, University of Sydney St Leonards NSW Australia
| | - Christine L. Roberts
- Clinical and Population Perinatal Health Research Kolling Institute Northern Sydney Local Health District St Leonards NSW Australia
- Sydney Medical School‐Northern, University of Sydney St Leonards NSW Australia
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Hollowell J, Rowe R, Townend J, Knight M, Li Y, Linsell L, Redshaw M, Brocklehurst P, Macfarlane A, Marlow N, McCourt C, Newburn M, Sandall J, Silverton L. The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03360] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundEvidence from the Birthplace in England Research Programme supported a policy of offering ‘low risk’ women a choice of birth setting, but a number of unanswered questions remained.AimsThis project aimed to provide further evidence to support the development and delivery of maternity services and inform women’s choice of birth setting: specifically, to explore maternal and organisational factors associated with intervention, transfer and other outcomes in each birth setting in ‘low risk’ and ‘higher risk’ women.DesignFive component studies using secondary analysis of the Birthplace prospective cohort study (studies 2–5) and ecological analysis of unit/NHS trust-level data (studies 1 and 5).SettingObstetric units (OUs), alongside midwifery units (AMUs), freestanding midwifery units (FMUs) and planned home births in England.ParticipantsStudies 1–4 focused on ‘low risk’ women with ‘term’ pregnancies planning vaginal birth in 43 AMUs (n = 16,573), in 53 FMUs (n = 11,210), at home in 147 NHS trusts (n = 16,632) and in a stratified, random sample of 36 OUs (n = 19,379) in 2008–10. Study 5 focused on women with pre-existing medical and obstetric risk factors (‘higher risk’ women).Main outcome measuresInterventions (instrumental delivery, intrapartum caesarean section), a measure of low intervention (‘normal birth’), a measure of spontaneous vaginal birth without complications (‘straightforward birth’), transfer during labour and a composite measure of adverse perinatal outcome (‘intrapartum-related mortality and morbidity’ or neonatal admission within 48 hours for > 48 hours). In studies 1 and 3, rates of intervention/maternal outcome and transfer were adjusted for maternal characteristics.AnalysisWe used (a) funnel plots to explore variation in rates of intervention/maternal outcome and transfer between units/trusts, (b) simple, weighted linear regression to evaluate associations between unit/trust characteristics and rates of intervention/maternal outcome and transfer, (c) multivariable Poisson regression to evaluate associations between planned place of birth, maternal characteristics and study outcomes, and (d) logistic regression to investigate associations between time of day/day of the week and study outcomes.ResultsStudy 1 – unit-/trust-level variations in rates of interventions, transfer and maternal outcomes were not explained by differences in maternal characteristics. The magnitude of identified associations between unit/trust characteristics and intervention, transfer and outcome rates was generally small, but some aspects of configuration were associated with rates of transfer and intervention. Study 2 – ‘low risk’ women planning non-OU birth had a reduced risk of intervention irrespective of ethnicity or area deprivation score. In nulliparous women planning non-OU birth the risk of intervention increased with increasing age, but women of all ages planning non-OU birth experienced a reduced risk of intervention. Study 3 – parity, maternal age, gestational age and ‘complicating conditions’ identified at the start of care in labour were independently associated with variation in the risk of transfer in ‘low risk’ women planning non-OU birth. Transfers did not vary by time of day/day of the week in any meaningful way. The duration of transfer from planned FMU and home births was around 50–60 minutes; transfers for ‘potentially urgent’ reasons were quicker than transfers for ‘non-urgent’ reasons. Study 4 – the occurrence of some interventions varied by time of the day/day of the week in ‘low risk’ women planning OU birth. Study 5 – ‘higher risk’ women planning birth in a non-OU setting had fewer risk factors than ‘higher risk’ women planning OU birth and these risk factors were different. Compared with ‘low risk’ women planning home birth, ‘higher risk’ women planning home birth had a significantly increased risk of our composite adverse perinatal outcome measure. However, in ‘higher risk’ women, the risk of this outcome was lower in planned home births than in planned OU births, even after adjustment for clinical risk factors.ConclusionsExpansion in the capacity of non-OU intrapartum care could reduce intervention rates in ‘low risk’ women, and the benefits of midwifery-led intrapartum care apply to all ‘low risk’ women irrespective of age, ethnicity or area deprivation score. Intervention rates differ considerably between units, however, for reasons that are not understood. The impact of major changes in the configuration of maternity care on outcomes should be monitored and evaluated. The impact of non-clinical factors, including labour ward practices, staffing and skill mix and women’s preferences and expectations, on intervention requires further investigation. All women planning non-OU birth should be informed of their chances of transfer and, in particular, older nulliparous women and those more than 1 week past their due date should be advised of their increased chances of transfer. No change in the guidance on planning place of birth for ‘higher risk’ women is recommended, but research is required to evaluate the safety of planned AMU birth for women with selected relatively common risk factors.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Jennifer Hollowell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Townend
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yangmei Li
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City University London, London, UK
| | - Neil Marlow
- Institute for Women’s Health, University College London, London, UK
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City University London, London, UK
| | | | - Jane Sandall
- Division of Women’s Health, King’s College London, London, UK
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Torres JA, Domingues RMSM, Sandall J, Hartz Z, Gama SGND, Theme Filha MM, Schilithz AOC, Leal MDC. Caesarean section and neonatal outcomes in private hospitals in Brazil: comparative study of two different perinatal models of care. CAD SAUDE PUBLICA 2015; 30 Suppl 1:S1-12. [PMID: 25167181 DOI: 10.1590/0102-311x00129813] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2013] [Accepted: 03/19/2014] [Indexed: 11/21/2022] Open
Abstract
This study aims at comparing caesarean section rates and neonatal outcomes of two perinatal models of care provided in private hospitals in Brazil. Birth in Brazil data, a national hospital-based cohort conducted in the years 2011/2012 was used. We analysed 1,664 postpartum women and their offspring attended at 13 hospitals located in the South-east region of Brazil, divided into a "typical"--standard care model and "atypical"--Baby-Friendly hospital with collaborative practices between nurse-midwives and obstetricians on duty to attend deliveries in an alternative labour ward. The Robson's classification system was used to compare caesarean sections, which was lower in the atypical hospital (47.8% vs. 90.8%, p<0.001). Full term birth, early skin-to-skin contact, breastfeeding in the first hour, rooming-in care, and discharge in exclusive breastfeeding were more frequent in the atypical hospital. Neonatal adverse outcome did not differ significantly between hospitals. The atypical hospital's intervention should be further evaluated since it might reduce caesarean section prevalence and increase good practices in neonatal care.
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Affiliation(s)
| | | | - Jane Sandall
- Division of Women?s Health, King?s College London, London, England
| | - Zulmira Hartz
- Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | | | | | | | - Maria do Carmo Leal
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
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Macfarlane AJ, Blondel B, Mohangoo AD, Cuttini M, Nijhuis J, Novak Z, Ólafsdóttir HS, Zeitlin J. Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study. BJOG 2015; 123:559-68. [DOI: 10.1111/1471-0528.13284] [Citation(s) in RCA: 161] [Impact Index Per Article: 17.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Affiliation(s)
- AJ Macfarlane
- Centre for Maternal and Child Health Research; City University London; London UK
| | - B Blondel
- INSERM; Obstetrical Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
| | - AD Mohangoo
- Department of Child Health; TNO; the Netherlands Organisation for Applied Scientific Research; Leiden the Netherlands
| | - M Cuttini
- Research Unit of Perinatal Epidemiology; Bambino Gesù Children's Hospital; Rome Italy
| | - J Nijhuis
- Department of Obstetrics and Gynaecology; GROW School of Oncology and Developmental Biology; Maastricht University Medical Centre; Maastricht the Netherlands
| | - Z Novak
- Perinatology Unit; University Medical Centre; Llubjana University; Llubjana Slovenia
| | - HS Ólafsdóttir
- Department of Obstetrics and Gynaecology; Landspitali University Hospital; Landspitali v/Hringbraut Iceland
| | - J Zeitlin
- INSERM; Obstetrical Perinatal and Paediatric Epidemiology Research Team; Centre for Epidemiology and Biostatistics (U1153); Paris-Descartes University; Paris France
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Delnord M, Blondel B, Drewniak N, Klungsøyr K, Bolumar F, Mohangoo A, Gissler M, Szamotulska K, Lack N, Nijhuis J, Velebil P, Sakkeus L, Chalmers J, Zeitlin J. Varying gestational age patterns in cesarean delivery: an international comparison. BMC Pregnancy Childbirth 2014; 14:321. [PMID: 25217979 PMCID: PMC4177602 DOI: 10.1186/1471-2393-14-321] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/04/2014] [Indexed: 11/10/2022] Open
Abstract
Background While international variations in overall cesarean delivery rates are well documented, less information is available for clinical sub-groups. Cesarean data presented by subgroups can be used to evaluate uptake of cesarean reduction policies or to monitor delivery practices for high and low risk pregnancies based on new scientific evidence. We studied differences and patterns in cesarean delivery rates by multiplicity and gestational age in Europe and the United States. Methods This study used routine aggregate data from 17 European countries and the United States on the number of singleton and multiple live births with cesarean versus vaginal delivery by week of gestation in 2008. Overall and gestation-specific cesarean delivery rates were analyzed. We computed rate differences to compare mode of delivery (cesarean vs vaginal birth) between selected gestational age groups and studied associations between rates in these subgroups namely: very preterm (26–31 weeks GA), moderate preterm (32–36 weeks GA), near term (37–38 weeks GA), term (39–41 weeks GA) and post-term (42+ weeks GA) births, using Spearman’s rank tests. Results High variations in cesarean rates for singletons and multiples were observed everywhere. Rates for singletons varied from 15% in The Netherlands and Slovenia, to over 30% in the US and Germany. In singletons, rates were highest for very preterm births and declined to a nadir at 40 weeks of gestation, ranging from 8.0% in Sweden and Norway, to 22.5% in the US. These patterns differed across countries; the average rate difference between very preterm and term births was 43 percentage points, but ranged from 14% to 61%. High variations in rate differences were also observed for near term versus term births. For multiples, rates declined by gestational age in some countries, whereas in others rates were similar across all weeks of gestation. Countries’ overall cesarean rates were highly correlated with gestation-specific subgroup rates, except for very preterm births. Conclusions Gestational age patterns in cesarean delivery were heterogeneous across countries; these differences highlight areas where consensus on best practices is lacking and could be used in developing strategies to reduce cesareans.
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Affiliation(s)
- Marie Delnord
- INSERM UMR1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Research Center for Epidemiology and Biostatistics Sorbonne Paris Cité (CRESS), DHU Risks in pregnancy, Paris Descartes University, Port Royal Maternity Unit, 53 Avenue de l'Observatoire, Paris, 75014, France.
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