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Nathan NO, Bergholt T, Sejling C, Ersbøll AS, Ekelund K, Gerds TA, Gam CBF, Rode L, Hegaard HK. Maternal age and body mass index and risk of labor dystocia after spontaneous labor onset among nulliparous women: A clinical prediction model. PLoS One 2024; 19:e0308018. [PMID: 39240838 PMCID: PMC11379172 DOI: 10.1371/journal.pone.0308018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 07/16/2024] [Indexed: 09/08/2024] Open
Abstract
INTRODUCTION Obstetrics research has predominantly focused on the management and identification of factors associated with labor dystocia. Despite these efforts, clinicians currently lack the necessary tools to effectively predict a woman's risk of experiencing labor dystocia. Therefore, the objective of this study was to create a predictive model for labor dystocia. MATERIAL AND METHODS The study population included nulliparous women with a single baby in the cephalic presentation in spontaneous labor at term. With a cohort-based registry design utilizing data from the Copenhagen Pregnancy Cohort and the Danish Medical Birth Registry, we included women who had given birth from 2014 to 2020 at Copenhagen University Hospital-Rigshospitalet, Denmark. Logistic regression analysis, augmented by a super learner algorithm, was employed to construct the prediction model with candidate predictors pre-selected based on clinical reasoning and existing evidence. These predictors included maternal age, pre-pregnancy body mass index, height, gestational age, physical activity, self-reported medical condition, WHO-5 score, and fertility treatment. Model performance was evaluated using the area under the receiver operating characteristics curve (AUC) for discriminative capacity and Brier score for model calibration. RESULTS A total of 12,445 women involving 5,525 events of labor dystocia (44%) were included. All candidate predictors were retained in the final model, which demonstrated discriminative ability with an AUC of 62.3% (95% CI:60.7-64.0) and Brier score of 0.24. CONCLUSIONS Our model represents an initial advancement in the prediction of labor dystocia utilizing readily available information obtainable upon admission in active labor. As a next step further model development and external testing across other populations is warranted. With time a well-performing model may be a step towards facilitating risk stratification and the development of a user-friendly online tool for clinicians.
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Affiliation(s)
- Nina Olsén Nathan
- The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Thomas Bergholt
- Department of Obstetrics and Gynecology, Copenhagen University Hospital - Herlev, Herlev, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences and Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christoffer Sejling
- The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Biostatistics, University of Copenhagen, Copenhagen, Denmark
| | - Anne Schøjdt Ersbøll
- The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kim Ekelund
- Department of Anesthesia- and Operation, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Copenhagen Academy of Medical Education and Simulation (CAMES), Copenhagen University Hospital-Herlev, Herlev, Denmark
| | | | | | - Line Rode
- Department of Clinical Biochemistry, Copenhagen University Hospital-Rigshospitalet, Glostrup, Denmark
| | - Hanne Kristine Hegaard
- The Interdisciplinary Unit of Women's, Children's and Families' Health, the Juliane Marie Centre, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Obstetrics, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Institute of Clinical Medicine, Faculty of Health Sciences and Medicine, University of Copenhagen, Copenhagen, Denmark
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Kissler KJ, Carlson NS, Hernandez TL. Characterizing uterine responsiveness to oxytocin augmentation across four labor patterns in maternal obesity. Birth 2024; 51:295-306. [PMID: 37915283 PMCID: PMC11061267 DOI: 10.1111/birt.12786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/23/2023] [Accepted: 09/26/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Optimizing care during labor protraction is a key strategy for reducing cesareans, especially among people with obesity. The pathophysiology of labor dystocia remains poorly understood, limiting precise interventions targeting the cause of protraction. METHODS In this secondary analysis of nulliparas (n = 92) with obesity (BMI ≥ 30 kg/m2) and spontaneous labor onset, we classified labor into four phenotypes based on duration of protraction and birth route: (1) no protraction, (2) short protraction and vaginal birth, (3) extended protraction meeting criteria for labor arrest, but with eventual progression and vaginal birth, and (4) extended protraction meeting criteria for labor arrest and cesarean birth. Across these phenotypes, we compared MVU, oxytocin dose, and novel measures of uterine responsiveness to oxytocin augmentation (MVU to oxytocin dose ratios). RESULTS In our sample, phenotype group 1 comprised 14.1% (n = 13); group 2 comprised 30.4% (n = 28); group 3 comprised 34.8% (n = 32); and group 4 comprised 20.7% (n = 19). Uterine responsiveness to oxytocin, but not MVU, decreased with each labor phenotype. Participants with cesarean birth had the lowest uterine responsiveness to oxytocin. CONCLUSION Labor and birth outcomes were associated with measures of uterine responsiveness to oxytocin rather than MVU alone, and thus these may be more clinically appropriate measures for guiding clinical decision-making. Current criteria for labor arrest are likely too stringent for nulliparas with obesity, many of whom appear to progress to safe vaginal birth after longer labor durations. Differences in uterine responsiveness to oxytocin augmentation across the groups suggests underlying physiologic differences in the labor phenotypes, which should drive future research targeting pathophysiology.
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Affiliation(s)
- Katherine J. Kissler
- College of Nursing, University of Colorado Anschutz Medical Campus, 13120 East 19th Avenue, Mail Stop C288, Aurora, Colorado 80045
| | - Nicole S. Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Rd, Atlanta, GA 30322
| | - Teri L. Hernandez
- College of Nursing, University of Colorado Anschutz Medical Campus, 13120 East 19th Avenue, Mail Stop C288, Aurora, Colorado 80045
- Department of Medicine, Division of Endocrinology, Metabolism and Diabetes, University of Colorado Anschutz Medical Campus, Aurora, Colorado 80045
- Children’s Hospital Colorado. Aurora, Colorado 80045
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Stone NI, Downe S. Women's experience of early labour in a free-standing birth centre: Midwifing embodied labour. Women Birth 2023; 36:538-545. [PMID: 36906450 DOI: 10.1016/j.wombi.2023.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/22/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
ISSUE Women who present at hospital labour wards in early labour must often meet measurable diagnostic criteria before admission. BACKGROUND Early labour is a phase of neurohormonal, emotional, and physical changes that are often not measurable. When admission to birthplace is based on results of diagnostic procedures, women's embodied knowledge may be disregarded. AIM To describe the early labour experience of women with spontaneous onset of labour in a free-standing birth centre, as well as midwifery care when women arrived in labour. METHODOLOGY An ethnographic study was conducted in 2015 in a free-standing birth centre after receiving ethics approval. The findings for this article were drawn from a secondary analysis of the data, which included interview data with women and detailed field notes of midwives' activities related to early labour. FINDINGS The women in this study were instrumental in the decision-making process to stay at the birth centre. Observational data showed that vaginal exams were rarely conducted when women arrived at the birth centre and were not a deciding factor in admission. DISCUSSION The women and midwives co-constructed early labour based on the lived experience of women and the meaning that this experience held for both. CONCLUSION Given the growing concern about the need for respectful maternity care, this study provides examples of good practice in listening to women, as well as an illustration of the consequences of not doing so.
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Affiliation(s)
- Nancy Iris Stone
- Evangelische Hochschule Berlin, Department of Midwifery Sciences, Teltower Damm 118-122, 14167 Berlin, Germany.
| | - Soo Downe
- School of Community Health & Midwifery, University of Central Lancashire, Preston PR1 2HE, UK
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Grylka-Baeschlin S, Mueller AN. Symptoms of onset of labour and early labour: A scoping review. Women Birth 2023; 36:483-494. [PMID: 37059644 DOI: 10.1016/j.wombi.2023.03.009] [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: 01/27/2023] [Revised: 03/05/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Early labour care often insufficiently addresses the individual needs of pregnant women leading to great dissatisfaction. In-depth knowledge about symptoms of onset of labour and early labour is necessary to develop women-centred interventions. QUESTION OR AIM To provide an overview on the current evidence about pregnant women's symptoms of onset of labour and early labour. METHODS We conducted a scoping review in the five databases PubMed, Web of Science, CINHAL Complete, PsychInfo and MIDIRS in May 2021 and August 2022 using a sensitive search strategy. A total of 2861 titles and abstracts and 290 full texts were screened independently by two researchers using Covidence. For this article, data was extracted from 91 articles and summarised descriptively and narratively. FINDINGS The most frequently mentioned symptoms were 'Contractions, labour pain' (n = 78, 85.7 %), 'Details about the contractions' (n = 51 articles, 56.0 %), 'Positive and negative emotions' (n = 50, 54.9 %) and 'Fear and worries' (n = 48 articles, 52.7 %). Details about the contractions ranged from a slight pulling to unbearable pain and the emotional condition varied from joy to great fear, showing an extraordinary diversity of symptoms highlighting the very individual character of early labour. DISCUSSION A comprehensive picture of varying and contradicting symptoms of onset of labour and early labour was drawn. Different experiences indicate different needs. This knowledge builds a good basis to develop women-centred approaches to improve early labour care. CONCLUSION Further research is necessary to design individualised early labour interventions and evaluate their effectiveness.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400 Winterthur, Switzerland.
| | - Antonia N Mueller
- Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400 Winterthur, Switzerland
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Kissler K, Hurt KJ. The Pathophysiology of Labor Dystocia: Theme with Variations. Reprod Sci 2023; 30:729-742. [PMID: 35817950 PMCID: PMC10388369 DOI: 10.1007/s43032-022-01018-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 06/16/2022] [Indexed: 10/17/2022]
Abstract
Abnormally prolonged labor, or labor dystocia, is a common complication of parturition. It is the indication for about half of unplanned cesarean deliveries in low-risk nulliparous women. Reducing the rate of unplanned cesarean birth in the USA has been a public health priority over the last two decades with limited success. Labor dystocia is a complex disorder due to multiple causes with a common clinical outcome of slow cervical dilation and fetal descent. A better understanding of the pathophysiologic mechanisms of labor dystocia could lead to new clinical opportunities to increase the rate of normal vaginal delivery, reduce cesarean birth rates, and improve maternal and neonatal health. We conducted a literature review of the causes and pathophysiologic mechanisms of labor dystocia. We summarize known mechanisms supported by clinical and experimental data and newer hypotheses with less supporting evidence. We review recent data on uterine preparation for labor, uterine contractility, cervical preparation for labor, maternal obesity, cephalopelvic disproportion, fetal malposition, intrauterine infection, and maternal stress. We also describe current clinical approaches to preventing and managing labor dystocia. The variation in pathophysiologic causes of labor dystocia probably limits the utility of current general treatment options. However, treatments targeting specific underlying etiologies could be more effective. We found that the pathophysiologic basis of labor dystocia is under-researched, offering wide opportunities for translational investigation of individualized labor management, particularly regarding uterine metabolism and fetal position. More precise diagnostic tools and individualized therapies for labor dystocia might lead to better outcomes. We conclude that additional knowledge of parturition physiology coupled with rigorous clinical evaluation of novel biologically directed treatments could improve obstetric quality of care.
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Affiliation(s)
- Katherine Kissler
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, CO, 80045, USA
| | - K Joseph Hurt
- Division of Reproductive Sciences, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Aurora, CO, 80045, USA.
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Colorado Anschutz Medical Campus, 12700 East 19th Avenue, Mailstop 8613, Aurora, CO, 80045, USA.
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Kjerulff KH, Attanasio LB, Vanderlaan J, Sznajder KK. Timing of hospital admission at first childbirth: A prospective cohort study. PLoS One 2023; 18:e0281707. [PMID: 36795737 PMCID: PMC9934383 DOI: 10.1371/journal.pone.0281707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 01/30/2023] [Indexed: 02/17/2023] Open
Abstract
BACKGROUND AND AIMS It is difficult for women in labor to determine when best to present for hospital admission, particularly at first childbirth. While it is often recommended that women labor at home until their contractions have become regular and ≤ 5-minutes apart, little research has investigated the utility of this recommendation. This study investigated the relationship between timing of hospital admission, in terms of whether women's labor contractions had become regular and ≤ 5-minutes apart before admission, and labor progress. METHODS This was a cohort study of 1,656 primiparous women aged 18-35 years with singleton pregnancies who began labor spontaneously at home and delivered at 52 hospitals in Pennsylvania, USA. Women who were admitted before their contractions had become regular and ≤ 5-minutes apart (early admits) were compared to those who were admitted after (later admits). Multivariable logistic regression models were used to assess associations between timing of hospital admission and active labor status on admission (cervical dilation 6-10 cm), oxytocin augmentation, epidural analgesia and cesarean birth. RESULTS Nearly two-thirds of the participants (65.3%) were later admits. These women had labored for a longer time period before admission (median, interquartile range [IQR] 5 hours (3-12 hours)) than the early admits (median, (IQR) 2 hours (1-8 hours), p < 0.001); were more likely to be in active labor on admission (adjusted OR [aOR] 3.78, 95% CI 2.47-5.81); and were less likely to experience labor augmentation with oxytocin (aOR 0.44, 95% CI 0.35-0.55); epidural analgesia (aOR 0.52, 95% CI 0.38-0.72); and cesarean birth (aOR 0.66, 95% CI 0.50-0.88). CONCLUSIONS Among primiparous women, those who labor at home until their contractions have become regular and ≤ 5-minutes apart are more likely to be in active labor on hospital admission and less likely to experience oxytocin augmentation, epidural analgesia and cesarean birth.
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Affiliation(s)
- Kristen H. Kjerulff
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, United States of America
- Department of Obstetrics and Gynecology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States of America
- * E-mail:
| | - Laura B. Attanasio
- School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
| | - Jennifer Vanderlaan
- School of Nursing, University of Nevada, Las Vegas, Nevada, United States of America
| | - Kristin K. Sznajder
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pennsylvania, United States of America
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Fumagalli S, Antolini L, Cosmai G, Gramegna T, Nespoli A, Pedranzini A, Colciago E, Valsecchi MG, Vergani P, Locatelli A. Development and validation of a predictive model to identify the active phase of labor. BMC Pregnancy Childbirth 2022; 22:641. [PMID: 35971093 PMCID: PMC9377074 DOI: 10.1186/s12884-022-04946-y] [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: 02/18/2022] [Accepted: 07/25/2022] [Indexed: 11/10/2022] Open
Abstract
Background The diagnosis of the active phase of labor is a crucial clinical decision, thus requiring an accurate assessment. This study aimed to build and to validate a predictive model, based on maternal signs and symptoms to identify a cervical dilatation ≥4 cm. Methods A prospective study was conducted from May to September 2018 in a II Level Maternity Unit (development data), and from May to September 2019 in a I Level Maternity Unit (validation data). Women with singleton, term pregnancy, cephalic presentation and presence of contractions were consecutively enrolled during the initial assessment to diagnose the stage of labor. Women < 18 years old, with language barrier or induction of labor were excluded. A nomogram for the calculation of the predictions of cervical dilatation ≥4 cm on the ground of 11 maternal signs and symptoms was obtained from a multivariate logistic model. The predictive performance of the model was investigated by internal and external validation. Results A total of 288 assessments were analyzed. All maternal signs and symptoms showed a significant impact on increasing the probability of cervical dilatation ≥4 cm. In the final logistic model, “Rhythm” (OR 6.26), “Duration” (OR 8.15) of contractions and “Show” (OR 4.29) confirmed their significance while, unexpectedly, “Frequency” of contractions had no impact. The area under the ROC curve in the model of the uterine activity was 0.865 (development data) and 0.927 (validation data), with an increment to 0.905 and 0.956, respectively, when adding maternal signs. The Brier Score error in the model of the uterine activity was 0.140 (development data) and 0.097 (validation data), with a decrement to 0.121 and 0.092, respectively, when adding maternal signs. Conclusion Our predictive model showed a good performance. The introduction of a non-invasive tool might assist midwives in the decision-making process, avoiding interventions and thus offering an evidenced-base care.
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Affiliation(s)
- Simona Fumagalli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy.
| | - Laura Antolini
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Greta Cosmai
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Teresa Gramegna
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Antonella Nespoli
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Astrid Pedranzini
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, Monza, Italy
| | - Elisabetta Colciago
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Maria Grazia Valsecchi
- School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy
| | - Patrizia Vergani
- Department of Obstetrics and Gynecology, MBBM Foundation at San Gerardo Hospital, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Anna Locatelli
- Department of Obstetrics and Gynecology, Carate Brianza Hospital, ASST Brianza, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Seravalli V, Strambi N, Castellana E, Salamina MA, Bettini C, Di Tommaso M. Hospital Admission in the Latent versus the Active Phase of Labor: Comparison of Perinatal Outcomes. CHILDREN (BASEL, SWITZERLAND) 2022; 9:924. [PMID: 35740861 PMCID: PMC9221807 DOI: 10.3390/children9060924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 11/29/2022]
Abstract
Background: Admission in the latent phase of labor has been associated with increased risk of obstetric interventions compared to admission in the active phase. We aimed to investigate the relationship between labor phase at admission and obstetric and neonatal outcomes. Methods: A retrospective cohort study was conducted on 1005 women with uncomplicated singleton pregnancy admitted for spontaneous labor. Cesarean section rate and other perinatal outcomes were compared between women admitted in the latent phase and those admitted in the active phase. Results: Admission occurred in the active phase of labor for 331 women (32.9%) and in the latent phase for 674 (67.1%). Admission in the latent phase was more frequent in nulliparous than in multiparous (p < 0.01) and for Italian patients compared to foreigners. The incidence of caesarean section was similar between groups. Admission in the latent phase increased the likelihood of epidural analgesia (OR 3.47, 95% CI 1.96−6.14, in nulliparous, and OR 2.58, 95% CI 1.37−4.84, in multiparous) and increased the rate of augmentation of labor with oxytocin in multiparous (OR 2.87, 95% CI 1.05−7.85), without difference in neonatal outcomes. Conclusions: Admission in the latent phase is associated with more frequent use of epidural analgesia, without an increase in cesarean section or adverse neonatal outcomes.
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Iobst SE, Phillips AK, Wilson C. Shared Decision-Making During Labor and Birth Among Low-Risk, Active Duty Women in the U.S. Military. Mil Med 2021; 187:e747-e756. [PMID: 34850083 DOI: 10.1093/milmed/usab486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 09/30/2021] [Accepted: 11/10/2021] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION The cesarean birth rate of 24.7% in the Military Health System (MHS) is lower than the national rate of 31.7%. However, the MHS rate remains higher than the 15-19% threshold associated with optimal maternal and neonatal outcomes. For active duty servicewomen, increased morbidity associated with cesarean birth is likely to affect the ability to meet the demands of assigned missions. Several decision-points occur during pregnancy and after the onset of labor that can affect the likelihood of cesarean birth including choice of provider, choice of hospital, timing of admission, and type of fetal monitoring. Evidence suggests the overuse of labor interventions may be associated with cesarean birth. Shared decision-making (SDM) is a strategy that can be used to carefully consider the risks, benefits, and alternatives of each labor intervention and is shown to be associated with positive patient outcomes. Most existing evidence explores SDM as an interaction that occurs between women and their providers. Few studies have explored the role of stakeholders such as spouses, family members, friends, labor and delivery nurses, and doulas. Furthermore, little is known about the process of SDM during labor and childbirth in the hospital setting, particularly for active duty women in the U.S. military. The purpose of this study was to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. MATERIALS AND METHODS A qualitatively driven mixed-methods approach was conducted to propose a framework that explains the process of SDM during labor and childbirth in the hospital setting for active duty women in the U.S. military. Servicewomen were recruited from September 2019 to April 2020. Semi-structured interviews were analyzed using a constructivist grounded theory approach. Participants also completed the SDM Questionnaire (SDM-Q-9). RESULTS Interviews were conducted with 14 participants. The sample included servicewomen from the Air Force (n = 7), Army (n = 4), and Navy (n = 3). Two participants were enlisted and the remainder were officers. Ten births occurred at military treatment facilities (MTFs) and six births took place at civilian facilities. The mean score on the SDM Questionnaire was 86.7 (±11.6), indicating a high level of SDM. Various stakeholders (e.g., providers, labor and delivery nurses, doulas, spouses, family members, and friends) were involved in SDM at different points during labor and birth. The four stages of SDM included gathering information, identifying preferences, discussing options, and making decisions. Events that most often involved SDM were deciding when to travel to the hospital, deciding when to be admitted, and selecting a strategy for pain management. Military factors involved in SDM included sources of information, selecting and working with civilian providers, and delaying labor interventions to allow time for an active duty spouse to travel to the hospital. CONCLUSIONS SDM during labor and birth in the hospital setting is a multi-stage process that involves a variety of stakeholders, including the woman, members of her social and support network, and healthcare professionals. Future research is needed to explore perspectives of other stakeholders involved in SDM.
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Affiliation(s)
- Stacey E Iobst
- Department of Nursing, Towson University, Towson, MD 21252, USA
| | - Angela K Phillips
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.,Malcolm Grow Medical Clinics and Surgery Center, Joint Base Andrews, MD 20762, USA
| | - Candy Wilson
- Daniel K. Inouye Graduate School of Nursing, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Flanagan J, Mann S. Beginning to Optimize Peripartum Care for Somalia-Born Women by Evaluating Labor, Postpartum and Neonatal Outcomes in the Somali Population Delivering at a Tertiary Care Center in Vermont. J Immigr Minor Health 2021; 22:1017-1022. [PMID: 32279156 DOI: 10.1007/s10903-020-01008-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Vermont has a large population of Somali immigrants and previous research has shown outcome disparities in this population. Labor curves, pregnancy and delivery outcomes information is required and critical to optimize current labor management in an institution that provides obstetrical care for this population. Data were collected for both Somalia-born and non Somalia-born parturients in pre-pregnancy, pregnancy, delivery, neonatal and cervical change categories and were compared to non Somalia-born parturients to observe differences in demographic factors and outcomes as well as labor progress. Overall labor length trended differently between the two groups, the rate of preterm birth in the vaginal delivery group in the Somali population was much lower than the unmatched control group and overall more lacerations were noted. Findings are consistent with prior studies related to reduced preterm birth rate in Somalia-born women. Observation regarding refusal of care demonstrates need for targeted research related to concerns of Somali immigrants.
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Affiliation(s)
- Jenna Flanagan
- Department of Obstetrics and Gynecology, University of Vermont Medical Center, Burlington, VT, USA.
| | - Stephanie Mann
- Department of Maternal Fetal Medicine, University of Vermont Medical Center, Burlington, VT, USA
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Preis H, Mahaffey B, Pati S, Heiselman C, Lobel M. Adverse Perinatal Outcomes Predicted by Prenatal Maternal Stress Among U.S. Women at the COVID-19 Pandemic Onset. Ann Behav Med 2021; 55:179-191. [PMID: 33724334 PMCID: PMC7980766 DOI: 10.1093/abm/kaab005] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND High stress prenatally contributes to poor maternal and infant well-being. The coronavirus disease 2019 (COVID-19) pandemic has created substantial stress for pregnant women. PURPOSE To understand whether stress experienced by women pregnant at the beginning of the pandemic was associated with a greater prevalence of adverse perinatal outcomes. METHODS Pregnant women across the USA aged ≥18 years old enrolled in a prospective cohort study during the pandemic onset (T1) in April-May 2020. This report focuses on the 1,367 participants who gave birth prior to July-August 2020 (T2). Hierarchical logistic regression models predicted preterm birth, small for gestational age infants, and unplanned operative delivery from T1 stress, sociodemographic, and medical factors. RESULTS After controlling for sociodemographic and medical factors, preterm birth was predicted by high prenatal maternal stress, delivering an infant small for gestational age was predicted by interpersonal violence and by stress related to being unprepared for birth due to the pandemic, and unplanned cesarean or operative vaginal delivery was predicted by prenatal appointment alterations, experiencing a major stressful life event, and by stress related to being unprepared for birth due to the pandemic. Independent of these associations, African American women were more likely than other groups to deliver preterm. CONCLUSION Pregnant women who are experiencing high stress during the COVID-19 pandemic are at risk of poorer perinatal outcomes. A longitudinal investigation is critical to determine whether prenatal maternal stress and resulting outcomes have longer-term consequences for the health and well-being of children born in the midst of the current pandemic.
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Affiliation(s)
- Heidi Preis
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Brittain Mahaffey
- Department of Psychiatry and Behavioral Health, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Susmita Pati
- Department of Pediatrics, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Cassandra Heiselman
- Department of Obstetrics, Gynecology and Reproductive Medicine, Renaissance School of Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Marci Lobel
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
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Clark RRS, Lake ET. Spontaneous vaginal birth varies significantly across US hospitals. Birth 2021; 48:44-51. [PMID: 33174241 PMCID: PMC8043962 DOI: 10.1111/birt.12508] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Birth is the most common reason for hospitalization in the United States. Hospital variation in maternal outcomes is an important indicator of health care quality. Spontaneous vaginal birth (SVB) is the most optimal birth outcome for the majority of mothers and newborns. The purpose of this study was to examine hospital-level variation in SVB overall and among low-risk women in a four-state sample representing 25% of births in the United States in 2016. METHODS Women giving birth in California, Pennsylvania, New Jersey, and Florida were identified in 2016 state discharge abstracts. Patient data were merged with hospital data from the American Hospital Association's (AHA) 2016 Annual Survey. Overall and low-risk SVB rates were calculated for each hospital in the sample and stratified by bed size, teaching status, rurality, birth volume, and state. RESULTS Our final sample included 869 681 women who gave birth in 494 hospitals. The mean overall SVB rate in the sample was 61.1%, ranging from 16.8% to 79.9%. The mean low-risk SVB rate was 78% and ranged from 34.6% to 93.3%. Variation in SVB rates cut across all the hospital structural characteristic strata. DISCUSSION The wide variation in SVB rates indicates significant room for improvement in this maternal quality metric. Our finding, that hospitals of all types and locations had both low and high SVB rates, suggests that excellent maternal outcomes are possible in all hospital settings. The variation in SVB rates across hospitals warrants research into modifiable hospital factors that may be influencing SVB rates.
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Affiliation(s)
- Rebecca R S Clark
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
| | - Eileen T Lake
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
- Leonard Davis Institute of Health Economics, Philadelphia, PA, USA
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13
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Javernick JA, Dempsey A, DeLeon B. Low-Intervention Birth Suites Within a Community Hospital: An Innovative Approach to Perinatal Services. J Midwifery Womens Health 2021; 66:520-525. [PMID: 33619892 DOI: 10.1111/jmwh.13207] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 11/08/2020] [Accepted: 11/10/2020] [Indexed: 11/30/2022]
Abstract
Perinatal care leaders at a community hospital located in the Denver, Colorado metropolitan area searched for an innovative way to provide a low-intervention option that promoted physiologic birth for women seeking intrapartum care. This reasonably priced project focused on the transformation of traditional labor and delivery rooms into birth suites and included installation of birth slings, full-size beds with home-like mattresses, new sleep sofas for the partners, and the removal of computer screens and electronic fetal monitors. In addition, the team wrote a specific birth suite policy, provided nurse education focused on intermittent auscultation and labor support techniques, and developed a birth suite curriculum for patient education. This innovative model of care demonstrated outcomes similar to those seen in community-based birth centers and received positive feedback from families who labored and gave birth in these suites. In the instance when the birth suite is no longer the appropriate environment for intrapartum care secondary to risk factors, a woman's preference, or obstetric emergency management, this model allows for expeditious transfer of the woman or newborn to a location where an appropriate higher level of care can be provided. Converting 2 labor and delivery rooms to low-intervention birth suites required minimal funding and enabled a community hospital in Colorado to expand its perinatal services to women who are seeking low-intervention birth options that promote physiologic birth.
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Affiliation(s)
- Julie A Javernick
- Westside Women's Care, Arvada and Wheat Ridge, Colorado.,Denver College of Nursing, Denver, Colorado
| | - Amy Dempsey
- Lutheran Medical Center, Wheat Ridge, Colorado
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Clark RRS, Warren N, Shermock KM, Perrin N, Lake E, Sharps PW. The Role of Oxytocin in Primary Cesarean Birth Among Low-Risk Women. J Midwifery Womens Health 2020; 66:54-61. [PMID: 32930507 DOI: 10.1111/jmwh.13157] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 06/12/2020] [Accepted: 06/18/2020] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To examine whether there is a threshold of oxytocin exposure at which the risk for primary cesarean increases among women who are nulliparous with a term, singleton, vertex fetus (NTSV) and how oxytocin interacts with other risk factors to contribute to this outcome. METHODS This was a secondary analysis of the Consortium on Safe Labor data set that used a retrospective cohort study design. Women who met the criteria for NTSV who were not admitted for a prelabor cesarean and for whom oxytocin data were available, were included in the sample. Robust logistic regression was used to examine the association of oxytocin exposure with primary cesarean birth, while controlling for demographic and clinical risk factors and clustering by provider. RESULTS The sample comprised 17,331 women who were exposed to oxytocin during labor. The women were predominantly white non-Hispanic (59.2%) with an average (SD) gestational age of 39.4 (1.1) weeks and an 18.5% primary cesarean rate. Exposure to greater than 11,400-milliunits (mU) of oxytocin resulted in 1.6 times increased odds of primary cesarean birth compared with less than 11,400 mU (95% CI 1.01-2.6). DISCUSSION Exposure to greater than 11,400 mU of oxytocin in labor was associated with an increased odds of primary cesarean birth in NTSV women.
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Affiliation(s)
- Rebecca R S Clark
- Center for Health Outcomes and Policy Research, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Nicole Warren
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Kenneth M Shermock
- Center for Medication Safety and Quality, Department of Pharmacy, Johns Hopkins Hospital, Baltimore, Maryland.,Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Nancy Perrin
- Biostatistics and Methods Core, Johns Hopkins University School of Nursing, Baltimore, Maryland
| | - Eileen Lake
- Center for Health Outcomes and Policy Research, Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, Pennsylvania.,Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania
| | - Phyllis W Sharps
- Department of Community and Public Health, Johns Hopkins University School of Nursing, Baltimore, Maryland
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Wang JG, Sun JL, Shen J. Factors affecting failed trial of labor and countermeasures: A retrospective analysis. World J Clin Cases 2020; 8:3483-3492. [PMID: 32913855 PMCID: PMC7457101 DOI: 10.12998/wjcc.v8.i16.3483] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 05/04/2020] [Accepted: 07/14/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Vaginal delivery is the ideal mode of delivery for the termination of a pregnancy. However, the cesarean section rate in China is much higher than the published by the World Health Organization in the Lancet in 2010.
AIM To retrospectively analyze the factors related to failed trial of labor and the clinical indications for cesarean section conversion, explore how to promote the trial of labor success rate, and determine the feasibility of reducing the rate of conversion to cesarean section.
METHODS A retrospective analysis was performed on 9240 maternal women who met vaginal delivery conditions and required a trial of labor from January 2016 to December 2018 at our hospital. Among them, 8164 pregnant women who had a successful trial of labor were used as a control group, and 1076 pregnant women who had a failed trial of labor and converted to an emergency cesarean section were used as an observation group. The patients’ clinical data during hospitalization were collected for comparative analysis, the related factors of the failed trial of labor were discussed, and reasonable prevention and resolution strategies were proposed to increase the success rate of trial of labor.
RESULTS The analysis revealed that advanced age (≥ 35 years old), macrosomia (≥ 4000 g), delayed pregnancy (≥ 41 wk), use of uterine contraction drugs, primipara, and fever during labor were associated with conversion to an emergency cesarean section in the failed trial of labor. Multivariate regression analysis showed that age, gestational age, primipara, use of uterine contraction drugs, fever during birth, and newborn weight led to a higher probability of conversion to an emergency cesarean section in the failed trial of labor. The analysis indicated that the following clinical indications were associated with the conversion to cesarean section in the failed trial of labor: Fetal distress (44.3%), social factors (12.8%), malpresentation (face presentation, persistent occipitoposterior position, and persistent occipitotransverse position) (9.4%), and cephalopelvic disproportion (8.9%).
CONCLUSION The conversion to emergency cesarean section in failed trial of labor is affected by many factors. Medical staff should take appropriate preventive measures for the main factors, increase the trial of labor success rate, improve the quality of delivery, ensure the safety of mother and child during the perinatal period, and improve the relationship between doctors and patients.
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Affiliation(s)
- Jin-Guang Wang
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
| | - Jing-Li Sun
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
| | - Jian Shen
- Department of Obstetrics and Gynecology, General Hospital of Northern Theater Command (Heping Campus), Shenyang 110000, Liaoning Province, China
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Miller YD, Armanasco AA, McCosker L, Thompson R. Variations in outcomes for women admitted to hospital in early versus active labour: an observational study. BMC Pregnancy Childbirth 2020; 20:469. [PMID: 32807137 PMCID: PMC7430117 DOI: 10.1186/s12884-020-03149-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 07/31/2020] [Indexed: 11/20/2022] Open
Abstract
Background There is no available evidence for the prevalence of early labour admission to hospital or its association with rates of intervention and clinical outcomes in Australia. The objectives of this study were to: estimate the prevalence of early labour admission in one hospital in Australia; compare rates of clinical intervention, length of hospital stay and clinical outcomes for women admitted in early (< 4 cm cervical dilatation) or active (≥4 cm) labour; and determine the impact of recent recommendations to define early labour as < 5 cm on the findings. Methods We conducted a retrospective cohort study using medical record data from a random sample of 1223 women from live singleton births recorded between July 2013 and December 2015. Analyses included women who had spontaneous onset of labour at ≥37 weeks gestation whilst not a hospital inpatient, who had not scheduled a caesarean section before labour onset or delivered prior to hospital admission. Associations between timing of hospital admission in labour and clinical intervention, outcomes and hospital stay were assessed using logistic regression. Results Between 32.4% (< 4 cm) and 52.9% (< 5 cm) of eligible women (N = 697) were admitted to hospital in early labour. After adjustment for potential confounders, women admitted in early labour (< 4 cm) were more likely to have their labour augmented by oxytocin (AOR = 3.57, 95% CI 2.39–5.34), an epidural (AOR = 2.27, 95% CI 1.51–3.41), a caesarean birth (AOR = 3.50, 95% CI 2.10–5.83), more vaginal examinations (AOR = 1.73, 95% CI = 1.53–1.95), and their baby admitted to special care nursery (AOR = 1.54, 95% CI = 1.01–2.35). Defining early labour as < 5 cm cervical dilatation produced additional significant associations with artificial rupture of membranes (AOR = 1.41, 95% CI = 1.02–1.95), assisted vaginal birth (AOR = 1.96, 95% CI = 1.12–3.41) neonatal resuscitation (AOR = 1.73, 95% CI = 1.01–2.99) and longer maternal hospital stay (AOR = 1.21, 95% CI = 1.04–1.40). Conclusions Findings provide preliminary evidence that a notable proportion of labouring women are admitted in early labour and are more likely to experience several medical procedures, neonatal resuscitation and admission to special care nursery, and longer hospital stay.
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Affiliation(s)
- Yvette D Miller
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia.
| | - Ashleigh A Armanasco
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Laura McCosker
- Queensland University of Technology, Institute of Health & Biomedical Innovation, School of Public Health & Social Work, Kelvin Grove, Brisbane, QLD, 4059, Australia
| | - Rachel Thompson
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, 2006, Australia
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Baljon KJ, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e033844. [PMID: 32540887 PMCID: PMC7299053 DOI: 10.1136/bmjopen-2019-033844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Labour pain is among the severest pains primigravidae may experience during pregnancy. Failure to address labour pain and anxiety may lead to abnormal labour. Despite the many complementary non-pharmacological approaches to coping with labour pain, the quality of evidence is low and best approaches are not established. This study protocol describes a proposed investigation of the effects of a combination of breathing exercises, foot reflexology and back massage (BRM) on the labour experiences of primigravidae. METHODS AND ANALYSIS This randomised controlled trial will involve an intervention group receiving BRM and standard labour care, and a control group receiving only standard labour care. Primigravidae of 26-34 weeks of gestation without chronic diseases or pregnancy-related complications will be recruited from antenatal clinics. Eligible and consenting patients will be randomly allocated to the intervention or the control group stratified by intramuscular pethidine use. The BRM intervention will be delivered by a trained massage therapist. The primary outcomes of labour pain and anxiety will be measured during and after uterine contractions at baseline (cervical dilatation 6 cm) and post BRM hourly for 2 hours. The secondary outcomes include maternal stress hormone (adrenocorticotropic hormone, cortisol and oxytocin) levels, maternal vital signs (V/S), fetal heart rate, labour duration, Apgar scores and maternal satisfaction. The sample size is estimated based on the between-group difference of 0.6 in anxiety scores, 95% power and 5% α error, which yields a required sample size of 154 (77 in each group) accounting for a 20% attrition rate. The between-group and within-group outcome measures will be examined with mixed-effect regression models, time series analyses and paired t-test or equivalent non-parametric tests, respectively. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethical Committee for Research Involving Human Subjects of the Ministry of Health in the Saudi Arabia (H-02-K-076-0319-109) on 14 April 2019, and from the Ethics Committee for Research Involving Human Subjects (JKEUPM) Universiti Putra Malaysia on 23 October 2019, reference number: JKEUPM-2019-169. Written informed consent will be obtained from all participants. Results from this trial will be presented at regional, national and international conferences and published in indexed journals. TRIAL REGISTRATION NUMBER ISRCTN87414969, registered 3 May 2019.
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Affiliation(s)
- Kamilya Jamel Baljon
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Muhammad Hibatullah Romli
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Adibah Hanim Ismail
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lee Khuan
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Kissler KJ, Lowe NK, Hernandez TL. An Integrated Review of Uterine Activity Monitoring for Evaluating Labor Dystocia. J Midwifery Womens Health 2020; 65:323-334. [PMID: 32478978 PMCID: PMC7875314 DOI: 10.1111/jmwh.13119] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 03/24/2020] [Accepted: 03/27/2020] [Indexed: 11/30/2022]
Abstract
Introduction: Labor dystocia is the most common cause of cesarean birth in the United States, yet how dystocia develops during labor remains elusive. Uterine activity monitoring has significant potential for advancing our understanding of labor dystocia. While evaluating contraction frequency and amplitude is a common component of labor dystocia management, the literature describing the relationship between measures of uterine activity and labor dystocia is heterogeneous and has not been synthesized to identify the best methods for use in clinical investigation. Methods: We conducted a literature search for original research exploring the relationship between uterine activity and labor dystocia published between 2000 and 2019. Included articles were critically reviewed and synthesized. Results: Across 11 identified studies, investigators employed 3 different techniques for monitoring uterine activity and 9 different measures were employed. Uterine activity measures, including Montevideo units, uterine electromyography power density spectrum and sample entropy, and the fall-to-rise ratio of contraction shape, detected patterns associated with labor dystocia or cesarean birth. Discussion: The use of multiple regression with clinical covariates and a uterine activity measure increased the accuracy of predicting cesarean delivery. Uterine electromyography may be especially useful to evaluate labor dystocia phenotypes to differentiate uterine muscle fatigue from understimulation and lead to algorithms for increased precision in the diagnosis of labor dystocia and innovative approaches to treatment.
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Affiliation(s)
- Katherine J Kissler
- College of Nursing, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Nancy K Lowe
- College of Nursing, University of Colorado Anschutz Medical Center, Aurora, Colorado
| | - Teri L Hernandez
- College of Nursing, University of Colorado Anschutz Medical Center, Aurora, Colorado
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19
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Abstract
PURPOSE Reducing primary cesarean births is a national priority in the United States. Recommendations include delaying admission of low-risk pregnant women to the hospital until they are in active labor, considered to be 6 cm cervical dilatation. How this recommendation affects decision-making during triage requires further exploration. The purpose of this study was to explore the clinician's perspective on the triage process and deferral of hospital admission for low-risk pregnant women who were not yet in active labor. METHODS A qualitative descriptive approach was used via semistructured interviews with physicians, midwives, and nurses. Data analysis used an inductive approach and identified codes, a theme and subthemes. RESULTS Twenty-five clinicians participated. A triad of decision-making occurred between three main stakeholders: the low-risk pregnant woman, the triage nurse, and the physician or midwife. One theme and four subthemes related to this triad were identified. The theme Admission of Low-Risk Pregnant Women Depends on Many Factors provides context to the maternity care triage process. There are many factors clinicians consider prior to admitting women, including situational and clinical factors. Subthemes related to the woman are her expectation and knowledge about birth and her ability to cope with labor. Subthemes associated with the provider and triage nurse are care variation and concern for maternal and fetal safety. CLINICAL IMPLICATIONS From the clinician's perspective, triage is a complex, dynamic process, even for low-risk pregnant women. There is an interplay of different factors affecting clinical decision-making, thus the decision-making triad provides a possible framework for shared decision-making.
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Allen J, Jenkinson B, Tracy SK, Hartz DL, Tracy M, Kildea S. Women's unmet needs in early labour: Qualitative analysis of free-text survey responses in the M@NGO trial of caseload midwifery. Midwifery 2020; 88:102751. [PMID: 32512314 DOI: 10.1016/j.midw.2020.102751] [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: 02/04/2020] [Revised: 04/06/2020] [Accepted: 05/05/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to analyse women's experiences of early labour care in caseload midwifery in Australia. DESIGN this study sits within a multi-site randomised controlled trial of caseload midwifery versus standard care. Participant surveys were conducted at 6-weeks and 6-months after birth. Free-text responses about experiences of care were subject to critical thematic analysis in NVivo 11 software. SETTING two urban Australian hospitals in different states. PARTICIPANTS women 18 years and over, with a singleton pregnancy, less than 24 weeks' pregnant, not planning a caesarean section or already booked with a care provider; were eligible to participate in the trial. INTERVENTIONS participants were randomised to caseload midwifery or standard care for antenatal, labour and birth and postpartum care. MEASUREMENTS AND FINDINGS The 6-week survey response rate was 58% (n = 1,019). The survey included five open questions about women's experiences of pregnancy, labour and birth, and postnatal care. Nine-hundred and one respondents (88%) provided free text comments which were coded to generate 10 categories. The category of early labour contained data from 84 individual participants (caseload care n = 44; standard care n = 40). Descriptive themes were: (1) needing permission; (2) doing the 'wrong' thing; and (3) being dismissed. Analytic themes were: (1) Seeking: women wanting to be "close to those who know what's going on"; and (2) Shielding: midwives defending resources and normal birth. KEY CONCLUSIONS Regardless of model of care, early labour care was primarily described in negative terms. This could be attributed to reporting bias, because women who were neutral about early labour care may not comment. Nevertheless, the findings demonstrate a gap in knowledge about early labour care in caseload midwifery models. IMPLICATIONS FOR PRACTICE Maternity services that offer caseload midwifery are ideally placed to evaluate how early labour home visiting impacts women's experiences of early labour.
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Affiliation(s)
- Jyai Allen
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia; School of Nursing and Midwifery, Griffith University, Meadowbrook, Queensland, Australia.
| | - Bec Jenkinson
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia.
| | - Sally K Tracy
- Midwifery and Women's Health Research Unit, University of Sydney, Royal Hospital for Women, Randwick, New South Wales, Australia.
| | - Donna L Hartz
- Midwifery and Women's Health Research Unit, University of Sydney, Royal Hospital for Women, Randwick, New South Wales, Australia; College of Nursing and Midwifery, Charles Darwin University, Sydney Campus, New South Wales, Australia.
| | - Mark Tracy
- Department of Paediatrics and Child health Westmead Children's Clinical School, The University of Sydney, Westmead, New South Wales, Australia; Westmead Neonatal Intensive Care Unit, Westmead Hospital, Western Sydney Local Health District, New South Wales, Australia.
| | - Sue Kildea
- Mater Research Institute-The University of Queensland, Brisbane, Queensland, Australia; Molly Wardaguga Research Centre, College of Nursing and Midwifery, Charles Darwin University, Queensland, Australia.
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Glavind J, Greve T, de Wolff MG, Hansen MK, Henriksen TB. Medication used in Denmark in the latent phase of labor - Do we know what we are doing? SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 25:100515. [PMID: 32361536 DOI: 10.1016/j.srhc.2020.100515] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 04/10/2020] [Accepted: 04/17/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe the various combinations of medication used in Denmark in the latent phase of labor (i.e. for therapeutic rest) and to estimate the frequency of use. METHODS An informal e-mail survey based on personal information from Danish midwives or staff obstetricians. The main outcome measures were type and dosage of medications used individually or in combination ("cocktail") for therapeutic rest in Danish delivery wards during the latent phase of labor and also the frequency of their use. RESULTS All twenty-one delivery wards in Denmark participated in the survey. The types and dosages of medication varied substantially. Two delivery wards used prescriptions on morphine with no other medication for therapeutic rest. The remaining 19/21 delivery wards (90%) used a standard "cocktail" with two to four different types of medications; 19/21 wards (90%) used a mild analgesic (paracetamol), 17/21 (81%) used anxiolytics/hypnotics, and 14/21 (64%) wards used a strong analgesic (opioid) in their basic cocktail. Ten delivery wards (48%) combined an opioid, a sedative, and paracetamol in their basic cocktail. Between 7% and 21% of all pregnant women were given a cocktail. CONCLUSION In a small country, we found considerable national variation in the medication or combinations of medication used in the latent phase of labor, and polypharmacy was standard in the majority of the delivery wards.
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Affiliation(s)
- Julie Glavind
- Department of Obstetrics and Gynaecology, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark.
| | - Tine Greve
- Department of Obstetrics and Gynecology, Amager and Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Mie Gaarskjaer de Wolff
- Department of Obstetrics, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark
| | - Mette Kabell Hansen
- Department of Obstetrics and Gynecology, Amager and Hvidovre Hospital, Kettegaard Allé 30, 2650 Hvidovre, Denmark
| | - Tine Brink Henriksen
- Department of Paediatrics, Aarhus University Hospital, Palle Juul-Jensens Blvd. 99, 8200 Aarhus N, Denmark
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Faucher MA, Kennedy HP. Women's Perceptions on the Use of Video Technology in Early Labor: Being Able to See. J Midwifery Womens Health 2020; 65:342-348. [PMID: 32277583 DOI: 10.1111/jmwh.13091] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 12/03/2019] [Accepted: 12/12/2019] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Delaying admission to the birth setting until active labor has commenced has known benefits. However, women and their partners often struggle to stay home in early labor. Research on telephone triage during early labor at home has illuminated significant disadvantages with this model of care, contributing to women feeling dissatisfied with the early birth experience. Research conducted with midwives on the potential benefits of using video technology suggests it might be a helpful strategy for early labor support. This study examined women's perspectives on the potential use of this technology. METHODS Focus groups and individual interviews were conducted with 23 English-speaking women who experienced spontaneous labor within the last year. The recordings were transcribed verbatim. Content analysis was used to interpret women's perceptions. RESULTS The women identified potential advantages of video technology in early labor connected to the major theme of being able to see, which could enable closer human connections between the intrapartum care provider, the woman, and her partner, as well as better assessments of labor. This human connection was integral to enhancing empathy and building confidence. Concerns about using video calls during early labor at home focused on privacy issues and the need to practice beforehand. Concerns about privacy depended upon having a prior relationship with the intrapartum care provider and women being able to decide if they wanted to use the technology. DISCUSSION One way of optimizing the experience of staying home in early labor and overall satisfaction with the birth experience may be with video technology, which could offer enhancements over traditional telephone triage.
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Affiliation(s)
- Mary Ann Faucher
- Louise Herrington School of Nursing, Baylor University, Dallas, Texas
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Schick C, Spineli LM, Raio L, Gross MM. First assessed cervical dilatation: is it associated with oxytocin augmentation during labour? A retrospective cohort study in a university hospital in Switzerland. Midwifery 2020; 85:102683. [PMID: 32200140 DOI: 10.1016/j.midw.2020.102683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Revised: 02/15/2020] [Accepted: 02/24/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVES The primary objective of this study was to examine the association between the first assessed cervical dilatation in a labourward and the use of oxytocin augmentation during labour. Further analysis was performed by examining the actual stage of labour at the point oxytocin was first administered to those women. DESIGN Retrospective cohort study with the data collected from the medical records of the hospital. SETTING University Hospital Bern, Switzerland PARTICIPANTS: 1933 term nulliparous and multiparous women with a singleton pregnancy giving birth during the period June 2013 and May 2017, representing Robson groups 1 and 3. MEASUREMENTS AND FINDINGS Descriptive statistics and multivariable logistic regression models were performed. It was found that for the entire process of labour, nulliparous and multiparous women (n = 1933) with a first cervical dilatation of 5 or more cm were less likely to be augmented with oxytocin (OR 0.64, 95% CI 0.46; 0.88 and OR 0.56, 95% CI 0.38; 0.82, respectively) compared to women with a first cervical dilatation of less than 5 cm. Out of these augmented women (n = 746) having a first cervical dilatation of 5 or more cm, they had a lower likelihood of being augmented during the first stage of labour compared to women with a first cervical dilatation of less than 5 cm (OR 0.45, 95% CI 0.29; 0.7 for nulliparae and OR 0.32, 95% CI 0.16; 0.6 for multiparae). Additionally, it was observed that other factors contributed to the application of oxytocin. One such example was that epidural analgesia was associated with a high risk of oxytocin augmentation in nulliparae (OR 13.88, 95% CI 9.29; 20.74) and multiparae (OR 15.52, 95% CI 9.94; 24.22). The application of oxytocin was also found to affect the caesarean section rate in nulliparous and multiparous women as it was 20% and 13% respectively for those with oxytocin versus 13% and 4% respectively for those without oxytocin. KEY CONCLUSIONS Early admission to the labourward is associated with an increased use of oxytocin to augment labour, particularly, during the first stage of labour. Epidural analgesia is a main predictor for oxytocin augmentation in nulliparous and multiparous women. IMPLICATIONS FOR PRACTICE Pregnant women warrant more appropriate support during early labour, avoiding early maternal exhaustion and excessive obstetrical interventions.
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Affiliation(s)
- Céline Schick
- Midwifery Research and Education Unit, Hannover Medical School, Germany
| | - Loukia M Spineli
- Midwifery Research and Education Unit, Hannover Medical School, Germany
| | - Luigi Raio
- Departement of Obstetrics and Gynecology, Bern University Hospital, Switzerland
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Germany.
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Attanasio LB, Alarid-Escudero F, Kozhimannil KB. Midwife-led care and obstetrician-led care for low-risk pregnancies: A cost comparison. Birth 2020; 47:57-66. [PMID: 31680337 DOI: 10.1111/birt.12464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Revised: 09/13/2019] [Accepted: 10/03/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Low-risk pregnant women cared for by midwives have similar birth outcomes to women cared for by physicians, although experiencing fewer medical procedures. However, limited research has assessed cost implications in the United States. Using national data, we assessed costs and resource use of midwife-led care vs obstetrician-led care for low-risk pregnancies using a decision-analytic approach. METHODS We developed a decision-analytic model of costs (health plan payments to clinicians) and use of medical procedures during childbirth (epidural analgesia, labor induction, cesarean birth, episiotomy) and outcomes of care (birth at preterm gestation) that may differ with midwife-led vs obstetrician-led care. Model parameters for obstetric procedures were generated using Listening to Mothers III data, a national survey of women who gave birth in US hospitals in 2011-2012 and other published estimates. Cost estimates came from published or publicly available information on health insurance claims payments. RESULTS The costs of childbirth for low-risk women with midwife-led care were, on average, $2262 less than births to low-risk women cared for by obstetricians. These cost differences derive from lower rates of preterm birth and episiotomy among women with midwife-led care, compared with obstetrician-led care. Across the population of US women with low-risk births each year (approximately 2.6 million), the model predicted substantially fewer preterm births (167 259 vs 219 427 for midwife-led vs obstetrician-led care) and fewer episiotomies (170 504 vs 415 686, for midwife-led vs obstetrician-led care). CONCLUSIONS A shift from obstetrician-led care to midwife-led care for low-risk pregnancies could be cost saving.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | | | - Katy B Kozhimannil
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, Minnesota
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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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Abasian Kasegari F, Pazandeh F, Darvish S, Huss R, Nasiri M. Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions. Women Birth 2019; 33:e543-e548. [PMID: 31892475 DOI: 10.1016/j.wombi.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2019] [Revised: 12/07/2019] [Accepted: 12/09/2019] [Indexed: 10/25/2022]
Abstract
AIM To determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth. METHODS This single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or "show". The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann-Whitney and Chi-square tests. The level of statistical significance was set as p<0.05. FINDING There were significant differences between the intervention and control groups in the number of caesarian section (CS) (p<0.001). Two groups had a statistically significant difference in amniotomy (p=0.003), augmentation by oxytocin (p<0.001), number of vaginal examinations (p<0.001) and fundal pressure (p<0.001). CONCLUSIONS Using a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.
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Affiliation(s)
- Freshteh Abasian Kasegari
- School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- Department of Midwifery and Reproductive Health, Midwifery and Reproductive Health Research Centre, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Soodabeh Darvish
- School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reinhard Huss
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK; Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Malihe Nasiri
- School of Nursing and Midwifery Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Biostatistics, Faculty of Paramedical, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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ACOG Committee Opinion No. 766: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol 2019; 133:e164-e173. [PMID: 30575638 DOI: 10.1097/aog.0000000000003074] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obstetrician-gynecologists, in collaboration with midwives, nurses, patients, and those who support them in labor, can help women meet their goals for labor and birth by using techniques that require minimal interventions and have high rates of patient satisfaction. Many common obstetric practices are of limited or uncertain benefit for low-risk women in spontaneous labor. For women who are in latent labor and are not admitted to the labor unit, a process of shared decision making is recommended to create a plan for self-care activities and coping techniques. Admission during the latent phase of labor may be necessary for a variety of reasons, including pain management or maternal fatigue. Evidence suggests that, in addition to regular nursing care, continuous one-to-one emotional support provided by support personnel, such as a doula, is associated with improved outcomes for women in labor. Data suggest that for women with normally progressing labor and no evidence of fetal compromise, routine amniotomy need not be undertaken unless required to facilitate monitoring. The widespread use of continuous electronic fetal monitoring has not been shown to significantly affect such outcomes as perinatal death and cerebral palsy when used for women with low-risk pregnancies. Multiple nonpharmacologic and pharmacologic techniques can be used to help women cope with labor pain. Women in spontaneously progressing labor may not require routine continuous infusion of intravenous fluids. For most women, no one position needs to be mandated or proscribed. Obstetrician-gynecologists and other obstetric care providers should be familiar with and consider using low-interventional approaches, when appropriate, for the intrapartum management of low-risk women in spontaneous labor. Birthing units should carefully consider adding family-centric interventions that are otherwise not already considered routine care and that can be safely offered, given available environmental resources and staffing models. These family-centric interventions should be provided in recognition of the value of inclusion in the birthing process for many women and their families, irrespective of delivery mode. This Committee Opinion has been revised to incorporate new evidence for risks and benefits of several of these techniques and, given the growing interest on the topic, to incorporate information on a family-centered approach to cesarean birth.
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Breman RB, Storr CL, Paul J, LeClair M, Johantgen M. Women's Prenatal and Labor Experiences in a Hospital With an Early-Labor Lounge. Nurs Womens Health 2019; 23:299-308. [PMID: 31251934 DOI: 10.1016/j.nwh.2019.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2018] [Revised: 03/19/2019] [Accepted: 05/01/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To evaluate the information that women with low-risk pregnancies received during the prenatal period about latent labor and the early-labor lounge (ELL) and their subsequent use of the ELL. DESIGN Cross-sectional design with survey. SETTING/LOCAL PROBLEM Community hospital in the northeastern United States with a low-risk cesarean birth rate of 33%, which exceeds the national target rate of 23.9%. PARTICIPANTS Low-risk, nulliparous, pregnant women with a term singleton vertex fetus at hospital admission (N = 67). INTERVENTION/MEASUREMENTS An electronic survey was administered before hospital discharge following birth. The survey assessed prenatal education, use of the ELL, admission characteristics, and birth satisfaction. Descriptive analysis was used. RESULTS Nearly half (43.9%) of the women surveyed used the ELL. ELL users received prenatal care (72.3%), knew signs of active labor (93.1%), and had a cesarean birth rate of 7.1%. Significantly greater proportions of women prenatally cared for by midwives reported knowledge of the signs of early labor (100% vs. 80%; χ2 = 4.4, p = .04) and of the availability of the ELL (18.2% vs. 70.6%; χ2 = 15.2, p < .001). A range of activities were offered in the ELL, and at least 75% of women indicated that all activities were helpful during latent labor. Birth satisfaction scores, measured on a scale of 0 to 40, with 40 indicating greatest satisfaction, ranged from 22 to 35 among ELL participants. CONCLUSION An ELL is a care innovation that hospitals can consider for providing support to women with low-risk pregnancies during the latent phase of labor. Women who used the ELL reported feeling that it provided guidance and support. An ELL is a woman-centered option for delayed admission.
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Iobst SE, Breman RB, Bingham D, Storr CL, Zhu S, Johantgen M. Associations among cervical dilatation at admission, intrapartum care, and birth mode in low-risk, nulliparous women. Birth 2019; 46:253-261. [PMID: 30689220 DOI: 10.1111/birt.12417] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/31/2018] [Accepted: 12/31/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND Admission in early labor is associated with increased likelihood of cesarean birth, but the context in which this occurs is unclear. Previous research has explored the relationship between dilatation at admission and the use of single intrapartum interventions; however, the majority of women in the United States receive multiple intrapartum interventions. The objective of this study was to examine the associations among cervical dilatation at admission, intrapartum care, and birth mode in low-risk, nulliparous women with spontaneous onset of labor. METHODS This was a cross-sectional, observational study of 21 858 nulliparous, singleton, term vertex births that occurred from 2002 to 2007 across nine hospitals in the Consortium on Safe Labor. Outcome measures included the individual and combined use of intrapartum interventions (amniotomy, epidural anesthesia, oxytocin augmentation) and birth mode. RESULTS In this sample, 92.0% of women received at least one intrapartum intervention and 22.7% received all three interventions. After propensity score adjustment, women were more than twice as likely to receive the combination of amniotomy-epidural-oxytocin when admitted at 0-3 cm (RR 2.83 [95% CI 2.45-3.27]) and 4-5 cm (2.49 [2.15-2.89]) compared to 6-10 cm. Adjusted likelihood of cesarean birth was five times greater for women admitted at 0-3 cm (5.26 [4.36-6.34]) and two times greater for women admitted at 4-5 cm (2.27 [1.86-2.77]) compared to 6-10 cm. CONCLUSIONS To promote normal physiologic birth, low-risk, nulliparous women should be engaged in shared decision-making about timing of admission after spontaneous onset of labor.
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Affiliation(s)
- Stacey E Iobst
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Rachel B Breman
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Debra Bingham
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Carla L Storr
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Shijun Zhu
- School of Nursing, University of Maryland, Baltimore, Maryland
| | - Meg Johantgen
- School of Nursing, University of Maryland, Baltimore, Maryland
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Williams L, Jenkinson B, Lee N, Gao Y, Allen J, Morrow J, Kildea S. Does introducing a dedicated early labour area improve birth outcomes? A pre-post intervention study. Women Birth 2019; 33:259-264. [PMID: 31113743 DOI: 10.1016/j.wombi.2019.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
Abstract
PROBLEM Women increasingly present to hospital in early labour, but admission before active labour contributes to overuse of interventions, poorer clinical and psychological outcomes, and higher healthcare costs. BACKGROUND Innovative models of early labour care have so far not improved birth outcomes. AIM To examine if reconfiguring the early labour service in a large Australian maternity service improved (1) the birth outcomes of women who presented in early labour and (2) alleviated bed blockages by decreasing length of stay in the Pregnancy Assessment and Observation Unit. METHODS Pre-post intervention design, using routinely collected clinical data before and after the implementation of the reconfigured early labour service. FINDINGS There were 527 women in pre-intervention cohort and 747 in the post-intervention cohort. The two groups were similar in age, body mass index, marital status, education level and gestation at birth. Post intervention, epidural use did not change significantly, but rates of amniotomy (35.7% vs. 49.9%, p = <0.001), meconium-stained liquor (20.1% vs 26.1%, p = 0.04), and neonatal nursery admission (2.7% vs. 5.8% p = 0.01) increased. The proportion of women staying in the Assessment unit more than two hours decreased, but not significantly. CONCLUSION Changing the location and model of early labour care did not influence epidural use, nor improve women's birth outcomes. For women in early labour, admission to any location within the hospital may be as problematic as admission to birth suite specifically.
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Affiliation(s)
- Lauren Williams
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Mater Mothers' Hospital, Mater Health Services, South Brisbane, Queensland, Australia; School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Bec Jenkinson
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Nigel Lee
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia.
| | - Yu Gao
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; Mater Mothers' Hospital, Mater Health Services, South Brisbane, Queensland, Australia
| | - Jyai Allen
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Jane Morrow
- School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Melbourne, Victoria, Australia
| | - Sue Kildea
- Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia; School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
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Attanasio LB, Paterno MT. Correlates of Trial of Labor and Vaginal Birth After Cesarean in the United States. J Womens Health (Larchmt) 2019; 28:1302-1312. [PMID: 30864889 DOI: 10.1089/jwh.2018.7270] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background: Little is known about trial of labor after cesarean (TOLAC) uptake and vaginal birth after cesarean (VBAC) success on the national level, which is important as national-level data may help shape future clinical guidelines. This study examined correlates of trial of labor and successful VBAC among women with one prior cesarean in the United States in 2016. Materials and Methods: We used publically available birth certificate data for 2016. Outcomes were TOLAC among women with one prior cesarean (N = 338,311) and VBAC among women with a TOLAC (N = 76,688). We used logistic regression to assess the association between the outcomes and the following categories of independent variables: social determinants of health, demographic and medical factors impacting birth, behavioral factors, and geographic access. Results: About 23% of women had a TOLAC, and 74% of women with a TOLAC gave birth vaginally. Black women had higher odds of TOLAC relative to White women, but lower odds of successful VBAC. Women without a high school degree had higher odds of TOLAC and of successful VBAC compared to women who completed high school or beyond, as did women with inadequate prenatal care utilization. Conclusions: Understanding correlates of TOLAC and successful VBAC at the population level is important for developing national guidelines that can be considered and individualized at the patient/provider level.
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Affiliation(s)
- Laura B Attanasio
- Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts Amherst, Amherst, Massachusetts
| | - Mary T Paterno
- College of Nursing, University of Massachusetts Amherst, Amherst, Massachusetts
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Redling K, Schaedelin S, Huhn EA, Hoesli I. Efficacy and safety of misoprostol vaginal insert vs. oral misoprostol for induction of labor. J Perinat Med 2019; 47:176-182. [PMID: 30179853 DOI: 10.1515/jpm-2018-0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 08/06/2018] [Indexed: 11/15/2022]
Abstract
Objectives To compare the oral application form of misoprostol with the misoprostol vaginal insert (MVI) in a Swiss cohort with special regards to the efficacy and safety. Methods We performed a retrospective case series including a historical group induced with oral misoprostol (MO, n=101) and an MVI group (n=101). The primary outcome was time to delivery. Secondary outcomes were mode of delivery, occurrence of tachysystole, use of analgesia and neonatal adverse outcome. Results A total of 202 women were included in the analysis (101 in the MVI as well as in the MO group). Time from start of induction to delivery was significantly shorter in the MVI group compared to the MO group (15.91 h vs. 37.68 h, P<0.001). Within the first 24 h, 78.2% of the women in the MVI group had given birth compared to 28.7% in the MO group (P<0.001). Tachysystole occurred more often in the MVI group (22.8% vs. 5.0%, P<0.001). Women in the MVI group more often needed opioid analgesia during the induction before onset of active labor (31.7% vs. 2.0%, P<0.001). There was no significant difference between neonatal outcomes in the two groups. Conclusion Time to delivery was significantly shorter in the MVI group with a higher rate of vaginal deliveries within the first 24 h. However, patients needed more opioids for pain relief during induction with MVI. There was no difference in neonatal outcomes.
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Affiliation(s)
- Katharina Redling
- Department of Obstetrics and Gynecology, University Hospital Basel, Women's Hospital, Spitalstr. 21, 4031 Basel, Switzerland
| | - Sabine Schaedelin
- Department Klinische Forschung, Clinical Trial Unit, University of Basel, University Hospital, Basel, Switzerland
| | - Evelyn Annegret Huhn
- Department of Obstetrics and Gynecology, University of Basel, University Hospital, Basel, Switzerland
| | - Irene Hoesli
- Department of Obstetrics and Gynecology, University of Basel, University Hospital, Basel, Switzerland
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Neal JL, Lowe NK, Caughey AB, Bennett KA, Tilden EL, Carlson NS, Phillippi JC, Dietrich MS. Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women. Birth 2018; 45:358-367. [PMID: 29851163 PMCID: PMC6342020 DOI: 10.1111/birt.12358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women's risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. METHODS A sample of low-risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes. RESULTS At admission, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45-2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45-3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. CONCLUSIONS Adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
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Affiliation(s)
- Jeremy L. Neal
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Nancy K. Lowe
- University of Colorado College of Nursing, Aurora, CO, USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Kelly A. Bennett
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN, USA
| | - Ellen L. Tilden
- Oregon Health and Science University School of Nursing, Portland, OR, USA
| | - Nicole S. Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Mary S. Dietrich
- Schools of Nursing and Medicine, Vanderbilt University, Nashville, TN, USA
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Neal JL, Lowe NK, Phillippi JC, Carlson NS, Knupp AM, Dietrich MS. Likelihood of cesarean birth among parous women after applying leading active labor diagnostic guidelines. Midwifery 2018; 67:64-69. [PMID: 30253316 DOI: 10.1016/j.midw.2018.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Revised: 08/24/2018] [Accepted: 09/10/2018] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Hospital admission during early labor may increase women's risk for medical and surgical interventions. However, it is unclear which diagnostic guideline is best suited for identifying the active phase of labor among parous women. Dr. Emanuel Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) support different active labor diagnostic guidelines. Our aims were (1) to determine the proportions of parous women admitted to the hospital before or in active labor per these leading guidelines and (2) to compare associations of labor status at admission (i.e., early labor or active labor) with oxytocin augmentation, cesarean birth, and adverse birth outcomes when using the different active labor diagnostic guidelines. DESIGN Active labor diagnostic guidelines were applied retrospectively to cervical examination data. Binomial logistic regression was used to assess associations of labor status at admission (i.e., early labor relative to active labor) and outcomes. SETTING A large, academic, tertiary medical center in the Midwestern United States. PARTICIPANTS Parous women with spontaneous labor onset who gave birth to a single, cephalic-presenting fetus at term gestation between 2006 and 2010 (n = 3,219). FINDINGS At admission, 28.8%, 71.9%, and 24.4% of parous women were in active labor per Friedman, NICE, and ACOG/SMFM diagnostic guidelines, respectively. Oxytocin augmentation was more likely among women admitted in early labor, regardless of the diagnostic strategy used (p < 0.001 for each guideline). Cesarean birth was also more likely among women admitted before versus in active labor according to all guidelines (Friedman: adjusted odds ratio [AOR] 3.63 [95% CI 1.46-9.03]), NICE: AOR 2.71 [95% CI 1.47-4.99]), and ACOG/SMFM: AOR 2.11 [95% CI 1.02-4.34]). There were no differences in a composite measure of adverse outcomes within active labor diagnostic guidelines after adjusting for covariates. KEY CONCLUSIONS Many parous women with spontaneous labor onset are admitted to the hospital before active labor. These women are more likely to receive oxytocin augmentation during labor and are more likely to have a cesarean birth. IMPLICATIONS FOR PRACTICE Diagnosing active labor prior to admission or prior to intervention aimed at speeding labor after admission may decrease likelihoods for primary cesarean births. The NICE dilation-rate based active labor diagnostic guideline is more inclusive than Friedman or ACOG/SMFM guidelines and its use may be the most clinically-useful for improving the likelihood of vaginal birth among parous women.
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Affiliation(s)
- Jeremy L Neal
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Nancy K Lowe
- University of Colorado College of Nursing, 13120 East 19th Avenue, Aurora, CO 80045, USA.
| | - Julia C Phillippi
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
| | - Nicole S Carlson
- Emory University Nell Hodgson Woodruff School of Nursing, 1520 Clifton Rd NE, Atlanta, GA 30322, USA.
| | - Amy M Knupp
- The Ohio State University Wexner Medical Center, 410 West 10th Avenue, Columbus, OH USA.
| | - Mary S Dietrich
- Vanderbilt University School of Nursing, 461 21st Avenue South, Nashville, TN 37240, USA.
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Edmonds JK, Miley K, Angelini KJ, Shah NT. Decision Making about Hospital Arrival among Low-Risk Nulliparous Women after Spontaneous Labor Onset at Home. J Midwifery Womens Health 2018; 63:455-461. [PMID: 29763994 DOI: 10.1111/jmwh.12741] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 01/19/2018] [Accepted: 01/26/2018] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Postponing hospital admission until the active phase of labor is a recommended strategy to safely reduce the incidence of primary cesarean births. Success of this strategy depends on women's decisions about when to transfer from home to the hospital, a process that is largely absent from research about childbirth. This study aimed to determine the decision-making criteria used by women about when to go to the hospital after the self-identification of labor onset at home. METHODS A qualitative study was conducted at an academic medical center with a sample of 21 nulliparous women who went into spontaneous labor at home and had term, singleton, and vertex-presentation births. The purposive sample consisted of women who decided to stay at home or go to the hospital in early labor. Birth narratives from in-depth interviews conducted in the postpartum period using a semistructured interview guide were subjected to content analysis. The verbatim transcriptions of the interviews were coded and categorized into a set of decision criteria. RESULTS Criteria used by women in deciding to go to the hospital or stay at home in early labor included the degree of certainty with the self-identification of labor onset, ability to cope with labor pain, influence of social network members, health care provider advice, and concerns about travel to the hospital. Perception of childbirth risk and the need for reassurance about the normalcy of symptoms and fetal well-being also influenced women's decisions. DISCUSSION Women use a common set of criteria in deciding when to arrive at the hospital during labor. Antenatal education and telephone triage interventions that incorporate the considerations of women deciding to seek or delay hospital admission in childbirth may facilitate health seeking in more advanced labor. Symptom recognition education about early labor onset and progression could reduce decisional uncertainty.
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Ängeby K, Wilde-Larsson B, Hildingsson I, Sandin-Bojö AK. Prevalence of Prolonged Latent Phase and Labor Outcomes: Review of Birth Records in a Swedish Population. J Midwifery Womens Health 2018; 63:33-44. [DOI: 10.1111/jmwh.12704] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 09/26/2017] [Accepted: 09/27/2017] [Indexed: 11/27/2022]
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Pitchaimuthu N, Bhaskaran S. Labor Pattern Among Primigravida in Local Population. J Obstet Gynaecol India 2017; 68:482-486. [PMID: 30416276 DOI: 10.1007/s13224-017-1083-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 12/05/2017] [Indexed: 11/28/2022] Open
Abstract
Objectives In this study, we tried to make the customized labor curve by studying the labor pattern among the primigravidas and we compared the cervicograph with Zhang's and Suzuki's curves. This study may be a motivator for future research to create own labor norms for our Indian population which may help in reducing the cesarean section rates, principally in primigravidas. Materials and Methods It was a prospective observational study, which included 156 primigravidas with uncomplicated term singleton pregnancy with spontaneous onset and progression of labor, who had normal vaginal delivery with good maternal and neonatal outcome. Results The shape of the labor curve of this study was similar to Zhang' and Suzuki-Horiuchi's curves which had slower progression. The active phase started from 5 to 6 cm of cervical dilatation onwards which was similar to Suzuki-Horiuchi's curve. In the present study, the mean rate of cervical dilatation in the active phase was 1.5 cm/hour in contrast to Friedman's study which had a mean rate of cervical dilatation of 3 cm/hour with lower limit of 1.2 cm/hour as 5th centile. Conclusion In the present study the mean rate of cervical dilatation in active phase in Indian women was approximately equivalent to the lowest acceptable rate of cervical dilatation in Friedman's study. If we continued to follow Friedman's labor norms, it could result in increasing c-sections. Hence, it would be prudent to create a customized labor curve for the local population served based on their individual characteristics features.
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Affiliation(s)
- Nivethitha Pitchaimuthu
- Department of Obstetrics and Gynaecology, Southern Railway HQ Hospital, Chennai, Constable Road, Perambur, Aynavaram, Chennai, Tamilnadu 600023 India
| | - Shanta Bhaskaran
- Department of Obstetrics and Gynaecology, Southern Railway HQ Hospital, Chennai, Constable Road, Perambur, Aynavaram, Chennai, Tamilnadu 600023 India
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Agosta LJ, Johnson C. Implementing Interventions Aimed at Reducing Rates of Cesarean Birth. Nurs Womens Health 2017; 21:260-273. [PMID: 28784207 DOI: 10.1016/j.nwh.2017.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 03/20/2017] [Indexed: 10/19/2022]
Abstract
Increased incidence of both nulliparous, term, singleton, vertex and overall cesarean birth rates has warranted close monitoring and scrutiny by various health care associations and by individual obstetric facilities and providers of obstetric care. Concerted efforts to reduce rates of nonmedically indicated cesarean birth have resulted in the development and implementation of comprehensive action plans aimed at effecting reductions and enhancing overall obstetric quality care. Here we describe how a multidisciplinary team at our hospital developed and implemented interventions aimed at reducing rates of cesarean birth.
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Edmonds JK, Zabbo G. Women's Descriptions of Labor Onset and Progression Before Hospital Admission. Nurs Womens Health 2017; 21:250-258. [PMID: 28784206 DOI: 10.1016/j.nwh.2017.06.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 03/08/2017] [Indexed: 10/19/2022]
Abstract
We conducted a cross-sectional, descriptive, qualitative study, set in a postpartum unit, of 21 nulliparous women who spontaneously went into term labor at home. Our aim was to characterize symptoms of labor onset and progression to active labor before hospital admission for childbirth. The most frequent symptoms reported at labor onset were contractions, pain, ruptured membranes, cramping, and feelings of nervousness and excitement. Women reported that as labor progressed to the active phase, their pain increased, length and strength of contractions increased, and labor symptoms became more difficult to tolerate. Women's descriptions of symptoms of labor onset can aid the development of criteria to help women identify active labor and support decisions about timing of hospital admission for childbirth.
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Javernick JA, Dempsey A. Reducing the Primary Cesarean Birth Rate: A Quality Improvement Project. J Midwifery Womens Health 2017; 62:477-483. [DOI: 10.1111/jmwh.12606] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 12/07/2016] [Accepted: 12/11/2016] [Indexed: 11/28/2022]
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Neal JL, Lowe NK, Phillippi JC, Ryan SL, Knupp AM, Dietrich MS, Thung SF. Likelihood of cesarean delivery after applying leading active labor diagnostic guidelines. Birth 2017; 44:128-136. [PMID: 28198038 PMCID: PMC7608623 DOI: 10.1111/birt.12274] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Revised: 12/09/2016] [Accepted: 12/11/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND Friedman, the United Kingdom's National Institute for Health and Care Excellence (NICE), and the American College of Obstetricians and Gynecologists/Society for Maternal-Fetal Medicine (ACOG/SMFM) support different active labor diagnostic guidelines. Our aims were to compare likelihoods for cesarean delivery among women admitted before vs in active labor by diagnostic guideline (within-guideline comparisons) and between women admitted in active labor per one or more of the guidelines (between-guideline comparisons). DESIGN Active labor diagnostic guidelines were retrospectively applied to cervical examination data from nulliparous women with spontaneous labor onset (n = 2573). Generalized linear models were used to determine outcome likelihoods within- and between-guideline groups. RESULTS At admission, 15.7%, 48.3%, and 10.1% of nulliparous women were in active labor per Friedman, NICE, and ACOG/SMFM diagnostic guidelines, respectively. Cesarean delivery was more likely among women admitted before vs in active labor per the Friedman (AOR 1.75 [95% CI 1.08-2.82] or NICE guideline (AOR 2.55 [95% CI 1.84-3.53]). Between guidelines, cesarean delivery was less likely among women admitted in active labor per the NICE guideline, as compared with the ACOG/SMFM guideline (AOR 0.55 [95% CI 0.35-0.88]). CONCLUSION Many nulliparous women are admitted to the hospital before active labor onset. These women are significantly more likely to have a cesarean delivery. Diagnosing active labor before admission or before intervention to speed labor may be one component of a multi-faceted approach to decreasing the primary cesarean rate in the United States. The NICE diagnostic guideline is more inclusive than Friedman or ACOG/SMFM guidelines and its use may be the most clinically useful for safely lowering cesarean rates.
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Affiliation(s)
- Jeremy L. Neal
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Nancy K. Lowe
- College of Nursing, University of Colorado, Aurora, CO, USA
| | | | - Sharon L. Ryan
- Clinical Nursing, The Ohio State University College of Nursing, Columbus, OH, USA
| | - Amy M. Knupp
- Nursing Quality Improvement & Patient Safety at The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mary S. Dietrich
- Schools of Nursing and Medicine at Vanderbilt University, Nashville, TN, USA
| | - Stephen F. Thung
- Department of Obstetrics &Gynecology, The Ohio State University, Columbus, OH, USA
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Paul JA, Yount SM, Breman RB, LeClair M, Keiran DM, Landry N, Dever K. Use of an Early Labor Lounge to Promote Admission in Active Labor. J Midwifery Womens Health 2017; 62:204-209. [DOI: 10.1111/jmwh.12591] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 10/08/2016] [Accepted: 10/19/2016] [Indexed: 11/29/2022]
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Committee Opinion No. 687: Approaches to Limit Intervention During Labor and Birth. Obstet Gynecol 2017; 129:e20-e28. [DOI: 10.1097/aog.0000000000001905] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
IMPORTANCE The role of obstetric triage in the care of pregnant women has expanded significantly. Factors driving this change include the Emergency Medical Treatment and Active Labor Act, improved methods of testing for fetal well-being, increasing litigation risk, and changes in resident duty hour guidelines. The contemporary obstetric triage facility must have processes in place to provide a medical screening examination that complies with regulatory statues while considering both the facility's maternal level of care and available resources. OBJECTIVE This review examines the history of the development of obstetric triage, current considerations in a contemporary obstetric triage paradigm, and future areas for consideration. An example of a contemporary obstetric triage program at an academic medical center is presented. RESULT A successful contemporary obstetric triage paradigm is one that addresses the questions of "sick or not sick" and "labor or no labor," for every obstetric patient that presents for care. Failure to do so risks poor patient outcome, poor patient satisfaction, adverse litigation outcome, regulatory scrutiny, and exclusion from federal payment programs. CONCLUSIONS Understanding the role of contemporary obstetric triage in the current health care environment is important for both providers and health care leadership. TARGET AUDIENCE This study is for obstetricians and gynecologists as well as family physicians. LEARNING OBJECTIVES After completing this activity, the learner should be better able to understand the scope of a medical screening examination within the context of contemporary obstetric triage; understand how a facility's level of maternal care influences clinical decision making in a contemporary obstetric triage setting; and understand the considerations necessary for the systematic evaluation of the 2 basic contemporary obstetric questions, "sick or not sick?" and "labor or no labor?"
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Lee N, Kildea S, Stapleton H. "No pain, no gain": The experience of women using sterile water injections. Women Birth 2016; 30:153-158. [PMID: 27771320 DOI: 10.1016/j.wombi.2016.09.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 08/22/2016] [Accepted: 09/29/2016] [Indexed: 11/27/2022]
Abstract
PROBLEM/BACKGROUND Sterile water injections (SWI) are gaining popularity amongst women and midwives for the relief of back pain in labour. However the brief but intense pain associated with the injection has been cited as a deterrent to use and may negatively affect the birth experience. AIM To explore women's experiences of using sterile water injections as analgesia for back pain in labour. DESIGN A qualitative study, which generated data through individual semi-structured interviews with postnatal women. Data were analysed thematically. SETTING Two metropolitan maternity units in Queensland, Australia. PARTICIPANTS Nine postnatal women who had participated in a randomised controlled trial investigating the use of sterile water injections for back pain in labour FINDINGS: Three major themes were identified including sterile water injections as a non-pharmacological injection; balancing injection pain against expectations of pain relief; the analgesic effect of sterile water injections. KEY CONCLUSIONS Women in this study largely viewed sterile water injections as an effective analgesia with few side effects. The pain associated with the injection of sterile water was weighed against the likelihood of rapid, effective pain relief. Women used the period of analgesia to support their objectives, be this a period of respite during the labour or to enhance the ability to focus on the birth experience. Information on SWI provided by health professionals should also balance realistic descriptions of the injection pain with prospect of analgesia.
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Affiliation(s)
- Nigel Lee
- School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, Queensland 4072, Australia; Midwifery Research Unit, Mater Research Institute-UQ, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia.
| | - Sue Kildea
- School of Nursing, Midwifery and Social Work, University of Queensland, St. Lucia, Queensland 4072, Australia; Midwifery Research Unit, Mater Research Institute-UQ, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia; Mater Mothers' Hospital, Mater Health Services, Raymond Terrace, South Brisbane 4101, Australia
| | - Helen Stapleton
- Midwifery Research Unit, Mater Research Institute-UQ, Aubigny Place, Raymond Terrace, South Brisbane, Queensland 4101, Australia
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Dias MAB, Domingues RMSM, Schilithz AOC, Nakamura-Pereira M, do Carmo Leal M. Factors associated with cesarean delivery during labor in primiparous women assisted in the Brazilian Public Health System: data from a National Survey. Reprod Health 2016; 13:114. [PMID: 27766983 PMCID: PMC5073796 DOI: 10.1186/s12978-016-0231-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND The rate of cesarean delivery (CD) in Brazil has increased over the past 40 years. The CD rate in public services is three times above the World Health Organization recommended values. Among strategies to reduce CD, the most important is reduction of primary cesarean. This study aimed to describe factors associated with CD during labor in primiparous women with a single cephalic pregnancy assisted in the Brazilian Public Health System (SUS). METHODS This study is part of the Birth in Brazil survey, a national hospital-based study of 23,894 postpartum women and their newborns. The rate of CD in primiparous women was estimated. Univariate and multivariable logistic regression was performed to analyze factors associated with CD during labor in primiparous women with a single cephalic pregnancy, including estimation of crude and adjusted odds ratios and their respective 95 % confidence intervals. RESULTS The analyzed data are related to the 2814 eligible primiparous women who had vaginal birth or CD during labor in SUS hospitals. In adjusted analyses, residing in the Southeast region was associated with lower CD during labor. Occurrence of clinical and obstetric conditions potentially related to obstetric emergencies before delivery, early admission with < 4 cm of dilatation, a decision late in pregnancy for CD, and the use of analgesia were associated with a greater risk for CD. Favorable advice for vaginal birth during antenatal care, induction of labor, and the use of any good practices during labor were protective factors for CD. The type of professional who attended birth was not significant in the final analyses, but bivariate analysis showed a higher use of good practices and a smaller proportion of epidural analgesia in women cared for by at least one nurse midwife. CONCLUSIONS The CD rate in primiparous women in SUS in Brazil is extremely high and can compromise the health of these women and their newborns. Information and support for vaginal birth during antenatal care, avoiding early admission, and promoting the use of good practices during labor assistance can reduce unnecessary CD. Considering the experience of other countries, incorporation of nurse midwives in childbirth care may increase the use of good practices during labor.
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Affiliation(s)
| | | | | | - Marcos Nakamura-Pereira
- Instituto Fernandes Figueira/FIOCRUZ, Av. Rui Barbosa 716, Rio de Janeiro, CEP: 22250-020 Brasil
| | - Maria do Carmo Leal
- Escola Nacional Saúde Publica Sérgio Arouca/FIOCRUZ, Av. Brasil, 4365 - Manguinhos, Rio de Janeiro, CEP: 21040-360 Brasil
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Mikolajczyk RT, Zhang J, Grewal J, Chan LC, Petersen A, Gross MM. Early versus Late Admission to Labor Affects Labor Progression and Risk of Cesarean Section in Nulliparous Women. Front Med (Lausanne) 2016; 3:26. [PMID: 27446924 PMCID: PMC4921453 DOI: 10.3389/fmed.2016.00026] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2016] [Accepted: 05/21/2016] [Indexed: 11/29/2022] Open
Abstract
Background Rates of cesarean section increase worldwide, and the components of this increase are partially unknown. A strong role is prescribed to dystocia, and at the same time, the diagnosis of dystocia is highly subjective. Previous studies indicated that risk of cesarean is higher when women are admitted to the hospital early in the labor. Methods We examined data on 1,202 nulliparous women with singleton, vertex pregnancies and spontaneous labor onset. We selected three groups based on cervical dilatation at admission: early (0.5–1.5 cm, N = 178), intermediate (2.5–3.5 cm, N = 320), and late (4.5–5.5 cm, N = 175). The Kaplan–Meier estimator was used to analyze the risk of delivery by cesarean section at a given dilatation, and thin-plate spline regression with a binary outcome (R library gam) to assess the form of the associations between the cesarean section in either the first or second stage versus vaginal delivery and dilatation at admission. Results Women who were admitted to labor early had a higher risk of delivery by cesarean section (18 versus 4% in the late admission group), while the risk of instrumental delivery did not differ (24 versus 24%). Before 4 cm dilatation, the earlier a woman was admitted to labor, the higher was her risk of delivery by cesarean section. After 4 cm dilatation, however, the relationship disappeared. These patterns were true for both first and second stage cesarean deliveries. Oxytocin use was associated with a higher risk of cesarean section only in the middle group (2.5–3.5 cm dilatation at admission). Conclusion Early admission to labor was associated with a significantly higher risk of delivery by cesarean section during the first and second stages. Differential effects of oxytocin augmentation depending on dilation at admission may suggest that admission at the early stage of labor is an indicator rather than a risk factor itself, but admission at the intermediate stage (2.5–3.5 cm) becomes a risk factor itself. Further research is needed to study this hypothesis.
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Affiliation(s)
- Rafael T Mikolajczyk
- Department for Epidemiology of Infectious Diseases, Hannover Medical School, Hannover, Germany; Department of Epidemiology, Helmholtz-Centre for Infection Research, Braunschweig, Germany
| | - Jun Zhang
- Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiaotong University School of Medicine , Shanghai , China
| | - Jagteshwar Grewal
- Epidemiology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health , Bethesda, MD , USA
| | - Linda C Chan
- Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Naval Hospital Camp Lejeune , Camp Lejeune, NC , USA
| | - Antje Petersen
- Midwifery Research and Education Unit, Department of Gynecology and Obstetrics, Hannover Medical School , Hannover , Germany
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Department of Gynecology and Obstetrics, Hannover Medical School , Hannover , Germany
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Faivre M, Mottet N, Bourtembourg A, Ramanah R, Maillet R, Riethmuller D. Pronostic obstétrical de la présentation du siège en cas d’admission en travail avancé. ACTA ACUST UNITED AC 2016; 45:585-91. [DOI: 10.1016/j.jgyn.2015.06.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Revised: 05/18/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
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Carlsson IM. Being in a safe and thus secure place, the core of early labour: A secondary analysis in a Swedish context. Int J Qual Stud Health Well-being 2016; 11:30230. [PMID: 27172510 PMCID: PMC4864843 DOI: 10.3402/qhw.v11.30230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/10/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Early labour is the very first phase of the labour process and is considered to be a period of time when no professional attendance is needed. However there is a high frequency of women who seek care at the delivery wards during this phase. When a woman is admitted to the delivery ward, one role for midwives is to determine whether the woman is in established labour or not. If the woman is assessed as being in early labour she will probably then be advised to return home. This recommendation is made due to past research that found that the longer a woman is in hospital the higher the risk for complications for her and her child. Women have described how this situation leaves them in a vulnerable situation where their preferences are not always met and where they are not always included in the decision-making process. AIM The aim of this study was to generate a theory based on where a woman chooses to be during the early labour process and to increase our understanding about how experiences can differ from place to place. METHODS The method was a secondary analysis with grounded theory. The data used in the analysis was from two qualitative interview studies and 37 transcripts. CONCLUSION The findings revealed a substantive theory that women needed to be in a safe and thus secure place during early labour. This theory also describes the interplay between how women ascribed their meaning of childbirth as either a natural live event or a medical one, how this influenced where they wanted to be during early labour, and how that chosen place influenced their experiences of labour and birth.
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Affiliation(s)
- Ing-Marie Carlsson
- School of Health and Welfare, department of health and nursing, Halmstad University, Halmstad, Sweden;
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Tilden EL, Emeis CL, Caughey AB, Weinstein SR, Futernick SB, Lee CS. The Influence of Group Versus Individual Prenatal Care on Phase of Labor at Hospital Admission. J Midwifery Womens Health 2016; 61:427-34. [DOI: 10.1111/jmwh.12437] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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