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Levett KM, Sutcliffe KL, Vanderlaan J, Kjerulff KH. The First Baby Study: What women would like to have known about first childbirth. A mixed-methods study. Birth 2024. [PMID: 39166782 DOI: 10.1111/birt.12854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 02/06/2024] [Accepted: 07/24/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Although prenatal care providers aim to prepare women for first childbirth, little research has explored retrospectively what birthing people would like to have known before first childbirth. AIM To describe women's reports of what they would like to have known before first childbirth but feel they were not told. METHODS This is a secondary analysis of the First Baby Study, a large prospective cohort study conducted in Pennsylvania, USA. Telephone interviews were conducted with 3006 women 1 month after their first childbirth. Women were first asked: "Was there anything that you would have liked to have known before your delivery that you were not told?". If "yes" they were asked a second question: "Please tell me what you would have liked to have known before your delivery". ANALYSIS A convergent mixed-methods analysis including descriptive analytics to compare characteristics of women by answers to the first question, and qualitative content analysis of women's open-ended answers to the second question. FINDINGS A total of 441 women (14.7%) reported there was something they would like to have known before their first childbirth. Women described that communication with care providers was their main concern. They would have liked a better understanding of their options before birth, more agency in decision-making, and more information about the topics of their body, their birth, their baby, and what to expect beyond birth. CONCLUSIONS Results highlight important topics for childbirth education, and the impact of gaps in shared decision-making, patient-provider communication, and supportive care practices for first childbirth, especially where women have identified vulnerabilities.
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Affiliation(s)
- Kate M Levett
- National School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- NICM Health Research Institute, and THRI, Western Sydney University, Sydney, New South Wales, Australia
- Collective for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Kerry L Sutcliffe
- National School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
| | | | - Kristen H Kjerulff
- Department of Public Health Sciences and Obstetrics and Gynecology, College of Medicine, Penn State University, University Park, Pennsylvania, USA
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2
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Barthasarathy K, Lam L. Perinatal outcomes among Indian-born mothers in Australia. BMC Pregnancy Childbirth 2023; 23:595. [PMID: 37605130 PMCID: PMC10440895 DOI: 10.1186/s12884-023-05897-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 08/03/2023] [Indexed: 08/23/2023] Open
Abstract
OBJECTIVE To examine the incidence of adverse perinatal outcomes and the risk of adverse perinatal outcomes for Indian-born mothers compared to other mothers living and giving birth in Australia. DESIGN, SETTING AND PARTICIPANTS This retrospective cohort study was designed to investigate all births in Australia in 2012 and those in the Monash Health Birthing Outcomes System (BOS) 2014 to Indian-born mothers in Australia. Data sets were analysed involving descriptive statistics using Statistical Package for Social Sciences (SPSS vs. 23). RESULTS Indian-born mothers in Australia are at increased risk of induced labour, emergency caesarean section, very preterm birth (20-27 weeks), babies with low to very low birth weight, and low Apgar score (0-2) at 5 min, gestational diabetes, hypothyroidism, iron deficiency anaemia and vitamin B12 deficiencies compared to other mothers giving birth in Australia. This is despite a range of protective factors (25-34 years, married, nonsmokers, and a BMI < 30) that would normally be expected to reduce the risk of adverse perinatal outcomes for mothers giving birth in a developed country. CONCLUSION In the absence of many of the recognized maternal risk factors, Indian-born mothers continue to face increased risk of adverse perinatal outcomes, despite access to high quality maternity care in Australia. Recommendations arising from this study include the need for an intervention study to identify maternal risk factors for Indian-born mothers in mid to late pregnancy that contribute to the risk for very preterm birth and low birth weight.
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Affiliation(s)
| | - Louisa Lam
- School of Nursing, Midwifery and Paramedicine (VIC), Australian Catholic University, Sydney, VIC, Australia.
- Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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3
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Kragelund Nielsen K, Davidsen E, Husted Henriksen A, Andersen GS. Gestational Diabetes and International Migration. J Endocr Soc 2022; 7:bvac160. [DOI: 10.1210/jendso/bvac160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
In many countries, immigrant women constitute a substantial proportion of women giving birth. With gestational diabetes being one of the most common complications in pregnancy, understanding gestational diabetes in the context of international migration becomes increasingly relevant. Here, we examine the current evidence related to international migration and gestational diabetes, including short- and long-term adverse outcomes and the experiences of immigrant women with gestational diabetes care and long-term follow-up. Existing evidence focuses on immigrants in high-income countries, and has mainly examined differences in the risk of developing gestational diabetes, or on the experiences of immigrant women diagnosed with gestational diabetes. Studies suggest that the risk of gestational diabetes may be influenced by migration and that immigrant women likely experience particular barriers to care and follow-up. Current research on perinatal outcomes is inconclusive and studies on long-term outcomes are practically absent. Future research should include data on country of origin and examine the role of premigration and postmigration factors in developing gestational diabetes and its associated short- and long-term outcomes. Understanding these factors will provide useful insights into improving the health and health care needs of migrating populations and enable inclusion of culturally appropriate health care practices, thereby improving the health of our current and future generations.
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Affiliation(s)
| | - Emma Davidsen
- Health Promotion Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
| | | | - Gregers S Andersen
- Clinical Research, Steno Diabetes Center Copenhagen , 2730 Herlev , Denmark
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4
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Väisänen H, Remes H, Martikainen P. Perinatal health among migrant women: A longitudinal register study in Finland 2000-17. SSM Popul Health 2022; 20:101298. [DOI: 10.1016/j.ssmph.2022.101298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 11/18/2022] [Accepted: 11/18/2022] [Indexed: 11/25/2022] Open
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Burger RJ, Delagrange H, van Valkengoed IGM, de Groot CJM, van den Born BJH, Gordijn SJ, Ganzevoort W. Hypertensive Disorders of Pregnancy and Cardiovascular Disease Risk Across Races and Ethnicities: A Review. Front Cardiovasc Med 2022; 9:933822. [PMID: 35837605 PMCID: PMC9273843 DOI: 10.3389/fcvm.2022.933822] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/06/2022] [Indexed: 12/30/2022] Open
Abstract
Pregnancy is often considered to be a "cardiometabolic stress-test" and pregnancy complications including hypertensive disorders of pregnancy can be the first indicator of increased risk of future cardiovascular disease. Over the last two decades, more evidence on the association between hypertensive disorders of pregnancy and cardiovascular disease has become available. However, despite the importance of addressing existing racial and ethnic differences in the incidence of cardiovascular disease, most research on the role of hypertensive disorders of pregnancy is conducted in white majority populations. The fragmented knowledge prohibits evidence-based targeted prevention and intervention strategies in multi-ethnic populations and maintains the gap in health outcomes. In this review, we present an overview of the evidence on racial and ethnic differences in the occurrence of hypertensive disorders of pregnancy, as well as evidence on the association of hypertensive disorders of pregnancy with cardiovascular risk factors and cardiovascular disease across different non-White populations, aiming to advance equity in medicine.
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Affiliation(s)
- Renée J Burger
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
| | - Hannelore Delagrange
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Irene G M van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Public Health, Health Behaviors & Chronic Diseases, Amsterdam, Netherlands
| | - Christianne J M de Groot
- Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands.,Department of Obstetrics and Gynaecology, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bert-Jan H van den Born
- Department of Vascular Medicine, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Cardiovascular Sciences, Atherosclerosis and Ischemic Syndromes, Amsterdam, Netherlands
| | - Sanne J Gordijn
- Department of Obstetrics, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Wessel Ganzevoort
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location University of Amsterdam, Amsterdam, Netherlands.,Amsterdam Reproduction and Development, Pregnancy and Birth, Amsterdam, Netherlands
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6
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Adverse Pregnancy Outcomes and International Immigration Status: A Systematic Review and Meta-analysis. Ann Glob Health 2022; 88:44. [PMID: 35854922 PMCID: PMC9248985 DOI: 10.5334/aogh.3591] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 06/02/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Disparities in health outcomes between immigrant and native-origin populations, particularly pregnant women, pose significant challenges to healthcare systems. The aim of this systematic-review and meta-analysis was to investigate the risk of adverse pregnancy outcomes among immigrant-women compared to native-origin women in the host country. Methods: PubMed (including MEDLINE), Scopus, and Web of Science were searched to retrieve studies published in English language up to September 2020. All observational studies examining the prevalence of at least one of the short-term single pregnancy outcomes for immigrants who crossed international borders compared to native-origin pregnant population were included. The meta-prop method was used for the pooled-estimation of adverse pregnancy-outcomes’ prevalence. For pool-effect estimates, the association between the immigration-status and outcomes of interest, the random-effects model was applied using the model described by DerSimonian and Laird. I2 statistic was used to assess heterogeneity. The publication bias was assessed using the Harbord-test. Meta-regression was performed to explore the effect of geographical region as the heterogeneity source. Findings: This review involved 11 320 674 pregnant women with an immigration-background and 56 102 698 pregnant women as the native-origin population. The risk of emergency cesarean section (Pooled-OR = 1.1, 95%CI = 1.0–1.2), shoulder dystocia (Pooled-OR = 1.1, 95%CI = 1.0–1.3), gestational diabetes mellites (Pooled-OR = 1.4, 95%CI = 1.2–1.6), small for gestational age (Pooled-OR=1.3, 95%CI = 1.1–0.4), 5-min Apgar less than 7 (Pooled-OR = 1.2, 95%CI = 1.0–1.3) and oligohydramnios (Pooled-OR = 1.8, 95%CI = 1.0–3.3) in the immigrant women were significantly higher than those with the native origin background. The immigrant women had a lower risk of labor induction (Pooled-OR = 0.8, 95%CI = 0.7–0.8), pregnancy induced hypertension (Pooled-OR = 0.6, 95%CI = 0.5–0.7) preeclampsia (Pooled-OR = 0.7, 95%CI = 0.6–0.8), macrosomia (Pooled-OR = 0.8, 95%CI = 0.7–0.9) and large for gestational age (Pooled-OR = 0.8, 95%CI = 0.7–0.8). Also, the risk of total and primary cesarean section, instrumental-delivery, preterm-birth, and birth-trauma were similar in both groups. According to meta-regression analyses, the reported ORs were not influenced by the country of origin. Conclusion: The relationship between the immigration status and adverse perinatal outcomes indicated a heterogenous pattern, but the immigrant women were at an increased risk of some important adverse pregnancy outcomes. Population-based studies with a focus on the various aspects of this phenomena are required to explain the source of these heterogenicities.
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7
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Panahi MH, Mardani A, Gåre Kymre I, Paal P, Vaismoradi M. A Systematic Review and Meta-Analysis of the Risk of Stillbirth, Perinatal and Neonatal Mortality in Immigrant Women. Int J Public Health 2022; 67:1604479. [PMID: 35664648 PMCID: PMC9156626 DOI: 10.3389/ijph.2022.1604479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 04/28/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives: This study aimed to investigate the risk of stillbirth, perinatal and neonatal mortality in immigrant women compared to native-origin women in host countries. Methods: A systematic literature review and meta-analysis was conducted. Relevant studies were identified using a thorough literature search and their quality was appraised. The analysis of heterogeneous data was carried out using the random effects model and publication bias was assessed using the Harbord-test. Also, the pooled odds ratio of events was calculated through the DerSimonian and Laird, and inverse variance methods. Results: In the search process 45 studies were retrieved consisting of 8,419,435 immigrant women and 40,113,869 native-origin women. The risk of stillbirth (Pooled OR = 1.35, 95% CI = 1.22-1.50), perinatal mortality (Pooled OR = 1.50, 95% CI = 1.35-1.68), and neonatal mortality (Pooled OR = 1.09, 95% CI = 1.00-1.19) in the immigrant women were significantly higher than the native-origin women in host countries. According to the sensitivity analyses, all results were highly consistent with the main data analysis results. Conclusion: The immigrant women compared to the native-origin women had the higher risks of stillbirth, perinatal and neonatal mortality. Healthcare providers and policy makers should improve the provision of maternal and neonatal healthcare for the immigrant population.
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Affiliation(s)
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing Care Research Center, Department of Medical Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | | | - Piret Paal
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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8
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Leppälä S, Lamminpää R, Gissler M, Vehviläinen-Julkunen K. Prenatal care adequacy of migrants born in conflict-affected countries and country-born parturients in Finland. J Migr Health 2022; 6:100122. [PMID: 35677660 PMCID: PMC9168177 DOI: 10.1016/j.jmh.2022.100122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/14/2022] [Accepted: 05/30/2022] [Indexed: 11/30/2022] Open
Abstract
Migrants from conflict-affected areas had a 3.5-fold risk for delayed prenatal care. Less prenatal visits prior to term birth compared with country-born parturients. No differences in prepartum hospitalization between migrants and country-born parturients.
Background The 2015 refugee crisis led into a forced migration of millions of people globally. As a consequence, many countries experienced a quick change in the proportion of conflict-area born migrants. This group being stated as an especially vulnerable group for suboptimal maternal health, a timely inspection of preventive maternity care was required. This study investigated prenatal care in terms of gestation trimester at the first prenatal visit, number of check-ups prior to birth, and prepartum hospitalization in conflict-country born migrants and Finnish parturients in Finland. Material and methods Cross-sectional study included all pregnancies of migrants born in conflict-affected countries (n = 3 155) and country-born parturients (n = 93 600) in Finland in 2015–16. The data were obtained through Medical Birth Registry and Population Information System. Statistical analysis employed T-test, Chi-square test, and logistic regression analysis. Odds ratios with 95% Confidence Intervals (CI) were adjusted for sociodemographic and health-related background variables. Results Migrant parturients had a higher probability for delayed enter in prenatal care compared with Finnish-born parturients (adjusted odds ratio aOR = 3.46; 95% Confidence Interval CI 3.06, 3.91). Recommended minimum number of check-ups was participated by 95.3% of the migrant, and 96.4% of the Finnish-born group (P <0.000). Migrants’ probability for more than ten visits prior to term birth was significantly lower (aOR = 0.58; 95% CI 0.51, 0.66). No significant differences in prepartum hospitalization yielded between the groups. Conclusions Migrant parturients had significantly smaller number of check-ups and later entry in care compared with the country-born parturients. These findings add to earlier reported challenges in the organizing of conflict-affected country born migrants’ prenatal care in a high-income setting, in which the proportion of conflict-area born migrants has risen rapidly and unexpectedly.
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Affiliation(s)
- Satu Leppälä
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Corresponding author.
| | - Reeta Lamminpää
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
| | - Mika Gissler
- Department of Knowledge Brokers, THL Finnish Institute for Health and Welfare, Helsinki, Finland
- Department of Molecular Medicine and Surgery, Karolinska Institute, Stockholm, Sweden
| | - Katri Vehviläinen-Julkunen
- Department of Nursing Science, University of Eastern Finland, P.O. Box 1627, Kuopio 70211, Finland
- Kuopio University Hospital, Finland
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9
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Making good care essential: The impact of increased obstetric interventions and decreased services during the COVID-19 pandemic. Women Birth 2021; 35:484-492. [PMID: 34774446 PMCID: PMC8559154 DOI: 10.1016/j.wombi.2021.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/30/2021] [Accepted: 10/21/2021] [Indexed: 11/21/2022]
Abstract
Problem & background Since the onset of the COVID-19 pandemic in Canada, policies have been implemented to limit interpersonal contact in clinical and community settings. The impacts of pandemic-related policies on experiences of pregnancy and birth are crucial to investigate and learn from. Aim To examine the impact of pandemic policy changes on experiences of pregnancy and birth, thereby identifying barriers to good care; to inform understandings of medicalization, care, pregnancy, and subjectivity during times of crisis; and to critically examine the assumptions about pregnancy and birth that are sustained and produced through policy. Methods Qualitative descriptive study drawing on 67 in-depth interviews with people who were pregnant and/or gave birth in Canada during the pandemic. The study took a social constructionist standpoint and employed thematic analysis to derive meaning from study data. Findings The pandemic has resulted in an overall scaling back of perinatal care alongside the heavy use of interventions (e.g., induction of labour, cesarian section) in response to pandemic stresses and uncertainties. Intervention use here is an outcome of negotiation and collaboration between pregnant people and their care providers as they navigate pregnancy and birth in stressful, uncertain conditions. Discussion Continuity of care throughout pregnancy and postpartum, labour support persons, and non-clinical services and interventions for pain management are all essential components of safe maternal healthcare. However, pandemic perinatal care demonstrates that they are not viewed as such. Conclusion The pandemic has provided an opportunity to restructure Canadian reproductive health care to better support and encourage out-of-hospital births – including midwife-assisted births – for low-risk pregnancies.
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10
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Rogers HJ, Hogan L, Coates D, Homer CSE, Henry A. Cross Cultural Workers for women and families from migrant and refugee backgrounds: a mixed-methods study of service providers perceptions. BMC WOMENS HEALTH 2021; 21:222. [PMID: 34044833 PMCID: PMC8161620 DOI: 10.1186/s12905-021-01368-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/17/2021] [Indexed: 11/13/2022]
Abstract
Background Women from migrant and refugee backgrounds who live in high-income countries are at increased risk of adverse perinatal outcomes, including mental health issues, preterm birth and maternal and infant mortality. There is a need to implement and evaluate models of care to meet their specific needs in order to improve health outcomes, their experiences of care, and overcome barriers to access. In Sydney, Australia, a unique model of care was implemented to support women and families from migrant and refugee backgrounds to access health and community-based services through the continuum of pregnancy to the early parenting period. This model of care is known as the Cross Cultural Workers (CCWs) in Maternity and Child and Family Health Service (the CCW Service). The aim of this study was to explore the perceptions of service providers regarding the CCW Service and identify recommendations for improvement. Methods A mixed-methods study was conducted consisting of surveys and face to face semi-structured interviews. Service providers were recruited from hospital-based maternity and community-based services. Survey data were analysed descriptively. Interviews were analysed using qualitative content analysis. Results Sixty-nine service providers completed surveys and 19 were interviewed. The CCW Service was highly regarded by service providers who perceived it to be critical in improving care for women from migrant and refugee backgrounds. The overarching theme from the interviews was the ability of the CCW Service to act as a ‘bridge to health’ through the provision of culturally responsive care. There were three main categories; supporting access to health and community-based services, improving the healthcare experience, and organisational factors, including part-time hours, capacity, heavy workloads and confusion/lack of clarity regarding the CCW role, which affected CCWs’ capacity to optimally support service providers in providing culturally responsive care. These limitations meant CCWs were not able to meet demand, and fully operationalise the model. Conclusion Service providers perceived the CCW model to be a culturally responsive model of care tailored to the needs of women and families from migrant and refugee backgrounds, that reduces barriers to access, and has the potential to improve perinatal outcomes, and women's experience and satisfaction with care. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01368-4.
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Affiliation(s)
- Helen J Rogers
- Child, Youth and Family Services, South Eastern Sydney Local Health District, Sydney, NSW, 2010, Australia. .,School of Women's and Children's Health, University of NSW (UNSW), Sydney, NSW, 2052, Australia.
| | - Lily Hogan
- School of Women's and Children's Health, University of NSW (UNSW), Sydney, NSW, 2052, Australia
| | - Dominiek Coates
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia
| | - Caroline S E Homer
- Centre for Midwifery and Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, 2007, Australia.,Maternal and Child Health, Burnet Institute, Melbourne, VIC, 3004, Australia
| | - Amanda Henry
- School of Women's and Children's Health, University of NSW (UNSW), Sydney, NSW, 2052, Australia.,Department of Women's and Children's Health, St George Hospital, Sydney, NSW, 2217, Australia.,Australia Global Women's Health Program, The George Institute for Global Health, Sydney, NSW, 2042, Australia
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11
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Akyıldız D, Çoban A, Gör Uslu F, Taşpınar A. Effects of Obstetric Interventions During Labor on Birth Process and Newborn Health. FLORENCE NIGHTINGALE JOURNAL OF NURSING 2021; 29:9-21. [PMID: 34263219 PMCID: PMC8137733 DOI: 10.5152/fnjn.2021.19093] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 03/26/2020] [Indexed: 11/25/2022]
Abstract
AIM This study aimed to investigate the effects of the interventions in the delivery room on the delivery process and the newborn health. METHOD The analytical-cross-sectional study was carried out with 354 puerperal women who gave birth in hospital between December 2016 and June 2017 in a public hospital. The data were collected by the data collection form developed by the researchers. Data analysis was done by using descriptive statistics and chi-square test in SPSS 21.00 program. RESULTS The interventions were determined in continuous electro fetal monitoring (80.5%), oxytocin induction (79.9%), restriction of free movement (56.8%), amniotomy (49.7%), enema (44.1%), and movement restriction (56.8%). The intervention period of the second phase of delivery was longer and the rate of cesarean section was higher, and the need for NICU, suction difficulty, 5th APGAR score less than 7, trauma development, difficulty in suction, and higher trauma rates were found in infants. It was determined that the rate of oxygen need in puerperals admitted to the delivery room with cervical dilatation below five cm, vacuum and episiotomy applications in those who underwent amniotomy, and vacuum application rates in those undergoing oxytocin inductions were found to be high. In addition, the rate of fundal compression and episiotomy was significantly higher in patients who used continuous electro fetal monitoring, fundal compression and vacuum rate in patients who were administered analgesic drugs, and episiotomy rates in patients using analgesic drugs. CONCLUSION It has been concluded that interventions in the first phase of labor negatively affect the delivery process and neonatal health and increase the need for intervention in the second phase.
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Affiliation(s)
- Deniz Akyıldız
- Department of Midwifery, Kahramanmaras Sütçü İmam University, Faculty of Health Sciences, Kahramanmaraş, Turkey
| | - Ayden Çoban
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
| | | | - Ayten Taşpınar
- Department of Midwifery, Faculty of Health Sciences, Aydın Adnan Menderes University, Aydın, Turkey
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12
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Berman Y, Ibiebele I, Randall D, Torvaldsen S, Nippita TA, Bowen J, Baldwin HJ, Todd SM, Morris JM, Ford JB, Patterson JA. Rates of neonatal morbidity by maternal region of birth and gestational age in New South Wales, Australia 2003-2016. Acta Obstet Gynecol Scand 2020; 100:331-338. [PMID: 33007108 DOI: 10.1111/aogs.14012] [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: 02/12/2020] [Revised: 09/11/2020] [Accepted: 09/15/2020] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Research suggests that neonatal morbidity differs by maternal region of birth at different gestational ages. This study aimed to determine the overall and gestation-specific risk of neonatal morbidity by maternal region of birth, after adjustment for maternal, infant and birth characteristics, for women giving birth in New South Wales, Australia, from 2003 to 2016. MATERIAL AND METHODS The study utilized a retrospective cohort study design using linked births, hospital and deaths data. Modified Poisson regression was used to determine risk with 95% confidence intervals (95% CI) of neonatal morbidity by maternal region of birth, overall and at each gestational age, compared with Australian or New Zealand-born women giving birth at 39 weeks. RESULTS There were 1 074 930 live singleton births ≥32 weeks' gestation that met the study inclusion criteria, and 44 394 of these were classified as morbid, giving a neonatal morbidity rate of 4.13 per 100 live births. The gestational age-specific neonatal morbidity rate declined from 32 weeks' gestation, reaching a minimum at 39 weeks in all maternal regions of birth. The unadjusted neonatal morbidity rate was highest in South Asian-born women at most gestations. Adjusted rates of neonatal morbidity between 32 and 44 weeks were significantly lower for babies born to East (adjusted relative risk [aRR] 0.65, 95% CI 0.62-0.68), South-east (aRR 0.76, 95% CI 0.73-0.79) and West Asian-born (aRR 0.93, 95% CI 0.88-0.98) mothers, and higher for babies of Oceanian-born (aRR 1.11, 95% CI 1.04-1.18) mothers, compared with Australian or New Zealand-born mothers. Babies of African, Oceanian, South Asian and West Asian-born women had a lower adjusted risk of neonatal morbidity than Australian or New Zealand-born women until 37 or 38 weeks' gestation, and thereafter an equal or higher risk in the term and post-term periods. CONCLUSIONS Maternal region of birth is an independent risk factor for neonatal morbidity in New South Wales.
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Affiliation(s)
- Ye'elah Berman
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, NSW, Australia
| | - Ibinabo Ibiebele
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Deborah Randall
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Siranda Torvaldsen
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW, Australia
| | - Tanya A Nippita
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Obstetrics and Gynecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Jennifer Bowen
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Neonatology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Heather J Baldwin
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Stephanie M Todd
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,NSW Biostatistics Training Program, NSW Ministry of Health, Sydney, NSW, Australia
| | - Jonathan M Morris
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia.,Department of Obstetrics and Gynecology, Royal North Shore Hospital, Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Jane B Ford
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
| | - Jillian A Patterson
- Women and Babies Research, The University of Sydney Northern Clinical School, St Leonards, NSW, Australia.,Kolling Institute, Northern Sydney Local Health District, St Leonards, NSW, Australia
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13
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Pérez-Morente MÁ, Gázquez-López M, Álvarez-Serrano MA, Martínez-García E, Femia-Marzo P, Pozo-Cano MD, Martín-Salvador A. Sexually Transmitted Infections and Associated Factors in Southeast Spain: A Retrospective Study from 2000 to 2014. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207449. [PMID: 33066154 PMCID: PMC7601973 DOI: 10.3390/ijerph17207449] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 01/02/2023]
Abstract
The World Health Organization estimates that more than one million people acquire a Sexually Transmitted Infection (STI) every day, compromising quality of life, sexual and reproductive health, and the health of newborns and children. It is an objective of this study to identify the factors related to a Sexually Transmitted Infection diagnosis in the province of Granada (Spain), as well as those better predicting the risk of acquiring such infections. In this study, 678 cases were analyzed on a retrospective basis, which were treated at the Centre for Sexually Transmitted Diseases and Sexual Orientation in Granada, between 2000–2014. Descriptive statistics were applied, and by means of binary logistic regression, employing the forward stepwise-likelihood ratio, a predictive model was estimated for the risk of acquiring an STI. Sex, age, occupation, economic crisis period, drug use, number of days in which no condoms were used, number of sexual partners in the last month and in the last year, and number of subsequent visits and new subsequent episodes were associated with an STI diagnosis (p < 0.05). The risk of being diagnosed with an STI increased during the economic crisis period (OR: 1.88; 95%-CI: 1.28–2.76); during the economic crisis and if they were women (OR:2.35, 95%- CI: 1.24–4.44); and if they were women and immigrants (OR: 2.09; 95%- CI:1.22–3.57), while it decreased with age (OR: 0.97, 95%-CI: 0.95–0.98). Identification of the group comprised of immigrant women as an especially vulnerable group regarding the acquisition of an STI in our province reflects the need to incorporate the gender perspective into preventive strategies and STI primary health care.
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Affiliation(s)
| | - María Gázquez-López
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain;
| | - María Adelaida Álvarez-Serrano
- Department of Nursing, Faculty of Health Sciences, University of Granada, 51001 Ceuta, Spain;
- Correspondence: (M.A.Á.-S.); (E.M.-G.)
| | - Encarnación Martínez-García
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain;
- Guadix High Resolution Hospital, 18500 Guadix, Granada, Spain
- Correspondence: (M.A.Á.-S.); (E.M.-G.)
| | - Pedro Femia-Marzo
- Department of Statistics, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain;
| | - María Dolores Pozo-Cano
- Department of Nursing, Faculty of Health Sciences, University of Granada, 18016 Granada, Spain;
| | - Adelina Martín-Salvador
- Department of Nursing, Faculty of Health Sciences, University of Granada, 52005 Melilla, Spain;
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14
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Levett KM, Lord SJ, Dahlen HG, Smith CA, Girosi F, Downe S, Finlayson KW, Fleet J, Steen M, Davey MA, Newnham E, Werner A, Arnott L, Sutcliffe K, Seidler AL, Hunter KE, Askie L. The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis. BMJ Open 2020; 10:e037175. [PMID: 32967876 PMCID: PMC7513601 DOI: 10.1136/bmjopen-2020-037175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Rates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme? METHODS AND ANALYSIS: Population: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural.Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women's confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting.Comparator: standard care alone in hospital-based maternity units. OUTCOMES Primary: CS.Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being.Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components. STUDY DESIGN An individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees. ETHICS AND DISSEMINATION Participants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group. TRIAL REGISTRATION NUMBER CRD42020103857.
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Affiliation(s)
- Kate M Levett
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
| | - Sarah J Lord
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, New South Wales, Australia
| | - Caroline A Smith
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
- Graduate Research School, University of Western Sydney, Kingswood, New South Wales, Australia
| | - Federico Girosi
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Capital Markets CRC, New South Wales, Australia, Sydney, New South Wales, Australia
| | - Soo Downe
- School of Midwifery and Community Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Julie Fleet
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary Steen
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary-Ann Davey
- Obstetrics & Gynaecology, Monash Health, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Elizabeth Newnham
- School of Nursing & Midwifery, Griffith University, Medowbrook, Queensland, Australia
| | - Anette Werner
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Leslie Arnott
- The B.E.A.R. Program, Lamaze Australia, Melbourne, Victoria, Australia
| | - Kerry Sutcliffe
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kylie Elizabeth Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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15
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Aasheim V, Nilsen RM, Vik ES, Small R, Schytt E. Epidural analgesia for labour pain in nulliparous women in Norway in relation to maternal country of birth and migration related factors. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 26:100553. [PMID: 32919243 DOI: 10.1016/j.srhc.2020.100553] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/28/2020] [Accepted: 09/01/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To investigate associations between maternal country of birth and other migration related factors (length of residence, reason for migration, paternal origin) and epidural analgesia for labour pain in nulliparous women in Norway. DESIGN Population-based register study including nulliparous migrant women (n = 75,922) and non-migrant women (n = 444,496) with spontaneous or induced labour. Data were retrieved from the Medical Birth Registry and Statistics Norway, 1990-2013. Odds ratios (OR) with 95% confidence intervals (CI) were estimated by logistic regression, and adjusted for maternal age, marital status, maternal education, gross income, birth year, hospital size and health region. MAIN OUTCOME Epidural analgesia for labour pain. RESULTS Epidural analgesia was administered to 38% of migrant women and 31% of non-migrant women. Compared with non-migrants, the odds of having epidural analgesia were lowest in women from Vietnam (adjOR 0.54; CI 0.50-0.59) and Somalia (adjOR 0.63; CI 0.58-0.68) and highest in women from Iran (adjOR 1.32; CI 1.19-1.46) and India (adjOR 1.19; CI 1.06-1.33). Refugees (adjOR 0.83; CI 0.79-0.87) and newly arrived migrants (adjOR 0.92; CI 0.89-0.94) had lower odds of epidural analgesia. Migrant women with a non-migrant partner (adjOR 1.14; CI 1.11-1.17) and those with length of residence ≥10 years (adjOR 1.06; CI 1.02-1.10) had higher odds. CONCLUSION The use of epidural analgesia varied by maternal country of birth, reason for migration, paternal origin and length of residence. Midwives and obstetricians should pay extra attention to the provision of adequate information about pain relief options for refugees and newly arrived migrants, who had the lowest use.
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Affiliation(s)
- Vigdis Aasheim
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway.
| | - Roy M Nilsen
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway; Department of Global Public Health and Primary Care, University of Bergen, Norway
| | - Rhonda Small
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne, Australia
| | - Erica Schytt
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Norway; Centre for Clinical Research Dalarna - University of Uppsala, Falun, Sweden
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16
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Cox AG, Narula S, Malhotra A, Fernando S, Wallace E, Davies-Tuck M. The influence of maternal ethnicity on neonatal respiratory outcome. Arch Dis Child Fetal Neonatal Ed 2020; 105:50-55. [PMID: 31123055 DOI: 10.1136/archdischild-2018-316418] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 04/08/2019] [Accepted: 04/11/2019] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Higher rates of neonatal morbidity and mortality at term combined with earlier spontaneous delivery have led to the hypothesis that babies born to South Asian born (SA-born) women may mature earlier and/or their placental function decreases earlier than babies born to Australian and New Zealand born (Aus/NZ-born) women. Whether babies born to SA-born women do better in the preterm period, however, has yet to be evaluated. In this study we investigated respiratory outcomes, indicative of functional maturity, of preterm babies born to SA-born women compared with those of Aus/NZ-born women to explore this hypothesis further. STUDY DESIGN AND SETTING This retrospective cohort study was conducted at Monash Health. PATIENTS Data were collected from neonatal and birth records of moderate-late preterm (32-36 weeks) infants born between 2012 and 2015 to SA-born and Aus/NZ-born women. OUTCOME MEASURES Rates of nursery admissions and neonatal respiratory outcomes were compared. RESULTS Babies born to Aus/NZ-born women were more likely to be admitted to a nursery (80%) compared with SA-born babies (72%, p=0.004). Babies born to SA-born mothers experienced significantly less hyaline membrane disease (7.8%), required less resuscitation at birth (28.6%) and were less likely to require ventilation (20%) than babies born to Aus/NZ-born mothers (18%, 42.2%, 34.6%; p<0.001). There was no difference in the duration of ventilation or length of stay in hospital. CONCLUSIONS Moderate-late preterm babies born to SA-born women appear to have earlier functional maturity, as indicated by respiratory outcomes, than Aus/NZ-born babies. Our findings support the hypothesis of earlier fetal maturation in SA-born women.
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Affiliation(s)
- Annie Georgina Cox
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Shagun Narula
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Atul Malhotra
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia.,Monash Newborn, Monash Medical Centre, Melbourne, Victoria, Australia.,Department of Pediatrics, Monash University, Melbourne, Victoria, Australia
| | - Shavi Fernando
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Euan Wallace
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
| | - Miranda Davies-Tuck
- Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria, Australia
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17
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Indian migrant women's experiences of motherhood and postnatal support in Australia: A qualitative study. Women Birth 2019; 33:479-489. [PMID: 31630995 DOI: 10.1016/j.wombi.2019.09.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Revised: 08/16/2019] [Accepted: 09/23/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The postpartum period can be challenging for many women. For migrant women, the arrival of a new baby brings unique issues. This study aimed to explore the experiences of motherhood and postpartum support of Indian migrant mothers. METHODS A qualitative descriptive naturalist inquiry was adopted, with data collected through face-to-face, semi-structured, in-depth interviews with a purposive sample of 11 English speaking Indian migrant women over 18 years old, (6 weeks to 6 months postpartum) in 2016. The data were thematically analysed. FINDINGS Four themes were found in this study: the role of social support in postpartum care, support from health services, a psycho-emotional journey with socio-cultural expectations and struggling to bridge two cultures. Many of the women felt alone and were distressed with undertaking household duties and caring for older children, as this would not have happened in India. The women expressed needing practical support until they settled back into their normal lives. Women never sought professional advice for their ongoing mental health concerns. Conflicting advice from health professionals left some women confused about their expectations of traditional and modern postnatal care. CONCLUSION This study gives a unique insight into the experiences of Indian migrant women following birth. There is a need for culturally sensitive and appropriate postnatal services that encourage Indian men to support their partners and help women to find alternative sources of culturally appropriate support. It is vital that mental health support is a key component of any such program of care.
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18
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Wan CS, Abell S, Aroni R, Nankervis A, Boyle J, Teede H. Ethnic differences in prevalence, risk factors, and perinatal outcomes of gestational diabetes mellitus: A comparison between immigrant ethnic Chinese women and Australian-born Caucasian women in Australia. J Diabetes 2019; 11:809-817. [PMID: 30773821 DOI: 10.1111/1753-0407.12909] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 01/03/2019] [Accepted: 02/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The prevalence of gestational diabetes mellitus (GDM) is increasing worldwide. Ethnic differences in risk factors and perinatal outcomes are clinically important. Chinese women constitute approximately 10% of the world's population, and are an increasing migrant population, yet prevalence, risk factors, and outcomes of GDM in this population are insufficiently explored. METHODS A retrospective study of a large pregnancy dataset comparing GDM prevalence, risk factors, and perinatal outcomes between immigrant ethnic Chinese women and Australian-born Caucasian women was conducted using logistic regression. RESULTS Overall, 73 517 births were extracted from the pregnancy databases of two of Australia's largest maternity services. Chinese women (n = 3419) had a 4-fold higher risk of GDM than Caucasians (n = 28 594) after adjusting for risk factors of GDM. A past history of GDM (adjusted odds ratio [aOR] 5.24; 95% confidence interval [95% CI] 2.91-9.42] was the main GDM risk factor in both groups. Other GDM risk factors varied between groups. Perinatal outcomes in Chinese women with and without GDM were similar, except for neonatal hypoglycemia (aOR 2.01; 95% CI 1.14-3.56]. Caucasian women with GDM had more adverse perinatal outcomes than women without GDM. After adjusting for confounders, Chinese women with GDM had a lower risk of labor induction, large-for-gestational-age babies, neonatal hypoglycemia, respiratory distress, and low Apgar scores than Caucasian women with GDM. CONCLUSIONS Differences in prevalence, risk profile, and adverse outcomes in GDM were evident between ethnic Chinese and Caucasian women. A precision medicine approach to GDM may be warranted considering ethnicity and individual risk profiles rather than a one-size-fits-all approach.
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Affiliation(s)
- Ching S Wan
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Sally Abell
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Rosalie Aroni
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Alison Nankervis
- Departments of Diabetes and Endocrinology, The Royal Melbourne and Royal Women's Hospitals, Parkville, Victoria, Australia
- Department of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
| | - Jacqueline Boyle
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Obstetrics and Gynecology, Monash Health, Clayton, Victoria, Australia
| | - Helena Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Endocrinology and Diabetes, Monash Health, Clayton, Victoria, Australia
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19
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Dahlen HG, Thornton C, Fowler C, Mills R, O'Loughlin G, Smit J, Schmied V. Characteristics and changes in characteristics of women and babies admitted to residential parenting services in New South Wales, Australia in the first year following birth: a population-based data linkage study 2000-2012. BMJ Open 2019; 9:e030133. [PMID: 31543503 PMCID: PMC6773315 DOI: 10.1136/bmjopen-2019-030133] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth. DESIGN A linked population data cohort study was undertaken for the years 2000-2012. SETTING New South Wales (NSW), Australia. PARTICIPANTS All women giving birth and babies born in NSW were compared with those admitted to RPS. RESULTS During the time period there were a total of 1 097 762 births (2000-2012) in NSW and 32 991 admissions to RPS. Women in cohort 1: (those admitted to RPS) were older at the time of birth, more likely to be admitted as a private patient at the time of birth, be born in Australia and be having their first baby compared with women in cohort 2 (those not admitted to an RPS). Women admitted to RPS experienced more birth intervention (induction, instrumental birth, caesarean section), had more multiple births and were more likely to have a male infant. Their babies were also more likely to be resuscitated and have experienced birth trauma to the scalp. Between 2000 and 2012 the average age of women in the RPS increased by nearly 2 years; their infants were older on admission and women were less likely to smoke. Over the time period there was a drop in the numbers of women admitted to RPS having a normal vaginal birth and an increase in women having an instrumental birth. CONCLUSION Women who access RPS in the first year after birth are more socially advantaged and have higher birth intervention than those who do not, due in part to higher numbers birthing in the private sector where intervention rates are high. The rise in women admitted to RPS (2000-2012) who have had instrumental births is intriguing as overall rates did not increase.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Cathrine Fowler
- Tresillian Chair in Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Robert Mills
- Tresillian Family Care Centres, Belmore, New South Wales, Australia
| | - Grainne O'Loughlin
- Karitane Residential Family Care Unit, Karitane, Carramar, New South Wales, Australia
| | - Jenny Smit
- Tresillian Family Care Centres, Belmore, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
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20
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Jirojwong S, Brownhill S, Dahlen HG, Johnson M, Schmied V. Going up, going down: the experience, control and management of gestational diabetes mellitus among Southeast Asian migrant women living in urban Australia. Health Promot J Austr 2019; 28:123-131. [PMID: 27745571 DOI: 10.1071/he15130] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 08/04/2016] [Indexed: 01/15/2023] Open
Abstract
Issue addressed In many developed countries the rate of gestational diabetes mellitus (GDM) for Asian-born women is higher than other groups. Studies suggest that some women have limited knowledge of the disease and poor self-management leading to health problems for themselves and their baby. Few studies report the experience of GDM among Southeast Asian migrant women living in Australia and factors that influence their management of the disease. Methods A qualitative interpretive design was used to explore Southeast Asian migrant women's experience and management of GDM. Women diagnosed with the disease during pregnancy were recruited from an antenatal clinic at two Sydney metropolitan hospitals. Nineteen women were interviewed in their first language. Thematic analysis was used to analyse the data. Results A diagnosis of GDM conferred an unanticipated 'up and down' experience for this group of Southeast Asian women. Their experience of the disease, likened to an elevator ride, was modulated by 'insulin' and 'information' used to control the disease and manage blood glucose levels, dietary levels, exercise levels and anxiety levels. Conclusions Health promotion material that captures the fluctuating experience of GDM has the potential to help women, particularly at the time of diagnosis, to be better prepared, and health professionals to be better informed to control and manage the disease more effectively. So what? GDM is a serious problem. The model generated from our study has the potential to better inform health professionals to prepare women for the inevitable fluctuating physical and emotional effects of the disease. Culturally sensitive material and an educational strategy based on the model may also facilitate women's lifestyle changes and compliance, and improve migrant women's relationship with, and trust in, health professionals involved in their GDM care.
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Affiliation(s)
- Sansnee Jirojwong
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Suzanne Brownhill
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Maree Johnson
- Faculty of Health Sciences, Australian Catholic University, PO Box 968, North Sydney, NSW 2059, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
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21
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Breckenkamp J, Läcke EM, Henrich W, Borde T, Brenne S, David M, Razum O. Advanced cervical dilatation as a predictor for low emergency cesarean delivery: a comparison between migrant and non-migrant Primiparae - secondary analysis in Berlin, Germany. BMC Pregnancy Childbirth 2019; 19:1. [PMID: 30606156 PMCID: PMC6318868 DOI: 10.1186/s12884-018-2145-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/12/2018] [Indexed: 02/07/2023] Open
Abstract
Background Cesarean rates are higher in women admitted to labor ward during early stages rather than at later stages of labor. In a study in Germany, crude cesarean rates among Turkish and Lebanese immigrant women were low compared to non-immigrant women. We evaluated whether these immigrant women were admitted during later stages of labor, and if so, whether this explains their lower cesarean rates. Methods We enrolled 1413 nulliparous women with vertex pregnancies, singleton birth, and 37+ week of gestation, excluding elective cesarean deliveries, in three Berlin obstetric hospitals. We applied binary logistic regression to adjust for social and obstetric factors; and standardized coefficients to rank predictors derived from the regression model. Results At the time of admission to labor ward, a smaller proportion of Turkish migrant women was in the active phase of labor (cervical dilation: 4+ cm), compared to women of Lebanese origin and non-immigrant women. Rates of cesarean deliveries were lower in women of Turkish and Lebanese origin (15.8 and 13.9%) than in non-immigrant women (23.9%). In the logistic regression analysis, more advanced cervical dilatation was inversely associated with the outcome cesarean delivery (OR: 0.76, 95%CI: 0.70–0.82). In addition, higher maternal age (OR: 1.06, 95%CI: 1.04–1.09), application of oxytocic agents (OR: 0.55, 95%CI: 0.42–0.72), and obesity (OR: 2.25, 95%CI: 1.51–3.34) were associated with the outcome. Ranking of predictors indicate that cervical dilatation is the most relevant predictor derived from the regression model. Conclusions Advanced cervical dilatation at the time of admission to labor ward does not explain lower emergency cesarean delivery rates in Turkish and Lebanese migrant women, despite the fact that this is the strongest among the predictors for emergency cesarean delivery identified in this study.
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Affiliation(s)
- Jürgen Breckenkamp
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany.
| | - Eileen Marie Läcke
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany
| | - Wolfgang Henrich
- Obstetrics Clinics, Charité University Medicine Berlin, Campus Virchow-Klinikum and Mitte, Berlin, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin, University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany.,Institute of General Medicine, Medical Faculty, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| | - Matthias David
- Clinic for Gynaecology, Charité University Medicine Berlin, Campus Virchow-Klinikum, Berlin, Germany
| | - Oliver Razum
- School of Public Health, Department of Epidemiology & International Public Health, Bielefeld University, Bielefeld, Germany
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Boxall N, David M, Schalinski E, Breckenkamp J, Razum O, Hellmeyer L. Perinatal Outcome in Women with a Vietnamese Migration Background - Retrospective Comparative Data Analysis of 3000 Deliveries. Geburtshilfe Frauenheilkd 2018; 78:697-706. [PMID: 30057426 PMCID: PMC6059858 DOI: 10.1055/a-0636-4224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction
Perinatal data of women with a Vietnamese migration background have not been systematically studied in Germany to date. Numerous details of important maternal and child outcomes were compared and analysed. The studyʼs primary parameters were the frequency of and indication for c-section.
Methodology
The perinatal data from a Berlin hospital were analysed retrospectively. The women (Vietnamese migration background vs. autochthonous) were grouped using name analysis. Datasets of 3002 women giving birth, including 999 women with a Vietnamese migration background, were included. The associations between primary or secondary cesarean delivery and different child outcomes depending on the migration background (exposure) were studied using logistical regression analysis.
Results
Women with a Vietnamese migration background have a lower c-section rate of 8.0% for primary and 12.6% for secondary c-section than women without a migration background (11.1% primary and 16.4% secondary c-section respectively). Regression analysis shows that the odds that women with a Vietnamese migration background will have a primary (OR 0.75; p = 0.0884) or secondary c-section (OR 0.82; p = 0.1137) are not significantly lower. A Vietnamese migration background was associated with higher odds for an episiotomy but not for a grade 3 – 4 perineal tear. A Vietnamese migration background does not have a significant influence on poor 5-min Apgar scores ≤ 7 and low umbilical cord arterial pH values ≤ 7.10. Newborns of mothers with a Vietnamese migration background have higher odds of a relatively higher birth weight (> 3110 g).
Summary
There was no evidence that women with a Vietnamese migration background are delivered more often by caesarean section. There were also no differences as regards important child outcome data from women in the comparator group. Overall, the results do not provide any evidence for poorer quality of care of women with a Vietnamese migration background in Berlin despite the cultural and communication barriers in the reality of care provision.
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Affiliation(s)
- Nicole Boxall
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Matthias David
- Charité - Universitätsmedizin Berlin, Klinik für Gynäkologie, Campus Virchow-Klinikum, Berlin, Germany
| | - Elisabeth Schalinski
- Vivantes Klinikum im Friedrichshain, Klinik für Gynäkologie und Geburtsmedizin, Berlin, Germany
| | - Jürgen Breckenkamp
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG 3 - Epidemiologie & International Public Health, Bielefeld, Germany
| | - Oliver Razum
- Universität Bielefeld, Fakultät für Gesundheitswissenschaften, AG 3 - Epidemiologie & International Public Health, Bielefeld, Germany
| | - Lars Hellmeyer
- Vivantes Klinikum im Friedrichshain, Klinik für Gynäkologie und Geburtsmedizin, Berlin, Germany
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Dahlen HG, Munoz AM, Schmied V, Thornton C. The relationship between intimate partner violence reported at the first antenatal booking visit and obstetric and perinatal outcomes in an ethnically diverse group of Australian pregnant women: a population-based study over 10 years. BMJ Open 2018; 8:e019566. [PMID: 29695386 PMCID: PMC5922470 DOI: 10.1136/bmjopen-2017-019566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/17/2018] [Accepted: 02/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Intimate partner violence (IPV) is a global health issue affecting mainly women and is known to escalate during pregnancy and impact negatively on obstetric and perinatal outcomes. The aim of this study is to determine the incidence of IPV in a pregnant multicultural population and to determine the relationship between IPV reported at booking interview and maternal and perinatal outcomes. DESIGN This is a retrospective population-based data study. We analysed routinely collected data (2006-2016) from the ObstetriX system on a cohort of pregnant women. SETTING AND PARTICIPANTS 33 542 women giving birth in a major health facility in Western Sydney. PRIMARY OUTCOMES Incidence of IPV, association with IPV and other psychosocial variables and maternal and perinatal outcomes. RESULT 4.3% of pregnant women reported a history of IPV when asked during the routine psychosocial assessment. Fifty-four per cent were not born in Australia, and this had increased significantly over the decade. Women born in New Zealand (7.2%) and Sudan (9.1%) were most likely to report IPV at the antenatal booking visit, with women from China and India least likely to report IPV. Women who reported IPV were more likely to report additional psychosocial concerns including Edinburgh Postnatal Depression Scale scores > 13 (7.6%), thoughts of self-harm (2.4%), childhood abuse (23.6%), and a history of anxiety and depression (34.2%). Women who reported IPV were more likely to be Australian born, smoke and be multiparous and to have been admitted for threatened preterm labour (Adjusted Odds Ratio (AOR) 1.8, 95% CI 1.28 to 2.39). CONCLUSIONS A report of IPV at the first antenatal booking visit is associated with a higher level of reporting on all psychosocial risks, higher antenatal admissions, especially for threatened preterm labour. More research is needed regarding the effectiveness of current IPV screening for women from other countries.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
| | - Ana Maria Munoz
- Blacktown Mount Druitt Hospitals, Blacktown, New South Wales, Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Penrith, New South Wales, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
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Agius PA, Davey MA, Small R. Risk of unplanned caesarean birth in Vietnamese-born women in Victoria, Australia: A cross-sectional study. Women Birth 2018; 31:496-504. [PMID: 29449157 DOI: 10.1016/j.wombi.2018.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/07/2017] [Accepted: 02/01/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Understanding the prevalence of, and factors associated with, caesarean birth among immigrant populations is essential for appropriate antenatal and postnatal resource allocation. AIMS To compare rates of caesarean birth between one of the largest immigrant populations of women giving birth in Australia (Vietnamese-born women) with those of Australian-born women and investigate the odds of unplanned caesarean in these women, controlling for maternal characteristics, pregnancy complications and labour management factors. METHODS Cross-sectional analysis of data on singleton births in Victoria, Australia; using data from the routinely collected Victorian Perinatal Data Collection. Descriptive analyses comparing maternal and obstetric factors for Vietnamese-born women with Australian-born women were undertaken. Using the more recent nine years of routinely collected data, multivariable logistic regression explored the association between unplanned caesarean birth and maternal country of birth, adjusted for maternal and obstetric factors, admission status and time (n=468,131). This association was also explored for 'standard primiparae' (n=69,039). FINDINGS Planned and unplanned caesarean births increased dramatically in both Australian-born and Vietnamese-born women between 1984 and 2007. After adjustment for obstetric and maternal factors, Vietnamese-born women were at greater odds of an unplanned caesarean birth compared to Australian-born women (adjusted odds ratio=1.32, 95% confidence interval=1.25-1.40). These greater odds were also found among the 'standard primiparae' (adjusted odds ratio=1.22, 95% confidence interval=1.07-1.40). CONCLUSION Factors other than clinical risk appear to predispose Vietnamese-born women to unplanned caesarean birth. These may include intrapartum communication, length of residence and familiarity with care systems, and variations in care practices for Vietnamese women.
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Affiliation(s)
- Paul A Agius
- Maternal and Child Health, Burnet Institute, 85 Commercial Road, Melbourne, Victoria, 3004, Australia; Judith Lumley Centre, La Trobe University, Bundoora, Victoria, 3086, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, 3004, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, 3086, Australia; Department of Obstetrics and Gynaecology, Monash University, 245 Clayton Rd, Clayton, 3168, Melbourne, Victoria, Australia
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria, 3086, Australia; Reproductive Health, Department of Women's and Children's Health, Karolinska Institute, Tomtebodavägen 18
- SE-171 77, Stockholm, Sweden
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Levett KM, Dahlen HG, Smith CA, Finlayson KW, Downe S, Girosi F. Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour. BMJ Open 2018; 8:e017333. [PMID: 29439002 PMCID: PMC5829839 DOI: 10.1136/bmjopen-2017-017333] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To assess whether the multitherapy antenatal education 'CTLB' (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings. DESIGN Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data. METHODS We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group. RESULTS If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to $A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95% confidence level. Significantly more women in the study group experienced a normal vaginal birth, and significantly fewer women in the study group experienced a caesarean section. The main cost saving resulted from the reduced rate of caesarean section in the study group. CONCLUSION The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from $A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%. TRIAL REGISTRATION NUMBER ACTRN12611001126909.
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Affiliation(s)
- Kate M Levett
- School of Medicine, University of Notre Dame Australia, Sydney, New South Wales, Australia
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia
| | - Caroline A Smith
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, New South Wales, Australia
| | | | - Soo Downe
- School of Midwifery and Community Health, University of Central Lancashire (UCLan), Preston, UK
| | - Federico Girosi
- School of Medicine, Centre for Health Research, Western Sydney University, Sydney, New South Wales, Australia
- Research, Health Market Quality program, Capital Markets CRC, Sydney, New South Wales, Australia
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Siad FM, Fang XY, Santana MJ, Butalia S, Hebert MA, Rabi DM. Understanding the Experiences of East African Immigrant Women With Gestational Diabetes Mellitus. Can J Diabetes 2018; 42:632-638. [PMID: 29914780 DOI: 10.1016/j.jcjd.2018.01.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVES East African (EA) women are a subpopulation who are at very high risk for gestational diabetes (GDM) and poor obstetric outcomes, but little is known about the care experiences of this understudied group. The objective of this study was to document the impact of a diagnosis of GDM and the perceptions of diabetes care among EA immigrant women. METHODS Semistructured in-depth interviews were conducted with 10 EA immigrant women diagnosed with GDM in Calgary; they were recruited from community and tertiary care settings. Interviews were transcribed verbatim and analyzed using inductive thematic content analysis to explore participants' experiences when accessing and receiving care. RESULTS EA immigrant women had varied experiences related to GDM. Thematic analysis revealed the negative impact of GDM diagnoses on women, including the burdens of self-care, fear, community influences and cultural and financial barriers. The positive impacts of the experience of diagnosis noted were primarily in the empowerment to make healthful behaviour changes. CONCLUSIONS Study findings point to the need for more context-specific and culturally appropriate support and care. Diagnoses of GDM extended beyond the individuals affected and impacted their families culturally, psychologically and financially. Addressing the emergent themes during pregnancy is imperative to improving care providers' engagement with EA immigrant women in postpartum diabetes screening activities and beyond. The findings of this study contain elements transferable to other immigrant groups in similar socioecologic contexts.
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Affiliation(s)
- Fartoon M Siad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Xiao Yang Fang
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Maria J Santana
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sonia Butalia
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Marilynne A Hebert
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Doreen M Rabi
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Libin Cardiovascular Institute of Alberta, Foothills Medical Centre, Calgary, Alberta, Canada; Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
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Melov SJ, Hitos K. Venous thromboembolism risk and postpartum lying-in: Acculturation of Indian and Chinese women. Midwifery 2017; 58:13-18. [PMID: 29275264 DOI: 10.1016/j.midw.2017.11.006] [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: 06/29/2017] [Revised: 11/15/2017] [Accepted: 11/28/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE many cultures have a set time of traditional rest in the postpartum period. There is limited information on how this activity may potentially increase the risk of venous thromboembolism (VTE). We aimed to investigate VTE risk by determining the prevalence of the cultural practice of postpartum "lying-in", quantifying activity and determining the factors that influence this tradition in women from China and the Indian subcontinent (India, Bangladesh, Pakistan and Sri Lanka) at an Australian tertiary referral hospital. DESIGN we surveyed a prospective cohort of 150 women aged ≥ 18 years who self-identified culturally as from the Indian subcontinent or Chinese, at baseline (≥ 32 weeks gestation) and at follow-up (six to eight weeks postpartum). Demographic details collected included VTE risk factors such as caesarean section, lack of graduated compression stockings (GCS), postpartum haemorrhage greater than 1000mL, comorbidities and immobility. We quantified postpartum activities and investigated factors that might influence inactivity. RESULTS there were 100 women identifying as from the Indian subcontinent and 50 women identifying as Chinese recruited at the baseline of over 32 weeks' gestation. Most of the study participants (85%) rested in the postpartum period for cultural reasons. Of the women surveyed, 51% rested in bed as much as possible in the postpartum period. We found a significant correlation between increased number of children and decreased overall immobility or rest (P = 0.03). Overall, 91% of participants had relative live-in help, and this significantly increased the risk of immobility by more than six-fold (odds ratio [OR], 6.17; 95% CI, 1.6-23.5; P = 0.008). Furthermore, a vaginal compared to a caesarean birth increased immobility risk by almost 3.5 times (OR, 3.4; 95% CI, 1.20-9.4; P = 0.021). CONCLUSIONS acculturation is highly individualised, however postpartum rest remains prevalent in women who identify themselves culturally as from the Indian subcontinent or as Chinese. Inactivity and comorbidities compounded the impact of cultural postpartum rest, and put women at increased risk for VTE. IMPLICATIONS FOR PRACTICE targeted, culturally appropriate, postnatal education should include VTE-prevention information to women who intend to practise postpartum rest.
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Affiliation(s)
- Sarah J Melov
- Westmead Institute for Maternal and Fetal Medicine, Westmead Hospital, Australia.
| | - Kerry Hitos
- Westmead Research Centre for Evaluation of Surgical Outcomes, Department of Surgery, Westmead Hospital, The University of Sydney, Australia
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Winn A, Hetherington E, Tough S. Systematic Review of Immigrant Women's Experiences With Perinatal Care in North America. J Obstet Gynecol Neonatal Nurs 2017; 46:764-775. [PMID: 28667831 DOI: 10.1016/j.jogn.2017.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To understand the perinatal care experiences of pregnant immigrant women in North America. DATA SOURCES We searched five electronic databases: MEDLINE, PsycINFO, SocINDEX, CINAHL, and Social Work Abstracts. Two categories of search terms, pregnancy and immigrant, were used to conduct a title/abstract and subject heading search. We manually searched the reference lists of all relevant articles to identify additional articles. STUDY SELECTION Inclusion criteria were qualitative or mixed methods study design, focus on immigrant women's experiences of accessing perinatal care, and data collection in North America. Two reviewers were involved in a three-stage selection process: title/abstract screen, full text review, and data extraction and quality appraisal. DATA EXTRACTION Data on authors, date, location, methodology, sample characteristics, data collection, and themes or topics were extracted from 19 articles. DATA SYNTHESIS We followed the Thomas and Harden (2008) thematic synthesis methodology, which involved a three-stage data analysis approach: free line-by-line coding, organization of free codes into descriptive themes, and construction of analytical themes. We developed three meta-themes from the 19 articles included in our review: Expectations of Pregnancy as Derived From Home, Reality of Pregnancy in the Host Health Care System, and Support. CONCLUSION Immigration is a relevant issue in North America, and pregnancy can be an entry point into the health care system for immigrant women. We provide relevant information for health care providers, policy makers, program planners, and researchers about opportunities to explain models of health care delivery, improve communication, and facilitate social support to improve the experiences of immigrant women who interact with the health care system during pregnancy.
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Lockie E, McCarthy EA, Hui L, Churilov L, Walker SP. Feasibility of using self-reported ethnicity in pregnancy according to the gestation-related optimal weight classification: a cross-sectional study. BJOG 2017; 125:704-709. [DOI: 10.1111/1471-0528.14825] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2017] [Indexed: 12/28/2022]
Affiliation(s)
- E Lockie
- Mercy Perinatal; Mercy Hospital for Women; Melbourne Vic. Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Melbourne Vic. Australia
| | - EA McCarthy
- Mercy Perinatal; Mercy Hospital for Women; Melbourne Vic. Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Melbourne Vic. Australia
| | - L Hui
- Mercy Perinatal; Mercy Hospital for Women; Melbourne Vic. Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Melbourne Vic. Australia
| | - L Churilov
- Statistics and Decision Analysis Academic Platform; Florey Institute of Neuroscience and Mental Health; University of Melbourne; Melbourne Vic. Australia
| | - SP Walker
- Mercy Perinatal; Mercy Hospital for Women; Melbourne Vic. Australia
- Department of Obstetrics and Gynaecology; University of Melbourne; Melbourne Vic. Australia
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Rayment-Jones H, Butler E, Miller C, Nay C, O'Dowd J. A multisite audit to assess how women with complex social factors access and engage with maternity services. Midwifery 2017; 52:71-77. [PMID: 28732307 DOI: 10.1016/j.midw.2017.06.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 06/22/2017] [Accepted: 06/24/2017] [Indexed: 11/28/2022]
Abstract
OBJECTIVE to audit women with socially complex lives' documented access to and engagement with antenatal care provided by three inner city, UK maternity services in relation to birth and neonatal outcomes, and referral processes. BACKGROUND women living socially complex lives, including young mothers, recently arrived immigrants, non-English speaking, and those experiencing domestic violence, poor mental health, drug and alcohol abuse, and poverty experience high rates of morbidity, mortality and poor birth outcomes. This is associated with late access to and poor engagement with antenatal care. METHOD data was collected from three separate NHS trusts data management systems for a total of 182 women living socially complex lives, between January and December 2015. Data was presented by individual trust and compared to standards derived from NICE guidelines, local trust policy and national statistic using Excel and SPSS Version 22. Tests of correlation were carried out to minimise risks of confounding factors in characteristic differences. FINDINGS non-English speaking women were much less likely to have accessed care within the recommended timeframes, with over 70% of the sample not booked for maternity care by 12 weeks gestation. On average 89% primiparous women across all samples had less than the recommended number of antenatal appointments. No sample met the audit criteria in terms of number of antenatal appointments attended. Data held on the perinatal data management systems for a number of outcomes and processes was largely incomplete and appeared unreliable. CONCLUSION this data forms a baseline against which to assess the impact of future service developments aimed at improving access and engagement with services for women living with complex social factors. The audit identified issues with the completeness and reliability of data on the perinatal data management system.
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Affiliation(s)
- Hannah Rayment-Jones
- Division of Women's Health, Faculty of Life Sciences & Medicine, King's College London, Women's Health Academic Centre, St. Thomas' Hospital, London SE1 7EH, United Kingdom.
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Davies-Tuck ML, Davey MA, Wallace EM. Maternal region of birth and stillbirth in Victoria, Australia 2000-2011: A retrospective cohort study of Victorian perinatal data. PLoS One 2017; 12:e0178727. [PMID: 28586367 PMCID: PMC5460852 DOI: 10.1371/journal.pone.0178727] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 05/17/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND There is growing evidence from high-income countries that maternal country of birth is a risk factor for stillbirth. We aimed to examine the association between maternal region of birth and stillbirth between 2000 and 2011 inclusive in Victoria, Australia. METHODS Retrospective population based cohort study of all singleton births at 24 or more weeks gestational age from 2000-2011 in Victoria, Australia. Stillbirths due to termination of pregnancy, babies with congenital anomalies and Indigenous mothers were excluded. Main Outcome Measure: Stillbirth. RESULTS Over the 12-year period there were 685,869 singleton births and 2299 stillbirths, giving an overall stillbirth rate of 3·4 per 1000 births. After adjustment for risk factors, compared to women born in Australia/New Zealand, women born in South Asia (aOR 1.27, 95% CI 1.01-1.53, p = 0.01), were more likely to have a stillbirth whereas women born in South East and East Asia were (aOR 0.60, (95% CI 0.49-0.72, p<0.001) less likely to have a stillbirth. Additionally, the increasing rate of stillbirth as gestation length progressed began to rise earlier and more steeply in the South Asian compared to Australian/New Zealand born women. The following risk factors were also significantly associated with an increased odds of stillbirth in multivariate analyses: maternal age <20 and 35 years and more, nulliparity, low socio-economic status, previous stillbirth, no ultrasound reported in 1st trimester, pre-existing hypertension, antepartum haemorrhage and failure to detect growth restriction antenatally. CONCLUSION Maternal region of birth is an independent risk factor for stillbirth. Improvements in the rate of stillbirth, particularly late pregnancy stillbirth, are likely to be gained in high-income settings where clinical care is informed by maternal region of birth.
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Affiliation(s)
- Miranda L. Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Melbourne, Victoria, Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, Clayton, Melbourne, Victoria, Australia
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Morton A. Traditional practices and adverse pregnancy outcomes in migrant women. Obstet Med 2017; 10:45-46. [PMID: 28491134 DOI: 10.1177/1753495x16681199] [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: 09/07/2016] [Accepted: 11/06/2016] [Indexed: 11/15/2022] Open
Abstract
Traditional practices during pregnancy may lead to adverse outcomes in migrant women. Very little is known regarding the efficacy or safety of many cultural practices during pregnancy, and research is required to address this deficiency in knowledge. Greater awareness of traditional practices by health professionals may result in improved pregnancy outcomes in migrant women.
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Affiliation(s)
- Adam Morton
- Mater Hospital, University of QLD and Mater Health, South Brisbane, QLD, Australia
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Biro MA, East C. Poorer detection rates of severe fetal growth restriction in women of likely refugee background: A case for re-focusing pregnancy care. Aust N Z J Obstet Gynaecol 2017; 57:186-192. [DOI: 10.1111/ajo.12593] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 12/11/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Mary Anne Biro
- School of Nursing and Midwifery; Clayton Campus, Monash University; Clayton Victoria Australia
| | - Christine East
- School of Nursing and Midwifery; Clayton Campus, Monash University; Clayton Victoria Australia
- Monash Health; Monash Medical Centre; Clayton Victoria Australia
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Post-term surveillance and birth outcomes in South Asian-born compared with Australian-born women. J Perinatol 2017; 37:139-143. [PMID: 27929532 DOI: 10.1038/jp.2016.190] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 09/01/2016] [Accepted: 09/09/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine if apparently healthy post-term South Asian-born (SA) women were more likely to have abnormal post-term fetal surveillance than Australian- and New Zealand-born (AUS/NZ) women, whether those abnormalities were associated with increased rates of obstetric intervention and adverse perinatal outcomes, and whether SA women and their babies were at higher risk of adverse outcomes in the post-term period irrespective of their post-term surveillance outcomes. STUDY DESIGN Post-term surveillance and perinatal outcomes of 145 SA and 272 AUS/NZ nulliparous women with a singleton post-term pregnancy were compared in a retrospective multicentre cohort analysis. RESULTS Post-term SA women were not significantly more likely to have a low amniotic fluid index (AFI) than AUS/NZ women. However, they were nearly four times more likely (odds ratio 3.75; 95% CI 1.49-9.44) to have an abnormal CTG (P=0.005). Irrespective of maternal region of birth having an abnormal cardiotocography (CTG) or AFI was not associated with adverse intrapartum or perinatal outcomes. However, post-term SA women were significantly more likely than AUS/NZ women to have intrapartum fetal compromise (P=0.03) and an intrapartum cesarean section (P=0.002). Babies of SA women were more also significantly likely to be admitted to the Special Care Nursery or Neonatal Intensive Care Unit (P=0.02). CONCLUSION Post-term SA women experience higher rates of fetal compromise (antenatal and intrapartum) and obstetric intervention than AUS/NZ women. Irrespective of maternal region of birth an abnormal CTG or AFI was not predictive of adverse outcomes.
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Christensen LF, Overgaard C. Are freestanding midwifery units a safe alternative to obstetric units for low-risk, primiparous childbirth? An analysis of effect differences by parity in a matched cohort study. BMC Pregnancy Childbirth 2017; 17:14. [PMID: 28068929 PMCID: PMC5223304 DOI: 10.1186/s12884-016-1208-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 12/28/2016] [Indexed: 11/21/2022] Open
Abstract
Background Intrapartum complications and the use of obstetric interventions are more common in primiparous childbirth than in multiparous childbirth, leading to concern about out of hospital birth for primiparous women. The purpose of this study was to determine whether the effect of birthplace on perinatal and maternal morbidity and the use of obstetric interventions differed by parity among low-risk women intending to give birth in a freestanding midwifery unit or in an obstetric unit in the North Denmark Region. Methods The study is a secondary analysis of data from a matched cohort study including 839 low-risk women intending birth in a freestanding midwifery unit (primary participants) and 839 low-risk women intending birth in an obstetric unit (individually matched control group). Analysis was by intention-to-treat. Conditional logistic regression analysis was applied to compute odds ratios and effect ratios with 95% confidence intervals for matched pairs stratified by parity. Results On no outcome did the effect of birthplace differ significantly between primiparous and multiparous women. Compared with their counterparts intending birth in an obstetric unit, both primiparous and multiparous women intending birth in a freestanding midwifery unit were significantly more likely to have an uncomplicated, spontaneous birth with good outcomes for mother and infant and less likely to require caesarean section, instrumental delivery, augmented labour or epidural analgesia (although for caesarean section this trend did not attain statistical significance for multiparous women). Perinatal outcomes were comparable between the two birth settings irrespective of parity. Compared to multiparas, transfer rates were substantially higher for primiparas, but fell over time while rates for multiparas remained stable. Conclusions Freestanding midwifery units appear to confer significant advantages over obstetric units to both primiparous and multiparous mothers, while their infants are equally safe in both settings. Our findings thus support the provision of care in freestanding midwifery units as an alternative to care in obstetric units for all low-risk women regardless of parity. In view of the global rise in caesarean section rates, we consider it an important finding that freestanding midwifery units show potential for reducing first-birth caesarean. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-1208-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Louise Fischer Christensen
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark. .,Department of Gynecology & Obstetrics, Aalborg University Hospital, Sdr. Skovvej 15, DK-9000, Aalborg, Denmark.
| | - Charlotte Overgaard
- Department of Health Science and Technology, Faculty of Medicine, Aalborg University, Aalborg, Denmark
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Reddy M, Wallace EM, Mockler JC, Stewart L, Knight M, Hodges R, Skinner S, Davies-Tuck M. Maternal Asian ethnicity and obstetric intrapartum intervention: a retrospective cohort study. BMC Pregnancy Childbirth 2017; 17:3. [PMID: 28056853 PMCID: PMC5217270 DOI: 10.1186/s12884-016-1187-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 12/07/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Maternal ethnicity is a recognized risk factor for stillbirth, such that South Asian women have higher rates than their Caucasian counterparts. However, whether maternal ethnicity is a risk factor for intrapartum outcomes is less clear. The aim of this study is to explore associations between maternal country of birth, operative vaginal delivery and emergency cesarean section, and to identify possible mechanisms underlying any such associations. METHODS We performed a retrospective cohort study of singleton term births among South Asian, South East/East Asian and Australian/New Zealand born women at an Australian tertiary hospital in 2009-2013. The association between maternal country of birth, operative vaginal birth and emergency cesarean was assessed using multivariate logistic regression. RESULTS Of the 31,932 births, 54% (17,149) were to Australian/New Zealand-born women, 25% (7874) to South Asian, and 22% (6879) to South East/East Asian born women. Compared to Australian/New Zealand women, South Asian and South East/East Asian women had an increased rate of both operative vaginal birth (OR 1.43 [1.30-1.57] and 1.22 [1.11-1.35] respectively, p < 0.001 for both) and emergency cesarean section (OR 1.67 [1.53-1.82] and 1.16 [1.04-1.26] respectively, p < 0.001 and p = 0.007 respectively). While prolonged labor was the predominant reason for cesarean section among Australian/New Zealand and South East/East Asian women, fetal compromise accounted for the majority of operative births in South Asian women. CONCLUSION South Asian and South East/East Asian women experience higher rates of both operative vaginal birth and cesarean section in comparison to Australian/New Zealand women, independent of other risk factors for intrapartum interventions.
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Affiliation(s)
- Maya Reddy
- Monash Health, Monash Medical Centre, Clayton, Australia. .,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia.
| | - Euan M Wallace
- Monash Health, Monash Medical Centre, Clayton, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Joanne C Mockler
- Monash Health, Monash Medical Centre, Clayton, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia
| | - Lynne Stewart
- Monash Health, Monash Medical Centre, Clayton, Australia
| | | | - Ryan Hodges
- Monash Health, Monash Medical Centre, Clayton, Australia.,The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia
| | - Sasha Skinner
- Monash Health, Monash Medical Centre, Clayton, Australia
| | - Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Australia.,Department of Obstetrics and Gynecology, Monash University, Level 5, Monash Medical Centre, Clayton, VIC, 3168, Australia
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Davies-Tuck M, Mockler JC, Stewart L, Knight M, Wallace EM. Obesity and pregnancy outcomes: Do the relationships differ by maternal region of birth? A retrospective cohort study. BMC Pregnancy Childbirth 2016; 16:288. [PMID: 27680687 PMCID: PMC5041541 DOI: 10.1186/s12884-016-1087-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 09/16/2016] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND We aimed to determine whether the association between obesity and a range of adverse maternal and perinatal outcomes differed in South Asian and Australian and New Zealand born women. METHODS A retrospective cohort study of singleton births in South Asian (SA) and Australian/New Zealand (AUS/NZ) born women at an Australian hospital between 2009 and 2013. The interaction between maternal region of birth and obesity on a range of maternal and perinatal outcomes was assessed using multivariate logistic regression. RESULTS Obesity was more strongly associated with gestational hypertension/Preeclampsia/HELLP and Gestational Diabetes Mellitus in AUS/NZ born women (p = 0.001 and p < 0.001, respectively for interaction) and was only associated with shoulder dystocia in SA born women (p = 0.006 for interaction). There was some evidence that obesity was more strongly related with admission to NICU/Special care nursery (SCN) (p = 0.06 for interaction) and any perinatal morbidity (p = 0.05 for interaction) in SA born women. CONCLUSIONS Interventions targeted at reducing maternal obesity will have different impacts in SA compared to AUS/NZ born women.
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Affiliation(s)
- Miranda Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Vic, 3168, Australia.
| | - Joanne C Mockler
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Vic, 3168, Australia
- Monash Health, Monash Medical Centre, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | - Lynne Stewart
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
| | | | - Euan M Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Vic, 3168, Australia
- Monash Health, Monash Medical Centre, Clayton, Australia
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
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Levett KM, Smith CA, Bensoussan A, Dahlen HG. Complementary therapies for labour and birth study: a randomised controlled trial of antenatal integrative medicine for pain management in labour. BMJ Open 2016; 6:e010691. [PMID: 27406639 PMCID: PMC4947718 DOI: 10.1136/bmjopen-2015-010691] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the effect of an antenatal integrative medicine education programme in addition to usual care for nulliparous women on intrapartum epidural use. DESIGN Open-label, assessor blind, randomised controlled trial. SETTING 2 public hospitals in Sydney, Australia. POPULATION 176 nulliparous women with low-risk pregnancies, attending hospital-based antenatal clinics. METHODS AND INTERVENTION The Complementary Therapies for Labour and Birth protocol, based on the She Births and acupressure for labour and birth courses, incorporated 6 evidence-based complementary medicine techniques: acupressure, visualisation and relaxation, breathing, massage, yoga techniques, and facilitated partner support. Randomisation occurred at 24-36 weeks' gestation, and participants attended a 2-day antenatal education programme plus standard care, or standard care alone. MAIN OUTCOME MEASURES Rate of analgesic epidural use. Secondary: onset of labour, augmentation, mode of birth, newborn outcomes. RESULTS There was a significant difference in epidural use between the 2 groups: study group (23.9%) standard care (68.7%; risk ratio (RR) 0.37 (95% CI 0.25 to 0.55), p≤0.001). The study group participants reported a reduced rate of augmentation (RR=0.54 (95% CI 0.38 to 0.77), p<0.0001); caesarean section (RR=0.52 (95% CI 0.31 to 0.87), p=0.017); length of second stage (mean difference=-0.32 (95% CI -0.64 to 0.002), p=0.05); any perineal trauma (0.88 (95% CI 0.78 to 0.98), p=0.02) and resuscitation of the newborn (RR=0.47 (95% CI 0.25 to 0.87), p≤0.015). There were no statistically significant differences found in spontaneous onset of labour, pethidine use, rate of postpartum haemorrhage, major perineal trauma (third and fourth degree tears/episiotomy), or admission to special care nursery/neonatal intensive care unit (p=0.25). CONCLUSIONS The Complementary Therapies for Labour and Birth study protocol significantly reduced epidural use and caesarean section. This study provides evidence for integrative medicine as an effective adjunct to antenatal education, and contributes to the body of best practice evidence. TRIAL REGISTRATION NUMBER ACTRN12611001126909.
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Affiliation(s)
- Kate M Levett
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - C A Smith
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - A Bensoussan
- National Institute for Complementary Medicines (NICM), Western Sydney University, Sydney, Australia
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
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Levett KM, Smith CA, Bensoussan A, Dahlen HG. The Complementary Therapies for Labour and Birth Study making sense of labour and birth - Experiences of women, partners and midwives of a complementary medicine antenatal education course. Midwifery 2016; 40:124-31. [PMID: 27428108 DOI: 10.1016/j.midw.2016.06.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 05/03/2016] [Accepted: 06/08/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE to gain insight into the experiences of women, partners and midwives who participated in the Complementary Therapies for Labour and Birth Study, an evidence based complementary medicine (CM) antenatal education course. DESIGN qualitative in-depth interviews and a focus group as part of the Complementary Therapies for Labour and Birth Study. SETTING AND PARTICIPANTS thirteen low risk primiparous women and seven partners who had participated in the study group of a randomised controlled trial of the complementary therapies for labour and birth study, and 12 midwives caring for these women. The trial was conducted at two public hospitals, and through the Western Sydney University in Sydney, Australia. INTERVENTIONS the Complementary Therapies for Labour and Birth (CTLB) protocol, based on the She Births® course and the Acupressure for labour and birth protocol, incorporated six evidence-based complementary medicine (CM) techniques; acupressure, relaxation, visualisation, breathing, massage, yoga techniques and incorporated facilitated partner support. Randomisation to the trial occurred at 24-36 weeks' gestation, and participants attended a two-day antenatal education programme, plus standard care, or standard care alone. FINDINGS the overarching theme identified in the qualitative data was making sense of labour and birth. Women used information about normal birth physiology from the course to make sense of labour, and to utilise the CM techniques to support normal birth and reduce interventions in labour. Women's, partners' and midwives' experience of the course and its use during birth gave rise to supporting themes such as: working for normal; having a toolkit; and finding what works. KEY CONCLUSIONS the Complementary Therapies for Labour and Birth Study provided women and their partners with knowledge to understand the physiology of normal labour and birth and enabled them to use evidence-based CM tools to support birth and reduce interventions. IMPLICATIONS FOR PRACTICE the Complementary Therapies for Labour and Birth Study introduces concepts of what constitutes normal birth and provides skills to support women, partners and midwives. It appears to be an effective form of antenatal education that supports normal birth, and maternity services need to consider how they can reform current antenatal education in line with this evidence.
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Affiliation(s)
- K M Levett
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - C A Smith
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - A Bensoussan
- National Institute of Complementary Medicines (NICM), Western Sydney University, Sydney, Australia.
| | - H G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia.
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40
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Mengesha ZB, Dune T, Perz J. Culturally and linguistically diverse women. Sex Health 2016; 13:SH15235. [PMID: 27209062 DOI: 10.1071/sh15235] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 03/08/2016] [Indexed: 02/28/2024]
Abstract
The proportion of women from culturally and linguistically diverse backgrounds is growing in Australia. Synthesising existing evidence concerning the views and experiences of these women in accessing sexual and reproductive health care is crucial to future policy and service development. A systematic review of scientific articles and grey literature published in English between 1990 and 2015 was conducted to identify the barriers and facilitators in accessing sexual and reproductive health care in Australia experienced by culturally and linguistically diverse women. The search strategy covered seven electronic databases (ProQuest, PubMed, EMBASE/Elsevier, SCOPUS, PsycINFO, CINAHL and Infomit) and websites. Thematic analysis methodology was used to analyse and interpret the data extracted from individual studies. From the 1401 potentially relevant articles identified, 22 articles that represent the views and experiences of 1943 culturally and linguistically diverse women in accessing sexual and reproductive health care in Australia were reviewed. The main barriers and facilitators identified were grouped into three major themes. These include personal level experiences of accessing health care, women's interaction with the healthcare system and women's experience with healthcare providers. Implications for clinical practice and future research are discussed based on the findings of the review.
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Belihu FB, Davey MA, Small R. Perinatal health outcomes of East African immigrant populations in Victoria, Australia: a population based study. BMC Pregnancy Childbirth 2016; 16:86. [PMID: 27113930 PMCID: PMC4845379 DOI: 10.1186/s12884-016-0886-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 04/21/2016] [Indexed: 11/25/2022] Open
Abstract
Background Sub-Saharan African women are often treated as a single group in epidemiological studies of immigrant birth outcomes, potentially masking variations across countries. Methods Cross-sectional population-based study of 432,567 singleton births in Victoria, Australia comparing mothers born in one of four East African countries (453 Eritreans, 1094 Ethiopians, 1,861 Somali and 1,404 Sudanese) relative to 427,755 Australian-born women was conducted using the Victorian Perinatal Data Collection. Pearson’s chi-square test and logistic regression analyses were performed to investigate disparities and estimate risks of perinatal mortality and other adverse perinatal outcomes after adjustment for confounders selected a priori. Results Compared with mothers born in Australia, East African immigrants as a group had elevated odds of perinatal mortality (ORadj1.83, 95 % CI 1.47, 2.28), small for gestational age births (SGA) (ORadj1.59 95 % CI 1.46, 1.74), very low birthweight (ORadj1.33, 95 % CI 1.11, 1.58) and very preterm birth (ORadj1.55, 95 % CI 1.27, 1.90). However, they had lower odds of preterm birth (ORadj0.86 95 % CI 0.76, 0.98) and macrosomia (ORadj0.65 95 % CI 0.51, 0.83). Individual country of birth analyses indicated significant variations, with Eritrean women having higher odds of very low birthweight (ORadj1.80, 95 % CI 1.09, 2.98), very preterm birth (ORadj 1.96, 95 % CI 1.08, 3.58), small for gestational age births (ORadj 1.52, 95 % CI 1.14, 2.03) and perinatal mortality (ORadj 2.69, 95 % CI 1.47, 4.91). Sudanese women had higher odds of low birthweight (ORadj 1.36, 95 % CI 1.10, 1.68), very low birthweight (ORadj 1.53, 95 % CI 1.13, 2.07), very preterm birth (ORadj 1.78, 95 % CI 1.26, 2.53), small for gestational age births (ORadj 2.13, 95 % CI 1.84, 2.47) and perinatal mortality (ORadj 2.10, 95 % CI 1.44, 3.07)]. Ethiopian women differed from Australian-born women only in relation to higher odds of very preterm birth, (ORadj1.70 95 % CI 1.16, 2.50), and only Somali-women had significantly lower odds of preterm birth (ORadj0.70 95 % CI 0.56, 0.88). Conclusions Overall, East African countries of birth were associated with increased perinatal death and some adverse perinatal outcomes; suggesting the need for strategies to enhance surveillance and health care delivery for these women. Analysis by individual country of birth groups has shown women from Eritrea and Sudan are particularly at increased risk of adverse outcomes, demonstrating the importance of antenatal identification of maternal country of birth. Electronic supplementary material The online version of this article (doi:10.1186/s12884-016-0886-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fetene B Belihu
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia.
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia.,Department of Obstetrics and Gynaecology, Monash University, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, 215 Franklin Street, Melbourne, VIC, 3000, Australia
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Merry L, Semenic S, Gyorkos TW, Fraser W, Small R, Gagnon AJ. International migration as a determinant of emergency caesarean. Women Birth 2016; 29:e89-e98. [PMID: 27150314 DOI: 10.1016/j.wombi.2016.04.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Revised: 11/20/2015] [Accepted: 04/01/2016] [Indexed: 11/29/2022]
Abstract
BACKGROUND High caesarean rates are of concern given associated risks. International migrant women (women born abroad) represent a substantial proportion of women giving birth in high-income countries (HICs) and face social conditions that may exacerbate childbearing health risks. Among migrant women, emergency rather than planned caesareans, tend to be more prevalent. This method of delivery can be stressful, physically harmful and result in an overall negative birth experience. Research establishing evidence of risk factors for emergency caesareans in migrants is insufficient. AIMS (1) Describe potential pathways (with a focus on modifiable factors) by which migration, using internationally recommended migration indicators: country of birth, length of time in country, fluency in receiving-country language, migration classification and ethnicity, may lead to emergency caesarean; and (2) propose a framework to guide future research for understanding "potentially preventable" emergency caesareans in migrant women living in HICs. DISCUSSION "Potentially preventable" emergency caesareans in migrant women are likely due to several modifiable, interrelated factors pre-pregnancy, during pregnancy and during labour. Migration itself is a determinant and also shapes other determinants. Complications and ineffective labour progress and/or foetal distress and ultimately the decision to perform an emergency caesarean may be the result of poor health (i.e., physiological effects), lack of support and disempowerment (i.e., psychological effects) and sub-optimal care. CONCLUSION Understanding the direct and indirect effects of migration on emergency caesarean is crucial so that targeted strategies can be developed and implemented for reducing unnecessary caesareans in this vulnerable population.
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Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada.
| | - Sonia Semenic
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; Women's Health Mission, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - Theresa W Gyorkos
- Department of Epidemiology, Biostatistics & Occupational Health, McGill University, Montreal, Quebec, Canada; Division of Clinical Epidemiology, McGill University Health Centre (MUHC), Montreal, Quebec, Canada
| | - William Fraser
- Centre hospitalier universitaire de Sherbrooke (CHUS) Research Centre, Sherbrooke, Quebec, Canada; Department of Obstetrics and Gynecology, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Rhonda Small
- Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Anita J Gagnon
- Ingram School of Nursing, McGill University, Montreal, Quebec, Canada; The Research Institute of the McGill University Health Centre (RI-MUHC), Montreal, Quebec, Canada
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Pregnancy-Related Hypertensive Disorders and Immigrant Status: A Systematic Review and Meta-analysis of Epidemiological Studies. J Immigr Minor Health 2016; 19:1488-1497. [DOI: 10.1007/s10903-016-0410-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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Thompson F, Dempsey K, Mishra G. Trends in Indigenous and non-Indigenous caesarean section births in the Northern Territory of Australia, 1986-2012: a total population-based study. BJOG 2016; 123:1814-23. [PMID: 26777399 DOI: 10.1111/1471-0528.13881] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine trends in caesarean section deliveries and factors associated with these trends for Indigenous and non-Indigenous mothers. DESIGN Total population-based study. SETTING Northern Territory of Australia, 1986-2012. POPULATION Pregnancies among Northern Territory residents, limited to singleton live births with cephalic presentations delivered at 37-42 weeks' gestation (n = 78 561). METHODS Descriptive analyses of demographic and obstetric risk factors. Poisson regression with robust variance to estimate the likelihood of caesarean delivery with and without labour compared with vaginal delivery, over time and between Indigenous and non-Indigenous mothers, adjusting for risk factors. MAIN OUTCOME MEASURES Trends in caesarean sections and risk of caesarean delivery compared with vaginal delivery. RESULTS The total rate of caesarean deliveries in the Northern Territory increased between 1986 and 2012. From the year 2000, the rise was driven by increases in caesareans with labour among nulliparous mothers and no labour caesareans among multiparous mothers. Increases in demographic and obstetric risk factors explained the rise in caesareans with labour among nulliparous Indigenous mothers, whereas other unmeasured variables contributed to the rise among non-Indigenous mothers. Increases in previous caesarean delivery contributed to the rise in all caesareans among multiparous mothers. Following adjustment, the risk of Indigenous nulliparous mothers having a caesarean with labour was 47% greater than for non-Indigenous nulliparous mothers [adjusted risk ratio 1.47 (95% CI 1.34-1.60)]. CONCLUSIONS Increases in demographic and obstetric risk factors partially explained the increase in caesarean rates in the Northern Territory and the contribution of these factors differed between Indigenous and non-Indigenous mothers. TWEETABLE ABSTRACT Caesarean section rates increased between 1986 and 2012 in the Northern Territory of Australia.
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Affiliation(s)
- F Thompson
- Department of Health, Northern Territory Government, Darwin, NT, Australia. .,School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia. .,The Centre for Chronic Disease Prevention, The Cairns Institute, James Cook University, Cairns, Qld, Australia.
| | - K Dempsey
- Department of Health, Northern Territory Government, Darwin, NT, Australia.,Australia Menzies School of Health Research, Charles Darwin University, Casuarina, NT, Australia
| | - G Mishra
- School of Public Health, Faculty of Medicine and Biomedical Sciences, University of Queensland, Brisbane, Qld, Australia
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Dahlen HG, Barnett B, Kohlhoff J, Drum ME, Munoz AM, Thornton C. Obstetric and psychosocial risk factors for Australian-born and non-Australian born women and associated pregnancy and birth outcomes: a population based cohort study. BMC Pregnancy Childbirth 2015; 15:292. [PMID: 26552427 PMCID: PMC4640409 DOI: 10.1186/s12884-015-0681-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 10/04/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One in four Australians is born overseas and 47% are either born overseas or have a parent who was. Obstetric and psychosocial risk factors for these women may differ. METHOD Data from one Sydney hospital (2012-2013) of all births recorded in the ObstetriX database were analysed (n = 3,092). Demographics, obstetric and psychosocial risk profile, obstetric interventions and complications and selected maternal and neonatal outcomes were examined for women born in Australia and overseas. RESULTS Women born in Australia were younger, more likely to be primiparous (28.6 v 27.5%), be obese (32.0% v 21.4%), smoke (19.7 % v 3.0%), have an epidural (26.2% v 20.2%) and were less likely to have gestational diabetes mellitus (GDM) (6.8% v 13.7% when compared to non-Australian born women. The highest rates of GDM, Gestational Hypertension (GH) and maternal anaemia were seen in women born in China, the Philippines and Pakistan respectively. Differences were also seen in psychosocial screening between Australian and non-Australian women with Australian-born women more likely to smoke and report a mental health disorder. There was an association between having an Edinburgh Postnatal Depression Scale (EPDS) ≥ 13 and other psychosocial issues, such as thoughts of self-harm, domestic violence, childhood abuse etc. These women were also less likely to breastfeed. Women with an EPDS ≥ 13 at booking compared to women with EPDS ≤12 had a higher chance of being diagnosed with GDM (AOR 1.85 95% CI 1.14-3.0). CONCLUSIONS There are significant differences in obstetric and psychosocial risk profiles and maternal and neonatal outcomes between Australian-born and non-Australian born women. In particular there appears to be an association between an EPDS of ≥13 and developing GDM, which warrants further investigation.
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Affiliation(s)
- Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Bryanne Barnett
- School of Psychiatry, Clinical Director, St John of God Raphael Centre, Medicine, University of New South Wales, 36-38 First Avenue, Blacktown, NSW, 2148, Australia. .,St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia.
| | - Jane Kohlhoff
- St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia. .,Karitane, P.O. Box 241, Villawood, 2163 NSW, Australia.
| | - Maya Elizabeth Drum
- St John of God Raphael Centre Blacktown, 36-38 First Ave, Blacktown, 2148, NSW, Australia.
| | - Ana Maria Munoz
- Clinical Midwifery Consultant, Blacktown Hospital, Blacktown, Australia.
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.
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Asif S, Baugh A, Jones NW. The obstetric care of asylum seekers and refugee women in the UK. ACTA ACUST UNITED AC 2015. [DOI: 10.1111/tog.12224] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Sonia Asif
- Department of Obstetrics and Gynaecology; Nottingham University Hospitals NHS Trust; Queens Medical Centre; University Road Nottingham NG7 2UH UK
| | - Amy Baugh
- Department of Genitourinary Medicine; Sherwood Hospitals NHS Foundation Trust; Kings Mill Hospital; Mansfield Road Sutton in Ashfield Nottinghamshire NG17 4JL UK
| | - Nia Wyn Jones
- Division of Child Health, Obstetrics and Gynaecology; University of Nottingham; D floor East Block; Queens Medical Centre; University Road Nottingham NG7 2UH UK
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Merry L, Vangen S, Small R. Caesarean births among migrant women in high-income countries. Best Pract Res Clin Obstet Gynaecol 2015; 32:88-99. [PMID: 26458998 DOI: 10.1016/j.bpobgyn.2015.09.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 08/13/2015] [Accepted: 09/06/2015] [Indexed: 01/05/2023]
Abstract
High caesarean birth rates among migrant women living in high-income countries are of concern. Women from sub-Saharan Africa and South Asia consistently show overall higher rates compared with non-migrant women, whereas women from Latin America and North Africa/Middle East consistently show higher rates of emergency caesarean. Higher rates are more common with emergency caesareans than with planned caesareans. Evidence regarding risk factors among migrant women for undergoing a caesarean birth is lacking. Research suggests that pathways leading to caesarean births in migrants are complex, and they are likely to involve a combination of factors related to migrant women's physical and psychological health, their social and cultural context and the quality of their maternity care. Migration factors, including length of time in receiving country and migration classification, have an influence on delivery outcome; however, their effects appear to differ by women's country/region of origin.
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Affiliation(s)
- Lisa Merry
- Ingram School of Nursing, McGill University, Montreal, QC, Canada.
| | - Siri Vangen
- Norwegian National Advisory Unit on Women's Health, Department for Women and Children's Health, Women and Children's Division, Oslo University Hospital, Oslo, Norway
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, College of Science, Health and Engineering, La Trobe University, Melbourne, VIC, Australia
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Gibson-Helm ME, Teede HJ, Cheng IH, Block AA, Knight M, East CE, Wallace EM, Boyle JA. Maternal health and pregnancy outcomes comparing migrant women born in humanitarian and nonhumanitarian source countries: a retrospective, observational study. Birth 2015; 42:116-24. [PMID: 25864573 DOI: 10.1111/birt.12159] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/20/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND The relationship between migration and pregnancy outcomes is complex, with little insight into whether women of refugee background have greater risks of adverse pregnancy outcomes than other migrant women. This study aimed to describe maternal health, pregnancy care, and pregnancy outcomes among migrant women from humanitarian and nonhumanitarian source countries. METHODS Retrospective, observational study of singleton births, at a single maternity service in Australia 2002-2011, to migrant women born in humanitarian source countries (HSCs, n = 2,713) and non-HSCs (n = 10,606). Multivariable regression analysis assessed associations between maternal HSC-birth and pregnancy outcomes. RESULTS Compared with women from non-HSCs, the following were more common in women from HSCs: age < 20 years (0.6 vs 2.9% p < 0.001), multiparity (51 vs 76% p < 0.001), body mass index (BMI) ≥ 25 (38 vs 50% p < 0.001), anemia (3.2 vs 5.9% p < 0.001), tuberculosis (0.1 vs 0.4% p = 0.001), and syphilis (0.4 vs 2.5% p < 0.001). Maternal HSC-birth was independently associated with poor or no pregnancy care attendance (OR 2.5 [95% CI 1.8-3.6]), late first pregnancy care visit (OR 1.3 [95% CI 1.1-1.5]), and postterm birth (> 41 weeks gestation) (OR 2.5 [95% CI 1.9-3.4]). Stillbirth (0.8 vs 1.2% p = 0.04, OR 1.5 [95% CI 1.0-2.4]) and unplanned birth before arrival at the hospital (0.6 vs 1.2% p < 0.001, OR 1.3 [95% CI 0.8-2.1]) were more common in HSC-born women but not independently associated with maternal HSC-birth after adjusting for age, parity, BMI and relative socioeconomic disadvantage. CONCLUSIONS These findings suggest areas where women from HSCs may have additional needs in pregnancy compared with women from non-HSCs. Refugee-focused strategies to support engagement in pregnancy care and address maternal health needs would be expected to improve health outcomes in resettlement countries.
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Affiliation(s)
- Melanie E Gibson-Helm
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | | | - I-Hao Cheng
- Southern Academic Primary Care Research Unit, School of Primary Health Care, Monash University, Dandenong, Victoria, Australia.,South Eastern Melbourne Medicare Local, Dandenong, Victoria, Australia
| | - Andrew A Block
- Dandenong Hospital, Monash Health, Dandenong, Victoria, Australia
| | - Michelle Knight
- Monash Women's Maternity Services, Monash Health, Clayton, Victoria, Australia
| | - Christine E East
- School of Nursing and Midwifery, Monash University Clayton, Victoria, Australia
| | | | - Jacqueline A Boyle
- Monash Centre for Health Research and Implementation, Monash University Clayton, Victoria, Australia
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Chalmers BE, Dzakpasu S. Interventions in labour and birth and satisfaction with care: The Canadian Maternity Experiences Survey Findings. J Reprod Infant Psychol 2015. [DOI: 10.1080/02646838.2015.1042964] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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50
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David M, Borde T, Brenne S, Henrich W, Breckenkamp J, Razum O. Caesarean Section Frequency among Immigrants, Second- and Third-Generation Women, and Non-Immigrants: Prospective Study in Berlin/Germany. PLoS One 2015; 10:e0127489. [PMID: 25985437 PMCID: PMC4435809 DOI: 10.1371/journal.pone.0127489] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Accepted: 02/10/2015] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The frequency of caesarean section delivery varies between countries and social groups. Among other factors, it is determined by the quality of obstetrics care. Rates of elective (planned) and emergency (in-labor) caesareans may also vary between immigrants (first generation), their offspring (second- and third-generation women), and non-immigrants because of access and language barriers. Other important points to be considered are whether caesarean section indications and the neonatal outcomes differ in babies delivered by caesarean between immigrants, their offspring, and non-immigrants. METHODS A standardized interview on admission to delivery wards at three Berlin obstetric hospitals was performed in a 12-month period in 2011/2012. Questions on socio-demographic and care aspects and on migration (immigrated herself vs. second- and third-generation women vs. non-immigrant) and acculturation status were included. Data was linked with information from the expectant mothers' antenatal records and with perinatal data routinely documented in the hospital. Regression modeling was used to adjust for age, parity and socio-economic status. RESULTS The caesarean section rates for immigrants, second- and third-generation women, and non-immigrant women were similar. Neither indications for caesarean section delivery nor neonatal outcomes showed statistically significant differences. The only difference found was a somewhat higher rate of crash caesarean sections per 100 births among first generation immigrants compared to non-immigrants. CONCLUSION Unlike earlier German studies and current studies from other European countries, this study did not find an increased rate of caesarean sections among immigrants, as well as second- and third-generation women, with the possible exception of a small high-risk group. This indicates an equally high quality of perinatal care for women with and without a migration history.
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Affiliation(s)
- Matthias David
- Charité University Medicine Berlin, Clinic for Gynaecology, Campus Virchow-Klinikum, Berlin, Germany
| | - Theda Borde
- Alice Salomon Hochschule Berlin—University of Applied Sciences, Berlin, Germany
| | - Silke Brenne
- Charité University Medicine Berlin, Clinic for Gynaecology, Campus Virchow-Klinikum, Berlin, Germany
| | - Wolfgang Henrich
- Charité University Medicine Berlin, Obstetrics Clinics, Campus Virchow-Klinikum and Mitte, Berlin, Germany
| | - Jürgen Breckenkamp
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, Bielefeld, Germany
| | - Oliver Razum
- Bielefeld University, School of Public Health, Department of Epidemiology & International Public Health, Bielefeld, Germany
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