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Lunda P, Minnie CS, Lubbe W. Factors influencing respectful perinatal care among healthcare professionals in low-and middle-resource countries: a systematic review. BMC Pregnancy Childbirth 2024; 24:442. [PMID: 38914945 PMCID: PMC11194958 DOI: 10.1186/s12884-024-06625-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND This review aimed to provide healthcare professionals with a scientific summary of best available research evidence on factors influencing respectful perinatal care. The review question was 'What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?' METHODS A detailed search was done on electronic databases: EBSCOhost: Medline, OAlster, Scopus, SciELO, Science Direct, PubMed, Psych INFO, and SocINDEX. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. RESULTS Studies conducted in various settings were included in the study. Various factors influencing respectful perinatal care were identified. During data synthesis three themes emerged namely healthcare institution, healthcare professional and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women's knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of this care. CONCLUSION Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care.
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Affiliation(s)
- Petronellah Lunda
- School of Nursing, North-West University, NuMIQ Research Focus Area, Potchefstroom, South Africa.
| | - Catharina Susanna Minnie
- School of Nursing, North-West University, NuMIQ Research Focus Area, Potchefstroom, South Africa
- School of Nursing, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Welma Lubbe
- School of Nursing, North-West University, NuMIQ Research Focus Area, Potchefstroom, South Africa
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Seijmonsbergen-Schermers AE, Peerdeman KMCM, van den Akker T, Titulaer LML, Roovers JP, Peters LL, Verhoeven CJ, de Jonge A. Differences in rates of severe perineal trauma between midwife-led and obstetrician-led care in the Netherlands: A nationwide cohort study. Heliyon 2024; 10:e24609. [PMID: 38312656 PMCID: PMC10835235 DOI: 10.1016/j.heliyon.2024.e24609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 12/15/2023] [Accepted: 01/11/2024] [Indexed: 02/06/2024] Open
Abstract
Objective To investigate trends and rates of severe perineal trauma (SPT), also known as obstetric anal sphincter injury (OASI), between midwife-led and obstetrician-led care in the Netherlands, and factors associated with SPT. Methods This nationwide cohort study included registry data from 2000 to 2019 (n = 2,169,950) of spontaneous vaginal births of term, live, cephalic, single infants, without a (previous) caesarean section or assisted vaginal birth.First, trends of SPT and episiotomy were shown. Second, differences in SPT rates between midwife- and obstetrician-led care were assessed. Third, associations of care factors with SPT were examined. Multivariable logistic regression analyses were used to determine which factors were important in the associations. All outcomes were stratified for parity. Results Over time, the SPT incidence increased mainly in midwife-led care and episiotomy rates decreased. Compared to midwife-led care, SPT rates were lower in obstetrician-led care among primiparous women (aOR 0.78; 99 % CI 0.74-0.81) and comparable among multiparous women (aOR 1.04; 99 % CI 0.99-1.10). Among women without epidural analgesia, these differences were smaller for primiparous women (aOR 0.88; 99 % CI 0.84-0.92), but the SPT rate was higher in obstetrician-led care among multiparous women (aOR 1.09; 99 % CI 1.03-1.15). Among women without shoulder dystocia, induction, augmentation, and pain medication, SPT rates were comparable among primiparous women, but higher among multiparous women in obstetrician-led care. In midwife-led care, SPT occurred more often among hospital versus home births. In obstetrician-led care, lower SPT incidences were found among births with epidural analgesia and for multiparous women with induction or augmentation. Conclusions Iinduction, augmentation, and epidural analgesia in obstetrician-led care may be an explanatory factor for the higher incidence of SPT among primiparous women in midwife-led care. More research is needed to explain differences in SPT rates and to understand how SPT can be prevented, while maintaining a high intact perineum rate.
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Affiliation(s)
- Anna E. Seijmonsbergen-Schermers
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Kelly MCM. Peerdeman
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Center, Albinusdreef 2, 2333, ZA, Leiden, Netherlands
- Athena Institute, Vrije Universiteit Amsterdam, De Boelelaan 1085, 1081, HV, Amsterdam, Netherlands
| | - Linde ML. Titulaer
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Jan-Paul Roovers
- Department of Obstetrics and Gynaecology, Amsterdam UMC Location AMC, Amsterdam, Netherlands
| | - Lilian L. Peters
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
| | - Corine J. Verhoeven
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Amsterdam Reproduction and Development, Amsterdam, Netherlands
| | - Ank de Jonge
- Amsterdam UMC Location Vrije Universiteit Amsterdam, Midwifery Science, De Boelelaan 1117, Amsterdam, Netherlands
- Midwifery Academy Amsterdam Groningen, Inholland, Amsterdam, Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, Netherlands
- University of Groningen, University Medical Center Groningen, Department of General Practice & Elderly Care Medicine, PO Box 196, 9700, AD, Groningen, Netherlands
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
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Palau-Costafreda R, García Gumiel S, Eles Velasco A, Jansana-Riera A, Orus-Covisa L, Hermida González J, Algarra Ramos M, Canet-Vélez O, Obregón Gutiérrez N, Escuriet R. The first alongside midwifery unit in Spain: A retrospective cohort study of maternal and neonatal outcomes. Birth 2023; 50:1057-1067. [PMID: 37589398 DOI: 10.1111/birt.12749] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 05/07/2022] [Accepted: 06/28/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND Midwife-led units have been shown to be safer and reduce interventions for women at low risk of complications at birth. In 2017, the first alongside birth center was opened in Spain. The aim of this study was to compare outcomes for women with uncomplicated pregnancies giving birth in the Midwife-led unit (MLU) and in the Obstetric unit (OU) of the same hospital. METHODS Retrospective cohort study comparing birth outcomes between low-risk women, depending on their planned place of birth. Data were analyzed with an intention-to-treat approach for women that gave birth between January 2018 and December 2020. RESULTS A total of 878 women were included in the study, 255 women chose to give birth in the MLU and 623 in the OU. Findings showed that women in the MLU were more likely to have a vaginal birth (91.4%) than in the OU (83.8%) (aOR 2.98 [95%CI 1.62-5.47]), less likely to have an instrumental delivery, 3.9% versus 11.2% (0.25 [0.11-0.55]), to use epidural analgesia, 19.6% versus 77.9% (0.15 [0.04-0.17]) and to have an episiotomy, 7.4% versus 15.4% (0.27 [0.14-0.53]). There were no differences in rates of postpartum hemorrhage, retained placenta, or adverse neonatal outcomes. Intrapartum and postpartum transfer rates from the MLU to the OU were 21.1% and 2.4%, respectively. CONCLUSIONS The high rate of obstetric interventions in Spain could be reduced by implementing midwife-led units across the whole system, without an increase in maternal or neonatal complications.
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Affiliation(s)
- Roser Palau-Costafreda
- Biomedicine Programme, Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra - affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Sara García Gumiel
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Amaranta Eles Velasco
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Anna Jansana-Riera
- Department of Epidemiology and Evaluation, Hospital del Mar Institute for Medical Research, Barcelona, Spain
| | - Lluna Orus-Covisa
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Júlia Hermida González
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Miriam Algarra Ramos
- Department of Obstetrics and Gynecology, Fundació Hospital Sant Joan de Déu de Martorell, Martorell, Spain
| | - Olga Canet-Vélez
- Department of Nursing, Faculty of Health Sciences, Universitat Ramon Llull, Barcelona, Spain
| | | | - Ramón Escuriet
- Directorate General of Health Planning, Ministry of Health of the Government of Catalonia, Barcelona, Spain
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4
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Andraczek T, Magister S, Bautzmann S, Poppke S, Stepan H, Tauscher A. [Birth in the Midwife-Led Delivery Room of a Perinatal Center - Learning Curve, Outcomes and Benchmark]. Z Geburtshilfe Neonatol 2023; 227:364-376. [PMID: 37279799 DOI: 10.1055/a-2082-2176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
INTRODUCTION Most births in Germany take place in a clinical setting. Midwife-led units have been offered in Germany since 2003 as an addition to the primarily physician-led obstetric care. The purpose of this study was to analyze differences regarding medical parameters between a midwife-led and a primarily physician-led unit in a level 1 perinatal center. MATERIAL AND METHODS Between 12/2020 and 12/2021, all births begun in the midwife-led unit were retrospectively analyzed and compared to a physician-led control cohort. Outcome measures were defined as obstetric interventions, delivery mode and duration, delivery position, and maternal and neonatal outcome. RESULTS The percentage of deliveries started in the midwife-led unit out of the total birth rate was 4.8% (n=132). Most transfers were made for more effective analgesia (52.6%). Among medically indicated transfers (n=30, 39.5%), transfers due to CTG abnormalities and failure to progress in labor after rupture of membranes predominated. 43.9% (n=58) of patients gave birth successfully in the midwife-led unit. The rate of episiotomy was significantly higher in the primarily physician-led unit compared to the successful midwife-led unit (p=0.019). CONCLUSION Birth in a midwife-led unit within a perinatal center can be considered an equivalent alternative to primarily physician-led birth for low-risk pregnant women.
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Affiliation(s)
- Theresa Andraczek
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Susann Magister
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Sandy Bautzmann
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Stephanie Poppke
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Holger Stepan
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
| | - Anne Tauscher
- Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum Leipzig, Leipzig, Germany
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Kuliukas L, Warland J, Cornell P, Thomson B, Godwin H, Bradfield Z. Embracing the continuity of care experience: A new Australian graduate entry master of midwifery course with a student caseload of 15 women per year. Women Birth 2023; 36:151-154. [PMID: 36456446 DOI: 10.1016/j.wombi.2022.11.011] [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: 08/30/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Women receiving continuity of midwifery care have increased satisfaction and improved outcomes. Preparation of midwifery students to work in continuity models from the point of graduation may provide an ongoing midwifery workforce that meets rising demand from women for access to such care. AIM OF THE PAPER The aim of this paper is to describe an innovative midwifery course based on a continuity model, where students acquire more than 50 % of clinical hours through continuity of care experiences. Additional educational strategies incorporated in the course to enhance the CCE experience within the philosophy of midwifery care, include a virtual maternity centre, case-based learning and the Resources Activities Support Evaluation (RASE) pedagogical model of learning. DISCUSSION Australian accredited midwifery courses vary in structure, format and philosophy; this new course provides students with an alternative option of study for those who have a particular interest in continuity of midwifery care. CONCLUSION A midwifery course which provides the majority of clinical hours through continuity of care may prepare graduates for employment within midwifery group practice models by demonstrating the benefits of relationship building, improved outcomes and the reality of an on-call lifestyle.
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Affiliation(s)
- Lesley Kuliukas
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Jane Warland
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Peta Cornell
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Brooke Thomson
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Helen Godwin
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
| | - Zoe Bradfield
- Curtin University School of Nursing, GPO Box U1987, Perth, Western Australia 6845, Australia.
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6
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Goodarzi B, Seijmonsbergen-Schermers A, Cronie D, van Laerhoven H, van den Akker T, van Kaam AH, de Jonge A. (Un)warranted variation in local hospital protocols for neonatal referral to the pediatrician: An explorative study in the Netherlands. Birth 2023; 50:215-233. [PMID: 36373864 DOI: 10.1111/birt.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/23/2022] [Accepted: 10/27/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND Studies indicate unwarranted variation in a wide range of neonatal care practices, contributing to preventable morbidity and mortality. Unwarranted variation is the result of complex interactions and multiple determinants. One of the determinants contributing to unwarranted variation in care may be variation in local hospital protocols. The purpose of this study was to examine variation in the content of obstetric and neonatal protocols for six common indications for neonatal referral to the pediatrician: large for gestational age/macrosomia, small for gestational age/fetal growth restriction, meconium-stained amniotic fluid, vacuum extraction, forceps extraction, and cesarean birth. METHODS We conducted a nationwide cross-sectional study examining protocols for neonatal referral to the pediatrician in the obstetric and neonatal departments of all Dutch hospitals. Variation in protocols was analyzed between regions, between neonatal and obstetrics departments located in the same hospital, and within neonatal and obstetrics departments. RESULTS There was considerable variation in protocols between regions, between neonatal and obstetrics departments, and within neonatal and obstetrics departments. The results of this study showed considerable variation in recommendations for type of referral, admission, screening/diagnostic tests, treatment, and discharge. Furthermore, results generally showed lower referral thresholds in neonatal departments compared with obstetric departments, and higher referral thresholds in the eastern region of the Netherlands. We also found variation in local hospital protocols, which could not be explained by population characteristics but which may be explained by varying recommendations in existing national and international guidelines and/or lack of adherence to these guidelines. CONCLUSIONS To reduce unwarranted variation in local protocols, evidence-based, multidisciplinary guidelines should be developed in the Netherlands. Further research addressing knowledge gaps is needed to inform these guidelines. Attention should be paid to the implementation of evidence, and only where evidence is lacking or inconclusive should agreements be based on multidisciplinary consensus. Where protocols deviate from evidence-based guidelines because of specific local circumstances, clearer, more transparent justifications should be made. Uniformity in guidance will offer clear standards for care evaluation and provide opportunities to reduce inappropriate care.
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Affiliation(s)
- Bahareh Goodarzi
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Anna Seijmonsbergen-Schermers
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | - Doug Cronie
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rotterdam, The Netherlands
| | | | - Thomas van den Akker
- Department of Obstetrics and Gynaecology, Leiden University Medical Centre, Leiden, The Netherlands.,Athena Institute, VU University, Amsterdam, The Netherlands.,Department of neonatology, Emma Children's Hospital, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Anton H van Kaam
- Department of neonatology, Emma Children's Hospital, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
| | - Ank de Jonge
- Department of Midwifery Science, Vrije Universiteit Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands.,Midwifery Academy Amsterdam Groningen, Amsterdam, The Netherlands.,Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands.,Amsterdam Reproduction and Development, Amsterdam, The Netherlands
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Carroll L, Thompson S, Coughlan B, McCreery T, Murphy A, Doherty J, Sheehy L, Cronin M, Brosnan M, O’Brien D. ‘Labour Hopscotch’: Women’s evaluation of using the steps during labor. Eur J Midwifery 2022; 6:59. [PMID: 36132188 PMCID: PMC9460932 DOI: 10.18332/ejm/152492] [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: 03/10/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION METHODS RESULTS CONCLUSIONS
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Affiliation(s)
- Lorraine Carroll
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Sinead Thompson
- National Women and Infants Health Programme, Dublin, Ireland
| | - Barbara Coughlan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | - Aisling Murphy
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | | | | | | | | | - Denise O’Brien
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
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Sabetghadam S, Keramat A, Goli S, Malary M, Rezaie Chamani S. Assessment of Medicalization of Pregnancy and Childbirth in Low-risk Pregnancies: A Cross-sectional Study. INTERNATIONAL JOURNAL OF COMMUNITY BASED NURSING AND MIDWIFERY 2022; 10:64-73. [PMID: 35005042 PMCID: PMC8724730 DOI: 10.30476/ijcbnm.2021.90292.1686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 08/30/2021] [Accepted: 09/01/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND Medicalization may lead to over-testing during pregnancy and increased cesarean section (CS). This study investigated the medicalization of low-risk pregnancies and childbirths in Rasht, Iran. METHODS In this cross-sectional study, 337 postpartum women completed a demographic questionnaire and the Medicalized Pregnancy and Childbirth checklist. In this study, medicalization indicators were the source of providing prenatal care, prenatal screening for aneuploidy, number of received care, hospitalization before the onset of labor, intrapartum drug use, and CS. Demographic data were reported using descriptive statistics. Chi-square or Fisher's exact and Man-Whitney tests were used for comparison purposes. Logistic regression was run to determine the medicalization indicators associated with the mode of childbirth. RESULTS Of the participants, 82.2% received prenatal care from obstetricians, 85.8% had undergone prenatal screening tests. There was a significant difference between the median number of ultrasound examinations (P=0.006), prenatal screening for aneuploidy (P=0.002), and multivitamin/mineral supplements use (P<0.001), according to the source of providing prenatal care. Of the participants, 67.1% had CS. Women who received prenatal care from obstetricians had about 2.3 times more odds of CS (OR=2.23, P=0.019). Furthermore, with the increased number of ultrasounds, the odds of CS augmented by 25% (OR=1.25, P=0.013). Finally, 26.4% of the participants were hospitalized before the onset of labor; the intervention increased the odds of CS more than twice (OR=2.08, P=0.026). CONCLUSION The study showed a picture of medicalization in low-risk pregnancies. Of the medicalization indicators, the source of providing prenatal care, time of admission, and use of ultrasounds were associated with CS. Midwife-led care could diminish medicalization.
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Affiliation(s)
- Shadi Sabetghadam
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Afsaneh Keramat
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Shahrbanoo Goli
- Department of Epidemiology and Biostatistics, School of Public Health, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mina Malary
- Student Research Committee, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Sedighe Rezaie Chamani
- Department of Midwifery, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran
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Martin-Arribas A, Escuriet R, Borràs-Santos A, Vila-Candel R, González-Blázquez C. A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes. Int J Nurs Stud 2021; 126:104129. [PMID: 34890836 DOI: 10.1016/j.ijnurstu.2021.104129] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Revised: 10/14/2021] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. OBJECTIVE The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. DESIGN A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016-2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. RESULTS Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. CONCLUSIONS The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. REGISTRY NUMBER ISRCTN14062994.
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Affiliation(s)
- Anna Martin-Arribas
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain; Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain.
| | - Ramon Escuriet
- Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain; Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain.
| | - Alicia Borràs-Santos
- Gimbernat School of Nursing, Universitat Autònoma de Barcelona (UAB), Sant Cugat del Vallès, Spain.
| | - Rafael Vila-Candel
- La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Alzira, Valencia, Spain; Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain; Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain.
| | - Cristina González-Blázquez
- Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain.
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Welffens K, Derisbourg S, Costa E, Englert Y, Pintiaux A, Warnimont M, Kirkpatrick C, Buekens P, Daelemans C. The "Cocoon," first alongside midwifery-led unit within a Belgian hospital: Comparison of the maternal and neonatal outcomes with the standard obstetric unit over 2 years. Birth 2020; 47:115-122. [PMID: 31746028 PMCID: PMC7065252 DOI: 10.1111/birt.12466] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Revised: 10/14/2019] [Accepted: 10/15/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES Our aim was to compare maternal and neonatal outcomes of women with a low-risk pregnancy attending the "Cocoon," an alongside midwifery-led birth center and care pathway, with women with a low-risk pregnancy attending the traditional care pathway in a tertiary care hospital in Belgium. METHODS We performed a retrospective cohort study of maternal and neonatal outcomes of women with a low-risk pregnancy who chose to adhere to the Cocoon pathway of care (n = 590) and women with a low-risk pregnancy who chose the traditional pathway of care (n = 394) from March 1, 2014, to February 29, 2016. We performed all analyses using an intention-to-treat approach. RESULTS In this setting, the cesarean birth rate was 10.3% compared with 16.0% in the traditional care pathway (adjusted odds ratios [aOR] 0.42 [95% CI 0.25-0.69]), the induction rate was 16.3% compared with 30.5% (0.46 [0.30-0.69]), the epidural analgesia rate was 24.9% compared with 59.1% (0.15 [0.09-0.22]), and the episiotomy rate was 6.8% compared with 14.5% (0.31 [0.17-0.56]). There was no increase in adverse neonatal outcomes. Intrapartum and postpartum transfer rates to the traditional pathway of care were 21.1% and 7.1%, respectively. CONCLUSIONS Women planning their births in the midwifery-led unit, the Cocoon, experienced fewer interventions with no increase in adverse neonatal outcomes. Our study gives initial support for the introduction of similar midwifery-led care pathways in other hospitals in Belgium.
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Affiliation(s)
- Karine Welffens
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Sara Derisbourg
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Elena Costa
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Yvon Englert
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Axelle Pintiaux
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Michèle Warnimont
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Christine Kirkpatrick
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
| | - Pierre Buekens
- Department of EpidemiologySchool of Public Health and Tropical MedicineTulane UniversityNew Orleans, Louisiana
| | - Caroline Daelemans
- Departement of Obstetrics and GynecologyCliniques Universitaires de BruxellesHôpital ErasmeBrusselsBelgium
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Walsh D, Spiby H, McCourt C, Coleby D, Grigg C, Bishop S, Scanlon M, Culley L, Wilkinson J, Pacanowski L, Thornton J. Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08120] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Midwifery-led units (MUs) are recommended for ‘low-risk’ births by the National Institute for Health and Care Excellence but according to the National Audit Office were not available in one-quarter of trusts in England in 2013 and, when available, were used by only a minority of the low-risk women for whom they should be suitable. This study explores why.
Objectives
To map the provision of MUs in England and explore barriers to and facilitators of their development and use; and to ascertain stakeholder views of interventions to address these barriers and facilitators.
Design
Mixed methods – first, MU access and utilisation across England was mapped; second, local media coverage of the closure of free-standing midwifery units (FMUs) were analysed; third, case studies were undertaken in six sites to explore the barriers and facilitators that have an impact on the development of MUs; and, fourth, by convening a stakeholder workshop, interventions to address the barriers and facilitators were discussed.
Setting
English NHS maternity services.
Participants
All trusts with maternity services.
Interventions
Establishing MUs.
Main outcome measures
Numbers and types of MUs and utilisation of MUs.
Results
Births in MUs across England have nearly tripled since 2011, to 15% of all births. However, this increase has occurred almost exclusively in alongside units, numbers of which have doubled. Births in FMUs have stayed the same and these units are more susceptible to closure. One-quarter of trusts in England have no MUs; in those that do, nearly all MUs are underutilised. The study findings indicate that most trust managers, senior midwifery managers and obstetricians do not regard their MU provision as being as important as their obstetric-led unit provision and therefore it does not get embedded as an equal and parallel component in the trust’s overall maternity package of care. The analysis illuminates how provision and utilisation are influenced by a complex range of factors, including the medicalisation of childbirth, financial constraints and institutional norms protecting the status quo.
Limitations
When undertaking the case studies, we were unable to achieve representativeness across social class in the women’s focus groups and struggled to recruit finance directors for individual interviews. This may affect the transferability of our findings.
Conclusions
Although there has been an increase in the numbers and utilisation of MUs since 2011, significant obstacles remain to MUs reaching their full potential, especially FMUs. This includes the capacity and willingness of providers to address women’s information needs. If these remain unaddressed at commissioner and provider level, childbearing women’s access to MUs will continue to be restricted.
Future work
Work is needed on optimum approaches to improve decision-makers’ understanding and use of clinical and economic evidence in service design. Increasing women’s access to information about MUs requires further studies of professionals’ understanding and communication of evidence. The role of FMUs in the context of rural populations needs further evaluation to take into account user and community impact.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 12. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Denis Walsh
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Helen Spiby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | | | - Dawn Coleby
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Celia Grigg
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Simon Bishop
- School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Miranda Scanlon
- School of Health Sciences, City, University of London, London, UK
| | - Lorraine Culley
- Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | | | | | - Jim Thornton
- School of Health Sciences, University of Nottingham, Nottingham, UK
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12
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Are women attending a midwifery-led birthing center at increased risk of anal sphincter injury? Int Urogynecol J 2020; 31:583-589. [PMID: 31901952 DOI: 10.1007/s00192-019-04218-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 12/16/2019] [Indexed: 10/25/2022]
Abstract
INTRODUCTION AND HYPOTHESIS In recent years there has been renewed interest in midwifery-led care for women, with studies reporting similar neonatal outcomes despite lower rates of intervention in midwifery-led birthing centers. Research into obstetric anal sphincter injuries (OASI) in these birthing centers is scarce. The objective of this study was to compare the rate of OASI after spontaneous vaginal delivery in nulliparous women in consultant or midwifery-led units over a ten-year period. METHODS All spontaneous vaginal deliveries in nulliparous women from 2008 to 2017 were analyzed in a single-center retrospective study. Women who had neuraxial analgesia were excluded. The primary endpoint was OASI. Labor characteristics in both groups were compared, and a multiple regression model was created. RESULTS During the study period, there were 3260 spontaneous vaginal deliveries in nulliparous women; 75.7% (2467/3260) delivered in the consultant-led unit and 24.3% (793/3260) in the midwifery-led unit (MLU). Women delivering in the MLU had a greater risk of anal sphincter injury than those delivering in the CLU (4.9% [39/793] vs 2.5% [62/2467], OR 2.01, 95% CI 1.32 - 3.01). Significant risk factors that increased the risk of OASI on regression analysis were birthweight and delivery in the midwifery-led unit. CONCLUSIONS Women delivering in the midwifery-led unit appear to be at double the risk of OASI when compared to those delivering in the consultant-led unit. These results are in contrast to previous studies in midwifery-led centers. This difference may be site-specific and further research is required before these results form part of patient counseling.
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13
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Clesse C, Lighezzolo-Alnot J, De Lavergne S, Hamlin S, Scheffler M. Factors related to episiotomy practice: an evidence-based medicine systematic review. J OBSTET GYNAECOL 2019; 39:737-747. [DOI: 10.1080/01443615.2019.1581741] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Christophe Clesse
- Interpsy Laboratory (EA4432), Université de Lorraine, Nancy, France
- Hospital Centre of Jury-les-Metz – Route d’Ars Laquenexy, Jury-Lesmetz, France
- Polyclinic Majorelle, Nancy, France
| | | | | | | | - Michèle Scheffler
- Polyclinic Majorelle, Nancy, France
- Cabinet de Gynécologie Médicale et Obstétrique, Nancy, France
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14
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Begley CM, Gyte GML, Devane D, McGuire W, Weeks A, Biesty LM. Active versus expectant management for women in the third stage of labour. Cochrane Database Syst Rev 2019; 2:CD007412. [PMID: 30754073 PMCID: PMC6372362 DOI: 10.1002/14651858.cd007412.pub5] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Active management of the third stage of labour involves giving a prophylactic uterotonic, early cord clamping and controlled cord traction to deliver the placenta. With expectant management, signs of placental separation are awaited and the placenta is delivered spontaneously. Active management was introduced to try to reduce haemorrhage, a major contributor to maternal mortality in low-income countries. This is an update of a review last published in 2015. OBJECTIVES To compare the effects of active versus expectant management of the third stage of labour on severe primary postpartum haemorrhage (PPH) and other maternal and infant outcomes.To compare the effects of variations in the packages of active and expectant management of the third stage of labour on severe primary PPH and other maternal and infant outcomes. SEARCH METHODS For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the World health Organization International Clinical Trials Registry Platform (ICTRP), on 22 January 2018, and reference lists of retrieved studies. SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing active versus expectant management of the third stage of labour. Cluster-randomised trials were eligible for inclusion, but none were identified. DATA COLLECTION AND ANALYSIS Two review authors independently assessed the studies for inclusion, assessed risk of bias, carried out data extraction and assessed the quality of the evidence using the GRADE approach. MAIN RESULTS We included eight studies, involving analysis of data from 8892 women. The studies were all undertaken in hospitals, seven in higher-income countries and one in a lower-income country. Four studies compared active versus expectant management, and four compared active versus a mixture of managements. We used a random-effects model in the analyses because of clinical heterogeneity. Of the eight studies included, we considered three studies as having low risk of bias in the main aspects of sequence generation, allocation concealment and completeness of data collection. There was an absence of high-quality evidence according to GRADE assessments for our primary outcomes, which is reflected in the cautious language below.The evidence suggested that, for women at mixed levels of risk of bleeding, it is uncertain whether active management reduces the average risk of maternal severe primary PPH (more than 1000 mL) at time of birth (average risk ratio (RR) 0.34, 95% confidence interval (CI) 0.14 to 0.87, 3 studies, 4636 women, I2 = 60%; GRADE: very low quality). For incidence of maternal haemoglobin (Hb) less than 9 g/dL following birth, active management of the third stage may reduce the number of women with anaemia after birth (average RR 0.50, 95% CI 0.30 to 0.83, 2 studies, 1572 women; GRADE: low quality). We also found that active management of the third stage may make little or no difference to the number of babies admitted to neonatal units (average RR 0.81, 95% CI 0.60 to 1.11, 2 studies, 3207 infants; GRADE: low quality). It is uncertain whether active management of the third stage reduces the number of babies with jaundice requiring treatment (RR 0.96, 95% CI 0.55 to 1.68, 2 studies, 3142 infants, I2 = 66%; GRADE: very low quality). There were no data on our other primary outcomes of very severe PPH at the time of birth (more than 2500 mL), maternal mortality, or neonatal polycythaemia needing treatment.Active management reduces mean maternal blood loss at birth and probably reduces the rate of primary blood loss greater than 500 mL, and the use of therapeutic uterotonics. Active management also probably reduces the mean birthweight of the baby, reflecting the lower blood volume from interference with placental transfusion. In addition, it may reduce the need for maternal blood transfusion. However, active management may increase maternal diastolic blood pressure, vomiting after birth, afterpains, use of analgesia from birth up to discharge from the labour ward, and more women returning to hospital with bleeding (outcome not pre-specified).In the comparison of women at low risk of excessive bleeding, there were similar findings, except it was uncertain whether there was a difference identified between groups for severe primary PPH (average RR 0.31, 95% CI 0.05 to 2.17; 2 studies, 2941 women, I2 = 71%), maternal Hb less than 9 g/dL at 24 to 72 hours (average RR 0.17, 95% CI 0.02 to 1.47; 1 study, 193 women) or the need for neonatal admission (average RR 1.02, 95% CI 0.55 to 1.88; 1 study, 1512 women). In this group, active management may make little difference to the rate of neonatal jaundice requiring phototherapy (average RR 1.31, 95% CI 0.78 to 2.18; 1 study, 1447 women).Hypertension and interference with placental transfusion might be avoided by using modifications to the active management package, for example, omitting ergot and deferring cord clamping, but we have no direct evidence of this here. AUTHORS' CONCLUSIONS Although the data appeared to show that active management reduced the risk of severe primary PPH greater than 1000 mL at the time of birth, we are uncertain of this finding because of the very low-quality evidence. Active management may reduce the incidence of maternal anaemia (Hb less than 9 g/dL) following birth, but harms such as postnatal hypertension, pain and return to hospital due to bleeding were identified.In women at low risk of excessive bleeding, it is uncertain whether there was a difference between active and expectant management for severe PPH or maternal Hb less than 9 g/dL (at 24 to 72 hours). Women could be given information on the benefits and harms of both methods to support informed choice. Given the concerns about early cord clamping and the potential adverse effects of some uterotonics, it is critical now to look at the individual components of third-stage management. Data are also required from low-income countries.It must be emphasised that this review includes only a small number of studies with relatively small numbers of participants, and the quality of evidence for primary outcomes is low or very low.
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Affiliation(s)
- Cecily M Begley
- Trinity College DublinSchool of Nursing and Midwifery24 D'Olier StreetDublinIreland
| | - Gillian ML Gyte
- University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyUniversity RoadGalwayIreland
| | - William McGuire
- University of YorkCentre for Reviews and DisseminationYorkY010 5DDUK
| | - Andrew Weeks
- The University of LiverpoolDepartment of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Linda M Biesty
- National University of Ireland GalwaySchool of Nursing and MidwiferyUniversity RoadGalwayIreland
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15
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Goodarzi B, Holten L, van El C, de Vries R, Franx A, Houwaart E. Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands. HEALTH RISK & SOCIETY 2018. [DOI: 10.1080/13698575.2018.1558182] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Bahareh Goodarzi
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG - Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Lianne Holten
- Amsterdam UMC, Vrije Universiteit Amsterdam, Midwifery Science, AVAG - Amsterdam Public Health research institute, Amsterdam, The Netherlands
| | - Carla van El
- Amsterdam UMC, Vrije Universiteit Amsterdam, Community Genetics Department of Clinical Genetics, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond de Vries
- Academie Verloskunde Maastricht, Zuyd University, Maastricht University/CAPHRI School for Public Health and Primary Care, Maastricht, The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Eddy Houwaart
- Department Health, Ethics and Society Faculty of Health, Medicine and Life Sciences Maastricht University, Maastricht, The Netherlands
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16
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Larkin P. Joy, guilt and disappointment: An interpretative phenomenological analysis of the experiences of women transferred from midwifery led to consultant led care. Midwifery 2018; 62:128-134. [DOI: 10.1016/j.midw.2018.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 03/13/2018] [Accepted: 04/03/2018] [Indexed: 11/16/2022]
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17
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Begley C, Guilliland K, Dixon L, Reilly M, Keegan C, McCann C, Smith V. A qualitative exploration of techniques used by expert midwives to preserve the perineum intact. Women Birth 2018; 32:87-97. [PMID: 29730096 DOI: 10.1016/j.wombi.2018.04.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 03/29/2018] [Accepted: 04/18/2018] [Indexed: 12/23/2022]
Abstract
BACKGROUND The perineum stretches during birth to allow passage of the baby, but 85% of women sustain some degree of perineal trauma during childbirth, which is painful post-partum. Episiotomy rates vary significantly, with some countries having rates of >60%. Recent Irish and New Zealand studies showed lower severe perineal trauma and episiotomy rates than other countries. AIM To explore expert Irish and New Zealand midwives' views of the skills that they employ in preserving the perineum intact during spontaneous vaginal birth. METHODS Following ethical approval a qualitative, descriptive study was undertaken. Semi-structured, recorded, interviews were transcribed and analysed using the constant comparative method. Expert midwives employed in New Zealand and one setting in Ireland, were invited to join the study. "Expert" was defined as achieving, in the preceding 3.5 years, an episiotomy rate for nulliparous women of <11.8%, a 'no suture' rate of 40% or greater, and a severe perineal tear rate of <3.2%. Twenty-one midwives consented to join the study. RESULTS Four core themes emerged: 'Calm, controlled birth', 'Position and techniques in early second stage', 'Hands on or off?' and 'Slow, blow and breathe the baby out.' Using the techniques described enabled these midwives to achieve rates, in nulliparous women, of 3.91% for episiotomy, 59.24% for 'no sutures', and 1.08% for serious lacerations. CONCLUSIONS This study provides further understanding of the techniques used by expert midwives at birth. These findings, combined with existing quantitative research, increases the evidence on how to preserve the perineum intact during spontaneous birth.
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Affiliation(s)
- C Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Sweden.
| | - K Guilliland
- New Zealand College of Midwives, Christchurch, New Zealand
| | - L Dixon
- New Zealand College of Midwives, Christchurch, New Zealand
| | - M Reilly
- Midwife-Led Unit, Cavan General Hospital, Cavan, Ireland
| | - C Keegan
- Midwife-Led Unit, Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - C McCann
- Our Lady of Lourdes Hospital, Drogheda, Ireland
| | - V Smith
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
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Exploring factors that influence students' attitudes toward midwifery in Jordan: Measuring psychometric properties of a newly developed tool. Nurse Educ Pract 2018; 29:219-224. [PMID: 29453022 DOI: 10.1016/j.nepr.2018.02.005] [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: 04/12/2017] [Revised: 01/30/2018] [Accepted: 02/07/2018] [Indexed: 11/24/2022]
Abstract
Students' professional choice to proceed in midwifery is influenced by many factors. This study validated an instrument developed to assess students' attitudes toward midwifery in Jordan. It also addressed the motivating and de-motivating factors influencing students' decision concerning joining and continuing in midwifery. A descriptive, cross-section study was conducted on a convenience sample of 374 midwifery students representing private, governmental, and military midwifery colleges. The researchers developed the study questionnaire through conducting a comprehensive literature review, organizing common themes and consulting experts. Exploratory factor analysis and tests of normality and reliability, including Cronbach's Alpha and Bartlett's test, were used in the analysis. The result was three factors were explained by 23 items. They were as follows: professional knowledge, professional motivation factors, and de-motivating professional factors. The first 8 items explained nearly 61% of the variance. Cronbach's Alpha was 0.834 with a range of 0.835-0.839. The Spearman-Brown coefficient was 0.81 and Guttman Split-Half coefficient was 0.83. Issues of reliability and validity require a repetitive process of testing under a range of circumstances to ensure both stability and representation of the construct. However, addressing factors found to have impact of students' decisions is crucial to improve retention of high quality students.
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