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Pollock D, Bailey HD, Hasanoff S, Munn Z, Valenzuela C, Stern C, Price C, Marriott R, Gliddon J, Lewis C, Michie C, Bowie M, Penny M, Reibel T, Warland J, Farrant B, White SW, Shepherd CCJ. First Nations Peoples' perceptions, knowledge and beliefs regarding stillbirth prevention and bereavement practices: A mixed methods systematic review. Women Birth 2024; 37:101604. [PMID: 38640744 DOI: 10.1016/j.wombi.2024.101604] [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: 12/05/2023] [Revised: 03/24/2024] [Accepted: 03/25/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND First Nations Peoples endure disproportionate rates of stillbirth compared with non-First Nations Peoples. Previous interventions have aimed at reducing stillbirth in First Nations Peoples and providing better bereavement care without necessarily understanding the perceptions, knowledge and beliefs that could influence the design of the intervention and implementation. AIM The aim of this review was to understand the perceptions, knowledge and beliefs about stillbirth prevention and bereavement of First Nations Peoples from the US, Canada, Aotearoa/New Zealand, and Australia. METHODS This review was conducted in accordance with the JBI methodology for a convergent integrated mixed method systematic review. This review was overseen by an advisory board of Aboriginal Elders, researchers, and clinicians. A search of eight databases (PubMed, MEDLINE, PsycInfo, CINAHL, Embase, Emcare, Dissertations and Theses and Indigenous Health InfoNet) and grey literature was conducted. All studies were screened, extracted, and appraised for quality by two reviewers and results were categorised, and narratively summarised. RESULTS Ten studies were included within this review. Their findings were summarised into four categories: safeguarding baby, traditional practices of birthing and grieving, bereavement photography and post-mortem examination. The results indicate a diversity of perceptions, knowledge and beliefs primarily around smoking cessation and bereavement practices after stillbirth. However, there was a paucity of research available. CONCLUSIONS Further research is needed to understand the perceptions, knowledge and beliefs about stillbirth among First Nations Peoples. Without research within this area, interventions to prevent stillbirth and support bereaved parents and their communities after stillbirth may face barriers to implementation.
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Affiliation(s)
- Danielle Pollock
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia.
| | - Helen D Bailey
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Sabira Hasanoff
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Zachary Munn
- Health Evidence Synthesis Recommendations and Impact (HESRI), School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Chelsea Valenzuela
- JBI, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Cindy Stern
- JBI, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Carrie Price
- Albert S. Cook Library, Towson University, Towson, MD, USA
| | - Rhonda Marriott
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Janinne Gliddon
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | - Carolyn Lewis
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Carol Michie
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Muriel Bowie
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Millie Penny
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Tracy Reibel
- Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
| | | | - Brad Farrant
- Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia
| | - Scott W White
- Division of Obstetrics and Gynaecology, The University of Western Australia, Perth, WA, Australia; Maternal Fetal Medicine Service, King Edward Memorial Hospital, Perth, WA, Australia; The Western Australian Centre for Health Research for Women and Babies, The University of Western Australia, Perth, WA, Australia
| | - Carrington C J Shepherd
- Curtin Medical School, Faculty of Health Sciences, Curtin University, Perth, WA, Australia; Telethon Kids Institute, The University of Western Australia, Perth, WA, Australia; Ngangk Yira Institute for Change, Murdoch University, Perth, WA, Australia
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2
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Silver RM, Reddy U. Stillbirth: we can do better. Am J Obstet Gynecol 2024:S0002-9378(24)00628-8. [PMID: 38789073 DOI: 10.1016/j.ajog.2024.05.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 04/23/2024] [Accepted: 05/20/2024] [Indexed: 05/26/2024]
Abstract
Stillbirth is far too common, occurring in millions of pregnancies per year globally. The rate of stillbirth (defined as death of a fetus prior to birth at 20 weeks' gestation or more) in the United States is 5.73 per 1000. This is approximately 1 in 175 pregnancies accounting for about 21,000 stillbirths per year. Although rates are much higher in low-income countries, the stillbirth rate in the United States is much higher than most high resource countries. Moreover, there are substantial disparities in stillbirth, with rates twice as high for non-Hispanic Black and Native Hawaiian or Other Pacific Islanders compared to non-Hispanic Whites. There is considerable opportunity for reduction in stillbirths, even in high resource countries such as the United States. In this article, we review the epidemiology, risk factors, causes, evaluation, medical and emotional management, and prevention of stillbirth. We focus on novel data regarding genetic etiologies, placental assessment, risk stratification, and prevention.
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Affiliation(s)
- Robert M Silver
- Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, University of Utah, Salt Lake City, UT.
| | - Uma Reddy
- Departments of Obstetrics and Gynecology, Divisions of Maternal Fetal Medicine, Columbia University, New York, NY
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3
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Massi L, Lewis C, Stewart S, Jans D, Gautam R, Jalloub L, Bowman A, Middleton P, Vlack S, Boyle FM, Shepherd C, Flenady V, Stuart-Butler D, Rae KM. Looking after bubba for all our mob: Aboriginal and Torres Strait Islander community experiences and perceptions of stillbirth. Front Public Health 2024; 12:1385125. [PMID: 38689763 PMCID: PMC11059953 DOI: 10.3389/fpubh.2024.1385125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 03/18/2024] [Indexed: 05/02/2024] Open
Abstract
The stillbirth rate among Aboriginal and Torres Strait Islander women and communities in Australia is around double that of non-Indigenous women. While the development of effective prevention strategies during pregnancy and improving care following stillbirth for women and families in communities has become a national priority, there has been limited progress in stillbirth disparities. With community permission, this study aimed to gain a better understanding of community experiences, perceptions, and priorities around stillbirth. We undertook an Indigenous researcher-led, qualitative study, with community consultations guided by a cultural protection protocol and within an unstructured research framework. A total of 18 communities were consulted face-to-face through yarning interviews, focus groups and workshops. This included 54 community member and 159 health professional participants across remote, regional, and urban areas of Queensland, Western Australia, Victoria, South Australia, and Northern Territory. Thematic analysis of consultation data identified common themes across five focus/priority areas to address stillbirth: Stillbirth or Sorry Business Baby care needs to be family-centered; using Indigenous "ways of knowing, being, and doing" to ensure cultural safety; application of Birthing on Country principles to maternal and perinatal care; and yarning approaches to improve communication and learning or education. The results underscore the critical need to co-design evidence-based, culturally appropriate, and community-acceptable resources to help reduce existing disparities in stillbirth rates.
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Affiliation(s)
- Luciana Massi
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Indigenous Health Research Group, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Carolyn Lewis
- Curtin Medical School, Curtin University, Perth, WA, Australia
| | | | - Diana Jans
- Apunipima Cape York Health Council, Cairns, QLD, Australia
| | - Rupesh Gautam
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Lina Jalloub
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Anneka Bowman
- Department Aboriginal Communities and Families Research Alliance, South Australia Health and Medical Research Institute, Adelaide, SA, Australia
| | - Philippa Middleton
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Pregnancy and Perinatal Care, South Australia Health and Medical Research Institute, Adelaide, SA, Australia
| | - Sue Vlack
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Frances M. Boyle
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Institute for Social Science Research (ISSR), The University of Queensland, Brisbane, QLD, Australia
| | - Carrington Shepherd
- Curtin Medical School, Curtin University, Perth, WA, Australia
- Ngangk Yira Research Institute, Murdoch University, Perth, WA, Australia
- Telethon Kids Institute, Perth, WA, Australia
| | - Vicki Flenady
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Deanna Stuart-Butler
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
| | - Kym M. Rae
- Stillbirth Centre of Research Excellence, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Indigenous Health Research Group, Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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4
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O'Connor E, Leitao S, Fogarty AP, Greene R, O'Donoghue K. A systematic review of standardised tools used in perinatal death review programmes. Women Birth 2024; 37:88-97. [PMID: 37793961 DOI: 10.1016/j.wombi.2023.09.006] [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: 06/06/2023] [Revised: 09/14/2023] [Accepted: 09/20/2023] [Indexed: 10/06/2023]
Abstract
INTRODUCTION Reducing preventable perinatal deaths is the focus of perinatal death surveillance and response programmes. Standardised review tools can help identify modifiable factors in perinatal deaths. AIM This systematic review aimed to identify, compare, and appraise perinatal mortality review tools (PMRTs) in upper-middle to high-income countries. METHODS Four major scientific databases were searched for publications relating to perinatal death reviews. There were no restrictions on date, study, or publication type. Professional websites for each country were searched for relevant material. The Appraisal of Guidelines Research and Evaluation Health Systems (AGREE-HS) checklist was used for quality appraisal of each tool. A narrative synthesis was used to describe and compare tools. FINDINGS Ten PMRTs were included. Five PMRTs were from high-income countries, four from upper-middle income countries and one was designed for use in a global context. The structure, content, and quality of each PMRT varied. Each tool collected information about the antepartum, intrapartum, and neonatal periods and a section to classify perinatal deaths using a standardised classification system. All tools reviewed the care provided. Five tools included recommendation development for changes to clinical care. Four tools mentioned parent involvement in the review process. For quality appraisal, one review tool scored "high quality", six scored "moderate quality" and two scored "poor quality". CONCLUSION There is little standardisation when it comes to PMRTs. Guidance on structuring PMRTs in a standardised way is needed. Recommendation development from a review is important to highlight changes to care required to reduce preventable perinatal deaths.
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Affiliation(s)
- Emily O'Connor
- INFANT Research Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland.
| | - Sara Leitao
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland
| | - Amy P Fogarty
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
| | - Richard Greene
- National Perinatal Epidemiology Centre, Dept. of Obstetrics and Gynaecology, 5th Floor, Cork University Maternity Hospital, Ireland
| | - Keelin O'Donoghue
- INFANT Research Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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5
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Bailey C, Medeiros PDB, Ellwood DA, Middleton P, Andrews CJ, Flenady VJ. A systematic review of interventions to increase the use of smoking cessation services for women who smoke during pregnancy. Aust N Z J Obstet Gynaecol 2023; 63:737-745. [PMID: 37621216 PMCID: PMC10952730 DOI: 10.1111/ajo.13745] [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: 04/25/2023] [Accepted: 07/30/2023] [Indexed: 08/26/2023]
Abstract
BACKGROUND Although many pregnant women accept referrals to stop-smoking support, the uptake of appointments often remains low. AIM The aim was to review the success of interventions to increase the uptake of external stop-smoking appointments following health professional referrals in pregnancy. MATERIALS AND METHODS Embase, PubMed, Cochrane Central Register of Controlled Trials, Scopus and CINAHL were searched in February 2023 for studies with interventions to increase the uptake rates of external stop-smoking appointments among pregnant women who smoke. Eligible studies included randomised, controlled, cluster-randomised, quasi-randomised, before-and-after, interrupted time series, case-control and cohort studies. Cochrane tools assessing for bias and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. RESULTS Two before-and-after studies were included, including a combined total of 1996 women who smoked during pregnancy. Both studies had a serious risk of bias, and meta-analysis was not possible due to heterogeneity. One study testing carbon monoxide monitors and opt-out referrals showed increased uptake of external stop-smoking appointments, health professional referrals and smoking cessation rates compared to self-identified smoking status and opt-in referrals. Results were limited in the second study, which used carbon monoxide monitors, urinary cotinine levels and self-disclosed methods to identify the smoking status with opt-out referrals. Only post-intervention data were available on the uptake of appointments to external stop-smoking services. The number of health professional referrals increased, but change in smoking cessation rates was less clear. CONCLUSIONS There is insufficient evidence to inform practice regarding strategies to increase the uptake of external stop-smoking appointments by women during pregnancy.
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Affiliation(s)
- Cheryl Bailey
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
| | - Poliana de Barros Medeiros
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- Department of Paediatrics and NeonatologySunshine Coast University HospitalSunshine CoastQueenslandAustralia
| | - David A. Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- School of Medicine & DentistryGriffith University and Gold Coast University HospitalGold CoastQueenslandAustralia
| | - Philippa Middleton
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
- South Australian Health and Medical Research Institute (SAHMRI) : Women and Kids and The University of AdelaideAdelaideSouth AustraliaAustralia
| | - Christine J. Andrews
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
| | - Vicki J. Flenady
- Centre of Research Excellence in Stillbirth, Mater Research InstituteThe University of QueenslandBrisbaneQueenslandAustralia
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6
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Martínez-García E, Lara-Rodríguez H, Álvarez-Serrano MA, González-García A, Martín-Salvador A, Gázquez-López M, Pérez-Morente MÁ. Good practices in perinatal bereavement care in public maternity hospitals in Southern Spain. Midwifery 2023; 124:103749. [PMID: 37271065 DOI: 10.1016/j.midw.2023.103749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 04/23/2023] [Accepted: 05/29/2023] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the attitudes and care practices of midwives and nurses in the province of Granada in relation to death care and perinatal bereavement, to determine their degree of adaptation to international standards and to identify possible differences in personal factors among those who best adapt to international recommendations. DESIGN A local survey of 117 nurses and midwives from the five maternity hospitals in the province was conducted using the Lucina questionnaire developed to explore professionals' emotions, opinions, and knowledge during perinatal bereavement care. Adaptation of practices to international recommendations was assessed using the CiaoLapo Stillbirth Support (CLASS) checklist. Socio-demographic data were collected to establish their association with increased compliance with recommendations. FINDINGS The response rate was 75.4%, the majority were women (88.9%), with a mean age of 40.9 (SD=1.4) and 17.4 (SD= 10.58) years of work experience. Midwives were the most represented (67.5%) and reported having attended more cases of perinatal death (p = 0.010) and having more specific training (p<0.001.) Of these, 57.3% would recommend immediate delivery, 26.5% would recommend the use of pharmacological sedation during delivery and 47% would take the baby immediately if the parents expressed their wish not to watch them. On the other hand, only 58% would be in favour of taking photos for the creation of memories, 47% would bathe and dress the baby in all cases, and 33.3% would allow the company of other family members. The percentage that matched each recommendation on memory-making was 58%, 41.9% matched the recommendations on respect for the baby and parents, and 23% and 10.3% matched the appropriate delivery and follow-up options, respectively. The factors associated with 100% of the recommendations, according to the care sector, were being a woman, a midwife, having specific training and having personally experienced the situation. KEY CONCLUSIONS Although the levels of adaptation observed are more favourable than in other nearby contexts, serious deficiencies are identified in the province of Granada with respect to internationally agreed recommendations on perinatal bereavement care. More training and awareness-raising of midwives and nurses is needed, which also considers factors related to better compliance. IMPLICATION FOR PRACTICE This is the first study to quantify the degree of adaptation to international recommendations in Spain reported by midwives and nurses, as well as the individual factors associated with a higher level of compliance. Areas for improvement and explanatory variables of adaptation are identified, which allow support for possible training and awareness-raising programmes aimed at improving the quality of care provided to bereaved families.
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Affiliation(s)
- Encarnación Martínez-García
- Department of Nursing. University of Granada, Spain; Guadix Hospital (Granada). Andalusian Health Service, Spain
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7
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Escañuela Sánchez T, O Donoghue K, Byrne M, Meaney S, Matvienko-Sikar K. A systematic review of behaviour change techniques used in the context of stillbirth prevention. Women Birth 2023; 36:e495-e508. [PMID: 37179243 DOI: 10.1016/j.wombi.2023.05.002] [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: 02/10/2023] [Revised: 05/02/2023] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND Stillbirth is one of the most devastating pregnancy outcomes that families can experience. Previous research has associated a wide range of risk factors with stillbirth, including maternal behaviours such as substance use, sleep position and attendance and engagement with antenatal care. Hence, some preventive efforts have been focused on tackling the behavioural risk factors for stillbirth. This study aimed to identify the Behaviour Change Techniques (BCTs) used in behaviour change interventions tacking behavioural risk factors for stillbirth such as substance use, sleep position, unattendance to antenatal care and weight management. STUDY DESIGN A systematic review of the literature was conducted in June 2021 and updated in November 2022 in five databases: CINHAL, Psyhinfo, SociIndex, PubMed and Web of Science. Studies published in high-income countries describing interventions designed in the context of stillbirth prevention, reporting stillbirth rates and changes in behaviour were eligible for inclusion. BCTs were identified using the Behaviour Change Technique Taxonomy v1. RESULTS Nine interventions were included in this review identified in 16 different publications. Of these, 4 interventions focused on more than one behaviour (smoking, monitoring fetal movements, sleep position, care-seeking behaviours), one focused on smoking, three on monitoring fetal movements and one on sleep position. Twenty-seven BCTs were identified across all interventions. The most commonly used was "Information about health consequences" (n = 7/9) followed by "Adding objects to the environment" (n = 6/9). One of the interventions included in this review has not been assessed for efficacy yet, of the remaining eight, three showed results in the reduction of stillbirth rates. and four interventions produced behaviour change (smoking reductions, increased knowledge, reduced supine sleeping time). CONCLUSIONS Our findings suggest that interventions designed to date have limited effects on the rates of stillbirth and utilise a limited number of BCTs which are mostly focused on information provision. Further research is necessary to design evidence base behaviour change interventions with a greater focus to tackle all the other factors influencing behaviour change during pregnancy (e.g.: social influence, environmental barriers).
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Affiliation(s)
- Tamara Escañuela Sánchez
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland; National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, University College Cork, Cork, Ireland.
| | - Keelin O Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics and Gynaecology, University College Cork, Cork University Maternity Hospital, Cork, Ireland; INFANT Centre, University College Cork, Cork, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, NUI Galway, Galway, Ireland
| | - Sarah Meaney
- National Perinatal Epidemiology Centre (NPEC), University College Cork. Dept. of Obstetrics and Gynaecology, University College Cork, Cork, Ireland
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8
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Wilson DL, Fung AM, Pell G, Skrzypek H, Barnes M, Bourjeily G, Walker SP, Howard ME. Polysomnographic analysis of maternal sleep position and its relationship to pregnancy complications and sleep-disordered breathing. Sleep 2022; 45:6527683. [PMID: 35150285 PMCID: PMC8996027 DOI: 10.1093/sleep/zsac032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/12/2022] [Indexed: 11/14/2022] Open
Abstract
Links between supine "going to sleep" position and stillbirth risk have led to campaigns regarding safe maternal sleep position. This study profiles the distribution of sleep positions overnight and relationships to sleep onset position during pregnancy, and the relationships between supine sleep, sleep-disordered breathing (SDB), and pregnancy outcomes. Data from three prospective cohort studies evaluating SDB in healthy and complicated pregnancies were pooled. All participants underwent one night of polysomnography in late pregnancy and birth outcome data were collected. 187 women underwent polysomnography at a median gestation of 34 weeks'. The left lateral position was preferred for falling asleep (52%) compared to supine (14%), but sleep onset position was the dominant sleep position overnight in only half (54%) of women. The median percentage of sleep time in the supine position was 24.2%; women who fell asleep supine spent more time supine overnight compared to those who began non-supine (48.0% (30.0,65.9) vs. 22.6% (5.7,32.2), p < .001). Women with growth-restricted fetuses were more likely to fall asleep supine than those with well-grown fetuses (36.6% vs. 7.5%, p < .001). Positional SDB was observed in 46% of those with an RDI ≥ 5. Sleep onset position was the dominant position overnight for half of the sample, suggesting that sleep onset position is not always a reliable indicator of body position overnight. Supine sleep was related to fetal growth restriction and birthweight at delivery, though causality cannot be inferred. It is critical that we pursue research into verifying the important relationship between supine sleep and increased stillbirth risk, and the mechanisms behind it.
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Affiliation(s)
- Danielle L Wilson
- Corresponding author. Danielle L. Wilson, Institute for Breathing and Sleep, Level 5 Harold Stokes Building, Austin Health, Heidelberg, Victoria, Australia.
| | - Alison M Fung
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Gabrielle Pell
- Department of Obstetrics and Gynaecology, University of Melbourne, Parkville, Victoria, Australia
| | - Hannah Skrzypek
- Mercy Perinatal, Mercy Hospital for Women, Heidelberg, Victoria, Australia
| | - Maree Barnes
- Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia,Department of Medicine, University of Melbourne, Parkville, Victoria, Australia
| | - Ghada Bourjeily
- Department of Medicine, The Miriam Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
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9
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Helps Ä, Leitao S, Gutman A, Greene R, O'Donoghue K. National perinatal mortality audits and resultant initiatives in four countries. Eur J Obstet Gynecol Reprod Biol 2021; 267:111-119. [PMID: 34749039 DOI: 10.1016/j.ejogrb.2021.10.012] [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: 08/08/2021] [Revised: 09/23/2021] [Accepted: 10/12/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND It is important to examine perinatal deaths as part of a national mortality audit to identify risk factors. Implementing and re-evaluating recommendations from perinatal mortality audits completes the audit cycle, preventing similar deaths in the future. Lack of implementation results in recommendations recurring. OBJECTIVES In this study we examine national perinatal mortality audits' methodology in four high-income countries (United Kingdom, New Zealand, Ireland, Netherlands) to highlight different approaches taken. We compare the recommendations made in these audits' reports over the last five years, as well as review national initiatives and programmes addressing them. STUDY DESIGN This study is an integrative review where two comprehensive literature searches were completed: on established national perinatal mortality audits in high-income countries; and on national initiatives addressing recommendations from these audits. Content analysis of the audits' recommendations was performed organising them into themes according to topics these focused on. RESULTS Though the methodology of the national perinatal mortality audits varied, all four were state-funded and had standardised online data collection forms to report deaths. The recommendations themes included: Raising public awareness of perinatal mortality risk factors, Detection of fetal growth restriction, Prevention of preterm birth, Resources for data collection and review. Only the UK had various initiatives addressing perinatal mortality risk factors directly. New Zealand included stakeholders in the audit recommendations' development and provided updates on their implementation. The Netherlands developed a programme for audit recommendation implementation. Ireland created a group which is progressing some recommendations from the audit. CONCLUSIONS National perinatal mortality audits are important in identifying contributory factors and making recommendations to address these. Recurring recommendations suggest a failure to resolve the identified issues. This study shows how some challenges are common to high-income countries' audits, highlighting the need for shared learning of successful initiatives.
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Affiliation(s)
- Änne Helps
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland.
| | - Sara Leitao
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland; Pregnancy Loss Research Group, University College Cork, Cork, Ireland
| | - Arlene Gutman
- Pregnancy Loss Research Group, University College Cork, Cork, Ireland; School of Medicine, University College Cork, Cork, Ireland
| | - Richard Greene
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, University College Cork, Cork, Ireland; The Irish Centre for Maternal and Child Health Research (INFANT), University College Cork, Cork, Ireland
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10
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Wilkinson C. Outpatient labour induction. Best Pract Res Clin Obstet Gynaecol 2021; 77:15-26. [PMID: 34556409 DOI: 10.1016/j.bpobgyn.2021.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 08/09/2021] [Accepted: 08/10/2021] [Indexed: 11/26/2022]
Abstract
The inexorable rise in induction rates over the past two decades, in parallel with increasing medical costs and pressure to reduce length of stay, has led to marked logistic difficulties for health care workers, managers and planners. Maternity services are being overwhelmed by the need to allocate staff and delivery suite space for the scheduling and undertaking of induction processes, rather than focussing care for women in spontaneous labour. Induction of labour according to the majority of current protocols and guidelines necessitates increased length of stay and relatively aggressive use of oxytocin (to reduce the time expended in the labour ward from artificial rupture of membranes (AROM) to establishment of labour). This increased oxytocin usage requires increased use of continuous electronic foetal monitoring, and may also increase epidural usage, further increasing the complexity of labour for the woman and her health care workers. Outpatient care after cervical priming and even outpatient care after AROM may help to ease these pressures and may reduce the medicalisation of the birth experience when induction is indicated, with a potential to reduce oxytocin use and associated interventions. If the period between cervical priming to AROM is managed as outpatient care, then the woman may be able to find better psychological and social support at home, as well as maintain autonomy and get better rest prior to the onset of labour. Inpatient AROM could also be followed by outpatient care until the pregnant person returns to the hospital, either in spontaneous labour, or for initiation of syntocinon after 12-18 h. High-quality research has already demonstrated that outpatient care for cervical ripening is acceptable to mothers and caregivers, has economic benefits and has an acceptable safety profile in appropriately selected low-risk inductions.
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Affiliation(s)
- Chris Wilkinson
- Women's and Children's Hospital, North Adelaide, 5006, South Australia, Australia; Robinson Institute, University of Adelaide, Adelaide, 5000, South Australia, Australia.
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Andrews C, Meredith N, Seeho S, Weller M, Griffin A, Ellwood D, Middleton P, Jennings B, Flenady V. Evaluation of an online education module designed to reduce stillbirth. Aust N Z J Obstet Gynaecol 2021; 61:675-683. [PMID: 34096613 DOI: 10.1111/ajo.13380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 04/08/2021] [Accepted: 04/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Safer Baby Bundle (SBB) eLearning is an online education module that addresses practice gaps in stillbirth prevention in Australia. It provides healthcare professionals with evidence-based resources for: smoking cessation; fetal growth restriction; decreased fetal movements; maternal safe going-to-sleep position; and timing of birth for women with risk factors for stillbirth. AIMS To determine whether participants' reported knowledge and confidence in providing care designed to reduce stillbirth changed following completion of the module. To assess the module's suitability and acceptability, and participants' reported likelihood to change practice. MATERIALS AND METHODS In-built surveys undertaken pre- and post-eLearning module assessed participant knowledge and confidence, module suitability and acceptability, and likelihood of practice change using Likert items. Responses were dichotomised. Differences pre- and post-module were tested using McNemar's test and differences by profession were examined using descriptive statistics and Pearson's χ2 test. RESULTS Between 15 October 2019 and 2 November 2020, 5223 participants across Australia were included. Most were midwives (82.0%), followed by student midwives (4.6%) and obstetricians (3.3%). Reported knowledge and confidence improved in all areas (P < 0.001). Post-module 96.7-98.9% 'agreed' they had a sound level of knowledge and confidence across all elements of the SBB. Over 95% of participants agreed that the module was helpful and relevant, well organised, and easy to access and use. Eighty-eight percent reported they were likely to change some aspect of their clinical practice. CONCLUSIONS The SBB eLearning module is a valuable education program that is well-received and likely to result in improvements in practice.
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Affiliation(s)
- Christine Andrews
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Natasha Meredith
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Sean Seeho
- Women and Babies Research, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Megan Weller
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
| | - Alison Griffin
- QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - David Ellwood
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,Gold Coast University Hospital, and School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Philippa Middleton
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia.,SAHMRI Women and Kids, South Australian Health and Medical Research Institute, Adelaide, South Australia, Australia
| | - Belinda Jennings
- Department of Health, Northern Territory Government, Darwin, Northern Territory, Australia
| | - Vicki Flenady
- Centre of Research Excellence in Stillbirth, Mater Research Institute, The University of Queensland, Brisbane, Queensland, Australia
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S C Horne R. Sleep your baby supine, but mums-to-be should sleep on their side. J Physiol 2021; 599:1725-1726. [PMID: 33533488 DOI: 10.1113/jp281258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Rosemary S C Horne
- The Ritchie Centre, Department of Paediatrics, Monash University and Hudson Institute of Medical Research, Melbourne, Victoria, Australia
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