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McKinney JA, Vilchez G, Jowers A, Atchoo A, Lin L, Kaunitz AM, Lewis KE, Sanchez-Ramos L. Water birth: a systematic review and meta-analysis of maternal and neonatal outcomes. Am J Obstet Gynecol 2024; 230:S961-S979.e33. [PMID: 38462266 DOI: 10.1016/j.ajog.2023.08.034] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/30/2023] [Accepted: 08/31/2023] [Indexed: 03/12/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis aimed to conduct a thorough and contemporary assessment of maternal and neonatal outcomes associated with water birth in comparison with land-based birth. DATA SOURCES We conducted a comprehensive search of PubMed, EMBASE, CINAHL, and gray literature sources, from inception to February 28, 2023. STUDY ELIGIBILITY CRITERIA We included randomized and nonrandomized studies that assessed maternal and neonatal outcomes in patients who delivered either conventionally or while submerged in water. METHODS Pooled unadjusted odds ratios with 95% confidence intervals were calculated using a random-effects model (restricted maximum likelihood method). We assessed the 95% prediction intervals to estimate the likely range of future study results. To evaluate the robustness of the results, we calculated fragility indices. Maternal infection was designated as the primary outcome, whereas postpartum hemorrhage, perineal lacerations, obstetrical anal sphincter injury, umbilical cord avulsion, low Apgar scores, neonatal aspiration requiring resuscitation, neonatal infection, neonatal mortality within 30 days of birth, and neonatal intensive care unit admission were considered secondary outcomes. RESULTS Of the 20,642 articles identified, 52 were included in the meta-analyses. Based on data from observational studies, water birth was not associated with increased probability of maternal infection compared with land birth (10 articles, 113,395 pregnancies; odds ratio, 0.93; 95% confidence interval, 0.76-1.14). Patients undergoing water birth had decreased odds of postpartum hemorrhage (21 articles, 149,732 pregnancies; odds ratio, 0.80; 95% confidence interval, 0.68-0.94). Neonates delivered while submerged in water had increased odds of cord avulsion (10 articles, 91,504 pregnancies; odds ratio, 1.75; 95% confidence interval, 1.38-2.24) and decreased odds of low Apgar scores (21 articles, 165,917 pregnancies; odds ratio, 0.69; 95% confidence interval, 0.58-0.82), neonatal infection (15 articles, 53,635 pregnancies; odds ratio, 0.64; 95% confidence interval, 0.42-0.97), neonatal aspiration requiring resuscitation (19 articles, 181,001 pregnancies; odds ratio, 0.60; 95% confidence interval, 0.43-0.84), and neonatal intensive care unit admission (30 articles, 287,698 pregnancies; odds ratio, 0.56; 95% confidence interval, 0.45-0.70). CONCLUSION When compared with land birth, water birth does not appear to increase the risk of most maternal and neonatal complications. Like any other delivery method, water birth has its unique considerations and potential risks, which health care providers and expectant parents should evaluate thoroughly. However, with proper precautions in place, water birth can be a reasonable choice for mothers and newborns, in facilities equipped to conduct water births safely.
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Affiliation(s)
- Jordan A McKinney
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL.
| | - Gustavo Vilchez
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Missouri-Kansas City, Kansas City, MO
| | - Alicia Jowers
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Amanda Atchoo
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Lifeng Lin
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ
| | - Andrew M Kaunitz
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Kendall E Lewis
- Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
| | - Luis Sanchez-Ramos
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Florida College of Medicine, Jacksonville, FL
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da Costa Silveira de Camargo J, Dos Santos Oliveira Gama F, Ochiai AM, Araújo NM, Pinheiro LR, Néné M, Grande MCLR. Spiritual Experiences of Portuguese Women Who had a Water Birth. J Relig Health 2023; 62:3267-3284. [PMID: 37193939 DOI: 10.1007/s10943-023-01826-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/17/2023] [Indexed: 05/18/2023]
Abstract
This study aimed to understand the significance of spirituality to Portuguese women who had a water birth. In-depth interviews, using a semi-structured questionnaire, were conducted with 24 women who experienced water birth at the hospital or home. Results were analyzed from a narrative interpretation perspective. Three spirituality-related categories emerged: (1) Beliefs and connections with the body; (2) Spirituality: integration of being a woman and transformation during birth; and (3) Spirituality as wisdom, intuition, or the sixth sense. Spirituality was perceived in women's faith and beliefs in a superior being that helped them manage the unpredictability and uncontrollability of giving birth.
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Affiliation(s)
- Joyce da Costa Silveira de Camargo
- Abel Salazar Institute of Sciences, Biomedical of the University of Porto, Porto, Portugal.
- Research and Study Group in Clinical Simulation and Obstetric Practices (GPESPO), School of Arts, Sciences and Humanities of University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil.
| | - Flávia Dos Santos Oliveira Gama
- Management of Historical and Cultural Heritage, Federal University of Minas Gerais, Belo Horizonte, Brazil
- School of Arts, Sciences and Humanities at the University of Sao Paulo, Rua Arlindo Béttio, 1000, Jardim Keralux, São Paulo, SP, 03828-000, Brazil
| | - Angela Megumi Ochiai
- Research and Study Group in Clinical Simulation and Obstetric Practices (GPESPO), School of Arts, Sciences and Humanities of University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
- Midwifery Program of the School of Arts, Sciences and Humanities of the University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
| | - Natalucia Matos Araújo
- Research and Study Group in Clinical Simulation and Obstetric Practices (GPESPO), School of Arts, Sciences and Humanities of University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
- Midwifery Program of the School of Arts, Sciences and Humanities of the University of Sao Paulo, Rua Arlindo Béttio, 1000 - Jardim Keralux, São Paulo, SP, 03828-000, Brazil
| | - Leonor Ramos Pinheiro
- Faculty of Public Health, University of Sao Paulo, Midwife at Casa Angela - Humanized Childbirth Center, Sao Paulo, SP, Brazil
| | - Manuela Néné
- School of Health of Portuguese Red Cross, Lisbon, Portugal
- CINTESIS - NursID - Innovation and Development in Nursing, Porto, Portugal
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Lugg-Widger F, Barlow C, Cannings-John R, Gale C, Houlding N, Milton R, Plachcinski R, Robling M, Sanders J. The practicalities of adapting UK maternity clinical information systems for observational research: Experiences of the POOL study. Int J Popul Data Sci 2023; 8:2072. [PMID: 38414546 PMCID: PMC10897763 DOI: 10.23889/ijpds.v8i1.2072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024] Open
Abstract
Background Using routinely collected clinical data for observational research is an increasingly important method for data collection, especially when rare outcomes are being explored. The POOL study was commissioned to evaluate the safety of waterbirth in the UK using routine maternity and neonatal clinical data. This paper describes the design, rationale, set-up and pilot for this data linkage study using bespoke methods. Methods Clinical maternity information systems hold many data items of value for research purposes, but often lack specific data items required for individual studies. This study used the novel method of amending an existing clinical maternity database for the purpose of collecting additional research data fields. In combination with the extraction of existing data fields, this maximised the potential use of existing routinely collected clinical data for research purposes, whilst reducing NHS staff data collection burden.Wellbeing Software®, provider of the Euroking® Maternity Information System, added new study specific data fields to their information system, extracted data from participating NHS sites and transferred data for matching with the National Neonatal Research Database to ascertain outcomes for babies admitted to neonatal units. Study set-up processes were put in place for all sites. The data extraction, linkage and cleaning processes were piloted with one pre-selected NHS site. Results Twenty-six NHS sites were set-up over 27 months (January 2019 - April 2021). Twenty-four thousand maternity records were extracted from the one NHS site, pertaining to the period January 2015 to March 2019. Data field completeness for maternal and neonatal primary outcomes were mostly acceptable. Neonatal identifiers flowed to the National Neonatal Research Database for successful matching and linkage between maternity and neonatal unit records. Discussion Piloting the data extraction and linkage highlighted the need for additional governance arrangements, training at NHS sites and new processes for the study team to ensure data quality and confidentiality are upheld during the study. Amending existing NHS electronic information systems and accessing clinical data at scale, is possible, but continues to be a time consuming and a technically challenging exercise.
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Affiliation(s)
- Fiona Lugg-Widger
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Christian Barlow
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Rebecca Cannings-John
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Chris Gale
- Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital campus, London, SW10 9NH, UK
| | - Nicola Houlding
- Wellbeing Software Group, i2 Mansfield, Hamilton Court, Oakham Business Park, Mansfield, NG18 5FB
| | - Rebecca Milton
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
| | - Rachel Plachcinski
- Parent, patient and public representative, National Childbirth Trust [NCT], Brunel House, Clifton, Bristol BS8 3NG
| | - Michael Robling
- Centre for Trials Research, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, CF14 4YS, UK
- DECIPHer, School of Social Sciences, Cardiff University, Cardiff, CF10 3WT, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Ty Dewi Sant, Heath Park, Cardiff. CF14 4YS, UK
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Xie J, Zeng Q. Application of virtual reality technology combined with moderate perineal protection in natural childbirth. Ginekol Pol 2022; 94:978-983. [PMID: 36448347 DOI: 10.5603/gp.a2022.0134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 09/06/2022] [Accepted: 09/24/2022] [Indexed: 12/05/2022] Open
Abstract
OBJECTIVES To explore the application effect of virtual reality (VR) combined with moderate perineal protection on singleton primipara delivery. MATERIAL AND METHODS The study utilised a two-group design intervention and a randomised clinical trial. A total of 200 singleton primiparas who had a regular prenatal examination in a third-class hospital (between 1 September 2018 and 30 December 2018) and were willing to give birth naturally were randomly divided into treatment (traditional prenatal health mission combined with desktop VR health education system mode) and control (traditional health education mode) groups. The delivery conditions of the two groups were surveyed, recorded, analysed and compared. RESULTS There was no significant difference in the time of the second stage of labour between the treatment and control groups, and the comparison of neonatal Apgar scores and neonatal weight between the two groups showed that the different modes of prenatal education had no effect on newborns (p > 0.05). The amount of postpartum haemorrhage in 2 h and the pain score in the treatment group were significantly lower than in the control group, and the degree of perineal injury in the treatment group was not as serious as that in the control group. Meanwhile, there was a statistically significant difference in the anxiety score, self-efficacy score and quality of life satisfaction between the treatment and control groups (p < 0.05). CONCLUSIONS VR technology combined with moderate perineal protection could improve the delivery outcome of a primipara, maternal self-confidence of delivery and the quality of vaginal delivery; effectively alleviate the anxiety of a primipara; have no adverse effects on both mothers and newborns; and be widely used in clinical settings.
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Affiliation(s)
- Jinqiu Xie
- Department of Nursing, Heze Jia Zheng Vocational College, Heze, Shandong, China.
| | - Qingxiang Zeng
- Department of Obstetrics and Gynecology, Heze Municipal Hospital, Heze, Shandong, China
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Guzewicz P, Sierakowska M. The Role of Midwives in the Course of Natural Childbirth-Analysis of Sociodemographic and Psychosocial Factors-A Cross-Sectional Study. Int J Environ Res Public Health 2022; 19:15824. [PMID: 36497898 PMCID: PMC9739036 DOI: 10.3390/ijerph192315824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/24/2022] [Accepted: 11/25/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND An important role in the course of natural childbirth is played by midwives, who should effectively work on relieving pain. This study aims to present the opinions of midwives on non-pharmacological methods of relieving labor pain; the frequency of their use and reasons for their abandonment; and the relationship between the use of non-pharmacological methods of relieving labor pain and perceived job satisfaction, burnout, and self-efficacy of the midwife. METHODS The study was conducted online, with the participation of 135 Polish midwives working in the delivery room. The author's survey questionnaire, the Generalized Self-Efficacy Scale (GSES), the LBQ Burnout Questionnaire, and the Scale of Job Satisfaction were used. RESULTS Among the surveyed midwives, 77% use vertical positions in work with a patient giving birth. Almost all respondents consider vertical positions as an example of a non-pharmacological method of relieving labor pain; those with master's degree felt more prepared for their use (p = 0.02). The most common reason for abandoning their use was disagreement on the part of co-workers (p = 0.005). An association was observed between the use of vertical positions and the level of burnout (p = 0.001) and a significant correlation between preparation for their use and self-efficacy assessment, burnout, and job satisfaction. CONCLUSION Our research shows that it would be important to conduct additional training on the use of non-pharmacological methods to relieve labor pain and to present their benefits. In contrast to other research results, our results showed that midwives feel well prepared to use these methods; however, similar to other research, we found that they often feel disagreement from colleagues and a lack of support from their leaders. The use of vertical positions is related to burnout.
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Kubeczková L, Kučerová Daňková J, Prašivková P, Gelnar M, Mrózek M, Wiecek P, Janíček D, Heczko D, Canibal H, Blachut V, Otevřel P, Vrána T. In water or on land? Evaluation of perinatal and neonatal outcomes of water births in low-risk women. Ceska Gynekol 2021; 86:311-317. [PMID: 34736328 DOI: 10.48095/cccg2021311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Evaluate perinatal and neonatal outcomes comparing a water birth to regular childbirth in low-risk women. File and methods: Retrospective analysis of a set of childbirths that took place over a given period of time in the hospital and health center of Havířov. We compared a set of low-risk women that had given a water birth to a selected control group of low-risk women that had given regular childbirth. We evaluated statistical comparability, as well as perinatal and neonatal outcomes in both sets. RESULTS From 1. 1. 2020 to 28. 2. 2021, 1,083 women gave birth in the delivery department of Havířov hospital; from this set 122 were water births (11.3%). In our study, we only included 101 water deliveries (we designed our study to monitor low-risk births in order to be able to statistically correlate our findings; 21 water deliveries were excluded from our study due to perinatal risk factors - gestational diabetes and induced deliveries). We selected 60 low-risk women for our control group. Both sets of women were compared and we ruled out any statistically significant differences in age, education, body mass index, number of births given, gestation week at time of labor, number of smokers, premature rupture of membranes, women with previous history of one cesarean section, becoming pregnant by in vitro fertilization, presence of streptokoka skupiny B, and fetal weight. Water birth does not affect the Apgar score, neonatal adaptation to extra-uterine life, umbilical blood pH decrease, complications of infection, need of intensive care, and neonatal mortality. In the water birth set, we found increased occurrence of non-infectious conjunctivitis, treatable by regular eye drops without antibio-tics. We have not observed the effect of water birth on duration of the first and second stage of labor, total amount of uterotonics used, blood loss determined by the obstetrician, and uterine hypotonia. In the water birth group, we observed a prolonged third stage of delivery, lesser need for pharmacological stimulation (augmentation) of labor, notably lower use of analgesics, lower occurrence of birth injuries, shorter in-patient time, and more frequent bonding. CONCLUSIONS We discovered that water birth does not increase the risk for mother and neonate in low-risk women. Despite initial concerns, our outcomes and mother satisfaction have clearly shown that water births are not only a temporary whim, but probably a new integral part of our obstetric care.
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Camargo J, Araújo N, Catão L, Sarubbi Junior V, Silva LC, Nené M, Grande MC. Sexuality and childbirth: a qualitative analysis of women who had a waterbirth. Cult Health Sex 2021; 23:1006-1013. [PMID: 32484397 DOI: 10.1080/13691058.2020.1742384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 03/10/2020] [Indexed: 06/11/2023]
Abstract
Waterbirth is associated with a less painful childbirth, enhanced couples' intimacy, and positive feelings toward women's bodies and sexuality. In a qualitative, descriptive case study involving 21 participants, we examined the sexual experiences-during childbirth and postpartum-of women who had a waterbirth in a hospital environment. Women discussed their sexuality in the intrapartum and postpartum period after having a waterbirth in public or private hospitals. Two main themes were developed from the data analysis: 'women's sexual pleasure during waterbirth' and 'sexuality after childbirth'. Experiences included transcendence during waterbirth, a feeling that it represented a unique experience, and couples' more positive feelings about intimacy. The shared representations of women suggest that waterbirth can be a calming, joyful event for couples. During this process, they felt that it was a loving, shared event. In addition, after childbirth women experienced positive feelings toward their bodies and sexuality (including orgasm), as well as closer intimacy with their partners.
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Affiliation(s)
- Joyce Camargo
- Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Natalucia Araújo
- School of Arts, Sciences and Humanities, University of Sao Paulo, São Paulo, Brazil
| | | | | | - Lucia Cristina Silva
- School of Arts, Sciences and Humanities, University of Sao Paulo, São Paulo, Brazil
| | - Manuela Nené
- Portuguese Red Cross Higher School of Health-Lisbon, (CINTESIS - NursID - Innovation and Development in Nursing), Lisboa, Portugal
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The effect of waterbirth on neonatal mortality and morbidity. Nurs Health Sci 2021; 23:556-9. [PMID: 33977632 DOI: 10.1111/nhs.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Milton R, Sanders J, Barlow C, Brocklehurst P, Cannings-John R, Channon S, Gale C, Holmes A, Hunter B, Paranjothy S, Lugg-Widger FV, Milosevic S, Morantz L, Plachcinski R, Nolan M, Robling M. Establishing the safety of waterbirth for mothers and babies: a cohort study with nested qualitative component: the protocol for the POOL study. BMJ Open 2021; 11:e040684. [PMID: 33419905 PMCID: PMC7798679 DOI: 10.1136/bmjopen-2020-040684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 11/26/2020] [Accepted: 12/17/2020] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Approximately 60 000 (9/100) infants are born into water annually in the UK and this is likely to increase. Case reports identified infants with water inhalation or sepsis following birth in water and there is a concern that women giving birth in water may sustain more complex perineal trauma. There have not been studies large enough to show whether waterbirth increases these poor outcomes. The POOL Study (ISRCTN13315580) plans to answer the question about the safety of waterbirths among women who are classified appropriate for midwifery-led intrapartum care. METHODS AND ANALYSIS A cohort study with a nested qualitative component. Objectives will be answered using retrospective and prospective data captured in electronic National Health Service (NHS) maternity and neonatal systems. The qualitative component aims to explore factors influencing pool use and waterbirth; data will be gathered via discussion groups, interviews and case studies of maternity units. ETHICS AND DISSEMINATION The protocol has been approved by NHS Wales Research Ethics Committee (18/WA/0291) the transfer of identifiable data has been approved by Health Research Authority Confidentiality Advisory Group (18CAG0153).Study findings and innovative methodology will be disseminated through peer-reviewed journals, conferences and events. Results will be of interest to the general public, clinical and policy stakeholders in the UK and will be disseminated accordingly.
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Affiliation(s)
- Rebecca Milton
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Julia Sanders
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | | | - Peter Brocklehurst
- Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, UK
| | | | - Sue Channon
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | | | - Abigail Holmes
- Maternity Services, Cardiff and Vale University Health Board, Cardiff, UK
| | - Billie Hunter
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Shantini Paranjothy
- Aberdeen Health Data Science Research Centre, University of Aberdeen, Aberdeen, UK
| | | | | | | | | | - Mary Nolan
- Institute of Health and Society, University of Worcester, Worcester, UK
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Milosevic S, Channon S, Hughes J, Hunter B, Nolan M, Milton R, Sanders J. Factors influencing water immersion during labour: qualitative case studies of six maternity units in the United Kingdom. BMC Pregnancy Childbirth 2020; 20:719. [PMID: 33228569 PMCID: PMC7682119 DOI: 10.1186/s12884-020-03416-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 11/12/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Water immersion during labour can provide benefits including reduced need for regional analgesia and a shorter labour. However, in the United Kingdom a minority of women use a pool for labour or birth, with pool use particularly uncommon in obstetric-led settings. Maternity unit culture has been identified as an important influence on pool use, but this and other possible factors have not been explored in-depth. Therefore, the aim of this study was to identify factors influencing pool use through qualitative case studies of three obstetric units and three midwifery units in the UK. METHODS Case study units with a range of waterbirth rates and representing geographically diverse locations were selected. Data collection methods comprised semi-structured interviews, collation of service documentation and public-facing information, and observations of the unit environment. There were 111 interview participants, purposively sampled to include midwives, postnatal women, obstetricians, neonatologists, midwifery support workers and doulas. A framework approach was used to analyse all case study data. RESULTS Obstetric unit culture was a key factor restricting pool use. We found substantial differences between obstetric and midwifery units in terms of equipment and resources, staff attitudes and confidence, senior staff support and women's awareness of water immersion. Generic factors influencing use of pools across all units included limited access to waterbirth training, sociodemographic differences in desire for pool use and issues using waterproof fetal monitoring equipment. CONCLUSIONS Case study findings provide new insights into the influence of maternity unit culture on waterbirth rates. Access to pool use could be improved through midwives based in obstetric units having more experience of waterbirth, providing obstetricians and neonatologists with information on the practicalities of pool use and improving accessibility of antenatal information. In terms of resources, recommendations include increasing pool provision, ensuring birth room allocation maximises the use of unit resources, and providing pool room environments that are acceptable to midwives.
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Affiliation(s)
- Sarah Milosevic
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS.
| | - Susan Channon
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS
| | - Jacqueline Hughes
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS
| | - Billie Hunter
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Eastgate House, 35-43 Newport Road, Cardiff, Wales, CF24 0AB
| | - Mary Nolan
- College of Health, Life and Environmental Sciences, University of Worcester, Henwick Grove, Worcester, England, WR2 6AJ
| | - Rebecca Milton
- Centre for Trials Research, College of Biomedical and Life Sciences, Cardiff University, Neuadd Meirionnydd, Heath Park, Cardiff, Wales, CF14 4YS
| | - Julia Sanders
- School of Healthcare Sciences, College of Biomedical and Life Sciences, Cardiff University, Heath Park Campus, Cardiff, Wales, CF14 4XN
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Li M, Yin H, Jin Z, Zhang H, Leng B, Luo Y, Zhao Y. Impact of Wuhan lockdown on the indications of cesarean delivery and newborn weights during the epidemic period of COVID-19. PLoS One 2020; 15:e0237420. [PMID: 32790709 PMCID: PMC7425855 DOI: 10.1371/journal.pone.0237420] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 07/27/2020] [Indexed: 12/18/2022] Open
Abstract
Objective To prevent the rapid spread of COVID-19, the Chinese government implemented a strict lockdown in Wuhan starting on 23 January, 2020, which inevitably led to the changes in indications for the mode of delivery. In this retrospective study, we present the changes in the indications for cesarean delivery (CD) and the birth weights of newborns after the lockdown in Wuhan. Methods A total of 3,432 pregnant women in the third trimester of their pregnancies who gave birth in our hospital from 23 January 2019 to 24 March 2020 were selected as the observation group, while 7,159 pregnant women who gave birth from 1 January 2019 to 22 January 2020 were selected as the control group; control group was matched using propensity score matching (PSM). A comparative analysis of the two groups was performed with the chi-square test, t test and rank sum test. Results The difference in the overall rate of CD between the two groups was not statistically significant (p<0.05). Among the indications for CD, CD on maternal request (CDMR) and fetal distress were also significantly more common in the observation group (p<0.05) than the control group. Furthermore, we found that the weight of newborns was significantly heavier in the observation group than in the control group when considering full-term or close-to-full-term births (p<0.05). Conclusions The results may provide useful information to management practices regarding pregnancy and childbirth after lockdown in other cities or countries, enabling better control of the rate of CD due to CDMR, reducing fetal distress, and controlling newborn weight. We recommend that pregnant women pay more attention to controlling the weight of newborns through diet and exercise.
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Affiliation(s)
- Min Li
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Heng Yin
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhichun Jin
- Department of Traditional Chinese Medicine, Maternal and Child Health Hospital of Hubei Province Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Zhang
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bingjie Leng
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yan Luo
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yun Zhao
- Department of Obstetrics, Maternal and Child Health Hospital of Hubei Province Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
- * E-mail:
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Hodgson ZG, Comfort LR, Albert AAY. Water Birth and Perinatal Outcomes in British Columbia: A Retrospective Cohort Study. J Obstet Gynaecol Can 2019; 42:150-155. [PMID: 31843289 DOI: 10.1016/j.jogc.2019.07.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/04/2019] [Accepted: 07/08/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aimed to quantify adverse neonatal outcomes in a cohort of registered midwife (RM)-attended conventional and water births in British Columbia. METHODS The study included all term singleton births in British Columbia between January 1, 2005 and March 31, 2016 attended by RMs. Births were allocated to a conventional birth cohort or a water birth cohort according to where the actual birth of the neonate took place. The primary outcome was a composite adverse neonatal outcome (Apgar <7 at 5 minutes, resuscitation need, neonatal intensive care unit admission). Secondary outcomes included individual components of the primary outcome, maternal length of labour, and degree of perineal laceration (Canadian Task Force Classification Level II-2). RESULTS The population included 25 798 births. Of these, 23 201 were conventional, and 2567 were water births. The rate of the composite adverse neonatal outcome was not higher in water births compared with conventional births (hospital conventional, 5.0%; hospital water, 4.2%; home conventional, 3.4%; and home water, 2.9%). Rates of individual components of the composite adverse neonatal score were not greater in the water birth cohort. Maternal outcomes included statistically shorter labours in the water birth cohort and no difference between the cohorts in incidence of third- and fourth-degree lacerations. CONCLUSION Water births attended by RMs in British Columbia are not associated with higher rates of adverse neonatal outcomes than conventional births attended by midwives.
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Affiliation(s)
- Zoë G Hodgson
- Department of Midwifery, BC Women's Hospital and Health Centre, Vancouver, BC; Department of Family Practice, University of British Columbia, Vancouver, BC; Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC.
| | - L Ruth Comfort
- Department of Midwifery, BC Women's Hospital and Health Centre, Vancouver, BC; Department of Family Practice, University of British Columbia, Vancouver, BC
| | - Arianne A Y Albert
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC; Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC
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Tilden EL, Snowden JM. The Causal Inference Framework: A Primer on Concepts and Methods for Improving the Study of Well-Woman Childbearing Processes. J Midwifery Womens Health 2018; 63:700-709. [PMID: 29883528 PMCID: PMC6235714 DOI: 10.1111/jmwh.12710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 01/16/2023]
Abstract
The causal inference framework and related methods have emerged as vital within epidemiology. Scientists in many fields have found that this framework and a variety of designs and analytic approaches facilitate the conduct of strong science. These approaches have proven particularly important for catalyzing knowledge development using existing data and addressing questions for which randomized clinical trials are neither feasible nor ethical. The study of healthy women and normal childbearing processes may benefit from more direct and deliberate engagement with the process of inferring causes and, further, may be strengthened through use of methods appropriate for this undertaking. The purpose of this primer, the first in a series of 3 articles, is to provide the reader an introduction to concepts and methods relevant for causal inference, aimed at the clinician scientist and offer details and references supporting further application of epidemiologic knowledge. The causal inference framework and associated methods hold promise for generating strong, broadly representative, and actionable science to improve the outcomes of healthy women during the childbearing cycle and their children.
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Abdulghani N, Edvardsson K, Amir LH. Worldwide prevalence of mother-infant skin-to-skin contact after vaginal birth: A systematic review. PLoS One 2018; 13:e0205696. [PMID: 30379859 PMCID: PMC6209188 DOI: 10.1371/journal.pone.0205696] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 09/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Despite the World Health Organization's (WHO) recommendation for immediate skin-to-skin contact (SSC) after birth, separation of mothers and infants seems to be common practice in many hospitals. It is unknown how common the practice of SSC is worldwide. Therefore, we aimed to determine the reported prevalence of SSC for healthy mothers and infants immediately after normal birth. METHODS We systematically searched CINAHL, Medline, ProQuest Central, PubMed and the Cochrane Library for articles published between January 2007 and October 2017 using the keywords "kangaroo care" or "skin to skin contact" or "breastfeeding initiation" or "breast crawl" or "maternal infant contact" or "maternal newborn contact" or "baby friendly hospital initiative" or "ten steps for successful breastfeeding". RESULTS After an initial screening of 5266 records, 84 full text articles were assessed for eligibility, and 35 of these met the inclusion criteria. The studies were from 28 countries representing all six WHO world regions. There was a wide range in the practice of SSC for mother-infant dyads around the world: from 1% to 98%. Only 15 studies clearly defined SSC. Most of the studies were from high-income countries, and these reported higher rates of SSC than studies from low and middle-income countries. CONCLUSION There was a great heterogeneity in the definition of SSC as well as study designs, which makes cross-county comparison difficult. National studies reporting SSC rates are lacking. Future studies and guidelines to enhance SSC practice should include a standardised set of indicators and measurement tools that document SSC starting time and duration of SSC.
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Affiliation(s)
- Nawal Abdulghani
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
- Faculty of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
- * E-mail: ,
| | | | - Lisa H. Amir
- Judith Lumley Centre, La Trobe University, Melbourne, Australia
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Abstract
BACKGROUND Water immersion during labour and birth is increasingly popular and is becoming widely accepted across many countries, and particularly in midwifery-led care settings. However, there are concerns around neonatal water inhalation, increased requirement for admission to neonatal intensive care unit (NICU), maternal and/or neonatal infection, and obstetric anal sphincter injuries (OASIS). This is an update of a review last published in 2011. OBJECTIVES To assess the effects of water immersion during labour and/or birth (first, second and third stage of labour) on women and their infants. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register, ClinicalTrials.gov and the WHO International Clinical Trials Registry Platform (ICTRP) (18 July 2017), and reference lists of retrieved trials. SELECTION CRITERIA We included randomised controlled trials (RCTs) comparing water immersion with no immersion, or other non-pharmacological forms of pain management during labour and/or birth in healthy low-risk women at term gestation with a singleton fetus. Quasi-RCTs and cluster-RCTs were eligible for inclusion but none were identified. Cross-over trials were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Two review authors assessed the quality of the evidence using the GRADE approach. MAIN RESULTS This review includes 15 trials conducted between 1990 and 2015 (3663 women): eight involved water immersion during the first stage of labour; two during the second stage only; four during the first and second stages of labour, and one comparing early versus late immersion during the first stage of labour. No trials evaluated different baths/pools, or third-stage labour management. All trials were undertaken in a hospital labour ward setting, with a varying degree of medical intervention considered as routine practice. No study was carried out in a midwifery-led care setting. Most trial authors did not specify the parity of women. Trials were subject to varying degrees of bias: the intervention could not be blinded and there was a lack of information about randomisation, and whether analyses were undertaken by intention-to-treat.Immersion in water versus no immersion (first stage of labour)There is probably little or no difference in spontaneous vaginal birth between immersion and no immersion (82% versus 83%; risk ratio (RR) 1.01, 95% confidence interval (CI) 0.97 to 1.04; 6 trials; 2559 women; moderate-quality evidence); instrumental vaginal birth (14% versus 12%; RR 0.86, 95% CI 0.70 to 1.05; 6 trials; 2559 women; low-quality evidence); and caesarean section (4% versus 5%; RR 1.27, 95% CI 0.91 to 1.79; 7 trials; 2652 women; low-quality evidence). There is insufficient evidence to determine the effect of immersion on estimated blood loss (mean difference (MD) -14.33 mL, 95% CI -63.03 to 34.37; 2 trials; 153 women; very low-quality evidence) and third- or fourth-degree tears (3% versus 3%; RR 1.36, 95% CI 0.85 to 2.18; 4 trials; 2341 women; moderate-quality evidence). There was a small reduction in the risk of using regional analgesia for women allocated to water immersion from 43% to 39% (RR 0.91, 95% CI 0.83 to 0.99; 5 trials; 2439 women; moderate-quality evidence). Perinatal deaths were not reported, and there is insufficient evidence to determine the impact on neonatal intensive care unit (NICU) admissions (6% versus 8%; average RR 1.30, 95% CI 0.42 to 3.97; 2 trials; 1511 infants; I² = 36%; low-quality evidence), or on neonatal infection rates (1% versus 1%; RR 2.00, 95% CI 0.50 to 7.94; 5 trials; 1295 infants; very low-quality evidence).Immersion in water versus no immersion (second stage of labour)There were no clear differences between groups for spontaneous vaginal birth (97% versus 99%; RR 1.02, 95% CI 0.96 to 1.08; 120 women; 1 trial; low-quality evidence); instrumental vaginal birth (2% versus 2%; RR 1.00, 95% CI 0.06 to 15.62; 1 trial; 120 women; very low-quality evidence); caesarean section (2% versus 1%; RR 0.33, 95% CI 0.01 to 8.02; 1 trial; 120 women; very low-quality evidence), and NICU admissions (11% versus 9%; RR 0.78, 95% CI 0.38 to 1.59; 2 trials; 291 women; very low-quality evidence). Use of regional analgesia was not relevant to the second stage of labour. Third- or fourth-degree tears, and estimated blood loss were not reported in either trial. No trial reported neonatal infection but did report neonatal temperature less than 36.2°C at birth (9% versus 9%; RR 0.98, 95% CI 0.30 to 3.20; 1 trial; 109 infants; very low-quality evidence), greater than 37.5°C at birth (6% versus 15%; RR 2.62, 95% CI 0.73 to 9.35; 1 trial; 109 infants; very low-quality evidence), and fever reported in first week (5% versus 2%; RR 0.53, 95% CI 0.10 to 2.82; 1 trial; 171 infants; very low-quality evidence), with no clear effect between groups being observed. One perinatal death occurred in the immersion group in one trial (RR 3.00, 95% CI 0.12 to 72.20; 1 trial; 120 infants; very low-quality evidence). The infant was born to a mother with HIV and the cause of death was deemed to be intrauterine infection.There is no evidence of increased adverse effects to the baby or woman from either the first or second stage of labour.Only one trial (200 women) compared early and late entry into the water and there were insufficient data to show any clear differences. AUTHORS' CONCLUSIONS In healthy women at low risk of complications there is moderate to low-quality evidence that water immersion during the first stage of labour probably has little effect on mode of birth or perineal trauma, but may reduce the use of regional analgesia. The evidence for immersion during the second stage of labour is limited and does not show clear differences on maternal or neonatal outcomes intensive care. There is no evidence of increased adverse effects to the fetus/neonate or woman from labouring or giving birth in water. Available evidence is limited by clinical variability and heterogeneity across trials, and no trial has been conducted in a midwifery-led setting.
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Affiliation(s)
- Elizabeth R Cluett
- University of SouthamptonFaculty of Health SciencesNightingale Building (67)HighfieldSouthamptonHantsUKSO17 1BJ
| | - Ethel Burns
- Faculty of Health and Life Sciences, Oxford Brookes UniversityDepartment of Psychology, Social Work and Public HealthJack Straws LaneOxfordUKOX3 0FL
| | - Anna Cuthbert
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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Bronstein JM, Nelson LJ. Malpractice Verdicts and Changing Birthing Practices. J Midwifery Womens Health 2018; 63:395-398. [PMID: 29763983 DOI: 10.1111/jmwh.12749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/12/2018] [Accepted: 02/15/2018] [Indexed: 11/29/2022]
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Matos VTGD, Batista FDM, Versage NV, Pinto CS, Oliveira VMD, Vasconcelos-Pereira ÉFD, Matos RBDRD, Dal Fabbro MMFJ, Oliveira ALLD. High vertical HIV transmission rate in the Midwest region of Brazil. Braz J Infect Dis 2018; 22:177-185. [PMID: 29752892 PMCID: PMC9425683 DOI: 10.1016/j.bjid.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/24/2018] [Accepted: 04/02/2018] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES To estimate vertical HIV transmission rate in a capital city of the Midwest region of Brazil and describe the factors related to transmission. METHODS A descriptive epidemiological study based on the analysis of secondary data from the Notifiable Diseases Information System (SINAN). The analysis considered all HIV-infected pregnant women with delivery in Campo Grande-MS in the years 2007-2013 and their HIV-exposed infants. RESULTS A total of 218 births of 176 HIV-infected pregnant women were identified during the study period, of which 187 infants were exposed and uninfected, 19 seroconverted, and 12 were still inconclusive in July 2015. Therefore, the overall vertical HIV transmission rate in the period was 8.7%. Most (71.6%) of HIV-infected pregnant women were less than 30 years at delivery, housewives (63.6%) and studied up to primary level (61.9%). Prenatal information was described in 75.3% of the notification forms and approximately 80% of pregnant women received antiretroviral prophylaxis. Among infants, 86.2% received prophylaxis, but little more than half received it during the whole period recommended by the Brazilian Ministry of Health. Among the exposed children, 11.3% were breastfed. CONCLUSION The vertical HIV transmission rate has increased over the years and the recommended interventions have not been fully adopted. HIV-infected pregnant women need adequate prophylactic measures in prenatal, intrapartum and postpartum, requiring greater integration among health professionals.
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Affiliation(s)
| | - Fabiani de Morais Batista
- Universidade Federal do Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian, Programa de Residência Multiprofissional em Saúde, Campo Grande, MS, Brazil
| | - Naiara Valera Versage
- Universidade Federal do Mato Grosso do Sul, Hospital Universitário Maria Aparecida Pedrossian, Programa de Residência Multiprofissional em Saúde, Campo Grande, MS, Brazil
| | - Clarice Souza Pinto
- Departamento de Saúde do Estado do Mato Grosso do Sul, Campo Grande, MS, Brazil
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Cookson G, Laliotis I. Promoting normal birth and reducing caesarean section rates: An evaluation of the Rapid Improvement Programme. Health Econ 2018; 27:675-689. [PMID: 29114977 DOI: 10.1002/hec.3624] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 09/19/2017] [Accepted: 10/17/2017] [Indexed: 06/07/2023]
Abstract
This paper evaluates the impact of the 2008 Rapid Improvement Programme that aimed at promoting normal birth and reducing caesarean section rates in the English National Health Service. Using Hospital Episode Statistics maternity records for the period 2001-2013, a panel data analysis was performed to determine whether the implementation of the programme reduced caesarean sections rates in participating hospitals. The results obtained using either the unadjusted sample of hospitals or a trimmed sample determined by a propensity score matching approach indicate that the impact of the programme was small. More specifically there were 2.3 to 3.4 fewer caesarean deliveries in participating hospitals, on average, during the postprogramme period offering a limited scope for cost reduction. This result mainly comes from the reduction in the number of emergency caesareans as no significant effect was uncovered for planned caesarean deliveries.
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Batten M, Stevenson E, Zimmermann D, Isaacs C. Implementation of a Hydrotherapy Protocol to Improve Postpartum Pain Management. J Midwifery Womens Health 2017; 62:210-214. [PMID: 28376565 DOI: 10.1111/jmwh.12580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 09/20/2016] [Accepted: 09/28/2016] [Indexed: 10/19/2022]
Abstract
INTRODUCTION A growing number of women are seeking alternatives to traditional pharmacologic pain management during birth. While there has been an extensive array of nonpharmacologic options developed for labor, there are limited offerings in the postpartum period. The purpose of this quality improvement project was to implement a hydrotherapy protocol in the early postpartum period to improve pain management for women choosing a nonmedicated birth. PROCESS The postpartum hydrotherapy protocol was initiated in a certified nurse-midwife (CNM) practice in an urban academic medical center. All women who met criteria were offered a 30-minute warm water immersion bath at one hour postpartum. Pain scores were assessed prior to the bath, at 15 minutes after onset, and again at the conclusion (30 minutes). Women who completed the bath were also asked to complete a brief survey on their experience with postpartum hydrotherapy. OUTCOMES In women who used the bath (N = 45), there was a significant reduction in pain scores (P < .001) between the onset of the bath and scores at both 15 minutes and 30 minutes. There was no significant difference between pain scores at 15 minutes and 30 minutes (P = .97). Of those women who completed a survey (n = 43), 97.7% reported both that the bath reduced their pain and improved their birth experience. One hundred percent reported they would use it again in another birth. DISCUSSION This project demonstrated successful implementation of a hydrotherapy protocol as an alternative or adjunct to medication for early postpartum pain management that significantly reduced pain and improved the birth experience for those who used it. It offers a nonpharmacologic alternative where there have traditionally been limited options.
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Weed S. Sage Femme. Midwifery Today Int Midwife 2017:14-15. [PMID: 29912527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Affiliation(s)
- Zahra Shahshahan
- Department of Obstetrics and Gynecology, Shahid Beheshti Hospital, Isfahan University of Medical Sciences, Isfahan 81746-73461, Iran.
| | - Bahram Heshmati
- Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Mojtaba Akbari
- Department of Epidemiology, School of Health and Nutrition, Shiraz University of Medical Science, Shiraz, Iran
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Duff E. Indicators for performance of maternity care in Europe. Midwifery 2016; 33:9. [PMID: 27294232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Paul D. IXCHEL: The Mayan Goddess of Midwifery. Midwifery Today Int Midwife 2016:56. [PMID: 27464410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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Toepke McLean M. Marion's Message: How Our Grandmothers' Lives Affect Our Own. Midwifery Today Int Midwife 2016:8. [PMID: 29911806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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MorningStar S. Micromanaging the Microbiota. Midwifery Today Int Midwife 2016:12-15. [PMID: 29912496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Ainsworth S. Women of wisdom. Pract Midwife 2015; 18:50. [PMID: 26336790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Stenzel A. To Eat or Not to Eat: A Nuanced Analysis of the Placenta Question. Midwifery Today Int Midwife 2015:59-62. [PMID: 26591424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
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Yadav AK, Chaudhari H, Warke H, Shah PK, Dodagatta-Marri E, Kishore U, Madan T. Differential expression of collectins in human placenta and role in inflammation during spontaneous labor. PLoS One 2014; 9:e108815. [PMID: 25303045 PMCID: PMC4193748 DOI: 10.1371/journal.pone.0108815] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Accepted: 09/01/2014] [Indexed: 12/15/2022] Open
Abstract
Collectins, collagen-containing Ca2+ dependent C-type lectins and a class of secretory proteins including SP-A, SP-D and MBL, are integral to immunomodulation and innate immune defense. In the present study, we aimed to investigate their placental transcript synthesis, labor associated differential expression and localization at feto-maternal interface, and their functional implication in spontaneous labor. The study involved using feto-maternal interface (placental/decidual tissues) from two groups of healthy pregnant women at term (≥37 weeks of gestation), undergoing either elective C-section with no labor (‘NLc’ group, n = 5), or normal vaginal delivery with spontaneous labor (‘SLv’ group, n = 5). The immune function of SP-D, on term placental explants, was analyzed for cytokine profile using multiplexed cytokine array. SP-A, SP-D and MBL transcripts were observed in the term placenta. The ‘SLv’ group showed significant up-regulation of SP-D (p = 0.001), and down-regulation of SP-A (p = 0.005), transcripts and protein compared to the ‘NLc’ group. Significant increase in 43 kDa and 50 kDa SP-D forms in placental and decidual tissues was associated with the spontaneous labor (p<0.05). In addition, the MMP-9-cleaved form of SP-D (25 kDa) was significantly higher in the placentae of ‘SLv’ group compared to the ‘NLc’ group (p = 0.002). Labor associated cytokines IL-1α, IL-1β, IL-6, IL-8, IL-10, TNF-α and MCP-1 showed significant increase (p<0.05) in a dose dependent manner in the placental explants treated with nSP-D and rhSP-D. In conclusion, the study emphasizes that SP-A and SP-D proteins associate with the spontaneous labor and SP-D plausibly contributes to the pro-inflammatory immune milieu of feto-maternal tissues.
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Affiliation(s)
- Ajit Kumar Yadav
- Department of Innate Immunity, National Institute for Research in Reproductive Health (Indian Council of Medical Research), Mumbai, Maharashtra, India
| | - Hemangi Chaudhari
- Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edward Medical (KEM) Hospital, Mumbai, Maharashtra, India
| | - Himangi Warke
- Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edward Medical (KEM) Hospital, Mumbai, Maharashtra, India
| | - Premanand Keshavlal Shah
- Department of Obstetrics and Gynecology, Seth Gordhandas Sunderdas Medical College and King Edward Medical (KEM) Hospital, Mumbai, Maharashtra, India
| | - Eswari Dodagatta-Marri
- Centre for Infection, Immunity and Disease Mechanisms, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Uday Kishore
- Centre for Infection, Immunity and Disease Mechanisms, College of Health and Life Sciences, Brunel University London, Uxbridge, United Kingdom
| | - Taruna Madan
- Department of Innate Immunity, National Institute for Research in Reproductive Health (Indian Council of Medical Research), Mumbai, Maharashtra, India
- * E-mail:
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Nedin P, Coppel A. Priorities for birthing rooms set out. Health Estate 2014; 68:61-66. [PMID: 25219085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Phil Nedin, a Chartered Engineer, Fellow of IHEEM, and Past President of the Institute, who, recently left Arup--having worked for the company for 25 years - to set up his own consultancy, and Anna Coppel, a Chartered Engineer based in Arup's Advanced Technology and Research team in London, describe a design analysis that used computational fluid dynamics (CFD) to investigate and validate the effectiveness of a number of mechanical ventilation options often associated with birthing rooms, thereby ensuring a system that is fit for purpose. In such settings, they point out, the need to reduce the levels of nitrous oxide to a COSHH threshold is a legal requirement.
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Smit M, Dawson JA, Ganzeboom A, Hooper SB, van Roosmalen J, te Pas AB. Pulse oximetry in newborns with delayed cord clamping and immediate skin-to-skin contact. Arch Dis Child Fetal Neonatal Ed 2014; 99:F309-14. [PMID: 24688080 DOI: 10.1136/archdischild-2013-305484] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To assess whether defined reference ranges of oxygen saturation (SpO₂) and heart rate (HR) of term infants after birth also apply for infants born after midwifery supervised uncomplicated vaginal birth, where delayed cord clamping (DCC) and immediate skin to skin contact (ISSC) is routine management. DESIGN Prospective observational study. SETTING AND PATIENTS Infants born vaginally after uncomplicated birth, that is, no augmentation, maternal pain relief or instrumental delivery. INTERVENTIONS Midwives supervising uncomplicated birth at home or in hospital in the Leiden region (The Netherlands) used an oximeter and recorded SpO₂ and HR in the first 10 min after birth. MAIN OUTCOME MEASURES SpO₂ and HR values were compared to the international defined reference ranges. RESULTS In Leiden, values of 109 infants were obtained and are comparable with previously defined reference ranges, except for a higher SpO₂ (p<0.05) combined with a slower increase in the first 3 min. The Leiden cohort also had a lower HR (p<0.05) during the first 10 min with a slower increase in the first 3 min. In the first minutes after birth, tachycardia (HR>180 bpm) occurred less often, and a bradycardia (<80 bpm) more often (p<0.05). CONCLUSIONS Defined reference ranges can be used in infants born after uncomplicated vaginal birth with DCC and ISSC, but higher SpO₂ and lower HR were observed in the first minutes.
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Byrom S. A clash of paradigms. Pract Midwife 2014; 17:50. [PMID: 24669524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ni Aódagaín H. The birth of Mariposa: a fictional story. Midwifery Today Int Midwife 2014:56-57. [PMID: 25975084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Ivanov S, Tzvetkov K, Kovachev E, Staneva D, Nikolov D. [Puerperal infections after Cesarean section and after a natural childbirth]. Akush Ginekol (Sofiia) 2014; 53 Suppl 1:25-28. [PMID: 25510038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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McLean MT. Marion's message: birth and the human future. Midwifery Today Int Midwife 2014:8. [PMID: 25112058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Abstract
The prevalence of convenience-driven delivery via Caesarian-section (C-section) has been steadily increasing in Western as well as in developing societies. Today, significantly more deliveries occur via surgical means than medical necessity mandates. Despite tremendous advances in surgical techniques and pre- and post-operative surgical care, there remains to be limited understanding on the physiological influence of vaginal birth with particular emphasis on long term outcome on the offspring. Serendipitously, we recently uncovered in mice that vaginal birth induces significantly higher level of Ucp2 mRNA expression in the hippocampus than experimental C-section. We showed that during the early postnatal period, UCP2 expression promotes neuronal differentiation, axonal outgrowth and synapse formation in the hippocampus. We also observed that Ucp2 knockout animals show adult behaviors associated with the hippocampal formation that is different from wild type littermates. Taken together these observations suggest that vaginal birth may play a crucial role in determining adult brain structure and function that is different from that of the effect of surgically assisted birth.
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Affiliation(s)
- Emre Seli
- Department of Ob/Gyn and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, 06520, USA
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What have you learned in animal birth that has helped you in understanding human birth? Midwifery Today Int Midwife 2013;:64-6. [PMID: 24133816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Calvin S. On the need for a real choice. J Clin Ethics 2013; 24:291-292. [PMID: 24282859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
For low-risk mothers who do not wish to give birth in a hospital, a nearby birth center led by midwives is an excellent option.
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Share with women. Second stage of labor: pushing your baby out. J Midwifery Womens Health 2012; 57:107-8. [PMID: 22251920 DOI: 10.1111/j.1542-2011.2011.00145.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Bennett L. Babin Den. Midwifery Today Int Midwife 2012:50. [PMID: 22486030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Harman T. Freedom for birth: how a documentary filmmaker became a birth warrior. Midwifery Today Int Midwife 2012:24-25. [PMID: 23367609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Tritten J. Babies have rights, too. Midwifery Today Int Midwife 2012:5. [PMID: 23367602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Orange FAD, Passini R, Melo ASO, Katz L, Coutinho IC, Amorim MMR. Combined spinal-epidural anesthesia and non-pharmacological methods of pain relief during normal childbirth and maternal satisfaction: a randomized clinical trial. Rev Assoc Med Bras (1992) 2012; 58:112-117. [PMID: 22392325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Accepted: 11/18/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVE The objective of this study was to compare maternal satisfaction with childbirth according to whether or not combined spinal-epidural anesthesia (CSE) of pain relief was used during labor. METHODS A randomized, open clinical trial was performed with 70 pregnant women, 35 of whom received CSE anesthesia while 35 received only non-pharmacological forms of pain relief during labor. The variables evaluated were visual analogue scale (VAS) pain score, maternal satisfaction with the technique of pain relief used during childbirth and with delivery, the patient's intention to request the same technique in a subsequent delivery, and loss of control during delivery. RESULTS VAS pain score decreased significantly in patients receiving CSE during vaginal delivery. Furthermore, maternal satisfaction with the technique of pain relief and with delivery was higher in the CSE group, and around 97% of the patients would repeat the same technique at future deliveries compared to 82.4% of the women in the group using only non-pharmacological methods. With respect to the women's impressions of their control during delivery, approximately half the women in both groups felt that they had lost control at some point during the process. CONCLUSION The use of CSE was associated with a significant reduction in VAS pain scores during delivery and with greater maternal satisfaction with the pain relief method and with the childbirth process.
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Lim IR. The fourth stage: sharing the Asian way. Midwifery Today Int Midwife 2012:9-11. [PMID: 22856065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Miller RS, Smiley RM, Daniel D, Weng C, Emala CW, Blouin JL, Flood PD. Beta-2 adrenoceptor genotype and progress in term and late preterm active labor. Am J Obstet Gynecol 2011; 205:137.e1-7. [PMID: 21600547 DOI: 10.1016/j.ajog.2011.03.045] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 02/09/2011] [Accepted: 03/23/2011] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We sought to evaluate whether beta-2 adrenoceptor (β2AR) genotype at a functional polymorphic site encoding for amino acid residue 16 influences rate of cervical dilatation in term and late preterm active labor. STUDY DESIGN Subjects who underwent vaginal delivery at ≥34 weeks' gestational age from May 2006 through August 2007 were identified. Each subject had provided venous blood from which DNA was extracted for β2AR genotyping. Digital cervical examinations with paired examination times were collected from intrapartum records. Rate of cervical dilatation in active labor was determined using linear regression. Rates were compared between genotype groups. RESULTS Among 401 subjects with satisfactory genotype and intrapartum data, overall rate of active labor was 0.76±0.01 cm/h. When labor was compared by genotype, homozygous Arg/Arg16 subjects progressed at a slower rate (0.64±0.03 cm/h) than all other pooled genotypes (0.8±0.02 cm/h, P<.001). CONCLUSION Homozygous β2AR genotype encoding for Arg/Arg16 was associated with slower progress in active labor.
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MESH Headings
- Adult
- Cervical Ripening/genetics
- Cohort Studies
- Delivery, Obstetric/methods
- Female
- Gene Expression Regulation, Developmental
- Genotype
- Gestational Age
- Humans
- Infant, Newborn
- Infant, Premature
- Labor Onset/genetics
- Labor Stage, First/genetics
- Labor Stage, First/physiology
- Linear Models
- Maternal Age
- Natural Childbirth
- Obstetric Labor, Premature/genetics
- Obstetric Labor, Premature/physiopathology
- Parity
- Polymorphism, Genetic
- Predictive Value of Tests
- Pregnancy
- Pregnancy Outcome
- Receptors, Adrenergic, beta-2/genetics
- Retrospective Studies
- Term Birth
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Affiliation(s)
- Russell S Miller
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Columbia University Medical Center, New York, NY 10032, USA.
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Marks MM. Birth as a shape-shifter. Midwifery Today Int Midwife 2011:22. [PMID: 21322443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Bee R. Due for change? Midwifery Today Int Midwife 2011:59-60. [PMID: 21882752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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McLean MT. Marion's message. History: human rights in childbearing. Midwifery Today Int Midwife 2011:8. [PMID: 21999046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Dawn S. New birth paradigm. Midwifery Today Int Midwife 2011:45. [PMID: 21882746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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