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Feeley C, Thomson G, Downe S. Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study. PLoS One 2020; 15:e0242508. [PMID: 33216777 PMCID: PMC7678977 DOI: 10.1371/journal.pone.0242508] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 10/12/2020] [Indexed: 12/30/2022] Open
Abstract
UK legislation and government policy favour women's rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women's alternative physiological birthing choices-defined in this study as 'birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth'. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives' processes of facilitating women's alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women's needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.
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Affiliation(s)
- Claire Feeley
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
- MAINN Group, University of Central Lancashire, Preston, United Kingdom
| | - Soo Downe
- THRIVE Centre, ReaCH Group, University of Central Lancashire, Preston, United Kingdom
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Witteveen T, Kallianidis A, Zwart JJ, Bloemenkamp KW, van Roosmalen J, van den Akker T. Laparotomy in women with severe acute maternal morbidity: secondary analysis of a nationwide cohort study. BMC Pregnancy Childbirth 2018; 18:61. [PMID: 29482505 PMCID: PMC5828385 DOI: 10.1186/s12884-018-1688-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Accepted: 02/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although pregnancy-related laparotomy is a major intervention, literature is limited to small case-control or single center studies. We aimed to identify national incidence rates for postpartum laparotomy related to severe acute maternal morbidity (SAMM) in a high-income country and test the hypothesis that risk of postpartum laparotomy differs by mode of birth. METHODS In a population-based cohort study in all 98 hospitals with a maternity unit in the Netherlands, pregnant women with SAMM according to specified disease and management criteria were included from 01/08/2004 to 01/08/2006. We calculated the incidence of postpartum laparotomy after vaginal and cesarean births. Laparotomies were analyzed in relation to mode of birth using all births in the country as reference. Relative risks (RR) were calculated for laparotomy following emergency and planned cesarean section compared to vaginal birth, excluding laparotomies following births before 24 weeks' gestation and hysterectomies performed during cesarean section. RESULTS The incidence of postpartum laparotomy in women with SAMM in the Netherlands was 6.0 per 10,000 births. Incidence was 30.1 and 1.8 per 10,000 following cesarean and vaginal birth respectively. Compared to vaginal birth, RR of laparotomy after cesarean birth was 16.7 (95% confidence interval [95% CI] 12.2-22.6). RR was 21.8 (95% CI 15.8-30.2) for emergency and 10.5 (95% CI 7.1-15.6) for planned cesarean section. CONCLUSIONS Risk of laparotomy, although small, was considerably elevated in women who gave birth by cesarean section. This should be considered in counseling and clinical decision making.
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Affiliation(s)
- Tom Witteveen
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
| | - Athanasios Kallianidis
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Department of Obstetrics and Gynecology, Haga Teaching Hospital, Els Borst-Eilersplein 275, 2545 AA Den Haag, The Netherlands
| | - Joost J. Zwart
- Department of Obstetrics and Gynecology, Deventer Ziekenhuis, Nico Bolkesteinlaan 75, 7416 SE Deventer, The Netherlands
| | - Kitty W. Bloemenkamp
- Department of Obstetrics, Wilhelmina Children’s Hospital Birth Centre, University Medical Centre Utrecht, Lundlaan 6, 3584 EA Utrecht, The Netherlands
| | - Jos van Roosmalen
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
- Athena Institute, Faculty of Science, VU University Amsterdam, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
| | - Thomas van den Akker
- Department of Obstetrics, Leiden University Medical Center, building 1, room K-6-P-35, P.O. Box 9600, 2300 RC Leiden, The Netherlands
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Shatken-Stern S. Outside the Evidence: Births Missing from the Research. Midwifery Today Int Midwife 2016:66. [PMID: 27192766] [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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Cheyne H, Bowers J. Reducing the length of postnatal hospital stay. Midwives 2016; 19:34. [PMID: 27498475] [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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Sister MorningStar. Dear Editor. Midwifery Today Int Midwife 2016;:57. [PMID: 27464411] [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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Pendleton J. Why won't Polish women birth at home? Pract Midwife 2015; 18:34-36. [PMID: 26547999] [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: 06/05/2023]
Abstract
Polish women living in the United Kingdom (UK) are statistically more likely to have normal births than their British counterparts, yet anecdotally, do not choose to birth their babies at home. A medicalised approach to birth in their country of origin means women are unaware of the benefits of midwifery-led care, which they often perceive as sub-standard. Affordable travel means Polish women can access care in both countries and compounds the difficulties in acclimatising to UK maternity services. Online discussion groups and Internet forums represent an opportunity for midwives to engage with women to promote their services. This is increasingly important with rising numbers of both Polish migrants to the UK and Polish residents applying for British citizenship.
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McLean MT. Marion's Message. Birth, Safe Motherhood and the Human Future. Midwifery Today Int Midwife 2015:8. [PMID: 26309922] [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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Marshall JL, Spiby H, McCormick F. Evaluating the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme': A mixed method study in England. Midwifery 2014; 31:332-40. [PMID: 25467600 DOI: 10.1016/j.midw.2014.10.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [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: 05/02/2014] [Revised: 10/04/2014] [Accepted: 10/28/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND caesarean section plays an important role in ensuring safety of mother and infant but rising rates are not accompanied by measurable improvements in maternal or neonatal mortality or morbidity. The 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' was a facilitative initiative developed to promote opportunities for normal birth and reduce caesarean section rates in England. OBJECTIVE to evaluate the 'Focus on Normal Birth and Reducing Caesarean section Rates' programme, by assessment of: impact on caesarean section rates, use of service improvements tools and participants׳ perceptions of factors that sustain or hinder work within participating maternity units. DESIGN a mixed methods approach included analysis of mode of birth data, web-based questionnaires and in-depth semi-structured telephone interviews. PARTICIPANTS twenty Hospital Trusts in England (selected from 68 who applied) took part in the 'Focus on Normal Birth and Reducing Caesarean section Rates Rapid Improvement Programme' initiative. In each hospital Trust, the head of midwifery, an obstetrician, the relevant lead for organisational development, a supervisor of midwives, or a clinical midwife and a service user representative were invited to participate in the independent evaluation. METHODS collection and analysis of mode of birth data from 20 participating hospital Trusts, web-based questionnaires administered to key individuals in all 20 Trusts and in-depth semi-structured telephone interviews conducted with key individuals in a sample of six Trusts. FINDINGS there was a marginal decline of 0.5% (25.9% from 26.4%) in mean total caesarean section rate in the period 1 January 2009 to 31 January 2010 compared to the baseline period (1 July-31 December 2008). Reduced total caesarean section rates were achieved in eight trusts, all with higher rates at the beginning of the initiative. Features associated with lower caesarean section rates included a shared philosophy prioritising normal birth, clear communication across disciplines and strong leadership at a range of levels, including executive support and clinical leaders within each discipline. CONCLUSIONS it is important that the philosophy and organisational context of care are examined to identify potential barriers and facilitative factors.
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Affiliation(s)
- Joyce L Marshall
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK.
| | - Helen Spiby
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
| | - Felicia McCormick
- Department of Health Sciences, The University of York, Seebohm Rowntree Building, Heslington, York YO10 5DD, UK
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Wickham S. Does induction really reduce the likelihood of caesarean section? Pract Midwife 2014; 17:39-40. [PMID: 25326966] [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: 06/04/2023]
Abstract
Two recent systematic reviews have arrived at the same, rather surprising and somewhat counter-intuitive result. That is, contrary to the belief and experience of many people who work on labour wards every day, induction of labour doesn't increase the chance of caesarean section at all. In fact, the reviewers argue, their results demonstrate that induction of labour reduces the likelihood of caesarean section. It might be that our instincts are wrong, and that we need to reconsider what we think we know. But before we rush to recommend induction as the latest tool to promote normal birth, we might want to look a bit more closely at the evidence, as I am not at all certain that this apparently straightforward conclusion is quite as cut-and-dried as it sounds.
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Adam MB, Dillmann M, Chen MK, Mbugua S, Ndung’u J, Mumbi P, Waweru E, Meissner P. Improving maternal and newborn health: effectiveness of a community health worker program in rural Kenya. PLoS One 2014; 9:e104027. [PMID: 25090111 PMCID: PMC4121293 DOI: 10.1371/journal.pone.0104027] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [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: 02/18/2014] [Accepted: 07/08/2014] [Indexed: 11/22/2022] Open
Abstract
Background Volunteer community health workers (CHWs) form an important element of many health systems, and in Kenya these volunteers are the foundation for promoting behavior change through health education, earlier case identification, and timely referral to trained health care providers. This study examines the effectiveness of a community health worker project conducted in rural Kenya that sought to promote improved knowledge of maternal newborn health and to increase deliveries under skilled attendance. Methods The study utilized a quasi-experimental nonequivalent design that examined relevant demographic items and knowledge about maternal and newborn health combined with a comprehensive retrospective birth history of women’s children using oral interviews of women who were exposed to health messages delivered by CHWs and those who were not exposed. The project trained CHWs in three geographically distinct areas. Results Mean knowledge scores were higher in those women who reported being exposed to the health messages from CHWs, Eburru 32.3 versus 29.2, Kinale 21.8 vs 20.7, Nyakio 26.6 vs 23.8. The number of women delivering under skilled attendance was higher for those mothers who reported exposure to one or more health messages, compared to those who did not. The percentage of facility deliveries for women exposed to health messages by CHWs versus non-exposed was: Eburru 46% versus 19%; Kinale 94% versus 73%: and Nyakio 80% versus 78%. Conclusion The delivery of health messages by CHWs increased knowledge of maternal and newborn care among women in the local community and encouraged deliveries under skilled attendance.
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Affiliation(s)
- Mary B. Adam
- AIC Kijabe Medical Center, Kijabe, Kenya
- * E-mail:
| | - Maria Dillmann
- Department of Pediatric and Adolescent Medicine, Ulm University, Ulm, Germany
| | - Mei-kuang Chen
- University of Arizona, Tucson, Arizona, United States of America
| | | | | | | | | | - Peter Meissner
- Department of Pediatric and Adolescent Medicine, Ulm University, Ulm, Germany
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Rabinerson D, Aviram A, Gabbay-Benziv R. [Elective cesarean section on maternal request--what's new?]. Harefuah 2014; 153:329-367. [PMID: 25095605] [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
Elective cesarean section on maternal request is a debatable issue with regard to all of its aspects. Current literature discusses topics such as its prevalence, risks and benefits in comparison with vaginal delivery, as well as ethical, judicial and economical questions regarding its execution. We reviewed the relevant literature from the last decade. There are no clear research findings which indicate that overall, elective cesarean section on maternal request is better, or alternatively, more perilous, in comparison with vaginal delivery, from both maternal and fetal or neonatal aspects. Due to its prevalence, there is a need for the obstetric establishment in Israel to make a formal statement regarding its attitude towards this issue.
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Tracy SK, Welsh A, Hall B, Hartz D, Lainchbury A, Bisits A, White J, Tracy MB. Caseload midwifery compared to standard or private obstetric care for first time mothers in a public teaching hospital in Australia: a cross sectional study of cost and birth outcomes. BMC Pregnancy Childbirth 2014; 14:46. [PMID: 24456576 PMCID: PMC3903023 DOI: 10.1186/1471-2393-14-46] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2012] [Accepted: 01/14/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND In many countries midwives act as the main providers of care for women throughout pregnancy, labour and birth. In our large public teaching hospital in Australia we restructured the way midwifery care is offered and introduced caseload midwifery for one third of women booked at the hospital. We then compared the costs and birth outcomes associated with caseload midwifery compared to the two existing models of care, standard hospital care and private obstetric care. METHODS We undertook a cross sectional study examining the risk profile, birth outcomes and cost of care for women booked into one of the three available models of care in a tertiary teaching hospital in Australia between July 1st 2009 December 31st 2010. To control for differences in population or case mix we described the outcomes for a cohort of low risk first time mothers known as the 'standard primipara'. RESULTS Amongst the 1,379 women defined as 'standard primipara' there were significant differences in birth outcome. These first time 'low risk' mothers who received caseload care were more likely to have a spontaneous onset of labour and an unassisted vaginal birth 58.5% in MGP compared to 48.2% for Standard hospital care and 30.8% with Private obstetric care (p < 0.001). They were also significantly less likely to have an elective caesarean section 1.6% with MGP versus 5.3% with Standard care and 17.2% with private obstetric care (p < 0.001). From the public hospital perspective, over one financial year the average cost of care for the standard primipara in MGP was $3903.78 per woman. This was $1375.45 less per woman than those receiving Private obstetric care and $1590.91 less than Standard hospital care per woman (p < 0.001). Similar differences in cost were found in favour of MGP for all women in the study who received caseload care. CONCLUSIONS Cost reduction appears to be achieved through reorganising the way care is delivered in the public hospital system with the introduction of Midwifery Group Practice or caseload care. The study also highlights the unexplained clinical variation that exists between the three models of care in Australia.
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Affiliation(s)
- Sally K Tracy
- Midwifery and Women’s Health Research Unit, Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia
- University of Sydney, Sydney, New South Wales 2006, Australia
| | - Alec Welsh
- Department of Maternal Fetal Medicine, University of New South Wales, Randwick, New South Wales 2031, Australia
| | - Bev Hall
- Midwifery and Women’s Health Research Unit, Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia
- University of Sydney, Sydney, New South Wales 2006, Australia
| | - Donna Hartz
- Midwifery and Women’s Health Research Unit, Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia
- University of Sydney, Sydney, New South Wales 2006, Australia
| | - Anne Lainchbury
- Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia
| | - Andrew Bisits
- Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia
| | - Jan White
- Royal Hospital for Women, Barker Street, Randwick, New South Wales 2031, Australia
| | - Mark B Tracy
- Centre for Newborn Care, Westmead Hospital, Cnr Hawkesbury & Darcy Roads, Westmead, New South Wales 2145, Australia
- University of Sydney, Sydney, New South Wales 2006, Australia
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Muñoz-Sellés E, Vallès-Segalés A, Goberna-Tricas J. Use of alternative and complementary therapies in labor and delivery care: a cross-sectional study of midwives' training in Catalan hospitals accredited as centers for normal birth. BMC Complement Altern Med 2013; 13:318. [PMID: 24238197 PMCID: PMC4225673 DOI: 10.1186/1472-6882-13-318] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/14/2013] [Accepted: 10/30/2013] [Indexed: 12/18/2022]
Abstract
BACKGROUND The use of complementary and alternative medicine (CAM) and complementary and alternative therapies (CAT) during pregnancy is increasing. Scientific evidence for CAM and CAT in the field of obstetrics mainly covers pain relief in labor. Midwives are responsible for labor and delivery care: hence, their knowledge of CAM and CAT is important. The aims of this study are to describe the professional profile of midwives who provide care for natural childbirth in Catalan hospitals accredited as centers for normal birth, to assess midwives' level of training in CAT and their use of these therapies, and to identify specific resources for CAT in labor wards. METHODS A descriptive, cross-sectional, quantitative method was used to assess the level of training and use of CAT by midwives working at 28 hospitals in Catalonia, Spain, accredited as public normal birth centers. RESULTS Just under a third of midwives (30.4%) trained in CAT after completion of basic training. They trained in an average of 5.97 therapies (SD 3.56). The number of CAT in which the midwives were trained correlated negatively with age (r = - 0.284; p < 0.001) and with their time working at the hospital in years (r = - 0.136; p = 0.036). Midwives trained in CAT considered that the following therapies were useful or very useful for pain relief during labor and delivery: relaxation techniques (64.3%), hydrotherapy (84.8%) and the application of compresses to the perineum (75.9%). The availability of resources for providing CAT during normal birth care varied widely from center to center. CONCLUSIONS Age may influence attitudes towards training. It is important to increase the number of midwives trained in CAM for pain relief during childbirth, in order to promote the use of CAT and ensure efficiency and safety. CAT resources at accredited hospitals providing normal childbirth care should also be standardized.
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Affiliation(s)
- Ester Muñoz-Sellés
- Department of Public Health, Mental Health and Perinatal Nursing, University School of Nursing, University of Barcelona, Barcelona, Spain
| | - Antoni Vallès-Segalés
- Department of Public Health, Faculty of Medicine, University of Barcelona, Barcelona, Spain
| | - Josefina Goberna-Tricas
- Department of Public Health, Mental Health and Perinatal Nursing, University School of Nursing, University of Barcelona, Barcelona, Spain
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Crichton M. Midwifery in Somaliland. Pract Midwife 2013; 16:20-23. [PMID: 24371912] [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: 06/03/2023]
Abstract
During the civil war in Somaliland (1982-1991), health facilities were devastated and many healthcare workers were killed or became refugees. Since then the country has struggled to rebuild hospitals and health centres and increase the number of healthcare professionals. Many non government officers from a variety of countries are assisting throughout the country. In 2011 I accepted a post establishing the first BSc in midwifery in Hargeisa, the capital of Somaliland. I was employed by Tropical Health Education Trust (THET) in conjunction with Edna Adan University hospital. The students were to be nurse-midwives; the hope was that they would go on to become the movers and shakers in Somaliland. Little did I know how big the challenge would be.
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Gordon W, Menzel A, McCulloch J, Roach JM, Booker C, Joseph J, Greenwood N, Wood LSH, Robinson TG, Gerke N, Kennedy A, van Roojen M, Aurilio D, Kass E, Basile M, Phillips A, Casey B, Spicer G, Raum C, Novak M, Heffernan A, Linstad J, Corcoran D, Lawler RT, Corbeil E, Kali K, Moffat A, Hill M, Ebers B, Zaslow R, Kimball O, Cherney AM, Hannon G, Scar D, Folin A, Potter B, Vergo A, Lucido-Conate J, Hydeman T, Fontaine M, Kinne MH, Hirsch A, Haines K, Ceremy J, Davis S, Goldberger J, Herman D, Kamara M, Cockrill M, Carnesciali M, Hill T, Plaskett N, Fairman A, Darlin J, Morales N, Islam T, Effland K, Viehmann K, German E, Tenney E, Churness D, Myers S, Jones S, Burke B, McLaughlin EY, Pickard K, Cook SS, Kreuger J, Muza S, Hart L, Parsons M, Hodges S, Four R, Bey A, Clem L, Payne S, Phoenix A, Wilkes A, Reiner ESK, Ryerson G, Tanner SL, Francis B, Palagi T, Whitley L, Chorley H, Porter M, Moore L, Sampson A, Seruntine L, Levine A, Everett L, Lawlor M, Simkins G, Cole ER, Lane E, Maisonville M, Pretlow A, Deggins N. Childbirth freedom fighters. Midwifery Today Int Midwife 2013:62-63. [PMID: 23847907] [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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Garvey M. The national birth center study II: Research confirms low Cesarean rates and health care costs at birth centers. Midwifery Today Int Midwife 2013:40-68. [PMID: 23847895] [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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Lokugamage A. In pursuit of the benefits of physiological birth. Midwifery Today Int Midwife 2013:38-41. [PMID: 24511839] [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: 06/03/2023]
Abstract
This article discusses the physical, emotional and societal benefits of physiological birth. The motivation behind women seeking this type of birth and non-labor ward birth settings, such as homebirth, is explored as well as models of intellectual versus intuitive/embodied knowledge of personal health. The emerging field of human rights in childbirth is also examined.
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Zwart M. Growing awareness in Portugal. Midwifery Today Int Midwife 2012:51. [PMID: 22329231] [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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Walker S. Breech birth: an unusual normal. Pract Midwife 2012; 15:18-21. [PMID: 22479850] [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: 05/31/2023]
Abstract
Over the last decade, there has been a loss in confidence and eroded skills due to the near universal policy of advising caesarean section in the wake of the Term Breech trial (Hannah et al 2000). Breech birth has been increasingly viewed as a complication, and management of the breech presenting baby at term has shifted firmly into the realm of obstetric practice in most parts of the UK. Small pockets of exception remain, among NHS and independent midwives who have maintained their skills with breech birth and are sought out by women denied the choice of a vaginal birth elsewhere. With continued focus on consumer choice, women led care and increasing normality, we urgently need to address the issue of how the NHS can safely provide the option of normal breech birth before these skills are permanently lost. This article suggests ways midwives may play a role within the NHS in ensuring women have a choice to birth their breech babies normally, in the safest possible way.
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Kornacka MK, Kufel K. [Neonatal outcome after cesarean section]. Ginekol Pol 2011; 82:612-617. [PMID: 21957607] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Cesarean section is the most commonly performed procedure all over the world. Both American and European data reveal constant and steady increase of pregnancies resolved by a cesarean section. The reasons include: growing number of medical indications or requests of the pregnant women. Regardless of the fact that elective cesarean section decreases the risk of intrauterine hypoxia, meconium aspiration and injury during labor it remains a significant risk factor for respiratory failure in the course of transient tachypnea of the newborn, infant respiratory distress syndrome and pulmonary hypertension, both for term and late preterm infants. As a consequence, the infant requires a prolonged stay in the intensive care unit, together with advanced and often expensive medical procedures such as mechanical (often high-frequency) ventilation, nitric oxide therapy and extracorporeal membrane oxygenation. The American Association of Obstetricians and Gynecologists and the European Association of Perinatal Medicine recommend for a cesarean section due to medical indications to be performed after 39 weeks gestation, preferably after uterine contractions started, and elective cesarean section, particularly if there are indications to finish the pregnancy before 39 weeks gestation, after lung maturity has been assessed (in other case steroids ought to be administered prenatally to mature the lung muscles). That includes also cases of elective cesarean sections performed due to previous cesarean sections, which are the most frequent reasons for repeating procedure. The recommendations also restrict the indications for cesarean section in case of significant prematurity what in turn is connected with more restricted indications for resuscitation of extremely premature infants and babies with extremely low birth weight.
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Affiliation(s)
- Maria Katarzyna Kornacka
- Klinik Neonatologii i Intensywnej Terapii Noworodka Warszawskiego Uniwersytetu Medycznego w Warszawie, Polska.
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N'dinga HG, Oyere GR, Iloki LH. [Unassisted natural childbirth at the Talangai Central Hospital in Brazzaville, Congo]. Med Trop (Mars) 2011; 71:278-280. [PMID: 21870558] [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: 05/31/2023]
Abstract
OBJECTIVES The purpose of this study was to determine the profile of women who give unassisted natural home childbirth (UNHC) in Brazzaville and to evaluate maternal and perinatal morbidity and mortality. PATIENTS AND METHODS This prospective descriptive study was carried out at the Maternity Clinic of the Talangaï Central Hospital (TCH) from November 1, 2006 to October 31, 2008. PATIENT SELECTION Women who gave UNHC and were afterwards admitted to the TCH. RESULTS The frequency of UNHC was 3.7%. The 19- to 35-year age bracket accounted for 72.6% of cases. The main causes underlying UNHC were ignorance of the initial clinical signs of labor for 37 of the 61 primipares (60.7%) and waiting for onset of labor before going to the hospital for 167 of the 360 paucipares and multipares (46.4%). For 234 women, UNHC occurred after pregnancy without prenatal care. In 57.8% of these cases, the reason for admission after UNCR was hemorrhage. More than half of the women (56.8%) who gave UNHC lived women live near a medical facility. Term pregnancies accounted for 41.3% cases of UNHC and undetermined term for 34.4%. At least one maternal complication was observed in 65.3% of cases. Neonatal morbidity was observed in 24% of cases and perinatal mortality in 11.4%. CONCLUSION UNHC is still common in Brazzaville owing mainly to poor public awareness. Public information campaigns to educate women to recognize the initial signs of labor could decrease the frequency of UNHC.
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Affiliation(s)
- H G N'dinga
- Maternité Hôpital de base de Talangai, Brazzaville, Congo.
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Gandy J, Ross J. Every birth the best birth: women centred care in Nottingham. Pract Midwife 2011; 14:22-25. [PMID: 21675474] [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: 05/30/2023]
Abstract
Nottingham University Hospitals (NUH) NHS Trust aspired to increase and maintain its focus on normality in childbirth in its two large maternity units. It achieved this by employing two Leads for Women Centred Care Midwives. This article describes some of the measures taken to promote normal childbirth and empower women and midwives to re-focus on the normal aspects of giving birth. Such measures include; setting up a normal birth focus group for staff, developing study days and a normal birth skills package for staff, work to de-medicalise the birthing environment, one to one care in labour audits, active birth workshops for women and their birthing partners and virtual tours of the maternity unit. The authors hope this may give midwives and staff in other obstetric units ideas and ways in which they can focus on normalising childbirth for all women they care for.
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Affiliation(s)
- Jacqueline Gandy
- Queen's Medical Centre, Nottingham University Hospital NHS Trust
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Blakey J. Normal birth or spontaneous vertex delivery? Pract Midwife 2011; 14:12-13. [PMID: 21675470] [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: 05/30/2023]
Abstract
The declining normal birth rate and increasing Caesarean Section (CS) rates have been a worldwide cause for concern and debate for two decades. In the United Kingdom (UK) normal birth rates have fallen from 70 per cent in the 1970s to 46.7 per cent in 2009 (Birth Choice UK 2011). As normal birth rates continue to fall, researchers and advocates of normality are focusing on the midwife's role in response to this decline. The language and definitions used to classify normality and normal birth are contentious issues leading to confusion for midwives and women. This paper seeks to contribute to the debates around defining and promoting normality.
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Affiliation(s)
- Jill Blakey
- The Countess of Chester NHS Foundation Trust
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McCabe N. Baby Friendly Conference 2010. Empowering women to have a natural birth. Pract Midwife 2010; 13:37-38. [PMID: 21138139] [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: 05/30/2023]
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Bond S. Study finds no differences between groups using natural childbirth methods versus standard childbirth education in choice of epidural anesthesia. J Midwifery Womens Health 2010; 55:290-1. [PMID: 20434096 DOI: 10.1016/j.jmwh.2010.02.003] [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: 02/10/2010] [Accepted: 02/10/2010] [Indexed: 11/19/2022]
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Bond S. Water birth study demonstrates shorter active phases and fewer interventions, but is flawed. J Midwifery Womens Health 2010; 55:288-9. [PMID: 20434094 DOI: 10.1016/j.jmwh.2010.02.006] [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: 02/10/2010] [Accepted: 02/10/2010] [Indexed: 11/17/2022]
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Pomorski M, Woytoń R, Woytoń P, Kozłowska J, Zimmer M. [Cesarean section versus vaginal delivery--state-of-the-art paper]. Ginekol Pol 2010; 81:347-351. [PMID: 20568514] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023] Open
Abstract
AIM OF THE STUDY The aim of the study was to perform a comparative analysis of complications after vaginal deliveries and cesarean sections and to introduce emotional status of the mother as an indication for a cesarean section. MATERIAL AND METHODS 406 patients after vaginal deliveries and cesarean sections, that took place in the first quarter of 2009, were enrolled into the study. RESULTS In the studied group of 406 patients, 200 women (49.2%) had cesarean section and 206 women (50.8%) delivered vaginally. In both groups there were no differences in the clinical state of newborns, which were assessed according to the Apgar score, and in umbilical cord blood pH. Hemoglobin concentration evaluated on the second day of puerperium was statistically significantly higher in the group of patients after cesarean section than after vaginal delivery. Episiotomy and laparotomy wound healing complications were observed in 2 (0.97%) and 3 (1.5%) cases, respectively. CONCLUSIONS Due to lack of differences in complication rates between cesarean section and vaginal delivery patients, the emotional status of a pregnant woman should be considered as an indication for cesarean section.
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Affiliation(s)
- Michał Pomorski
- II Katedra i Klinika Ginekologii Połoznictwa i Neonatologii Akademii Medycznej im. Piastów Slaskich we Wrocławiu.
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Lessa H. Humanising birth in Brazil. Pract Midwife 2010; 13:13-14. [PMID: 20302044] [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: 05/29/2023]
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Francis J. Given the choice? Pract Midwife 2009; 12:20-21. [PMID: 20063572] [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: 05/28/2023]
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Jacob S. Maternal healthcare in South India. Pract Midwife 2009; 12:33-35. [PMID: 19653391] [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: 05/28/2023]
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Kukulu K, Oncel S. Factors influencing women's decision to have a home birth in rural Turkey. Midwifery 2009; 25:32-8. [PMID: 17368665 DOI: 10.1016/j.midw.2006.12.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2006] [Revised: 10/26/2006] [Accepted: 12/17/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE to ascertain the reasons why mothers choose to have a home birth and the factors that influence these reasons. METHODS this cross-sectional study involved 392 women and was conducted between June and September 2003 in a rural setting in Turkey. The data were collected using a questionnaire developed by the authors. The questionnaire included demographic information, obstetric background, the reasons for deciding to give birth at home as well as questions on who encouraged the decision to give birth at home and who assisted in the home births. FINDINGS the decision to have a home birth is related to economic difficulties and the desire to benefit from the assistance of neighbours. Women who had experienced both planned and unplanned home births reported that home birth was unsafe. CONCLUSION preliminary information is provided about women having home births that may inform practitioners' educational efforts and future research.
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Affiliation(s)
- Kamile Kukulu
- School of Health, Akdeniz University, 07058, Antalya, Turkey.
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Calhoun A. Giving birth at home. Time 2008; 172:54-57. [PMID: 18756710] [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: 05/26/2023]
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Affiliation(s)
- B Anthony Armson
- Department of Obstetrics and Gynaecology, University of Toronto, and the Maternal, Infant and Reproductive Health Research Unit, Women's College Research Institute, Toronto, Ont.
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Albers LL, Migliaccio L, Bedrick EJ, Teaf D, Peralta P. Does epidural analgesia affect the rate of spontaneous obstetric lacerations in normal births? J Midwifery Womens Health 2007; 52:31-6. [PMID: 17207748 DOI: 10.1016/j.jmwh.2006.08.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [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] [Indexed: 11/19/2022]
Abstract
The precise relationship between epidural use and genital tract lacerations in normal childbirth is unclear. Data from a clinical trial on measures to lower genital tract trauma in vaginal birth were used for a secondary analysis. The goal was to assess whether epidurals affect the rate of spontaneous obstetric lacerations in normal vaginal births. Maternal characteristics and intrapartum variables were compared in women who did and did not use an epidural in labor, and also in those with and without any sutured lacerations following vaginal birth. Variables that were statistically different in both cases were entered into regression equations for simultaneous adjustment. Epidural use was not an independent predictor of sutured lacerations. Predictors of sutured lacerations included nulliparity, a prolonged second stage, being non-Hispanic white, and an infant birthweight greater than 4000 grams. Elements of midwifery management need further research.
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Affiliation(s)
- Leah L Albers
- University of New Mexico College of Nursing, Nursing/Pharmacy Building, Room 216, Albuquerque, NM 87131-5688, USA.
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Tritten J. Who are the statistics? Midwifery Today Int Midwife 2007:5. [PMID: 17927105] [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: 05/25/2023]
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Shemesh I. My midwifery practice in Israel. Midwifery Today Int Midwife 2007:48-51. [PMID: 17447702] [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: 05/15/2023]
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Rytlewski K, Olszanecki R, Lauterbach R, Grzyb A, Basta A. Effects of Oral L-Arginine on the Foetal Condition and Neonatal Outcome in Preeclampsia: A Preliminary Report. Basic Clin Pharmacol Toxicol 2006; 99:146-52. [PMID: 16918716 DOI: 10.1111/j.1742-7843.2006.pto_468.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Estimation of the influence of oral supplementation with low dose of L-arginine on biophysical profile, foeto-placental circulation and neonatal outcome in preeclampsia. Randomized, placebo-controlled, double-blind, clinical trial. Oral therapy with 3 g of L-arginine daily or placebo as a supplement to standard therapy. Eighty-three preeclamptic women, randomly assigned to the L-arginine (n=42) or placebo (n=41) groups; [n=30 (L-arginine) and n=31 (placebo) ended the study, respectively]. Foetal gain chances due to ultrasound biometry, biophysical profile, Doppler velocimetry of pulsatility indices of umbilical and middle cerebral arteries, cerebro-placental ratio, as well as differences in duration of pregnancy and clinical data of newborn. L-arginine treatment transitory accelerated foetal gain and improved biophysical profile. Starting from 3rd week of therapy, the umbilical artery pulsatility indices values were significantly lower in L-arginine than in placebo group. Moreover, treatment with L-arginine caused significant increase of middle cerebral artery pulsatility indices and cerebro-placental ratio values. Latency was longer in L-arginine group. Neonates delivered in the L-arginine group revealed higher Apgar score. Supplementary treatment with oral L-arginine seems to be promising in improving foetal well-being and neonatal outcome as well as in prolonging pregnancy complicated with preeclampsia. However, these benefits require confirmation in more-powered, larger studies.
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Affiliation(s)
- Krzysztof Rytlewski
- Department of Gynaecology, Obstetrics and Oncology, Jagiellonian University Medical College, Krakow, Poland.
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Queiroz MVO, Jacobina e Silva NS, Jorge MSB, Moreira TMM. [Incidence and features of cesarean section and natural childbirth: study in a city from Ceara's countryside]. Rev Bras Enferm 2006; 58:687-91. [PMID: 16689502 DOI: 10.1590/s0034-71672005000600011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The research aimed to describe the features of a given population studied, as civil state, occupation and number of pre-natal appointments; to verify the incidence of cesarean section and normal labor in clients attended in an institution; to compare these occurrence in the period of research, discussing the indications of cesarean sections more frequently referred. It is a descriptive-retrospective study based upon patient records from a philanthropic institution of the National Health System. It highlighted a rising percentage of cesarean sections with high incidence in teenagers. It evidenced that the main indications of cesarean section were due to former cesarean section and pregnancy specific hypertensive disease. It was recorded predominance of pregnants with 4 to 7 pre-natal appointments. Changes in pre-natal care can impact in cesarean section rate, preparing the mother to natural labor, something that can be closely related to midwives obstetrical nurses and physicians capacitation, as well as the placement of group care instead individual care.
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Cohain JS. Vaginal births after C-section are not necessarily riskier in a birth center than in the hospital. Midwifery Today Int Midwife 2006:16-7, 60. [PMID: 16623142] [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: 05/08/2023]
Abstract
Recent research concluded that VBACs are riskier in a birth center than in the hospital. This conclusion is only true if the woman is sure she will not have any more pregnancies and if she does not suffer from "Fear of Hospitals." Since childbirth centers offered a VBAC rate of 87%, whereas US hospitals currently offer a VBAC rate of less than 10%, the woman has a much higher risk of a repeat cesarean if she delivers in hospital, which increases her risk on subsequent pregnancies.
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Chico A, Lopez-Rodo V, Rodriguez-Vaca D, Novials A. Features and outcome of pregnancies complicated by impaired glucose tolerance and gestational diabetes diagnosed using different criteria in a Spanish population. Diabetes Res Clin Pract 2005; 68:141-6. [PMID: 15860242 DOI: 10.1016/j.diabres.2004.09.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 07/22/2004] [Accepted: 09/06/2004] [Indexed: 11/22/2022]
Abstract
The main objective of this study was to determine the prevalence and risk of complications of a population of Spanish pregnant women with GDM diagnosed following the O'Sullivan-Mahan "standard" criteria, compared with pregnant women with GDM diagnosed using the "new" Carpenter-Coustan criteria. In Spain, limited data are published concerning as the prevalence of GDM and its morbidity. In this sense, the "new" criteria for GDM diagnosis has not been adopted in Spain due to the absence of adequate studies. We retrospectively reviewed all pregnancies handled at our center from 1999 to 2001 (n=6248). Using the standard and the new criteria, the prevalence of GDM was 6.46 and 6.75%, respectively. GDM patients diagnosed using the new criteria showed the same pregnancy evolution that patients diagnosed with the classic criteria. Those patients complicated only with impaired glucose intolerance (IGT) (0.94%) showed a worst outcome. Based on the pregnancy evolution observed, it is not recommended that the new GDM diagnostic criteria be adopted in Spain. More accurate follow-up of patients with IGT is needed.
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Affiliation(s)
- Ana Chico
- Institute of Diabetes, Fundació Sardà Farriol, Passeig de la Bonanova 69, 4, 08017 Barcelona, Spain
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Abstract
OBJECTIVE To assess the frequency of large fetomaternal hemorrhage and to estimate its incidence in cesarean compared with vaginal deliveries. METHODS In this prospective cohort study, the study group was composed of 313 women who underwent cesarean delivery. Control subjects were 253 women who delivered vaginally and were matched for age, parity, ethnic origin, and gestational age. Ninety-six pregnant women at term, but before delivery (prelabor group), were also included to determine whether delivery itself is the cause of fetomaternal hemorrhage. Fetomaternal hemorrhage was measured by using the Kleihauer-Betke test. RESULTS Twenty women (6.4%) in the study group and 17 (6.7%) in the control group had a large fetomaternal hemorrhage (Kleihauer-Betke test > 0.4%). Five women (5.2%) in the prelabor group had a large fetomaternal hemorrhage. The differences were not significant. A large fetomaternal hemorrhage occurred in 14 of 146 (9.6%) women who underwent emergency cesarean, compared with 6 of 167 (3.5%) who delivered by elective cesarean (P = .04). In deliveries complicated by oligohydramnios, cord around the neck, or low birth weight, a higher rate of large fetomaternal hemorrhage was seen. CONCLUSION Our results indicate a rate of large fetomaternal hemorrhage that is substantially higher than previously reported, with no difference between vaginal and cesarean deliveries. This may reflect inaccuracies with the current method used to estimate the degree of fetomaternal hemorrhage.
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Affiliation(s)
- Raed Salim
- Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel
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Abstract
OBJECTIVE To evaluate whether epidural analgesia is associated with a higher rate of abnormal fetal head position at delivery. METHODS We conducted a prospective cohort study of 1,562 women to evaluate changes in fetal position during labor by using serial ultrasound examinations. Ultrasound examinations were performed at enrollment, epidural administration, 4 hours after the initial ultrasonography if epidural had not been administered, and late in labor (> 8 cm). Information about fetal head position at delivery was obtained from the provider. RESULTS Regardless of fetal head position at enrollment (occiput transverse, occiput posterior, or occiput anterior), most fetuses were occiput anterior at delivery (enrollment position: occiput transverse 78%, occiput posterior 80%, occiput anterior 83%, P = .1). Final fetal position was established close to delivery. Of fetuses that were occiput posterior late in labor, only 20.7% were occiput posterior at delivery. Changes in fetal head position were common, and 36% of women had an occiput posterior fetus on at least one ultrasound examination. Women receiving epidural did not have more occiput posterior fetuses at the enrollment (23.4% epidural versus 26.0 no epidural, P = .9) or the epidural/4-hour ultrasound examination (24.9% epidural, 28.3% no epidural), but did have more occiput posterior fetuses at delivery (12.9% epidural versus 3.3% no epidural, P = .002); the association remained in a multivariate model (adjusted odds ratio 4.0, 95% confidence interval 1.4-11.1). CONCLUSION Fetal position changes are common during labor, with the final fetal position established close to delivery. Our demonstration of a strong association of epidural with fetal occiput posterior position at delivery represents a mechanism that may contribute to the lower rate of spontaneous vaginal delivery consistently observed with epidural.
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Affiliation(s)
- Ellice Lieberman
- Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, and Boston Medical Center, Boston, Massachusetts, USA.
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Walker DS, Schmunk SB, Summers L. Do birth certificate data accurately reflect the number of CNM-attended births? An exploratory study. J Midwifery Womens Health 2004; 49:443-8. [PMID: 15351335 DOI: 10.1016/j.jmwh.2004.03.010] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The number of midwife-attended births is increasing as reported on birth certificates in the United States. However, there is some evidence that births attended by certified nurse-midwives (CNMs) may not be accurately recorded. In this exploratory study, data on birth attendants for those clients giving birth during the study period were compared by using four sources: the client's hospital chart, the CNM birth log, hospital birth certificate records, and state vital statistics records. Researchers sought to determine the accuracy of birth attendant data as reflected in these four sources and whether other providers were listed as the birth attendant for actual CNM-attended births. During the study period, the CNM birth log showed that CNMs attended 97 vaginal births, whereas the client hospital charts for these same births noted 92 births as attended by CNMs (the other five were operative vaginal births). Hospital birth certificate and state vital statistics data during the study time period credited 88 and 82 of the client's births, respectively, to the CNMs. Exploration of the inaccurately reported birth attendant data, implications for practice, and recommendations for accurately recording birth certificate data are discussed.
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Affiliation(s)
- Deborah S Walker
- College of Nursing, School of Medicine, Wayne State University, Detroit, Michigan, USA.
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Royal College of Midwives. Normal childbirth. RCM Midwives 2004; 7:332. [PMID: 15739269] [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: 05/01/2023]
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Abstract
OBJETIVO: Conhecer a preferência de mulheres quanto às vias e formas de parto, e a opinião de médicos a respeito dessa preferência. MÉTODOS: Foram entrevistadas 656 mulheres atendidas no Sistema Único de Saúde, em hospitais de São Paulo e Pernambuco incluídos no Estudo Latino-Americano de Cesárea (ELAC): 230 em três hospitais de intervenção, em que a estratégia da segunda opinião diante da decisão de realizar uma cesárea foi adotada como rotina, e 426 mulheres em quatro hospitais de controle, onde não houve intervenção. Os médicos responderam a um auto-questionário, sendo 77 dos hospitais de intervenção e 70 dos de controle. Para análise dos dados foram utilizados o qui-quadrado de Mantel-Haenszel, o teste Yates ou o Exacto de Fischer. RESULTADOS: Nos dois tipos de hospital, a grande maioria das mulheres declarou preferir o parto vaginal à cesárea. Essa preferência foi significativamente maior entre as entrevistadas que já haviam experimentado as duas formas de parto (cerca de 90% nos dois tipos de hospital), comparadas às que haviam tido só cesáreas (72,8% nos hospitais de intervenção e 77,8% nos de controle). Na opinião de 45% dos médicos dos hospitais de intervenção e de 55% dos de hospitais de controle, a maioria das mulheres submetidas a uma cesárea sentia-se satisfeita; 81 e 85% dos médicos, respectivamente, consideraram que as mulheres solicitam cesariana, porque têm medo do parto vaginal. CONCLUSÕES: O conceito de que a principal causa do aumento na taxa de cesárea é o respeito dos desejos das mulheres por parte dos médicos não tem sustentação na opinião declarada pelas mulheres. Uma melhor comunicação entre médicos e mulheres grávidas talvez possa contribuir para melhoria da situação atual.
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Affiliation(s)
- Aníbal Faúndes
- Centro de Pesquisas Materno-Infantis de Campinas, Campinas, SP, Brazil.
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Duarte G, Coltro PS, Bedone RV, Nogueira AA, Gelonezzi GM, Franco LJ. Trends in the modes of delivery and their impact on perinatal mortality rates. Rev Saude Publica 2004; 38:379-84. [PMID: 15243667 DOI: 10.1590/s0034-89102004000300007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
OBJECTIVE To determine changes in the incidence of vaginal deliveries, cesarean sections, and forceps deliveries and their potential association with fetal, early neonatal, and perinatal mortality rates over time. METHODS A retrospective study was carried out and the occurrence of deliveries supervised by university services between January 1991 and December 2000 was determined. Data regarding fetal, early neonatal, and perinatal deaths were assessed using obstetric and pediatric records and autopsy reports. RESULTS Of a total of 33,360 deliveries, the incidence of vaginal deliveries, cesarean sections, and forceps deliveries was relatively steady (around 60, 30, and 10%, respectively) while, at the same time, there was a marked reduction in fetal mortality (from 33.3 to 13.0 per thousand), early neonatal mortality (from 30.6 to 9.0 per thousand), and perinatal mortality (from 56.4 to 19.3 per thousand). CONCLUSIONS The marked reduction in perinatal mortality rates seen during the study period without an increase in cesarean sections indicates that the decrease in perinatal mortality was not impacted by cesarean section rates. The plausible hypothesis seems to be that the reduction in perinatal mortality of deliveries performed under the supervision of university services was more likely to be associated with better neonatal care rather than the mode of delivery.
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Affiliation(s)
- Geraldo Duarte
- Departamento de Ginecologia e Obstetrícia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil.
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48
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Abstract
BACKGROUND In South Korea, cesarean section rates (i.e., the proportion of all live births delivered by cesarean section) approached 40 percent in 2000. The relative contribution of physicians and women to this high rate has been a source of debate. This study explored attitudes toward mode of delivery among South Korean women. METHODS A nationwide cross-sectional telephone survey of 505 Korean women aged 20 to 49 years was conducted using a proportionate quota and systematic random sampling method. The response rate was 57.3 percent. Data were collected using a structured questionnaire consisting of 7 questions about vaginal and cesarean delivery. RESULTS Over 95 percent of women preferred vaginal delivery during pregnancy and were willing to recommend this method to others. Of the women who delivered by cesarean section, 10.6 percent stated that they had requested a cesarean birth. Attitudes toward vaginal or cesarean delivery differed significantly according to a woman's education level. CONCLUSIONS Most study participants showed more favorable attitudes toward vaginal delivery than cesarean delivery. This result does not support the assumption that the upsurge of cesarean section rates in South Korea is associated with women's positive attitudes toward cesarean section. The main cause of the rapid rise of cesarean section rates in South Korea during the past two decades have its origins in health care practitioners and the health care system in which they work.
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Affiliation(s)
- Sang-Il Lee
- Departmrnt of Preventive Medicine, University of Ulsan College of Medicine, 388-1 Pungnap-2Dong, Songpa-Gu, Seoul 138-736, Korea
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49
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Abstract
BACKGROUND The proportion of births by cesarean section in Australia has recently increased by 35 percent, rising from 17 percent in 1990 to 23 percent in 2000. Unlike previous research, which has focused on women's role in increasing rates of cesarean section, this study aimed to explore the existence of wider cultural norms of acceptance of cesarean section in the Australian community, and the implications these might have for rising rates. METHODS A postal self-completion questionnaire was sent to a consecutive sample of 148 women who delivered 7 weeks earlier at the Women's and Children's Hospital, a tertiary-referral public maternity hospital in metropolitan Adelaide, South Australia. These women were recruited at 18 weeks' gestation, and had been involved in a wider study. The questionnaire included three sections, one section on agreement with statements pertaining to cultural acceptance of cesarean section, a second on personal consideration of cesarean section in early pregnancy, and a third including sociodemographic questions. RESULTS Of the total sample, 92 women responded to the questionnaire (response rate 62%). Of 6 items relating to community acceptance of cesarean section, responses ranged from 71.4 percent agreement ("common for people to think that cesarean section offers an easier way of giving birth") to 23.1 percent agreement ("the media seems to portray cesarean section as a better option than vaginal delivery"). The option of having a cesarean section was considered by almost 15 percent (10/68) of women early in their pregnancy. For the vast majority (8/10) this consideration was clinically based. CONCLUSIONS This investigation demonstrated that these Australian women, independent of sociodemographic variables such as age and education level, agreed that cesarean section was perceived as an easy, convenient way of giving birth.
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Affiliation(s)
- Ruth Walker
- Department of Public Health, University of Adelaide, Adelaide, SA 5005, Australia
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van Der Hulst LAM, van Teijlingen ER, Bonsel GJ, Eskes M, Bleker OP. Does a pregnant woman's intended place of birth influence her attitudes toward and occurrence of obstetric interventions? Birth 2004; 31:28-33. [PMID: 15015990 DOI: 10.1111/j.0730-7659.2004.0271.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A home confinement with midwifery care is still an integral part of Dutch maternity care. It has been argued that the existence of home birth itself influences the course of the birth process positively, which is why obstetric interventions are low in comparison with neighboring countries. This study examined the impact of women's intended place of birth (home or hospital) and the course of pregnancy and labor when attended by midwives. METHODS This is a prospective study of 625 low-risk pregnant women, gestation 20 to 24 weeks, enrolled in 25 independently working midwifery practices. The course of labor was measured by the frequency of interventions by midwives and obstetricians. RESULTS A more non-technological approach to childbirth was observed within the women opting for a home birth compared with the women opting for a hospital birth. Data showed a relationship between interventions and planned birth site: sweeping membranes and amniotomy by midwives were more likely to be conducted in women opting for a home birth. Multiparas opting for hospital birth were more likely to experience consultations and referrals. Within the group of multiparas referred for obstetrician care, women intending to have a home birth experienced fewer interventions (e.g., induction, augmentation, pharmacologic pain relief, assisted delivery, cesarean section) compared with those who had opted for a hospital birth. CONCLUSIONS A large proportion of women desire a home birth. The impact of that choice demonstrated a smoother course of the birth process, compared with women who desired to deliver in the hospital, as measured by fewer obstetric interventions. We suggest that psychological factors (expectation and perceptions) influence both a woman's decision of birthplace and the actual birth process.
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Affiliation(s)
- Leonie A M van Der Hulst
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands
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