A concept analysis of obstetric violence in the United States of America

The aim is to clarify the concept of "obstetric violence in the United States of America." Obstetric violence (OV) is a poorly defined and rarely applied concept in the United States that causes significant harm and requires recognition. The design is a concept analysis to examine the structure and function of OV in the United States. An English language literature review with no date restrictions was performed using CINAHL, PubMed, and Google search. The search was expanded to the related terms "birth rape" and "birth trauma." The concept analysis was conducted using the method outlined by Walker and Avant. The synthesized definition proposed is: Obstetric violence is abuse or mistreatment by a health care provider of a female who is engaged in fertility treatment, preconception care, pregnant, birthing, or postpartum; or the performance of any invasive or surgical procedure during the full span of the childbearing continuum without informed consent, that is coerced, or in violation of refusal. It is a sex-specific form of violence against women (VAW) that is a violation of human rights. A clear definition and understanding of OV in the United States will allow for its recognition. A conceptual basis for naming it can lead to better knowing its prevalence, further studies, and operationalizing the term to create pathways for accountability and restitution. Nurses are in a unique position to minimize OV risk and to promote individual and unit-based responses for zero-tolerance.

Changes in Hospital-Based Obstetric Services in Rural US Counties, 2014-2018

This study describes hospital-based obstetric service losses in rural US counties between 2014 and 2018 overall and by county population and urban adjacency.

Robot chores: machines make the decisions on mock maternity ward

Robots could be used to make decisions on wards, American scientists have claimed.

Trend in mode of delivery in Rajavithi Hospital: a ten-year analysis (2002-2011)

OBJECTIVE

To create trends in mode of delivery both public and private service at Rajavithi Hospital.

MATERIAL AND METHOD

The medical records of singleton pregnant women delivered between January 1, 2002 and December 31, 2011 were retrospectively analyzed for mode of delivery, indication of operative obstetrics, and modality of services (public and private service).

RESULTS

During the study period, total singleton deliveries gradually decreased from 9,418 to 6,023 while the spontaneous vaginal delivery rate fluctuated, and the cesarean delivery rate increased from 25.48% to 34.70%. Vaginal operative deliveries steadily declined such as, forceps extraction 3.83% to 0.95%, vacuum extraction, 1.72% to 0.85%, and vaginal breech delivery 0.92 to 0.28%.

CONCLUSION

The cesarean delivery rate increased in contrast with the decline of the vaginal operative delivery rate.

Hospital discharges in New Zealand 1991-2005: changes over time and variation between districts

AIM

This paper describes changes in the rate of hospital discharges in New Zealand between 1991 and 2006, and assesses variation across districts; it contributes to the discussion of the adequacy of the health system.

METHODOLOGY

Data on public hospital discharges were obtained from the NZ Health Information Service. Diagnostic Related Groups were used to group and weight cases; domiciliary codes were used to assign cases to districts and as an indication of patients' socioeconomic status. The Intervention Ratio was used as a relative measure of national hospital throughput from 1991 to 2005, and of district service volume. The Coefficient of Variation was used as a measure of overall system variation.

RESULTS

There has been an increase of 50.5% in weighted discharges from public hospitals between 1991/2 and 2005/6; adjusted for population change the increase is 17.9%. There has been a modest fall in the degree of variation between districts, but in medicine and surgery 24% of district departments appear to have levels of discharge significantly above or below the national average.

CONCLUSIONS

The intensity of public hospital care to the New Zealand public has increased. Where services are provided at a level above or below the national average, local explanations should be sought and corrective action undertaken if warranted.

Facilitators and barriers to adoption of evidence-based perinatal care in Latin American hospitals: a qualitative study

Selective episiotomy and the active management of labor have been shown by numerous studies to benefit women's experience of labor as well as its outcomes. However, many Latin American public hospitals have not updated their clinical practices to reflect these findings. Limited access to new knowledge, limited time and physical resources and attitudes resistant to change are factors limiting the adoption of new practices in such hospitals. Interviews were conducted with three department heads, and focus groups were conducted with 31 physicians and midwives working in 10 public hospitals in Argentina and Uruguay. All were asked about facilitators and barriers to making changes in clinical practice. In addition, three focus groups were conducted with 16 pregnant women served by public hospitals. Responses were grouped according to stages of change in incorporating new evidence into practice. Numerous facilitators and barriers were identified by participants, as well as potential strategies for promoting change that could be incorporated into interventions. Barriers included limited access to information, negative attitudes toward changes in practice, lack of skills in performing new practices, lack of medical resources and explicit guidelines and a perceived need to practice defensive medicine. Changing long-standing clinical practice is difficult. Interventions must be adapted to translate evidence-based approaches to new cultures and contexts. Improving information access, use of role models, skill development and improved resources and support may be effective ways to overcome barriers to change in Latin American obstetric care.

Changing trends in MTP at SSG hospital, Baroda--a retrospective study

This is a retrospective study carried out in the postpartum unit of Medical College and SSG Hospital, Baroda, Gujarat with an aim to assess the changes in the practices of medical termination of pregnancy over the last 20 years. Randomisation was achieved by selecting every tenth year from 1983 as a study year. Chi-square test was used as the test of significance. There was a rise in the total number of medical termination of pregnancies performed in the postpartum unit from 1983 to 1993 and then to 2003 (498 to 965 and then to 1054 respectively). Majority of the beneficiaries in all the 3 study years belonged to the urban population in the age group of 21-30 years with two living children. Number of unmarried beneficiaries were on rise but the difference was not statistically significant (1.6% to 1.8% and then to 2.8% respectively). There was a positive trend of coming for medical termination at earlier weeks and significant decline in the number of second trimester medical termination of pregnancies (57.0% to 13.3% and then to 13.4% respectively). There was a significant increase in the beneficiaries opting for temporary methods of contraception from 1983 to 1993 (48.6% to 55.6%). Copper-T was the most favoured method of temporary contraception in all the 3 study years. Medical termination of pregnancy was like an entry point for contraception, either temporary or permanent in all the study years.

[Evolution of the hospital institutions of Brussels and the progressive individualization of the departments of obstetrics]

The origin of Brussels hospitals goes back to the XIIth century when several institutions created by the Church were only aimed at lodging poor pilgrims. The evolution from ecclesiastic management to municipal direction ended up in the establishment of two main public hospitals devoted to health care : Saint-Jean and Saint-Pierre. The latter, founded under Austrian rule and associated from the start with clinical teaching, gained therefore a prominent position. In 1834, it became a university hospital thanks to an agreement between the recently founded Free University of Brussels and the municipal health authorities. Finally, the administration of the main university clinical infrastructure was totally taken over by the University and moved to the newly erected Erasmus Hospital together with all faculty buildings. Development of the Brussels Maternity occurred rather slowly and underwent several location changes because of varying general politics as well as for sanitary reasons of hygiene. It was not before the XXth century that obstetrical practice progressively shifted from the private domiciliary sphere at the hands of midwives, to the hospital environment and medical control as is the case today.

Implementation of hysteroscopic surgery in The Netherlands

OBJECTIVE

This study was conducted to assess the degree of diffusion of hysteroscopic surgery in gynaecological practice in The Netherlands in order to guide further implementation. The diffusion was objectified by defining the percentage of hospitals performing hysteroscopic procedures and the number of different procedures performed per gynaecologist.

STUDY DESIGN

In 2003 all Departments of Gynaecology (n=102) in The Netherlands were sent a questionnaire. The questionnaire addressed the number and type of all hysteroscopic procedures that were performed in each hospital in 2002. Data from this study were compared to previously published data from 1997.

RESULTS

Responses were received from 80% of all gynaecological departments in The Netherlands. Diagnostic hysteroscopy was performed in almost all hospitals in both 1997 and 2002. The percentage of hospitals that adopted polypectomy, myomectomy and endometrial ablation increased to more than 90% in 2002. The number of teaching hospitals that integrated diagnostic hysteroscopy, polypectomy and myomectomy (procedures required for graduation) into their operative spectrum increased to 100%.

CONCLUSION

This survey indicates a growing trend of the diffusion of diagnostic and "basic" therapeutic hysteroscopic procedures in The Netherlands. However, figures upon more advanced hysteroscopic surgery are less optimistic.

Implementation of a health care policy: an analysis of barriers and facilitators to practice change

Background

Governments often create policies that rely on implementation by arms length organizations and require practice changes on the part of different segments of the health care system without understanding the differences in and complexities of these agencies. In 2000, in response to publicity about the shortening length of postpartum hospital stay, the Ontario government created a universal program offering up to a 60-hour postpartum stay and a public health follow-up to mothers and newborn infants. The purpose of this paper is to examine how a health policy initiative was implemented in two different parts of a health care system and to analyze the barriers and facilitators to achieving practice change.

Methods

The data reported came from two studies of postpartum health and service use in Ontario Canada. Data were collected from newly delivered mothers who had uncomplicated vaginal deliveries. The study samples were drawn from the same five purposefully selected hospitals for both studies. Questionnaires prior to discharge and structured telephone interviews at 4-weeks post discharge were used to collect data before and after policy implementation. Qualitative data were collected using focus groups with hospital and community-based health care practitioners and administrators at each site.

Results

In both studies, the respondents reflected a population of women who experienced an "average" or non-eventful hospital-based, singleton vaginal delivery. The findings of the second study demonstrated wide variance in implementation of the offer of a 60-hour stay among the sites and focus groups revealed that none of the hospitals acknowledged the 60-hour stay as an official policy. The uptake of the offer of a 60-hour stay was unrelated to the rate of offer. The percentage of women with a hospital stay of less than 25 hours and the number with the guideline that the call be within 48 hours of hospital discharge. Public health telephone contact was high although variable in relation to compliance the guideline that the call be within 48 hours of hospital discharge. Home visits were offered at consistently high rates.

Conclusion

Policy enactment is sometimes inadequate to stimulate practice changes in health care. Policy as a tool for practice change must thoughtfully address the organizational, professional, and social contexts within which the policy is to be implemented. These contexts can either facilitate or block implementation. Our examination of Ontario's universal postpartum program provides an example of differential implementation of a common policy intended to change post-natal care practices that reflects the differential influence of context on implementation.

The effect of income pooling within a call group on rates of obstetric intervention

BACKGROUND

On July 1, 1997, the call group at a tertiary referral hospital in Ottawa changed its remuneration. The authors tested the hypothesis that change in an obstetric call group's remuneration from individual fee-for-service billing to equal sharing of the pooled group income would result in reduced rates of obstetric intervention.

METHODS

Intervention rates were compared for the 12 months before (1678 births) and the 12 months after (1934 births) the change. Data were collected on onset of labour, indication for induction of labour, mode of delivery and neonatal outcome. Statistical analysis was performed with Wilcoxon's signed-rank test.

RESULTS

The mean rate of elective induction of labour was 38.6% in the year before the change and 33.3% in the year after the change (p = 0.01). There were small but statistically significant increases in the mean duration of labour and mean length of the second stage (p = 0.03).

INTERPRETATION

Billing policy may affect clinical decisions. Our findings add weight to the literature showing increased intervention rates with fee-for-service remuneration.

Trends in small hospital obstetric services in Ontario

OBJECTIVE

To compare obstetric services provided in small Ontario hospitals in 1995 with those provided in 1988.

DESIGN

Mailed survey questionnaire.

SETTING

Small hospitals in Ontario.

PARTICIPANTS

Chiefs of Staff of the hospitals.

MAIN OUTCOME MEASURES

Hospital size and location; numbers of physicians; availability of obstetric, anesthesia, and general surgery services; and other medical services. The 1995 questionnaire was identical to the 1988 one, except for addition of questions on midwives and deletion of the detailed emergency medicine section.

RESULTS

A study group of 35 hospitals that provided active obstetric care in both years had significantly fewer births, fewer family physicians attending births, and fewer GP anesthetists in 1995 than in 1988. There were fewer cesarean births, but a similar number of epidural anesthetics. Availability of anesthetic, epidural, and cesarean services was significantly lower in 1995 than in 1988 in these 35 hospitals. Also, 11 other hospitals that had provided active obstetric care (defined as more than 25 births yearly) in 1988 no longer did so in 1995.

CONCLUSION

By almost all measures, obstetric services in these rural Ontario hospitals were less available in 1995 than they had been in 1988.

Joining forces: a realistic approach for gynecologic oncology services in a midsize community

In summary, the team approach model to problem-solving worked to meet some of the gynecologic oncology needs for women in northern Indiana. The steps of clarifying the issue, identifying potential problems and needs, setting goals and a timetable, establishing an implementation plan and assigning accountability for the steps helped to successfully bring a Gynecologic Oncology Clinic to South Bend. The final step, that oftentimes sets up another chain of events, is re-evaluating the clinic from cost, quality and service delivery perspectives. This will be done prior to the end of the year.

Progress and evaluation of a consultation-liaison psychiatry service to an obstetric-gynaecology hospital

OBJECTIVE

Recently we described the establishment and first 6 months of a psychiatric consultation-liaison service to a Melbourne obstetric-gynaecology teaching hospital. The follow-up report evaluates the service in two ways: first, it compares referral data for the 12 months of 1992 with that of the first 6 months of operation in 1990; and second, it reports on results of a survey of referrer and patient satisfaction with the service.

METHOD

Referral data were collected for the data comparison from the consultation-liaison referral book and patients' files. Referrer and patient satisfaction was evaluated by questionnaires sent to 45 medical staff, 7 charge nurses, and 100 consecutive patients.

RESULT

A fairly constant referral rate for inpatients has emerged at 0.8%, this very low referral rate being some cause for concern. An internal shift in the type of referrals over time has developed, with an increase in obstetric and a decrease in gynaecology referrals. High referrer satisfaction, with 86% of the doctors finding the consultation(s) "very" or "quite" helpful, and high patient satisfaction, with 83% of respondents having found the consultation(s) "very" or "quite" helpful, was found.

CONCLUSIONS

Despite high referrer and consumer satisfaction, and objective evidence of need, this pioneering consultation-liaison service in obstetric-gynaecology continues to be grossly under-utilised. Increasing the referral rate will be one of the greatest challenges in the future of this service.

Development of an innovative nursing care delivery system

In the reform of healthcare lies its renaissance, and in its challenges lie its opportunities. Faced with the changing needs of consumers, the evolving roles of care givers, technologic advances, and economic pressures, institutions are redesigning their physical facilities and systems of care delivery in preparation for a new era in healthcare. Innovative care delivery systems, developed to complement creative facility designs, will provide an approach to health-care that promotes administrative efficiency, patient/care giver satisfaction, and cost-effective use of resources. This article chronicles the development of a care delivery system for obstetric nursing, a blueprint for future healthcare at one institution.

Breast-feeding policies and routines among Arizona hospitals and nursery staff: results and implications of a descriptive study

In 1988, Arizona's 61 hospitals providing obstetrical services were canvased with regard to hospital routines that favor either breast-feeding or bottle-feeding. Forty-five hospitals provided responses that were used in the survey. Practices favoring breast-feeding, which were reported by a majority of the hospitals (more than 50%), were demand feeding, staff assessment for "latch-on" (the action of nipple presentation and sucking initiation) and positioning, "rooming-in" (the practice of minimal mother-infant separation), and information about follow-up support services. Hospital practices suggested to promote bottle-feeding were the provision of pacifiers and supplemental water or glucose, issuance of formula packs at discharge, and a first feed of sterile water. A positive significant relationship was identified for policies advocating breast-feeding and the prevalence of breast-feeding encouragement from professional staff. Of 44 respondents, 41 indicated that their hospital's policies endorse breast-feeding as the ideal method of feeding healthy newborns. Hospital staff perceived that they encourage mothers to breast-feed and offer support to those who initiate breast-feeding. On the basis of this information, we conclude that dietetics practitioners should evaluate current breast-feeding practices and integrate policies supportive of breast-feeding into the health care system.

The status and future of small maternity services in Iowa

Small Iowa community hospitals (fewer than 500 deliveries annually) are currently the site of approximately 37% of hospital births in the state. Many of these facilities face severe financial constraints aggravated by reduced Medicare payments and diagnosis-related group payment mechanisms. The quality and quantity of services provided by small hospitals are illustrated by birth and mortality data for the period that spans the development of Iowa's regionalized perinatal care system. Small hospitals appear to compare very favorably when matched with their larger level I counterparts with regard to neonatal mortality rates, incidence of births of very-low-birth-weight neonates, survival of very-low-birth-weight neonates, occurrence of neonatal deaths relative to the total birth population, and incidence of neonatal morbidities. Because these hospitals provide valuable services in Iowa's perinatal care system, their closure may seriously compromise perinatal health care for rural Iowans.

Trends in obstetric-gynecologic academic manpower--1983

Since 1980 medical school faculty growth has essentially ceased, in comparison to earlier substantial increases. Women are represented in full-time faculty positions in a larger proportion than among practicing obstetrician-gynecologists. Subspecialist numbers on faculties have increased, with a small decline in generalist obstetrician-gynecologists. Despite the current plateau, medical school departments project a 36% increase in faculty members during the next five years, and an even larger increase in faculty involved in research.

A microcomputer system in the delivery suite

Microcomputer systems have been installed in the delivery suites of two obstetric units which cater between them for nearly 10 000 deliveries annually. The midwifery and medical staff enter administrative, antenatal, anaesthetic and delivery details during labour and as soon after delivery as possible. The computer prints out the official Birth Notification, the entry for the Midwives Register and the record of labour and delivery for the patient's notes. Subsequently the postnatal doctor and anaesthetist, where relevant, enter details of puerperium and anaesthetic follow-up, before the production by the computer of discharge and anaesthetic summaries for the community and records. In the first 6 months of use at the Bristol Maternity Hospital (July to December 1982) 2229 patients were delivered and have had obstetric details recorded on the computer. A general obstetric audit of these patients is presented.

Survival of departments of obstetrics and gynecology: ten points for Association of Professors of Gynecology and Obstetrics action in the 1980s

Major changes have occurred in medicine during the past few years: the number of medical students who graduate per year has recently doubled, the federal government pays a significant portion of health care costs, and the body of scientific information is expanding logarithmically. The changes which will occur during the next 10 to 15 years will be equally dramatic, and in order for our specialty to increase its presence and position in medicine, it needs to begin to consider these changes and take actions to capitalize on them. Four areas of change were singled out and discussed in terms of their significance and possible plans of action to address them. The four include the increased numbers of women in obstetrics and gynecology, the demand for departments to generate more practice income, the reduced support for research, and the large numbers of physicians being trained in obstetrics and gynecology. Ten places for action by academic departments of obstetrics and gynecology were outlined, and these are listed in Table III. Continued review of the past and the present will allow us to be prepared for the future.

[Results of a questionnaire issued to expectant and delivered mothers (author's transl)]

At the Department of Obstetrics and Gynaecology, Wilhelminenspital der Stadt Wien, Vienna, 98% of all deliveries are continuously monitored. 30% (1979) received epidural anaesthesia. The presence of the husband in the delivery room and partial rooming-in is available to all mothers. To find out if the service to expectant and delivered mothers is according to the requirement of our patients, questionnaires were distributed indiscriminately over a two-month period to 350 pregnant women and to 240 women in the puerperium. Fetal monitoring was valued positively in the majority of cases, the presence of the husband during delivery is requested in a minority of cases only, but would be welcomed by a higher proportion of puerperal women for the next delivery. Expectant mothers wished epidural anaesthesia in 50% of cases. Not only pregnant, but also delivered women demanded rooming-in, the latter group agreeing in the main with our partial form of rooming-in. Nearly 90% of mothers with rooming-in felt well prepared for baby care on leaving the hospital. We believe in the possibility of a synthesis of continuous monitoring to achieve optimum safety of delivery and family-orientated obstetrics in the hospital management of labour and the puerperium.

Consolidation of hospital obstetric services--is it a reality?

Despite efforts toward regional planning of maternity services and consolidation of small hospital units, the number of US hospitals with maternity services has increased every year since 1973. Only 2 states have significantly reduced the number of hospitals performing less than 500 deliveries annually. The average number of annual deliveries per hospital is 728. No state has achieved an average number of deliveries as high as the 1500 deliveries called for in national guidelines for health planning.

Assessing trends in perinatology

Hospital administrators must respond as the medical profession renews its efforts to reduce newborn mortality rates. Technological changes in the case of obstetric and newborn patients, pressures for the regionalization of service, and consumer demands for a more humane birth environment are factors the administrator must consider.