Antenatal and intrapartum consent: Implications of the NSW Consent Manual 2020

Pelvic organ prolapse: Women's experiences of Accessing Care & Recommendations for improvement

Up to 50% of women will develop pelvic organ prolapse (POP) over their lifetime. Symptoms include pain, bulge, urinary, bowel and sexual symptoms affecting all aspects of a woman's life.Many women with POP symptoms present initially to primary care settings. Research has shown these interactions are often unsatisfactory, with women reporting their health care professional (HCP) trivialized their symptoms or appeared to have poor knowledge about pelvic floor dysfunction (PFD).Aim The aim of this qualitative study was to explore experiences of younger women seeking treatment for POP and their recommendations for improvements.Methods Ethics approval was obtained (LS-21-01-Carroll-Ful). Women with POP were recruited from an online support group (n = 930 members). Inclusion criteria: adult women, diagnosed with POP and aware of their POP stage. Following informed consent, a demographic questionnaire, interview questions and the Central Sensitization Inventory (CSI) were forwarded. Semi-structured zoom audio-recorded interviews were conducted. Thematic analysis was undertaken; transcripts coded, and themes identified.Results Fourteen women aged 32-41, parity 1-3, with POP Grade 1-3 participated. Many women reported HCPs as dismissive or not appreciative of the impact of their condition. Others described interactions with HCPs who they felt listened, understood the impact of their POP, gave simple explanations, a positive prognosis and outlined a realistic treatment plan.Current antenatal education, post-partum care and primary HCP screening for PFD were identified by women as deficient. Many highlighted delays in accessing specialist care for POP. Women made several recommendations for improvements to the current model of care.Conclusions Increased focus on person-centred care, particularly emotional support, information and education may improve younger women's experiences when seeking care for POP.

Diagnosis of maternal birth trauma by pelvic floor ultrasound

BRIEF SUMMARY

Maternal somatic birth trauma due to vaginal delivery is more common than generally assumed and an important cause of future morbidity. Maternal birth trauma may involve both psychological and somatic morbidity, some of it long-term and permanent. Somatic birth trauma is now understood to encompass not just episiotomy, perineal tears and obstetric anal sphincter injuries (OASI), but also trauma to the levator ani muscle, termed 'avulsion'. This review will focus on recent developments in the imaging diagnosis of maternal birth trauma, discuss the most important risk factors and strategies for primary and secondary prevention. Translabial and exo-anal ultrasound allow the assessment of maternal birth trauma in routine clinical practice and enable the use of levator avulsion and anal sphincter trauma as key performance indicators of maternity services. This is likely to lead to a greater awareness of maternal birth trauma amongst maternity caregivers and improved outcomes for patients, not the least due to an increasing emphasis on patient autonomy and informed consent in antenatal and intrapartum care.

Head in the sand: Contemporary Australian attitudes towards induction of labour

Ambivalence in Australian thought on induction of labour, despite recent evidence, stands out in contrast to ever-increasing rates of this intervention. As consent obligations on information provision have crystallised in maternity care, this article examines whether consumer-led expectations and legal obligations may precipitate change to end the cultural stigma around induction of labour.

Have we lost sight of the women? An observational study about normality-centred care in Australian maternity services

BACKGROUND

Prioritising normal birth has led to harm in some instances in the United Kingdom. While Australian organisations also promote normal birth, its negative impact is less well understood here.

AIMS

This study explores the problems that may arise from the promotion of normal birth and the quality of clinical incident investigations.

MATERIALS AND METHODS

This study uses a survey-based research design and has received 1278 responses. The main outcome measures include perceptions on bias against interventions, delays in interventions, systemic attempts to reduce caesarean rates, and clinical incident investigations.

RESULTS

The perception among both obstetric and midwifery cohorts is that the promotion of normal birth may sometimes or frequently lead to bias against intervention for women (93.8% vs 63.2%), bias against intervention for clinicians (81.1% vs 53.1%), delays in interventions (86.8% vs 37.4%), maternal request caesarean sections being discouraged (81.2% vs 66.9%), an increased emphasis on vaginal birth after caesarean (88.1% vs 69.3%), and a culture of vaginal births 'at all costs' leading to poor outcomes for mothers and babies (79.5% vs 24.7%). Respondents believe clinical incident investigations to be 'frequently' independent (48% vs 48.2%) but engagement of women in these processes is often missing or 'rarely' seen (46.6% vs 51.7%).

CONCLUSIONS

This study finds that Australian maternity healthcare providers believe institutional encouragement of normal birth has created work practices in maternity care that compromise patient safety and reduce the agency of the woman in the choices she makes. Current regulatory standards must change to reflect core ethical and legal obligations around informed consent.