1
|
Butler SE, Wallace EM, Bisits A, Selvaratnam RJ, Davey MA. Induction of labor and cesarean birth in lower-risk nulliparous women at term: A retrospective cohort study. Birth 2024; 51:521-529. [PMID: 38173333 DOI: 10.1111/birt.12806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 10/13/2023] [Accepted: 11/30/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE To evaluate whether induction of labor (IOL) is associated with cesarean birth (CB) and perinatal mortality in uncomplicated first births at term compared with expectant management outside the confines of a randomized controlled trial. METHODS Population-based retrospective cohort study of all births in Victoria, Australia, from 2010 to 2018 (n = 640,191). Preliminary analysis compared IOL at 37 weeks with expectant management at that gestational age and beyond for uncomplicated pregnancies. Similar comparisons were made for IOL at 38, 39, 40, and 41 weeks of gestation and expectant management. The primary analysis repeated these comparisons, limiting the population to nulliparous women with uncomplicated pregnancies and excluding those with a medical indication for IOL. We compared perinatal mortality between groups using Chi-square tests and multivariable logistic regression for all other comparisons. Adjusted odds ratios and 99% confidence intervals were reported. p < 0.01 denoted statistical significance. RESULTS Among nulliparous, uncomplicated pregnancies at ≥37 weeks of gestation in Victoria, IOL increased from 24.6% in 2010 to 30.0% in 2018 (p < 0.001). In contrast to the preliminary analysis, the primary analysis showed that IOL in lower-risk nulliparous women was associated with increased odds of CB when performed at 38 (aOR 1.23(1.13-1.32)), 39 (aOR 1.31(1.23-1.40)), 40 (aOR 1.42(1.35-1.50)), and 41 weeks of gestation (aOR 1.43(1.35-1.51)). Perinatal mortality was rare in both groups and non-significantly lower in the induced group at most gestations. DISCUSSION For lower-risk nulliparous women, the odds of CB increased with IOL from 38 weeks of gestation, along with decreased odds of perinatal mortality at 41 weeks only.
Collapse
Affiliation(s)
- Sarah E Butler
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Euan M Wallace
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
- Department of Health, Melbourne, Victoria, Australia
| | - Andrew Bisits
- Department of Obstetrics and Gynaecology, Royal Hospital for Women, Sydney, New South Wales, Australia
| | - Roshan J Selvaratnam
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
2
|
Lawson J, Amaratunge L, Goh M, Selvaratnam RJ. Perinatal outcomes after regional analgesia during labour. Aust N Z J Obstet Gynaecol 2024; 64:334-340. [PMID: 38348733 DOI: 10.1111/ajo.13797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/21/2024] [Indexed: 08/06/2024]
Abstract
BACKGROUND Regional analgesia is a common and effective form of in-labour analgesia. However, there are concerns whether it is associated with adverse maternal and neonatal outcomes. AIMS To examine the association between regional analgesia and maternal and neonatal outcomes. MATERIALS AND METHODS A retrospective population-based cohort study of singleton term births in Victoria, Australia, between 2014 and 2020. Women who received regional analgesia were compared with women who did not. Multivariable logistic and linear regressions were used. RESULTS There were 107 013 women who received regional analgesia and 214 416 women who did not. Compared to women who did not receive regional analgesia, regional analgesia was associated with an increased risk of instrumental birth (adjusted odds ratio (aOR) = 3.59, 95% CI: 3.52-3.67), caesarean section (aOR = 2.30, 95% CI: 2.24-2.35), longer duration of the second stage of labour (β coefficient = 26.6 min, 95% CI: 26.3-27.0), Apgar score below seven at five minutes (aOR = 1.30, 95% CI: 1.21-1.39), need for neonatal resuscitation (aOR = 1.44, 95% CI: 1.40-1.48), need for formula in hospital (aOR = 1.68, 95% CI: 1.65-1.72), and the last feed before discharge not exclusively from the breast (aOR = 1.59, 95% CI: 1.56-1.62). CONCLUSION Regional analgesia use in labour was associated with adverse maternal and neonatal outcomes. These findings may add to the risk-benefit discussion regarding regional analgesia for pain relief and highlight the importance of shared decision-making. Further large prospective studies and randomised controlled trials will be useful.
Collapse
Affiliation(s)
- Janna Lawson
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
| | - Lahiru Amaratunge
- Department of Anaesthesia and Pain Medicine, Western Health, Melbourne, Victoria, Australia
| | - Melody Goh
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, Australia
| | - Roshan J Selvaratnam
- The Ritchie Centre, Department of Obstetrics and Gynaecology, Monash University, Melbourne, Victoria, Australia
- Safer Care Victoria, Department of Health, Melbourne, Victoria, Australia
| |
Collapse
|
3
|
Hulman A, Pakai A, Csákvári T, Varga K. Impact of different obstetric interventions and types of delivery on breastfeeding: a nationwide cross-sectional survey of Hungarian women. BMC Pregnancy Childbirth 2024; 24:473. [PMID: 38992633 PMCID: PMC11241934 DOI: 10.1186/s12884-024-06666-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 06/30/2024] [Indexed: 07/13/2024] Open
Abstract
BACKGROUND We assessed the effect of different obstetric interventions and types of delivery on breastfeeding. METHODS A quantitative, cross-sectional study was carried out using an online questionnaire. Data collection was performed in 2021 in Hungary. We included biological mothers who had raised their at least 5-year-old child(ren) at home (N = 2,008). The questionnaire was completed anonymously and voluntarily. In addition to sociodemographic data (age, residence, marital status, education, occupation, income status, number of biological children, and anthropometric questions about the child and the mother), we asked about the interventions used during childbirth, and the different ways of infant feeding used. Statistical analysis was carried out using Microsoft Excel 365 and SPSS 25.0. Descriptive statistics, two-sample t tests, χ2 tests and ANOVA were used to analyse the relationship or differences between the variables (p < 0,05). RESULTS We found that in deliveries where synthetic oxytocin was used for both induction and acceleration, there was a higher incidence of emergency cesarean section. However, the occurrence of vaginal deliveries was significantly higher in cases where oxytocin administration was solely for the purpose of accelerating labour (p < 0.001).Mothers who received synthetic oxytocin also received analgesics (p < 0.001). Women giving birth naturally who used oxytocin had a lower success of breastfeeding their newborn in the delivery room (p < 0.001). Children of mothers who received obstetric analgesia had a higher rate of complementary formula feeding (p < 0.001). Newborns born naturally had a higher rate of breastfeeding in the delivery room (p < 0.001) and less formula feeding in the hospital (p < 0.001). Infants who were breastfed in the delivery room were breastfed for longer periods (p < 0.001). Exclusive breastfeeding up to six months was longer for infants born naturally (p = 0.005), but there was no difference in the length of breastfeeding (p = 0.081). CONCLUSIONS Obstetric interventions may increase the need for further interventions and have a negative impact on early or successful breastfeeding. TRIAL REGISTRATION Not relevant.
Collapse
Affiliation(s)
- Anita Hulman
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 4 Vörösmarty str, Pécs, H-7621, Hungary
| | - Annamária Pakai
- Institute of Emergency Care, Pedagogy of Health and Nursing Sciences, University of Pécs, 4 Vörösmarty str, Pécs, H-7621, Hungary
| | - Tímea Csákvári
- Department of Health Economics and Health Care Management, Institute of Health Insurance, Faculty of Health Sciences, University of Pécs, 33 Landorhegyi str, Zalaegerszeg, H-8900, Hungary.
| | - Katalin Varga
- Department of Affective Psychology, Institute of Psychology, ELTE Eötvös Loránd University, 46 Izabella str, Budapest, H-1064, Hungary
| |
Collapse
|
4
|
Nixarlidou E, Margioula-Siarkou C, Almperis A, Vavoulidis E, Laganà AS, Dinas K, Petousis S. Clinical significance and main parameters promoting the breast‑feeding strategy (Review). MEDICINE INTERNATIONAL 2024; 4:14. [PMID: 38410759 PMCID: PMC10895466 DOI: 10.3892/mi.2024.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 02/02/2024] [Indexed: 02/28/2024]
Abstract
Breastfeeding provides numerous nutritional and immunological benefits, promotes neurological and cognitive development, and protects against chronic and infectious diseases, rendering it beneficial to the survival and well-being of infants. According to international recommendations, infants should be exclusively breastfed for the first 6 months. However, despite global health recommendations and funding initiatives, exclusive breastfeeding rates remain low worldwide. A number of studies attribute the low rates to factors that can be grouped into demographic, psychosocial, economic and midwifery factors, and outline the profile of each mother who opts to exclusively breastfeed her infant. In addition, the number of previous pregnancies, induced labor, the use of epidurals at birth or the possibility of the newborn being delivered prematurely, and the need for admission to an intensive care unit are the factors that reduce the likelihood of exclusive breastfeeding. Further research is required to understand the factors influencing the initiation and maintenance of exclusive breastfeeding, as international interventions have been ineffective. The aim of the present review was to provide an up-to-date summary of these various factors in an aim to assist health care professionals and policy makers in developing effective interventions with which to promote and support exclusive breastfeeding.
Collapse
Affiliation(s)
- Eleni Nixarlidou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Chrysoula Margioula-Siarkou
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Aristarchos Almperis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Eleftherios Vavoulidis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS 'Civico-Di Cristina-Benfratelli', Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, I-90127 Palermo, Italy
| | - Konstantinos Dinas
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| | - Stamatios Petousis
- 2nd Department of Obstetrics and Gynecology, Aristotle University of Thessaloniki, 54624 Thessaloniki, Greece
| |
Collapse
|
5
|
Otter G, Davis D, Kurz E, Hooper ME, Shield A, Samarawickrema I, Spiller S, Atchan M. Promoting breastfeeding in women with gestational diabetes mellitus in high-income settings: an integrative review. Int Breastfeed J 2024; 19:4. [PMID: 38233823 PMCID: PMC10795405 DOI: 10.1186/s13006-023-00603-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 11/25/2023] [Indexed: 01/19/2024] Open
Abstract
BACKGROUND Breastfeeding provides many short- and long-term health benefits for mothers and their infants and is a particularly relevant strategy for women who experience Gestational Diabetes Mellitus (GDM) during pregnancy. However, breastfeeding rates are generally lower amongst this group of women than the general population. This review's objective is to identify the factors that influence breastfeeding by exploring the experiences and outcomes of women in in high-income health care contexts when there is a history of GDM in the corresponding pregnancy. METHODS A comprehensive search strategy explored the electronic databases Medline, CINAHL, Web of Science and Scopus for primary studies exploring breastfeeding practices for papers published between January 2011 and June 2023. All papers were screened independently by two researchers with included papers assessed using the Crowe Critical Appraisal tool. Findings were analysed using a narrative synthesis framework. RESULTS From an initial search result of 1037 papers, 16 papers representing five high-income nations were included in this review for analysis - the United States of America (n = 10), Australia (n = 3), Finland (n = 1), Norway (n = 1), and Israel (n = 1). Fifteen papers used a quantitative design, and one used a qualitative design. The total number of participants represented in the papers is 963,718 of which 812,052 had GDM and 151,666 did not. Women with an immediate history of GDM were as likely to initiate breastfeeding as those without it. However, they were more likely to have the first feed delayed, be offered supplementation, experience delayed lactogenesis II and or a perception of low supply. Women were less likely to exclusively breastfeed and more likely to completely wean earlier than the general population. Maternity care practices, maternal factors, family influences, and determinants of health were contextual and acted as either a facilitator or barrier for this group. CONCLUSION Breastfeeding education and support need to be tailored to recognise the individual needs and challenges of women with a history of GDM. Interventions, including the introduction of commercial milk formula (CMF) may have an even greater impact and needs to be very carefully considered. Supportive strategies should encompass the immediate and extended family who are major sources of influence.
Collapse
Affiliation(s)
- Georgia Otter
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Deborah Davis
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Ella Kurz
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Mary-Ellen Hooper
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia
| | - Alison Shield
- School of Health Science, University of Canberra, Bruce, Australia
| | | | - Sarah Spiller
- Health Care Consumer Association, Canberra, Australia
| | - Marjorie Atchan
- School of Nursing and Midwifery, University of Canberra, Bruce, Australia.
| |
Collapse
|
6
|
Flood MM, Pollock WE, McDonald SJ, Cullinane F, Davey MA. Primary postpartum haemorrhage adversely impacts breastfeeding initiation in Victoria, Australia. Women Birth 2023; 36:e582-e590. [PMID: 37183136 DOI: 10.1016/j.wombi.2023.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 03/30/2023] [Accepted: 05/02/2023] [Indexed: 05/16/2023]
Abstract
PROBLEM Breastfeeding has many important benefits for both mother and baby but sustained breastfeeding is sub-optimal. BACKGROUND Identifying women who need increased support to establish breastfeeding has the potential to improve this. Analysis of the relationship between primary postpartum haemorrhage (PPH) and primary severe PPH and breastfeeding may prove informative as PPH has potentially negative impacts on breastfeeding. AIM To determine the relationship between PPH and severe PPH and breastfeeding at postnatal discharge and formula use for breastfed babies in hospital. METHODS Population-based retrospective cohort study using the Victorian Perinatal Data Collection for all liveborn singleton births at ≥ 37 weeks' gestation (n = 339,854) for 2009-13 in Victoria. Estimated blood loss was categorised as PPH ≥ 500 mL and severe PPH ≥ 1500 mL. Descriptive analysis was conducted and multivariable logistic regression was used to determine the adjusted odds ratio for the relationship between PPH/severe PPH and breastfeeding outcomes after adjustment for relevant confounders. FINDINGS Overall, 94.9% of women initiated breastfeeding. Babies whose mother had a PPH or severe PPH were less likely than others to be exclusively breastfeeding at discharge (aOR 0.88; (95% CI 0.86, 0.90) and aOR 0.57; (95% CI 0.53, 0.61) respectively). Formula - given to 25.9% of all breastfed babies - was more likely for those whose mothers had a PPH or severe PPH (aOR 1.15; (95% CI 1.12, 1.17) and aOR 2.15; (95% CI 2.01, 2.29) respectively. CONCLUSIONS Women have greater challenges establishing exclusive breastfeeding following PPH and severe PPH. Improving support in hospital for women following PPH may increase breastfeeding success.
Collapse
Affiliation(s)
- Margaret M Flood
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia.
| | - Wendy E Pollock
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia; School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
| | - Susan J McDonald
- School of Nursing and Midwifery, La Trobe University, Melbourne, Victoria, Australia; Mercy Health, Heidelberg 3084, Victoria, Australia
| | - Fiona Cullinane
- Maternity Services, Royal Women's Hospital, Melbourne, Victoria, Australia
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria, Australia
| |
Collapse
|
7
|
Buckley S, Uvnäs-Moberg K, Pajalic Z, Luegmair K, Ekström-Bergström A, Dencker A, Massarotti C, Kotlowska A, Callaway L, Morano S, Olza I, Magistretti CM. Maternal and newborn plasma oxytocin levels in response to maternal synthetic oxytocin administration during labour, birth and postpartum - a systematic review with implications for the function of the oxytocinergic system. BMC Pregnancy Childbirth 2023; 23:137. [PMID: 36864410 PMCID: PMC9979579 DOI: 10.1186/s12884-022-05221-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 11/15/2022] [Indexed: 03/04/2023] Open
Abstract
BACKGROUND The reproductive hormone oxytocin facilitates labour, birth and postpartum adaptations for women and newborns. Synthetic oxytocin is commonly given to induce or augment labour and to decrease postpartum bleeding. AIM To systematically review studies measuring plasma oxytocin levels in women and newborns following maternal administration of synthetic oxytocin during labour, birth and/or postpartum and to consider possible impacts on endogenous oxytocin and related systems. METHODS Systematic searches of PubMed, CINAHL, PsycInfo and Scopus databases followed PRISMA guidelines, including all peer-reviewed studies in languages understood by the authors. Thirty-five publications met inclusion criteria, including 1373 women and 148 newborns. Studies varied substantially in design and methodology, so classical meta-analysis was not possible. Therefore, results were categorized, analysed and summarised in text and tables. RESULTS Infusions of synthetic oxytocin increased maternal plasma oxytocin levels dose-dependently; doubling the infusion rate approximately doubled oxytocin levels. Infusions below 10 milliunits per minute (mU/min) did not raise maternal oxytocin above the range observed in physiological labour. At high intrapartum infusion rates (up to 32 mU/min) maternal plasma oxytocin reached 2-3 times physiological levels. Postpartum synthetic oxytocin regimens used comparatively higher doses with shorter duration compared to labour, giving greater but transient maternal oxytocin elevations. Total postpartum dose was comparable to total intrapartum dose following vaginal birth, but post-caesarean dosages were higher. Newborn oxytocin levels were higher in the umbilical artery vs. umbilical vein, and both were higher than maternal plasma levels, implying substantial fetal oxytocin production in labour. Newborn oxytocin levels were not further elevated following maternal intrapartum synthetic oxytocin, suggesting that synthetic oxytocin at clinical doses does not cross from mother to fetus. CONCLUSIONS Synthetic oxytocin infusion during labour increased maternal plasma oxytocin levels 2-3-fold at the highest doses and was not associated with neonatal plasma oxytocin elevations. Therefore, direct effects from synthetic oxytocin transfer to maternal brain or fetus are unlikely. However, infusions of synthetic oxytocin in labour change uterine contraction patterns. This may influence uterine blood flow and maternal autonomic nervous system activity, potentially harming the fetus and increasing maternal pain and stress.
Collapse
Affiliation(s)
- Sarah Buckley
- grid.1003.20000 0000 9320 7537Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | | | - Zada Pajalic
- grid.463529.f0000 0004 0610 6148Faculty for Health Sciences, VID Specialized University, Oslo, Norway
| | - Karolina Luegmair
- grid.9018.00000 0001 0679 2801Institute for Health Care and Nursing Studies, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Anette Ekström-Bergström
- grid.412716.70000 0000 8970 3706Department of Health Sciences, University West, Trollhättan, Sweden
| | - Anna Dencker
- grid.8761.80000 0000 9919 9582Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Göteborg, Sweden
| | - Claudia Massarotti
- grid.5606.50000 0001 2151 3065Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Alicja Kotlowska
- grid.11451.300000 0001 0531 3426Department of Clinical and Experimental Endocrinology, Faculty of Health Sciences, Medical University of Gdańsk, Gdańsk, Poland
| | - Leonie Callaway
- grid.1003.20000 0000 9320 7537Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Sandra Morano
- grid.5606.50000 0001 2151 3065Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
| | - Ibone Olza
- European Institute of Perinatal Mental Health, Madrid, Spain
| | - Claudia Meier Magistretti
- grid.425064.10000 0001 2191 8943Institute for Health Policies, Prevention and Health Promotion, Lucerne University of Applied Sciences and Arts, Luzern, Switzerland
| |
Collapse
|
8
|
Greenwood K, Engel R, Grace S. Osteopathic intervention for infants with breastfeeding difficulty: A retrospective case series. INT J OSTEOPATH MED 2022. [DOI: 10.1016/j.ijosm.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
|