Mrs Killer and Dr Crook: birth attendants and birth outcomes in early twentieth-century Derbyshire

Hospital Geographic Location and Unexpected Complications in term Newborns in Florida

INTRODUCTION

Birth trauma rates in term of neonates is a quality measure used by the Joint Commission. In the United States birth trauma rates occurs at a rate of 37 per 1000 live births and are on the decline. However, this decline has been significantly lower among term neonates born in rural facilities. There is a critical lack of evidence toward the influence geographical risk factors has on birth trauma rates for neonatal patients. We sought to measure rural community and hospital characteristics associated with birth trauma.

METHODS

A retrospective longitudinal study design was used to examine inpatient medical discharge data across 103 hospitals of neonates at birth from 2013 to 2018. Discharge data was linked to the American Hospital Association annual survey. We used a multi-level mixed effect model to investigate the relationship between individual and hospital-level attributes associated with increased risk of birth trauma among neonatal patients.

RESULTS

We found that rural hospitals were 3.99 times (p < 0.001) more likely to experience higher birth trauma than urban hospitals. Medium sized hospitals were 2.11 times (p < 0.001) more likely to experience higher birth trauma. Hospitals who indicate having a safety culture were more likely (p < 0.05) to have high rates of birth trauma.

DISCUSSION

Neonates born at rural hospitals, were more likely to experience a birth-related injury. Policy strategies focusing on improving health care quality in rural areas are critical to mitigating this increased risk of birth trauma. Further research is required to assess how physician characteristics may impact birth trauma rates.

Maternal physical, socioeconomic, and demographic characteristics and childbirth complications in rural lowland Nepal: Applying an evolutionary framework to understand the role of phenotypic plasticity

OBJECTIVES

Evolutionary perspectives on human childbirth have primarily focused on characteristics of our species in general, rather than variability within and between contemporary populations. We use an evolutionary framework to explore how physical and demographic characteristics of mothers shape the risks of childbirth complications in rural lowland Nepal, where childbearing typically commences in adolescence and chronic undernutrition is widespread, though maternal overweight is increasing in association with nutrition transition.

METHODS

We conducted secondary analyses of data from a cluster-randomized trial. Women aged 14-35 years were categorized by age, number of previous pregnancies, height, body mass index (BMI), husband's education, and household wealth. Multivariable logistic regression models tested whether these characteristics independently predicted risks of episiotomy and cesarean section (CS, n = 14 261), and obstructed labor (OL, n = 5185).

RESULTS

Risks were greatest among first-time adolescent mothers, though associations with age varied by outcome. Independent of age and parity, short stature and high BMI increased risks of CS and OL, whereas associations were weaker for episiotomy. Male offspring had increased risk of CS and OL but not episiotomy. Wealth was not associated with OL, but lower wealth and lower husband's education were associated with lower likelihood of episiotomy and CS.

CONCLUSIONS

At the individual level, the risk childbirth complications is shaped by trade-offs between fertility, growth, and survival. Some biological markers of disadvantage (early childbearing, short stature) increased the risk, whereas low socio-economic status was associated with lower risk, indicating reduced access to relevant facilities. Independent of these associations, maternal age showed complex effects.

Medical provision and urban-rural differences in maternal mortality in late nineteenth century Scotland

This paper examines the effect of variable reporting and coding practices on the measurement of maternal mortality in urban and rural Scotland, 1861–1901, using recorded causes of death and women who died within six weeks of childbirth. This setting provides data (n = 604 maternal deaths) to compare maternal mortality identified by cause of death with maternal mortality identified by record linkage and to contrast urban and rural settings with different certification practices. We find that underreporting was most significant for indirect causes, and that indirect causes accounted for a high proportion of maternal mortality where the infectious disease load was high. However, distinguishing between indirect and direct maternal mortality can be problematic even where cause of death reporting appears accurate. Paradoxically, underreporting of maternal deaths was higher in urban areas where deaths were routinely certified by doctors, and we argue that where there are significant differences in medical provision and reported deaths, differences in maternal mortality may reflect certification practices as much as true differences. Better health services might therefore give the impression that maternal mortality was lower than it actually was. We end with reflections on the interpretation of maternal mortality statistics and implications for the concept of the obstetric transition.

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There was marked under-reporting of maternal mortality in 19th century Scotland.

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Differences in maternal mortality may reflect different certification practices.

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Doctors were more likely to mis-report maternal deaths than lay informants.

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Maternal mortality may not be a good indicator of the coverage of health services.

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Conceptual models relying on cause of death should be treated with caution.

Mrs Stone and Dr Smellie: British eighteenth-century birth attendance and long-run levels and trends in maternal mortality discussed in a north European context

This is a book review turned research paper. The aim is to estimate the differences in the maternal mortality rate (MMR) between untrained midwives, expert midwives, and the famous obstetrician Dr Smellie in eighteenth-century Britain. The paper shows that the birth attendance practices of the expert midwife Mrs Stone and of Dr Smellie were very similar, though Stone used her hands whereas Smellie used forceps. Both applied the same invasive techniques to successfully deliver women with similar fatal complications, techniques that untrained midwives and most surgeons of the time could not perform. However, the same procedures, if used for normal births, would have increased the MMR. So, the key to the low MMR of both was that they kept interventions away from the majority of births that were normal. The paper quantifies the likely MMR for a 'Stone and Smellie style' birth attendance and concludes that the wider dissemination of their techniques can explain the decline in the British MMR.

Factors associated with fresh stillbirths: A hospital-based, matched, case-control study in Burkina Faso

OBJECTIVE

To determine the risk factors for fresh stillbirths in hospitals in Burkina Faso.

METHODS

A hospital-based, matched (1:1), case-control study was conducted from July to August 2014 in 50 hospitals across the country. All cases of stillbirth that occurred during this period in the participating facilities were included, and an appropriate control was selected for each case from the same health facility. Cases and controls were matched for gestational age. Conditional logistic regression with robust standard errors was used to compute both unadjusted and adjusted conditional odds ratios.

RESULTS

Cases were 67% less likely to have been delivered by a midwife compared with a nonmidwife attendant (ACOR=0.33; 95% CI, 0.12-0.84; P=0.02). Use of a partograph to monitor labor lowered the odds of fresh stillbirth by 82% (ACOR=0.18; 95% CI, 0.05-0.61; P=0.006). Mothers who had been transferred from another health facility were five times more likely to experience a fresh stillbirth (ACOR=5.36; 95% CI, 2.02-14.23; P<0.001).

CONCLUSION

Quality and timing of intrapartum obstetric care is key to preventing fresh stillbirths. Easy to implement and available interventions, such as use of a partograph for all laboring women and improving the referral system, have the potential to save the lives of many fetuses.