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Henshall BI, Grimes HA, Davis J, East CE. What is 'physiological birth'? A scoping review of the perspectives of women and care providers. Midwifery 2024; 132:103964. [PMID: 38432119 DOI: 10.1016/j.midw.2024.103964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 08/20/2023] [Revised: 01/07/2024] [Accepted: 02/28/2024] [Indexed: 03/05/2024]
Abstract
PROBLEM Physiological birth was defined by the World Health Organization in 1997, however, clinical practices in childbirth have changed considerably since this time. BACKGROUND Ambiguous terms in healthcare such as 'physiological birth' may cause confusion amongst care providers and consumers. AIM To identify what is known about physiological birth, and how perceptions of physiological birth manifest in current literature. METHODS This review followed the Joanna Briggs Institute methodology for scoping reviews and the PRISMA-ScR checklist. Four databases were searched using keywords relating to physiological birth. Relevant studies were identified using agreed criteria, and data were extracted and synthesised. RESULTS A total of 24 studies met the inclusion criteria for this review. Three connected factors were identified: (1) Physiological birth in a risk-averse system, (2) Dominant voices in birth, and (3) Lack of exposure to physiological birth. No unified universal definition of physiological birth was identified in the literature. DISCUSSION 'Physiological birth' as a term lacks consistency. A risk-averse healthcare system could be a barrier to physiological birth. Dominant voices in the birthing space can dictate the way birth occurs. Lack of exposure to physiological birth may diminish the acquisition and maintenance of important skills and knowledge among care providers. Recognising the factors important to women could lead to a positive birth experience. CONCLUSION Excluding a woman's subjective experience from health professionals' understanding of physiological birth increases the likelihood of risk management being the paramount objective in clinical decision-making. We propose it is timely to align clinical understanding of physiological birth with midwifery's woman-centred professional philosophy.
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Affiliation(s)
- Brooke I Henshall
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Mercy Hospital for Women, Mercy Health Pty Ltd, Heidelberg Victoria, Australia.
| | - Heather A Grimes
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Department of Nursing & Midwifery, Dames Cook University, James Cook University, Townsville, Queensland, Australia
| | - Jennifer Davis
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia
| | - Christine E East
- La Trobe University, School of Nursing & Midwifery, Bundoora, Victoria, Australia; Judith Lumley Centre, School of Nursing & Midwifery, La Trobe University, Bundoora, Victoria, Australia; Mercy Hospital for Women, Mercy Health Pty Ltd, Heidelberg Victoria, Australia
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Kuipers Y, De Bock V, Van de Craen N, Bosmans V. 'Naming and faming' maternity care providers: A mixed-methods study. Midwifery 2024; 130:103912. [PMID: 38154428 DOI: 10.1016/j.midw.2023.103912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 05/15/2023] [Revised: 10/21/2023] [Accepted: 12/20/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Positive benchmarking can serve as a catalyst for maternity care improvement. AIM To retrospectively benchmark Flemish maternity care providers' qualities, based on women's positive care experiences, and to explore which attributes of the different care providers contribute to these experiences. METHODS A sequential, two-phased mixed-methods study benchmarking the qualities of the community midwife, the hospital midwife, and the obstetrician. An online questionnaire was used to collect the data among pregnant and postpartum women, who rated their care experiences with the various care providers using the Net Promoter Score. Non-parametric and post hoc tests established the differences between types of clinicians and between antenatal, intrapartum, and postpartum Net Promoter Score mean scores. Content analysis was used to construct a final pool of keywords representing attributes of care professionals, accumulated from the promoters' free text responses. Ranks were assigned to each keyword based on its frequency. FINDINGS A total of 2385 Net Promoter Scale scores and 1856 free-text responses of 1587 responders were included. The community midwife received the overall highest NPS scores (p < .001). The promoters (n = 1015) assigned community midwives the highest NPS scores (9.67), followed by obstetricians (9.57) and hospital-based midwives (9.51). The distinct benchmarking attributes of community midwives were availability (p < .001), supportiveness (p = .04) and personalised care (p < .001). Being honest (p < .001), empathic (p < .001) and inexhaustible (p = .04) benchmarked hospital midwives. Calmness (p < .001), a no-nonsense approach (p < .001), being humane (p = .01) and comforting (p = .02) benchmarked obstetricians. DISCUSSION/CONCLUSION The findings indicate that all care providers are highly valued, but community midwives are ranked the highest. The distinct differences between the care professionals can serve as exemplary performance for professional development and shape the profiles of maternity care professionals.
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Affiliation(s)
- Yvonne Kuipers
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium; School of Health and Social Care, Edinburgh Napier University, Sighthill Campus, EH11 4BN Edinburgh, United Kingdom.
| | - Vanessa De Bock
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium
| | - Natacha Van de Craen
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium
| | - Valerie Bosmans
- Department of Health and Social Care, School of Midwifery, AP University of Applied Sciences, Noorderplaats 2, 2000 Antwerp, Belgium
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Peterwerth NH, Halek M, Schäfers R. Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:155. [PMID: 38389073 PMCID: PMC10882933 DOI: 10.1186/s12884-024-06338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Risk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions. METHODS Case vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression. RESULTS Risk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5-30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals' willingness to intervene. CONCLUSIONS The results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians' and midwives' decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance. TRIAL REGISTRATION German Clinical Trials Register DRKS00017172 (18.06.2019).
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Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Germany.
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rainhild Schäfers
- Institute of Midwifery Science, Faculty of Medicine, University of Münster, Malmedyweg 17-19, 48149, Münster, Germany
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Nieuwenhuijze M, Leahy-Warren P, Healy M, Aktaş S, Aydin R, Calleja-Agius J, Goberna-Tricas J, Hadjigeorgiou E, Hartmann K, Henriksen L, Horsch A, Lange U, Murphy M, Pierron A, Schäfers R, Pajalic Z, Verhoeven C, Berdun DR, Hossain S. The impact of severe perinatal events on maternity care providers: a scoping review. BMC Health Serv Res 2024; 24:171. [PMID: 38326880 PMCID: PMC10848539 DOI: 10.1186/s12913-024-10595-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/12/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Severe events during the perinatal period can be experienced as traumatic by pregnant women, their partners or others who are closely involved. This includes maternity care providers who can be affected by being involved in or observing these events. This may have an impact on their personal well-being and professional practice, influencing quality of care. The aim of this study is to map research investigating the impact of severe events during the perinatal period on maternity care providers, and how these experiences affect their well-being and professional practice. METHOD A scoping review following the manual of the Joanna Briggs Institute was undertaken. The electronic bibliographic databases included PubMed/MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX, Cochrane, Scopus, Web of Science and databases for grey literature. Records passing the two-stage screening process were assessed, and their reference lists hand searched. We included primary research papers that presented data from maternity care professionals on the impact of severe perinatal traumatic events. A descriptive content analysis and synthesis was undertaken. RESULTS Following a detailed systematic search and screening of 1,611 records, 57 papers were included in the scoping review. Results of the analysis identified four categories, which highlighted the impact of traumatic perinatal events on maternity care providers, mainly midwives, obstetricians and nurses: Traumatic events, Impact of traumatic events on care providers, Changes in care providers' practice and Support for care providers; each including several subcategories. CONCLUSION The impact of traumatic perinatal events on maternity care providers ranged from severe negative responses where care providers moved position or resigned from their employment in maternity care, to responses where they felt they became a better clinician. However, a substantial number appeared to be negatively affected by traumatic events without getting adequate support. Given the shortage of maternity staff and the importance of a sustainable workforce for effective maternity care, the impact of traumatic perinatal events requires serious consideration in maintaining their wellbeing and positive engagement when conducting their profession. Future research should explore which maternity care providers are mostly at risk for the impact of traumatic events and which interventions can contribute to prevention.
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Affiliation(s)
- Marianne Nieuwenhuijze
- CAPHRI, Maastricht University, Universiteitssingel 60, 6229 ER, Maastricht, The Netherlands.
| | | | | | | | | | | | | | | | | | | | | | - Ute Lange
- University of Applied Sciences Bochum, Bochum, Germany
| | | | | | | | | | - Corine Verhoeven
- Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Koranteng YB, Adu-Bonsaffoh K, Oppong-Yeboah B. Physiotherapy practice in women's health: awareness and attitudes of obstetricians and gynecologists in Ghana. BMC Womens Health 2023; 23:666. [PMID: 38082319 PMCID: PMC10714590 DOI: 10.1186/s12905-023-02705-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 10/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Physiotherapy is relatively well integrated into women's health in many high-income countries (HICs) as compared to low- and middle- countries (LMICs) like Ghana. Suboptimal integration of physiotherapy in modern obstetrics and gynecology especially in low resource settings is partly due to issues related to the awareness and attitudes of referring physicians. This study assessed the awareness and attitude levels towards physiotherapy in women's health among obstetricians/gynecologists and factors associated with its utilization in Ghana. METHODS A cross-sectional study was conducted among obstetricians/gynecologists working at a tertiary hospital in Ghana using an "Awareness and Attitude Questionnaire" adapted from a standardized questionnaire. Chi-square test or Fisher exact test was performed and logistic regression was used to assess the association between doctors' awareness level of physiotherapy's role in women's health and years of clinical practice. RESULTS Sixty-one (61) respondents comprising 7 consultants, 20 senior residents and 34 junior residents, with age median age of 35 years (range: 29-65 years) were recruited. There were more males than females (82% versus 18%) with a mean (SD) duration of practice of (9.41 ± 4.71) years. The participants reported a considerable awareness of physiotherapists' role in obstetrics (between 72.1% for intrapartum to 91.8% for postnatal) but wide variation in gynecology (from 19.7% in PID to 95. 1% in uterine prolapse). Consultants were more (71.4%) aware of the role of physiotherapy in antenatal care and gynecology while senior residents had more awareness in intrapartum and postnatal care. Junior residents generally showed lowest awareness levels. Duration of clinical practice (≥ 10years) was not significantly associated with doctors' awareness regarding the importance of physiotherapy in childbirth. There were mixed findings concerning doctors' attitudes toward physiotherapy: (1) 41% indicated that physiotherapists have been effective in their inter-professional relationship; (2) none of the doctors strongly agreed that physiotherapy may not contribute significantly to the complete well-being of gynecological patients. The main factors influencing utilization of physiotherapy were the perceived notion of non-availability of physiotherapists to cover various wards and physiotherapists not attending ward rounds with doctors to facilitate more education on the scope of physiotherapy practice. CONCLUSION Although obstetricians/gynecologists showed appreciable awareness and attitudes towards physiotherapy, there remains a considerable gap in provider education to ensure optimal utilization of physiotherapy in contemporary obstetrics and gynecology. Further research is recommended to assess implementation challenges associated with regular utilization of physiotherapy services in women's health in the hospital.
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Affiliation(s)
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynecology, University of Ghana Medical School, Accra, Ghana.
| | - Bertha Oppong-Yeboah
- Department of Physiotherapy, University of Health and Allied Sciences, Ho, Ghana
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Benahmed N, Demyttenaere B, Dramaix M, Willaert D, Pirson M. Modeling the future workforce of obstetrics and gynecology in Belgium: From population ratio to gap analysis between supply and demand. Eur J Obstet Gynecol Reprod Biol 2023; 286:126-134. [PMID: 37245358 DOI: 10.1016/j.ejogrb.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 05/12/2023] [Accepted: 05/14/2023] [Indexed: 05/30/2023]
Affiliation(s)
- Nadia Benahmed
- Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Université Libre de Bruxelles, Belgium
| | | | - Michèle Dramaix
- Emeritus Professor at School of Public Health, Université Libre de Bruxelles, Belgium
| | | | - Magali Pirson
- Université Libre de Bruxelles, Director of Health Economics, Hospital Management and Nursing Research Dept, School of Public Health, Belgium
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Delafield R, Hermosura A, Ahn HJ, Kaholokula JK. Implicit Racial Attitudes and Associations Among Obstetricians in Hawai'i: a Pilot Study. J Racial Ethn Health Disparities 2022; 9:2395-2403. [PMID: 34973153 PMCID: PMC9633441 DOI: 10.1007/s40615-021-01176-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 10/15/2021] [Accepted: 10/21/2021] [Indexed: 12/29/2022]
Abstract
INTRODUCTION Pacific Islanders living in Hawai'i with ancestral ties to islands in the western Pacific region of Micronesia are common targets of uninhibited forms of prejudice in multiple sectors, including healthcare. Whether the explicit societal-level attitudes toward this group are reflected in implicit attitudes among healthcare providers is unknown; therefore, we designed a pilot study to investigate this question. Our study measures implicit racial bias toward Pacific Islanders from Micronesia among Obstetrician-Gynecologists (OB-GYNs) in Hawai'i. METHODS We developed 4 new implicit association tests (IATs) to measure implicit attitudes and associations (i.e., stereotypes) toward Pacific Islanders from Micronesia in 2 conditions: (1) Micronesians vs. Whites and (2) Micronesians vs. Japanese Americans. Participants were practicing OB-GYNs in Hawai'i. The study was conducted online and included survey questions on demographic and physician practice characteristics in addition to IATs. The primary outcome was the mean IAT D score. Associations between IAT D scores and demographic and practice characteristics were also analyzed. RESULTS Of the 49 OB-GYNs, 38 (77.6%) were female, mean age was 40 years, 29.5% were Japanese, 22.7% were White, and none were from a Micronesian ethnic group. The mean IAT D score in the Micronesian vs. White condition (N = 29) was 0.181, (SD: 0.465, p < 0.05) for the Attitude IAT and 0.197 (SD: 0.427; p < 0.05) for the Stereotype IAT. CONCLUSION The findings from this pilot suggest a slight degree of implicit bias favoring Whites over Micronesians within this sample of OB-GYNs and warrant a larger investigation into implicit biases toward this unique and understudied Pacific Islander population.
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Affiliation(s)
- Rebecca Delafield
- Department of Native Hawaiian Health, University of Hawai'i, John A. Burns School of Medicine, 677 Ala Moana Blvd., Ste. 1016B, Honolulu, HI, 96813, USA.
| | - Andrea Hermosura
- Department of Native Hawaiian Health, University of Hawai'i, John A. Burns School of Medicine, 677 Ala Moana Blvd., Ste. 1016B, Honolulu, HI, 96813, USA
| | - Hyeong Jun Ahn
- Department of Quantitative Health Sciences, University of Hawai'i, John A. Burns School of Medicine, 651 Ilalo St. Medical Education Bldg., Ste 411, Honolulu, HI, 96813, USA
| | - Joseph Keaweʻaimoku Kaholokula
- Department of Native Hawaiian Health, University of Hawai'i, John A. Burns School of Medicine, 677 Ala Moana Blvd., Ste. 1016B, Honolulu, HI, 96813, USA
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Mwamba B. Delayed cord clamping practice at birth: A narrative review of literature. Eur J Obstet Gynecol Reprod Biol 2022; 277:116-121. [PMID: 36084387 DOI: 10.1016/j.ejogrb.2022.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 03/28/2022] [Revised: 08/23/2022] [Accepted: 08/27/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Anaemia in infants is a major public health concern particularly in low and middle-income countries. Delayed cord clamping (DCC) has been advocated as a strategy to decrease iron deficiency anaemia in infants because of the benefits that come with placental transfusion. Despite the documented benefits of delayed cord clamping in preventing anaemia the current practices of delayed cord clamping by midwives and obstetricians across countries and in different contexts is unclear. This narrative review assesses the literature on delayed cord clamping practices published from 2013 to February 2022, in order to examine current practice in birth units globally, and with a focus in low and middle-income countries (LMICs). METHOD A search of four bibliographic databases Medline, Scopus (Elsevier), ProQuest, CINAHL and two network and search engines, Wiley and Google Scholar, was undertaken from 2013 to February 2022 using key terms related to delayed cord clamping and immediate cord clamping. A snowball method as well as backward and forward reference checking was also undertaken. RESULTS The search strategy identified 10 studies on umbilical cord clamping practices by midwives and obstetricians. Only two studies were conducted in low and middle-income countries. CONCLUSION Despite the potential benefits of DCC in reducing anaemia, particularly in low and middle-income countries where the burden of anaemia is a public health concern, there is a paucity of literature on current DCC practices by obstetricians and midwives. Research to establish current DCC practices in these countries is needed to address this gap in the literature.
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Affiliation(s)
- Bupe Mwamba
- University of Technology Sydney, Building 10,235 Jones St, Ultimo, New South Wales (NSW) 2007, Australia; School of Nursing and Midwifery. Faculty of Health, Australia.
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Small KA, Sidebotham M, Fenwick J, Gamble J. The social organisation of decision-making about intrapartum fetal monitoring: An Institutional Ethnography. Women Birth 2022:S1871-5192(22)00322-5. [PMID: 36127282 DOI: 10.1016/j.wombi.2022.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND International guidelines recommend intrapartum cardiotocograph (CTG) monitoring for women at risk for poor perinatal outcome. Research has not previously addressed how midwives and obstetricians enable or hinder women's decision-making regarding intrapartum fetal monitoring and how this work is structured by external organising factors. AIM To examine impacts of policy and research texts on midwives' and obstetricians' work with labouring women related to intrapartum fetal monitoring decision-making. METHODS We used a critical feminist qualitative methodology known as Institutional Ethnography (IE). The research was conducted in an Australian tertiary maternity service. Data collection included interviews, observation, and texts relating to midwives' and obstetricians' work with the fetal monitoring system. Textual mapping was used to explain how midwives' and obstetricians' work was organised to happen the way it was. FINDINGS CTG monitoring was initiated predominantly by midwives applying mandatory policy. Midwives described reluctance to inform labouring women that they had a choice of fetal monitoring method. Discursive approaches used in a national fetal surveillance guideline, a Cochrane systematic review, and the largest randomised controlled trial regarding CTG monitoring in labour generated and reproduced assumptions that clinicians, not labouring women, were the appropriate decision-maker regarding fetal monitoring in labour. DISCUSSION AND CONCLUSION Guidelines structured midwives' and obstetricians' work in a manner that undermined women's participation in decisions about fetal monitoring method. Intrapartum fetal monitoring guidelines should be critically reviewed to ensure they encourage and enable midwives and obstetricians to support women to make decisions about intrapartum care.
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Efobi CC, Okoye HC, Korubo KI, Ezebialu IU, John OC. Evaluation of Obstetricians' Opinion of Thrombocytopenia in Pregnancy: A Cross-Sectional Study. West Afr J Med 2022; 39:657-662. [PMID: 35921687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
BACKGROUND Thrombocytopenia occurs in about 8-10% of pregnancies. Thrombocytopenia may be incidental in pregnancy and could point to medical or gestational conditions that may pose a morbidity and mortality risk to both mother and foetus. AIM To determine Obstetricians' view/opinion about thrombocytopenia in pregnancy. METHODS A pre-tested structured questionnaire was distributed amongst consultant and resident obstetricians during their antenatal clinics in 3 tertiary hospitals over a period of one month. Analysis was descriptive and results were expressed as frequencies in words, tables and charts. RESULTS A total of 91 responders were studied of which 24 were consultants (26.4%), 57 (62.6%) senior registrars and 10 (11%) were registrars. There were 20 (22.7%) responders who were unaware of incidental thrombocytopenia in pregnancy. Most obstetricians (n=83, 91.2%) requested for only packed cell volume (PCV) at antenatal booking, only 2 (2.9%) routinely requested for full blood count (FBC). At booking; only 10 (11.1%) obstetricians asked for a history of thrombocytopenia. Majority (n=87, 98.9%) never requested for platelet counts. If they encountered thrombocytopenia, up to 89 (97.8%) would investigate further with a repeat FBC (n=77, 86.5%), coagulation screen (n=54, 61.4%) or bone marrow aspiration (n=20, 24.7%). Most of the obstetricians (n=82, 96.5%) would transfuse patients with thrombocytopenia and 34 (43.6%) of them would do so when the count is <50 X 109/L. CONCLUSION Obstetricians have the capacity to investigate symptomatic thrombocytopenia in pregnancy but do not routinely screen for asymptomatic thrombocytopenia. Routine FBC if done at booking may identify missed cases of asymptomatic thrombo-cytopenia for adequate management.
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Affiliation(s)
- C C Efobi
- Department of Haematology and Blood Transfusion, Faculty of Medicine, College of Health Sciences, Nnamdi Azikiwe University, Nnewi Campus
| | - H C Okoye
- Department of Haematology and Immunology, College of Medicine, University of Nigeria, Ituku Ozalla Campus, Enugu State, Nigeria
| | - K I Korubo
- Department of Haematology and Blood Transfusion, University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
| | - I U Ezebialu
- Department of Obstetrics and Gynaecology, College of Medicine, Chukwuemeka Odumegwu Ojukwu University, Awka Campus
| | - O C John
- Department of Obstetrics and Gynaecology. University of Port Harcourt Teaching Hospital, Port Harcourt, Rivers State, Nigeria
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Mogren I, Ntaganira J, Sengoma JPS, Holmlund S, Small R, Pham Thi L, Kidanto HL, Ngarina M, Bergström C, Edvardsson K. Maternal health care professionals' experiences and views on the use of obstetric ultrasound in Rwanda: A cross-sectional study. BMC Health Serv Res 2021; 21:789. [PMID: 34376210 PMCID: PMC8356395 DOI: 10.1186/s12913-021-06758-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/12/2021] [Indexed: 11/25/2022] Open
Abstract
Background This study, undertaken in Rwanda, aimed to investigate health professionals’ experiences and views on the following topics: current clinical guidelines for ultrasound from second trimester at the clinic, regional and national levels, and adherence to clinical guidelines; medically indicated ultrasound examinations; non-medical use of ultrasound including ultrasounds on maternal request; commercialisation of ultrasound; the value of ultrasound in relation to other clinical examinations in pregnancy; and ultrasound and medicalisation of pregnancy. Methods A cross-sectional design was adopted. Health professionals providing antenatal care and delivery services to pregnant women in 108 health facilities were invited to complete a survey, which was developed based on the results of earlier qualitative studies undertaken as part of the CROss Country Ultrasound Study (CROCUS). Results Nine hundred and seven health professionals participated: obstetricians/gynecologists (3.2%,) other physicians (24.5%), midwives (29.7%) and nurses (42.7%). Few physicians reported the existence of clinical guidelines at clinic, regional or national levels in Rwanda, and guidelines were moderately adhered to. Three obstetric ultrasound examinations were considered medically indicated in an uncomplicated pregnancy. Most participants (73.0%) were positive about obstetric ultrasound examinations on maternal request. Commercialisation was not considered a problem, and the majority (88.5%) agreed that ultrasound had contributed to medicalisation of pregnancy. Conclusions Findings indicate that clinical guidelines for the use of obstetric ultrasound are limited in Rwanda. Non-medically indicated obstetric ultrasound was not considered a current problem at any level of the healthcare system. The positive attitude to obstetric ultrasound examinations on maternal request may contribute to further burden on a maternal health care system with limited resources. It is essential that limited obstetric ultrasound resources are allocated where they are most beneficial, and clearly stated medical indications would likely facilitate this.
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Affiliation(s)
- Ingrid Mogren
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden. .,Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.
| | - Joseph Ntaganira
- School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Jean Paul Semasaka Sengoma
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden.,School of Public Health, College of Medicine and Health Sciences, University of Rwanda, Kigali, Rwanda
| | - Sophia Holmlund
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden.,Department of Nursing, Umeå University, Umeå, Sweden
| | - Rhonda Small
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia.,Department of Women's and Children's and Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Lan Pham Thi
- Department of Dermatology and Venereology, Hanoi Medical University, Hanoi, Vietnam
| | | | - Matilda Ngarina
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Cecilia Bergström
- Department of Clinical Sciences, Obstetrics and Gynecology, Umeå University, S-90187, Umeå, Sweden
| | - Kristina Edvardsson
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
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Dirik D, Sak R, Şahin-Sak İT. Compassion fatigue among obstetricians and gynecologists. Curr Psychol 2021;:1-8. [PMID: 34220173 DOI: 10.1007/s12144-021-02022-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2021] [Indexed: 12/05/2022]
Abstract
Obstetricians and gynecologists are likely to be at risk of occupational distress because their quality of life is affected as a result of their experiences of assisting with traumatic births and/or providing abortions, among others. Nevertheless, there have been few studies of this group of doctors’ compassion fatigue. This study aimed to examine obstetricians and gynecologists’ compassion fatigue. This survey-based quantitative study examined 107 obstetricians and gynecologists’ compassion fatigue. Data were collected using a demographic information form and the Compassion Fatigue Short Scale. This established that had low levels of compassion fatigue related to secondary trauma and job burnout, but moderate levels of it overall. Among female obstetricians and gynecologists, compassion fatigue was higher than among their male counterparts, and respondents who worked at private hospitals had higher compassion fatigue related to secondary trauma than those who worked in state-run hospitals. The data also revealed that obstetricians and gynecologists with 11–15 years’ seniority scored higher on the job-burnout subdimension of compassion fatigue, and overall, than their more senior counterparts. Interestingly, however, no statistically significant differences in the participants’ compassion fatigue were found to be associated with their ages, marital statuses, numbers of children, number of patients seen per day, or number of daily operations performed. Professional sharing groups that allow doctors to share their experiences and to gain awareness about their colleagues’ traumas should be organized. Teamwork should also be encouraged; and various prevention strategies should also be considered.
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Schytt E, Wahlberg A, Small R, Eltayb A, Lindgren H. The community-based bilingual doula - A new actor filling gaps in labour care for migrant women. Findings from a qualitative study of midwives' and obstetricians' experiences. Sex Reprod Healthc 2021; 28:100614. [PMID: 33813256 DOI: 10.1016/j.srhc.2021.100614] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/26/2021] [Accepted: 03/08/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVES To explore midwives' and obstetricians' views about community-based bilingual doula (CBD) support during migrant women's labour and birth and their experiences of collaborating with CBDs. STUDY DESIGN A qualitative study with semi-structured individual interviews with 7 midwives and 4 obstetricians holding clinical positions in labour care in Stockholm, Sweden, who all had experiences of working with a CBD. Data analysis followed the framework of thematic analysis. RESULTS The overarching theme was A new actor filling gaps in labour care - With appropriate boundary setting, CBDs can help improve care for migrant women. One year after the introduction of CBDs, the midwives and obstetricians had mainly positive experiences of CBDs who were considered to fill important gaps in maternity care for migrant women, being with the woman and simultaneously being part of the care team and this made providing high quality care easier. The CBDs' main contribution was to help migrant women navigate the maternity care system, to bridge language and cultural divides, and guarantee continuous labour and birth support. However, midwives and obstetricians sometimes experienced CBDs interfering with their professional assessments and decisions and the role of the CBD was somewhat unclear to them. CONCLUSIONS Community-based bilingual doula support was viewed as improving migrant women's well-being during labour and birth and as increasing the possibilities for midwives and obstetricians to provide good and safe care, however, some ambivalence remained about the CBD's role and boundaries.
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Affiliation(s)
- Erica Schytt
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Dalarna - Uppsala University, Falun, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Anna Wahlberg
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Rhonda Small
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden; Judith Lumley Centre, La Trobe University, Melbourne Victoria, Australia
| | - Amani Eltayb
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Helena Lindgren
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
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Hussein K, Gari A, Kamal R, Alzharani H, Alsubai N, Aljuhani T, Katib H. Acceptance of trial of labor after cesarean (Tolac) among obstetricians in the Western Region of Saudi Arabia: A cross-sectional study. Saudi J Biol Sci 2021; 28:2795-801. [PMID: 34012321 DOI: 10.1016/j.sjbs.2021.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 01/25/2021] [Accepted: 02/01/2021] [Indexed: 11/24/2022] Open
Abstract
Background Babies to women eligible for trial of labor after a cesarean (TOLAC) are sometimes delivered by cesarean section (CS). To obtain clinicians' attitudes and beliefs about TOLAC, this study was designed to investigate the views of clinicians when advising TOLAC-eligible pregnant women about TOLAC, and to explore their reasons in favor of or against TOLAC. Methods Interviews were carried out individually (face-to-face) with clinicians using a specially designed questionnaire to collect data from obstetricians in the Western Region of Saudi. Regression analysis was used as appropriate. Results Among the 183 obstetricians included in the current study, approximately 79.2% were against offering TOLAC. However, most of the physicians (89.1%) were in favor of offering TOLAC to patients who had had a successful vaginal birth after CS. significant associations were found between physicians' opposition to TOLAC and medical and most non-medical factors. Conclusion Clinicians should recognize that the critical role they play in the delivery decision-making process and in boosting women's confidence in TOLAC may be key to increasing the rate of TOLAC.
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Peberdy L, Young J, Massey D, Kearney L. Australian maternity healthcare professionals' knowledge, attitudes and practices relevant to cord blood banking, donation and clamp timing: A cross-sectional survey. Women Birth 2020; 34:e584-e591. [PMID: 33309477 DOI: 10.1016/j.wombi.2020.11.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/31/2020] [Accepted: 11/20/2020] [Indexed: 11/26/2022]
Abstract
PROBLEM Australian health professionals' knowledge and attitudes towards third stage labour options of cord clamp timing, cord blood banking and donation and their practice of informing parents of these options is unknown. BACKGROUND Parents have several options for the management of their infant' cord blood during the third stage of labour. Early or deferred cord clamping practices may affect parent choices about physiological transfusion to the neonate and/or cord blood collection for private or public banking or donation. AIM To identify health professionals' knowledge and attitudes towards third stage labour options of cord clamp timing, cord blood banking and donation and their practice of informing parents of these options. METHODS A total of 129 Australian maternity healthcare professionals responded to the self-administered survey between December 2017 and June 2018. FINDINGS Occupational differences were revealed in regard to cord clamp timing, cord blood banking and donation knowledge, attitudes and practices. Midwives were more likely to discuss cord clamp timing with parents and to clamp the cord later than obstetricians. Obstetricians were more knowledgeable of cord blood banking and donation options than midwives. Cord blood banking and donation options were discussed by both groups if parents asked. DISCUSSION Identification of gaps in knowledge should guide future maternity health professional education that is inclusive of all third stage labour options to ensure that open discussion and informing parents of options is consistent, contemporary and evidence-based. CONCLUSION To make informed decisions, parents need evidence-based information on all third stage labour options.
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Affiliation(s)
- Lisa Peberdy
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Jeanine Young
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Debbie Massey
- Southern Cross University, Gold Coast Airport, Terminal Dr, Bilinga, Queensland, 4225, Australia.
| | - Lauren Kearney
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
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Abdulrazeq F, Matsumoto MM, Abduljabbar R, Al-Hajj A, Alayash M, Ballourah R, Issak S, Issak Z. Identifying Barriers to Umbilical Cord Blood Banking in Jordan: A Cross-Sectional Survey of Obstetricians. Int J Hematol Oncol Stem Cell Res 2020; 14:213-225. [PMID: 33603982 PMCID: PMC7876430 DOI: 10.18502/ijhoscr.v14i4.4474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: The expansion of umbilical cord blood (UCB) banking necessitates a greater understanding among obstetricians in order to responsibly inform parents about UCB collection and storage. Gaps in knowledge can compromise public UCB banking efforts and result in missed opportunities and public misguidance about UCB banking. Materials and Methods: A cross-sectional survey was disseminated among obstetricians in Amman, Jordan. The questionnaire aimed to evaluate obstetricians' knowledge of and attitude toward UCB storage and applications, as well as current practice patterns. Results: Ninety-six obstetricians responded (55% response rate), most of whom were Jordanian (71%), female (83%), resident physicians (59%), and working in either private (43%) or public (42%) hospitals, with an average of 6.5 years in practice. Only 26% had personal experience in UCB collection, and 20% had received education on UCB collection. Nearly 75% said their hospitals lacked standard operating procedures, guidelines, or infectious disease screening for UCB units. Overall knowledge about UCB was moderate, and the internet was the most common information source (54%). Overall attitudes were positive, especially in desire to expand personal knowledge about UCB, integrate information into medical residency curricula, and establish a public UCB bank in Jordan. However, many believed that ethical (61%) and religious (56%) controversies surround UCB donation. Conclusion: This study identifies deficiencies in quality control and experience in UCB collection in Jordan, as well as areas of inadequate knowledge and ethical controversies among obstetricians. These issues contribute to public misinformation and limit public UCB donation programs, and requires improved medical education on this topic.
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Affiliation(s)
- Fayez Abdulrazeq
- Community Medicine and Public Health Department, Faculty of Medicine, Yemen's University of Science and Technology-Jordan Branch, Farid Abu Minnah Street, Amman, Jordan
| | - Monica M Matsumoto
- Pritzker School of Medicine, University of Chicago, 924 E. 57 Street, Suite 104, Chicago, IL, 60637, USA
| | - Reem Abduljabbar
- Community Medicine and Public Health Department, Faculty of Medicine, Yemen's University of Science and Technology-Jordan Branch, Farid Abu Minnah Street, Amman, Jordan
| | - Amira Al-Hajj
- Community Medicine and Public Health Department, Faculty of Medicine, Yemen's University of Science and Technology-Jordan Branch, Farid Abu Minnah Street, Amman, Jordan
| | - Melad Alayash
- Community Medicine and Public Health Department, Faculty of Medicine, Yemen's University of Science and Technology-Jordan Branch, Farid Abu Minnah Street, Amman, Jordan
| | - Rahaf Ballourah
- Community Medicine and Public Health Department, Faculty of Medicine, Yemen's University of Science and Technology-Jordan Branch, Farid Abu Minnah Street, Amman, Jordan
| | - Sumayya Issak
- Community Medicine and Public Health Department, Faculty of Medicine, Yemen's University of Science and Technology-Jordan Branch, Farid Abu Minnah Street, Amman, Jordan
| | - Zubeida Issak
- Community Medicine and Public Health Department, Faculty of Medicine, Yemen's University of Science and Technology-Jordan Branch, Farid Abu Minnah Street, Amman, Jordan
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Paulsen CB, Zetner D, Rosenberg J. Variation in abdominal wall closure techniques in lower transverse incisions: a nationwide survey across specialties. Hernia 2021; 25:345-52. [PMID: 32770366 DOI: 10.1007/s10029-020-02280-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 07/24/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE Lower transverse abdominal incisions are typically used by obstetricians/gynecologists and colorectal surgeons. The suture technique and choice of material when closing the abdomen is an essential factor to decrease the risk of incisional hernia. We conducted a nationwide survey among obstetricians/gynecologists and colorectal surgeons investigating the surgical handling of the fascia, rectus muscle, subcutis, peritoneum, and skin, in lower transverse incisions. METHODS All departments of obstetrics/gynecology and departments of surgery performing colorectal surgery in Denmark were invited to participate. An online questionnaire was sent to consultant obstetricians/gynecologists and colorectal surgeons. The survey consisted of demographic information together with questions on surgical details. The study was reported according to STROBE guidelines. RESULTS A total of 252 (64.5%) consultants provided a complete response to the survey. We found that 98.0% of the colorectal surgeons and 65.8% of the obstetricians/gynecologists used monofilament suture when closing the fascia. The majority of the colorectal surgeons used continuous suture and small bites technique. This was only the case for half of the obstetricians/gynecologists. Approximately two thirds of the colorectal surgeons and one third of the OB/GYN used the suture length to wound length ratio > 4:1. Furthermore, we found significant differences between the groups in the handling of subcutis, peritoneum, and skin. CONCLUSION We found significant variation in abdominal wall closure techniques in lower transverse incisions. Disagreement between the current guidelines within the specialties together with insufficient evidence on the closure of lower transverse incisions emphasizes the need for education as well as further studies.
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Peberdy L, Young J, Massey D, Kearney L. Maternity health professionals' perspectives of cord clamp timing, cord blood banking and cord blood donation: a qualitative study. BMC Pregnancy Childbirth 2020; 20:410. [PMID: 32677904 PMCID: PMC7364524 DOI: 10.1186/s12884-020-03102-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 07/08/2020] [Indexed: 11/10/2022] Open
Abstract
Background Parents today have several options for the management of their infant’s cord blood during the third stage of labour. Parents can choose to have their infant’s cord clamped early or to have deferred cord clamping. If the cord is clamped early, cord blood can be collected for private cord blood banking or public cord blood donation for use later if needed. If cord clamping is deferred, the placental blood physiologically transfuses to the neonate and there are physiological advantages to this. These benefits include a smoother cardiovascular transition and increased haemoglobin levels while not interfering with the practice of collecting cord blood for gases if needed. The aim of this study is to explore Australian maternity health professionals’ perspectives towards cord clamp timing, cord blood banking and cord blood donation. Methods Fourteen maternity health professionals (midwives and obstetricians) from both private and public practice settings in Australia participated in semi-structured interviews either in person or by telephone. Interviews were transcribed and data analysed using thematic analysis. Results Overall there was strong support for deferred cord clamping, and this was seen as important and routinely discussed with parents as part of antenatal care. However, support did not extend to the options of cord blood banking and donation and to routinely informing parents of these options even when these were available at their birthing location. Conclusion Formalised education for maternity health professionals is needed about the benefits and implications of cord blood banking and cord blood donation so that they have the confidence to openly discuss all options of cord clamp timing, cord blood banking and cord blood donation to facilitate informed decision-making by parents.
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Affiliation(s)
- Lisa Peberdy
- Clinical Nursing - Maternal, Child and Family Health, The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia.
| | - Jeanine Young
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia
| | - Debbie Massey
- Southern Cross University, Gold Coast Airport, Terminal Dr, Bilinga, Queensland, 4225, Australia
| | - Lauren Kearney
- The University of the Sunshine Coast, 90 Sippy Downs Drive, Sippy Downs, Queensland, 4556, Australia
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Bando H, Kataoka A, Tamaki K, Kobayashi M, Tamura N, Ozawa M, Kawano J, Fukatsu Y, Kitano A, Shiota K, Yamauchi H. Physician's knowledge, attitudes and practice pattern for breast cancer diagnosed during pregnancy: a survey among breast care specialists in Japan. Breast Cancer 2020; 27:796-802. [PMID: 32592140 DOI: 10.1007/s12282-020-01118-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/31/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Breast cancer diagnosed during pregnancy (BCP) is uncommon, and thus there is limited evidence on its treatment. However, the incidence of BCP is increasing probably due to women having children at an older age. We aimed to clarify the practice patterns and limitations in treatment for BCP in Japan. METHODS A cross-sectional survey was developed for board-certified Japanese breast cancer specialists (n = 1583) to evaluate their knowledge, attitude, experience, and practice patterns regarding BCP. Survey items also included questions regarding potential barriers of practice toward patients diagnosed during pregnancy and respondents' background. RESULTS In March 2018, 492 (31.1%) breast oncologists responded to the survey. Among them, 234 (48%) respondents had the experience of treating at least one case of BCP. The accuracy of knowledge about BCP was evaluated by three items regarding BCP treatment from the latest Japanese Breast Cancer Society treatment guideline, and 265 (54%) were categorized to have "appropriate knowledge". Majority of the physicians (89%) have responded that patients should be treated in a center where both a cancer-treating team and obstetrician exist, and 48% responded that treating patients by the collaboration of cancer-treating team and obstetric team in different institutes is an alternative reasonable option. CONCLUSIONS Interest, knowledge, and awareness of the guidelines appear to influence physician attitude, and thus it is urgently important to lay out educational materials and learning opportunities regarding BCP for breast specialists. A regional network of oncologists, obstetricians, and pediatricians to support the BCP patients should be developed.
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Affiliation(s)
- Hiroko Bando
- Department of Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - Akemi Kataoka
- Department of Surgical Oncology, Breast Oncology Center, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | | | - Nobuko Tamura
- Department of Breast Surgical Oncology, Toranomon Hospital, Tokyo, Japan
| | - Miwa Ozawa
- Department of Pediatrics, St. Luke's International Hospital, Tokyo, Japan
| | - Junko Kawano
- Department of Breast Surgical Oncology, Hakuaikai Sagara Hospital, Kagoshima, Japan
| | - Yumi Fukatsu
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan
| | - Atsuko Kitano
- Department of Medical Oncology, St. Luke's International Hospital, Tokyo, Japan
| | - Kyoko Shiota
- Integrated Woman's Health, St. Luke's International Hospital, Tokyo, Japan
| | - Hideko Yamauchi
- Department of Breast Surgical Oncology, St. Luke's International Hospital, 9-1 Akashi-cho, Chuo-ku, Tokyo, 104-8560, Japan.
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Panda S, Begley C, Daly D. Influence of women's request and preference on the rising rate of caesarean section - a comparison of reviews. Midwifery 2020; 88:102765. [PMID: 32531664 DOI: 10.1016/j.midw.2020.102765] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 05/10/2020] [Accepted: 05/24/2020] [Indexed: 01/12/2023]
Abstract
The rising caesarean section (CS) rates have been, in part, attributed to women's requests. Several individual studies and literature reviews have attempted to determine the degree of influence of women's requests on overall CS rates, and the common reasons behind these requests, from women's, midwives' and obstetricians' viewpoints. Despite many similarities in their findings, there is both a lack of clarity and disparity on the degree of influence women's requests actually has on the decision to perform a CS. This paper presents a critique of a key finding from a recently published systematic review of clinicians' (midwives' and obstetricians') views of factors that influenced their decision to perform a CS, which identified their belief in 'women's request' as a key factor. This finding is contrasted with findings from three other published reviews, which concluded that women's request contributed minimally to the overall rising rates of CS indicating a disparity in evidence around influence and contribution of women's request. Some of the possible reasons for this disparity can be explained by differences in views of women and clinicians, women's decision being guided by clinicians' beliefs of what is 'safe' and unsafe', and women's concerns being interpreted as their request and preferences to birth by CS. An insight into the possible reasons for the disparity in findings can help explain whether maternal request has any influence on the rising rates of CSs.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin. 2 Clare St, Dublin 2 CK80. Ireland.
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin. 2 Clare St, Dublin 2 CK80. Ireland.
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin. 2 Clare St, Dublin 2 CK80. Ireland.
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Chao SD, Cheung CM, Chang ET, Pei A, So SKS. Management of hepatitis B infected pregnant women: a cross-sectional study of obstetricians. BMC Pregnancy Childbirth 2019; 19:275. [PMID: 31375078 DOI: 10.1186/s12884-019-2421-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 07/23/2019] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Our study aims to describe how obstetricians manage pregnant women infected with chronic hepatitis B in a region with a large high-risk population. METHODS We performed a cross-sectional study among practicing obstetricians in Santa Clara County, California. All obstetricians practicing in Santa Clara County were invited to participate in the study. Obstetricians were recruited in person or by mail to complete a voluntary, multiple choice survey on hepatitis B (HBV). Survey questions assessed basic HBV knowledge and obstetricians' self-reported clinical practices of the management of HBV-infected pregnant women. Pooled descriptive analyses were calculated for the cohort, as well as, correlation coefficients to evaluate the association between reported clinical practices and hepatitis B knowledge. RESULTS Among 138 obstetricians who completed the survey, 94% reported routinely testing pregnant women for hepatitis B surface antigen (HBsAg) with each pregnancy. Only 60.9% routinely advised HBsAg-positive patients to seek specialist evaluation for antiviral treatment and monitoring and fewer than half (48.6%) routinely provided them with HBV information. While most respondents recognized the potential complications of chronic HBV (94.2%), only 21% were aware that chronic HBV carries a 25% risk of liver related death when left unmonitored and untreated, and only 25% were aware of the high prevalence of chronic HBV in the foreign-born Asian, Native Hawaiian and Pacific Islander population. Obstetricians aware of the high risk of perinatal HBV transmission were more likely to test pregnant women for HBV DNA or hepatitis B e-antigen in HBV-infected women (r = 0.18, p = 0.033). Obstetricians who demonstrated knowledge of the long-term consequences of untreated HBV infection were no more likely to refer HBV-infected women to specialists for care (r = 0.02, p = 0.831). CONCLUSION Our study identified clear gaps in the practice patterns of obstetricians that can be readily addressed to enhance the care they provide to HBV-infected pregnant women.
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Khresheh R, Barclay L. Knowledge, attitude and experience of episiotomy practice among obstetricians and midwives in Jordan. Women Birth 2019; 33:e176-e181. [PMID: 30910398 DOI: 10.1016/j.wombi.2019.03.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 03/08/2019] [Accepted: 03/10/2019] [Indexed: 12/01/2022]
Abstract
INTRODUCTION Episiotomy is still performed routinely by clinicians in many countries. The aim of this study was to determine the knowledge of, attitudes towards and experience of episiotomy practice among clinicians working in public hospitals in Jordan. METHODS A cross-sectional study, using a self-administered survey questionnaire, was conducted among midwives and obstetricians in three public hospitals in Jordan. RESULTS 112 (87.5%) clinicians responded to the questionnaire. Low knowledge level of evidence about overuse and risk of episiotomy was identified among participants with a significant difference among obstetricians and midwives (P<0.05). Results revealed that both obstetricians and midwives have limited access to evidence which is not emphasised in their learning, practice, or hospital policy. The majority of obstetricians (80%) and midwives (79%) thought an episiotomy rate of 81% is about right. The most common reason for performing episiotomy identified by both obstetricians (83.1%) and midwives (75.5%) was to reduce the risk of 3rd and 4th degree perineal laceration. The most common obstacle to reducing episiotomy rate reported by obstetricians (78.0%) was lack of training on preventing perineal tears, while the most common obstacles reported by midwives were insufficient time to wait for the perineum to stretch (56.6%) and difficulty changing the conventional practices in the labour ward (52.8%). CONCLUSION This study identifies that obstetricians and midwives in Jordan rely on non evidence-based beliefs to guide their practice on performing an episiotomy. Training, continuing education, and developing evidence based clinical policies and guidelines for surgical procedures, such as in an episiotomy, are needed.
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Affiliation(s)
| | - Lesley Barclay
- School of Medicine, University Centre for Rural Health, The University of Sydney, NSW Australia.
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Panda S, Daly D, Begley C, Karlström A, Larsson B, Bäck L, Hildingsson I. Factors influencing decision-making for caesarean section in Sweden - a qualitative study. BMC Pregnancy Childbirth 2018; 18:377. [PMID: 30223780 PMCID: PMC6142337 DOI: 10.1186/s12884-018-2007-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 09/04/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Rising rates of caesarean section (CS) are a concern in many countries, yet Sweden has managed to maintain low CS rates. Exploring the multifactorial and complex reasons behind the rising trend in CS has become an important goal for health professionals. The aim of the study was to explore Swedish obstetricians' and midwives' perceptions of the factors influencing decision-making for CS in nulliparous women in Sweden. METHODS A qualitative design was chosen to gain in-depth understanding of the factors influencing the decision-making process for CS. Purposive sampling was used to select the participants. Four audio-recorded focus group interviews (FGIs), using an interview guide with open ended questions, were conducted with eleven midwives and five obstetricians from two selected Swedish maternity hospitals after obtaining written consent from each participant. Data were managed using NVivo© and thematically analysed. Ethical approval was granted by Trinity College Dublin. RESULTS The thematic analysis resulted in three main themes; 'Belief in normal birth - a cultural perspective'; 'Clarity and consistency - a system perspective' and 'Obstetrician makes the final decision, but...', and each theme contained a number of subthemes. However, 'Belief in normal birth' emerged as the core central theme, overarching the other two themes. CONCLUSION Findings suggest that believing that normal birth offers women and babies the best possible outcome contributes to having and maintaining a low CS rate. Both midwives and obstetricians agreed that having a shared belief (in normal birth), a common goal (of achieving normal birth) and providing mainly midwife-led care within a 'team approach' helped them achieve their goal and keep their CS rate low.
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Affiliation(s)
- Sunita Panda
- School of Nursing and Midwifery, Trinity College Dublin, 2 Clare Street, D02 CK80 Dublin, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
| | - Cecily Begley
- School of Nursing and Midwifery, Trinity College Dublin, 24 D’Olier Street, Dublin, D02 T283 Ireland
- Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Annika Karlström
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Birgitta Larsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Lena Bäck
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
| | - Ingegerd Hildingsson
- Department of Nursing, Mid Sweden University, 86170 Sundsvall, Sweden
- Department of Women’s and Children’s health, Uppsala University, Uppsala, Sweden
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Hobeika E, Usta IM, Helou R, Jabak S, El Kak F, Nassar AH. Practice and attitudes towards immunization among Lebanese obstetricians and gynecologists. Hum Vaccin Immunother 2018; 14:1501-1508. [PMID: 29461912 DOI: 10.1080/21645515.2018.1440163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We designed our study to evaluate the knowledge and immunization practices among Lebanese obstetricians and gynecologists (OBGYN) for women of different age groups. Anonymous questionnaires were used to assess the knowledge and immunization practices among OBGYN. The survey was conducted at the annual meeting of the Lebanese Society of Obstetrics and Gynecology on November 13-15, 2014. Data collected included demographics, type of practice, academic background and familiarity with vaccine guidelines. Descriptive statistical methods were used to evaluate the responses. The response rate was 54.8% (114/208). Only 62.3% (71/114) recommend vaccination(s) to pregnant women with only 25.9% of those who recommend the Tdap vaccine for pregnant women giving it during the recommended third trimester. In addition, 52.6% are unaware of the CDC/ACIP immunization schedule for women in general. However, 83.0% (93/112) of respondents are willing to integrate vaccination in their practice. Our study highlights several gaps in the knowledge of Lebanese OBGYN regarding vaccination in addition to practices that are not in full accordance with common guidelines. Measures should be taken to spread proper awareness of the proper guidelines among Lebanese practitioners.
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Affiliation(s)
- Elie Hobeika
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut-Lebanon
| | - Ihab M Usta
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut-Lebanon
| | - Rami Helou
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut-Lebanon
| | - Salma Jabak
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut-Lebanon
| | - Faysal El Kak
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut-Lebanon
| | - Anwar H Nassar
- a Department of Obstetrics and Gynecology , American University of Beirut Medical Center , Beirut-Lebanon
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Hollander M, de Miranda E, van Dillen J, de Graaf I, Vandenbussche F, Holten L. Women's motivations for choosing a high risk birth setting against medical advice in the Netherlands: a qualitative analysis. BMC Pregnancy Childbirth 2017; 17:423. [PMID: 29246129 PMCID: PMC5732454 DOI: 10.1186/s12884-017-1621-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 12/07/2017] [Indexed: 11/25/2022] Open
Abstract
Background Home births in high risk pregnancies and unassisted childbirth seem to be increasing in the Netherlands. Until now there were no qualitative data on women’s motivations for these choices in the Dutch maternity care system where integrated midwifery care and home birth are regular options in low risk pregnancies. We aimed to examine women’s motivations for birthing outside the system in order to provide medical professionals with insight and recommendations regarding their interactions with women who have birth wishes that go against medical advice. Methods An exploratory qualitative research design with a constructivist approach and a grounded theory method were used. In-depth interviews were performed with 28 women on their motivations for going against medical advice in choosing a high risk childbirth setting. Open, axial and selective coding of the interview data was done in order to generate themes. A focus group was held for a member check of the findings. Results Four main themes were found: 1) Discrepancy in the definition of superior knowledge, 2) Need for autonomy and trust in the birth process, 3) Conflict during negotiation of the birth plan, and 4) Search for different care. One overarching theme emerged that covered all other themes: Fear. This theme refers both to the participants’ fear (of interventions and negative consequences of their choices) and to the providers’ fear (of a bad outcome). Where for some women it was a positive choice, for the majority of women in this study the choice for a home birth in a high risk pregnancy or an unassisted childbirth was a negative one. Negative choices were due to previous or current negative experiences with maternity care and/or conflict surrounding the birth plan. Conclusions The main goal of working with women whose birthing choices do not align with medical advice should not be to coerce them into the framework of protocols and guidelines but to prevent negative choices. Recommendations for maternity caregivers can be summarized as: 1) Rethink risk discourse, 2) Respect a woman’s trust in the birth process and her autonomous choice, 3) Have a flexible approach to negotiating the birth plan using the model of shared decision making, 4) Be aware of alternative delivery care providers and other sources of information used by women, and 5) Provide maternity care without spreading or using fear.
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Affiliation(s)
- Martine Hollander
- Department of Obstetrics, Radboud University Medical Center, Brouwketel 4, 6681 GT Bemmel, Nijmegen, the Netherlands.
| | - Esteriek de Miranda
- Department of Obstetrics, Academic Medical Center, Amsterdam, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Irene de Graaf
- Department of Obstetrics, Academic Medical Center, Amsterdam, the Netherlands
| | - Frank Vandenbussche
- Department of Obstetrics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Lianne Holten
- AVAG school of midwifery and VU/EMGO research institute, Amsterdam, the Netherlands
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Hodges NL, Anderson SE, McKenzie LB, Katz ML. Infant Safe Sleep: A Survey of the Knowledge, Attitudes, and Behaviors of Obstetric Physicians. J Community Health 2018; 43:488-95. [PMID: 29129033 DOI: 10.1007/s10900-017-0441-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Obstetricians may be a pregnant woman's primary professional source of information about her infant prior to the birth, but infant safe sleep knowledge, attitudes and behaviors of this population are unknown. This study explores obstetric physicians' knowledge, attitudes, and behaviors related to Sudden Infant Death Syndrome and infant safe sleep and identifies barriers as well as enabling and/or reinforcing factors associated with providing infant safe sleep education in the prenatal environment. A cross-sectional survey was conducted with obstetric physicians who provide prenatal healthcare to women in Ohio. Surveys were sent to all licensed physicians included in the registry of the State Medical Board of Ohio with "obstetrics," "obstetrics and gynecology," or "maternal and fetal medicine" as their primary specialty (n = 1771). The response rate was 30%, with 418 physicians included in the analysis. Many participants were knowledgeable about infant safe sleep recommendations; however, only 55% indicated that it was important for obstetric physicians to discuss Sudden Infant Death Syndrome and/or infant safe sleep with prenatal patients. Many participants (70%) perceived barriers to providing infant safe sleep education, however most (82%) indicated interest in doing so. Participants' knowledge and attitudes were significant predictors of whether they discuss this topic with patients. Obstetric physicians can influence the infant safe sleep decisions that women make. Improving obstetricians' knowledge and attitudes about infant safe sleep and supporting physicians who wish to provide education on this topic may help to ensure that women are receiving frequent and consistent infant safe sleep messaging throughout the prenatal period.
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Morano S, Migliorini L, Rania N, Piano L, Tassara T, Nicoletti J, Lundgren I. Emotions in labour: Italian obstetricians' experiences of presence during childbirth. J Reprod Infant Psychol 2017. [PMID: 29517301 DOI: 10.1080/02646838.2017.1395399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The present study represents a qualitative research aimed to explore the obstetricians' psychological experiences of birth. BACKGROUND During labour the role of obstetricians assumes a fundamental importance in hospitalised childbirth. However, literature analysis has shown that the psychological side of birth has been investigated only considering the woman's and midwife's points of view. The obstetricians' psychological experiences have not been considered enough and only a few studies at a quantitative level have been performed. METHODS Seven focus groups for a total of 72 obstetricians were conducted in hospital contexts in Italy. The qualitative methodology of grounded theory was adopted. FINDINGS The results were divided into three different core themes: obstetricians' approaches to delivery, critical aspects about relationships in the delivery room, and obstetricians' feelings and emotions in the delivery room. Each theme was subdivided into different subthemes. CONCLUSION The results highlight different ways obstetricians approach their profession, the complex and multifaceted relationship with the woman and the extraordinary variety of feelings and emotions, which enrich, but also may complicate, life in the delivery room. Further studies could provide more details to help researchers to develop new and more effective strategies to support obstetricians' training and work.
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Affiliation(s)
- S Morano
- a Department of Neurosciences, Rehabilitation, Ophtalmology, Genetics, Mother Infant Sciences , University of Genoa , Genova , Italy
| | - L Migliorini
- b Department of Education Sciences , University of Genoa , Genoa , Italy
| | - N Rania
- b Department of Education Sciences , University of Genoa , Genoa , Italy
| | - L Piano
- b Department of Education Sciences , University of Genoa , Genoa , Italy
| | - T Tassara
- b Department of Education Sciences , University of Genoa , Genoa , Italy
| | - J Nicoletti
- a Department of Neurosciences, Rehabilitation, Ophtalmology, Genetics, Mother Infant Sciences , University of Genoa , Genova , Italy
| | - I Lundgren
- c Institute of Health and Care Sciences , The Sahlgrenska Academy, University of Gothenburg , Gothenburg , Sweden
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Küçük M. Obstetrician perceptions of the causes of high cesarean delivery rates in Turkey. Int J Gynaecol Obstet 2017; 138:100-106. [PMID: 28387945 DOI: 10.1002/ijgo.12172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/18/2017] [Accepted: 04/05/2017] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To assess obstetricians' perceptions surrounding cesarean delivery rates in Turkey. METHODS The present cross-sectional descriptive study was performed between May 1 and June 30, 2016. Practicing obstetricians with contact details known by the researchers and those attending a conference in Turkey were asked to complete a self-administered questionnaire that collected demographic data and information on participants' opinions, beliefs, knowledge, attitudes, and practices related to cesarean delivery. RESULTS There were 100 obstetricians who responded to the survey. Awareness of high cesarean delivery rates was reported by 96 (96%) participants and 95 (95%) respondents said they were supportive of efforts to reduce it. There were 60 (60%), 83 (83%), and 100 (100%) participants aware of associations between high cesarean delivery rates and increased maternal and infant mortality; increased risk of uterine rupture; and increased risk of placenta previa, placenta accreta, and emergency cesarean hysterectomy, respectively. The most commonly reported reason for high cesarean delivery rates was high compensation costs during medical litigation legal proceedings, reported by all 100 (100%) participants. CONCLUSION Participants were generally aware of the risks associated with high cesarean delivery rates. The results suggest that the greatest concern among obstetricians who perform cesarean deliveries was malpractice litigation.
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Affiliation(s)
- Mert Küçük
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mugla Sıtkı Kocman University, Merkez, Muğla, Turkey.,Department of Medical Education and Bioinformatics, Faculty of Medicine, Mugla Sıtkı Kocman University, Merkez, Muğla, Turkey
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Wahlberg Å, Andreen Sachs M, Bergh Johannesson K, Hallberg G, Jonsson M, Skoog Svanberg A, Högberg U. Self-reported exposure to severe events on the labour ward among Swedish midwives and obstetricians: A cross-sectional retrospective study. Int J Nurs Stud 2016; 65:8-16. [PMID: 27815987 DOI: 10.1016/j.ijnurstu.2016.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 10/19/2016] [Accepted: 10/21/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The process of delivery entails potentially traumatic events in which the mother or child becomes injured or dies. Midwives and obstetricians are sometimes responsible for these events and can be negatively affected by them as well as by the resulting investigation or complaints procedure (clinical negligence). OBJECTIVE To assess the self-reported exposure rate of severe events among midwives and obstetricians on the delivery ward and the cumulative risk by professional years and subsequent investigations and complaints. DESIGN Cross-sectional survey. PARTICIPANTS Members of the Swedish Association of Midwives (SFB) and the Swedish Society of Obstetrics and Gynaecology (SFOG). METHODS A questionnaire covering demographic characteristics, experiences of self-reported severe events on the delivery ward, and complaints of medical negligence was developed. Potential consequences of the complaint was not reported. A severe event was defined as: 1) the death of an infant due to delivery-related causes during childbirth or while on the neonatal ward; 2) an infant being severely asphyxiated or injured at delivery; 3) maternal death; 4) very severe or life threatening maternal morbidity; or 5) other stressful events during delivery, such as exposure to violence or aggression. RESULTS The response rate was 39.9% (n=1459) for midwives and 47.1% (n=706) for obstetricians. Eighty-four percent of the obstetricians and almost 71% of responding midwives had experienced one or more self-reported severe obstetric event with detrimental consequences for the woman or the new-born. Fourteen percent of the midwives and 22.4% of the obstetricians had faced complaints of medical negligence from the patient or the family of the patient. CONCLUSIONS A considerable proportion of midwives and obstetricians will, in the course of their working life, experience severe obstetric events in which the mother or the new-born is injured or dies. Preparedness for such exposure should be part of the training, as should managerial and peer support for those in need. This could prevent serious consequences for the health care professionals involved and their subsequent careers.
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Affiliation(s)
- Åsa Wahlberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden; Department of Gynecology and Obstetrics, Skåne University Hospital, Malmö, Sweden.
| | | | | | - Gunilla Hallberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden; Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden
| | - Maria Jonsson
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden; Department of Gynecology and Obstetrics, Akademiska Hospital, Uppsala, Sweden
| | - Agneta Skoog Svanberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden
| | - Ulf Högberg
- Department of Women's and Children's Health/Obstetrics & Gynecology, Uppsala University, Sweden
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Nuzum D, Meaney S, O'Donoghue K. The Place of Faith for Consultant Obstetricians Following Stillbirth: A Qualitative Exploratory Study. J Relig Health 2016; 55:1519-1528. [PMID: 26093617 DOI: 10.1007/s10943-015-0077-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Stillbirth remains among the most challenging areas in obstetric practice. The objectives of this study were to explore the impact of stillbirth on the faith of obstetricians. Semi-structured in-depth qualitative interviews were conducted with obstetricians focusing on the impact of stillbirth on their faith. Data were analyzed using interpretative phenomenological analysis. Stillbirth was identified as one of the most difficult experiences, and most consultants were unable to engage with their personal beliefs when dealing with death at work. The major study themes were conflict of personal faith and incongruence between personal faith and professional practice. This study highlights a gap in how obstetricians see their own faith and feeling able to respond to the faith needs of bereaved parents. Participating obstetricians did not demonstrate that spirituality was an integrated part of their professional life.
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Affiliation(s)
- Daniel Nuzum
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland.
| | - Sarah Meaney
- National Perinatal Epidemiology Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Department of Obstetrics and Gynaecology, Cork University Maternity Hospital, University College Cork, Wilton, Cork, Ireland
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Sahlin M, Andolf E, Edman G, Wiklund I. Mode of delivery among Swedish midwives and obstetricians and their attitudes towards caesarean section. Sex Reprod Healthc 2016; 11:112-116. [PMID: 28159121 DOI: 10.1016/j.srhc.2016.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 04/18/2016] [Accepted: 04/25/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND A knowledge gap exists around midwives' and obstetricians' mode of delivery in comparison to the general population, and if their personal experience influences their attitudes towards different modes of delivery. OBJECTIVES The aim of the present study was to investigate midwives' and obstetricians' mode of delivery compared to the population at large. The second aim was to see if their mode of delivery had been influenced by the expanded indications for caesarean section as described in medical literature. Thirdly, the differences between obstetricians' and midwifes' attitudes to caesarean section on maternal request was investigated. MATERIAL AND METHOD Textbooks from midwifery education and medical schools were reviewed using a structured protocol. A questionnaire for midwives and obstetricians containing questions on mode of delivery, attitudes towards patients' autonomy and performing caesarean sections on maternal request was sent to 380 midwives and 97 obstetricians born in 1935, 1955 or 1975 with an invitation to participate in the study. Two hundred and sixty three midwives and 55 obstetricians provided completed responses. RESULTS The review of textbooks identified that the number of indications for caesarean section has increased. Indications for caesarean section increased in medical textbooks from seven in the oldest books, from year 1955, to 11 in the textbook from 1993. The focus has shifted in more recently published textbooks to prevention of fatal deliveries. In earlier obstetric care they tend to learn to solve the catastrophe when it had occurred. No significant relationship between midwives' and obstetricians; own mode of delivery and their attitudes towards performing a caesarean section on maternal request (p = 0.191) was found. Thirty percent of the obstetricians reported that they would perform a caesarean section if the pregnant woman requested one. The study found a significant difference between the professions in the statement "the proportion of caesarean section is too high" where midwives to a greater extent agreed with the statement (p = 0.033). There were no significant differences between caesarean section as the mode of delivery for midwives and obstetricians as compared to the general population. Midwives born in 1975 had significantly lower rate of instrumental births compared to the population at large (p < 0.05). CONCLUSIONS Over the years, the indications for caesarean section have increased. The increase is shown in both the textbooks read during the different time periods as well as among the Swedish midwives and obstetricians born in 1955 and 1975.
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Affiliation(s)
- Maria Sahlin
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.
| | - Ellika Andolf
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
| | - Gunnar Edman
- Department of Psychiatry, R&D Section, Tiohundra AB, Norrtälje, Sweden
| | - Ingela Wiklund
- Department of Clinical Sciences, Division of Obstetrics and Gynaecology, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
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Lightly K, Shaw E, Dailami N, Bisson D. Personal birth preferences and actual mode of delivery outcomes of obstetricians and gynaecologists in South West England; with comparison to regional and national birth statistics. Eur J Obstet Gynecol Reprod Biol 2014; 181:95-8. [PMID: 25129154 DOI: 10.1016/j.ejogrb.2014.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [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: 02/26/2014] [Revised: 07/01/2014] [Accepted: 07/20/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine personal birth preferences of obstetricians in various clinical scenarios, in particular elective caesarean section for maternal request. To determine actual rates of modes of deliveries amongst the same group. To compare the obstetrician's mode of delivery rates, to the general population. STUDY DESIGN Following ethical approval, a piloted online survey link was sent via email to 242 current obstetricians and gynaecologists, (consultants and trainees) in South West England. Mode of delivery results were compared to regional and national population data, using Hospital Episode Statistics and subjected to statistical analysis. RESULTS The response rate was 68%. 90% would hypothetically plan a vaginal delivery, 10% would consider a caesarean section in an otherwise uncomplicated primiparous pregnancy. Of the 94/165 (60%) respondents with children (201 children), mode of delivery for the first born child; normal vaginal delivery 48%, caesarean section 26.5% (elective 8.5%, emergency 18%), instrumental 24.5% and vaginal breech 1%. Only one chose an elective caesarean for maternal request. During 2006-2011 obstetricians have the same overall actual modes of birth as the population (p=0.9). CONCLUSIONS Ten percent of obstetricians report they would consider requesting caesarean section for themselves/their partner, which is the lowest rate reported within UK studies. However only 1% actually had a caesarean solely for maternal choice. When compared to regional/national statistics obstetricians currently have modes of delivery that are not significantly different than the population and suggests that they choose non interventional delivery if possible.
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Affiliation(s)
- Katie Lightly
- Speciality Trainee in Obstetrics and Gynaecology, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, United Kingdom.
| | - Elisabeth Shaw
- Consultant Obstetrician and Gynaecologist. Arrowe Park Hospital, Wirral, Merseyside, CH49 5PE
| | - Narges Dailami
- University of West of England. Coldharbour Lane, Bristol, BS16 1QY, United Kingdom
| | - Dina Bisson
- Consultant Obstetrician and Gynaecologist, North Bristol NHS Trust, Southmead Hospital, Bristol, BS10 5NB, United Kingdom
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Obed J, Bako B, Agida T, Nwobodo E. Caesarean delivery on maternal request: consultants' view and practice in the west african sub region. J West Afr Coll Surg 2013; 3:72-83. [PMID: 25453013 PMCID: PMC4228811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Caesarean Delivery on Maternal Request (CDMR) is increasingly seen as a viable option to vaginal delivery even in the absence of medical or obstetric contraindications to vaginal delivery. MATERIAL AND METHODS Self administered questionnaires were instituted to Senior Consultant Obstetricians attending the examiners' meeting of the faculty of obstetrics and gynaecology of the West African College of Surgeon in Ibadan, Nigeria on 17(th) April, 2013 and 23(th) October, 2013. This was to assess their experience and attitudes toward CDMR. The data were analysed with SPSS version 16.0 RESULTS: The majority of the consultants, 94.4%(85/90) have had antenatal client(s) ask for CDMR and 81.2%(69/85) of them have operated on at least a patient for CDMR. The reasons for the CDMR were: precious pregnancy/infertility, previous traumatic delivery and to avoid the stress of labour in 33%, 20.7% and 16.2% respectively. Eighty percent(68/85) consultants have counseled the women but only 11.8%(10/85) of them have had their patients change their minds and opted for vaginal delivery. Eighty eight(97.8%) of the obstetricians sampled are aware of the FIGO stand on Caesarean section however, 80(88.9%) of them opined that it is important to accommodate the feelings of the women and offer CDMR for the respect of the patient's autonomy. CONCLUSION There are cases of CDMR in the West African sub region and increasing willingness of the consultants to oblige to the request. There is need to develop a treatment guidelines/protocols for CDMR that will suit our environment in order to avoid over burdening of the limited health resources.
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Vinod J, Bonheur J, Korelitz BI, Panagopoulos G. Choice of laxatives and colonoscopic preparation in pregnant patients from the viewpoint of obstetricians and gastroenterologists. World J Gastroenterol 2007; 13:6549-52. [PMID: 18161925 PMCID: PMC4611294 DOI: 10.3748/wjg.v13.i48.6549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To elucidate the preferences of gastroenterologists at our institution and compare them to those of obstetricians when making decisions in the pregnant patient, including which type of bowel preparations to use for flexible sigmoidoscopy or colonoscopy, as well as which laxatives can be used safely.
METHODS: Surveys were mailed to all attending gastroenterologists (n = 53) and obstetricians (n = 99) at our institution. Each survey consisted of the 14 most common laxative or motility agents used in pregnancy and inquired about the physician’s prescribing habits in the past as well as their willingness to prescribe each medication in the future. The survey also listed four common bowel preparations used prior to colonoscopy and sigmoidoscopy and asked the physician to rank the order of the preferred agent in each case.
RESULTS: With regard to common laxatives, both gastroenterologists and obstetricians favor the use of Metamucil, Colace, and Citrucel. Both groups appear to refrain from using Fleets Phosphosoda and Castor oil. Of note, obstetricians are less inclined to use PEG solution and Miralax, which is not the case with gastroenterologists. In terms of comparing bowel preparations for colonoscopy, 50% of gastroenterologists prefer to use PEG solution and 50% avoid the use of Fleets Phosphosoda. Obstetricians seem to prefer Fleets Phosphosoda (20%) and tend to avoid the use of PEG solution (26%). With regard to bowel preparation for sigmoidoscopy, both groups prefer Fleets enema the most (51%), while magnesium citrate is used least often (38%).
CONCLUSION: It is clear that preferences in the use of bowel cleansing preparations between the two groups exist, but there have not been many case controlled human studies in the pregnant patient that give clear cut indications for using one versus another drug. In light of the challenge of performing controlled trials in pregnant women, more extensive surveys should be undertaken to gather a larger amount of data on physicians’ experiences and individual preferences.
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