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Mesquita ADL, Rodrigues HBV, Ferreira UR, Domingos MAF, de Oliveira BLCA, Cardoso AMR, Biazus-Dalcin C, Aquino PDS. Factors associated with antepartum pilgrimage at a reference maternity hospital in Ceará. Rev Esc Enferm USP 2024; 58:e20230012. [PMID: 38634686 PMCID: PMC11025457 DOI: 10.1590/1980-220x-reeusp-2023-0012en] [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: 05/03/2023] [Accepted: 02/14/2024] [Indexed: 04/19/2024] Open
Abstract
OBJECTIVE To identify factors associated with antepartum pilgrimage in pregnant women in Fortaleza, Ceará, Brazil. METHOD A cross-sectional study with 300 postpartum women from a state reference maternity hospital, carried out from March 2020 to January 2021. The frequency of pilgrimage was estimated according to socioeconomic characteristics and prenatal care. Analysis with Pearson's chi-square test selected variables for adjusted Poisson regression. RESULTS The frequency of antepartum pilgrimage to more than one health service was 34.3%. Not knowing the reference maternity hospital (1.16; 95%CI: 1.04-1.30) and not living close to the reference maternity hospital (1.16; 95%CI: 1.03-1.31) were associated with the occurrence of pilgrimage among women. Personal characteristics and prenatal care were not associated. CONCLUSION There was an association between antepartum pilgrimage and lack of knowledge of the reference maternity hospital and residence far from that maternity hospital, which requires better team communication and the guarantee of easier access to obstetric care services, through effective implementation of regionalization of maternal care.
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Affiliation(s)
| | | | - Uly Reis Ferreira
- Universidade Federal do Ceará, Departamento de Enfermagem, Fortaleza, CE, Brazil
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Chapman M, Evans EC, Long MH. Midwifery Practice Leaders' Experiences of Practice Changes Early in the COVID-19 Pandemic: A Qualitative Exploration. J Midwifery Womens Health 2024; 69:236-242. [PMID: 37986664 DOI: 10.1111/jmwh.13584] [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] [Revised: 09/08/2023] [Indexed: 11/22/2023]
Abstract
INTRODUCTION The coronavirus disease 2019 (COVID-19) pandemic generated considerable upheaval in all sectors of the US health care system, including maternity care. We focused this inquiry on midwifery practice leaders' experiences and perspectives on changes that occurred in their practices early in the pandemic. METHODS This was a qualitative descriptive study using thematic analysis. The data were responses to an open-ended question in a survey of pandemic-related employment and clinical practice changes. Findings are presented from a constructivist perspective, describing the experiences and perspectives of a group of US midwifery practice leaders during the initial phase of the COVID-19 pandemic. RESULTS Two main themes emerged from the analysis: demands on midwives and driving forces. Demands on midwives were 3-fold: clients' needs, modification of care, and midwives' needs. These encompassed the psychological, physical, and emotional toll that caring for women during the pandemic placed on midwives. Driving forces were those entities that spurred and directed change and included regulations, institutions, financial logistics, and team dynamics. Survey respondents in community (home and birth center) practices reported substantial increases in inquiries and client volume, and many respondents expressed concern about withdrawal of students from clinical placements. DISCUSSION Midwifery practices experienced profound changes in their work environments during the COVID-19 pandemic, with both positive and negative characteristics. These challenges in providing birth care were similar to those reported in other countries. Results indicated existing guidance for maternity care during emergencies did not meet clients' needs. Coordinated planning for maternity care in future prolonged health emergencies should incorporate best practices and include midwives in the process.
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Affiliation(s)
- Meredith Chapman
- School of Nursing, University of Virginia, Charlottesville, Virginia
| | | | - Maryann H Long
- School of Nursing, University of Virginia, Charlottesville, Virginia
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Lopes GA, Teixeira TT, Leister N, Riesco ML. Methods of induction and augmentation of labor in a freestanding birth center: a cross-sectional study. Rev Esc Enferm USP 2024; 57:e20230158. [PMID: 38324551 PMCID: PMC10849464 DOI: 10.1590/1980-220x-reeusp-2023-0158en] [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: 05/23/2023] [Accepted: 11/08/2023] [Indexed: 02/09/2024] Open
Abstract
OBJECTIVE To describe and analyze the use of methods of induction and augmentation of labor in a freestanding birth center (FBC). METHOD Cross-sectional study carried out at a FBC located in São Paulo (SP), with all women booked from 2011 to 2021 (n = 3,397). RESULTS The majority of women (61.3%) did not receive any method. The methods were used alone or in combination (traditional Chinese medicine, massage, castor oil, stimulating tea, amniotomy, and oxytocin). Traditional Chinese medicine (acupuncture, acupressure, and moxa) was the most used method (14.7%) and oxytocin was the least frequent (5.1%). The longer the water breaking time, the greater the number of methods used (p < 0.001). Amniotomy was associated with maternal transfers (p < 0.001). CONCLUSION Induction and augmentation of labor were strictly adopted. The use of natural or non-pharmacological methods prevailed. Robust clinical studies are needed to prove the effectiveness of non-pharmacological methods of stimulation of childbirth, in addition to strategies for their implementation in other childbirth care services, to really prove the effectiveness of non-pharmacological methods in the parturition process, that is, in labor and birth.
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Affiliation(s)
- Gisele Almeida Lopes
- Universidade de São Paulo, Escola de Enfermagem, Programa de Pós-Graduação em Enfermagem, São Paulo, SP, Brazil
| | | | - Nathalie Leister
- City, University of London, School of Health & Psychological Sciences, Centre for Maternal & Child Health Research, London, United Kingdom
| | - Maria Luiza Riesco
- Universidade de São Paulo, Escola de Enfermagem, Departamento de Enfermagem Materno-Infantil e Psiquiátrica, São Paulo, SP, Brazil
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Manns-James L, Vines S, Alliman J, Hoehn-Velasco L, Stapleton S, Wright J, Jolles D. Race, ethnicity, and indications for primary cesarean birth: Associations within a national birth center registry. Birth 2023. [PMID: 37929686 DOI: 10.1111/birt.12791] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Revised: 08/03/2023] [Accepted: 10/12/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND Racial and ethnic disparities in cesarean rates in the United States are well documented. This study investigated whether cesarean inequities persist in midwife-led birth center care, including for individuals with the lowest medical risk. METHODS National registry records of 174,230 childbearing people enrolled in care in 115 midwifery-led birth center practices between 2007 and 2022 were analyzed for primary cesarean rates and indications by race and ethnicity. The lowest medical risk subsample (n = 70,521) was analyzed for independent drivers of cesarean birth. RESULTS Primary cesarean rates among nulliparas (15.5%) and multiparas (5.7%) were low for all enrollees. Among nulliparas in the lowest-risk subsample, non-Latinx Black (aOR = 1.37; 95% CI, 1.15-1.63), Latinx (aOR = 1.51; 95% CI, 1.32-1.73), and Asian participants (aOR = 1.48; 95% CI, 1.19-1.85) remained at higher risk for primary cesarean than White participants. Among multiparas, only Black participants experienced a higher primary cesarean risk (aOR = 1.49; 95% CI, 1.02-2.18). Intrapartum transfers from birth centers were equivalent or lower for Black (14.0%, p = 0.345) and Latinx (12.7%, p < 0.001) enrollees. Black participants experienced a higher proportion of primary cesareans attributed to non-reassuring fetal status, regardless of risk factors. Place of admission was a stronger predictor of primary cesarean than race or ethnicity. CONCLUSIONS Place of first admission in labor was the strongest predictor of cesarean. Racism as a chronic stressor and a determinant of clinical decision-making reduces choice in birth settings and may increase cesarean rates. Research on components of birth settings that drive inequitable outcomes is warranted.
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Affiliation(s)
| | | | - Jill Alliman
- Frontier Nursing University, Versailles, Kentucky, USA
| | | | - Susan Stapleton
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Jennifer Wright
- American Association of Birth Centers, Perkiomenville, Pennsylvania, USA
| | - Diana Jolles
- Frontier Nursing University, Versailles, Kentucky, USA
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Nwanja E, Akpan U, Toyo O, Nwaokoro P, Badru T, Gana B, Nwanja I, Ayabi O, Ayeni B, Xavier E, Idemudia A, Sanwo O, Khamofu H, Bateganya M. Improving access to HIV testing for pregnant women in community birth centres in Nigeria: an evaluation of the Prevention of Mother-to-Child Transmission program. Ther Adv Infect Dis 2023; 10:20499361231172088. [PMID: 37152184 PMCID: PMC10155002 DOI: 10.1177/20499361231172088] [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: 07/11/2022] [Accepted: 04/11/2023] [Indexed: 05/09/2023] Open
Abstract
Background The elimination of mother-to-child HIV transmission requires access to HIV testing services (HTS) for pregnant women. In Akwa Ibom, Nigeria, 76% of pregnant women receive antenatal care from traditional birth attendants and may not have access to HIV testing. Objectives This study examines the contribution of traditional birth attendants and other healthcare workers in community birth centres in improving access to HTS among pregnant women and their HIV-exposed infants. Design A retrospective cross-sectional study of previously collected programme data at two points in time to evaluate the prevention of mother-to-child transmission (PMTCT) programme. Methods We assessed programme records before and after introducing an intervention that engaged traditional birth attendants and other healthcare workers in community birth centres to expand access to HTS among pregnant women and their HIV-exposed infants in Akwa Ibom State, Nigeria. Data were abstracted from the programme database for the preintervention period (April 2019 to September 2020) and the intervention period (October 2020 to March 2022). Data abstracted include the number of pregnant women tested for HIV, those diagnosed with HIV, the number of HIV-exposed infants who had samples collected for early infant diagnosis and those diagnosed with HIV. The data were analysed descriptively and inferentially. Results Before the intervention, 39,305 pregnant women and 2248 HIV-exposed infants were tested for HIV. After the intervention, the number of pregnant women tested increased to 127,005 and the number of HIV-exposed infants tested increased to 2490. Among pregnant women, the postintervention testing increased by 3.2-fold, with community birth centres reporting 63% of all tests. The intervention also resulted in an 11% increase in HIV-exposed infants benefitting from early infant diagnosis with community birth centres reporting 5% of all tests. Of those diagnosed with HIV, 24% of pregnant women and 12% of infants were diagnosed at community birth centres. Conclusion Community-based HIV testing for pregnant women can reduce mother-to-child transmission and improve early diagnosis and treatment of exposed infants. Collaboration with birth attendants is crucial to ensure testing opportunities are not missed. Prospective research is needed to understand the clinical outcomes of intervention programmes in the community.
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Cicero RV, Colaceci S, Amata R, Spandonaro F. Cost analysis of planned out-of-hospital births in Italy. Acta Biomed 2022; 93:e2022227. [PMID: 36043966 PMCID: PMC9534258 DOI: 10.23750/abm.v93i4.12923] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 04/13/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND AIM In Italy, the main birthplace is a hospital, and only a few women choose an out-of-hospital setting. This study assessed the costs related to delivery in different birthplaces in Italy. METHODS The cost analysis considered direct and amortizable costs associated with mother-child care in physiological conditions. An analysis of the hospital births considered the Diagnoses-Related Groups 373 and 391. To estimate the cost of the births assisted privately by freelance midwives, an evaluation based on an experts' opinion was carried out. RESULTS Childbirth hospital care in Italy amounts to € 1832.00, and birth in an out-of-hospital setting accredited with the National Health System has a full cost of € 1345.19 in the 'maternity home' and € 909.60 at home. The average cost of the birth in 'private maternity homes' amounted to € 3260.00, while at-home births amounted to € 2910.00. CONCLUSIONS Any accreditation of out-of-hospital settings by the NHS would considerably reduce the waste of economic resources compared to hospital childbirth.
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Affiliation(s)
- Roberta Vittoria Cicero
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy - Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy
| | - Sofia Colaceci
- Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy
| | - Rosanna Amata
- Department of Economics and Business, University of Catania, Catania, Italy
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Mehretie Adinew Y, Kelly J, Marshall A, Smith M. Care Providers' Perspectives on Disrespect and Abuse of Women During Facility-Based Childbirth in Ethiopia: A Qualitative Study. Int J Womens Health 2021; 13:1181-1195. [PMID: 34876861 PMCID: PMC8643202 DOI: 10.2147/ijwh.s333863] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 11/25/2021] [Indexed: 11/24/2022] Open
Abstract
Background It is increasingly evident that disrespect and abuse of women during facility-based childbirth is a violation of a woman’s rights and a deterrent to the use of life-saving maternity care. Understanding care providers’ perspectives of disrespect and abuse during facility-based childbirth is an essential element to aid in fully comprehending the problem and its underlying complexities. Objective To explore care providers’ perspectives of disrespect and abuse during facility-based childbirth. Methods This study used a qualitative descriptive design involving fifteen in-depth, semi-structured, interviews conducted between 5 October 2019 and 25 January 2020 in north Showa zone of Oromia region, central Ethiopia. Purposive sampling enabled health care professionals working in maternity units of health facilities who have direct involvement in care of women during pregnancy and labor to be recruited. Thematic analysis using Open Code software was used to explore the perspectives of participants. Results Four themes were identified. 1) Disrespect and abuse breaches professional standards, 2) Disrespectful and abusive actions are justified at times to save the mother and her baby, 3) Disrespect and abuse is used as a tool to assert power, and 4) Disrespect and abuse arise from health system deficiencies. Conclusion Disrespect and abuse is triggered by underlying beliefs about risk versus care, provider attitudes, stress and burnout, and health service structural issues including a lack of medicines and supplies. A number of strategies could improve the quality of maternity care, including training providers how to manage difficult and complex situations, addressing root causes of disrespect and abuse, and increasing access to resources.
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Affiliation(s)
- Yohannes Mehretie Adinew
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.,College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Amy Marshall
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Morgan Smith
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
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Abstract
Background Respectful maternity care is a fundamental human right, and an important component of quality maternity care. Objective The aim of this study was to quantify the frequency and categories of D&A and identify factors associated with reporting D&A among women in north Showa zone of Ethiopia. Method A cross-sectional study was conducted with 435 randomly selected women who had given birth at public health facility within the previous 12 months in North Showa zone of Ethiopia. A digital (tablet-based) structured and researcher administered tool was used for data collection. Frequencies of D&A items organised around the Bowser and Hill categories of D&A and presented in the White Ribbon Alliance’s Universal Rights of Childbearing Women Framework were calculated. Multivariable logistic regression was used to identify the association between experience of disrespect and abuse and interpersonal and structural factors at p-value <0.05 and odds ratio values with 95% confidence interval. Results All participants reported at least one form of disrespect and abuse during childbirth. Types of disrespect and abuse experienced by participants were physical abuse 435 (100%), non-consented care 423 (97.2%), non-confidential care 288 (66.2%), abandonment/neglect (34.7%), non-dignified care 126 (29%), discriminatory care 99 (22.8%) and detention 24 (5.5%). Hospital birth [AOR: 3.04, 95% CI: 1.75, 5.27], rural residence [AOR: 1.44, 95% CI: 0.76, 2.71], monthly household income less than 1,644 Birr (USD 57) [AOR: 2.26, 95% CI: 1.20, 4.26], being attended by female providers [AOR: 1.74, 95% CI: 1.06, 2.86] and midwifery nurses [AOR: 2.23, 95% CI: 1.13, 4.39] showed positive association with experience of disrespect and abuse. Conclusion Hospital birth showed consistent association with all forms of disrespect and abuse. Expanding the size and skill mix of professionals in the hospitals, sensitizing providers consequences of disrespect and abuse could promote dignified and respectful care.
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Affiliation(s)
- Yohannes Mehretie Adinew
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia.,College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia
| | - Helen Hall
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
| | - Amy Marshall
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
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Mehretie Adinew Y, Kelly J, Marshall A, Hall H. "I Would Have Stayed Home if I Could Manage It Alone": A Case Study of Ethiopian Mother Abandoned by Care Providers During Facility-Based Childbirth. Int J Womens Health 2021; 13:501-507. [PMID: 34079387 PMCID: PMC8163623 DOI: 10.2147/ijwh.s302208] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 05/04/2021] [Indexed: 11/24/2022] Open
Abstract
Background Every woman is entitled to respectful care during pregnancy and childbirth as a basic human right. However, not all women are being treated equally well. Case Presentation This case study highlights some of the common disrespectful practices that women face. This is a testimony of a 28-year-old mother of two, narrated in her own words. The data were collected during an in-depth interview in November 2019. The interview was conducted in her house and her name has been changed to protect her identity. The interview was audio-taped using a digital voice recorder, later transcribed, and translated verbatim from the local language – Amharic, to English. Conclusion This woman’s story highlights the unfortunate reality for some women. Five themes emerged from her narrative: denial of care: the provider left her unattended at a critical moment and denied her the care that she came for; non-consented care: she did not consent to the episiotomy; non-dignified care: she was carried by her arms and legs to the delivery couch, and left naked and bleeding on the couch after birth; taking a sick baby home without medical assistance: she was forced to leave the hospital even though her child had breathing difficulties and was not able to suck or breastfeed; and loss of trust in care providers: for her second birth this woman went to a facility where a relative works, as she no longer trusted these providers.
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Affiliation(s)
- Yohannes Mehretie Adinew
- College of Health Sciences and Medicine, Wolaita Sodo University, Sodo, Ethiopia.,Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Janet Kelly
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Amy Marshall
- Adelaide Nursing School, The University of Adelaide, Adelaide, Australia
| | - Helen Hall
- Monash Nursing and Midwifery, Monash University, Melbourne, Australia
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Pillai S, Cheyney M, Everson CL, Bovbjerg ML. Fetal macrosomia in home and birth center births in the United States: Maternal, fetal, and newborn outcomes. Birth 2020; 47:409-417. [PMID: 33058197 PMCID: PMC8923081 DOI: 10.1111/birt.12506] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 09/03/2020] [Accepted: 09/11/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Fetal macrosomia is associated with negative outcomes, although less is known about how severities of macrosomia influence these outcomes. Planned community births in the United States have higher rates of gestational age-adjusted macrosomia than planned hospital births, providing a novel population to examine macrosomia morbidity. METHODS Maternal and neonatal outcomes associated with grade 1 (4000-4499 g), grade 2 (4500-4999 g), and grade 3 (≥5000 g) macrosomia were compared to normal birthweight newborns (2500-3999 g), using data from the MANA Statistics Project-a registry of planned community births, 2012-2018 (n = 68 966). Outcomes included perineal trauma, postpartum hemorrhage, cesarean birth, neonatal birth injury, shoulder dystocia, neonatal respiratory distress, neonatal intensive care unit (NICU) stay >24 hours, and perinatal death. Logistic regressions controlled for parity and mode of birth, obesity, gestational diabetes, and preeclampsia. RESULTS Sixteen percent of the sample were grade 1 macrosomic, 3.3% were grade 2 macrosomic, and 0.4% were grade 3 macrosomic. Macrosomia grades 1-3 were associated in a dose-response fashion with higher odds of all outcomes, compared to non-macrosomia. The adjusted odds ratios and 95% confidence intervals for postpartum hemorrhage for grade 1, grade 2, and grade 3 macrosomia vs normal birthweight were 1.75 (1.56-1.96), 2.12 (1.70-2.63), and 5.18 (3.47-7.74), respectively. Other outcomes had similar patterns. DISCUSSION The adjusted odds of negative outcomes increase as grade of macrosomia increases in planned community births; results are comparable with the published literature. Pre-birth fetal weight estimation is imprecise; prenatal supports and shared decision-making processes should reflect these complexities.
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Affiliation(s)
- Sabrina Pillai
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
| | - Melissa Cheyney
- College of Liberal Arts, Oregon State University, Corvallis, OR, USA
| | - Courtney L. Everson
- College of Health and Human Sciences, Colorado State University, Fort Collins, CO, USA
| | - Marit L. Bovbjerg
- College of Public Health and Human Sciences, Oregon State University, Corvallis, OR, USA
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Bączek G, Tataj-Puzyna U, Sys D, Baranowska B. Freestanding Midwife-Led Units: A Narrative Review. Iran J Nurs Midwifery Res 2020; 25:181-188. [PMID: 32724762 PMCID: PMC7299417 DOI: 10.4103/ijnmr.ijnmr_209_19] [Citation(s) in RCA: 4] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 01/04/2020] [Accepted: 03/09/2020] [Indexed: 11/04/2022]
Abstract
Background Strengthening of midwives' position and support for freestanding birth centers, frequently referred to as Freestanding Midwife-led Units (FMUs), raise hopes for a return to humanized labor. Our study aimed to review published evidence regarding FMUs to systematize the knowledge of their functioning and to identify potential gaps in this matter. Materials and Methods A structured integrative review of theoretical papers and empirical studies was conducted. The literature search included MEDLINE, Cochrane, Scopus, and Embase databases. The analysis included papers published in 1977-2017. Relevant documents were identified using various combinations of search terms and standard Boolean operators. The search included titles, abstracts, and keywords. Additional records were found through a manual search of reference lists from extracted papers. Results Overall, 56 out of 107 originally found articles were identified as eligible for the review. Based on the critical analysis of published data, six groups of research problems were identified and discussed, namely, 1) specifics of FMUs, 2) costs of perinatal care at FMUs, 3) FMUs as a place for midwife education, 4) FMUs from midwives' perspective, 5) perinatal, maternal, and neonatal outcomes, and 6) FMUs from the perspective of a pregnant woman. Conclusions FMUs offers a home-like environment and complex midwifery support for women with uncomplicated pregnancies. Although emergency equipment is available as needed, FMU birth is considered a natural spontaneous process. Midwives' supervision over low-risk labors may provide many benefits, primarily related to lower medicalization and fewer medical interventions than in a hospital setting.
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Affiliation(s)
- Grażyna Bączek
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warszawa, Poland
| | - Urszula Tataj-Puzyna
- Department of Obstetrics and Gynecology Didactics, Medical University of Warsaw, Warszawa, Poland
| | - Dorota Sys
- Department of Reproductive Health, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw, Poland
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Coates R, Rocca-Ihenacho L, Olander E, Ayers S, Salmon D. A postgraduate Optimum Birth module to increase midwives' readiness to work in midwifery-led settings: A mixed-methods evaluation. Birth 2019; 46:533-539. [PMID: 30240045 DOI: 10.1111/birt.12399] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Revised: 08/27/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND Midwifery-led birth settings have been recommended as the most cost-effective birthplaces for healthy women experiencing uncomplicated pregnancies. However, midwives complete most of their training in obstetric units where birth interventions are common. To prepare for working in a midwifery-led setting training is a key priority. This study evaluated a postgraduate-level midwifery module on Optimum Birth (defined as birth which supports physiology and empowerment, avoiding unnecessary intervention) designed to prepare midwives for supporting women in midwifery-led settings. METHODS A mixed-methods design was employed. Pre-module and post-module questionnaires measured attitudes, knowledge, confidence, and learning outcomes. Qualitative data collection included a final-day focus group and 8- to 10-week follow-up interviews. The target for recruitment was 15 postgraduate midwives. Fifteen midwives practicing in three London boroughs enrolled of whom 14 completed the module. Pre-total and post-total scores were analyzed with paired-sample t tests. Qualitative data were analyzed using thematic analysis. RESULTS Quantitative and qualitative data indicated that the module increased participants' self-reported skills, knowledge, and confidence in practicing Optimum Birth. Qualitative data indicated ways in which midwives were implementing changes to promote Optimum Birth in their place of work. Attitudes were highly positive pre-module and post-module. CONCLUSIONS The Optimum Birth module provided appropriate training for preparing midwives for the shift toward working in midwifery-led settings. Midwifery leaders and managers should implement strategies to develop midwives' philosophy, knowledge, and skills to increase their readiness to work in midwifery-led birth settings.
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Affiliation(s)
- Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Lucia Rocca-Ihenacho
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Ellinor Olander
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Susan Ayers
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
| | - Debra Salmon
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, London, UK
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Reszel J, Sidney D, Peterson WE, Darling EK, Van Wagner V, Soderstrom B, Rogers J, Graves E, Khan B, Sprague AE. The Integration of Ontario Birth Centers into Existing Maternal-Newborn Services: Health Care Provider Experiences. J Midwifery Womens Health 2018; 63:541-549. [PMID: 30088845 PMCID: PMC6221115 DOI: 10.1111/jmwh.12883] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [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: 10/04/2017] [Revised: 05/16/2018] [Accepted: 05/24/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In 2014, 2 freestanding, midwifery-led birth centers opened in Ontario, Canada. The purpose of this study was to qualitatively investigate the integration of the birth centers into the local, preexisting intrapartum systems from the perspective of health care providers and managerial staff. METHODS Focus groups or interviews were conducted with health care providers (paramedics, midwives, nurses, physicians) and managerial staff who had experienced urgent and/or nonurgent maternal or newborn transports from a birth center to one of 4 hospitals in Ottawa or Toronto. A descriptive qualitative approach to data analysis was undertaken. RESULTS Twenty-four health care providers and managerial staff participated in a focus group or interview. Participants described positive experiences transporting women and/or newborns from the birth centers to hospitals; these positive experiences were attributed to the collaborative planning, training, and communication that occurred prior to opening the birth centers. The degree of integration was dependent on hospital-specific characteristics such as history, culture, and the presence or absence of midwifery privileging. Participants described the need for only minor improvements to administrative processes as well as the challenge of keeping large numbers of staff updated with respect to urgent transport policies. Planning and opening of the birth centers was seen as a driving force in further integrating midwifery care and improving interprofessional practice. DISCUSSION The collaborative approach for the planning and implementation of the birth centers was a key factor in the successful integration into the existing maternal-newborn system and contributed to improving integrated professional practice among midwives, paramedics, nurses, and physicians. This approach may be used as a template for the integration of other new independent health care facilities and programs into the existing health care system.
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Jolles DR, Langford R, Stapleton S, Cesario S, Koci A, Alliman J. Outcomes of childbearing Medicaid beneficiaries engaged in care at Strong Start birth center sites between 2012 and 2014. Birth 2017; 44:298-305. [PMID: 28850706 PMCID: PMC5873276 DOI: 10.1111/birt.12302] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 06/15/2017] [Accepted: 06/28/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Variations in care for pregnant women have been reported to affect pregnancy outcomes. METHODS This study examined data for all 3136 Medicaid beneficiaries enrolled at American Association of Birth Centers (AABC) Center for Medicare and Medicaid Innovation Strong Start sites who gave birth between 2012 and 2014. Using the AABC Perinatal Data Registry, descriptive statistics were used to evaluate socio-behavioral and medical risks, and core perinatal quality outcomes. Next, the 2082 patients coded as low medical risk on admission in labor were analyzed for effective care and preference sensitive care variations. Finally, using binary logistic regression, the associations between selected care processes and cesarean delivery were explored. RESULTS Medicaid beneficiaries enrolled at AABC sites had diverse socio-behavioral and medical risk profiles and exceeded quality benchmarks for induction, episiotomy, cesarean, and breastfeeding. Among medically low-risk women, the model demonstrated effective care variations including 82% attendance at prenatal education classes, 99% receiving midwifery-led prenatal care, and 84% with midwifery- attended birth. Patient preferences were adhered to with 83% of women achieving birth at their preferred site of birth, and 95% of women using their preferred infant feeding method. Elective hospitalization in labor was associated with a 4-times greater risk of cesarean birth among medically low-risk childbearing Medicaid beneficiaries. CONCLUSIONS The birth center model demonstrates the capability to achieve the triple aims of improved population health, patient experience, and value.
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Affiliation(s)
- Diana R. Jolles
- Nurse‐midwife El Rio Community Health CenterFaculty, Frontier Nursing UniversityTucsonAZUSA
| | | | - Susan Stapleton
- American Association of Birth Centers Perinatal Data RegistryPerkiomenvillePAUSA
| | | | - Anne Koci
- Texas Woman's UniversityHoustonTXUSA
| | - Jill Alliman
- American Association of Birth Centers Perinatal Data RegistryPerkiomenvillePAUSA
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Al-Assaf N, Moore H, Leifso K, Ben Fadel N, Ferretti E. Disseminated Neonatal Herpes Simplex Virus Type 1 After a Water Birth. J Pediatric Infect Dis Soc 2017; 6:e169-e172. [PMID: 28510692 DOI: 10.1093/jpids/pix035] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 04/20/2017] [Indexed: 11/13/2022]
Abstract
Neonatal herpes simplex virus (NHSV) infections are associated with significant morbidity and mortality. Numerous factors influence the transmission of HSV infection to newborns; however, immersion in water during labor has received very little attention as a possible risk factor despite the increasing popularity of water births. We report a case of disseminated NHSV type 1 infection, possibly acquired during a water birth. The purpose of this report is to alert healthcare providers to this potential route of transmission and to highlight the importance of screening guidelines for HSV before a water birth. Furthermore, it is essential to consider NHSV infection in any febrile infant who is not responding to standard empirical antibiotic management, even in the absence of herpetic lesions.
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Affiliation(s)
- Niazy Al-Assaf
- University of Ottawa, Department of Pediatrics, Division of Neonatology
| | - Heather Moore
- Children's Hospital of Eastern Ontario, Ottawa, Canada
| | - Kirk Leifso
- Queen's University, Department of Pediatrics, Kingston, Ontario, Canada
| | - Nadya Ben Fadel
- University of Ottawa, Department of Pediatrics, Division of Neonatology
| | - Emanuela Ferretti
- University of Ottawa, Department of Pediatrics, Division of Neonatology
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Furtado ÉZL, Gomes KRO, da Gama SGN. Access to childbirth care by adolescents and young people in the Northeastern region of Brazil. Rev Saude Publica 2016; 50:23. [PMID: 27253899 PMCID: PMC4902090 DOI: 10.1590/s1518-8787.2016050005396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 06/10/2015] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To identify the factors that interfere with the access of adolescents and young people to childbirth care for in the Northeast region of Brazil. METHODS Cross-sectional study with 3,014 adolescents and young people admitted to the selected maternity wards to give birth in the Northeast region of Brazil. The sample design was probabilistic, in two stages: the first corresponded to the health establishments and the second to women who had recently given birth and their babies. The data was collected by means of interviews and consulting the hospital records, from pre-tested electronic form. Descriptive statistics were used for the univariate analysis, Pearson's Chi-square test for the bivariate analysis and multiple logistic regressions for the multivariate analysis. Sociodemographic variables, obstetrical history, and birth care were analyzed. RESULTS Half of the adolescents and young people interviewed had not been given guidance on the location that they should go to when in labor, and among those who had, 23.5% did not give birth in the indicated health service. Furthermore, one third (33.3%) had to travel in search of assisted birth, and the majority (66.7%) of the postpartum women came to maternity by their own means. In the bivariate analysis, the variables marital status, paid work, health insurance, number of previous pregnancies, parity, city location, and type of health establishment showed a significant association (p < 0.20) with inadequate access to childbirth care. The multivariate analysis showed that married adolescents and young people (p < 0.015), with no health insurance (p < 0.002) and from the countryside (p < 0.001) were more likely to have inadequate access to childbirth care. CONCLUSIONS Adolescents and young women, married, without health insurance, and from the countryside are more likely to have inadequate access to birth care. The articulation between outpatient care and birth care can improve this access and, consequently, minimize the maternal and fetal risks that arise from a lack of systematic hospitalization planning.
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Affiliation(s)
| | - Keila Rejane Oliveira Gomes
- Programa de Pós-Graduação em Ciências e Saúde. Centro de Ciências da Saúde. Universidade Federal do Piauí. Teresina, PI, Brasil
| | - Silvana Granado Nogueira da Gama
- Programa de Pós-Graduação em Epidemiologia em Saúde Pública. Escola Nacional de Saúde Pública. Fundação Oswaldo Cruz. Rio de Janeiro, RJ, Brasil
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Permezel M, Milne KJ. Pregnancy outcome at term in low-risk population: study at a tertiary obstetric hospital. J Obstet Gynaecol Res 2015; 41:1171-7. [PMID: 25832990 DOI: 10.1111/jog.12695] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 06/04/2014] [Revised: 12/28/2014] [Accepted: 01/13/2015] [Indexed: 11/30/2022]
Abstract
AIM The aim of this study was to evaluate the risk of perinatal death and peripartum morbidity at term amongst the models of care at a single tertiary hospital. MATERIAL AND METHODS This is a 10-year population study of singleton births at term at the Mercy Hospital for Women comparing the mixed-risk models of care (private obstetrician and a conventional collaborative model of obstetricians and midwives) with the low-risk models (team midwifery and family birth center). Outcome measures included rates of perinatal death, low Apgar scores and obstetric procedures. RESULTS Data on 44 557 normal term singletons were available for study. Overall, the hospital has a substantially lower term singleton perinatal mortality (1.3/1000) than the reported rate from the state of Victoria over an overlapping period (2.4/1000). The perinatal mortality amongst women selected for low obstetric risk (2.3/1000) was significantly higher than the perinatal mortality in other patients (1.2/1000; P = 0.03). Low Apgar scores at 5 min were also significantly more likely in women selected for low obstetric risk (9.0 vs 6.7/1000; P = 0.03). The differences could not be attributed to socioeconomic status, as this was higher in the low obstetric risk group. Obstetric procedures (induction of labor, cesarean section and instrumental birth) were substantially less common in the low-risk-care patients, as is expected for a low-risk population. CONCLUSION Women selected for low-risk under midwife-led models of care do not appear to have better outcomes than women with all levels of perinatal risk cared for under traditional obstetrician-led models of care.
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Affiliation(s)
- Michael Permezel
- Department of Obstetrics and Gynaecology, University of Melbourne.,Mercy Hospital for Women, Melbourne, Victoria, Australia
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Abstract
The objective of this study was to describe nulliparas' reasons for the type of provider (i.e., midwife, physician) and childbirth setting (i.e., home, hospital, hospital-based birth center) that respondents expected for their births. Data were collected via a cross-sectional, descriptive, self-administered, Web-based survey including both close- and open-ended questions and were analyzed using conventional content analysis. Respondents were 220 nulliparous women aged 18-40 years, living in the United States, and pregnant at 20 or fewer weeks' gestation. Women's reasons were categorized broadly as relating to provider/setting attributes, relationship with provider/setting, normative choices, respondent attributes, and practical considerations. Respondents' reasons highlight misconceptions about childbirth care options, especially regarding midwifery and nonhospital settings, which may be addressed by childbirth education.
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Gunnarsson B, Smárason AK, Skogvoll E, Fasting S. Characteristics and outcome of unplanned out-of-institution births in Norway from 1999 to 2013: a cross-sectional study. Acta Obstet Gynecol Scand 2014; 93:1003-10. [PMID: 25182192 DOI: 10.1111/aogs.12450] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [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: 09/26/2013] [Accepted: 06/25/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. DESIGN Register-based cross-sectional study. POPULATION All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. METHODS Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). RESULTS The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. CONCLUSIONS Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital.
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Affiliation(s)
- Björn Gunnarsson
- Norwegian Air Ambulance Foundation, Drøbak, Norway; Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Deline J, Varnes-Epstein L, Dresang LT, Gideonsen M, Lynch L, Frey JJ. Low primary cesarean rate and high VBAC rate with good outcomes in an Amish birthing center. Ann Fam Med 2012; 10:530-7. [PMID: 23149530 PMCID: PMC3495927 DOI: 10.1370/afm.1403] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin. METHODS We undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010. RESULTS The cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000). CONCLUSIONS Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates.
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