Effects of skin-to-skin contact and breastfeeding at birth on the incidence of PPH: A physiologically based theory

BackgroundThe importance of optimising maternal/baby psychophysiology has been integrated into contemporary midwifery theories but not in the detail required to really understand the underpinning biological basis.MethodThe functioning of the autonomic nervous system, as it relates to the uterus is reviewed. The physiology of myometrial cell contraction and relaxation is outlined. The main focus is on the factors that affect the availability and uptake of oxytocin and adrenaline/noradrenaline in the myometrial cells. These are the two key neuro-hormones, active in the 3rd and 4th stages of labour, that affect uterine contraction and retraction and therefore determine whether the woman will have an atonic PPH or not.DiscussionThe discussion explains and predicts the physiological functioning of the uterus during the 3rd and 4th stages of labour when skin-to-skin contact and breastfeeding occurs and when it does not.ConclusionThis biologically based theory hypothesises that to achieve and maintain eutony and eulochia, midwives and birthing women should ensure early, prolonged and undisturbed skin-to-skin contact for mother and baby at birth including easy access for spontaneous breastfeeding.     

The importance of delayed cord clamping for Aboriginal babies: a life-enhancing advantage

Third stage management has typically focused on women and postpartum haemorrhage. Clamping and cutting the umbilical cord following the birth of the baby has continued to be a routine part of this focus. Active versus physiological management of third stage is generally accepted as an evidence-based plan for women to avoid excessive blood loss. Other considerations around this decision are rarely considered, including the baby's perspective. This paper provides a review of the literature regarding timing of clamping and cutting of the umbilical cord and related issues, and discusses the consequences for babies and in particular *Aboriginal babies. Iron stores in babies are improved (among other important advantages) if the cord is left to stop pulsating for 3 min before being clamped. Such a simple measure of patience and informed practice can make a long lasting difference to a baby's health and for Aboriginal babies this advantage can be critical in the short and the long term for their development and wellbeing. To achieve much needed reductions in infancy anaemia and essential increases in infant survival, delayed cord clamping and cutting is recommended for all Aboriginal babies.     

The influence of the birthplace and models of care on midwifery practice for the management of women in labour

This paper will examine how the settings in which midwives practice (the birthplace) and models of care affect midwives’ decision making during the management of labour. One-hundred-and-four independent, team and hospital based midwives and 100 low obstetric risk nulliparous women to whom labour care was provided were surveyed. These midwives and women resided in the Auckland metropolitan area of New Zealand. The majority of midwives who participated worked in models of care which provided women with continuity of carer and care, however, this was not found to influence the way the midwives provided labour care. Instead, practice was found to be relatively homogenous regardless of whether the midwives worked in independent, team, or hospital-based practice. The birthplace setting in which the labour care took place did influence midwifery practice. The majority of midwives provided labour care in large obstetric hospitals and identified practices dominated by the medical model of care. Practice was described as being influenced by intervention and the need for technology, however, this did not prevent the majority of women from perceiving they were actively involved in the decision making process and that they worked in partnership with their midwives. Closer examination of the midwives’ decision making processes whilst providing the labour care revealed that the midwives’ individual decisions were influenced by the needs of the women rather than the hospital protocols. What became evident was that the midwives in this study had adopted a humanistic approach to care whereby technology was used alongside relationship-centred care.     

Born in another country: Women's experience of labour and birth in Queensland,Australia

BackgroundWomen born outside Australia make up more than a fifth of the Queensland birthing population and like migrants in other parts of the world face the challenges of cultural dislocation and possible language barriers. Recognising that labour and birth are major life events the aim was to investigate the experiences of these women in comparison to native-born English speaking women.MethodsSecondary analysis of data from a population based survey of women who had recently birthed in Queensland. Self-reported clinical outcomes and quality of interpersonal care of 481 women born outside Australia who spoke a language other than English at home were compared with those of 5569 Australian born women speaking only English.ResultsAfter adjustment for demographic factors and type of birthing facility, women born in another country were less likely to be induced, but more likely to have constant electronic fetal monitoring (EFM), to give birth lying on their back or side, and to have an episiotomy. Most women felt that they were treated as an individual and with kindness and respect. However, women born outside Australia were less likely to report being looked after ‘very well’ during labour and birth and to be more critical of some aspects of care.ConclusionIn comparing the labour and birth experiences of women born outside the country who spoke another language with native-born English speaking women, the present study presents a largely positive picture. However, there were some marked differences in both clinical and interpersonal aspects of care.     

The impact of COVID-19 on the provision of respectful maternity care: Findings from a global survey of health workers

BackgroundSignificant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care.AimTo explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally.MethodsWe conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses.FindingsHealth workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission.DiscussionMultidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term.ConclusionsThe measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.     

Impact of acupressure on onset of labour and labour duration: A systematic review

BackgroundThere is worldwide concern with increasing rates of pharmacologically induced labour and operative birth. Many women would like to avoid medical or surgical interventions in childbirth; a desire that may contribute towards the popularity of complementary and alternative medicine/therapies.MethodThis systematic review examines the effects of acupressure on labour onset and duration of labour. We searched MEDLINE, CINAHL, AMED, Cochrane Collaboration, and Science Direct from 1999 to 2013 for published randomised controlled trials and controlled trials comparing acupressure with placebo and no treatment. Studies recruited primiparous and/or multiparous women with either spontaneous or induced onset of labour. The outcome measures were labour onset and duration of all stages of labour.FindingsSeven trials with data reporting on 748 women using different acupressure points and methods of administration were included in the review. One study examined the initiation of labour and six studies examined labour duration and/or pain levels. The two most studied acupoints were Sanyinjiao/Spleen 6 and Hegu/Large Intestine 4. Results suggest acupressure may reduce the length of labour particularly in the first stage.ConclusionFurther research is required on whether acupressure can shorten labour duration, augment prolonged labour or initiate onset of labour by stimulating uterine contractions. Clinical trials should report the basis for acupressure treatment described in the STRICTA (minus needling) and CONSORT non-pharmaceutical guidelines.     

Veiled midwifery in the baby factory — A grounded theory study

Background

Midwives’ professional role has been changing drastically over time, from handling births in home settings to being part of a team in labour wards in hospitals. This demands a greater effort of interprofessional collaboration in childbirth care.

Key indicators influencing management of prolonged second stage labour by midwives in freestanding birth centres: Results from an ethnographic interview study

ProblemsComplications for newborns and postpartum clients in the hospital are more frequent after a prolonged second stage of labour. Midwives in community settings have little research to guide management in their settings.AimWe explored how US birth centre midwives identify onset of second stage of labour and determine when to transfer clients to the hospital for prolonged second stage.MethodsEthnographic interviews of midwives with at least 2 years’ experience in birth centres and participant observation of birth centre care.FindingsWe interviewed 21 midwives (18 CNMs, 3 CPMs/equivalent) from 18 birth centres in 11 US states, 45% with hospital practice privileges. Midwives relied on and engaged in embodied practice in evaluating each labour and making decisions concerning management of labour. Midwives considered time a useful but limited measure as a guiding factor in management. Though ideas of time and progress do play an important role in the decision-making process of midwives, their usefulness is limited due to the continual, multifactorial, and multisensory nature of the assessment. Relationship with the transfer hospital structured midwives’ decision-making about transfers.Discussion & conclusionThese findings can inform future robust multivariate evaluation of factors, including but not limited to time, in guidelines for management of second stage of labour. Optimal management may require formal consideration of more than just time and parity. Our findings also suggest the need for evaluation of how structural issues involving hospital privileges for midwives and relationships between birth centre and hospital staff affect the well-being of childbearing families.     

The Extent of Economic Vulnerability in the Canadian Labour Market and Federal Jurisdiction: Is There a Role for Labour Standards?

This paper characterizes vulnerable workers in Canada and the federal jurisdiction, based upon characteristics such as employment status, demographic characteristics, and job characteristics, and identifies areas in which labour standards may have a role. Based on this analysis, the paper evaluates the potential for labour standards to address economic vulnerability, focusing on labour standards policies aimed at wages and benefits, hours, and employment arrangements. In addition, the analysis considers the extent to which labour standards are likely to reach vulnerable workers. The results suggest several potential roles for labour standards and highlights policy implications.

劳动力迁移对收入分配的影响研究——以重庆市为例

劳动力迁移对收入分配影响的实证研究,可以度量我国劳动力迁移对收入水平提高程度和收入分配不均等程度,证实劳动力迁移可以大大提高迁移劳动力的收入水平,对于缩小地区、城乡之间以及不同人口特征的收入分配差距具有积极作用,稳定有序的劳动力迁移对于经济社会持续发展提供动力。     

新经济地理学视角下的劳动力跨省转移机制研究--以长三角城市群为例

新经济地理学理论认为劳动力出于商品多样性偏好和节约商品运输成本的目的集聚于厂商集聚的地区。文章以长三角城市群为例,利用第六次人口普查数据和NEG模型研究了劳动力流动跨省迁移的影响因素,着重考察了市场潜能对劳动力跨省迁移的作用。研究发现：市场潜能对劳动力跨省迁移有显著的正向效应,从而证明了新经济地理学的“前向联系”;地理距离对劳动力跨省迁移有弱化效应,但没有通过显著性检验;工资水平、就业率、边界效应对劳动力跨省迁移有显著的正向效应。     

上海从业劳动力分布变动与城市空间重构

本文主要根据上海市1996年和2001年两次基本单位普查基于工作地的从业劳动力数据,采用GIS技术和模型分析方法,系统地考察了1996~2001年间上海从业劳动力的空间分布及其变动特征,发现上海从业劳动力分布总体上呈都心区密度最高、由此向外依次降低的基本模式,以及都心区密度下降、周边地区上升、从业劳动力由都心区逐步向周边地区扩散的均衡化变动趋势。但第二、三产业从业劳动力的分布变动有所不同,第二产业主要表现为由中心城区向郊区扩散的较大范围的单向均衡化变动,第三产业则表现为在距离市中心15公里圈内由都心区向其边缘区扩散、15公里圈以外地区特别是远郊区则反呈趋向中心城区的集中化变动。从业劳动力的这种空间分布模式及其变动趋势基本符合大城市空间发展的一般规律,也有利于上海可持续城市空间的重构。     

Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions

AimTo determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth.MethodsThis single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or “show”. The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann–Whitney and Chi–square tests. The level of statistical significance was set as p < 0.05.FindingThere were significant differences between the intervention and control groups in the number of caesarian section (CS) (p < 0.001). Two groups had a statistically significant difference in amniotomy (p = 0.003), augmentation by oxytocin (p < 0.001), number of vaginal examinations (p < 0.001) and fundal pressure (p < 0.001).ConclusionsUsing a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.     

非农劳动力迁移特征与影响因素分析——基于重庆的实证研究

我国的劳动力迁移问题一直是宏观经济中的一个重要问题。由于二元经济结构是中国不可回避的国情,对于农业劳动力向非农业转移的研究较多。但随着经济体制改革和市场化的进一步发展,非农业劳动力在空间上的迁移也越来越普遍。文章通过对2005年全国1%人口抽样调查中重庆市的抽样调查数据进行统计分析,描述了非农劳动力迁移的人口特征,同时基于LOGISTIC回归方程方法,研究了非农业劳动力迁移的影响因素。结果表明非农劳动力的年龄、性别、受教育程度和单位性质对迁移意愿都有显著的影响,并且与农业劳动力的迁移影响因素存在差异。     

The impact of the labour market on the timing of marriage and births in Spain

This paper investigates how education and the labour market affect Spanish individual decisions on the timing of marriage and births, using a Cox hazard approach. It disentangles men and women, and two groups, Cohort 1945–1960 and Cohort 1961–1977. Results show that female employment delays marriage in Cohort 1945–1960, but it has a reverse effect in Cohort 1961–1977. We also find evidence that employment is a barrier for family formation since employed women postpone births in both cohorts. The precarious Spanish labour markets, captured by female unemployment rates, delay family formation, especially by putting off marriage. Male unemployment, at the individual level, impacts negatively on fertility only through delaying marriage.

Labour mobility and regional disparities: the role of female labour participation

Unemployment rates, as well as income per capita, differ vastly across the regions of Europe. Labour mobility can play a role in resolving regional disparities. This paper focuses on the questions of why labour mobility is low in the EU and how it is possible that it remains low. We explore whether changes in male and female labour participation act as an important alternative adjustment mechanism. We answer this question in the affirmative. We argue that female labour participation is very important in adjusting to regional disparities.