Subsequent child protection contact for a cohort of children reported to child protection prenatally in one Australian jurisdiction

Repeated reporting to child protection is common. One approach to early intervention is for jurisdictions to receive and respond to child protection concerns raised before children are born. Despite this, little research has comprehensively examined subsequent child protection contact for those first reported prenatally. This study aimed to examine the subsequent child protection contact for up to a two-year period for a cohort of children who were reported about prebirth. Child protection administrative data were extracted for 640 children reported for a concern about an unborn child in a single jurisdiction during 2014. Data about child protection contacts included reports, investigations, substantiations and out-of-home placements for children reported prenatally. Of the 640 children, 79% reported about prenatally also had contact with child protection between birth and age two. From birth and up to age two, children reported prenatally had between zero and 21 reports. Twenty-two per cent of the children reported prenatally were removed from their birth parents and placed in out-of-home care prior to age two. These findings highlight the importance of intervening and supporting families prior to and during pregnancy to reduce harm to children and reduce the need for contact with child protection.     

Red flags for episiotomy in a midwife-led birth: Using co-production with midwives to capture clinical experience

BackgroundOne of four key points in the Obstetric Anal Sphincter Injury Care Bundle, first piloted in the UK in 2016, was the directive to perform episiotomy when clinically indicated. Midwives are the primary health care professional for straightforward births in the UK and there is very little published literature that relates to their practice in this area.AimThe aim of the study was to explore experienced midwives’ decision-making processes in their assessments for episiotomy during birth.Methods43 midwives self-identifying as confident in performing episiotomy were sampled across 8 NHS Trusts in England and Wales. Data collection was via online focus groups and 1:1 interviews. Primary thematic analysis was undertaken by the research team. Preliminary themes were used to structure a co-production analysis workshop where eight experienced midwives undertook a secondary analysis of the data resulting in four overall themes.FindingsFour themes were identified, ‘Optimising Perineal Function’, ‘Red Flags to Stimulate Decision-Making’, ‘The Midwives’ Episiotomy’ and ‘Infiltration as a Catalyst for Birth’.DiscussionMidwives use a number of visual, auditory and touch cues to inform their assessments for episiotomy during birth.ConclusionThis study provides valuable insight into the cues that guide experienced midwives’ decision-making in relation to episiotomy and contributes evidence related to performing episiotomy when clinically indicated in spontaneous vaginal birth.     

Midwifery continuity of care and vaginal birth after caesarean section: A randomised controlled trial

Problem and backgroundCaesarean section (CS) rates in Australia and many countries worldwide are high and increasing, with elective repeat caesarean section a significant contributor.AimTo determine whether midwifery continuity of care for women with a previous CS increases the proportion of women who plan to attempt a vaginal birth in their current pregnancy.MethodsA randomised controlled design was undertaken. Women who met the inclusion criteria were randomised to one of two groups; the Community Midwifery Program (CMP) (continuity across the full spectrum — antenatal, intrapartum and postpartum) (n = 110) and the Midwifery Antenatal Care (MAC) Program (antenatal continuity of care) (n = 111) using a remote randomisation service. Analysis was undertaken on an intention to treat basis. The primary outcome measure was the rate of attempted vaginal birth after caesarean section and secondary outcomes included composite measures of maternal and neonatal wellbeing.FindingsThe model of care did not significantly impact planned vaginal birth at 36 weeks (CMP 66.7% vs MAC 57.3%) or success rate (CMP 27.8% vs MAC 32.7%). The rate of maternal and neonatal complications was similar between the groups.ConclusionModel of care did not significantly impact the proportion of women attempting VBAC in this study. The similarity in the number of midwives seen antenatally and during labour and birth suggests that these models of care had more similarities than differences and that the model of continuity could be described as informational continuity. Future research should focus on the impact of relationship based continuity of care.     

Experiences and outcomes on the use of telemetry to monitor the fetal heart during labour: findings from a mixed methods study

BackgroundWireless continuous electronic fetal monitoring (CEFM) using telemetry offers potential for increased mobility during labour. United Kingdom national recommendations are that telemetry should be offered to all women having CEFM during labour. There is limited contemporary evidence on experiences of telemetry use or impacts it may have.AimTo gather in-depth knowledge about the experiences of women and midwives using telemetry, and to assess any impact that its use may have on clinical outcomes, mobility in labour, control or satisfaction.MethodsA convergent parallel mixed-methods study was employed. Grounded theory was adopted for interviews and analysis of 13 midwives, 10 women and 2 partners. Satisfaction, positions during labour and clinical outcome data was analysed from a cohort comparing telemetry (n = 64) with wired CEFM (n = 64). Qualitative and quantitative data were synthesised to give deeper understanding.FindingsWomen using telemetry were more mobile and adopted more upright positions during labour. The core category A Sense of Normality encompassed themes of ‘Being Free, Being in Control’, ‘Enabling and Facilitating’ and ‘Maternity Unit Culture’. Greater mobility resulted in increased feelings of internal and external control and increased perceptions of autonomy, normality and dignity. There was no difference in control or satisfaction between cohort groups.ConclusionsWhen CEFM is used during labour, telemetry provides an opportunity to improve experience and support physiological capability. The use of telemetry during labour contributes to humanising birth for women who have CEFM and its use places them at the centre and in control of their birth experience.     

The impact of perinatal healthcare changes on birth trauma during COVID-19

BackgroundSince the onset of COVID-19, giving birth has involved navigating unprecedented healthcare changes that could significantly impact the psychological birth experience.AimResearch has demonstrated increasing rates of birth trauma and birth plan alterations during the COVID-19 pandemic. This study specifically examined these intersecting experiences to understand how COVID-related healthcare changes have impacted birth trauma during the pandemic.Methods269 people who gave birth in the U.S. during COVID-19 completed an online survey between November, 2020-May, 2021 which included questions about COVID-related perinatal healthcare changes and birth-related posttraumatic stress disorder (PTSD; The City Birth Trauma Scale). T-tests were run on birth demographics to assess for significant indicators of PTSD; variables having significant effects were used to build a hierarchical regression model to predict PTSD symptoms.Findings5.9% of the sample met criteria for PTSD and 72.3% met partial criteria. The overall regression model predicted approximately 19% of variance in total PTSD symptoms. Labor and birth demographics were entered in Step 1 and predicted approximately 11% of variance: limited length of stay for support person, being allowed 1 support person who had to be the same, and mask requirements were significant predictors of PTSD. Variables related to birth plan changes were entered in Step 2 and predicted approximately 8% of variance: changes to support person(s) for labor and birth, breastfeeding plans, and birth location were significant predictors of PTSD.ConclusionThe present study demonstrates the importance of COVID-related perinatal healthcare changes to the development of trauma symptoms following childbirth.     

谁主认同？转型时期中国女性阶层地位认同的多重建构及其世代变迁

女性的阶层地位认同研究近年来受到广泛关注，但缺乏多重建构视角下基于长期转型背景的世代变迁分析。本文旨在回答两个重要问题：第一，已婚女性的阶层地位认同是否受到婚姻匹配与代际流动的影响，丈夫、父亲与女性自身的客观阶层及其差异如何影响女性的主观地位认同；第二，上述影响模式如何随出生世代发生变化。在使用对角线参照模型分析中国综合社会调查（CGSS）2010—2017年的合并数据后发现：相较于自身的客观阶层，中国已婚女性整体上倾向于以丈夫的客观阶层来建构自身的阶层认同，但越年轻的世代这一倾向越弱；父亲客观阶层的影响则与自身客观阶层的影响并重，甚至随世代变迁略有增强。上述结果体现了中国特色的家庭现代化模式，即已婚女性虽愈少依赖于配偶，但依然与原生家庭保持着紧密连结。     

Factors that influence women’s decision on infant feeding: An integrative review

BackgroundMany women stop breastfeeding earlier than what they intended prior to birth. Although there are many studies that focus on the factors that influence women’s antenatal breastfeeding decisions, the factors that influence women’s decisions during the continuum of antenatal and postnatal period are less known.AimTo understand and synthesise the contemporary factors that influence women’s decisions on infant feeding from the antenatal period and across the breastfeeding continuum.MethodFive online databases (CINAHL, Medline, PubMed, Scopus and Web of Science) were searched. We included original search articles that were published since 2015 to August 2021 and were available in English. The framework of Whittemore and Knafl was used to guide this integrative literature review. Out of the 872 articles identified, 14 studies met the inclusion criteria of our study. We used theory of birth territory and midwifery guardianship to synthesise the interactions between the themes.FindingsFive main themes were identified: (a) Women’s own views, (b) Family and friend’s preferences and advice, (c) Health professional’s preference, advice and practice, (d) Sociocultural norms, and (e) Media representation. The interaction between the themes was explained based on women’s intrinsic and extrinsic power outlined in the birth territory and midwifery guardianship theory.ConclusionThe factors that influence women’s decisions towards infant feeding methods are complex and multi-dimensional. Promoting and supporting women towards breastfeeding need to focus on the factors that are tailored for a woman within her social network where she can feel safe about her breastfeeding decisions.     

The impacts of the COVID-19 pandemic on birth satisfaction in a prospective cohort of 2,341 U.S. women

ProblemBirth satisfaction is an important health outcome that is related to postpartum mood, infant caretaking, and future pregnancy intention.BackgroundThe COVID-19 pandemic profoundly affected antenatal care and intrapartum practices that may reduce birth satisfaction.AimTo investigate the extent to which pandemic-related factors predicted lower birth satisfaction.Methods2341 women who were recruited prenatally in April–May 2020 and reported a live birth between April–October 2020 were included in the current analysis. Hierarchical linear regression to predict birth satisfaction from well-established predictors of birth satisfaction (step 1) and from pandemic-related factors (step 2) was conducted. Additionally, the indirect associations of pandemic-related stress with birth satisfaction were investigated.FindingsThe first step of the regression explained 35% of variance in birth satisfaction. In the second step, pandemic-related factors explained an additional 3% of variance in birth satisfaction. Maternal stress about feeling unprepared for birth due to the pandemic and restrictions on companions during birth independently predicted lower birth satisfaction beyond the non-pandemic variables. Pandemic-related unpreparedness stress was associated with more medicalized birth and greater incongruence with birth preference, thus also indirectly influencing birth satisfaction through a mediation process.DiscussionWell-established contributors to birth satisfaction remained potent during the pandemic. In addition, maternal stress and restriction on accompaniment to birth were associated with a small but significant reduction in birth satisfaction.ConclusionStudy findings suggest that helping women set flexible and reasonable expectations for birth and allowing at least one intrapartum support person can improve birth satisfaction.     

Lived experiences of the partners of COVID-19 positive childbearing women: A qualitative study

ProblemSeveral maternity units worldwide have rapidly put in place changes to maternity care pathways and restrictive preventive measures in the attempt to limit the spread of COVID-19, resulting in birth companions often not being allowed to be present at birth and throughout hospital admission.BackgroundThe WHO strongly recommends that the emotional, practical, advocacy and health benefits of having a chosen birth companion are respected and accommodated, including women with suspected, likely or confirmed COVID-19.AimTo explore the lived experiences of the partners of COVID-19 positive childbearing women who gave birth during the first pandemic wave (March and April 2020) in a Northern Italy maternity hospital.MethodsA qualitative study using an interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 14 partners. Thematic data analysis was conducted using NVivo software. Ethical approval was obtained from the relevant Ethics Committee prior to commencing the study.FindingsThe findings include five main themes: (1) emotional impact of the pandemic; (2) partner and parent: a dual role; (3) not being present at birth: a ‘denied’ experience; (4) returning to ‘normality’; (5) feedback to ‘pandemic’ maternity services and policies.Discussion and conclusionKey elements of good practice to promote positive childbirth experiences in the context of a pandemic were identified: presence of a birth companion; COVID-19 screening tests for support persons; timely, proactive and comprehensive communication of information to support persons; staggered hospital visiting times; follow-up of socio-psychological wellbeing; antenatal and postnatal home visiting; family-centred policies and services.