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.     

应当重新确认孙思邈的出生年份

由于《四库全书总目提要》对孙思邈出生之年的误判,导致孙氏晚生40年。实际上孙思邈在与卢照邻的讲话中已提供了他生年的干支,也就是隋文帝的出生之年——开皇辛酉(公元541年)。重新认定孙思邈的出生之年,不仅是单纯的学术研究,它还具有很强的社会现实意义。     

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.     

Giving HOPE and minimising trauma: An intervention to support women who are separated from their babies at birth due to safeguarding concerns

Whatever the circumstances, the separation of infants from their mothers at birth is a traumatic experience for all concerned. The paper reports on a study designed to improve practice in this highly sensitive area. An analysis of data collected through semi-structured interviews with 38 mothers who had experienced removal at birth identified four common themes: isolation and unacknowledged support needs; shame, stigma and the failure of others to acknowledge their maternal identity; acute trauma, immediate downturn and disenfranchised grief following infant removal; and strategies to mitigate their pain and grief. These last themes included the use of artefacts both as transitional objects to help mothers come to terms with the permanent loss of a baby, and as a means of keeping maternal identity alive and connecting with an infant who might eventually return home. In response to these findings, and in collaboration with a group of women with lived experience, HOPE boxes were designed to ameliorate the trauma and psychological burden borne by women in this situation. The contents of the boxes have been chosen to reflect the changing experiences of the women's journeys but also the range of possible potential outcomes. The intervention has considerable potential to minimise the trauma of this painful experience.     

Child protection pathways for newborn infants: A multi-disciplinary retrospective chart review of an Irish maternity hospital’s records

In Ireland, little is known about mothers and infants where child welfare and protection concerns arise during the perinatal period. This study explores, for the first time, perinatal child protection. A retrospective audit was carried out of a large maternity hospital's medical social work, neonatal and psychiatric files for a five-year period from 2016 to 2020. The study identified 99 children, born to 86 mothers, who were either subject to a child protection conference; placed for adoption; discharged to someone other than the mother; or discharged home under supervision. The study found that two-thirds of the children were discharged to their mother's care. When compared to national data, the health indicators for this cohort of mothers and children painted a grim picture. The maternal profiles identified high prevalence of mental health and addiction difficulties and domestic violence. The study found evidence of supports provided to the mothers to enable them to care for their infants while they remained in the hospital and during an initial discharge from hospital. However, a significant number of the mothers were not caring for their children when viewed across a longer time frame. Dedicated multi-disciplinary clinics and improved data systems were identified as of importance.     

The role of experts in forming family policy under an adversarial subsystem in the Czech Republic

This article analyzes the interplay between policymakers and scientists in developing the Family Policy Plan for the Czech Republic in 2017. As former members of the government commission that developed the plan, we base the article on participatory observation. When we joined the commission, a ‘window of opportunity’ had opened as the country for the first time ever had feminist-friendly minister and vice-minister of labour and social affairs. We explain why due to the inter- and intra-party dynamics, the parental leave reform to introduce ‘daddy months’ failed. We argue an adversarial subsystem existed in that the three coalition partners disagreed on the reform. According to Ingold and Gschwend (2014), under such circumstances, scientists play a strategic role, especially if there is unity among them. However, although there was basic unity among the scientists in the commission, the coalition partners at the governing level were able to block or water down the reform proposal under the study.     

Does midwifery continuity of care make a difference to women with perinatal mental health conditions: A cohort study,from Australia

BackgroundPerinatal mental health (PMH) conditions are associated with an increased risk of adverse perinatal outcomes including preterm birth. Midwifery caseload group practice (continuity of care, MCP) improves perinatal outcomes including a 24 % reduction of preterm birth. The evidence is unclear whether MCP has the same effect for women with perinatal mental health conditions.AimTo compare perinatal outcomes in women with a mental health history between MCP and standard models of maternity care. The primary outcome measured the rates of preterm birth.MethodsA retrospective cohort study using routinely collected data of women with PMH conditions between 1st January 2018 – 31st January 2021 was conducted. We compared characteristics and outcomes between groups. Multivariate logistic regression models were performed adjusting for a-priori selected variables and factors that differ between models of care.ResultsThe cohort included 3028 women with PMH, 352 (11.6 %) received MCP. The most common diagnosis was anxiety and depression (n = 723, 23.9 %). Women receiving MCP were younger (mean 30.9 vs 31.3, p = 0.03), Caucasian (37.8 vs 27.1, p < 0.001), socio-economically advantaged (31.0 % vs 20.2, p < 0.001); less likely to smoke (5.1 vs 11.9, p < 0.001) and with lower BMI (mean 24.3 vs 26.5, p < 0.001) than those in the standard care group. Women in MCP had lower odds of preterm birth (adjOR 0.46, 95 % CI 0.24–0.86), higher odds of vaginal birth (adjOR 2.55, 95 % CI 1.93–3.36), breastfeeding at discharge (adj OR 3.06, 95 % CI 2.10–4.55) with no difference in severe adverse neonatal outcome (adj OR 0.79, 95 % CI 0.57–1.09).ConclusionsThis evidence supports MCP for women with PMH. Future RCTs on model of care for this group of women is needed to establish causation.