Trends and characteristics of women undergoing induction of labour in a tertiary hospital setting: A cross-sectional study

BackgroundIn many well-resourced countries, rising rates of intervention are being observed during pregnancy, labour and childbirth with induction of labour (IOL) fast becoming one of the most common. In Australia, the rate of induction of labour has increased by over 30% since 2007, and today one in three women have their labours induced. We do not however have a good understanding of the contribution of specific obstetric populations to this trend.MethodsWe examine the contribution of specific obstetric populations to induction of labour over a six-year period at one tertiary maternity service, using the Nippita classification system. Average Annual Percentage Changes (AAPC) were calculated along with 95% confidence intervals and P values set at 0.05.ResultsThe overall rate of induction of labour increased from 21.3% in 2012 to 30.9% in 2017, representing an Average Annual Percent Change of 8.1, P < 0.0001 (95% CI 7–9.6). The greatest AAPC was seen in group 5 (parous, no previous caesarean section, 39–40 weeks, single cephalic), followed by group 2 (nulliparous, 39–40 weeks, single cephalic) and 1 (nulliparous, 37–38 weeks, single cephalic).ConclusionsThe use of the Nippita classification system allowed for standardised comparison across timepoints, facilitating identification of the subpopulations driving changes in rates of induction of labour. Rates of induction of labour saw a year on year increase which in this maternity service, it is not being driven by post-dates pregnancies. Further work is required to understand the role of other potential contributors such as diabetes.     

Improving women’s experiences of perineal suturing: A pragmatic qualitative analysis of what is helpful and harmful

BackgroundPerineal trauma requiring suturing is increasing, along with the associated physiological and psychological morbidities for women. Provider training appears to focus more on technical aspects rather than respectful, relational care for women. Studies exploring women’s experiences have identified that how women are cared for can significantly impact upon overall experiences.AimTo identify areas of improvement to the perineal suturing process and provide robust recommendations for urgent change by investigating what aspects are most traumatic to women and which are most supportive.MethodsA pragmatic qualitative analysis of data generated from 15 in-depth interviews with women who were sutured following birth.FindingsRegardless of tear severity, what was identified as helpful included anything that made the process better by increasing feelings of trust and reassurance, and providing women with a sense of being seen and heard. Harmful experiences were identified as those that worsened the experience, by increasing feelings of fear and vulnerability and leaving women with a sense of being disregarded or disrespected.ConclusionThe study confirmed that how the suturing process is conducted can have a significant detrimental impact upon women’s short- and longer-term physical and psychological well-being.Implications for practiceAn improved experience for women is most likely with kind professionals who explain the process as it goes along, check-in regularly and validate how the women feel. Women prefer to be sutured by a known professional, only if this provider is also kind and respectful.     

Siblings in lockdown: International evidence for birth order effects on child adjustment in the Covid19 pandemic

Supportive family relationships may mitigate the impact of the Covid19 pandemic on young children's adjustment, but existing work is limited by its focus on within-country variation and parental influences. Addressing these gaps, and drawing on reported buffering effects of older siblings on child mental health (Lawson and Mace, 2010), the current international study examined whether child adjustment problems were, on average, elevated by the pandemic and whether this buffering effect of older siblings would be maintained. In the first wave of the Covid19 pandemic (April to July 2020), 2516 parents of 3- to 8-year-old children living in Australia, China, Italy, Sweden, United Kingdom, and United States of America—six countries with contrasting governmental responses to the pandemic—completed an online survey about family experiences and relationships and child adjustment, as indexed by ratings on the Strengths and Difficulties Questionnaire (SDQ: R. Goodman, 1997). As expected, child SDQ total difficulty scores were elevated in all sites except Sweden (which notably did not enforce mass school closures). Compared to children without siblings, children with one or more older siblings showed fewer adjustment problems. Children from lone-parent households displayed more adjustment problems, as did those whose parents reported increased sibling conflict. Finally, child adjustment problems were negatively associated with family socio-economic status, but positively related to the indices of Covid-19 family disruption and government stringency. We discuss these findings in relation to existing work on asymmetric effects of older versus younger siblings, and siblings as sources of support.     

Midwives’ experience of personal/professional risk when providing continuity of care to women who decline recommendations: A meta-synthesis of qualitative studies

ProblemWomen’s autonomous choices in pursuit of physiological childbirth are sometimes limited by the midwife’s willingness to support those choices, particularly when those choices are contrary to recommendations or outside of guidelines.BackgroundWomen’s reasons for making such choices have received some research attention, however there is a paucity of research examining this phenomenon from the perspective of caseloading midwives’ and their perception of personal/professional risk in such situations.AimTo synthesise qualitative research which includes the voices of midwives working in a continuity of carer model who perceive any kind of risk to themselves when caring for women who decline current established recommendations.MethodsSystematic literature search and meta-synthesis were carried out following a pre-determined search strategy. The search was executed in April 2021 and updated in July 2021. Studies were assessed for quality using JBI Critical Appraisal Checklist for Qualitative Research. Data extraction was assisted by JBI QARI Data Extraction Tool for Qualitative Research. GRADE-CERQual was applied to the findings.FindingsEight studies qualified for inclusion. Five main themes were synthesised as third order constructs and were incorporated into a line of argument: Women’s rights to bodily autonomy and choice in childbearing are violated, and their ability to access safe midwifery care in pursuit of physiological birth is restricted, when midwives practise within a maternity system which is adversarial towards midwives who provide the care which women require. Midwives who provide such care place themselves at risk of damaged reputation, collegial conflict, intimidating disciplinary processes, tensions of ‘being torn’, and a heavy psychological load. Despite these personal and professional risks, midwives who provide this care do so because it is the ethical and moral thing to do, because they recognise that women need them to, because it can be very rewarding, and because they are able to.ConclusionMaternity systems and colleagues can be key risk factors for caseloading midwives who facilitate women’s right to decline recommendations. These identified risks can make it unsustainable for midwives to continue providing woman-centred care and contribute to workforce attrition, reducing options/choices for women which paradoxically increases risk to women and babies.     

Looked after children's right to contact with birth parents: An Australian study

In Australia, there are more than 46 000 children in out-of-home care (OOHC). Most of these children have been in OOHC for more than 2 years. Similarly, there are more than 407 000 children in the United States and over 80 800 in England who are ‘looked after’ with approximately one third of these children being in OOHC for more than 2 years. This paper concerns ‘looked after’ children's rights to contact with their birth parents. The United Nations Convention on the Rights of the Child (UNCRC) requires child protection systems to recognize the rights of children to maintain contact with their families except where this is not in the child's ‘best interests’. In this paper, we report on a qualitative study conducted in Australia exploring legal and family support practitioners' perceptions of barriers to contact between children in OOHC and their birth parents. The thematic analysis identified four themes: These were as follows: a focus on systems driven responses; lack of cultural recognition and responsiveness; carers' disconnection from birth parents; and parents' exclusion. We discuss the implications of these findings for understanding and recognizing children's right to contact with birth parents.     

Trajectories of low-income mothers’ and fathers’ engagement in learning activities and child socioemotional skills in middle childhood

Using Fragile Families and Child Wellbeing data (N = 3259), the current study examined Black and Latinx mothers’ and fathers’ trajectories of engagement in learning activities (e.g., storytelling) from infancy to age 5, and whether those trajectories predicted socioemotional skills at age 9, predictors of the trajectories (poverty, mother-father nonresidence, temperament, race/ethnicity), and moderators of the trajectories. Mothers’ and fathers’ learning activities decreased significantly over time as children got older. Higher rates of decline in fathers’ engagement in learning activities over time significantly predicted lower socioemotional skills. Mother-father nonresidence during infancy was associated significantly with higher rates of decline in mothers’ and fathers’ learning activities. Difficult temperament moderated the association between fathers’ trajectories and child outcomes.     

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.