Five-year results of no-fault compensation related to childbirth injuries in Taiwan

ObjectiveIncreasing obstetric medical litigations had great impacts in health care system resulted in lower recruitment of residents and higher medical cost of defensive medicine in Taiwan. In order to reduce medical litigation, the “Childbirth Accident Emergency Relief Act” was implemented in June 2016. This study presented five-year results of a novel childbirth accident compensation system.Materials and methodsThe purpose of the Relief Act was to establish a national relief system to ensure timely relief, reduce medical disputes, promote the partnership between patient and medical personnel. The compensations included maximal 2 million NTD for maternal death, maximal 0.3 million NTD for neonatal and fetal deaths, and 3, 2, and 1.5 million NTD for maternal or neonatal profound, severe, and moderate disabilities, respectively. Puerperal hysterectomy was included with maximal 0.8 million NTD compensation.ResultsSince June 30, 2016 to June 30, 2021, there were 1340 applications reviewed by Committee and 1258 were approved with total relief of 744.7 million NTD (26.6 million USD) with approve rate of 93.9%. It took an average of 109.8 days to start application from childbirth and 102.4 days to get compensation from application. 66.1% of accident victims agreed this system can restore doctor–patient relationship by immediate care and assistance from medical institutions.ConclusionThe Relief Act is the first government leading compensation system to establish a national relief system. It was enacted to reduce medical disputes, promote the partnership between patient and medical personnel, and enhance health and safety of women during childbirth. A no-fault compensation would be an efficient alternative disputes resolution to childbirth accidents.     

产前分娩预演对初产妇自然分娩成功率及产后并发症的影响

[目的]探讨产前分娩预演对初产妇自然分娩成功率和产后并发症的影响.[方法]收集2016年9月至2018年10月在本院妇产科分娩的初产妇86例,按产前分娩教育方式分为观察组(n=42)和对照组(n=44).对照组孕妇产前接受常规产前健康教育课程培训,观察组在对照组的基础上进行分娩预演实践.比较两组自我效能感量表(GSES)、抑郁自评量表(SDS)和焦虑自评量表(SAS)评分及自然分娩成功率和产后并发症发生率等.[结果]与对照组相比,观察组分娩总产程和第一、二、三明显缩短;新生儿窒息率和产后SDS、SAS评分均明显降低;自然分娩成功率、GSES评分均明显提高,其差异均有统计学意义(P<0.05).观察组产后出血、感染、尿潴留、乳汁淤积发生率及总并发症发生率均低于对照组(P<0.05).[结论]采用常规产前健康教育培训结合产前分娩预演实践的产前管理方式,可有效提高初产妇自然分娩成功率,缩短产程,减少产后并发症的发生,值得临床推广应用.     

护理安全管理在产科应用的重要性

目的分析产科护理安全管理对产妇分娩的临床效果。方法选取该院于2018年1月—2019年1月接收的产妇200例,采用随机数字表法将其分为研究组(n=100)和对照组(n=100),对照组产妇实施常规产科管理,研究组产妇采用产科护理安全管理,将两组产妇的难产率、满意度、产妇产程时间、产妇分娩方式进行对比分析。结果对照组产妇难产率为30.0%,明显比研究组10.0%高,对照组满意度为60.0%,研究组为90.0%,对照组显著低于研究组,组间差异有统计学意义(P<0.05);对比两组产妇产程时间,对照组第一、第二、第三产程时间均比研究组较长,组间差异有统计学意义(P<0.05),对照组自然分娩率明显低于研究组,对照组剖宫产率显著高于研究组,组间对比差异有统计学意义(P<0.05)。结论产科护理安全应用于产妇分娩中,可以有效降低难产率、剖宫产率和产妇产程时间,并且能够提升满意度和自然分娩率。     

Universalización,paridad y evolución de la demanda de anestesia epidural durante el parto en Andalucía

ObjectiveAssess whether the universalization of epidural analgesia supplied in hospitals of the Andalusia Public Health Service (SSPA) has ended up with the inequalities shown in previous studies regarding to their demand: the percentage of women who rejected epidural analgesia was higher among the users having low educational level, lower income and working as housekeeper.MethodThe data are based on satisfaction surveys conducted by the Institute for Advanced Social Studies amongst of SSPA users. This survey includes a section aimed at women attended in labor (N = 21,300). The hierarchical segmentation analysis shows which variables are the ones that discriminate most in the usage of epidural analgesia. Subsequently, through a model of binary logistic regression we analyze which socio-demographic variables are significant (2012) and how its impact is on the choice of epidural analgesia in childbirth.ResultsOverall, the socio-demographic variables of the users are statistically significant in the demand or not of epidural analgesia during labor. However, the detailed analysis of the last year (2012) shows that none of the socio-demographic variables introduced in the model has a significant effect on the decision of using epidural analgesia.ConclusionsThe process of universalization of epidural anesthesia in childbirth has ended with social inequalities in their use, that is, with those differences that are not due to a real choice but are induced by socio-cultural characteristics of women.     

Room4Birth – The effect of giving birth in a hospital birthing room designed with person-centred considerations: A Swedish randomised controlled trial

ObjectiveTo evaluate if a birthing room designed with person-centred considerations improves labour and birth outcomes for nulliparous women when compared to regular birthing rooms.MethodsA randomised controlled trial was conducted at a Swedish labour ward between January 2019 and October 2020. Nulliparous women in spontaneous labour were randomised either to a birthing room designed with person-centred considerations (New room) or a Regular room. The primary outcome was a composite of four variables: vaginal non-instrumental birth; no oxytocin augmentation; postpartum blood loss < 1000 ml; and a positive childbirth experience. To detect a difference of 8% between the groups, 1274 study participants were needed, but the trial was terminated early due to consequences of the Covid-19 pandemic.ResultsA total of 406 women were randomised; 204 to the New room and 202 to the Regular room. There was no significant difference in the primary outcome between the groups (42.2% versus 35.1%; odds ratio: 1.35, 95% Confidence Interval 0.90–2.01; p = 0.18). Participants in the New room used epidural analgesia to a lower extent (54.4% versus 65.3%, relative risk: 0.83, 95% Confidence Interval 0.71–0.98; p = 0.03) and reported to a higher degree that the room contributed to a sense of safety, control, and integrity (p=<0.001).ConclusionsThe hypothesis that the New room would improve the primary outcome could not be verified. Considering the early discontinuation of the study, results should be interpreted with caution. Nevertheless, analyses of our secondary outcomes emphasise the experiential value of the built birth environment in improving care for labouring women.     

Parto con analgesia epidural en una gestante con parálisis periódica hipocaliémica

Familial hypokalaemic periodic paralysis (FHPP) is an uncommon genetic disease characterized by muscle weakness associated with hypokalaemia. Episodes are precipitated by drugs, stress, metabolic diseases, hypothermia or infection. We report the case of a 38-year-old pregnant women with FHPP who underwent epidural analgesia for labour. Pregnant women with FHPP require multidisciplinary management involving an anaesthesiologist, a gynaecologist and a paediatrician. It is important to maintain normothermia, prevent hyperventilation, monitor electrolytes, avoid glucose infusions and medications that cause hypokalaemia, and administer potassium supplements when required. Locoregional techniques should be preferred over general anaesthesia. Early epidural analgesia reduces the risk of pain that could trigger an episode of FHPP. In the case of general anaesthesia, drugs that can cause malignant hyperthermia should be avoided, and short-acting non-depolarizing neuromuscular blockers with blockade-depth monitoring should be used.     

The effects of a childbirth psychoeducation program on learned resourcefulness, maternal role competence and perinatal depression: A quasi-experiment

Background

Learned resourcefulness plays a significant role in facilitating maternal coping during the transition to motherhood. Given the growing evidence of perinatal depression and the frequent feeling of incompetence in the maternal role, the implementation of an effective intervention to promote maternal role competence and emotional well-being is essential.

Objectives

To determine the impact of a childbirth psychoeducation program based on the concept of learned resourcefulness on maternal role competence and depressive symptoms in Chinese childbearing women.

Design

A pretest-posttest, control group quasi-experimental design with repeated measures was used.

Setting

The study was conducted in two regional public hospitals in Hong Kong that provide routine childbirth education programs with similar content and structure. One hospital was being randomly selected as the experimental hospital.

Participants

A convenience sample of 184 Chinese pregnant women attending the childbirth education was recruited between October 2005 and April 2007. Inclusion criteria were primiparous with singleton and uneventful pregnancy, at gestation between 12 and 35 weeks, and did not have a past or familial psychiatric illness.

Methods

The intervention was a childbirth psychoeducation program that was incorporated into the routine childbirth education in the experimental hospital. The experimental group (n = 92) received the childbirth psychoeducation program and the routine childbirth education. The comparison group (n = 92) received the routine childbirth education alone in the comparison hospital. Outcomes were measured by the Self-Control Schedule, Parenting Sense of Competence Scale-Efficacy subscale and Edinburgh Postnatal Depression Scale at baseline, immediately post-intervention, at 6 weeks and 6 months postpartum. Analysis was by intention to treat.

Results

Women receiving the childbirth psychoeducation program had significant improvement in learned resourcefulness at 6 weeks postpartum (p = 0.004) and an overall reduction in depressive symptoms (p = 0.01) from baseline to 6 months postpartum compared with those who only received the routine childbirth education after adjusting for baseline group differences on age and social support. No significant group difference was found on maternal role competence.

Conclusions

The childbirth psychoeducation program appears to be a very promising intervention for promoting learned resourcefulness and minimizing the risk of perinatal depression in first-time Chinese childbearing women. Future empirical work is required to determine the effectiveness of extending the childbirth psychoeducation program into the early postpartum for the promotion of maternal role competence in Chinese childbearing women.     

Urinary incontinence after perineal trauma at childbirth

Stress urinary incontinence is the most common form of female incontinence. The purpose with this study was to describe consequences of episiotomy and spontaneous tears on urinary incontinence after the delivery. A postal questionnaire was sent to 205 women who had participated in an earlier study concerning episiotomy and spontaneous tears during delivery. They were contacted four years post-partum. One hundred and eighty-five women (90%) responded and there was no difference in the response rate between the group with episiotomy and in the group with spontaneous tears. Urinary incontinence symptoms were found in 65 women (36%). This frequency was similar in both groups. The study does not confirm the protective value of episiotomy on urinary incontinence.     

A pilot feasibility study of mindfulness childbirth education for women with a history of sexual trauma

Backgroundand purpose: Pregnant women with a history of sexual trauma are at increased risk for mood disorders. Mindfulness interventions delivered prenatally may reduce risk of mood disorders. The purpose of this pilot was to examine the feasibility and acceptability of Mindfulness-Based Childbirth and Parenting (MBCP) for women with a history of sexual trauma.Materials and methodsA one-group repeated measures design was employed, involving three assessments: baseline, post-intervention and at eight weeks postpartum. Twelve pregnant women were recruited and enrolled. Self-report measures and open-ended written questionnaires were used to assess health outcomes and intervention acceptability.ResultsResults show high satisfaction with the program, an immediate reduction in prenatal anxiety, and longitudinal increase in interoceptive awareness skills.ConclusionThe results suggest the feasibility and acceptability of the MBCP approach for women with a history of sexual trauma.