‘Every pregnant woman needs a midwife’—The experiences of HIV affected women in maternity care

Title

‘Every pregnant woman needs a midwife’—the experiences of HIV affected women in Northern Ireland.

Objective

to explore HIV positive women's experiences of pregnancy and maternity care, with a focus on their interactions with midwives.

Design

a prospective qualitative study.

Setting

regional HIV unit in Northern Ireland.

Participants

22 interviews were conducted with 10 women at different stages of their reproductive trajectories.

Findings

the pervasive presence of HIV related stigma threatened the women's experience of pregnancy and care. The key staff attributes that facilitated a positive experience were knowledge and experience, empathy and understanding of their unique needs and continuity of care.

Key conclusions

pregnancy in the context of HIV, whilst offering a much needed sense of normality, also increases woman's sense of anxiety and vulnerability and therefore the need for supportive interventions that affirm normality is intensified. A maternity team approach, with a focus on providing ‘balanced care’ could meet all of the woman and child's medical needs, whilst also emphasising the normalcy of pregnancy.     

Encefalopatía hipóxico-isquémica tras hematoma espontáneo de cordón umbilical

Objective

To present the case of a pregnant woman with a spontaneous umbilical cord hematoma and to provide a review of the literature.

Subjects and methods

A primigravida, with no antecedents of interest and uneventful pregnancy, was admitted to our hospital in the latent phase of labor. Cardiotocography was unsatisfactory, and an urgent cesarean section was performed.

Results

A 3050 g girl was born, with an Apgar score of 1/3, and was admitted to the intensive care unit. The neonate was discharged with a diagnosis of hypoxic-ischemic encephalopathy.

Conclusions

Umbilical cord abnormalities should be suspected when the results of fetal monitoring are unsatisfactory. Histological analysis of the umbilical cord should be performed.     

Epidemiología del aborto de repetición

Objective

To determine the possible causes of recurrent miscarriage in our environment and the pregnancy rate in these couples.

Material and methods

An observational retrospective study was carried out in 172 women who attended our unit for two or more recurrent miscarriages between 2002 and 2008.

Results

A total of 80.2% of the women became pregnant. Of these, 81.2% carried the fetus to term. The results of clinical study were normal in 70.9%. The alterations found were uterine in 48%, genetic in 2% and coagulation alterations in 44%. These alterations were associated in 6% of the patients.

Conclusions

Most of the couples consulting for recurrent miscarriage will not receive an etiologic diagnosis after clinical study. Reproductive prognosis worsens as the number of miscarriages increases. However, up to 80.2% of these women become pregnant again, of whom 81.1% will deliver a healthy neonate.     

Patient safety in midwifery-led care in the Netherlands

Objective

to describe the incidence and characteristics of patient safety incidents in midwifery-led care for low-risk pregnant women.

Design

multi-method study.

Setting

20 midwifery practices in the Netherlands; 1,000 patient records.

Population

low-risk pregnant women.

Methods

prospective incident reporting by midwives during 2 weeks; questionnaire on safety culture and retrospective content analysis of 1,000 patient records in 2009.

Main outcome measures

incidence, type, impact and causes of safety incidents.

Results

in the 1,000 patient records involving 14,888 contacts, 86 safety incidents were found with 25 of these having a noticeable effect on the patient. Low-risk pregnant women in midwifery care had a probability of 8.6% for a safety incident (95% CI 4.8–14.4). In 9 safety incidents, temporary monitoring of the mother and/or child was necessary. In another 6 safety incidents, reviewers reported psychological distress for the patient. Hospital admission followed from 1 incident. No safety incidents were associated with mortality or permanent harm. The majority of incidents found in the patient records concerned treatment and organisational factors.

Conclusions

a low prevalence of patient safety incidents was found in midwifery care for low-risk pregnant women. This first systematic study of patient safety in midwifery adds to the base of evidence regarding the safety of midwifery-led care for low-risk women. Nevertheless, some areas for improvement were found. Improvement of patient safety should address the better adherence to practice guidelines for patient risk assessment, better implementation of interventions for known lifestyle risk factors and better availability of midwives during birthing care.     

Factor de crecimiento de hepatocitos plasmático en preeclampsia y eclampsia

Objective

To compare plasma hepatocyte growth factor concentrations in eclamptic, preeclamptic and normotensive pregnant women.

Materials and method

We included 30 patients with mild preeclampsia (group A), 30 patients with severe preeclampsia (group B) and 30 patients with eclampsia (group C). A control group of 30 healthy pregnant women (group D) was selected with a similar age and body mass index to participants in the study groups. Only nulliparous patients were included. Blood samples were collected for plasma hepatocyte growth factor determination in all patients before delivery and in the study groups immediately after diagnosis.

Results

Plasma hepatocyte growth factor values were highest in eclamptic patients and in severe preeclamptic patients and were lowest in mild preeclamptic patients. Hepatocyte growth factor values were significantly higher in the study groups than in controls (P<.05). Linear regression analysis revealed that 24-hour proteinuria significantly affected plasma hepatocyte growth factor concentrations (P<.05).

Conclusion

The findings of this research showed that plasma hepatocyte growth factor concentrations were higher in eclamptic and preeclamptic patients than in normotensive pregnant women.     

Evolución clínica y paraclínica de 9 embarazos en 4 pacientes con enfermedad de Gaucher tipo 1 en el servicio de hematología de un hospital docente asistencial

Objectives

To describe the clinical presentation and course in a group of pregnant women with Gaucher disease type 1.

Subjects and methods

Pregnant women admitted to our hematology service with a medical diagnosis of Gaucher disease type 1.

Results

All patients were classified as high risk. We describe 9 pregnancies in 4 patients: 7 were on enzyme replacement therapy before the pregnancy and continued to receive this therapy throughout the pregnancy; 1 patient discontinued therapy 8 months previously and had a hematological exacerbation.

Conclusions

Pregnancy should not be contraindicated in patients with stable disease. Enzyme replacement therapy should not be interrupted or suspended because it decreases complications.     

Women's lived experience of fear of childbirth

Objective

to describe women's lived experience of fear of childbirth.

Design

a qualitative study using a phenomenological approach and a lifeworld perspective. Data were collected via tape-recorded interviews.

Setting

Sahlgrenska University Hospital, Göteborg, Sweden in 2003.

Participants

eight pregnant women (24–37 gestational weeks) seeking help within an outpatient clinic for women with severe fear of childbirth. Two of the women were primiparous.

Findings

four constituents were identified: feeling of danger that threatens and appeals; feeling trapped; feeling like an inferior mother-to-be and on your own. The essential structure was described as ‘to lose oneself as a woman into loneliness’.

Key conclusions

fear of childbirth affects women in such a way that they start to doubt themselves and feel uncertain of their ability to bear and give birth to a child. Previous birth experience was central to the multiparous women. They described their experiences of suffering in relation to the care they received during childbirth. This mainly concerned pain and negative experiences with staff.

Implications for practice

pregnant women who fear childbirth are an exposed group in need of much support during pregnancy and childbirth. The encounter between the woman and the midwife can be a way of breaking down the feeling of loneliness and restoring the woman's trust in herself as a childbearing woman.     

Approaches to assessment of alcohol intake during pregnancy in Swedish maternity care—a national-based investigation into midwives’ alcohol-related education,knowledge and practice

Objective

to evaluate how much education midwives in Sweden have undertaken to help them assess alcohol intake during pregnancy, and what tools they use to identify women who may be at risk of drinking during pregnancy.

Design

a national survey was conducted in March 2006, using a questionnaire constructed by a Swedish team of researchers and clinicians.

Setting

maternity health-care centres in Sweden.

Participant

2106 midwives.

Findings

nearly all midwives stated that they had excellent or good knowledge concerning the risks associated with drinking during pregnancy. They considered themselves less knowledgeable about detecting pregnant women with risky alcohol consumption before pregnancy. The majority of the midwives had participated in some education in handling risky drinking. Almost half of the midwives assessed women's alcohol intake before pregnancy. Important facilitators for increased activity concerned recommendations and decisions at different levels (national, local and management) on how to address alcohol with expectant parents and work with risky drinkers.

Key conclusions

more education was associated with more common use of a questionnaire for assessment of women's alcohol intake before pregnancy, and more frequent counselling when identifying a pregnant woman whose pre-pregnancy consumption was risky.     

Resultados obstétricos en cribado combinado de las aneuploidías en el primer trimestre superior al corte con resultado de amniocentesis con cariotipo fetal normal

Introduction

To evaluate whether there are adverse pregnancy outcomes in pregnant women with a risk index above the cut-off point in first-trimester screening for fetal chromosomal abnormalities and an amniocentesis result of normal fetal karyotype in a sample of pregnant women attending our clinic at the beginning of pregnancy.

Subjects and methods

We performed a case-control study. A series of patients who underwent first-trimester combined screening as part of antenatal care between January 2009 and January 2010 were selected.

Results

Of the maternal complications registered during the pregnancy, gestational diabetes was more frequent among cases.

Conclusions

The incidence of the remaining complications analyzed (intrauterine restricted growth, preeclampsia, oligoamnios) was similar in the two groups. In most of the pregnant women, delivery occurred after 37 weeks through the vaginal route.     

Histeroscopia en consulta: análisis de 5.000 pacientes

Objective

To assess the reliability, feasibility and safety of outpatient hysteroscopy.

Material and method

We performed a retrospective study of 5000 outpatient hysteroscopies performed between June 2003 and April 2008. All hysteroscopies were performed using a vaginoscopic approach and saline to distend the uterus. The indications, type of surgery, and success, failure and complication rates were analyzed.

Results

The hysteroscopies were successfully performed in nearly 97% of the patients. Severe pain and vasovagal syndrome occurred in 4% and 1.4% of the women, respectively. The most common indication was abnormal uterine bleeding and the most common diagnosis was endometrial polyps. Outpatient hysteroscopy was carried out in 60% of the patients. The most frequent type of surgery was hysteroscopic polypectomy (64%). Perforation and inflammatory disease rates were 0% and 0.08%, respectively.

Conclusions

Outpatient hysteroscopy is a well tolerated, effective and safe procedure. The combination of small-diameter hysteroscope and bipolar energy allows intrauterine disorders to be treated in the office setting without anesthesia.     

Birth environment facilitation by midwives assisting in non-hospital births: A qualitative interview study

Objective

midwifery homes (similar to birth centres) are rich in midwifery wisdom and skills that differ from those in hospital obstetrical departments, and a certain percentage of pregnant women prefer birth in these settings. This study aimed to understand the organisation of the perinatal environment considered important by independent midwives in non-hospital settings and to clarify the processes involved.

Design

semi-structured qualitative interview study and constant comparative analysis.

Participants

14 independent midwives assisting at births in midwifery homes in Japan, and six independent midwives assisting at home births.

Setting

Osaka, Kyoto, Nara, and Shiga, Japan.

Findings

midwives assisting at non-hospital births organised the birth environment based on the following four categories: ‘an environment where the mother and family are autonomous’; ‘a physical environment that facilitates birth’; ‘an environment that facilitates the movement of the mother for birth’; and ‘scrupulous safety preparation’. These, along with their sub-categories, are presented in this paper.

Key conclusions

independent midwives considered it important to create a candid relationship between the midwife and the woman/family from the period of pregnancy to facilitate birth in which the woman and her family were autonomous. They also organised a distinctive environment for non-hospital birth, with preparations to guarantee safety. Experiential knowledge and skills played a major part in creating an environment to facilitate birth, and the effectiveness of this needs to be investigated objectively in future research.     

Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking

Objective

to explore barriers to and possibilities for interactive communication between midwives and pregnant women regarding smoking behaviour during pregnancy.

Design

the study was based on a qualitative research design aiming at a Grounded Theory analysis of interviews with pregnant women.

Setting

public sector antenatal clinics in Cape Town, South Africa predominantly providing care to women of mixed ancestry.

Informants

in-depth interviews with 12 pregnant women purposively selected on the basis of smoking behaviour, age and marital status to reach maximum variation.

Findings

the findings indicated low levels of transparency and trust in antenatal visits. Lack of trust was related to categories such as conflicting personal capabilities and socio-cultural and medical expectations, combined with a didactic approach from caregivers. The unworthy woman was identified as the core category of the interviews describing how women feel in their relationship with midwives. A theoretical model illustrates possibilities for change in relation to an ideal situation where a supportive caregiver, congruent expectations and capabilities result in women feeling visible.

Key conclusions and implications for practice

culturally appropriate smoking cessation interventions should be of high priority. Training in patient-centred counselling for midwives is necessary for creating an open dialogue with pregnant mothers about their smoking habits. The time constraint experienced by midwives also suggests that other methods apart from midwife counselling should be investigated for inclusion in the clinical setting.     

Análisis inicial de eficiencia en la aplicación clínica de las nuevas recomendaciones para la prevención secundaria del cáncer de cuello de útero

Aim

To evaluate the efficiency of the application of the new cervical cancer screening recommendations sponsored by the Spanish Society of Obstetrics and Gynecology.

Material and methods

A total of 631 women, aged 30 years or older, who attended the Gynecology Unit of the Santa Cristina Hospital, Madrid, for cervical cancer screening underwent cervical cytology and DNA/human papilloma virus determination (Hybrid Capture 2).

Results

Analysis of the hospital's costs showed that the new prevention strategy generated an estimated saving of 198.47 € per woman undergoing cervical cancer screening.

Conclusions

The new cervical cancer screening recommendations sponsored by the Spanish Society of Gynecology and Obstetrics are highly efficient.     

Hemopatías malignas en el embarazo

Objective

To analyze the incidence of hematological malignancies, their obstetric and medical management, and maternal and perinatal outcomes in pregnant women.

Subjects and methods

Medical histories were reviewed, and all cases of women diagnosed with hematologic malignancies during pregnancy from 2000 to 2005 were analyzed.

Results

We found five cases (two leukemias and three lymphomas, two of which were Hodgkin's disease), in distinct trimesters of pregnancy. The women consulted mainly because of B symptoms. Blood tests and histological data were highly variable. In all patients, complete remission was achieved after proper staging and treatment.

Conclusions

Pregnancy does not alter the development of hematological malignancies. Long-term disease-free survival is similar in both pregnant and non-pregnant women with the same disease.     

The experience of pregnant women with a diagnosis of fetal lower urinary tract obstruction (LUTO)

Objective

to gain insight into the experiences and perspectives of pregnant women diagnosed antenatally with fetal lower urinary tract obstruction (LUTO) participating in an interventional fetal medicine randomised controlled trial (RCT).

Design

a qualitative study using semi-structured interviews. Interviews were analysed using Riessman's narrative analysis.

Setting

fetal medicine clinics within the United Kingdom National Health Service (NHS).

Participants

five pregnant women who were recruited as part of an RCT and two additional women who were recruited after the trial was terminated before completion.

Findings

three themes were identified and form the basis of this article: the use of technology in pregnancy, the loss of a normal pregnancy, and decision making in uncertainty.

Implications and conclusions

undertaking qualitative research within an RCT can illuminate the experience of the condition being studied. Women's experience of a pregnancy where LUTO was diagnosed in the fetus entailed an emotional journey following the visualisation of the abnormality through the use of routine ultrasound screening. Women tried to make sense of the diagnosis in order to make the best, albeit less than ideal, decisions for themselves, their baby, and their family. Midwives are in a good position to support women through the emotional distress of diagnosis and to help them negotiate the uncertain terrain in which they make decisions.     

Campaña de lucha contra el cáncer de cuello uterino en Guinea-Bissau. Estudio de las citologías de un trimestre

Objective

To study 300 cytologies from a single trimester, within a campaign against uterine cervical cancer in Guinea-Bissau.

Design

We compared 300 cytologies from Guinea-Bissau with 880 cytologies performed in a single month in autochthonous women attending our hospital for vaginal infections and cervical lesions.

Results

Significant differences between women in Guinea-Bissau and autochthonous women were found in Trichomonal infection (2% versus 0,34%, respectively; P < .001) and in low-grade squamous intraepithelial lesions (2% versus 0,68%, respectively; P = .05). One case of cervical cancer was detected in a 75-year-old multiparous woman. The mean number of deceased children in these women was 2 (range 1-8).

Conclusions

To avoid both cervical cancer and neonatal mortality, a permanent program for the early detection of cervical cancer in Guinea-Bissau is clearly needed, together with family planning, prenatal care and obstetric assistance.     

What do midwives need to know about approaches of women towards labour pain management? A qualitative interview study into expectations of management of labour pain for pregnant women receiving midwife-led care in the Netherlands

Objective

to investigate factors important to women receiving midwife-led care with regard to their expectations for management of labour pain.

Design

semi-structured ante partum interviews and analyses using constant comparison method.

Participants

fifteen pregnant women between 36 and 40 weeks gestation receiving midwife-led care.

Setting

five midwifery practices across the Netherlands between June 2009 and July 2010.

Main outcome

women's expectations regarding management of labour pain.

Results

we found three major themes to be important in women's expectations for management of labour pain: preparation, support and control and decision-making. In regards to all these themes, three distinct approaches towards women's planning for pain management in labour were identified: the ‘pragmatic natural’, the ‘deliberately uninformed’ and the ‘planned pain relief’ approach.

Conclusion

midwives need to recognise that women take different approaches to pain management in labour in order to adapt care to the individual woman.