Maternity Satisfaction Studies and Their Limitations: “What Is,Must Still Be Best”

ABSTRACT: Background: Health policymakers throughout the developed world are paying close attention to factors in maternity care that may influence women's satisfaction. This paper examines some of these factors in the light of observations from previous studies of satisfaction with health services. Methods: The Scottish Birth Study, a cross‐sectional questionnaire survey, sought the views of all women in Scotland delivering during a 10‐day period in 1998. A total of 1,137 women completed and returned questionnaires (response rate = 69%). Results: Women were overwhelmingly satisfied with their prenatal, intrapartum, and postnatal care. As is common in this type of study, reports of dissatisfaction were relatively low. However, differences occurred in satisfaction levels between subgroups; for example, the fewer the number of caregivers the woman had during childbirth, the more likely she was to be satisfied with the care received. A range of factors appeared to influence reported satisfaction levels, such as characteristics of the care provided and the woman's psychosocial circumstances. Conclusions: In addition to the inherent limitations of satisfaction studies found in the literature, problems may arise if such surveys are used uncritically to shape the future provision of maternity services, because service users tend to value the status quo over innovations of which they have no experience. Therefore, although satisfaction surveys have a role to play, we argue that they should only be used with caution, and preferably as part of an array of tools. (BIRTH 30:2 June 2003)     

Modifying the Stomach Contents of Laboring Women: Why and How; Success and Risks

ABSTRACT: Studies of gastric emptying time in laboring women show that delay occurs rarely, except after administration of drugs. In addition to narcotic analgesics, which cause marked delay, other drugs can also delay stomach emptying or provoke aspiration of vomitus, or aggravate its deleterious effects, including muscle relaxants, which abolish the protective cough reflex, and oxytocin in combination with large intravenous loads, which may contribute to pulmonary edema. Fasting may result in lower gastric volume within three to four hours, after which both volume and acidity of gastric juices increase. Emptying the stomach before general anesthesia by means of a nasogastric tube or giving apomorphine to induce vomiting succeeds only if done immediately before induction of anesthesia. Women prefer apomorphine, but it relaxes the gastroesophageal sphincter, making gastric reflux easier. Metoclopramide as an antiemetic has unreliable effects. Antacids can produce chalky particulate matter that is more harmful than clear fluid if aspirated. Other medications used to reduce gastric volume or raise pH have delayed action or deleterious side effects. We conclude that present approaches to preventing aspiration ofvomitus lack efficacy and entail unnecessary risks.     

Transition Care from Adolescence to Adulthood: A 10-Year Service Review of the Gynecological Implications for Young Women and Girls Born with Cloacal Anomalies

Study ObjectiveTo establish the gynecological and reproductive outcomes for girls born with a cloacal anomaly, seen in a pediatric specialist cloaca clinic.DesignLocal approval was granted to conduct this review. Outcomes were retrospectively identified using healthcare records.ParticipantsGirls with known cloacal anomaly, seen in the cloaca clinic between 2009 and 2019, who had attained menarche or received gynecological input.ResultsNine females met the inclusion criteria, who were 12-30 years old. The mean age of menarche was 12 years (SD = 1.29). Two developed obstructed menstruation, requiring surgical intervention. Vaginal stenosis affected all women. Three women underwent revision surgery, and 1 is awaiting surgery. None of the women have attempted a pregnancy, to our knowledge.ConclusionCloacal anomaly is a rare complex condition. Female individuals with cloacal anomaly require multidisciplinary gynecology specialist care throughout adolescence and adulthood. Provision of a dedicated gynecological service could improve the quality of life of these women.     

PREGNANCY INTERRUPTION USING MIFEPRISTONE (RU-486): A New Choice for Women in the USA

Mifepristone (RU-486) has recently been granted approval from the Food and Drug Administration for the early termination of pregnancy. Availability is anticipated during 1997. This article describes the pharmacologic function of mifepristone and discusses its potential clinical use in the United States, including its safety, efficacy, and possible complications.     

Reducing Pain and Enhancing Progress in Labor: A Guide to Nonpharmacologic Methods for Maternity Caregivers

ABSTRACT: Many simple, effective, low-cost methods to relieve labor pain can be initiated by nurses, midwives, or physicians with the potential benefits of improved labor progress, reduction in use of riskier medications, patient satisfaction, and lower costs. These nonpharmacologic methods are categorized by the mechanisms through which they reduce pain or improve labor progress: diminishing the painful stimulus at the source; providing alternate stimuli to inhibit pain awareness; and reducing the woman's negative reaction to the pain. This is a review of numerous pain relief techniques and a guide for maternity caregivers.     

Caring for Pregnant Women with Opioid Use Disorder in the USA: Expanding and Improving Treatment

Purpose of the Review

Opioid use disorder in the USA is rising at an alarming rate, particularly among women of childbearing age. Pregnant women with opioid use disorder face numerous barriers to care, including limited access to treatment, stigma, and fear of legal consequences. This review of opioid use disorder in pregnancy is designed to assist health care providers caring for pregnant and postpartum women with the goal of expanding evidence-based treatment practices for this vulnerable population.

Recent Findings

We review current literature on opioid use disorder among US women, existing legislation surrounding substance use in pregnancy, and available treatment options for pregnant women with opioid use disorder. Opioid agonist treatment (OAT) remains the standard of care for treating opioid use disorder in pregnancy. Medically assisted opioid withdrawal (“detoxification”) is not recommended in pregnancy and is associated with high maternal relapse rates. Extended release naltrexone may confer benefit for carefully selected patients. Histories of trauma and mental health disorders are prevalent in this population; and best practice recommendations incorporate gender-specific, trauma-informed, mental health services. Breastfeeding with OAT is safe and beneficial for the mother-infant dyad.

Summary

Further research investigating options of OAT and the efficacy of opioid antagonists in pregnancy is needed. The US health care system can adapt to provide quality care for these mother-infant dyads by expanding comprehensive treatment services and improving access to care.

     

First and Third Trimester Uterine Scar Thickness in Women With Previous Caesarean: A Prospective Comparative Study

Background

Lower uterine segment (LUS) thickness in the third trimester of gestation is associated with the risk of uterine scar defect at delivery. It was suggested that first trimester residual myometrial thickness (RMT) could also predict uterine scar defect at delivery.