A counselling model for postpartum women after distressing birth experiences

Objective

to describe the development and application of a brief counselling intervention for women who have experienced a traumatic birth.

Intervention

the birthing trauma counselling model reflecting women's need to establish a therapeutic connection with a midwife, talk about their birth experience and have their feelings validated. Gaps in understanding of events need explanation and explicit connections made between the event and subsequent emotions and behaviours. Developing a rational understanding of birthing events and how labour may have been managed differently assists women to revise their assumptions about maternity care and gain a sense of control. Fostering social support, reinforcing positive approaches to coping and exploring solutions to restoring self-confidence and reducing anxiety may help re-establish psychological equilibrium.

Discussion and conclusion

the counselling intervention is consistent with trauma theory and draws on cognitive behavioural therapy principles. Midwives are well placed to provide counselling support to women experiencing birth-related distress. Further testing of the intervention in the clinical setting with a large sample is required.     

Australian midwives' attitudes towards care for women with emotional distress

Objective

to assess Australian midwives' attitudes towards caring for women with emotional distress and their perceptions of the extent to which workplace policies and processes hindered such care.

Design

a postal survey.

Setting

members of the Australian College of Midwives.

Participants

815 Australian midwives completed the survey.

Measurements

a modified version of the 17-item REASON questionnaire (McCall et al., 2002) that was originally developed for used by General Practitioners to measure their attitudes towards their role in the management of patients with mental health disorders.

Findings

An exploratory factor analysis with Varimax rotation identified four factors that reflected midwives' (1) perceptions of systemic problems that hindered emotional care, (2) attitudes towards working with women experiencing emotional health problems, (3) perceived competence in using treatment techniques and (4) attitudes and perceived competence towards the referral of women with depression and anxiety to other health professionals.

Key conclusions and implications for practice

participating midwives indicated their willingness to offer assistance and acknowledged the importance of providing emotional care to women. In practice, emotional care by midwives is impeded by perceived lack of competency rather than a lack of interest. Midwives' competency in the assessment and care of women with conditions such as depression and anxiety may be enhanced through continuing professional education.     

A diet and physical activity intervention for preventing weight retention among Taiwanese childbearing women: a randomised controlled trial

Objective

to examine the effect of individual counselling on diet and physical activity from pregnancy to six months post partum, or from birth to six months post partum, on weight retention among Taiwanese women.

Design

a randomised controlled trial assigned participants to two experimental groups [from pregnancy to six months post partum (EP) and from birth to six months post partum (EPP)] and one comparison group.

Setting

a 3900-bed medical centre in northern Taiwan with around 3000 births annually.

Participants

a sample of 189 women who had regular check-ups during pregnancy and gave birth at the medical centre.

Interventions

the comparison group received the routine outpatient department obstetric educational programme. The EP group attended regularly scheduled clinic visits with individualised dietary and physical activity education plans from 16 gestational weeks to six months post partum, and received on brochure. The EPP group received the same educational intervention as the EP group from 24-48 hours after birth to six months post partum.

Measurements

body weight, body mass index, health-promoting behaviour and psycho-social variables (self-efficacy, body image, depression and social support).

Findings

average gestational weight gain was 14.02, 15.27 and 16.22 kg in the three EP, EPP and comparison groups respectively, and average weight retention at six months post partum was 2.34, 4.06 and 5.08 kg in the three groups, respectively.

Key conclusions

a diet and physical activity intervention from pregnancy is effective for reducing post-pregnancy weight retention.

Implications for practice

the findings of the present study should be taken into consideration when incorporating significant others and weight-loss maintenance strategies with interventions for a healthier family lifestyle.     

Evaluation of World Health Organization partograph implementation by midwives for maternity home birth in Medan, Indonesia

OBJECTIVE: to assess the effectiveness of promoting the use of the World Health Organization (WHO) partograph by midwives for labour in a maternity home by comparing outcomes after birth. SETTING: Medan city, North Sumatera Province, Indonesia. PARTICIPANTS: 20 midwives who regularly conducted births in maternity homes, randomly allocated into two equal groups. DESIGN: cluster randomised-control trial. INTERVENTION: under supervision from a team of obstetricians, midwives in the intervention group were introduced to the WHO partograph, trained in its use and instructed to use it in subsequent labours. MEASUREMENTS AND FINDINGS: there were 304 eligible women with vertex presentations among 358 labouring women in the intervention group and 322 among 363 in the control group. Among the intervention group, 304 (92.4%) partographs were correctly completed. From 71 women with the graph beyond the alert line, 42 (65%) were referred to hospital. Introducing the partograph significantly increased referral rate, and reduced the number of vaginal examinations, oxytocin use and obstructed labour. The proportions of caesarean sections and prolonged labour were not significantly reduced. Apgar scores of less than 7 at 1min was reduced significantly, whereas Apgar scores at 5mins and requirement for neonatal resuscitation were not significantly different. Fetal death and early neonatal death rates were too low to compare. IMPLICATIONS FOR PRACTICE: a training programme with follow-up supervision and monitoring may be of use when introducing the WHO partograph in other similar settings, and the findings of this study suggest that the appropriate time of referral needs more emphasis in continuing education. CONCLUSION: the WHO partograph should be promoted for use by midwives who care for labouring women in a maternity home.     

The Mediterranean diet adherence by pregnant women delivering prematurely: association with size at birth and complications of prematurity

Background: The Mediterranean diet (MD) is associated with decreased risk of metabolic syndrome and gestational diabetes due to the anti-inflammatory and antioxidative properties of its components. The aim was to investigate the potential association of MD adherence (MDA) during pregnancy by mothers delivering prematurely, with intrauterine growth as expressed by neonates’ anthropometry at birth and complications of prematurity.

Participants and methods: This is a single-center, prospective, observational cohort study of 82 women who delivered preterm singletons at post conceptional age (PCA)?≤?34 weeks and their live-born neonates. Maternal and neonatal demographic and clinical data were recorded. All mothers filled in a food frequency questionnaire, and the MDA score was calculated. Based on 50th centile of MD score, participants were classified into high-MDA and low-MDA groups.

Results: The low-MDA mothers had significantly higher pregestational BMI and rates of overweight/obesity (odd ratios (OR) 3.5) and gestational hypertension/preeclampsia (OR 3.8). Neonates in the low-MDA group had significantly higher incidence of intrauterine growth restriction (IUGR) (OR 3.3) and lower z-scores of birth weight and BMI. Regarding prematurity-related complications, the low MDA-group was more likely to develop necrotizing enterocolitis, bronchopulmonary dysplasia, and retinopathy of prematurity (OR 3.2, 1.3, and 1.6, respectively), while they were less likely to develop respiratory distress syndrome (OR 0.49), although the differences were not statistically significant. However, adjustment for confounders revealed MDA as a significant independent predictor of hypertension/preeclampsia, IUGR, birth weight z-score, necrotizing enterocolitis, and bronchopulmonary dysplasia.

Conclusions: High MDA during pregnancy may favorably affect intrauterine growth and certain acute and chronic complications of prematurity as well as maternal hypertension/preeclampsia.     

Relationship between complementary and alternative medicine use and incidence of adverse birth outcomes: An examination of a nationally representative sample of 1835 Australian women

Objectivethere is evidence of high use of complementary and alternative medicine (CAM) by pregnant women. Despite debate and controversy regarding CAM use in pregnancy there has been little research focus upon the impacts of CAM use on birth outcomes. This paper reports findings outlining the incidence of adverse birth outcomes among women accessing CAM during pregnancy.Designa survey-based cohort sub-study from the nationally-representative Australian Longitudinal Study on Women׳s Health (ALSWH) was undertaken in 2010.Participantswomen (aged 31–36 years) who identified in 2009 as pregnant or recently given birth (n=2445) from the younger cohort (n=8012) of ALSWH were recruited for the study.Measurements and findingsparticipants׳ responses were analysed to examine the relationship between use of CAM and adverse birth outcomes from their most recent pregnancy. Of the respondents (n=1835; 79.2%), there were variations in birth outcomes for the women who used different CAM. Notably, the outcome which was most commonly associated with CAM use was emotional distress. This was found to occur more commonly in women who practised meditation/yoga at home, used flower essences, or consulted with a chiropractor. In contrast, women who consulted with a chiropractor or consumed herbal teas were less likely to report a premature birth, whilst participation in yoga classes was associated with an increased incidence of post partum/intrapartum haemorrhage.Key conclusionsthe results emphasise the necessity for further research evaluating the safety and effectiveness of CAM for pregnant women, with a particular focus on birth outcomes.Implications for practicehealth professionals providing care need to be aware of the potential birth outcomes associated with CAM use during pregnancy to enable the provision of accurate information to women in their care, and to assist in safely supporting women accessing CAM to assist with pregnancy, labour and birth.     

Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study

Objectiveto assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization.Designthis study is a cross-sectional study using the ReproQ questionnaire filled out eight to ten weeks after birth. The primary outcome was responsiveness of birth care. Secondary outcomes included overall grades for birth care and experiences with the birth centre services. Regression analyses were performed to compare experiences among the planned places of birth. The study is part of the Dutch Birth Centre Study.Settingthe women were recruited by 82 midwifery practices in the Netherlands, within the study period 1 August 2013 and 31 December 2013.Participantsa total of 2162 women gave written consent to receive the questionnaire and 1181 (54.6%) women completed the questionnaire.Measurements and findingswomen who planned to give birth at a birth centre:(1) had similar experiences as the women who planned to give birth in a hospital receiving care of a community midwife.(2) had significantly less favourable experiences than the women who planned to give birth at home. Differences during birth were seen on the domains dignity (OR=1.58, 95% CI=1.09–2.27) and autonomy (OR=1.77, 95% CI=1.25–2.51), during the postpartum period on the domains social considerations (OR=1.54, 95% CI=1.06–2.25) and choice and continuity (OR=1.43, 95% CI=1.00–2.03).(3) had significantly better experiences than the women who planned to give birth in a hospital under supervision of an obstetrician. Differences during birth were seen on the domains dignity (OR=0.51, 95% CI=0.31–0.81), autonomy (OR=0.59, 95% CI=0.35–1.00), confidentiality (OR=0.57, 95% CI=0.36–0.92) and social considerations (OR=0.47, 95% CI=0.28–0.79). During the postpartum period differences were seen on the domains dignity (OR=0.61, 95% CI=0.38–0.98), autonomy (OR=0.52, 95% CI=0.31–0.85) and basic amenities (OR=0.52, 95% CI=0.30–0.88). More than 80% of the women who received care in a birth centre rated the facilities, the moment of arrival/departure and the continuity in the birth centre as good.Key conclusions and implications for practicein the last decades, many birth centres have been established in different countries, including the United Kingdom, Australia, Sweden and the Netherlands. For women who do not want to give birth at home a birth centre is a good choice: it leads to similar experiences as a planned hospital birth. Emphasis should be placed on ways to improve autonomy and prompt attention for women who plan to give birth in a birth centre as well as on the improvement of care in case of a referral.     

Willingness of pregnant women to participate in a birth cohort study in China

Objective

To determine the willingness of pregnant women in Guangzhou, China, to participate in a large-scale birth cohort study.

Methods

A cross-sectional survey was conducted of 526 pregnant women who attended their first prenatal class at Guangzhou Women and Children’s Medical Center, Guangzhou, China, between September 21 and November 15, 2011. Information on demographic characteristics, willingness to participate, and preferences regarding collection procedures and incentives were analyzed.

Results

In all, 47.9% of the women were willing to participate in a birth cohort study, whereas 23.0% refused and 29.1% were unsure. The majority of the women willing to participate (95.2%–98.4%) accepted the use of non-invasive data collection methods except for stool collection, and 85.9% would allow their offspring to participate in long-term follow-up. Willingness to participate rose to 85.2% when non-monetary incentives were offered. The most popular incentive was assessment of child development.

Conclusion

The willingness of pregnant Chinese women to participate in long-term observational research was similar to that reported in high-income countries. Non-monetary incentives improved their level of willingness, a finding that might inform future maternal and child health research in low- and middle-income countries.     

Womens' attitudes and beliefs of childbirth and association with birth preference: A comparison of a Swedish and an Australian sample in mid-pregnancy

Background

the rate of caesarean in Australia is twice that of Sweden. Little is known about women's attitudes towards birth in countries where the caesarean rate is high compared to those where normal birth is a more common event.

Objectives

to compare attitudes and beliefs towards birth in a sample of Australian and Swedish women in mid-pregnancy.

Participants

women from rural towns in mid Sweden (n=386) and north-eastern Victoria in Australia (n=123).

Methods

questionnaire data was collected from 2007 to 2009. Levels of agreement or disagreement were indicated on sixteen attitude and belief statements regarding birth. Principal components analysis (PCA) identified the presence of subscales within the attitudes inventory. Using these subscales, attitudes associated with preferred mode of birth were determined. Odds ratios were calculated at 95% CI by country of care.

Results

the Australian sample was less likely than the Swedish sample to agree that they would like a birth that: ‘is as pain free as possible' OR 0.4 (95% CI: 0.2–0.7), ‘will reduce my chance of stress incontinence' OR 0.2 (95% CI: 0.1–0.8), ‘will least affect my future sex life' OR 0.3 (95% CI: 0.2–0.6), ‘will allow me to plan the date when my baby is born' OR 0.4 (95% CI: 0.2–0.7) and ‘is as natural as possible' OR 0.4 (95% CI: 0.2–0.9). They were also less likely to agree that: ‘if a woman wants to have a caesarean she should be able to have one under any circumstances’ OR 0.4 (95% CI: 0.2–0.7) and ‘giving birth is a natural process that should not be interfered with unless necessary’ OR 0.3 (95% CI: 0.1–0.7). Four attitudinal subscales were found: ‘Personal Impact of Birth', ‘Birth as Natural Event', ‘Freedom of Choice' and ‘Safety Concerns'. Women who preferred a caesarean, compared to those who preferred a vaginal birth, across both countries were less likely to think of ‘Birth as a natural event’.

Key conclusions

the Australian women were less likely than the Swedish women to hold attitudes and beliefs regarding the impact of pregnancy and birth on their body, the right to determine the type of birth they want and to value the natural process of birth. Women from both countries who preferred caesarean were less likely to agree with attitudes related to birth as a natural event.     

Effectiveness of a peer support intervention for antenatal depression: a feasibility study

ABSTRACT

Objective

A feasibility study for a randomised controlled trial to assess the acceptability, recruitment, feasibility and effectiveness of a peer support intervention for women with antenatal depression. The key premise of peer support is based upon the trust and empathetic understanding engendered by common experiences.     

Estimation of birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010

Abstract

Objective: To estimate birth population-based perinatal-neonatal mortality and preterm rate in China from a regional survey in 2010.

Study design: Data of total births in 2010 obtained from 151 level I–III hospitals in Huai’an, Jiangsu, were prospectively collected and analyzed.

Results: From 61?227 birth registries (including 60?986 live births and 241 stillbirths), we derive a birth rate of 11.3‰ (of 5.4 million regional population), a male-to-female ratio of 116:100 and valid data from 60?615 newborns. Mean birth weight (BW) was 3441?±?491?g with 13.6% macrosomia. Low BW was 2.8% (1691/60?372) with 8.83% mortality. Preterm rate was 3.72% (2239/60?264) with 7.61% mortality. Cesarean section rate was 52.9% (31?964/60?445), multiple pregnancy 1.8% (1088/60?567) and birth defects 6.7‰ (411/61?227). There were 97.4% healthy newborns and 2.2% (1298) requiring hospitalized after birth. The perinatal mortality was 7.7‰ (471/61?227, including 241 stillbirths, 230 early neonatal deaths). The neonatal mortality was 4.4‰ (269/60?986). The main causes of neonatal death were birth asphyxia (24.5%), respiratory diseases (21.5%), prematurity related organ dysfunction (18.5%) and congenital anomalies (7.7%), whereas incidence of congenital heart disease and respiratory distress syndrome was 8.6‰ and 6.1‰, respectively.

Conclusions: This regional birth population-based data file contains low perinatal-neonatal mortality rates, associated with low proportion of LBW and preterm births, and incidences of major neonatal disease, by which we estimate, in a nationwide perspective, in 16 million annual births, preterm births should be around 800?000, perinatal and neonatal mortality may be 128?000–144?000 and 80?000–96?000, respectively, along with 100?000 respiratory distress syndrome.     

Fear of childbirth and risk for birth complications in nulliparous women in the Danish National Birth Cohort

Objectives  To examine the associations between fear of childbirth and emergency caesarean section and between fear of childbirth and dystocia or protracted labour and fetal distress.
Design  Prospective cohort study.
Setting  Danish National Birth Cohort.
Population  A total of 25 297 healthy nulliparous women in spontaneous labour with a single fetus in cephalic presentation at term following an uncomplicated pregnancy.
Methods  Data were collected during 1997–2003 from computer-assisted telephone interviews twice in pregnancy linked with national health registers.
Main outcome measures  Risk for emergency caesarean section of women who feared childbirth; risk for dystocia/protracted labour or fetal distress of women who feared childbirth.
Results  Fear of childbirth in early (16 weeks, 6 ± 29 days) and late (31 weeks, 4 ± 21 days) pregnancy was associated with emergency caesarean section: OR, 1.23 (1.05–1.47) and 1.32 (1.13–1.55), respectively. When fear of childbirth was expressed at both interviews, the OR was 1.43 (1.13–1.80). Women who feared childbirth had an increased risk for dystocia or protracted labour (OR, 1.33; 1.15–1.54), but not for fetal distress (OR, 0.94; 0.72–1.23).
Conclusions  Fear of childbirth during pregnancy was associated with dystocia and emergency caesarean section but not with fetal distress.     

Impact of a structured, hands-on, surgical skills training program for midwives performing perineal repair

Objective

To evaluate the effect of structured hands-on training for midwives performing perineal repair.

Methods

The training was performed using models and ox tongues. A total of 719 midwives completed an anonymous questionnaire prior to and immediately after training. Out of 300 participants, 151 completed a follow-up questionnaire 4 months later. Participants rated their knowledge and skills in the domains of instrument handling, knot tying, and subcuticular perineal repair.

Results

Compared with the situation before receiving the training, there was a significant increase in the use of the recommended evidence-based technique for perineal repair 4 months after training (28% vs 100%; P < 0.001), and in the mean scores for knowledge and skills in all the domains (P < 0.001). Participants believed that their patients were happier with the new technique.

Conclusions

Structured hands-on training is an effective way of improving the skills of midwives performing perineal repair and leads to modification of clinical practice.     

Developmental origins of polycystic ovary syndrome (PCOS), a case control study comparing birth weight in women with PCOS and control group

Evidence from various epidemiological studies and experimental animal studies has linked adverse intrauterine circumstances with health problems in adult life. This field of investigation is known as Developmental Origins of Health and Disease (DOHaD). Studies investigating the relation between developing polycystic ovary syndrome (PCOS) in adulthood and birth weight have yielded inconsistent results: PCOS is described more often in women with low birth weight and high birth weight, while other studies have failed to establish any relation. In this retrospective case–control study, we evaluated whether women diagnosed with PCOS had lower birth weight compared to women with a regular menstrual cycle (controls). Binary logistic regression models were used to analyze the data and correct for known confounders. About 65 women with PCOS and 96 controls were recruited for this purpose. The average birth weight of PCOS women (3357?g) did not differ from the average birth weight of controls (3409?g). Mean age at menarche differed significantly between groups, 13.7 years and 12.8 years (p?=?0.006), respectively, for PCOS women and controls. In conclusion, we could not confirm the effect of adverse intrauterine conditions, reflected in birth weight, on developing PCOS.     

Memory of childbirth in the second year: The long-term effect of a negative birth experience and its modulation by the perceived intranatal relationship with caregivers

Objective. To assess the memory of various subdimensions of the birth experience in the second year postpartum, and to identify women in the first weeks postpartum at risk of developing a long-term negative memory.

Design, method, outcome measures. New mothers' birth experience (BE) was assessed 48–96 hours postpartum (T1) by means of the SIL-Ger and the BBCI (perception of intranatal relationships); early postnatal adjustment (week 3 pp: T1_bis) was also assessed. Then, four subgroups of women were defined by means of a cluster-analysis, integrating the T1/T1_bis variables. To evaluate the memory of the BE, the SIL-Ger was again applied in the second year after childbirth (T2). First, the ratings of the SIL-Ger dimensions of T1 were compared to those at T2 in the whole sample. Then, the four subgroups were compared with respect to their ratings of the birth experience at T2 (correlations, ANOVAs and t-tests).

Results. In general, fulfillment, emotional adaptation, physical discomfort, and anxiety improve spontaneously over the first year postpartum, whereas in negative emotional experience, control, and time-going-slowly no shift over time is observed. However, women with a negative overall birth experience and a low level of perceived intranatal relationship at T1 run a high risk of retaining a negative memory in all of the seven subdimensions of the birth experience.

Conclusions. Women at risk of developing a negative long-term memory of the BE can be identified at the time of early postpartum, when the overall birth experience and the perceived intranatal relationship are taken into account.     

The economic costs of intrapartum care in Tower Hamlets: A comparison between the cost of birth in a freestanding midwifery unit and hospital for women at low risk of obstetric complications

Objectiveto compare the economic costs of intrapartum maternity care in an inner city area for ‘low risk’ women opting to give birth in a freestanding midwifery unit compared with those who chose birth in hospital.Designmicro-costing of health service resources used in the intrapartum care of mothers and their babies during the period between admission and discharge, data extracted from clinical notes.Settingthe Barkantine Birth Centre, a freestanding midwifery unit and the Royal London Hospital's consultant-led obstetric unit, both run by the former Barts and the London NHS Trust in Tower Hamlets, a deprived inner city borough in east London, England, 2007–2010.Participantsmaternity records of 333 women who were resident in Tower Hamlets and who satisfied the Trust's eligibility criteria for using the Birth Centre. Of these, 167 women started their intrapartum care at the Birth Centre and 166 started care at the Royal London Hospital.Measurements and findingswomen who planned their birth at the Birth Centre experienced continuous intrapartum midwifery care, higher rates of spontaneous vaginal delivery, greater use of a birth pool, lower rates of epidural use, higher rates of established breastfeeding and a longer post-natal stay, compared with those who planned for care in the hospital. The total average cost per mother-baby dyad for care where mothers started their intrapartum care at the Birth Centre was £1296.23, approximately £850 per patient less than the average cost per mother and baby who received all their care at the Royal London Hospital. These costs reflect intrapartum throughput using bottom up costing per patient, from admission to discharge, including transfer, but excluding occupancy rates and the related running costs of the units.Key conclusions and implications for practicethe study showed that intrapartum throughput in the Birth Centre could be considered cost-minimising when compared to hospital. Modelling the financial viability of midwifery units at a local level is important because it can inform the appropriate provision of these services. This finding from this study contribute a local perspective and thus further weight to the evidence from the Birthplace Programme in support of freestanding midwifery unit care for women without obstetric complications.