The effect of midwifery care on rates of cesarean delivery

Objective

To examine whether changing to a midwifery-led maternity service model was associated with a lower national rate of cesarean delivery.

Methods

We analyzed trends in the rate of cesarean delivery per 1000 live births between 1996 and 2010 in New Zealand. Estimates of relative increases in rate were calculated via Poisson regression for several maternal age groups over the study period.

Results

Rates of cesarean delivery increased over the study period, from 156.9 per 1000 live births in 1996 to 235 per 1000 in 2010: a crude increase of 49.8%. Increasing trends were apparent in each age group, with the largest increases occurring before 2003 and relatively stable rates in the subsequent period. The smoothed estimate showed that the increase in cesarean rate across all age groups was 43.7% (95% confidence interval, 41.6–45.8) over the 15-year period.

Conclusion

A national midwifery-led care model was not associated with a decreased rate of cesarean delivery but, instead, with an increase similar to that in other high-resource countries. This indicates that other factors may account for the increase. Further research is needed to examine maternity outcomes associated with different models of maternity care.     

Midwife-led care unit for ‘low risk’ pregnant women in a Japanese hospital

Objectives.?To examine the obstetric outcomes of our ‘low risk’ pregnant women under the midwife-led delivery care compared with those under the obstetric shared care.

Methods.?A retrospective cohort study compared outcomes of labor under midwife ‘primary’ care with those under obstetric shared care. The factors examined were: maternal age, parity, gestational age at delivery, length of labor, augmentation of labor pains, delivery mode, episiotomy, perineal laceration, postpartum hemorrhage, neonatal birth weight, Apgar score, and umbilical artery pH. In this study, pregnant women were initially considered ‘low risk’ at admission when they had no history of medical, gynecological, or obstetric problems and no complications during the present pregnancy.

Results.?There were 1031 pregnant women initially considered ‘low risk’ at admission. At admission, 878 of them (85%) requested to give birth under midwife care; however 364 of these women (42%) were transferred to obstetric shared care during labor. The average length of labor under the midwife ‘primary’ care was significantly longer than that under the obstetric shared care. However, there were no significant differences in the rate of prolonged labor (≥24?h). There were no significant differences in other obstetric or neonatal outcomes between the two groups.

Conclusions.?There was no evidence indicating that midwife ‘primary’ care is unsafe for ‘low risk’ pregnant women. Therefore, midwifery care is recommended for ‘low risk’ pregnant women.     

The effectiveness of a Chinese midwives’ antenatal clinic service on childbirth outcomes for primipare: A randomised controlled trial

Background

Antenatal care is an important component of maternity care. In many parts of the world, midwives are the primary caregivers for childbearing women, providing a high level of continuity of care during a normal pregnancy. While in China, obstetricians are the primary providers of antenatal care for all childbearing women; and midwives only provide intrapartum care to labouring women. Today midwifery as a profession in China has been marginalised. Pregnant women usually lack individualised continuity of care from midwives during the perinatal period. There have been few randomised controlled trials of midwifery care practice in mainland China.

Objective

(1) To develop and implement a model of Chinese midwives’ antenatal clinic service and (2) to explore its effect on childbirth outcomes, psychological state and satisfaction, for primiparae.

Design and methods

Two-group randomised controlled trial. One hundred and ten pregnant women were assessed for eligibility and invited to participate in either the intervention group (midwives’ antenatal clinic service) or the control group (routine antenatal care) in the Obstetrics and Gynaecology Hospital of Fudan University from September 2011 to December 2011. Baseline data were collected, and then women were randomised to individual midwives’ antenatal clinic care (intervention group) or regular antenatal clinic service by obstetricians and obstetric nurse (control group). The research hypothesis was that compared with regular obstetrician-led antenatal care, the midwives’ antenatal clinic service would decrease the caesarean section rate, produce more favourable birth outcomes and women's greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. The sample size of 110 was calculated to identify a decrease in caesarean birth from 70% to 40%. Birth outcomes, satisfaction and anxiety score in the two groups were compared.

Setting

The midwives’ antenatal clinic in the Obstetrics and Gynaecology Hospital of Fudan University, Shanghai, China.

Participants

55 women, attending the midwives’ antenatal clinic (the intervention group) and 55 women, entering the control group.

Results

Women in the intervention group were more likely than women in the control group to have a vaginal birth (35 [66.04%] versus 23 [43.40%]; 95% CI for difference 3.69–41.60). Women in the intervention group had a higher perinatal satisfaction but lower anxiety score than those in the control group. No differences were seen in neonatal Apgar score and in the amount of bleeding 2 h post partum.

Conclusion and implications for practice

The midwives’ antenatal clinic can decrease the rate of caesarean section and enhance women's satisfaction with midwifery care. Further research needs to be conducted to implement this model of care more widely. We will attempt to make midwifery care a true choice for Chinese women.     

探讨助产士门诊对流动人口孕妇妊娠结局的影响

目的探讨助产士门诊对流动人口孕妇妊娠结局的影响。方法回顾性分析2006年7月至2008年7月在我院分娩的流动人口孕产妇6236例,其中以2006年7月至2007年7月3076例（实施流动人口孕产妇管理前）作为对照组,以2007年7月至2008年7月3160例（实施流动人口孕产妇管理后）作为观察组,对比两组产前检查次数、住院分娩率、满意度以及不良妊娠结局。结果观察组产前检查覆盖率、住院分娩率、满意度明显高于对照组,差异有统计学意义（Hc=36395,P〈0.01）;观察组顺产者比对照组多,差异有统计学意义（χ2=126.44,P〈0.01）。观察组不良妊娠结局的发生率低于列照组,差异有统计学意义（P〈0.05）;两组产后出血及巨大儿发生率比较,差异无统计学意义（P〉0.05）。结论通过启用助产士门诊,加强流动人口孕产妇产前检查及随访,可以有效减少流动人口孕产妇不良妊娠结局的发生率。     

江苏省107所医疗机构助产士门诊开展现状的调查研究

目的 了解江苏省医疗机构助产士门诊的开展现状,并分析影响其开展的因素,为今后助产士门诊的建设及相关服务政策的制订提供参考依据。 方法 2021年1月采用自行设计的江苏省医疗机构助产士门诊开展现状调查表,对江苏省13个城市,共116所二级及以上医疗机构的助产士门诊开展现状进行调查。 结果 最终,107所医疗机构完成调查,开展助产士门诊的医疗机构有48所（44.86%）,其中11所（22.92%）每周只开诊4 h。妇幼保健类专科医院开设助产士门诊的比例和每周开诊时间高于综合性医院,三级医院开设助产士门诊的比例高于二级医院（P<0.05）;三级医院、妇幼保健类专科医院的出诊者学历较高（P<0.05）;妇幼保健类专科医院开始介入管理的孕周较早、开展模拟分娩较多（P<0.05）。所有已开设助产士门诊的医疗机构都没有专门配套的电子病历系统。影响59所医疗机构未开设助产士门诊的前3个原因是：没有医院政策支持、人员不足、不知道如何开展。 结论 助产士门诊在江苏省医疗机构中普及率不足50%,应加大综合性医院、二级医院助产士门诊的普及率;增加已开设助产士门诊医疗机构的门诊开诊时间、提高开诊质量,加快建设助产士门诊电子病历系统。建议在人力资源、出诊时间、软件信息、质量控制等政策上提供进一步支持和监督。     

Midwives’ lived experience of caring for new mothers with initial breastfeeding difficulties: A phenomenological study

ObjectiveThe aim of this study is to obtain a deeper understanding of midwives’ lived experiences of caring for new mothers with initial breastfeeding difficulties.MethodsA reflective lifeworld approach was used. Six midwives were recruited from a hospital in western Sweden. Data were collected via individual lifeworld interviews and analysed using phenomenological methods.ResultsThe essential meaning can be described as a midwife’s wish to help new mothers reach their breastfeeding goals by trying to interact with them as individual women in unique breastfeeding situations. This wish constitutes a contradiction to the midwife’s own desire to succeed in enabling mothers to breastfeed and the perceived risk of failure as a midwife if the mothers decide not to breastfeed. This is further described by five constituents: striving to provide individualised care, collegial and personal responsibility both enables and prevents care, a struggle to be sufficient, an uphill struggle and mutual joy becomes the motivation to care.ConclusionsCaring for new mothers with initial breastfeeding difficulties is a balancing act between the midwife’s personal desire to succeed in enabling mothers to breastfeed, the mothers’ wishes, the infants’ needs, the importance of collective collegial competence and the limitations in the health care organisation. This makes the midwife's efforts to provide individualised care frustrating and demanding as well as motivating.     

苏格拉底教学法在护士转型助产士理论教学中的应用

目的探讨苏格拉底教学法在护士转型助产士理论教学中的应用效果,提高护士转型助产士理论教学的质量。方法选择我院2013年8月~2016年12月护士转型助产士共28例,随机分为两组,观察组采用苏格拉底教学法进行助产理论知识教学,对照组采用传统的教师口头及书面讲述法进行教学。比较两组护士进入产房后1个月、2个月、3个月的理论知识考核成绩,并对28例护士发放调查问卷对两种教学方法进行综合评价。结果观察组护士1个月、2个月、3个月的理论考核成绩均优于对照组,差异具有统计学意义(P0.05);两组护士对教学效果的综合评价中,除掌握助产知识差异无统计学意义(P0.05)外,其余各项之间差异均有统计学意义(P0.05)。结论苏格拉底教学法在护士转型助产士这一特殊群体的理论教学中有较好的教学效果,可激发护士学习热情,提高护士思维能力,同时可达到教学相长的目的,使带教老师的理论水平得到进一步巩固与提升,值得推广。     

Strategies to support breastfeeding: a review

DEM?RTAS B. (2012) Strategies to support breastfeeding: a review. International Nursing Review Background: Mothers need to be given support, confidence and encouragement to successful breastfeeding. The importance of breastfeeding support has been addressed in numerous studies. However, reviews to explore strategies to support breastfeeding are sparse. Aim: The study aims to explore strategies to support breastfeeding. It was also aimed to reveal how the international papers compare with the Turkish situation. Methods: Searches of CINAHL, PubMed, ScienceDirect, Scopus, Web of Science databases, Cochrane databases, Turkish health databases were conducted for data collection. The search was limited to articles published between the years 1995 and 2011, focusing on the strategies related to the support received by mothers. Two experts independently read and analysed 38 articles. Findings: Thirty‐eight papers were included in this review. The findings identified strategies to support breastfeeding. These include collaboration with community and family members; confidence building; appropriate ratio of staffing levels; development of communication skills; and ‘closing the gap’ in inequalities in health. Conclusion: Mothers benefit from strategies that encourage breastfeeding, with guidance that supports their self‐efficacy and feelings of being capable and empowered, and is tailored to their individual needs.     

产房助产士对产后出血临床预防处理及护理

目的探讨产房助产士对产后出血临床预防处理及护理方法。方法选取我院2015年12月～2017年12月收治的分娩产妇共52例,作为本次研究的主要对象,对产妇进行随机分组处理,分为观察组和对照组两组,每组26例,对照组使用常规护理的方式,观察组使用产房助产士全程陪护的方式,观察两组产妇的产后出血情况和早产以及新生儿窒息、ARDS等。结果观察组产妇在产后2 h内出血率和产后2～6 h之间的出血率明显较对照组产妇低,两组对比差异具有统计学意义(P0.05)。观察组产妇的早产和新生儿窒息、ARDS等情况的发生率明显较对照组产妇低,两组对比差异明显(P0.05)。结论产房助产士在对产妇进行产后精心护理时,能够有效对产妇产后出血的情况加以有效预防,并且降低产妇产后的出血率,能够使产妇更快的恢复健康,并且对产妇的生命健康有效保障。     

Routine interventions in childbirth before and after initiation of an Action Research project

BackgroundUnnecessary routine interventions in uncomplicated labour and birth, like cardiotocography (CTG), amniotomy, use of scalp electrode and oxytocin treatment, are associated with further interventions that could harm the woman and the infant. A four year Action Research (AR) project was done on a labour ward to enhance the capacity of local midwives in the promotion of physiological labour and birth.AimTo describe the use of interventions during labour and birth in healthy women at term with spontaneous onset of labour, before and after initiation of an Action Research project.MethodsA retrospective before and after comparative study of clinical records from 2009 (before) and 2012 (after), based on a random selection of records from primiparous and multiparous women. Outcome measures were duration of admission CTG, frequency of admission CTG over 30 min, frequency of amniotomy, use of scalp electrode, and frequency of oxytocin augmentation in spontaneous labour.Results903 records were included. The duration of admission CTG (p = 0.001), frequency of admission CTG duration over 30 min (p = <0.001), the use of scalp electrodes (p = <0.001), and use of oxytocin augmentation of spontaneous labour (p = 0.014) were reduced significantly after initiation of the AR project. There were no significant differences in frequency of amniotomy, duration of total CTG, postpartum bleeding, sphincter tears, Apgar score <5 at 5 min, and mode of birth.ConclusionFollowing an AR project, several interventions were reduced during labour and birth. Controlled studies in other settings are needed to assess the impact of collaborative action on decreasing unnecessary interventions.