Good Outcome For Mother Research Articles

APPROACH AND TREATMENT OF NON-MELANOMA SKIN CANCER DURING PREGNANCY

Pregnancy presents unique challenges in diagnosing and treating non-melanoma skin cancer, the most common type of skin cancer. Hormonal and immunological changes during pregnancy can influence the development and progression of the disease, while ethical issues and concerns about fetal safety complicate the therapeutic approach. Therefore, it is crucial to understand how this condition is managed during pregnancy to ensure the best outcome for mother and baby. Objective: The objective of this systematic literature review is to analyze the approaches and treatments used for non-melanoma skin cancer during pregnancy, with a focus on maternal and fetal safety. Methodology: The review followed the PRISMA checklist guidelines. Articles published in the last 10 years were searched in the PubMed, Scielo and Web of Science databases. The descriptors used were "non-melanoma skin cancer", "pregnancy", "treatment", "approach" and "fetal safety". The inclusion criteria were studies that described cases of non-melanoma skin cancer during pregnancy, addressing treatment options and fetal safety considerations. The exclusion criteria were studies irrelevant to the topic, studies without access to the full text and studies not available in English, Portuguese or Spanish. Results: Analysis of the articles revealed several therapeutic approaches for non-melanoma skin cancer during pregnancy, including surgery, photodynamic therapy and cryotherapy. There was an emphasis on the individualized assessment of each case, taking into account the stage of the disease, the location of the tumor and the potential risks for the mother and fetus. Prevention was also highlighted, with an emphasis on sun protection and skin self-examination. However, some treatments have been delayed until after birth due to concerns about fetal safety. Conclusion: The management of non-melanoma skin cancer during pregnancy requires a multidisciplinary and individualized approach, considering the risks and benefits for the mother and fetus. Prevention, early diagnosis and adequate treatment are essential to guarantee the best result for both. More research is needed to further guide clinical practices in this area.

Holistic community-based group parenting programs for mothers with maternal mental health issues help address a growing public health need for a diversity of vulnerable mothers, children and families: Findings from an action research study.

Maternal mental illness is a major growing global concern which can affect parenting with serious negative implications for offspring. Group-based parenting programs for mothers which both enhance the parent-child relationship and address mental health symptoms in a supportive social setting may optimise better outcomes for mothers and children. The Acorn program in South Australia draws on attachment theory to integrate dance play, reflective diary keeping and therapeutic letters in a holistic program for a diversity of vulnerable mothers and children aged 1-36 months. The program seeks to nurture and enhance parental wellbeing and the quality of the parent-child relationship for mothers experiencing identified mental health illnesses that impinge upon their parenting. This study presents the evaluation of the program and its effectiveness. Action research approach for continuous monitoring and program improvement engaging Acorn program staff in evaluation data collection and interpretation of pre and post self-completion measures and standardized observations. Additional data was collected through a telephone interview of attending mothers 6-8 months after program completion to address sustainable impacts on parenting and wellbeing. The program engaged 353 diverse vulnerable mothers with their children. Many had profound overlapping mental health issues including borderline personality disorder (BPD) and depression. The quality of the parent-child interaction, parental confidence, competence and enjoyment were enhanced; mothers' wellbeing, ability to cope and lasting social supports were augmented. This occurred for a number of "most vulnerable" subgroups including single mothers, mothers with BPD, mothers from non-English speaking households and those with lower levels of education or household income. Mothers reported sustained improvements in their wellbeing, parenting, social and family lives, and feeling closer to their child as a result of participating in the program. Given the high prevalence of maternal mental health issues and substantial potential negative consequences for mothers and offspring, the Acorn parenting program offers an effective means of addressing this pressing public health issue potentially helping large numbers of vulnerable mothers and their children. This has additional gravitas in the shadow of COVID-19 due to expanded numbers of those experiencing greater parental stress, isolation and mental illness.

Case report and discussion of pregnancy in a woman with Labrune syndrome and neurofibromatosis type 1

Labrune syndrome is a rare neurological autosomal recessive condition characterised by leukoencephalopathy, cerebral calcification and parenchymal cysts. Pregnancy has not been previously reported in an individual with this condition. This case report details the pregnancy of a primiparous woman with Labrune syndrome and neurofibromatosis type 1 who experienced a seizure in the second trimester of pregnancy, but went on to deliver her baby at term with good outcome for mother and baby. The case highlights the importance of pre-pregnancy advice in women with genetic conditions, and a multidisciplinary approach to the care of women with rare and complicated medical conditions during pregnancy.

Патологічне прикріплення плаценти: діагностика, тактика ведення та розродження

The incidence of placenta previa is 0.2-0.9% but continues to be one of the most serious factors in the development of obstetric’s bleeding and perinatal losses. The situation is aggravated by the fact that placenta previa is combined with various variations of abnormal (deep) attachment of the placenta to the uterus (placenta adhaerens, accreta, increta, percreta). Placenta previa, placenta accreta, and vasa previa cause significant maternal and perinatal morbidity and mortality. With the increasing incidence of both cesarean delivery and pregnancies using assisted reproductive technology, these 3 conditions are becoming more common. Placental accretion remains the main cause of maternal hemorrhage and obstetric hysterectomy, resulting in significantly high maternal morbidity and mortality. Risk factors for placenta previa include prior cesarean delivery, pregnancy termination, intrauterine surgery, smoking, multifetal gestation, increasing parity, and maternal age. Advances in ultrasound have facilitated prenatal diagnosis of abnormal placentation allowing the development of multidisciplinary management plans to achieve the best outcomes for mother and baby. Purpose - to review the literature on abnormal placentation, including an evidence-based approach to diagnosis, management and treatment; to follow the evolution of this obstetric pathology in recent years and the complications that may arise. Identification of risk factors, correct antenatal and preoperative diagnosis, multidisciplinary treatment and counseling will help in the overall management of women with placenta accreta and reduce maternal morbidity. According to the literature, it can be concluded that true placenta previa or placenta percreta, as well as suspected placenta previa (for example, in cases with a history of caesarean section in anamnesis), should be managed and delivered by caesarean section in a tertiary health facility. In no case should the placenta be separated if edematous blood vessels with visible placental blood flow after laparotomy are found in the area of attachment of the placenta to the anterior wall of the uterus, as well as when the diagnosis is placenta percreta or placenta increta. As a tactic, not only primary hysterectomy should be considered, but also conservative therapy or delayed hysterectomy (two-stage hysterectomy). In a situation where placenta accreta or partial placenta accreta cannot be accurately diagnosed, a good understanding of hemostasis with balloon catheter occlusion, various methods of suture hemostasis, and total hysterectomy procedures should be considered. No conflict of interests was declared by the author.

C1 - Stronger Together (Original song by Lucy Mount)

Before I studied midwifery, I was doing a music degree in performance. I find music to be my greatest therapy, and a way to express myself. I have written a song which to me, explores the key values and philosophy of midwifery care. It portrays the experience and morals of midwives, women and a career in midwifery. The first part of the song is written from the midwives’ perspective. It is the last few moments of birth, and reveals the pure joy of being a midwife, helping women and being by their side through this miraculous experience. The chorus is created around values of strength, equality and standing together in unison- woman, midwife, and her healthcare team. It also explores the support offered by the midwife, the resilience that they have, the strength that they can share, the love that they pour into their profession all for the women they work alongside. This part of the song encapsulates the true essence of a woman centred care philosophy. I wrote the second part of the song from the woman’s perspective to portray the first few moments with her new baby, the sense of accomplishment, overpowering feeling of love, and gratitude for her midwife. I know that not all birth stories end like this, however it is something that as midwives we strive for, the best outcomes for mothers and babies. The structure of my song, from the different perspectives and being connected through the chorus represents the bond and equality between women and midwives. I also wanted to explore the concept of “professional friend”, as I believe that midwives are more than health care professionals to the women. To provide the best care, we need to dig a little deeper than the medical conditions or the alert sticker. Some of the best results stem from the best care, continuity of care, and making women feel comfortable and safe.

An analysis of obstetric practices and outcomes in a deep rural district hospital in South Africa

Internationally, there has been a focus on ensuring that Caesarean deliveries are performed only when indicated, to ensure the best outcome for mother and baby. In South Africa, despite a variety of health system interventions, maternal and perinatal mortality remain unacceptably high. To describe and compare the clinical outcomes related to the mode of delivery, for patients managed at rural primary healthcare level. This retrospective cross-sectional observational analytical study was conducted at a deep rural district hospital in northern KwaZulu-Natal, South Africa. Maternity Case Records and Caesarean delivery audit tools from 2018 were reviewed. In total, 634 files were retrieved. The Caesarean delivery rate in the sample was 30.8% (193 of 634 deliveries), and according to the Robson classification, groups 5 and 1 were the biggest contributors to Caesarean delivery. All Caesarean deliveries were deemed to have been medically indicated. As compared to those whose delivery was normal vaginal, the odds of having post-partum haemorrhage were 25 times higher, and the odds of having any complication were three times higher, if a mother delivered by Caesarean (p<0.001). In neonates who were delivered by Caesarean, the odds of being admitted to nursery were four times higher than those delivered vaginally (p<0.001). Showing a significantly higher risk of maternal and neonatal complications, this study validated Caesarean delivery at rural primary care as a potentially dangerous undertaking, for which adequate precautions should be taken. There is a need for interventions targeting rural healthcare in South Africa, to ensure that obstetric services are offered to patients in as safe a manner as possible in this environment.

Diagnosis, treatment and outcome of adnexal torsion at different gestational weeks during pregnancy

Objective: To investigate the clinical characteristics, diagnosis, treatment and outcome of adnexal torsion at different gestational weeks during pregnancy. Methods: A retrospective analysis was conducted of the clinical data of 24 pregnancy patients with adnexal torsion, aged 21-38 (30.6±4.4) years old, who were admitted and delivered in Peking University Third Hospital from 2015 to 2019. According to the gestational age, all patients were divided into two groups:<28 weeks group (11cases) and ≥28 weeks group (13 cases), to compare the intergroup differences in clinical characteristics, treatment and outcome, and the differences of clinical data and outcome between two groups were compared. Results: The proportion of patients with twin pregnancy and assisted reproductive technology in the<28 weeks group was significantly higher than that in the ≥28 weeks group (5/11 vs 1/13, 8/11 vs 1/13, P<0.05). No significant differences between the two groups were recorded in terms of the size of the adnexal mass, the cycles of torsion and the duration from onset to operation. Compared with the≥28 weeks group, the adnexal removal rate of the<28 weeks group was lower (3/11 vs 6/13), but the difference was not statistically significant. The proportion of blood flow signals of ultrasound before operation, cases undergoing laparoscopic surgery and cases whose pathological findings were physiological cysts in the<28 weeks group were significantly higher than that in the ≥28 weeks group (8/11 vs 4/13, 8/11 vs 0, 8/11vs 4/13; P<0.05). Concerning the pregnancy outcomes, there was no difference in the mode of delivery, the delivery gestational age and the body weight of newborns between the two groups. Conclusions: The patients with adnexal torsion prior to 28 weeks(<28 weeks)of pregnancy were more likely to be conceived by assisted reproductive technologies, and the etiology was more likely to be ovarian physiological cysts. Both laparoscopy and laparotomy were safe and effective in the treatment of adnexal torsion with good outcome for mother and infant in the study.

Couvelaire-Uterus: literature review and case report

Uteroplacental apoplexy or Couvelaire uterus is a rare complication in the spectrum of the life-threatening placental abruption. We report a 29-year-old pregnant woman who had a placental abruption complicated with the rare condition of Couvelaire uterus, with an delivery per uterus-sparring cesarean section. The early diagnosis and proper medical management of placental abruption through uterus-sparring cesarean section present the best outcome for mother and child.

The Odon Device\u2122 for assisted vaginal birth: a feasibility study to investigate safety and efficacy\u2014The ASSIST II study

BackgroundThe Odon Device™ is a new device for assisted vaginal birth that employs an air cuff around the fetal head for traction. Assisted vaginal birth (AVB) is a vital health intervention that can result in better outcomes for mothers and their babies when complications arise in the second stage of labour. Unfortunately, instruments for AVB (forceps and ventouse) are often not used in settings where there is most clinical need often due to lack of training and resources, resulting in maternal and neonatal morbidity and mortality which could have been prevented.This is often due to a lack of trained operators as well as difficulties in the sterilisation and maintenance of AVB devices. This novel, single use device has the potential to mitigate these difficulties as it is single use and is potentially simpler to use than forceps and ventouse.All the studies of the Odon Device to date (pre-clinical, preliminary developmental and clinical) suggest that the Odon Device does not present a higher risk to mothers or babies compared to current standard care, and recruitment to intrapartum research exploring the device is feasible and acceptable to women. The first study in which the Odon Device was used in clinically indicated conditions (the ASSIST Study) reported a lower efficacy than those reported with established devices. The reasons need to be explored, specifically focussing on learning curve, the technique of the doctors using this new device and potential modifications to device design. A follow-on clinical study to further investigate the efficacy and safety of the Odon Device in its indicated use, the ASSIST II Study, is therefore being undertaken.MethodsThe primary feasibility outcome is study feasibility (recruitment and retention rates) whilst the primary clinical outcome successful vaginal birth completed with the Odon Device. Key secondary feasibility outcomes include participant withdrawal, compliance in data collection and acceptability of the device to women and operators. Secondary clinical outcomes include maternal, neonatal and device outcomes. Safety data will be reviewed following every birth exploring maternal, neonatal and device risks. Using A’Hern approach for sample size calculation, we aim to recruit 104 women requiring an assisted vaginal birth for a recognised clinical indication. Assuming an AVB success rate of 65% or more, a one-sided alpha risk of 5% and power of 90%.DiscussionThe data from the ASSIST II Study will provide the information required regarding acceptability, recruitment, outcome data collection, device design, technique of device use and operator learning curve in order to design a future randomised controlled trial of the Odon Device versus current modes of assisted vaginal birth.Trial registrationISRCTN registration: 38829082 (prospectively registered July 26, 2019)

Association between breastfeeding and new mothers\u2019 sleep: a unique Australian time use study

BackgroundInfant sleep is of great interest to new parents. There is ongoing debate about whether infants fed with breastmilk substitutes sleep longer than those exclusively or partially breastfed, but what does this mean for the mother? What expectations are realistic for mothers desiring to exclusively breastfeed as recommended by health authorities?There are both biological and social influences on infant and maternal sleep. More accurate information on average maternal sleep hours for diverse feeding practices may help guide realistic expectations and better outcomes for mothers, infants and families.MethodsUsing a unique time use dataset purposefully designed to study the time use of new mothers, this study investigated whether the weekly duration of maternal sleep, sleep disturbance, unpaid housework, and free time activities differed by detailed feeding method. The study collected 24/7 time use data from 156 mothers of infants aged 3, 6 and/or 9 months between April 2005 and April 2006, recruited via mother’s groups, infant health clinics, and childcare services throughout Australia. Sociodemographic and feeding status data were collected by questionnaire. Statistical analysis used linear mixed modelling and residual maximum likelihood analysis to compare effects of different infant feeding practices on maternal time use.ResultsThere were no significant differences in time spent asleep between lactating and non lactating mothers, though lactating mothers had more time awake at night. Lactating mothers spent more time (8.5 h weekly) in childcaring activity (p = 0.007), and in employment (2.7 vs. 1.2 h, p < 0.01), but there were no significant differences in free time. Those not breastfeeding spent more time in unpaid domestic work.Exclusive breastfeeding was associated with reduced maternal sleep hours (average 7.08 h daily). Again, free time did not differ significantly between feeding groups. Exclusively breastfeeding mothers experienced reduced sleep hours, but maintained comparable leisure time to other mothers by allocating their time differently. Domestic work hours differed, interacting in complex ways with infant age and feeding practice.ConclusionsOptimal breastfeeding may require realistic maternal sleep expectations and equitable sharing of paid and unpaid work burdens with other household members in the months after the birth of an infant.

Comparing breastfeeding experiences between mothers spending the traditional Chinese confinement period in a confinement centre and those staying at home: a cohort study

BackgroundEthnic Chinese mothers in Malaysia adhere to 30 days of traditional postpartum practices (the “confinement period”) aimed at recuperation after delivery. Recently there has been an emergence of confinement centres (CCs) where mothers stay and receive traditional confinement care. Ethnic Chinese mothers have low breastfeeding rates. There are concerns that practices in CCs could contribute to this but no data exists. We described mothers’ breastfeeding experiences at CCs and identified areas for potential improvement in breastfeeding support.MethodsEthnic Chinese mothers intending to breastfeed their healthy infants were recruited post-delivery between August and October 2017 then, at 1 and 6 months, they were telephone interviewed about their experience. For every participant going to a CC after the birth, another mother going home (“home”) for her confinement was recruited. Chi-square test was used to compare groups and multiple logistic regression was used to assess the effect of confinement place on exclusive breastfeeding.ResultsOf 187 mothers, 88 (47%) went to CCs. Significantly more were primipara and fewer had previous breastfeeding experience. Response rates for the 1- and 6- month interviews were 88% (CC) versus 97% (home); and 77% (CC) versus 87% (home) respectively.Exclusive breastfeeding rates were similar between the groups: 62% (CC) versus 56% (home) at 1 month (p = 0.4); and 37% (CC) versus 42% (home) at 6 months (p = 0.5). Multiple logistic regression did not show that CCs were a factor affecting exclusive breastfeeding rates at 1 month, (adjusted odds ratio [aOR] 1.7, 95% confidence interval [CI] 0.9, 3.3), or 6 months (aOR 0.9, 95% CI 0.4, 1.7). However, significantly more CC participants only fed expressed breast milk. Despite 66% of CC participants reporting that their centre supported breastfeeding, only 6 (8%) CC participants compared to 66 (69%) of home participants roomed-in with their baby (p < 0.001). The proportion encountering breastfeeding difficulties were similar between groups. CC participants sought help for breastfeeding problems mainly from CC staff and support groups while home participants obtained help from friends and healthcare professionals.ConclusionsBreastfeeding rates appeared to be similar at CCs and at home during the confinement period, but there were gaps in how CCs supported breastfeeding. Targeted training to CC staff to support breastfeeding may result in better outcomes for mothers staying in CCs.

Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study.

Background: Birth plans are used for pregnant women to express their wishes and expectations about childbirth. The aim of this study was to compare obstetric and neonatal outcomes between women with and without birth plans. Methods: A multicentre, retrospective case–control study at tertiary hospitals in southern Spain between 2009 and 2013 was conducted. A total of 457 pregnant women were included, 178 with and 279 without birth plans. Women with low-risk gestation, at full-term and having been in labour were included. Sociodemographic, obstetric and neonatal variables were analysed and comparisons were established. Results: Women with birth plans were older, more educated and more commonly primiparous. Caesarean sections were less common in primiparous women with birth plans (18% vs. 29%, p = 0.027); however, no significant differences were found in instrumented births, 3rd–4th-degree tears or episiotomy rates. Newborns of primiparous women with birth plans obtained better results on 1 min Apgar scores, umbilical cord pH and advanced neonatal resuscitation. No significant differences were found on 5 min Apgar scores or other variables for multiparous women. Conclusions: Birth plans were related to less intervention, a more natural process of birth and better outcomes for mothers and newborns. Birth plans can improve the welfare of the mother and newborn, leading to birth in a more natural way.

The association of cannabis use late in pregnancy with engagement and retention in perinatal substance use disorder care for opioid use disorder: A cohort comparison

BackgroundPrenatal use of cannabis and opioids are increasing and very concerning. Engagement and retention in comprehensive, perinatal substance use disorder (PSUD) care are associated with better outcomes for mothers and babies. We compared the characteristics and engagement in care among women with opioid use disorder who used cannabis late in pregnancy versus those who didn't. MethodsThe primary outcome, “overall engagement and retention in PSUD care” included: utilization of substance use treatment prenatally, negative screening/toxicology at delivery (excluding cannabis), and attendance at expected prenatal and postpartum visits. Cannabis use late in pregnancy was objectively assessed at delivery via maternal urine drug screen and/or neonatal meconium/cord toxicology. Between-group comparisons utilized chi square, t-test or Mann-Whitney. Associations were assessed using Spearman Rho and two multivariate, binary logistic regressions for cannabis use and the primary outcome. Results18.0% (85/472) consumed cannabis late in pregnancy. Women of color, younger women, and those diagnosed with concurrent cannabis use disorder were more likely to consume cannabis. Engagement and retention in PSUD care was not associated with cannabis use, but rather, with prescribed pharmacotherapy for psychiatric disorders. The use of prescribed buprenorphine+naloxone was associated with cannabis avoidance late in pregnancy. ConclusionsCannabis use late in pregnancy, compared to none, did not impact engagement and retention in our PSUD program. Adjunctive psychotropic medication and/or buprenorphine+naloxone prescription were associated with cannabis avoidance suggesting the use and interactions of pharmacotherapies in an opioid dependent population is complex. A shared decision-making process during PSUD care is warranted.

Patient safety culture in Oman: A national study.

A positive patient safety culture in maternity units is linked to higher quality of care and better outcomes for mothers. However, safety culture varies across maternity units. Analyses of variation in safety culture using statistical process control (SPC) methods may help provider units to learn from each other's performance. This study aims to measure patient safety culture across maternity units in Oman using SPC methods. The 36-item Safety Attitude Questionnaire (SAQ) was distributed to all doctors, nurses, and midwifes working in ten maternity care units in Oman's hospitals and analysed using SPC methods. The SAQ considers six domains: job satisfaction, perception of management, safety climate, stress recognition, teamwork, and work condition. Of the 892 targeted participants, 735 (82%) questionnaires were returned. The overall percentage of positive safety responses in all hospitals ranged from 53% to 66%, but no hospital had the targeted response of above 75%. Job satisfaction had the highest safety score (4.10) while stress recognition was the lowest (3.17). SPC charts showed that the overall percentage of positive responses in three maternity units (H1, H7, and H10) was above and one (H4) was below the control limits that represent special cause variation that merits further investigation. Generally, the safety culture in maternity units in Oman is below target and suggests that considerable work is required to enhance safety culture. Several maternity units showed evidence of high/low special cause variation that may offer a useful starting point for understanding and enhancing safety culture.

Maternal and perinatal outcomes for women with body mass index ≥50kg/m2 in a non-tertiary hospital setting.

Obesity is prevalent in the Australian antenatal population, but there are scarce data on the prevalence and associated outcomes of body mass index (BMI) ≥50kg/m2 . To examine the prevalence and outcomes for women with BMI ≥50kg/m2 delivering in a non-tertiary hospital. Retrospective cohort study of women delivering a singleton pregnancy in a non-tertiary Victorian hospital during 2011-2016. Women >180kg were excluded as their care was managed in a tertiary centre. Maternal and perinatal outcomes were analysed by BMI group. Statistical analysis was performed using χ2 , Kruskal-Wallis and logistic regression with a significance level of 0.05. Of the 18518 births between 2011 and 2016, 99.4% had a maternal BMI recorded. The prevalence of BMI ≥50kg/m2 was 0.5%. Highest complication rates were observed among women with BMI ≥50kg/m2 , including gestational diabetes (29%), hypertensive disorders of pregnancy (20%) and caesarean section (48%). Of infants born to women with BMI ≥50kg/m2 , 12% were late-pre-term, 23% required special or intensive care and 20% had birth weight ≥4.0kg. When compared with obese women with BMI 30-49kg/m2 , women with BMI ≥50kg/m2 were significantly more likely to develop a hypertensive disorder of pregnancy (preeclampsia adjusted odds ratio (aOR) 3.98 (1.93-8.18), pregnancy-induced hypertension aOR 3.55 (1.79-7.03)) and deliver a late pre-term infant (aOR 2.45 (1.31-4.58)). The prevalence of severe maternal obesity in our non-tertiary setting is higher than previous national estimates. Women with BMI ≥50kg/m2 are an important subgroup of the obese obstetric population who experience high rates of complications and interventions. Health services need to respond to evolving needs of the antenatal population to achieve the best outcomes for mothers and babies.

The ASSIST Study - The BD Odon Device for assisted vaginal birth: a safety and feasibility study

BackgroundAssisted vaginal birth is a vital health intervention that can result in better outcomes for mothers and their babies when complications arise in the second stage of labour. Unfortunately, instruments for assisted vaginal birth (forceps and ventouse) are often not utilised in settings where there is most clinical need, resulting in maternal and neonatal morbidity and mortality which could have been prevented. The BD Odon Device is a new device for assisted vaginal birth that may be able to address this unmet need. However, before dissemination, the device requires evaluation in robust clinical trials. A feasibility study to investigate the clinical impact, safety, and acceptability of the BD Odon Device for assisted vaginal birth is therefore planned. This will provide further information on acceptability, recruitment, and the outcome data required to design a future randomised controlled trial of the BD Odon Device versus Kiwi ventouse.MethodsForty women who require an assisted vaginal birth for a recognised clinical indication will have the birth assisted with the BD Odon Device. The primary outcome is successful vaginal birth completed with the BD Odon Device. Secondary clinical outcomes include maternal and neonatal outcomes, and maternal and practitioner satisfaction. Safety data will be reviewed following every birth.DiscussionA future randomised controlled trial of the BD Odon Device versus the current standard instrument (the Kiwi ventouse) is planned. The findings of the ASSIST Study will inform the randomised controlled trial design.Trial registrationISRCTN, ISRCTN10203171. Prospectively registered on 27 July 2018.

A new infrastructure for patient empowerment through Family Integrated Obstetric and Neonatal Healthcare in Single Family Rooms. A case study

Introduction : Patient empowerment in mother and newborn care requires participation and a family centered approach, but is prevented by insufficient integration of Obstetrics and Neonatology in hospitals. Based on logistic grounds healthcare for sick newborns and sick mothers is still organized separately. The changes as described in this study are fed by the many stress-related disadvantages for empowerment due to separation of parents and newborns. Parents reported higher levels of perceived incapability in caring for their child, caused by a reduced level of bonding and breastfeeding success. This study describes and analyzes the changes for an unique infrastructure for integrated obstetric and neonatal healthcare from the concepts of patient empowerment. Methods : A qualitative descriptive methods design was used. All filed documentation regarding the preparation of the transition was collected. In-depth interviews with 5 stakeholders were conducted. Thematic analysis was performed using a conceptual map of patient empowerment, describing interventions and moderators at three levels; the Healthcare System, the Healthcare Providers and the Patient. Results : A positive culture for change of the two units and one vision of integrated care based on proven concepts for better outcomes for mother and newborns was the breeding ground for the transition process. The vision is: Families always stay together. From here all further changes were initiated. 1. Building one ward with only Single Family Rooms SFR with rooming in facilities for partners. 2. Reorganisation of high obstetric and neonatal level 2 care around the patients in the SFR. 3. The integration of the separate staff into one multidisciplinary staff and the two units into one unit for day to day management. 4. Training of the nurse staff to extend professional goals. 5. Create a new all-round nurse position and training for providing medium care for both, mother and newborn in order to limit the number of healthcare providers around the patients. 6. Implementing medical rounds in the SFR for shared decision making and healthcare planning with parents. 7. Intensify counseling and coaching of the parents. Discussion : Integration of high Obstetric Care and Neonatal level 2 care in the SFR may add to the discussion around patient empowerment. Conclusions : A positive change culture at the healthcare system level with one vision of integrated care for mother and newborn seems to be an important moderator for the design of the integrated infrastructure. All changes facilitating the new infrastructure are interventions and moderators for patient empowerment and should contribute to a higher level of patient empowerment. Lessons learned : Some interventions and moderators for patient empowerment were discussed less. Especially personal values of the staff related to patient empowerment and group-focused interventions such as patient education need more attention. Limitations : This case is about level 2 neonatal care with post-IC facilities. Additional requirements will be necessary for level 3 NICU’s. Suggestions for future research : As the levels of the model of Bravo seem to be interrelated, all levels should be explored in depth. Especially the patient level to establish whether the new infrastructure is sufficient for patient empowerment.

Contraception after pregnancy: Making the right choices

The postpartum period is a high-risk time for unintended pregnancy. Increasing access to postpartum contraception should reduce this risk. Unintended pregnancy may lead to abortion or miscarriage, but if the pregnancy continues and has been conceived within 12 months of a previous delivery, a short inter-pregnancy interval will occur. Short inter-pregnancy intervals are associated with a higher risk of negative consequences for the baby such as preterm birth and neonatal death. Most contraceptive methods can be safely initiated after childbirth, and immediate provision from within maternity services has significant advantages. Women should receive accurate information about available methods during the antenatal and postpartum periods, as well as the risks of unintended and short inter-pregnancy intervals. This can support informed decision-making about future reproductive intentions with better outcomes for mothers and babies. Hospital and community services can work together to increase the provision of contraceptive services after pregnancy.

"Be kind to the mother": A celebration of the life of Marshall Klaus, 1927-2017.

"Be kind to the mother": A celebration of the life of Marshall Klaus, 1927-2017.

Are freestanding midwifery units a safe alternative to obstetric units for low-risk, primiparous childbirth? An analysis of effect differences by parity in a matched cohort study

BackgroundIntrapartum complications and the use of obstetric interventions are more common in primiparous childbirth than in multiparous childbirth, leading to concern about out of hospital birth for primiparous women. The purpose of this study was to determine whether the effect of birthplace on perinatal and maternal morbidity and the use of obstetric interventions differed by parity among low-risk women intending to give birth in a freestanding midwifery unit or in an obstetric unit in the North Denmark Region.MethodsThe study is a secondary analysis of data from a matched cohort study including 839 low-risk women intending birth in a freestanding midwifery unit (primary participants) and 839 low-risk women intending birth in an obstetric unit (individually matched control group). Analysis was by intention-to-treat. Conditional logistic regression analysis was applied to compute odds ratios and effect ratios with 95% confidence intervals for matched pairs stratified by parity.ResultsOn no outcome did the effect of birthplace differ significantly between primiparous and multiparous women. Compared with their counterparts intending birth in an obstetric unit, both primiparous and multiparous women intending birth in a freestanding midwifery unit were significantly more likely to have an uncomplicated, spontaneous birth with good outcomes for mother and infant and less likely to require caesarean section, instrumental delivery, augmented labour or epidural analgesia (although for caesarean section this trend did not attain statistical significance for multiparous women). Perinatal outcomes were comparable between the two birth settings irrespective of parity. Compared to multiparas, transfer rates were substantially higher for primiparas, but fell over time while rates for multiparas remained stable.ConclusionsFreestanding midwifery units appear to confer significant advantages over obstetric units to both primiparous and multiparous mothers, while their infants are equally safe in both settings. Our findings thus support the provision of care in freestanding midwifery units as an alternative to care in obstetric units for all low-risk women regardless of parity. In view of the global rise in caesarean section rates, we consider it an important finding that freestanding midwifery units show potential for reducing first-birth caesarean.