Birth Center Research Articles

Planned Out-of-Hospital Birth as a Risk Factor for Nonreceipt of Hepatitis B Immunization.

The hepatitis B vaccine (HBV) is recommended at birth to prevent perinatal hepatitis B transmission; however, many newborns still do not receive HBV. The extent to which planned out-of-hospital births, which have increased over the past decade, are associated with nonreceipt of the HBV birth dose is unknown. The purpose of this study was to determine whether a planned out-of-hospital birth location is associated with the nonreceipt of the HBV birth dose. We performed a retrospective cohort study of all births from 2007 to 2019 recorded in the Colorado birth registry. χ2 analyses were used to compare maternal demographics by birth location. Univariate and multiple logistic regression were used to evaluate the association of birth location with nonreceipt of the HBV birth dose. In total 1.5% of neonates born in freestanding birth centers and 0.1% of neonates born at a planned home birth received HBV compared to 76.3% of neonates born in a hospital location. After adjusting for confounders, this translated to a large increase in the odds of not receiving HBV compared to in-hospital births [freestanding birth center (aodds ratio (aOR): 172.98, 95% confidence interval (CI): 136.98-219.88); planned home birth (aOR: 502.05, 95% CI: 363.04-694.29)]. Additionally, older maternal age, White/non-Hispanic race and ethnicity, higher income, and private or no insurance were associated with nonreceipt of the HBV birth dose. Planned out-of-hospital birth is a risk factor for nonreceipt of the HBV birth dose. As births in these locations become more common, targeted policies and education are warranted.

Estimation of SARS-COVID antibody level in mother and newborn baby among mothers affected by covid during the antenatal period

Background: Severe acute respiratory syndrome-coronavirus-2 infection increases the incidence of severe coronavirus disease-19 (COVID-19) in pregnant women. An increased risk of stillbirth and problems such as preeclampsia, preterm birth, and neonatal intensive care unit hospitalization may be caused by COVID-19 during pregnancy which might lead to an increased risk of COVID-19 mortality, admission to an intensive care unit, and mechanical ventilation. Aims and Objectives: To estimate SARS-COVID antibody level in mother and newborn baby among mothers affected by covid during the antenatal period. Materials and Methods: This is a prospective cross-sectional study conducted at Sri Ramachandra Institute of Higher Education and Research from June 2021 to September 2021. A total of 30 women, affected with SARS-COVID during the antenatal period, confirmed with reverse transcription-polymerase chain reaction testing were included in this study. Blood samples were collected from mothers at the time of delivery and cord blood sample was used for antibody detection in mothers and neonates respectively. Results: Severe infection was noted in 5 women (16.6%) who required oxygen supplementations, and 2 of them required heparin therapy. Women with severe illness showed decreased antibody levels-total antibody (≤500–100%), and neutralizing antibody (≤1000–60%), but statistical significance was not proved. Hence, antibody levels did not correlate with the severity of illness. Conclusion: The current study has demonstrated that women who were pregnant during the COVID-19 pandemic had good knowledge, attitudes, and practices. It is thought that these positive aspects will be beneficial to expectant mothers who are going through pregnancy while still adhering to health protocols or advice from medical professionals on how to carry a pregnancy safely amid this COVID-19 epidemic.

Midwifery care for a COVID-19 cohort of women in Northern Italy: two years of pandemic.

The rapid development of the COVID-19 pandemic has altered the context of healthcare around the world. SARS-CoV-2 positive pregnant and postnatal women, being at greater risk of complications, require continuous midwifery surveillance as well as specialized medical care. Scientific literature lacks studies related to midwifery care models in hospital settings during the pandemic. The aim of this work is to describe hospitalizations in an obstetric-gynecological COVID care unit and to provide a descriptive analysis of the organizational and care model adopted. A cohort retrospective descriptive study was carried out. The sample was stratified by COVID-related care complexity and by obstetric risk. The sample recruited pregnant women, postnatal women, and gynecological patients with confirmed SARS-CoV-2 infection admitted to the obstetric-gynecological COVID unit of a birth center in Northern Italy, from March 16, 2020, to March 16, 2022. A number of 1037 women were hospitalized, and of these, 551 were SARS-CoV-2 positive women. The 551 SARS-CoV-2 positive women included 362 pregnant women, 132 postnatal women, 9 gynecological patients with medical diagnosis while 17 with a surgical path, and 31 women undergoing voluntary interruption of pregnancy. The final sample included 536 women. 68.6% of women requested a low care complexity, 22.8% a medium one, and 8.6% a high care complexity. Among the obstetric women population, the majority (70.6%) showed a high obstetric risk. The COVID-19 cohort of women required different levels of care with various care complexity and levels of obstetric risk. The model adopted allowed the acquisition of new technical and professional skills as well as the sharing of responsibilities and competences according to the care model of the Buddy System. Future studies could investigate COVID-related care models adopted internationally, but also deepen the technical and professional skills developed by midwives during the pandemic in order to enrich, improve and support midwifery profession.

Surgical adhesive glue to repair first-degree perineal tears in vaginal birth: A randomised controlled clinical trial

BackgroundPerineal tears in vaginal birth are highly prevalent and may be related to physical and psychological trauma. Surgical glues are an alternative repair method to avoid the pain that may be caused by perineal repairs with sutures. ObjectiveTo evaluate the effectiveness of surgical adhesive glue in reducing perineal pain when compared to sutures in first-degree perineal tears resulting from vaginal birth. DesignOpen-label parallel-group randomised controlled trial. SettingAn alongside birth centre in Sao Paulo, Brazil. Participants84 intrapartum women with first-degree perineal tears needing repair. MethodsIn the experimental group (n = 42), the perineal tears were repaired with Epiglu® surgical glue (ethyl-2-cyanoacrylate); in the control group (n = 42), the tears were repaired with Vicryl Rapide® (polyglactin 910) sutures. The primary outcome was the intensity of perineal pain after birth measured by a numeric pain rating scale ranging from 0 to 10 points. The secondary outcomes were healing, measured by the “Redness, Oedema, Ecchymosis, Discharge, and Approximation" scale; women's satisfaction with the perineal repair, measured by a visual analogue scale; and the time necessary to complete the repair. Data were collected during postpartum hospitalisation and 10–20 days after discharge, from December 2020 to May 2021. Data were analysed using bivariate analysis and linear models by intention-to-treat. Results36–48 h after birth, the mean of perineal pain was 0.2 (95% Confidence Interval [CI] 0.1–0.8) in the experimental group and 0.9 (95% CI 0.5–1.5) in the control group; the perineal healing score was 0.7 (95% CI 0.4–1.2) and 0.8 (95% CI 0.5–1.2), in the experimental and control groups, respectively; satisfaction was higher among women in the experimental group (88.1% versus 83.3% in the control group). After discharge, the mean of perineal pain was 0.1 (95% CI 0.0–0.5) in the experimental group and 1.4 (95% CI 0.8–2.2) in the control group; the perineal healing score was 0.0 (95% CI 0) and 1.0 (95% CI 0.7–1.3) in the experimental and control groups, respectively. Satisfaction was higher in the experimental group (94.9% versus 75.0%). The longitudinal analysis showed statistically significant differences between the groups regarding perineal pain and women's satisfaction. The average time necessary for perineal repair was 6.0 (95% CI 4.7–8.7) minutes in the experimental group and 9.7 (95% CI 8.3–11.5) in the control group (p < 0.001). ConclusionsSurgical glue resulted in less perineal pain, faster repair, and greater satisfaction than perineal sutures after birth. The healing process was similar in both cases. Tweetable abstractSurgical glue was less painful and promoted greater satisfaction after birth compared to sutures in women with first-degree perineal tears. RegistrationRegistered on The Brazilian Clinical Trials Registry number RBR-52y5tq (http://www.ensaiosclinicos.gov.br/rg/RBR-52y5tq/), on July 16, 2020. The first recruitment was on December 17, 2020.

Survey of Neonatal Resuscitation Practices in Metropolitan and Nonmetropolitan Nontertiary Birthing Units in New South Wales and Australian Capital Territory

Objective To describe the neonatal training experience of birth attendants in New South Wales (NSW) and Australian Capital Territory (ACT) and explore the variations in respiratory management and equipment use at birth. Methods We contacted 119 nontertiary units in NSW/ACT by a written survey followed by telephone contact. A set questionnaire was offered, asking for details of the availability and skill levels of staff at neonatal resuscitation, and of the equipment available at all births. Results Staff from 103 out of 119 units (87%) participated in the study. Resuscitation at all metropolitan units was supported by qualified pediatricians whereas midwives provided neonatal resuscitation as the first responder in a nonmetropolitan unit, with support from a general medical practitioner. Twenty-two percent of nontertiary units relied on external agencies or online support for neonatal resuscitation training. Three quarters of the units used a T-piece resuscitator as the primary device to provide positive pressure ventilation, 65.3% of nonmetropolitan units had blenders available, and 19% of units administered some oxygen at initiation of resuscitation. Thirty-eight percent units responded having no prior knowledge of the pressure relief valve setting. Conclusion Equipment and availability of trained personnel for neonatal resuscitation in nontertiary birthing units across NSW and ACT vary widely. The resources to provide training and education are variable.

A mixed-design study on the development of birth unit assessment scale

IntroductionThis is a mixed design study planned to determine the views of women, midwives, and physicians about the ideal birth unit and to develop a to develop a valid and reliable measurement tool for postpartum women's evaluation of the effect of birth units in terms of physical, emotional, and social aspects on their satisfaction with the birth environment. MethodsThe exploratory sequential design, which is accepted as a mixed design, was used in the study. In the qualitative phase of the study, a content analysis was conducted by interviewing a total of 20 participants including 5 pregnant women, 5 postpartum women, 5 midwives and 5 obstetricians. In the quantitative phase, the Draft Birth Unit Satisfaction Assessment scale, which was developed in line with the data obtained as a result of the qualitative study, a literature review, and expert opinions, was used to evaluate postpartum women's (n = 435) satisfaction with the birth environment. Content validity, exploratory factor analysis, and confirmatory factor analysis were used for the validity analyses of the scale, and item analysis, internal consistency, and time-dependent invariance were evaluated for reliability. ResultsIn the qualitative phase of the study, the themes were grouped under 5 categories (physical features of the hospital, features of the birth room, privacy, aesthetics and support) according to the qualitative data on the factors that showed participants' views on the ideal birth unit. In the quantitative stage, the Birth Unit Satisfaction Assessment Scale, which consisted of 30 items and 5 sub-dimensions (communication and care, physical characteristics of the birth room, comfort, opportunities supporting birth, and decoration and aesthetics), was developed. DiscussionIn conclusion, it was determined that the scale developed in this study was a valid and reliable measurement tool that could be used to evaluate postpartum women's satisfaction with the birth environment.

Delivery Outcomes in Pregnant Women With Third-Trimester Vaginal Bleeding [ID: 1376165

INTRODUCTION: We sought to determine delivery-related morbidity outcomes in patients presenting with third-trimester vaginal bleeding in the absence of placenta previa or placenta accreta spectrum (PAS). METHODS: A retrospective cohort study was conducted among women presenting with third-trimester vaginal bleeding at our tertiary center from July 2020 to June 2022 with exclusion of placenta previa or PAS. Bleeding was categorized by amount documented on provider examination as follows: “light,” less than 50 mL; “heavy,” 50 mL or more. The primary outcome was postpartum hemorrhage (PPH; ≥1,000 mL). Secondary outcomes included relevant maternal and neonatal morbidity measures. RESULTS: Among 6,584 singleton pregnancies, 76 (1.2%) presented with third-trimester vaginal bleeding without evidence of placenta previa or PAS; 68 of patients had light and 8 had heavy bleeding. Bleeding was frequently accompanied by contractions (62%) and cervical change (74%). Bleeding on admission was not associated with increased risk of PPH (light: relative risk [RR] 0.7, 95% CI [0.3, 1.4], P=.14; heavy: RR 1.7, 95% CI [0.5, 5.5], P=.2) or need for blood transfusion. Cesarean delivery (CD), general anesthesia, preterm birth (PTB), and neonatal intensive care unit admissions were more common in patients with heavy bleeding (all P&lt;.05). Light bleeding did not increase the risk of PTB or CD and was associated with a higher rate of spontaneous vaginal delivery (RR 1.24, 95% CI [1.1, 1.4], P=.0003). No patients with bleeding required intensive care unit admission, hysterectomy, or had neonatal demise. Seventy-five percent of patients with heavy bleeding (n=8) and 16% of patients with light bleeding (n=11) had clinical or pathological evidence of abruption. CONCLUSION: Third-trimester vaginal bleeding, without placenta previa or PAS, is not associated with increased risk for PPH. Heavy bleeding, however, is associated with increased risk of preterm delivery and cesarean section, with abruption evident in 75% of these patients. Light bleeding on admission is usually not associated with an abruption or an increase in adverse maternal or neonatal outcomes.

Catalyzing Collaboration Among Interprofessional Birth Transfer Teams Through Simulation.

Planned home or birth center births sometimes require emergency transfers to a hospital. Poor communication among members of the birth care team during a transfer can lead to unfavorable outcomes for the birthing person and newborn. To improve the quality of birth transfers in Utah, the Utah Women and Newborns Quality Collaborative partnered with the LIFT Simulation Design Lab to develop and pilot an interprofessional birth transfer simulation training. We engaged community stakeholders to identify learning objectives and co-design the simulation trainings using principles of participatory design. We conducted 5 simulation trainings featuring birth transfers during a postpartum hemorrhage. The LIFT Lab evaluated the trainings to determine if they were feasible, acceptable, and effective. Measures included a post-training form asking participants to evaluate the quality of the training and a 9-question pre- and post-training survey measuring changes in participants' self-efficacy regarding components of birth transfer. The changes were assessed for significance using a paired t test. A total of 102 participants attended the 5 trainings; all health care provider groups were well represented. Most participants felt the simulations were similar to real situations and would benefit others in their professions. All participants said the trainings were a good use of their time. Following the training, participants had significantly higher levels of self-efficacy regarding their ability to manage birth transfers. Birth transfer simulation trainings are an acceptable, feasible, and effective method for training interprofessional birth care teams.

Effectiveness of an exclusive breastfeeding promotion strategy adopting the trans-theoretical model: a clinical study conducted at the clinical birth unit

Effectiveness of an exclusive breastfeeding promotion strategy adopting the trans-theoretical model: a clinical study conducted at the clinical birth unit

Implementation of Episcissors-60 for Prevention of Obstetric Anal Sphincter Injuries (OASIS) in a Centre with Low Episiotomy Rates

ObjectifCette étude avait pour objectif de déterminer si l’adoption des ciseaux Episcissors-60 à l’unité des naissances diminuerait la fréquence des lésions obstétricales du sphincter anal (LOSA). MéthodeUne étude sur l’amélioration de la qualité pré- et post-intervention a été menée pour la période du 1er avril 2020 au 31 mars 2021. Toutes les patientes ayant accouché par voie vaginale ont été incluses dans cette étude. Tous les fournisseurs de soins qui réalisent des accouchements vaginaux se sont fait offrir une séance de formation. Les ciseaux Episcissors-60 ont été ajoutés aux instruments disponibles à l’unité des naissances. Le critère de jugement principal était le changement de la fréquence des LOSA avant et après l’adoption des ciseaux Episcissors-60. Les critères de jugement secondaires étaient le taux d’épisiotomie avant et après l’adoption de ces ciseaux, le taux d’événements indésirables liés à l’instrument ainsi que le taux de satisfaction et les commentaires des fournisseurs de soins. Les données ont été analysées à l’aide de tests du chi carré, de tests t indépendants et de tests de Mann-Whitney. RésultatsAu total, dans la période à l’étude, il y a eu 1383 accouchements vaginaux avant et 1254 accouchements vaginaux après l’adoption des ciseaux Episcissors-60. Il y a eu une diminution du taux total de LOSA, lequel est passé de 7.37 % à 5.37 % de tous les accouchements vaginaux après l’adoption des ciseaux Episcissors-60 (P = 0,037). Le taux d’épisiotomie était de 11.42 % avant et de 9.97 % après l’adoption des ciseaux Episcissors-60 (P = 0.228). Le taux de LOSA chez les femmes ayant subi une épisiotomie était de 12.02 % avant et de 13.60 % après l’adoption des ciseaux Episcissors-60 (P = 0.421). ConclusionBien que l’adoption des ciseaux Episcissors-60 ait été associée à une diminution statistiquement significative du taux total de LOSA, il n’y avait aucune différence du taux de LOSA dans le sous-groupe d’épisiotomie. Par conséquent, la réduction du taux total de LOSA dans cette étude ne peut pas être attribuée à l’utilisation des ciseaux Episcissors-60.

Changes to Birth Plans Due to COVID-19: A Survey of Utah Midwives and Doulas.

This study seeks to understand the experiences of Utah midwives and doulas caring for patients during the recent coronavirus disease 2019 (COVID-19) pandemic. Specifically, the goal of the study was to describe the perceived impact on the community birth system and explore differences in the access and use of personal protective equipment (PPE) between in- and out-of-hospital births. This study used a cross-sectional, descriptive study design. A 26-item survey developed by the research team was sent via email to Utah birth workers, including nurse-midwives, community midwives, and doulas. Quantitative data were collected during December 2020 and January 2021. Descriptive statistics were used in the analysis. Of the 409 birth workers who were sent a link to the survey, 120 (30%) responded: 38 (32%) CNMs, 30 (25%) direct-entry or community midwives, and 52 (43%) doulas. The majority (79%) reported changes to clinical practice during the COVID-19 pandemic. Community midwives (71%) who responded indicated practice volume increased. Survey participants reported an increased patient preference for home births (53%) and birth center births (43%). Among those with one or more patient transfers to the hospital, 61% experienced a change in the process. One participant reported that it took 43 minutes longer to transfer to the hospital. Community midwives and doulas reported poor access to a regular source of PPE. Survey participants reported changes to planned birth locations during the COVID-19 pandemic. When necessary, transfers to hospitals were reported to be slower. Community midwives and doulas reported having insufficient access to PPE and reported limited knowledge about COVID-19 testing resources and resources for educating patients on COVID-19. This study adds an important perspective to the existing literature on COVID-19 by indicating that policymakers should include community birth partners in community planning for natural disasters and future pandemics.

Using exogenous organizational and regional hospital attributes to explain differences in case-mix adjusted hospital costs.

Diagnosis-related group (DRG) hospital reimbursement systems differentiate cases into cost-homogenous groups based on patient characteristics. However, exogenous organizational and regional factors can influence hospital costs beyond case-mix differences. Therefore, most countries using DRG systems incorporate adjustments for such factors into their reimbursement structure. This study investigates structural hospital attributes that explain differences in average case-mix adjusted hospital costs in Switzerland. Using rich patient and hospital-level data containing 4 million cases from 120 hospitals across 3 years, we show that a regression model using only five variables (number of discharges, ratio of emergency/ambulance admissions, rate of DRGs to patients, expected loss potential based on DRG mix, and location in large agglomeration) can explain more than half of the variance in average case-mix adjusted hospital costs, capture all cost variations across commonly differentiated hospital types (e.g., academic teaching hospitals, children's hospitals, birth centers, etc.), and is robust in cross-validations across several years (despite differing hospital samples). Based on our findings, we propose a simple practical approach to differentiate legitimate from inefficiency-related or unexplainable cost differences across hospitals and discuss the potential of such an approach as a transparent way to incorporate structural hospital differences into cost benchmarking and payment schemes.

Interprofessional collaboration in maternity care

African Journal of Midwifery and Women's HealthVol. 17, No. 2 EditorialInterprofessional collaboration in maternity careUnice GoshomiUnice GoshomiCorrespondence to:E-mail Address: [email protected]Social Sciences, Women's University in Africa, Harare, ZimbabweSearch for more papers by this authorUnice GoshomiPublished Online:16 Jun 2023https://doi.org/10.12968/ajmw.2023.0019AboutSectionsView articleView Full TextPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareShare onFacebookTwitterLinked InEmail View article References Behruzi R, Klam S, Dehertog M et al.. Understanding factors affecting collaboration between midwives and other health care professionals in a birth center and its affiliated Quebec hospital: a case study. BMC Pregnancy Childbirth. 2017;17(1):1–4. https://doi.org/10.1186/s12884-017-1381-x Crossref, Google ScholarCharalambous C, Rampton B. Language learning, identity, and intercultural communication in contexts of conflict and insecurity. In: Jackson J (ed). The Routledge handbook of language and intercultural communication. Abingdon, Oxfordshire: Routledge; 2020 Crossref, Google ScholarKruk ME, Gage AD, Arsenault C et al.. High-quality health systems in the sustainable development goals era: time for a revolution. Lancet Glob Health. 2018;6(11):e1196–e1252. https://doi.org/10.1016/S2214-109X(18)30386-3 Crossref, Google Scholar FiguresReferencesRelatedDetails 2 April 2023Volume 17Issue 2ISSN (online): 2052-4293 Metrics History Published online 16 June 2023 Published in print 2 April 2023 Information© MA Healthcare LimitedPDF download

Associations between antidepressant use patterns during pregnancy and birth outcomes among periconception antidepressant users.

Little is known about antidepressant medication use patterns during pregnancy among periconception (before and immediately following conception) users. Additionally, the associations between these patterns and birth outcomes is unclear, after taking into account underlying depression severity. This study describes patterns of antidepressant use among periconception users and examines associations between usage patterns and birth outcomes. This retrospective cohort study included pregnant Kaiser Permanente Northern California (KPNC) members with a live birth between 2014 and 2017 and an antidepressant medication fill that overlapped the 8th week of pregnancy. Outcomes were preterm birth and neonatal intensive care unit (NICU) admission. Data were extracted from KPNC's electronic health records. Modified Poisson regression was conducted. Of the 3637 pregnancies meeting inclusion criteria, 33% (n=1204) continued antidepressant use throughout the pregnancy (refilled throughout pregnancy), 47% (n=1721) discontinued use (no refills), and 20% (n=712) stopped and reinitiated use (refill after 30+ day gap in supply). Women who continued use had 1.86 (95% confidence interval (CI) 1.53, 2.27) times the risk of preterm birth and 1.76 (95% CI: 1.42, 2.19) times the risk of NICU admission, compared to women who discontinued use during pregnancy. Similarly, women with continued use had 1.66 (95% CI: 1.27, 2.18) times the risk of preterm birth and 1.85 (95% CI: 1.39, 2.46) times the risk of NICU admission, compared to women who stopped and reinitiated use. This relationship held when examining continuous exposure; the relationship between continuous exposure and preterm delivery was stronger in later trimesters. Periconception antidepressant users who continue use during pregnancy, particularly into the second and third trimesters, may be at higher risk of adverse birth outcomes. This evidence should be considered alongside the risks associated with depression relapse.

Effect of antenatal milk expression education on lactation outcomes in birthing people with pre-pregnancy body mass index ≥25: protocol for a randomized, controlled trial

BackgroundBirthing people with pre-pregnancy body mass indices (BMIs) ≥ 25 kg/m2, particularly those without prior breastfeeding experience, are at increased risk for suboptimal lactation outcomes. Antenatal milk expression (AME) may be one way to counteract the negative effects of early infant formula supplementation common in this population.MethodsThis ongoing, randomized controlled trial in the United States evaluates the efficacy of a telelactation-delivered AME education intervention versus an attention control condition on lactation outcomes to 1 year postpartum among 280 nulliparous-to-primiparous, non-diabetic birthing people with pre-pregnancy BMI ≥ 25 kg/m2. The assigned study treatment is delivered via four weekly online video consultations between gestational weeks 37–40. Participants assigned to AME meet with study personnel and a lactation consultant to learn and practice AME. Instructions are provided for home practice of AME between study visits. Control group participants view videos on infant care/development at study visits. Participants complete emailed surveys at enrollment (340/7–366/7 gestational weeks) and 2 weeks, 6 weeks, 12 weeks, 6 months, and 12 months postpartum. Surveys assess lactation and infant feeding practices; breastfeeding self-efficacy, attitudes, and satisfaction; perception of insufficient milk; onset of lactogenesis-II; lactation support and problems; and reasons for breastfeeding cessation. Surveys also assess factors associated with lactation outcomes, including demographic characteristics, health problems, birth trauma, racial discrimination, and weight stigma. Health information and infant feeding data are abstracted from the pregnancy and birth center electronic health record. Milk samples are collected from the intervention group at each study visit and from both groups at each postpartum follow-up for future analyses. Qualitative interviews are conducted at 6 weeks postpartum to understand AME experiences. Primary outcomes of interest are breastfeeding exclusivity and breastfeeding self-efficacy scores at 2 weeks postpartum. Outcomes will be examined longitudinally with generalized linear mixed-effects modeling.DiscussionThis is the first adequately powered trial evaluating the effectiveness of AME among U.S. birthing people and within a non-diabetic population with pre-pregnancy BMI ≥ 25 kg/m2. This study will also provide the first evidence of acceptability and effectiveness of telelactation-delivered AME.Trial registrationClinicalTrials.gov: NCT04258709.

Obstetric and Neonatal Outcomes in People Who Acquired a Spinal Cord Injury During Pregnancy

ObjectiveThe objectives of this study were to determine the obstetric and neonatal outcomes of people who acquired spinal cord injuries (SCI) during pregnancy. MethodsThis is part of an international observational questionnaire examining pregnancy outcomes of people with SCI. The outcome measures included demographics, level of injury and American Spinal Injury Association scores, prenatal and postnatal complications, and neonatal outcomes. ResultsOf 780 responses, 14 (1.79%) participants reported acquiring an SCI while pregnant. 64.2% (9/14) of injuries were due to trauma. Of 14 pregnancies, 1 person miscarried, and 3 pregnancies were terminated. There were 11 live births. One participant had twins and 9 live births were singletons. Six participants delivered vaginally, 3 had a cesarean delivery and 1 was unreported. The preterm birth rate was 54.5% (6/11). Approximately 36% (4/11) of newborns were admitted to the neonatal intensive care unit. The average birth weight reported was 2409.7 g (456.3 g–3458.6 g). Forty percent (4/10) of participants reported experiencing postpartum blues or depression. Sixty percent (6/10) of participants breastfed for over 2 weeks. ConclusionsThis is the largest known cohort to date of persons acquiring SCI during pregnancy. The most common cause of SCI was a motor vehicle accident. Complications included preterm birth and neonatal intensive care unit admission. People who have an SCI during pregnancy are at risk for complications; however, positive pregnancy and neonatal outcomes are possible. Absolute small numbers of this event limit the ability to assess incidence of outcomes.

Women’s experience of early labour in a free-standing birth centre: Midwifing embodied labour

IssueWomen who present at hospital labour wards in early labour must often meet measurable diagnostic criteria before admission. BackgroundEarly labour is a phase of neurohormonal, emotional, and physical changes that are often not measurable. When admission to birthplace is based on results of diagnostic procedures, women’s embodied knowledge may be disregarded. AimTo describe the early labour experience of women with spontaneous onset of labour in a free-standing birth centre, as well as midwifery care when women arrived in labour. MethodologyAn ethnographic study was conducted in 2015 in a free-standing birth centre after receiving ethics approval. The findings for this article were drawn from a secondary analysis of the data, which included interview data with women and detailed field notes of midwives’ activities related to early labour. FindingsThe women in this study were instrumental in the decision-making process to stay at the birth centre. Observational data showed that vaginal exams were rarely conducted when women arrived at the birth centre and were not a deciding factor in admission. DiscussionThe women and midwives co-constructed early labour based on the lived experience of women and the meaning that this experience held for both. ConclusionGiven the growing concern about the need for respectful maternity care, this study provides examples of good practice in listening to women, as well as an illustration of the consequences of not doing so.

Fewer glucose checks and decreased supplementation using dextrose gel for asymptomatic neonatal hypoglycemia.

Evaluate the impact of a neonatal hypoglycemia (NH) clinical pathway implementing buccal dextrose gel in late preterm and term infants. Quality improvement study at a children's hospital associated birth center. Number of blood glucose checks, use of supplemental milk, and need for IV glucose were followed for 26-months after implementation of dextrose gel and compared to previous 16-month period. After QI implementation, 2703 infants were screened for hypoglycemia. Of these, 874 (32%) received at least one dose of dextrose gel. Special cause shifts with reductions in mean number of blood glucose checks per infant (pre 6.6 vs. post 5.6), use of supplemental milk (pre 42% vs. post 30%), and need for IV glucose (pre 4.8% vs. post 3.5%) were found. Incorporating dextrose gel into a clinical pathway for NH was associated with a sustained reduction in number of interventions, use of supplemental milk and need for IV glucose.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales)

BackgroundIn Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+.MethodsWe undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff.ResultsDuring the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere.ConclusionThe Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right.

Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 1. Introduction and project description

BackgroundThe Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, was implemented in the Western Highlands of the Department of Huehuetenango, Guatemala. The Project utilized three participatory approaches in tandem: the Census-Based, Impact-Oriented (CBIO) Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, these are referred to as the Expanded CBIO Approach (or CBIO+).ObjectiveThis is the first article of a supplement that assesses the effectiveness of the Project’s community-based service delivery platform that was integrated into the Guatemalan government’s rural health care system and its special program for mothers and children called PEC (Programa de Extensión de Cobertura, or Extension of Coverage Program).MethodsWe review and summarize the CBIO+ Approach and its development. We also describe the Project Area, the structure and implementation of the Project, and its context.ResultsThe CBIO+ Approach is the product of four decades of field work. The Project reached a population of 98,000 people, covering the entire municipalities of San Sebastián Coatán, Santa Eulalia, and San Miguel Acatán. After mapping all households in each community and registering all household members, the Project established 184 Care Groups, which were composed of 5–12 Care Group Volunteers who were each responsible for 10–15 households. Paid Care Group Promoters provided training in behavior change communication every two weeks to the Care Groups. Care Group Volunteers in turn passed this communication to the mothers in their assigned households and also reported back to the Care Group Promoters information about any births or deaths that they learned of during the previous two weeks as a result of their regular contact with their neighbors. At the outset of the Project, there was one Birthing Center in the Project Area, serving a small group of communities nearby. Two additional Birthing Centers began functioning as the Project was operating. The Birthing Centers encouraged the participation of traditional midwives (called comadronas) in the Project Area.ConclusionThis article serves as an introduction to an assessment of the CBIO+ community-based, participatory approach as it was implemented by Curamericas/Guatemala in the Western Highlands of the Department of Huehuetenango, Guatemala. This article is the first of a series of articles in a supplement entitled Reducing Inequities in Maternal and Child Health in Rural Guatemala through the CBIO+ Approach of Curamericas.