Birth Center Research Articles

Midwives views about preceptorship and peer-learning in a birth unit: A cross-sectional study

BackgroundPractical training in a birthing unit is an important part of midwifery education. Previous research on the preceptor role predominantly consists of qualitative interview studies and have not explored pedagogical models like peer learning. ObjectivesThe purpose of this study was to quantitatively describe midwives' experiences, conditions, and needs in their role as preceptors in a birthing unit, as well as their attitudes towards and experiences of peer-learning. DesignA cross-sectional study, using a web-survey. SettingsThe survey was distributed to all midwives working in a birthing unit in Sweden. ParticipantsA total of 573 valid responses were obtained. MethodsA questionnaire consisting of 22 questions, which included background questions, questions to be answered on a four-point Likert scale, and open-ended questions, was sent out from November 2022 to March 2023. The collected data were analysed using descriptive statistics, Chi-square, and Mann Whitney U test analyses. The open-ended responses were analysed using quantitative content analysis. ResultsMidwives with ≤10 years of experience were more hesitant about taking on the preceptor role. They also described a lack of support and found it more challenging to integrate supervision into their working hours than midwives with >10 years of experience. Time for supervision and time for reflection with midwifery students were identified as areas that could improve the quality of supervision. Of the respondents, 42.8 % had experience of peer learning. “Students learn from each other” was identified as the most common advantage of peer learning. ConclusionsLong-term experience as a midwife plays a crucial role in how midwives perceive their role as a preceptor and the conditions they experience. The midwives in this study had started supervising students earlier than they deemed advantageous. As the preceptor plays a critical role in the midwifery student's learning process, it is important to have experienced preceptors.

Pre-University Students’ Attitudes and Beliefs about Childbirth: Implications for Reproductive Health and Maternity Care

Objectives: To determine pre-university students’ attitudes and beliefs about childbirth and identify key sources of information and knowledge.Methods: A survey of 359 Quebec pre-university students (215 female, 144 male) was undertaken to identify sources of beliefs about birth and opinions about types of maternity care providers and place/method of delivery. Results: Prime sources for birth beliefs were family (50.7% female, 39.9% male) and media (21.9% female, 33.6% male). The dominant preferred birth model was hospital vaginal delivery attended by an obstetrician. The students’ birth preferences reflected strong support for professional supervision/intervention and skepticism about the safety of home birth and out-of-hospital birth centres. Although 9.3% of female students and no males would choose elective cesarean section (CS) for themselves or partner, 71.2% of female students and 42.4% of male students agreed that CS is “just another way of having a baby.” Most female students believed “it is a woman’s right to choose CS for herself ” and had a higher preference/acceptance of CS, compared with male students. Students characterized birth as “painful” and “miraculous” and agreed on its relative safety. Female students were more fearful and more stressed about the prospect of birth, compared with male students. Over 75% of female students were aware of the benefits of breastfeeding and planned to breastfeed. Conclusions: Most students supported in-hospital maternity care and perceived CS as normal but did not express a preference for CS for themselves or their partners. Students were unaware of the risks/benefits of CS, epidurals, and out-of-hospital birth. These findings highlight the need for health care professionals to engage young adults and to provide them with evidence-based information about maternity care options.

Hospitals Are Closing in Tennessee: Investigating the Effect of Closures on Contraceptive Access and Short-Interval Birth [ID 2683524

INTRODUCTION: Access to maternity care (MC) and providers are important factors for contraception access and health outcomes for pregnant-capable individuals. After a series of hospital closures in Tennessee in the last decade, this study investigated the relationship between maternal county of residence and short-interval birth (SIB) rates statewide. METHODS: Tennessee birth certificate data for 2015–2020 from the Tennessee Department of Health was coded using March of Dimes 2022 definitions of access to MC overall, a hospital with obstetric (OB) care or birth center, and an OB provider (per 10k births) based on maternal county of residence. Short-interval birth was defined as birth interval 6–23 months. Nulliparous births and those with missing last living birth interval were excluded. Analysis was completed in SPSS 29.0, and Pearson χ2 tests compared SIB proportions between MC access groups. RESULTS: Overall, 269,908 births were analyzed. Of these, 78.1% maternal counties of residence had full MC access, 13.9% had low access, and 8.0% resided in a MC desert. Short-interval births were highest (24.4%; CI, 23.8–25.0) in MC deserts followed by areas with full access (23.7%; CI, 23.5–23.9) and low access (22.4%; CI, 22.0–22.8) (P<.001). Those with no access to an OB provider had highest rates of SIB (24.3%: CI, 23.7–24.8) compared to other categories (P<.001). CONCLUSION: Lacking access to maternity care likely corresponds with lacking access to contraception and higher rates of SIB in Tennessee. Prenatal and postpartum contraception counseling are important components of care for all individuals but especially those without acceptable access to OB providers and hospitals.

Obstetric Anal Sphincter Injury Management at a Tertiary Academic Birthing Center: A Quality Improvement Initiative [ID 2683441

INTRODUCTION: As a quality improvement project, we implemented an evidence-based management protocol to optimize outcomes after obstetric anal sphincter injuries (OASIS). The aim was to evaluate compliance with practice guidelines for antibiotic use, standardized surgical technique and documentation, utilization of a bowel regimen, and short-term outpatient follow-up after a resident educational OASIS program. METHODS: An OASIS practice guideline was implemented via a curriculum utilizing didactics and simulation with porcine sphincter models to demonstrate primary prevention, proper diagnosis, repair technique, documentation, and post-procedure OASIS management. Pre (August 2018 to July 2022) and post-intervention (August 2022 to July 2023) cohorts were compared for characteristics and provider adherence to guidelines. We used control charts, chi-squared, and Student's t-tests to estimate the effect of the intervention. RESULTS: Among 226 OASIS cases, 168 were pre-intervention and 58 were post-intervention. Proper documentation of OASIS repair increased from 13 (7.7%) pre-intervention to 24 (41.4%) post-intervention (risk ratio [RR] 7.57; 95% CI, 4.3–13.1); proper antibiotic use increased from 79 (47.0%) pre-intervention to 39 (67.2%) post-intervention (RR 1.42; CI, 1.12–1.18); and utilization of bowel regimen increased from 147 (87.5%) to 56 (96.6%) post-intervention (RR 1.1; CI, 1.02–1.18). There was no change in close follow-up appointment attendance (81.0% for both groups; P=.98). Control charts showed a process change in bowel regimen use and OASIS documentation, but no significant change in antibiotic use or close follow-up appointments. CONCLUSION: Implementation of an evidence-based management guideline was associated with increased compliance with evidence-based practices. Future improvement cycles are necessary to optimize outpatient follow-up after OASIS.

Listening to Black Women's Perspectives of Birth Centers and Midwifery Care: Advocacy, Protection, and Empowerment.

Black women in Texas experience high rates of adverse maternal outcomes that have been linked to health inequities and structural racism in the maternal care system. Birth centers and midwifery care are highlighted in the literature as contributing to improved perinatal care experiences and decreased adverse outcomes for Black women. However, compared with White women, Black women underuse birth centers and midwifery care. Black women's perceptions in Texas of birth center and midwifery care are underrepresented in research. Thus, this study aimed to highlight the views of Black women residing in Texas on birth centers and midwifery care to identify their needs and explore ways to increasing access to perinatal care. Semistructured interviews were conducted with 10 pregnant and postpartum Black women residing in Texas. Questions focused on the women's access, knowledge, and use of birth centers and midwifery care in the context of their lived maternal care experiences. Interview transcripts were reviewed and analyzed using inductive, qualitative content analysis. The Black women interviewed all shared experiences of discrimination and bias while receiving obstetric care that affected their interest in and overall perceptions of birth center and midwifery care. Participants also discussed financial and institutional barriers that impacted their ease of access to birth center and midwifery care services. Additionally, participants highlighted the need for culturally sensitive and respectful perinatalhealth care. The Black women interviewed in this study emphasized the prevalence of racism and discrimination in perinatal health care encounters, a reflection consistent with current literature. Black women also expressed a desire to use birth centers and midwifery care but identified the barriers in Texas that impede access. Study findings highlight the need to address barriers to promote equitable perinatal health care access for Black women.

Respectful maternity care interventions to address women mistreatment in childbirth: What has been done?

IntroductionOver the last decade, there has been an increasing number of studies regarding experiences of mistreatment, disrespect and abuse (D&A) during facility-based childbirth. These negative experiences during labour have been proven to create a barrier for seeking both facility-based childbirth and postnatal health care, as well as increasing severe postpartum depression among the women who experienced them. This constitutes a serious violation of human rights. However, few studies have carried out specifically designed interventions to reduce these practices. The aim of this scoping review is to synthetise available evidence on this subject, and to identify initiatives that have succeeded in reducing the mistreatment, D&A that women suffer during childbirth in health facilities.MethodsA PubMed search of the published literature was conducted, and all original studies evaluating the efficacy of any type of intervention specifically designed to reduce these negative experiences and promote RMC were selected.ResultsTen articles were included in this review. Eight studies were conducted in Africa, one in Mexico, and the other in the U.S. Five carried out a before-and-after study, three used mixed-methods, one was a comparative study between birth centres, and another was a quasi-experimental study. The most common feature was the inclusion of some sort of RMC training for providers at the intervention centre, which led to the conclusion that this training resulted in an improvement in the care received by the women in childbirth. Other strategies explored by a small number of articles were open maternity days, clinical checklists, wall posters and constant user feedback.DiscussionThese results indicate that there are promising interventions to reduce D&A and promote RMC for women during childbirth in health facilities. RMC training for providers stands as the most proven strategy, and the results suggest that it improves the experiences of care received by women in labour.ConclusionThe specific types of training and the different initiatives that complement them should be evaluated through further scientific research, and health institutions should implement RMC interventions that apply these strategies to ensure human rights-based maternity care for women giving birth in health facilities around the world.

The Birth Centre Midwifery Group in Winnipeg, Manitoba

Practice profile.

Perceptions of quality of care in Midwife-led Birth Centres (MLBCs) in Uganda: Why do women choose MLBCs over other options?

BackgroundMidwife-led birth centres (MLBCs) are associated with reduced childbirth interventions, higher satisfaction rates, and improved birth outcomes. The evidence on quality of care in MLBCs from low and middle-income countries (LMIC) is limited. AimThis study aimed to explore the perceptions of women and midwives regarding the quality of care in four MLBCs in Uganda. MethodsA qualitative study was conducted in four MLBCs in Uganda. We conducted interviews with women and midwives in the MLBCs to explore their perceptions and experiences related to care in the MLBCs. The study obtained ethical approval. Deductive thematic analysis was used for data analysis. ResultsThree key themes were identified regarding the perceptions of women and midwives about the quality of care in the MLBCs: providing respectful, and dignified care; a focus on woman-centred care; and reasons for choosing care in the MLBC. Women valued the respectful and humane care characterised by dignified and non-discriminatory care, non-abandonment, privacy, and consented care. The woman-centred care in the MLBC involved individualised holistic care, providing autonomy and empowerment, continuity of care, promoting positive birth experience, confidence in the woman’s own abilities, and responsive providers. Women chose MLBCs because the services were perceived to be available, accessible, affordable, with comprehensive and effective referral mechanisms. ConclusionWomen perceived care to be respectful, woman-centred, and of good quality. Global attention should be directed to scaling up the establishment of MLBCs, especially in LMIC, to improve the positive childbirth experience and increase access to care.

Postpartum care for parent-infant dyads: A community midwifery model.

Postpartum health is in crisis in the United States, with rising pregnancy-related mortality and worsening racial inequities. The World Health Organization recommends four postpartum visits during the 6 weeks after childbirth, yet standard postpartum care in the United States is generally one visit 6 weeks after birth. We present community midwifery postpartum care in the United States as a model concordant with World Health Organization guidelines, describing this model of care and its potential to improve postpartum health for birthing people and babies. We conducted semi-structured interviews with 34 community midwives providing care in birth centers and home settings in Oregon and California. A multidisciplinary team analyzed data using reflexive thematic analysis. A total of 24 participants were Certified Professional Midwives; 10 were certified nurse-midwives. A total of 14 midwives identified as people of color. Most spoke multiple languages. We describe six key elements of the community midwifery model of postpartum care: (1) multiple visits, including home visits; typically five to eight over six weeks postpartum; (2) care for the parent-infant dyad; (3) continuity of personalized care; (4) relationship-centered care; (5) planning and preparation for postpartum; and (6) focus on postpartum rest. The community midwifery model of postpartum care is a guideline-concordant approach to caring for the parent-infant dyad and may address rising pregnancy-related morbidity and mortality in the United States.

187 Achondroplasia Natural History Study (CLARITY): 60-Year Experience With Hydrocephalus in Achondroplasia From Four Skeletal Dysplasia Centers

INTRODUCTION: This study is the largest to date to look at the treatment of hydrocephalus in achondroplasia. METHODS: CLARITY (The Achondroplasia Natural History Study) is a registry for clinical data from achondroplasia patients receiving treatment at four skeletal dysplasia centers in the United States from 1957 to 2017. Data included surgeries with indications and complications, medical diagnoses, and radiographic information. RESULTS: 1374 patients with achondroplasia were included in this study. 124 (9%) of these patients underwent treatment of hydrocephalus at a median age of 14.6 months. There was wide variation by center and decade of birth, with treatment ranging from 0% to 28% of patients, although in the most recent decade, it fell to 3.4% of patients. Requiring cervicomedullary decompression (CMD) predicted treatment of hydrocephalus with an odds ratio of 5.8 (95% CI 3.9-8.4), although that association has disappeared in those born since 2010 with an odd’s ratio of 1.1 (95% CI 0.2-5.7). In patients born since 1990, treatment of hydrocephalus with an ETV has become more common. Kaplan Meier analysis suggests a single ETV will treat hydrocephalus in roughly half of these patients. CONCLUSIONS: While children with achondroplasia have enlarged intracranial CSF spaces and macrocephaly, treatment of hydrocephalus has become relatively unusual in the last twenty years. Historically there was a significant association between symptomatic foramen magnum (FM) stenosis and treatment of hydrocephalus, although concurrent treatment of both has fallen out of favor since CMD alone will treat hydrocephalus in some patients. While understood as communicating hydrocephalus, endoscopic third ventriculostomy (ETV) appears to be reasonably successful in certain patients and should be considered an option in selected patients.

The effect of gestational diabetes mellitus on pregnancy outcomes in advanced primiparous women: A retrospective study.

Gestational diabetes mellitus (GDM) could have a variable degree of adverse effects on pregnancy outcomes for both pregnant women and newborns. The purpose of the study was to explore the effect of GDM on pregnancy outcomes in advanced primiparous women. A total of 1076 advanced primiparous women were included between January 2020 and December 2022. All these women were divided into the GDM group (n = 434) and the non-GDM group (n = 642). Variables included baseline characteristics, maternal, and newborn outcomes were collected. The risk of each adverse outcome was analyzed by multivariate logistic regression models. The effect of blood glucose control on pregnancy outcomes was further analyzed among GDM women with good glycaemic control (n = 381) and poor glycaemic control (n = 53). Analysis of baseline characteristics demonstrated a significant difference in prepregnancy body mass index (median, IQR: 22.27 [20.58-24.44] vs 21.17 [19.53-22.86], P < .01) between the GDM group and the non-GDM group. A significantly higher incidence rate of adverse pregnancy outcomes was found in advanced primiparous women with GDM, such as polyhydramniosis, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission (all P < .05). Compared with the non-GDM group, the risk of polyhydramniosis was nearly twice as high in the GDM group (adjusted odds ratio: 1.94, 95% confidence interval: 1.01-3.72, P = .04) after adjusted baseline characteristics. Among the GDM group, the women with poor glycaemic control showed a significantly higher incidence rate of polyhydramnios, hypertensive disorders of pregnancy, cesarean delivery, premature birth, low-birth weight, macrosomia, and neonatal intensive care unit admission was significant than the women with good glycaemic control (all P < .05). GDM was an independent risk factor for polyhydramnios in advanced primiparous women. At the same time, good glycaemic control in diabetics advanced primiparous women could reduce adverse pregnancy outcomes.

Adverse pregnancy outcomes in pregnant women with chronic kidney disease: A systematic review and meta-analysis.

Chronic kidney disease (CKD) is associated with an increased risk of adverse pregnancy outcomes, but the risk at different stages of CKD (defined by estimated glomerular filtration rate, eGFR) compared with women without CKD has not been quantified in large cohorts. To quantify the association between CKD and adverse pregnancy outcomes according to CKD definition, CKD stage and presence or absence of diabetes. A systematic search of EMBASE and MEDLINE from inception to 5 January 2023. English-language randomised controlled trials as well as cohort and case-control studies investigating adverse pregnancy outcomes in pregnant women with CKD. Two reviewers conducted independent data extractions. A random-effects model was used to estimate risk. We included 19 studies with 3 251 902 women. Defining CKD using eGFR or serum creatinine produced results with greater effect size but wider confidence intervals. Compared with CKD stages 1-2, women with CKD stages 3-5 have a greater risk, but also greater imprecision in the risk estimate, of the following outcomes: pre-eclampsia (OR 55.18, 95% CI 2.63-1157.68, vs OR 24.74, 95% CI 1.75-348.70), preterm birth (OR 20.24, 95% CI 2.85-143.75, vs OR 8.18, 95% CI 1.54-43.46) and neonatal intensive care unit admission (OR 19.32, 95% CI 3.07-121.68, vs OR 9.77, 95% CI 2.49-38.39). Women with diabetic kidney disease, compared with women without diabetic kidney disease, have higher risks of maternal mortality, small-for-gestational-age neonates, pre-eclampsia and gestational hypertension. There is heterogeneity in the definition of CKD in pregnancy. Future studies should consider ways to standardise its definition and measurement in pregnancy.

History of Cholestasis Is Not Associated with Worsening Outcomes in Subsequent Pregnancy with Cholestasis.

Intrahepatic cholestasis of pregnancy is associated with adverse pregnancy outcomes including intrauterine fetal demise, spontaneous preterm labor, and meconium-stained amniotic fluid. Studies have yet to determine if patients with a history of pregnancy complicated by cholestasis had an association with more severe adverse outcomes in a subsequent pregnancy complicated by cholestasis. Retrospective cohort study of multiparous, singleton, nonanomalous live gestations complicated by cholestasis at Elmhurst Hospital Center from 2005 to 2019. We compared rates of adverse outcomes in multiparous pregnancies complicated by cholestasis with versus without prior cholestasis. Our primary outcome was rates of spontaneous preterm labor. Our secondary outcomes included rates of iatrogenic preterm birth, meconium-stained amniotic fluid, cesarean delivery for nonreassuring fetal heart tracing. Chi-square and multivariate regression tests were used to determine the strength of association. In all analyses, a p-value less than 0.05 and 95% confidence interval not crossing 1.00 indicated statistical significance. Mount Sinai Icahn School of Medicine Institutional Review Board approval was obtained for this project. Of the 795 multiparous pregnancies complicated by cholestasis, 618 (77.7%) had no prior history of cholestasis and 177 (23.3%) had prior history of cholestasis. Multiparous pregnancies with history of cholestasis had higher rates of prior preterm birth, earlier gestational age at diagnosis and delivery, and were more likely to receive ursodeoxycholic acid therapy. Pregnancies with history of cholestasis were not associated with spontaneous preterm labor in subsequent pregnancies with cholestasis, but history of cholestasis was associated with iatrogenic preterm birth and neonatal intensive care unit (NICU) admission. After adjusting for confounders, the association with iatrogenic preterm birth and NICU admission were no longer statistically significant. There was no significant association between history of cholestasis and other adverse obstetric outcomes. Findings suggests that history of prior cholestasis is not associated with worsening outcomes in subsequent pregnancies complicated by cholestasis. · Prior cholestasis may not alter risk in subsequent pregnancies.. · Unclear relationship between cholestasis and hepatobiliary disease.. · Studies needed to develop cholestasis screening protocol..

Risk factors associated with neonatal mortality among neonates admitted to neonatal intensive care unit of the University Teaching Hospital in Lusaka

Globally, several children die shortly after birth and many more of them within the first 28 days of life. Sub-Sharan Africa accounts for almost half (43%) of the global neonatal death with slow progress in reduction. These neonatal deaths are associated with lack of quality care at or immediately after birth and in the first 28 days of life. This study aimed to determine the trends and risk factors of facility-based neonatal mortality in a major referral hospital in Lusaka, Zambia. We conducted retrospective analysis involving all neonates admitted in the University Teaching Hospital Neonatal Intensive Care Unit (UTH-NICU) in Lusaka from January 2018 to December 2019 (N = 2340). We determined the trends and assessed the factors associated with facility-based neonatal mortality using Generalized Linear Models (GLM) with a Poisson distribution and log link function. Overall, the facility-based neonatal mortality was 40.2% (95% CI 38.0–42.0) per 1000 live births for the 2-year period with a slight decline in mortality rate from 42.9% (95% CI 40.0–46.0) in 2018 to 37.3% (95% CI 35.0–40.0) in 2019. In a final multivariable model, home delivery (ARR: 1.70, 95% CI 1.46–1.96), preterm birth (ARR: 1.59, 95% CI 1.36–1.85), congenital anomalies (ARR: 1.59, 95% CI 1.34–1.88), low birthweight (ARR: 1.57, 95% CI 1.37–1.79), and health centre delivery (ARR: 1.48, 95% CI 1.25–1.75) were independently associated with increase in facility-based neonatal mortality. Conversely, hypothermia (ARR: 0.36, 95% CI 0.22–0.60), antenatal attendance (ARR: 0.76, 95% CI 0.68–0.85), and 1-day increase in neonatal age (ARR: 0.96, 95% CI 0.95–0.97) were independently associated with reduction in facility-based neonatal mortality. In this hospital-based study, neonatal mortality was high compared to the national and global targets. The improvement in neonatal survival observed in this study may be due to interventions including Kangaroo mother care already being implemented. Early identification and interventions to reduce the impact of risks factors of neonatal mortality in Zambia are important.

Impact of Asthma Medications During Pregnancy on Asthma Exacerbation, Maternal, and Neonatal Outcomes

Asthma affects 5% to 13% of pregnant women, and many require daily pharmacotherapy to achieve asthma control; however, adherence to medication during pregnancy often decreases. To understand the association between the use of or adherence to asthma medication with asthma exacerbation and maternal/neonatal outcomes. Using linked population-based administrative databases from Alberta, Canada (2012-2018), pregnant women with asthma were categorized based on asthma medication use 1 year before pregnancy: short-acting β-agonists (SABA), inhaled corticosteroids (ICS), and ICS with long-acting β-agonists (ICS+LABA). Women on ICS+LABA were grouped by trajectory of adherence during pregnancy using group-based trajectory modeling. Logistic regressions were used to estimate the associations between the use of or trajectories of adherence to asthma medication during pregnancy with asthma exacerbation and maternal/neonatal outcomes. Overall, 13,509 of 238,751 (5.7%) pregnant women had asthma before pregnancy (SABA: 24.7%; ICS: 12.5%; ICS+LABA: 25.1%; none: 36.1%). The use of SABA (adjusted odds ratio [aOR]: 1.79, 95% confidence interval [CI]: 1.21, 2.64), ICS (aOR: 3.37, 95% CI: 2.10, 5.39), and ICS+LABA (aOR: 3.64, 95% CI: 2.57, 5.17) had greater odds of disease exacerbation than no asthma medication during pregnancy. ICS+LABA adherence groups during pregnancy included low (79.8%), moderate-to-decreasing (14.0%), and moderate-to-increasing (6.2%). The moderate-to-decreasing (aOR: 1.45, 95% CI: 1.14, 1.84) and moderate-to-increasing (aOR: 2.06, 95% CI: 1.50, 2.83) adherence groups had greater odds of disease exacerbation than the low adherence group. ICS use during pregnancy decreased odds of preterm birth (aOR: 0.62; 95% CI: 0.39, 0.99) and neonatal intensive care unit admission (aOR: 0.66; 95% CI: 0.45, 0.97). Other group comparisons were not statistically significant. Our study shows the importance of continuing asthma maintenance medication during pregnancy to improve outcomes. Future research should study the postpartum and long-term outcomes with asthma medication during pregnancy.

Midwife-led birthing centres in Bangladesh, Pakistan and Uganda: an economic evaluation of case study sites

IntroductionAchieving the Sustainable Development Goals to reduce maternal and neonatal mortality rates will require the expansion and strengthening of quality maternal health services. Midwife-led birth centres (MLBCs) are an alternative...

External Validation of a Multivariable Prediction Model for Placenta Accreta Spectrum

(Anesth Analg. 137(3):537–547) Placenta accreta spectrum (PAS) encompasses various forms of abnormal placental attachment and uterine invasion. PAS is a leading cause of severe postpartum hemorrhage and often leads to an emergency hysterectomy. Managing PAS and its associated complications, such as preterm birth, maternal morbidity, and neonatal intensive care unit admissions, is best achieved in tertiary-level hospitals equipped with specialized multidisciplinary care. To ensure the highest quality of care, proactive planning is essential. This involves identifying risk factors associated with PAS, facilitating rapid transfers to appropriate delivery facilities, efficient resource allocation, and minimizing the occurrence of life-threatening postpartum hemorrhage and its associated complications.

Clinical outcomes and financial estimates for women attending the largest private midwifery service in Australia compared to national data: a retrospective cohort study

Background and ProblemMultiple barriers to national scale-out of private midwifery practice in Australia exist. AimTo describe and compare maternal infant health outcomes of the largest private midwifery service in Australia with the national core maternity indicators and estimate the financial impact on collaborating public hospitals. MethodsA retrospective cohort of 2747 maternal health records from 2014 to 2022 were compared to national indicators. Financial calculations estimated the impact on hospitals. FindingsCompared to national data, women cared by private midwives were significantly: more likely to be 25–34 years and primiparous; less likely to be Indigenous, have diabetes, hypertension or multiple births. At birth, 5% required discussion with specialists, 25% required consultation and 39% were referred; 86% women had their primary midwife at birth; 12.5% birthed at home and 14.5% at a birth centre. Compared to national data, primiparous women had fewer inductions (22.9% vs 45.8%), caesarean sections (22.6% vs 32.1%), instrumental vaginal births (17.0% vs 25.7%), episiotomies (9.5% vs 23.9%) and more birthed vaginally after caesarean section (75.9% vs 11.9%). Significantly less babies were born with a birthweight <2750 g (0.5% vs 1.2%) and 83.7% babies were exclusively breastfed at six weeks. Collaborating hospitals would receive less DRG funding compared to public patients, require less intrapartum midwifery staff and receive a net benefit, even when bed fees were waived. ConclusionWomen attending My Midwives had significantly lower intervention rates when compared to national indicators although maternal characteristics could be contributing. Multidisciplinary care was evident. Financial modelling shows positive impacts for hospitals.

Faktor Yang Mempengaruhi Keberhasilan Pemberian Asi Eksklusif di Desa Nauli Kec. Sigumpar Kab.Toba

Efforts to increase the provision of breast milk (ASI) play a very big role in achieving infant mortality rates and reducing the prevalence of malnutrition in children under five. This research aims to determine the factors that influence the success of exclusive breastfeeding. This research design is descriptive analytical with a sample size of 26 respondents using a total sampling method. The results of this research were that the majority of respondents aged 26-30 years were 10 people (38.5%), the majority of respondents had secondary education as many as 19 people (73.1%), the majority of respondents were housewives as many as 20 people (76.9%), the majority of respondents had income &lt; 1,000,000 as many as 22 people (84.6%), and the majority of children are one child as many as 17 (65.4%). Data analysis using product moment. From the results of the product moment statistical test, it can be concluded that management factors in the birthing place that support breastfeeding and providing breastfeeding facilities in public places are factors that influence the success of exclusive breastfeeding. The relationship between management at the birth center that supports breastfeeding and exclusive breastfeeding obtained a value of r = 0.458, which means the relationship between the two variables has a sufficient relationship, and obtained a value of P = 0.019, meaning there is a significant influence. And for the relationship between providing breastfeeding facilities in public places and exclusive breastfeeding, the value obtained was r = 0.394, which means that the two variables have a sufficient relationship, and the value obtained was P = 0.047, which means there is a significant influence.

Maternal and fetal outcomes after planned cesarean or vaginal delivery in twin pregnancy: a comparison between 2 third level birth centers

Background Twin pregnancy is associated with higher risks of adverse perinatal outcomes for both the mother and the babies. Among the many challenges in the follow-up of twin pregnancies, the mode of delivery is the last but not the least decision to be made, with the main influencing factors being amnionicity and fetal presentation. The aim of the study was to compare perinatal outcomes in two European centers using different protocols for twin birth in case of non-cephalic second twin; the Italian patients being delivered mainly by cesarean section with those in Belgium being routinely offered the choice of vaginal delivery (VD). Methods This was a dual center international retrospective observational study. The population included 843 women with a twin pregnancy ≥ 32 weeks (dichorionic or monochorionic diamniotic pregnancies) and a known pregnancy outcome. The population was stratified according to chorionicity. Demographic and pregnancy data were reported per pregnancy, whereas neonatal outcomes were reported per fetus. We used multiple logistic regression models to adjust for possible confounding variables and to compute the adjusted odds ratio (adjOR) for each maternal or neonatal outcome. Results The observed rate of cesarean delivery was significantly higher in the Italian cohort: 85% for dichorionic pregnancies and 94.4% for the monochorionic vs 45.2% and 54.4% respectively in the Belgian center (p-value < 0.001). We found that Belgian cohort showed significantly higher rates of NICU admission, respiratory distress at birth and Apgar score of < 7 after 5 min. Despite these differences, the composite severe adverse outcome was similar between the two groups. Conclusion In this study, neither the presentation of the second twin nor the chorionicity affected maternal and severe neonatal outcomes, regardless of the mode of delivery in two tertiary care centers, but VD was associated to a poorer short-term neonatal outcome.