Birth Interventions Research Articles

AGGRESSIVE POSTERIOR RETINOPATHY OF PREMATURITY

The purpose of this study was to review the anatomic and functional outcomes of aggressive posterior retinopathy of prematurity occurring at the authors' institution. This is a retrospective chart review of inborn infants developing aggressive posterior retinopathy of prematurity from January 2004 through January 2008. Birth histories, interventions, and outcomes were reviewed. Twenty-two infants were identified as having aggressive posterior retinopathy of prematurity. All eyes underwent peripheral laser ablation. Seven infants (14 eyes) required a second session of laser. Five infants (eight eyes) progressed to retinal detachment that was successfully repaired by lens-sparing vitrectomy. Seven eyes developed stage 4a detachments, and 1 eye developed a stage 4b detachment. Forty-three eyes (43 of 44) demonstrated a good anatomic outcome with minimal posterior pole distortion. The management of aggressive posterior retinopathy of prematurity requires frequent screening examinations and timely intervention as outlined in the Early Treatment Retinopathy of Prematurity Study. Eyes progressing to retinal detachment may still have a good structural outcome with lens-sparing vitrectomy.

The comparison of birth outcomes and birth experiences of low-risk women in different sized midwifery practices in the Netherlands

To examine maternal birth outcomes and birth experiences of low-risk women in the Netherlands in different sized midwifery practices. Descriptive study using postal questionnaires six weeks after the estimated due date. Women were recruited from urban, semi-rural and rural areas from small-sized practices (1-2 midwives), medium-sized practices (3-4 midwives) or large-sized practices (5 or more). 718 Dutch speaking women with uncomplicated pregnancies, a representative sample of women in 143 midwifery practices in the Netherlands who had given birth in the period between 20 April and 20 May 2007. Distribution of place of birth categories and intervention categories, birth experience, woman-midwife relationship and presence of own midwife after referral. Data were analyzed with Statistical Package for Social Sciences (SPSS). Women in practices with a maximum of two midwives were significantly more likely to experience lower rates of referral, interventions in general and specifically pain relief by means of pethidine, CTG registration and unplanned caesarean sections. Women with a maximum of two midwives were significantly more likely to know their midwife or midwives and were more frequently supported by their own midwife after referral in comparison to women in practices with more than two midwives. The presence of the woman's own midwife added value to the birth experience. Women with a maximum of two midwives had higher levels of a positive birth experience than women in practices with more than two midwives. Midwifery practices with a maximum of two midwives contribute to non-interventionist birth and a positive birth experience. Awareness of the study results and further study is recommended to discuss reorganization of care in order to achieve significant reductions on referral and interventions during childbirth and positive maternal birth experiences.

Genetic and Environmental Contributions to Racial Disparities in Preterm Birth

The preterm birth rate exceeds 12% in the United States, and preterm birth continues to be a clinical and public health challenge globally. Even though preterm birth is a major contributor to infant mortality and lifelong morbidity, there are few effective strategies to predict preterm birth and few clinical interventions to prevent it. Genomic research approaches that identify risk factors at the intersection of genetics and the environment will likely provide insights. Both genetic and environmental factors are known to contribute to the racial disparity seen in preterm birth. Through the identification of relevant gene-environment interactions that contribute to preterm birth and may underlie the racial disparity in preterm birth, research that will translate to clinical practice and ultimately prevent a number of preterm births is possible.

Exploration of a cognitive model to predict post-traumatic stress symptoms following childbirth

Women can suffer from post-traumatic stress disorder (PTSD) following childbirth. This study investigated the application of a cognitive model to PTS symptoms following childbirth and explored the addition of social support to the model. Methods Women ( N = 138) completed questionnaires in pregnancy, 3-weeks and 3-months after birth, measuring prior trauma, beliefs, and coping in pregnancy; and birth interventions, social support, post-traumatic cognitions, and PTS symptoms post-birth. Results Using structural equation modeling, a cognitive model explained 23% of the variance in PTS symptoms 3-weeks postpartum. Three-months postpartum, the model explained only 9% of the variance in PTS symptoms. The addition of social support, partially mediated by post-traumatic cognitions, increased the variance to 16%. Discussion Results suggest that a cognitive model accounts for early PTS symptoms after birth. Social support after birth increases the explanatory power of the model at 3 months. A test of the model on a larger sample is warranted.

Global report on preterm birth and stillbirth (4 of 7): delivery of interventions.

BackgroundThe efficacious interventions identified in the previous article of this report will fail unless they are delivered at high and equitable coverage. This article discusses critical delivery constraints and strategies.Barriers to scaling up interventionsAchieving universal coverage entails addressing major barriers at many levels. An overarching constraint is the lack of political will, resulting from the dearth of preterm birth and stillbirth data and the lack of visibility. Other barriers exist at the household and community levels, such as insufficient demand for interventions or sociocultural barriers; at the health services level, such as a lack of resources and trained healthcare providers; and at the health sector policy and management level, such as poorly functioning, centralized systems. Additional constraints involve weak governance and accountability, political instability, and challenges in the physical environment.Strategies and examplesScaling up maternal, newborn and child health interventions requires strengthening health systems, but there is also a role for focused, targeted interventions. Choosing a strategy involves identifying appropriate channels for reaching high coverage, which depends on many factors such as access to and attendance at healthcare facilities. Delivery channels vary, and may include facility- and community-based healthcare providers, mass media campaigns, and community-based approaches and marketing strategies. Issues related to scaling up are discussed in the context of four interventions that may be given to mothers at different stages throughout pregnancy or to newborns: (1) detection and treatment of syphilis; (2) emergency Cesarean section; (3) newborn resuscitation; and (4) kangaroo mother care. Systematic reviews of the literature and large-scale implementation studies are analyzed for each intervention.ConclusionEquitable and successful scale-up of preterm birth and stillbirth interventions will require addressing multiple barriers, and utilizing multiple delivery approaches and channels. Another important need is developing strategies to discontinue ineffective or harmful interventions. Preterm birth and stillbirth interventions must also be placed in the broader maternal, newborn and child health context to identify and prioritize those that will help improve several outcomes at the same time. The next article discusses advocacy challenges and opportunities.

A metasynthesis of midwives’ experience of hospital practice in publicly funded settings: compliance, resistance and authenticity

Worldwide, increasing percentages of women are giving birth in centralized hospitals in the belief that this maximizes safety for themselves and their babies. In parallel, there is international recognition that the number of birth interventions used in the routine care of labouring women is rising. This is fuelling concern about iatrogenesis, and, particularly, maternal and infant morbidity and mortality. It also has an adverse impact on the economics of health care. National and international policy characterizes midwives as the guardians of normal childbirth. This guardianship appears to be failing. The objective of this metasynthesis is to explore midwives' perceptions of hospital midwifery with a focus on labour ward practice to examine professional discourses around midwifery work in the current modernist, risk averse and consumerist childbirth context. Based on an iterative search strategy, 14 studies were selected for the metasynthesis. Three overarching themes were identified: 'power and control'; 'compliance with cultural norms'; and 'attempting to normalize birth'. Most midwives aimed to provide what they characterized as 'real midwifery' but this intention was often overwhelmed with heavy workloads and the normative pressure to provide equitable care to all women. This raises questions of authenticity, both in terms of midwives living out their beliefs, and in terms of acknowledgement of the power to resist. The theoretical insights generated by the metasynthesis could have resonance for other professional and occupational groups who wish to offer autonomous individualized services in an increasingly risk-averse target driven global society.

Humanized birth in high risk pregnancy: barriers and facilitating factors

The medical model of childbearing assumes that a pregnancy always has the potential to turn into a risky procedure. In order to advocate humanized birth in high risk pregnancy, an important step involves the enlightenment of the professional's preconceptions on humanized birth in such a situation. The goal of this paper is to identify the professionals' perception of the potential obstacles and facilitating factors for the implementation of humanized care in high risk pregnancies. Twenty-one midwives, obstetricians, and health administrator professionals from the clinical and academic fields were interviewed in nine different sites in Japan from June through August 2008. The interviews were audio taped, and transcribed with the participants' consent. Data was subsequently analyzed using content analysis qualitative methods. Professionals concurred with the concept that humanized birth is a changing and promising process, and can often bring normality to the midst of a high obstetric risk situation. No practice guidelines can be theoretically defined for humanized birth in a high risk pregnancy, as there is no conflict between humanized birth and medical intervention in such a situation. Barriers encountered in providing humanized birth in a high risk pregnancy include factors such as: the pressure of being responsible for the safety of the mother and the fetus, lack of the women's active involvement in the decision making process and the heavy burden of responsibility on the physician's shoulders, potential legal issues, and finally, the lack of midwifery authority in providing care at high risk pregnancy. The factors that facilitate humanized birth in a high risk include: the sharing of decision making and other various responsibilities between the physicians and the women; being caring; stress management, and the fact that the evolution of a better relationship and communication between the health professional and the patient will lead to a stress-free environment for both. Humanized birth in a high risk pregnancy is something that goes beyond just curing women of their illnesses. It can be considered as a token of caring, and continued support, which positively consolidates the doctor-patient relationship. As yet, it has not been described as a practiced guideline, due to its ever-changing complexities.

Effect of a novel birth intervention and reminder-recall on on-time immunization compliance in high-risk children

Objectives: Profound racial/ethnic immunization rate disparities exist among young children in Chicago. We created BIRTH PIP, a program combining immunization education at birth with ongoing reminder-recall, to achieve greater than 90% on-time adherence with AAP/ACIP immunization recommendations among inner-city children aged 0-35 months. The study also examines the cost of this effort.Study Design: Outreach workers met with post-partum mothers who were English speaking, Chicago residents and receiving Medicaid, to provide immunization education and determine a contact strategy. Parents were reminded of each well-child appointment. Those missing appointments were re-contacted and rescheduled. Home visits were made when there was no contact by phone and mail. Enrollees and immunizations were tracked until all recommended immunizations were received. On-time immunization rates were compared with city-wide immunization data. Costs were calculated by assessing outreach worker effort and other programmatic costs.Results: A total of 400 neonates were enrolled. At all examined time points, on-time immunization rates exceeded city-wide data. Of those completing the program, 92% of children had 100% compliance with prescribed immunizations by 24 months. No child required follow-up past 29 months. Retention was an important problem, primarily due to pre-set eligibility requirements. Mean cost per child to complete recommended immunizations was $288. Compliant families were less expensive to maintain.Conclusions: BIRTH PIP is effective in improving immunization rates in underserved children. Economies of scale will decrease the per child cost. Preventing even a few cases of vaccine-preventable illness would likely render this initiative cost-effective.

Foetal and congenital talipes: interventions and outcome

Talipes is a congenital anomaly that can be corrected conservatively or surgically. Despite advances in management, a proportion of pregnancies still result in termination. We therefore aimed to establish the birth prevalence, interventions and outcome of talipes in our population. Cases with foetal talipes were identified from the ultrasound register at the James Cook University Hospital between 1990 and 2006. Infants with congenital talipes between 1998 and 2006 were identified from the physiotherapy database. Management details were obtained from case records. A total of 46 cases with foetal talipes were identified among 75 933 pregnancies. Of the 34 live-born infants, 24 (70.5%) required surgery to correct the talipes. Congenital talipes was found in 69 infants, giving a birth prevalence of 2 per 1000 live births. Sixteen (72.7%) infants with an antenatal diagnosis required surgical correction. Infants with an antenatal diagnosis were at an increased risk of requiring surgery (relative risk [RR]= 1.6). Surgical management was required in more than two-thirds of babies with foetal talipes. Conservative management was successful in the majority of the babies without an antenatal diagnosis. Infants with an antenatal diagnosis are 1.6 times as likely to need surgical correction as infants without an antenatal diagnosis.

Use of Routine Interventions in Vaginal Labor and Birth: Findings from the Maternity Experiences Survey

Intervention rates in maternity practices vary considerably across Canadian provinces and territories. The objective of this study was to describe the use of routine interventions and practices in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Rates of interventions and practices are considered in the light of current evidence and both Canadian and international recommendations. A sample of 8,244 estimated eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer-assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old (9-14 mo in the territories). Completed responses were obtained from 6,421 women (78%). Women frequently reported electronic fetal monitoring, a health care practitioner starting or speeding up their labor (or trying to do so), epidural anesthesia, episiotomy, and a supine position for birth. Some women also reported pubic or perineal shaves, enemas, and pushing on the top of their abdomen. Several practices and interventions were commonly reported in labor and birth in Canada, although evidence and Canadian and international guidelines recommend against their routine use. Practices not recommended for use at all, such as shaving, were also reported.

Sexual health of persons with DSD and 46,XY karyotype

Background Disorders resp. Divergencies of Sex Development (DSD) comprise various forms of untypical sex development in which chromosomal, gonadal and/or anatomical sex characteristics do not all correspond to one sex. Up to now the common medical practice has included an immediate gender assignment after birth and sex-correcting medical interventions to avoid the risk of an impaired psychosexual development. However, there is no evidence whether the current medical treatment strategies in fact improve the psychosexual development of the children or whether they rather impair the sexual sensitivity of the genitals. Objectives Aim of the study is a comprehensive investigation of sexuality and partnership of persons with DSD and 46,XY karyotype. Methods The sample comprises 47 persons (age: 16–60 years) with DSD and 46,XY karyotype who participated in the Hamburg Intersex-Study. As comparison group served 145 healthy women (age: 18–50 years). Participants were asked to fill in a questionnaire. Medical data was retrieved from the patientsrsquor; records. Standardized measures (e.g., Fragebogen zur Unsicherheit in sozio-sexuellen Situationen) as well as self-developed questions were applied. Results Results showed that persons with 46,XY DSD felt less self-confident in social and sexual situations, had more sexual problems, had fewer previous relationships and were less satisfied with both their general sexual life and their sexual function. However, no group differences were found with regard to sexual identity, partner status and number of previous sex partners. Conclusions This negative outcome indicate that sexual quality of life of persons with 46,XY DSD is impaired.

Reality Television as a Source of Information about Birth: The Messages and Their Implications

Purpose: Childbirth information in reality television programs needs critical examination. Messages regarding interventions and options were examined in the most popular show, A Baby Story. Research Question: How prevalent are medical interventions and potential alternatives on A Baby Story and how are these discussed by program participants? Significance/Background: Two-thirds of expectant mothers watch childbirth reality television programs, while maternal–infant outcomes worsen, medical intervention rates increase persistently, and midwifery remains underused. Methods: Forty episodes of A Baby Story were randomly sampled, recorded, transcribed, and analyzed for content, including frequencies of depicted birth options and interventions as well as comparisons by provider type and birth method. Conversations about childbirth and birth sequences were coded to evaluate discussions. Findings: Physician-attended births predominated (74%) and depicted routine interventions as necessary to facilitate labor progression and minimize pain, allowing medicalized births to appear normative. Alternative birth options were unclear and infrequent, occurring most often when midwives attended or when birthing women were identified as particularly well informed or motivated to avoid intervention. Discussion: Episodes of A Baby Story were not neutral arbiters of information. The majority mirrored the medical model, reinforcing women's fears about pain while inconsistently mentioning alternatives. As impersonal sources of birth information become more common, media messages that normalize medical intervention in childbirth need to be countered. Offering accessible, interesting, widely available information supporting midwifery and childbirth options seems a valuable national strategy.

Obstetrician–Gynecologists’ Screening and Management of Preterm Birth

To define obstetrician-gynecologists' screening for potential preterm birth risk factors and interventions they use when indicators suggest the patient may be at increased risk. Questionnaires were mailed to 1,193 American College of Obstetricians and Gynecologists members. The response rate was 59%. Respondents most frequently report screening for previous preterm birth (98%) and cone biopsy (95%) as risk factors for preterm birth. Twenty-one percent do not screen for asymptomatic urinary tract infection and 57% screen for group B streptococci in an attempt to prevent preterm birth. Almost one third (31%) routinely recommend bed rest in twin pregnancies. Most (98%) use tocolytics (primarily magnesium sulfate, 94%) for women with intact membranes in preterm labor. Nearly 100% use corticosteroids in anticipated preterm births, and few (4%) repeat the dosing if delivery has not occurred within 1 week. Twenty-four percent of respondents did not have access to a newborn intensive care unit (ICU); they were more likely to refer a patient with an impending preterm delivery to a maternal-fetal medicine specialist for complete care than were those with a newborn ICU available (79% compared with 9%; P<.001). Most obstetrician-gynecologists are practicing in accord with current findings on preterm birth risk factors and interventions. However, there may be overscreening and underscreening for various infections and overuse of bed rest as a preterm birth intervention. When preterm birth is imminent, physicians often and appropriately seek the most specialized care possible for their patients. III.

Disciplinary Discourses: Rates of Cesarean Section Explained by Medicine, Midwifery, and Feminism

In the context of international concern about increasing rates of cesarean sections, we used discourse analysis to examine explanations arising from feminism and the disciplines of medicine and midwifery, and found that each was positioned differently in relation to the rising rates. Medical discourses asserted that doctors are authorities on birth and that, although cesareans are sometimes medically necessary, women recklessly choose unnecessary cesareans against medical advice. Midwifery discourses portrayed medicine as paternalistic toward both women and midwifery, and feminist discourses situated birth and women's bodies in the context of a patriarchally structured society. The findings illustrate the complex ways in which this intervention in birth is discursively constructed, and demonstrate its significance as a site of disciplinary conflict.

The Canadian Maternity Experiences Survey: An Overview of Findings

ObjectiveThe Canadian Perinatal Surveillance System (CPSS) of the Public Health Agency of Canada (PHAC) routinely monitors national perinatal health indicators using available administrative databases and population health surveys. Women’s perceptions and assessments of their perinatal experiences are not captured by these data sources. The Maternity Experiences Survey (MES) addresses some of these knowledge gaps, and was designed to examine experiences, practices, perceptions and knowledge during pregnancy, birth and the early postpartum months among women giving birth in Canada. MethodsA randomly selected sample of 8542 women, stratified primarily by province and territory, was drawn from the May 2006 Canadian Census. Birth mothers living with their infants at the time of interview were invited to participate in a computer assisted telephone interview conducted by Statistics Canada on behalf of the PHAC. Interviews took approximately 45 minutes and were completed when infants were between five and 10 months old (between 9 and 14 months in the territories). Completed responses were obtained from 6421 women (78%). ResultsMost women reported being satisfied with the care they received. The findings suggested a higher use of selected interventions in pregnancy, labour and birth than is recommended by current evidence and a lower adherence to several best practices related to family-centred issues and the World Health Organization / United Nations Children’s Fund “Baby Friendly Hospital Initiative.” ConclusionAssessing women’s perceptions of their perinatal care provides a valuable supplement to traditional perinatal surveillance tools. The MES will allow for women’s views to be considered in relation to current maternity care policies and practices in Canada.

Pregnancy, delivery and birth outcome in different stages of maternal multiple sclerosis

To investigate the influence of maternal multiple sclerosis (MS) on pregnancy, we compared pregnancy, delivery and birth outcome in births prior to onset of MS (pre MS), between MS onset and diagnosis (early MS), and after diagnosis of MS (manifest MS). Mothers with MS were identified through linkage of the Norwegian MS Registry and the Medical Birth Registry of Norway (1967-2002). All pre MS births (n = 1910), early MS births (n = 555), and manifest MS births (n = 308) were compared. There was a significantly lower mean birth weight in term births (adjusted for gestation in weeks, mother's age, time period and caesarean section) in the manifest MS compared to the pre MS group (P = 0.046). The rate of birth complications and interventions did not differ between the three groups. Manifest MS in birth-giving mothers seems to affect birth weight.

Effects of algorithm for diagnosis of active labour: cluster randomised trial

Objective To compare the effectiveness of an algorithm for diagnosis of active labour in primiparous women with standard care in terms of maternal and neonatal outcomes.Design Cluster randomised trial.Setting Maternity...

Effects of Fathers’ Attendance to Labor and Delivery on the Experience of Childbirth in Turkey

This study was planned to experimentally determine the effects of fathers' attendance to labor and delivery on the experience of childbirth. Fifty primigravidae low-risk women and their partners were recruited to the study. The first 25 women were included in the experimental group, and their partners were allowed to participate in birth. The remaining 25 women were included in the control group, and their partners were not allowed to participate in birth. Perception of Birth Scale and Father Interview Form were used to evaluate couples' experiences during labor and delivery. In conclusion, fathers' support in birth helped mothers to have more positive experiences in all aspects of childbirth. There was no relationship between fathers' support and length of labor, use of pain-relieving drugs, or obstetric interventions in birth. When mother and father were supported during labor and delivery, the rate of the fathers who adopted an active role was high.

Doing midwifery between different belief systems

Childbirth has been increasingly concentrated in large centralised hospitals, with a parallel trend toward more birth interventions in Norway. These changes have resulted in new ways of framing birth from: a normal woman's life experience to a medical event. Caring for the birthing mother in a modern centralised ward, take place between two different belief- systems: a biomedical and a phenomenological. A phenomenological account of seven midwives’ descriptions of skilled midwifery in a Norwegian high-technology labour ward was carried out. The focus was on how skilled midwives experience their daily work between a biomedical and a phenomenological belief system. Three themes were identified: (1) sensing where the woman is in labour, (2) being available for but not overbearing to the women and (3) being in a room of struggle. The findings are discussed from the perspective of being between these two belief-systems, with special focus on wise midwifery judgement as a way of managing the struggle.

Foetal distress and birth interventions in children with developmental delay syndromes: A prospective controlled trial

To investigate the incidence of birth intervention/foetal distress in children with developmental delay syndromes (attention deficit disorder, attention deficit hyperactivity disorder, dyslexia, dyspraxia, obsessive compulsive disorder, Tourette's syndrome of childhood, autistic spectrum disorders). A population of 100 children aged 4–15 years and diagnosed with developmental delay syndrome(s) were investigated using a parental questionnaire to determine whether they had suffered any birth interventions or distress. These results were compared with an age- and gender-matched control group. On the basis of this relatively small study, significant risk of development delay syndrome(s) occurred with both foetal distress ( p < 0.001) and Ventouse assisted delivery ( p < 0.01).