Mode Of Birth Research Articles

Fertility policy changes, maternal and foetal characteristics and birth timing patterns at a tertiary referral centre in Beijing: a ten-year retrospective study

ObjectiveThis study aimed to explore the impacts of the changing national fertility policy on maternal and fetal characteristics, and birth timing patterns and provide a basis for the management of...

The impact of exclusion due to COVID-19 restrictions on partners' satisfaction with Swedish hospital postnatal ward care: A multi-methods approach.

To prevent the spread of SARS-CoV-2, hospitals around the world adopted protocols that, in varying ways, resulted in the exclusion of partners from hospital postnatal care wards. The objective of this study was to examine the effect this exclusion had on partners' satisfaction with postnatal care. An online survey (the Swedish Pregnancy Panel) including free-text comments was conducted before and during the first wave of the COVID-19 pandemic; partners of pregnant women were recruited at an early ultrasound appointment and followed until 2 months after childbirth. Data were linked to the Swedish Pregnancy Register. The survey was completed by 524 partners of women who gave birth during the pandemic and 203 partners of women who gave birth before. Partners' satisfaction with hospital postnatal care dropped 29.8 percent (-0.94 OLS, 95% CI = -1.17 to -0.72). The drop was largest for partners of first-time mothers (-1.40 OLS, 95% CI = -1.69 to -1.11), but unrelated to clinical outcomes such as mode of birth and most social backgrounds, except higher income. The qualitative analysis showed that partners (1) felt excluded as partners and parents, (2) thought the strain on staff led to deficiencies in the care provided, and (3) perceived the decision about partner restrictions as illogical. The exclusion of partners from the hospital postnatal wards clearly impaired satisfaction with care, and partners of first-time mothers were particularly affected. Planning for future restrictions on partners from hospital wards should factor in these consequences.

Risk of stillbirth after a previous caesarean delivery: A Swedish nationwide cohort study.

To investigate the risk of stillbirth in relation to (1) a previous caesarean delivery (CD) compared with those following a vaginal birth (VB); and (2) vaginal birth after caesarean (VBAC) compared with a repeat CD. Population-based cohort study. The Swedish Medical Birth registry. Women with their first and second singletons between 1982 and 2012. Multivariable logistic regression models were performed to estimate adjusted odds ratios (aOR) and 95% confidence intervals (CI) of the association between CD in the first pregnancy and stillbirth in the second pregnancy and the association between VBAC and stillbirth. Sub-group analyses were performed by types of CD and timing of stillbirth (antepartum and intrapartum). Stillbirth (antepartum and intrapartum fetal death). Of the 1 771 700 singleton births from 885 850 women, 117 114 (13.2%) women had a CD in the first pregnancy, and 51 755 had VBAC in the second pregnancy. We found a 37% increased odds of stillbirth (aOR 1.37; 95% CI 1.23-1.52) in women with a previous CD compared with VB. The odds of intrapartum stillbirth were higher in the previous pre-labour CD group (aOR 2.72; 95% CI 1.51-4.91) and in the previous in-labour CD group (aOR 1.35; 95% CI 0.76-2.40), although not statistically significant in the latter case. No increased odds were found for intrapartum stillbirth in women who had VBAC (aOR 0.99; 95% CI 0.48-2.06) compared with women who had a repeat CD. This study confirms that a CD is associated with an increased risk of subsequent stillbirth, with a greater risk among pre-labour CD. This association is not solely mediated by increases in intrapartum asphyxia, uterine rupture or attempted VBAC. Further research is needed to understand this association, but these findings might help healthcare providers to reach optimal decisions regarding mode of birth, particularly when CD is unnecessary.

The carbon footprint of different modes of birth in the UK and the Netherlands: An exploratory study using life cycle assessment.

To compare the carbon footprint of caesarean and vaginal birth. Life cycle assessment (LCA). Tertiary maternity units and home births in the UK and the Netherlands. Birthing women. A cradle-to-grave LCA using openLCA software to model the carbon footprint of different modes of delivery in the UK and the Netherlands. 'Carbon footprint' (in kgCO2 equivalents [kgCO2 e]). Excluding analgesia, the carbon footprint of a caesarean birth in the UK was 31.21 kgCO2 e, compared with 12.47 kgCO2 e for vaginal birth in hospital and 7.63 kgCO2 e at home. In the Netherlands the carbon footprint of a caesarean was higher (32.96 kgCO2 e), but lower for vaginal birth in hospital and home (10.74 and 6.27 kgCO2 e, respectively). Emissions associated with analgesia for vaginal birth ranged from 0.08 kgCO2 e (with opioid analgesia) to 237.33 kgCO2 e (nitrous oxide with oxygen). Differences in analgesia use resulted in a lower average carbon footprint for vaginal birth in the Netherlands than the UK (11.64 versus 193.26 kgCO2 e). The carbon footprint of a caesarean is higher than for a vaginal birth if analgesia is excluded, but this is very sensitive to the analgesia used; use of nitrous oxide with oxygen multiplies the carbon footprint of vaginal birth 25-fold. Alternative methods of pain relief or nitrous oxide destruction systems would lead to a substantial improvement in carbon footprint. Although clinical need and maternal choice are paramount, protocols should consider the environmental impact of different choices.

Experiences of success and failure in childbirth

ABSTRACT Aims To determine what kinds of birth-related experiences of success and failure are described by the participants, and whether there are differences according to fear of childbirth and parity. Studying these experiences is important for understanding the psychological mechanisms behind different childbirth experiences and their impact on maternal mental well-being. Methods This was a longitudinal mixed methods study. Descriptions of the birth experiences of 113 Finnish participants were gathered in a survey at 4–8 weeks postpartum and analysed with content analysis. Fear of childbirth was determined antenatally with the Wijma Delivery Expectations scale (W-DEQ A).The number of success and failure expressions were compared between people with FOC and others and between primiparous and multiparous people. Results The contents of the childbirth-related experiences of success and failure were categorised into 12 subcategories, organised under three higher-order categories that were named personal factors, course of childbirth, and support. The most typical expressions of success were in the categories of mode of birth, staff, and mental factors, and the most typical expressions of failure in the categories of staff and mental factors. Experiences of failure were more often expressed by primiparous than multiparous people, but there were no statistically significant differences by FOC. Expressions of success were equally common regardless of parity or FOC. Conclusion Postpartum people categorise aspects of their birth experiences in terms of success and failure. Primiparous people are more susceptible to experiencing failure at childbirth, but possible differences between people with FOC and other people warrant further investigation.

Women with Endometriosis-Who Is at Risk for Complications Associated with Pregnancy and Childbirth? A Retrospective Case-Control Study.

Women with endometriosis (EM), particularly the manifestations of adenomyosis (AM) and deep infiltrating endometriosis (DIE), suffer from pain and sterility. DIE also appears with several specific obstetric complications. To determine the risk profile, we designed a retrospective case-control study. Primary outcomes were defined as the risk of preterm birth and caesarean delivery (CD). Primiparous singleton pregnancies in women with DIE were compared with controls without EM. We matched for mode of conception and maternal age. A total of 41 women diagnosed with DIE and 164 controls were recruited. A total of 92.7% of the cases were also diagnosed with AM. Preterm birth occurred in 12.2% of cases and in 6.7% of controls. The difference was not statistically significant (OR: 1.932; 95% CI: 0.632-5.907). The rate of CD was similar in both groups. Remarkably, placental implantation disorders in the form of placenta praevia were eight times more frequent in women with DIE (9.8%) than in controls (1.2%, OR: 8.757; 95% CI: 1.545-49.614). Neonatal outcome was similar in both groups. Four out of fourteen cases reported abdominal wall endometriosis after CD. Women with DIE/AM and with placenta praevia are at risk of bleeding complications. After CD, they can develop abdominal wall EM. We therefore suggest evaluating the birth mode in each woman with DIE/AM.

Pregnancy outcomes post-kidney transplantation across 23 years.

Pregnancy in kidney transplant recipients has become increasingly common. However, pregnancy carries higher risks to these patients compared to the general population. To describe pregnancy outcomes in kidney transplant recipients. We conducted a single-centre retrospective cohort study of kidney transplant recipients who delivered after 20 weeks gestation at a quaternary hospital in Victoria, Australia, between 2000 and 2022 inclusive. The study included 37 pregnancies from 27 patients, accounting for 38 infants. Over half of recorded pregnancies occurred in the past five years (56.8%, n = 21). There were high rates of pre-existing hypertension (75.7%, n = 28). Pregnancy-induced hypertension and pre-eclampsia were common antenatal complications (21.6%, n = 8 and 48.6%, n = 18 respectively). Soluble fms-like tyrosine kinase-1 / placental growth factor ratios were elevated in all patients who developed severe pre-eclampsia (16.2%, n = 6). The median gestational age at birth was 36.4 weeks (range 20-40.4, Q1 32.9, Q3 37.6) and 59.5% (n = 22) of births were preterm. Unplanned caesarean without labour was the most common mode of birth (35.1%, n = 13). The overall caesarean rate was 62.1% (n = 23). Post-partum haemorrhage complicated over half of pregnancies (56.8%, n = 21). Fifty percent (n = 19) of infants were admitted for neonatal care, in particular neonatal intensive care, and had low birthweights under 2500 g. While there was a transient deterioration in kidney function, there was no graft rejection within one year of birth. Clinicians should consider the high rates of pre-existing hypertension, preterm birth, and caesarean birth when counselling and managing pregnant kidney transplant recipients.

Factors Affecting Mode of Birth in Women With Preexisting Diabetes and Gestational Diabetes: A Retrospective Cohort at a Tertiary Referral Center.

Women with preexisting diabetes and gestational diabetes mellitus (GDM) are at higher risk for adverse maternal and neonatal outcomes. However, there is no consensus on a uniform approach regarding mode of birth (MOB) for all forms of diabetes. The aim of the study is to compare MOB in women with preexisting diabetes and GDM and possible factors influencing it. A retrospective cohort study of women with GDM and preexisting diabetes between 2015 and 2021 at a tertiary referral center was conducted. One thousand three hundred eighty-five singleton pregnancies were included. One thousand twenty-two (74.4%) women had a vaginal birth (VB) and 351 (25.6%) a caesarean section. Preexisting diabetes was significantly associated with caesarean section compared to GDM (OR 2.43). Five hundred fifty-one (40.1%) women underwent induction of labor, and 122 (22.1%) women had a secondary caesarean after IOL. Women induced due to spontaneous rupture of membrane (SROM) achieved the highest rate of VB at 93%. The lowest rates of VB occurred if indication for induction was for preeclampsia or hypertension. IOL was significantly less successful in preexisting diabetes with a VB achieved in 56.4% for type 1 diabetes and 52.6% of type 2 diabetes compared to GDM (78.2% in GDM; 81.2% in IGDM; OR 3.25, 95% CI 1.70-6.19, p < 0.001). The rate of VB was higher who were induced preterm compared to women with term IOL (n = 240 (81.9%) vs. n = 199 (73.2%); p < 0.05). Parity, previous VB and SROM favored VB after IOL, whereas preexisting diabetes, hypertension, and IOL after 40 + 0 weeks are independent risk factors for caesarean delivery.

Length-of-stay and factors associated with early discharge after birth in health facilities in Guinea by mode of birth: Secondary analysis of Demographic and Health Survey 2018.

The immediate postpartum period (first 24 hours after birth) represents a critical time for women and newborns. Postnatal length-of-stay varies globally; in Guinea, a 24-hour facility stay following childbirth is recommended, with an emphasis on providing frequent monitoring of mother and newborn for the first 6 hours. This study describes postpartum length-of-stay following facility-based births in Guinea, and investigates factors associated with early discharge. This cross-sectional study analysed secondary Demographic and Health Survey data covering the most recent livebirths during 2013-2018. We included 2,763 women who gave birth vaginally or by caesarean section in healthcare facilities. Early discharge following vaginal birth was defined according to two cut-offs (<24 hours and <6 hours); early discharge following caesarean section was defined as <72 hours. We assessed socio-demographic, obstetric and health-system factors associated with early discharge using binary and multi-variable logistic regression. Among women with a vaginal birth, 81.5% were discharged <6 hours, with a median length-of-stay of 3 hours. 28% of women who had caesarean section were discharged <72 hours. Odds of discharge <6 hours among women who gave birth vaginally were lower for births in non-government hospital(aOR = 0.55[95%CI = 0.35;0.85]), and multiple births(aOR = 0.54[95%CI = 0.31;0.94]); while the odds were higher in five of the 8 regions compared to Boké. Among women who gave birth by caesarean section, odds of discharge <72 hours were lower for births in government hospitals(aOR = 0.09[95%CI = 0.03;0.3]), and girl newborns(aOR = 0.15[95%CI = 0.05;0.48]).This study showed that postpartum length-of-stays in Guinea is on average shorter than the local recommendations, with the majority of postpartum women with vaginal births spending less than 6-hours in health facilities after birth. Early discharge was associated with type of facility of birth and region. This warrants an in-depth exploration of reasons related to women's and families' preferences, health workers' practices, resource availability, and whether/how early discharge affects postpartum quality-of-care and health outcomes.

Childbirth in adolescents - features and outcomes

Introduction. Adolescent pregnancies significantly impact the welfare of young mothers, their infants, and the general population. These pregnancies represent a public healthcare concern associated with numerous consequences. Aim: To investigate the prevalence of adolescent pregnancies and their outcomes. Material and Methods. This retrospective descriptive study included adolescents who gave birth at the Gynecology and Obstetrics Clinic between January 1, 2020 and December 31, 2020. Data on anthropometric measurements, number and mode of deliveries, newborn birth weights, and complications were collected from medical records and statistically analyzed. Results. A total of 174 adolescents (aged 13-19) were included in the study. Most were first-time mothers living in common-law unions. Four spontaneous twin pregnancies were documented. No significant differences were found in the anthropometric measures between younger (&lt;15 years old) and older (16-19 years old) adolescents. Pelvic measurements did not affect the mode of delivery. Younger adolescents and those with smaller pelvic measurements experienced longer hospitalizations. Vaginal delivery was the prominent mode of birth. Newborns delivered by caesarian section had significantly lower birth weights and lengths. While no significant complications during labor and delivery were observed, there was notable postpartum blood loss and higher rates of anemia in the puerperium. Conclusion. Although the number of adolescent pregnancies and births is declining, it still remains a significant concern. Welldeveloped perinatal care and the promotion of reproductive health within educational and health systems could not only further reduce pregnancy rates but also ensure optimal conditions for normal pregnancies and deliveries in adolescents.

Implementing the QUALI-DEC project in Argentina, Burkina Faso, Thailand and Viet Nam: a process delineation and theory-driven process evaluation protocol

ABSTRACT The project ‘Quality Decision-making by women and providers’ (QUALI-DEC) combines four non-clinical interventions to promote informed decision-making surrounding mode of birth, improve women’s birth experiences, and reduce caesarean sections among low-risk women. QUALI-DEC is currently being implemented in 32 healthcare facilities across Argentina, Burkina Faso, Thailand, and Viet Nam. In this paper, we detail implementation processes and the planned process evaluation, which aims to assess how and for whom QUALI-DEC worked, the mechanisms of change and their interactions with context and setting; adaptations to intervention and implementation strategies, feasibility of scaling-up, and cost-effectiveness of the intervention. We developed a project theory of change illustrating how QUALI-DEC might lead to impact. The theory of change, together with on the ground observations of implementation processes, guided the process evaluation strategy including what research questions and perspectives to prioritise. Main data sources will include: 1) regular monitoring visits in healthcare facilities, 2) quantitative process and output indicators, 3) a before and after cross-sectional survey among post-partum women, 4) qualitative interviews with all opinion leaders, and 5) qualitative interviews with postpartum women and health workers in two healthcare facilities per country, as part of a case study approach. We foresee that the QUALI-DEC process evaluation will generate valuable information that will improve interpretation of the effectiveness evaluation. At the policy level, we anticipate that important lessons and methodological insights will be drawn, with application to other settings and stakeholders looking to implement complex interventions aiming to improve maternal and newborn health and wellbeing. Trial registration: ISRCTN67214403.

Non-linear model of the macroeconomic system dynamics: multiplier-accelerator

The article discusses one of the classic problems of macroeconomic dynamics, on which the neo-Keynesian theory of growth is based, so that the interaction between the multiplier and the accelerator. A new approach was proposed to develop a mathematical model of the dynamics of the mutual multiplier, which indicates the marginal propensity to save as a result of the GDP growth, and the accelerator, which reflects the growth of capital of the national income in the multiplier. The model is based on the hypothesis of non-linear dependence of the consumption on the amount of profit. This assumes that consumption growth is limited, i.e., a saturation effect occurs. In addition, the model took into account the delayed reaction of the accelerator to the influence of the multiplier. Under building the model, the considered processes were considered continuous in time. This made it possible to provide the mathematical model ”accelerator - multiplier” as a system of two differential equations of the first order. The application of the developed model to the analysis of the dynamic properties of the macroeconomic system makes it possible to evaluate the parameters at which the ”multiplier-accelerator” system enters a critical state. It has been proven that the conditions for the occurrence of self-oscillations depend on the critical value of the accelerator power. The presence of a two-fold limit cycle with corresponding ”soft” and ”hard” modes of birth (death) of the limit cycle was also founded. The applied usefulness of the model is that the choice of management decisions taking into account these results allow us preventing the occurrence of bifurcations and disasters in the process of evolution of the macroeconomic systems.

Mode of birth and long-term maternal mental health: A follow-up study in the Danish National Birth Cohort.

Cesarean birth has been associated with increased risks of short-term mental health problems. Little is known about whether these associations persist in the long term. This study aimed to estimate the associations between mode of birth and maternal mental health in midlife while considering mental health before and during pregnancy. Cohort study among mothers in the Danish National Birth Cohort. Birth mode for each woman's entire reproductive history was obtained from Danish national registries. Symptoms of depression and stress in midlife were self-reported using validated scales. Log binomial regression was used to calculate risk ratios (RR) with 95% confidence intervals (CI) for the association between birth mode and depressive symptoms. Linear regression was used to calculate mean difference in stress score by birth mode. Among 42,872 women, 15.5% reported depressive symptoms at follow-up, where they were, on average, 43.9 years and 11.2 years after their last birth. Compared with women who only ever had spontaneous vaginal births, women who only had cesarean births, or had both cesarean and vaginal births with the last birth by cesarean, reported slightly more symptoms of depression (RR 1.10, 95% CI 1.01;1.20) and stress (mean difference 0.68 on a 100-point scale, 95% CI 0.10;1.26). Whether due to the birth experience or underlying factors, depression and stress in midlife were more frequent in women with only cesarean births or whose last birth was by cesarean compared with women with vaginal births.

Association Between Doula Use on a Digital Health Platform and Birth Outcomes.

To examine the association between the use of virtual doula appointments on a comprehensive digital health platform and users' mode of birth and their birth experiences, among all platform users and Black platform users. Data for this retrospective cohort study were extracted from individuals who enrolled in a comprehensive digital health platform, between January 1, 2020, and April 22, 2023. Multivariable logistic regression models were used to estimate the association between number of virtual doula appointments completed on the digital health platform and odds of cesarean birth and user-reported birth experience outcomes, which included help deciding a birth preference, receiving a high level of support during pregnancy, learning medically accurate information about pregnancy complications and warning signs, and managing mental health during pregnancy, stratified by parity. The interaction of doula utilization by race for each outcome was also tested. Overall 8,989 platform users were included. The completion of at least two appointments with a virtual doula on the digital health platform was associated with a reduction in odds of cesarean birth among all users (adjusted odds ratio [aOR] 0.80, 95% CI, 0.65-0.99) and among Black users (aOR 0.32, 95% CI, 0.14-0.72). Among platform users with a history of cesarean birth, completion of any number of doula visits was associated with a reduction in odds of repeat cesarean birth (one visit: aOR 0.35, 95% CI, 0.17-0.72; two or more visits: aOR 0.37, 95% CI, 0.17-0.83). Analyses among all users indicated dose-response associations between increased virtual doula use and greater odds of users reporting support in deciding a birth preference (one visit: aOR 2.35, 95% CI, 2.02-2.74; two or more visits: aOR 3.67, 95% CI, 3.03-4.44), receiving a high level of emotional support during pregnancy (one visit: aOR 1.99, 95% CI, 1.74-2.28; two or more visits: aOR 3.26, 95% CI, 2.70-3.94), learning medically accurate information about pregnancy complications and warning signs (one visit: aOR 1.26, 95% CI, 1.10-1.44; two or more visits: aOR 1.55, 95% CI, 1.29-1.88), and help managing mental health during pregnancy (one visit: aOR 1.28, 95% CI, 1.05-1.56; two or more visits: aOR 1.78, 95% CI, 1.40-2.26). This analysis demonstrates that virtual doula support on a digital health platform is associated with lower odds of cesarean birth and an improved birth experience. Positive findings among Black users and users with vaginal birth after cesarean suggest that doula support is critical for patient advocacy, and that digital health may play a meaningful role in increasing health equity in birth outcomes.

Is Oxytocin Administration During Childbirth Associated With Increased Risk for Postpartum Posttraumatic Stress Symptoms?: A Preliminary Investigation.

Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS). In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum ( N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not. In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS ( P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS ( P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff. Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.

Enhancing antenatal education in Pakistan: an audit and recommendations

BackgroundAntenatal Education equips parents with knowledge for safe maternal health and infant care. It also reduces fear and anxiety during childbirth. ANE curriculum can vary according to country and institute. It can include classes focusing on childbirth, pain relief techniques, mode of birth, parenting, breastfeeding, breathing techniques, etc. Although ANE is widely practiced in developed countries, there is no standard program in developing countries like Pakistan. This study aims to improve antenatal education at a tertiary care hospital in Karachi, Pakistan potentially proposing an upgraded curriculum as a national standard.MethodsThis multiphase study used mix-method design was conducted in the Obstetrics and Gynaecology Department of a tertiary care hospital of Karachi, Pakistan from 2019 to 2021. Phase 1 of the study included reviewing and comparing the hospital’s antenatal curriculum with existing literature, followed by Phase 2, which was a desk review of attendance and patient feedback. The 3rd phase involved IDIs (in depth interviews) from health care workers (Obstetrics experts) to understand their perspectives regarding the ANE and the conducted classes. For phase one, gaps were identified and reported theoretically. For phase two, the annual attendance was recorded and participants’ satisfaction with the classes assessed. Qualitative data from phase 2 and 3 was converted into themes and sub-themes.ResultsThe audit showed a decline in the attendance of antenatal classes due to the pandemic and consequent shift to online sessions. The low attendance in online courses could be attributed to various factors. Patient feedback was generally positive, with a majority expressing high satisfaction levels. Expert feedback highlighted the need for additional topics such as mental health and COVID in pregnancy, as well as fathers' involvement. The curriculum was updated to include these topics and made more interactive with printed handouts for parents.ConclusionA standardized antenatal education covering various topics surrounding pregnancy, childbirth, and postnatal care must be available to parents nationwide.

Variations over time in mode of birth and perinatal outcomes in women with one previous cesarean in the Netherlands: A 20-year population-based study.

Globally, cesarean birth rates are rising, and while it can be a lifesaving procedure, cesarean birth is also associated with increased maternal and perinatal risks. This study aims to describe changes over time about the mode of birth and perinatal outcomes in second-pregnancy women with one previous cesarean birth in the Netherlands over the past 20 years. We conducted a nationwide, population-based study using the Dutch perinatal registry. The mode of birth (intended vaginal birth after cesarean (VBAC) compared with planned cesarean birth) was assessed in all women with one previous cesarean birth and no prior vaginal birth who gave birth to a term singleton in cephalic presentation between 2000 and 2019 in the Netherlands (n = 143,146). The reported outcomes include the trend of intended VBAC, VBAC success rate, and adverse perinatal outcomes (perinatal mortality up to 7 days, low Apgar score at 5 min, asphyxia, and neonatal intensive care unit admission ≥24 h). Intended VBAC decreased by 21.5% in women with one previous cesarean birth and no prior vaginal birth, from 77.2% in 2000 to 55.7% in 2019, with a marked deceleration from 2009 onwards. The VBAC success rate dropped gradually, from 71.0% to 65.3%, across the same time period. Overall, the cesarean birth rate (planned and unplanned) increased from 45.2% to 63.6%. Adverse perinatal outcomes were higher in women intending VBAC compared with those planning a cesarean birth. Perinatal mortality initially decreased but remained stable from 2009 onwards, with only minimal differences between both modes of birth. In the Netherlands, the proportion of women intending VBAC after one previous cesarean birth and no prior vaginal birth has decreased markedly. Particularly from 2009 onwards, this decrease was not accompanied by a synchronous reduction in perinatal mortality.

Survey of the infant male urobiome and genomic analysis of Actinotignum spp.

The urinary bladder harbors a community of microbes termed the urobiome, which remains understudied. In this study, we present the urobiome of healthy infant males from samples collected by transurethral catheterization. Using a combination of enhanced culture and amplicon sequencing, we identify several common bacterial genera that can be further investigated for their effects on urinary health across the lifespan. Many genera were shared between all samples suggesting a consistent urobiome composition among this cohort. We note that, for this cohort, early life exposures including mode of birth (vaginal vs. Cesarean section), or prior antibiotic exposure did not influence urobiome composition. In addition, we report the isolation of culturable bacteria from the bladders of these infant males, including Actinotignum spp., a bacterial genus that has been associated with urinary tract infections in older male adults. Herein, we isolate and sequence 9 distinct strains of Actinotignum spp. enhancing the genomic knowledge surrounding this genus and opening avenues for delineating the microbiology of this urobiome constituent. Furthermore, we present a framework for using the combination of culture-dependent and sequencing methodologies for uncovering mechanisms in the urobiome.

Incidence and management of premature rupture of membranes in Victoria, Australia: A retrospective cohort study of 636 590 births between 2009 and 2017.

Premature rupture of membranes (PROM) is a complication affecting 7-12% of pregnancies in which fetal chorioamniotic membranes rupture before labour begins. Preterm PROM (PPROM) (ie <37 weeks gestation) precedes one-third of preterm births, exposing the fetus to increased morbidity from placental abruption, respiratory distress syndrome and sepsis. To analyse trends in the incidence and mode of birth in preterm and term PROM in Victoria, Australia between 2009 and 2017. This retrospective population-based cohort study included all singleton pregnancies from 2009 to 2017. We examined women with PROM (both <37 weeks (PPROM) and at term). Management was assessed in three categories: (a) expectant management; (b) induction of labour (IOL); and (c) elective caesarean section (elCS). A multinomial logistic regression model was used to adjust for confounders influencing the choice of management. Of 636 590 singleton pregnancies, 52 669 (8.3%) births with PROM at term (42 439; 6.7%) or PPROM (10 230; 1.6%) were identified. Of these, the majority were managed expectantly (n = 22 726; 43.1%), or with IOL (25 931; 49.2%). While elCS represented only 7.6% of these cases (n = 4012), its use rose consistently from 2009 to 2017 for PROM at term and PPROM alike. For women with PPROM at 34-36 weeks the odds of elCS increased by 5% annually (adjusted odds ratio (aOR) 1.05; 95% CI 1.02-1.08) and 2% for IOL (aOR 1.02; 95% CI 1.00-1.05) vs expectant management. The use of elCS and IOL in PPROM is rising in Victoria, particularly between 34 and 36 completed weeks of pregnancy. Research is needed to determine the drivers for this increase.

Outcomes and perspectives of woman-newborn dyads following discharge from a quaternary maternity service in Australia: A cross-sectional survey

BackgroundThe average postnatal stay for most Australian mothers is two days. Postnatal length of stay is dependent on various factors, such as maternal preferences, mode of birth or complications following birth. However, little is known about the relationship between these elements. AimTo prospectively explore maternal and neonatal postnatal outcomes within the context of length of stay, model of care and personal expectations and experiences within the first 3–5 weeks following birth. MethodsA cross-sectional study within an urban quaternary Australian hospital was conducted between January 2021 to April 2021. A mixed methods convergent approach was taken. FindingsOf the 1066 questionnaires distributed, 216(20.2%) responses were usable for analysis. Most mothers (82%) were satisfied with their postnatal stay length (range 6–78 h). Models of care (such as GP shared care, midwifery group practice) were not associated with mothers’ satisfaction with their postnatal stay length. Mothers following cesarean section felt less supported, had lower breastfeeding rates and more difficulty accessing postnatal services. Neonatal readmissions (n = 11, 5%) in the first week of life were most often for jaundice, poor feeding or both (n = 7, 64%). Three key themes were generated from the qualitative data and categorised into themes labeled ‘Environmental and healthcare delivery constraints’, ‘Ready or not for discharge’ and ‘Home now, but support missing’. ConclusionParticipants identified that improvements in postnatal care require more than extending in-hospital length of stay. Rather a more individualised woman-centred focus, in-home supported options, with flexibility in timing needed, especially for those following a complicated birth.