Birth Plan Research Articles

It takes a village: A pilot cross-randomized trial to enhance pregnancy care and support in northern Ghana.

Maternal mortality remains a challenge in Ghana, where 263 women per 100 000 live births die during pregnancy or childbirth. Barriers to reaching the recommended antenatal care (ANC) include poor access to quality health care, cultural factors, and lack of support for pregnant women. We piloted two cross-randomized interventions: durbars, or local community meetings that incorporated education about ANC and supporting pregnant women, and an enhanced ANC model that added phone calls and a home visit to standard care. The study took place in 30 villages in the Upper East Region of Ghana between August 2021 and November 2022. We tracked 277 women during pregnancy, with 120 women randomly assigned to the enhanced ANC intervention and 142 women living in villages randomized to the durbar intervention. Women who were randomized to the enhanced ANC intervention were 13.2 percentage points (pp) (95% confidence interval (CI) = 0.1, 24.3) more likely to have average or above average knowledge of pregnancy danger signs, 22.1 pp (95% CI = 9.1, 36.5) more likely to have a birth plan, 28.2 pp (95% CI = 13.0, 42.4) more likely to prepare the plan with their partners, and 16.4 pp (95% CI = 0.9, 29.3) more likely to pay for delivery with funds set aside in birth plan. They were also 35 pp (95% CI = 16.1, 48.1) more likely to make blood donor arrangements than control women who made birth plans. We found no impact of the durbar intervention on study outcomes. Evidence from this pilot suggests that interventions that increase interactions between health providers and pregnant women outside of the health facility may substantially improve women's experience during pregnancy and maternal health outcomes. Providing structured ways for men to get engaged in ANC increased their involvement. Although we found no evidence the community meetings improved study outcomes, larger studies with repeated meetings and community-wide surveys are needed to make causal conclusions. American Economic Association RCT Registry: 10360; ISCRNT: ISRCTN95961119.

Identify of Preoperative and Postoperative Complication of Planned Management and Emergency Management of Patients with PAS Disorder

Background: Placenta accreta spectrum (PAS) often results in significant blood loss and peripartum hysterectomy; the mother may not survive. In many cases, timely prenatal diagnosis allows for careful birth planning in a specialized facility with a highly qualified multidisciplinary team. This has been shown to reduce maternal morbidity. Scheduled deliveries are associated with lower rates of bleeding and emergency procedures when compared to emergency deliveries. Objective: The aim of this study is to identify the preoperative and postoperative complication of planned management and emergency management of patients with PAS disorder. Methods: The cross-sectional comparative study was conducted in the Department of Obstetrics & Gynaecology, Dhaka Medical College Hospital, Dhaka from 18th January 2020 to 17th July 2020. A total of 84 patients diagnosed as a case of PAS disorder (antenatally and peroperative diagnosed) and scheduled for planned management or emergency management of PAS were included according to inclusion and exclusion criteria. 42 planned management of PAS disorder patients as Group A and 42 emergency management of PAS disorder patients as Group B. The questionnaire was pretested, corrected and finalized. Data were collected by face-to-face interview and analyzed by appropriate computer based programmed software Statistical Package for the Social Sciences (SPSS), version 24. Results: In this study, mean ± SD of age was calculated 26.3 ± 4.3 years for Group – A and 28.1 ± 3.2 years for Group – B. Urban population were predominant in group-A. About 30 (70.0%)) patients in group-A and 10 (23.8%) patients in group-B came from urban. Large number of respondents 22 (52.4%) and 10 (50.0%) were housewife in both groups. Among the patients, the lower class 18 (42.9%) and 23 (54.8%) comprised the major percentage of the patients in both groups. More participants in Group-A 29 (69.00%) received ANC regularly than Group B 10 (23.80%), the difference was statistically significant (p<0.05). In group-A maximum patients presented with only USG findings of PAS disorders and with APH or without APH 26 (61.8%). In group-B, PPH and internal haemorrhage 10 (23.8) was noted predominantly. The mild anemia was more in 23 (54.8%) patients in group A and 16 (38.1%) patients in group B which was statistically significant (p < 0.001). More participants in Group-B 26 (61.9%) required early termination, whereas majority of group A 35 (83.3%) was terminated at 35-36 weeks. There was a statistically significant difference between groups. Maximum patients were managed by peripartum hysterectomy 35 (82.0%) and 31 (73.8%) in group A & B respectively. Presence of multidisciplinary team was arranged in 38 (90.4%) in group A and 18 (42.9%) in group B. General anesthesia and CV line was given in 36 (85.7%) patients in group-A and 27 (64.3%) patients in group-B. Massive blood transfusion was needed in 23 (54.8%) patients in Group B & only 3 (7.1%) patients in Group A. Placenta acreta was present 11 (26.2%) patients in group A and 7 (16.7%) patients in group B. Placenta percreta with bladder invasion and peroperative bladder injury was higher in group-B patients. More than 3 L blood was transfused 3 (7.1%) patients in group A and 23 (54.8%) patients in group B. PPH, Sepsis, Re-exploration, DIC and ICU admission were the significant complication in Group-B patients, reported 41 (95.0), 4 (9.5%), 8 (19.0%), 9 (21.4%) and 21 (50.0%) of women and in less complication in Group A 13 (31.0), 0%, 0%, 1 (2.3) and 4 (9.5). In this study mortality rate was 2 (4.8%) in group-B (due to irreversible shock &DIC). Poor outcomes were significantly higher in group-B. NICU admission for prematurity was required in 9 (21.4%) of the babies in group-A and 23 (54.8%) babies of group-B. Birth asphyxia was observed in 4 (9.5%) of the babies in group-A and 13 (31.0%) in Group-B. Conclusion: Prenatal diagnosis and placenta preservation may be linked to lower rates of morbidity in mothers. For morbidly adherent placenta linked with placenta previa, we advise hysterectomy as the preferred course of therapy following extremely thorough prenatal counseling. Maternal problems and fetal outcomes may be improved by early risk factor identification and proactive management.

Like and share: A mixed-methods cross-sectional survey of social media use during monochorionic diamniotic twin pregnancies

ProblemMonochorionic-diamniotic (MCDA) twin pregnancies are high-risk, requiring specialized monitoring and procedures to screen for and treat potential complications. AimThis study examined decisions to use social media among those who have experienced MCDA pregnancies and how these groups influenced treatment and management decisions for these rare, complicated pregnancies. MethodsAn online mixed-methods, retrospective survey, was completed in 2021 by 624 participants who experienced MCDA pregnancies within 5 years of the study; participants were recruited from online MCDA pregnancy groups on Facebook and Twitter. Data was analyzed using descriptive statistics and thematic analysis. FindingsSixty-nine percent of participants used social media to communicate during their MCDA pregnancies, an 18 increase from before pregnancy, and most (74.2 %) used online support groups during pregnancy. Thematic analysis revealed participants used social media primarily to find others with similar experiences, learn more about MCDA pregnancies, and obtain guidance. Most would also recommend joining social media during a similar pregnancy. Nearly half indicated that social media influenced MCDA pregnancy management and treatment decisions - like decisions regarding birth plans, providers, and MCDA-related complications. Several participants cautioned that support groups can be triggering when negative stories are shared. ConclusionSocial media can provide information, support, and improve advocacy for those experiencing MCDA pregnancies. Providers may consider online groups as another source of support for pregnant people and be prepared to address questions that may arise. This study also reveals opportunities for increased and/or improved patient educational materials and patient-provider communication related to MCDA pregnancies.

Facilitating home birth in perinatal palliative care: A case report.

Perinatal palliative care can offer compassionate support to families following diagnosis of a life-limiting illness, to enable them to make valued choices and the most of the time that they have with their newborn. However, home birth is usually only offered in low-risk pregnancies. A couple who received an antenatal diagnosis of hypoplastic left heart syndrome and who had made a plan to provide palliative care to their baby after birth requested the option of a home birth. Recommend birth at hospital or explore the possibility of a home birth with perinatal palliative care support. Multidisciplinary discussion and collaboration enabled a plan for home birth to be made which anticipated potential complications. The baby was born at home and died on day 5 of life receiving outreach nursing, paediatric and palliative care support and buccal and oral opioids for symptom management. We include reflections from the family on the importance of this experience. We provide a list of potential criteria for considering home birth in the setting of perinatal palliative care. Facilitating a home birth in the setting of perinatal palliative care is an option that can be hugely valued by families, but this service may be practically difficult to deliver in many contexts. Further research is needed to understand the preferences of women and families receiving perinatal palliative care.

The effects of a quality improvement project to reduce caesarean sections in selected private hospitals in Brazil

BackgroundBrazil is one of the countries with the highest rates of caesarean sections (CS), reaching almost 90% of births in the private sector. A quality improvement project called “Adequate Childbirth Project (PPA)” was conceived to reduce CS in the private sector. This project consisted of four primary components: “Governance”, “Participation of Women”, “Reorganization of Care” and “Monitoring”. This paper aims to evaluate: (1) which specific activities of the PPA had the largest effect on the probability of a woman having a vaginal delivery; (2) which primary component of the PPA had the largest effect on the probability of vaginal delivery and (3) which scenarios combining the implementation of different activities planned in the PPA had a higher effect on the probability of vaginal delivery.MethodsA sample of 12 private hospitals participating in the PPA was evaluated. We used a Bayesian Network (BN) to capture both non-linearities and complex cause-effect relations. The BN integrated knowledge from experts and data from women to estimate 26 model parameters. The PPA was evaluated in 2473 women belonging to groups 1–4 of the Robson classification, who were divided into two groups: those participating or not participating in the PPA.ResultsThe probability of a woman having a vaginal delivery was 37.7% higher in women participating in the PPA. The most important component of the project that led to an increase in the probability of vaginal delivery was “Reorganization of Care”, leading to a 73% probability of vaginal delivery among women in labor. The activity that had the greatest effect on the type of delivery was access to best practices during labor, with a 72% probability of vaginal delivery. Considering the 12 scenarios combining the different activities of the PPA, the best scenarios included: a non-scheduled delivery, access to information about best practices, access to at least 4 best practices during labor and respect of the birth plan, with an 80% probability of vaginal delivery in the best combinations.ConclusionPPA has been shown to be an effective quality improvement program, increasing the likelihood of vaginal delivery in private Brazilian hospitals.

The Effect of Supportive Education About Gentle Birth with Audiovisual Media on Readiness to Childbirth in Third Trimester Primigravida

A third trimester primigravida mother's excessive anxiety indicates a lack of preparation that will negatively impact the mother's, the fetus's, and the delivery process's health. Making birth plans might help a mother feel more prepared for giving birth. The purpose of this study is to ascertain how preparedness for labor is affected by supportive education about gentle birth through the use of audiovisual media. Pre-experimental methodology with a single group pre-test–post-test design was employed in this study. Maternal preparation for labor and supportive education about gentle birth through audiovisual media were the research variables. In June 2023, the Pratama Anugrah Clinic in Surabaya recruited 30 participants for the study, of whom 30 were sampled using total sampling. The study group consisted of primigravida mothers in their third trimester. The questionnaire was the instrument, and the Wilcoxon test with α = 0.05 was utilized for analysis. The findings demonstrated that whereas most respondents (60%) felt well-prepared before receiving supportive education, nearly all respondents (93.3%) felt well-prepared for childbirth after receiving such information. The Pratama Anugrah Clinic Surabaya's mothers' preparedness for childbirth is impacted by supportive education, as indicated by the findings of the Wilcoxon test analysis, which yielded a P=0.003 result. The study concludes that maternal preparedness for childbirth can be positively impacted by supportive education about gentle birth through audiovisual media, leading to an increase in knowledge, information, and maternal readiness.

Predictors of Pregnant Women's Decision to Opt for Cesarean Section in Romania.

In Romania, the latest official report indicates that more than half of the births (80,890 cases, representing 52.88% of the total) are performed by cesarean, a rate significantly higher than the World Health Organization (WHO) recommendation of 15-20%. This study aims to identify the predictors associated with women's decisions to opt for cesarean in Romania. An analytical cross-sectional observational study was conducted in the general population of Romania. The study was carried out over the course of 2023, with a total duration of four months. During this period, researchers targeted pregnant women from various regions of the country, regardless of their place of residence, age, or education level. The primary data collection tool was a self-administered online questionnaire, distributed via Google Forms, an accessible and efficient platform that allows for automatic response collection. The questionnaire was distributed online, particularly on social media platforms frequented by pregnant women, such as Facebook, Instagram, and TikTok. A total of 1,301 participants were validated. Socio-demographic and clinical factors significantly influence women's decisions to give birth by cesarean.Among these participants, 435 expressed a preference for cesarean delivery. Key predictors include fear of pain and concern for the child's health. Fear of pain at birth is the first predictor in Romanian women to choose cesarean (OR=2.09; 95% CI: 1.62-2.68). Concerns about the child's health do not increase the likelihood of opting for a cesarean. By utilizing valuable resources such as midwives and implementing strategies like birth plans, significant contributions can be made toward reducing the cesarean rate and improving the childbirth experience for women worldwide.

Patient and provider perspectives on pain and other dimensions of anesthesia experience for cesarean delivery: A qualitative study.

There is a lack of evidence on the importance of pain or other aspects of clinical care in the overall patient experience and patient-centered outcomes in cesarean delivery. The purpose of this study was to discover patient priorities in cesarean delivery anesthesia experience, to compare patient and provider perspectives, and to explore attitudes on shared decision-making around anesthesia choices for cesarean delivery. Patients with recent cesarean deliveries and clinical care providers were approached using a purposeful sampling strategy for this prospective observational qualitative study. Patients were included if they were in the hospital within 72 hours of a cesarean delivery (scheduled or unscheduled), spoke English fluently, and had term gestation. Providers were included if they currently provide regular clinical care to patients having cesarean deliveries and have at least 3 years of practice experience. Semi-structured interviews were conducted using an interview guide. Interview transcripts were independently coded by three coders and qualitatively analyzed for major themes until thematic saturation was achieved. A total of 42 participants (20 patients and 22 providers) completed interviews. Five major themes emerged reflecting patient attitudes and beliefs toward cesarean delivery experience: 1) effective communication, education, and respect; 2) emotional support by care team; 3) intraoperative pain or discomfort; 4) varying acceptability around pain therapies; 5) stigma surrounding cesarean delivery. Five major themes emerged reflecting provider attitudes and beliefs toward cesarean delivery priorities: 1) complexity of pain responses; 2) multiple pain control strategies; 3) effective communication during emergency cesarean delivery; 4) patient psychological well-being during cesarean delivery; 5) barriers to observing the patients' birth plans. Patients and providers alike prioritize pain management, psychological well-being, and effective communication during cesarean delivery experiences. Patients emphasize relationships and trust in their cesarean experience, while clinicians emphasize clinical complexities and physical treatments. Our results guide future research in patient perspectives in cesarean deliveries.

Consent for interventions during childbirth: A national population-based study.

To assess the frequency and determinants of medical interventions during childbirth without women's consent at the population level. The nationwide cross-sectional Enquête Nationale Périnatale 2021 provided a representative sample of women who delivered in metropolitan France with a 2-month postpartum follow-up (n = 7394). Rates and 95% confidence intervals (CI) of interventions during childbirth (oxytocin administration, episiotomy or emergency cesarean section) without consent were calculated. Associations with maternal, obstetric, and organizational characteristics were assessed using robust variance Poisson regressions, after multiple imputation for missing covariates, and weighted to account for 2-month attrition. Women reporting failure to seek consent were 44.7% (CI: 42.6-47.0) for oxytocin administration, 60.2% (CI: 55.4-65.0) for episiotomy, and 36.6% (CI: 33.3-40.0) for emergency cesarean birth. Lack of consent for oxytocin was associated with maternal birth abroad (adjusted prevalence ratio [aPR] 1.20; 95% CI: 1.06-1.36), low education level, and increased cervical dilation at oxytocin initiation, whereas women with a birth plan reported less frequently lack of consent (aPR 0.79; 95% CI: 0.68-0.92). Delivery assisted by an obstetrician was more often associated with lack of consent for episiotomy (aPR 1.46; 95% CI: 1.11-1.94 for spontaneous delivery and aPR 1.39; 95% CI: 1.13-1.72 for instrumental delivery, reference: spontaneous delivery with a midwife). Cesarean for fetal distress was associated with failure to ask for consent for emergency cesarean delivery (aPR 1.58; 95% CI: 1.28-1.96). Women frequently reported that perinatal professionals failed to seek consent for interventions during childbirth. Reorganization of care, particularly in emergency contexts, training focusing on adequate communication and promotion of birth plans are necessary to improve women's involvement in decision making during childbirth.

Instrument to evaluate the perception of abuse and/or disrespectful treatment during childbirth: A validation study

AimTo design and validate a tool to assess a woman's perception of whether she has experienced a situation of abuse or disrespect during childbirth attendance: “Childbirth Abuse and Respect Evaluation-Maternal Questionnaire” (CARE-MQ). MethodsMultidisciplinary panel of experts (gynecologists, midwives, mothers) participated in creating CARE-MQ. A cross-sectional study was carried out on 901 Spanish women who had given birth between 1 and 3 months before to determine psychometric characteristics. Finally, an exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and a convergent validity study were carried out with the Quality Questionnaire from the Patient's Perspective-Intrapartum (QPP-I), and a reliability study using internal consistency (Cronbach's α) and coefficient of intraclass correlation (CCI). FindingsThe KMO test gave a value of 0.935, and Bartlett's sphericity test was <0.001. The EFA identified four components (“Emotional Abuse”, “Inadequate Professionalism”, “Physical Abuse” y “Lost contact”) that explained 55.16 % of variance. In the CFA, a good fit was observed for most of the evaluated indicators. CARE-MQ correlated negatively with QPP-I (Spearman's rho = −0.641, 95 % CI: −0.679, −0.600; p < 0.001) and was statistically associated with variables related to childbirth experience (p < 0.005) such as the use of a birth plan, use of regional analgesia, type of birth, episiotomy, presence of severe tears, skin-to-skin contact, length of hospital stay and postpartum surgical intervention. Cronbach's α value was 0.903. The ICC of absolute agreement after administering the questionnaire one week after was 0.927 (95 % CI: 0.85–0.97). ConclusionsCARE-MQ is a valid and reliable instrument to evaluate the perception of a woman regarding the situation of abuse and/or disrespect that she may have experienced during birth in a population of Spanish postpartum women.

Childbirth preparation and its facilitating and inhibiting factors from the perspectives of pregnant and postpartum women in Tabriz-Iran: a qualitative study

BackgroundThe World Health Organization recognizes childbirth preparation as an essential component of antenatal care, as it plays a crucial role in reducing maternal mortality and improving women's childbirth experience. Countries worldwide have implemented various interventions to assist women in preparing for childbirth, based on their own resources. This study was conducted with the aim of exploring the perspectives of pregnant and postpartum women on childbirth preparation and the facilitating and inhibiting factors, in Tabriz, Iran.MethodsThis qualitative study was conducted with 25 participants, selected purposively among pregnant women in weeks 37 to 40 of gestation and postpartum women within 10 days to 6 weeks after childbirth. Data collection was done through semi-structured, in-depth individual interviews using an interview guide. The data was analyzed using content analysis method with conventional approach.ResultsThe perspectives of pregnant and postpartum women regarding childbirth preparation revealed that factors such as maternal health during pregnancy, having an antenatal care plan, improving health literacy, and developing a birth plan were identified as crucial elements for effective childbirth preparation. Additionally, mental and emotional preparation, support, financial planning, participation in preparation classes, and awareness of childbirth methods were recognized as facilitators. On the other hand, insufficient mental and emotional preparedness, inadequate support, weak antenatal care, information deficiencies, insufficient physical activity, and a lack of a birth plan were identified as barriers.ConclusionThe findings highlight the multifaceted nature of childbirth preparedness, necessitating the involvement of families, the healthcare system, and the entire community. Utilizing the study results in strategic planning for pre-pregnancy, during pregnancy, and inter-pregnancy care can enhance childbirth preparedness and contribute to achieving Iran's population rejuvenation policy goals.

Impact of the midwife-led care model on mode of birth: a systematic review and meta-analysis

Background/Aims Increased rates of caesarean sections globally have potential short- and long-term impacts for mothers and babies. Research on models of care and mode of birth has reported varied results. The aim of this study was to analyse the relationship between the midwife-led model of care and mode of birth. Methods This systematic review and meta-analysis searched PubMed, Scopus and Web of Science. Quantitative full-text open access research articles published between 2010 and 2023 in Indonesian or English were included. Research that assessed the relationship between the model and birth planning were excluded. Results A total of 16 articles were included. Two were experimental, and the remaining 14 were observational, with a total sample of 125 201 people. The midwife-led model supported spontaneous vaginal birth (odds ratio: 1.64, P=0.01) when compared to other models. Conclusions Implementing the midwife-led model of care may increase the likelihood of physiological birth and reduce the incidence of caesarean section, especially in low-risk pregnancies.

Factors Associated With Palliative Care Birth Planning at a Pediatric Hospital

ObjectiveTo identify factors associated with the receipt, completion, and goals of palliative care birth plans during the prenatal period. DesignRetrospective observational study of medical record data. SettingMidwestern U.S. quaternary pediatric hospital. ParticipantsMaternal–fetal dyads who received maternal–fetal medicine and palliative care from July 2016 through June 2021 (N = 128). MethodsUsing demographic and clinical predictors, we performed descriptive statistics, group comparisons (chi-square or Fisher exact test and Wilcoxon rank sum test or Student t test), and logistic regression for three outcomes: birth plan offered, birth plan completed, and goals of care (comfort-focused vs. other). ResultsOf 128 dyads, 60% (n = 77) received birth plans, 30% (n = 23) completed them, and 31% (n = 40) expressed comfort-focused goals. Participants with comfort-focused goals compared to other goals were more likely to receive birth plans, odds ratio (OR) = 7.20, 95% confidence interval (CI) [1.73, 29.9], p = .01. Participants of non-Black minority races had lower odds of being offered birth plans when compared to White participants, OR = 0.11, 95% CI [0.02, 0.68], p = .02. Odds of being offered (OR = 11.54, 95% CI [2.12, 62.81], p = .005) and completing (OR = 4.37, 95% CI [1.71, 11.17], p < .001) the birth plan increased with each prenatal palliative care visit. Compared to those without, those with neurological (OR = 9.32, 95% CI [2.60, 33.38], p < .001) and genetic (OR = 4.21, 95% CI [1.04, 17.06], p = .04) diagnoses had increased odds of comfort-focused goals. ConclusionQuality improvement efforts should address variation in the frequency at which birth plans are offered. Increasing palliative care follow-up may improve completion of the birth plan.

The contribution of birth plans to shared decision-making from the perspectives of women, their partners and their healthcare providers.

The birth plan is a document expressing a pregnant woman's childbirth preferences, enabling communication of expectations and facilitating discussions among women, their partners, and healthcare providers for key birthing decisions. There has been limited research on the role of birth plans in shared decision-making (SDM). Our study aims to explore how the use of birth plans can contribute to SDM from women's, partners, and healthcare providers' perspectives. We conducted in-depth interviews with women, their partners, and their healthcare providers. We used a thematic analysis to identify themes and subthemes. Furthermore, we created a grounded theory about the role of birth plans as a tool in SDM. Three main themes were created: ''Creating a birth plan", ''Getting all on board" and ''Birth plans in the daily practice of decision-making". Most women, partners, and healthcare providers agreed that birth plans can facilitate communication and SDM. Women and their partners viewed the birth plan as a tool to prepare for birth. Most healthcare providers mentioned the birth plan as a tool to get to know the women, their partners, and their preferences. Barriers are the attitude of healthcare providers toward birth plans, such as their evident resistance to the birth plan itself or to certain preferences. Another barrier is the assumption women and their partners may have that these plans can accurately predict the childbirth experience, enhancing the chance of a disappointing, negative experience. Some healthcare providers view birth plans as barriers to SDM. The use of a birth plan seems to promote women's, partners', and healthcare providers' involvement in the birth process, and seems suitable to facilitate SDM. Further research is required to explore strategies for overcoming barriers, including healthcare providers' attitudes toward birth plans and the expectations of women and their partners regarding their role.

Birth "outside of guidance"-An exploration of a Birth Choices Clinic in the United Kingdom.

Decision-making around birthplace is complex and multifactorial. The role of clinicians is to provide unbiased, evidence-based information to support women and birthing people to make decisions based on what matters to them. Some decisions may fall outside of clinical guidance and recommendations. Birth Choices Clinics can provide an opportunity for extended discussion and personalized birthplace planning. This study aimed to explore the rationale behind choosing birthplace "outside of guidance" and examine the outcomes for women who attended a Birth Choices Clinic. The study was descriptive using data extracted from clinical documentation and consultation. The data included demographic information, maternal characteristics, reason for choosing a midwifery-led birth setting, birthplace preference, and outcome. Eighty-two women used the Birth Choices Clinic between April 2022 and February 2023 in one large maternity unit in the UK. Reasons for choosing birth in a midwifery-led setting included having access to a birthing pool, to reduce the chance of obstetric interventions and pragmatic reasons. Sixty-five percent of women experienced a spontaneous vaginal birth, 10% experienced an assisted vaginal birth, and 23% experienced a cesarean birth. Of the 33 women who ultimately commenced labor care in a midwifery-led setting, 76% (n = 25/33) birthed in this setting without complications. Transfer rates in labor were similar to those in a "low-risk" pregnant population. Birth choice clinics may facilitate an understanding of material risk and support individualizing birth planning. There is evidence that women changed their planned birthplace, possibly in recognition of a move along the risk spectrum.

Birth preparedness and pregnancy complication readiness and associated factors among pregnant women in Ethiopia: A multilevel analysis.

Maternal and child deaths occur during pregnancy and delivery. Timely information on signs of pregnancy complications and ways to plan for normal birth is a strategy to reduce maternal and child deaths. The purpose of this study was to assess birth preparedness, and pregnancy complications readiness and identify associated factors in Ethiopia. A cross-sectional study design was used. A total of 1635 weighted samples of pregnant women were included for analysis from the 2016 Ethiopian demographic and health survey data set. Multilevel mixed-effect logistic regression was used to estimate the effects of potential variables on birth preparedness and complication readiness. STATA version 15 software was used for data processing and analysis. A variable with a p-value < 0.05 with a 95% confidence interval was considered a significant factor. Pregnant women were informed about convulsions (8.02%), fever (35.95%), abdominal pain (28.92%), leaking fluid from the vagina (28.21%), and blurred vision (17.98%). Pregnant women prepared for supplies needed for birth (38.70%), transportation (20.04%), money (18.97%), people's support for birth (5.03%), and blood donors (3.11%). Only 56% and 44.91% of pregnant women had good birth preparedness and were informed about pregnancy complications respectively. Educational status, antenatal care visits, and region were significant factors associated with birth preparedness and complication readiness. Distance to health facility and residency were significantly associated with birth and complication readiness, respectively. Birth preparedness and complication readiness among pregnant women were low in Ethiopia. Empowering women with education, installing safe roads, building accessible health facilities, and emphasizing pregnancy complications and birth preparedness plans during antenatal care visits are important interventions to enhance birth preparedness and pregnancy complication readiness.

Male Partner Involvement in Birth Preparedness, Complication Readiness and Obstetric Emergencies in Central Rural India: A Cross-Sectional Study.

Childbirth is mainly thought to be a woman'sconcern, and mortality can be prevented by making a birth plan constituting birth preparedness and complication readiness with the entire family as one unit. Indian National Plans aim to increase male involvement, but the policies lack directions and monitoring systems; hence, it becomes important to address this issue. A cross-sectional study conducted in a rural hospital and a community-based setup included 350 male participants, consisting of new fathers or expecting fathers, who were interviewed with the help of a questionnaire. Only 28.29% of male participants were well involved in the process of birth preparedness and complication readiness. 83% of the husbands accompanied their respective wives during ANC visits (mean number of visits: 5.76). 33% of males were aware of various danger signs and complications related to pregnancy. The males with better education (p-value < 0.005) and economic status (p-value < 0.0001) had better birth preparedness. Several variables in the study were positively correlated with the amount of money saved. Interpretation and conclusion: Male involvement during pregnancy significantly impacts maternal and child health outcomes. However, this study highlights a lack of awareness and involvement among males. We strongly recommend enhancing existing maternal and child health (MCH) programs to include components focused on male partner engagement in birth preparedness, complication readiness, and obstetric emergencies.

Deconstructing Dissonance: Ontario Midwifery Clients Speak about Their Experiences of Testing Group B Streptococcus–Positive

Group B streptococcus (GBS) is a bacterium commonly found in the vaginal flora and is usually of no consequence to women. However, vertical transmission of GBS to the baby during pregnancy and/or birth can lead to GBS-associated disease, a leading cause of neonatal morbidity and mortality in Canada and throughout the world. Screening for GBS at 35–37 weeks’ gestation and administration of intrapartum antibiotic prophylaxis for colonized women has become standard practice; however, there is little research surrounding clients’ experiences, knowledge, and perceptions of both the test and of testing positive for the bacteria. This phenomenological study used semi-structured interviews guided by open-ended questions to explore the experiences of six midwifery clients in southern Ontario who tested GBS-positive in 2009. Transcribed interviews were analyzed using grounded theory to identify key themes. The diagnosis sharply affected women’s experiences during pregnancy and labour and often led to dissonance for them regarding questions of risk, health, the concept of normal, the midwifery model, their birth plans, and the competence of their midwife. The themes are discussed in terms of their relevance to midwifery practice. This article has been peer reviewed.

Does Longer Second-Trimester Cervical Length Increase Likelihood of Labor Induction? [ID 2683543

INTRODUCTION: Second-trimester transvaginal cervical length (TVCL) under 2.5 cm is associated with increased rates of spontaneous preterm birth; however, little is known about the effect of increasing TVCLs on spontaneous labor rates. We aimed to determine if longer TVCL is associated with increased risk of induction of labor (IOL). METHODS: This is a retrospective cohort study of patients eligible for vaginal birth with singleton term gestations and normal TVCL (at 16–24 weeks of gestation) delivering at a tertiary care center June 2022 to June 2023. Rates of IOL were compared by TVCL tertiles (T1: 2.5–3.49 cm; T2: 3.5–4.49 cm; and T3: 4.5 cm or greater). Multivariable logistic regression controlled for potential confounders. Institutional review board approval was obtained. RESULTS: Of 1,027 eligible deliveries, 594 (58%) underwent IOL. Patients with TVCLs in T2 and T3 were significantly more likely to undergo IOL than patients with TVCL in T1 (T2 59.6% versus T1 49.4%, P=.02; T3 56.5%, P=.04). Patients in T2 had increased odds of IOL compared to those in T1 (OR 1.5 [CI, 1.1–2.1]). This relationship did not remain significant after adjusting for potential confounders including term delivery, delivery mode, race/ethnicity, age, and body mass index. The odds of IOL with TVCL in T3 were not significantly different than for those in T1, before and after adjusting for confounders. CONCLUSION: Within a cohort of patients with normal mid-trimester TVCL, increasing TVCLs were not associated with higher rates of IOL after adjusting for confounding variables. These results can be used to guide patient counseling surrounding birth plans and expectations for labor and delivery.

Incorporation, adaptation and rejection of obstetric practices during the implementation of the “Adequate Childbirth Program” in Brazilian private hospitals: a qualitative study

BackgroundThe “Adequate Childbirth Program” (PPA) is a quality improvement project that aims to reduce the high rates of unnecessary cesarean section in Brazilian private hospitals. This study aimed to analyze labor and childbirth care practices after the first phase of PPA implementation.MethodThis study uses a qualitative approach. Eight hospitals were selected. At each hospital, during the period of 5 (five) days, from July to October 2017, the research team conducted face to face interviews with doctors (n = 21) and nurses (n = 28), using semi-structured scripts. For the selection of professionals, the Snowball technique was used. The interviews were transcribed, and the data submitted to Thematic Content Analysis, using the MaxQda software.ResultsThe three analytical dimensions of the process of change in the care model: (1) Incorporation of care practices: understood as the practices that have been included since PPA implementation; (2) Adaptation of care practices: understood as practices carried out prior to PPA implementation, but which underwent modifications with the implementation of the project; (3) Rejection of care practices: understood as those practices that were abandoned or questioned whether or not they should be carried out by hospital professionals.ConclusionsAfter the PPA, changes were made in hospitals and in the way, women were treated. Birth planning, prenatal hospital visits led by experts (for expecting mothers and their families), diet during labor, pharmacological analgesia for vaginal delivery, skin-to-skin contact, and breastfeeding in the first hour of life are all included. To better monitor labor and vaginal birth and to reduce CS without a clinical justification, hospitals adjusted their present practices. Finally, the professionals rejected the Kristeller maneuver since research has demonstrated that using it’s harmful.