Birth Plan Research Articles

Women’s Experience of Creating Birth Plans During Pregnancy

Women’s Experience of Creating Birth Plans During Pregnancy

The impact of perinatal healthcare changes on birth trauma during COVID-19

BackgroundSince the onset of COVID-19, giving birth has involved navigating unprecedented healthcare changes that could significantly impact the psychological birth experience. AimResearch has demonstrated increasing rates of birth trauma and birth plan alterations during the COVID-19 pandemic. This study specifically examined these intersecting experiences to understand how COVID-related healthcare changes have impacted birth trauma during the pandemic. Methods269 people who gave birth in the U.S. during COVID-19 completed an online survey between November, 2020-May, 2021 which included questions about COVID-related perinatal healthcare changes and birth-related posttraumatic stress disorder (PTSD; The City Birth Trauma Scale). T-tests were run on birth demographics to assess for significant indicators of PTSD; variables having significant effects were used to build a hierarchical regression model to predict PTSD symptoms. Findings5.9% of the sample met criteria for PTSD and 72.3% met partial criteria. The overall regression model predicted approximately 19% of variance in total PTSD symptoms. Labor and birth demographics were entered in Step 1 and predicted approximately 11% of variance: limited length of stay for support person, being allowed 1 support person who had to be the same, and mask requirements were significant predictors of PTSD. Variables related to birth plan changes were entered in Step 2 and predicted approximately 8% of variance: changes to support person(s) for labor and birth, breastfeeding plans, and birth location were significant predictors of PTSD. ConclusionThe present study demonstrates the importance of COVID-related perinatal healthcare changes to the development of trauma symptoms following childbirth.

Expectations and experiences of women regarding maternal healthcare services in Pakistan: challenges and lessons to be learnt

BackgroundAccess to maternal healthcare services is an essential pre-requisite for improving women’s health. However, due to poor access and underutilization, women in developing countries remain vulnerable to various complications. Evaluation of quality maternal healthcare services in any country must include the opinions of the women being as a key stakeholder utilizing maternal healthcare services.AimThe present study was designed to evaluate the experiences, perceptions and expectations of pre-birth and post-birth women regarding utilization and delivery of maternal healthcare services in Pakistan.MethodologyA qualitative study design was used. Snow ball sampling technique was adopted to identify the respondents. Interviews were conducted using semi-structures interview guide till saturation point was achieved. The sample size at saturation point for different respondents was: pre-birth women (n = 9) and post-birth women (n = 9). All interviews were recorded after getting permission from the respondents. The interviews were transcribed verbatim and were then subjected to thematic analysis.ResultsThe age group for the pre-birth respondents was 23–43 years while for post-birth group it was 23–32 years. Most of the respondents from both groups were from urban setting. Most of them were either first time pregnant or were having experience of one pregnancy. Thematic analysis of the interviews yielded different themes and sub-themes including birth experience, maternal treatment pathway, identified barriers for quality maternal care, involvement in healthcare decision-making, impact of Covid 19, payment dynamics, role of digital health and recommendations for improving maternal care services.ConclusionThe results of the present study concluded that the overall quality of the maternal care services provided in Pakistan was not up to the mark. High rate of caesarian section was prevalent. Majority of the women were not involved in the decision-making process or provided with any birth plan or counselling regarding birth signs, family planning, danger and birth signs. The cost of maternal care was quite high and not affordable for all.

COVID-19 Restrictions and Maternal Experience and Infant Feeding

The Movement Control Order (MCO), also known as the partial lockdown, was introduced in Malaysia in March 2020 to combat the COVID-19 pandemic, changing many public sector protocols and regulations. This may have implications for neonatal and maternity care and services, especially among new mothers. The aim of this study was to compare the postnatal experiences and feeding practices between mothers who gave birth before MCO (B-MCO) and during MCO (D-MCO). One thousand fifty-one mothers with an infant under 18 months in Malaysia completed an online survey between July 2020 and October 2020. The survey advertisement was disseminated online via various social media platforms. More D-MCO mothers faced a significant effect on the ability to pay rent/mortgage, with their spouses facing a higher impact on employment. D-MCO mothers were more likely to have changed their birth plans, perceived insufficient breastfeeding support, and experienced changes in postnatal services since MCO. In contrast, more B-MCO mothers had stopped breastfeeding during the MCO and started complementary feeding earlier than planned. Many mothers reported feeling down and lonely and having trouble sleeping and a poor appetite. D-MCO mothers had more time to focus on their health, whereas B-MCO mothers spent more time outdoors. MCO affected mothers' livelihood and postnatal experiences, potentially causing emotional distress. Hence, improved breastfeeding support, particularly at birth, is recommended, as is routine mental health screening during the postnatal checkup. Furthermore, because online contact was readily accessible during the pandemic, the efficacy of online breastfeeding support should be evaluated.

Incidence of home delivery among women living with HIV in Lira, Northern Uganda: a prospective cohort study

BackgroundHome delivery has been associated with mother-to-child transmission of HIV and remains high among HIV-infected women. Predictors for home delivery in the context of HIV have not been fully studied and understood in Northern Uganda. We therefore aimed to find out the incidence and risk factors for home delivery among women living with HIV in Lira, Northern Uganda.MethodsThis prospective cohort study was conducted between August 2018 and January 2020 in Lira district, Northern Uganda. A total of 505 HIV infected women receiving antenatal care at Lira regional referral hospital were enrolled consecutively and followed up at delivery. We used a structured questionnaire to obtain data on exposures which included: socio-demographic, reproductive-related and HIV-related characteristics. Data was analysed using Stata version 14.0 (StataCorp, College Station, Texas, U.S.A.). We estimated adjusted risk ratios using Poisson regression models to ascertain risk factors for the outcome of interest which was home delivery (which is delivering an infant outside a health facility setting under the supervision of a non-health worker).ResultsThe incidence of home delivery among women living with HIV was 6.9% (95%CI: 4.9–9.5%). Single women were more likely to deliver at home (adjusted risk ratio = 4.27, 95%CI: 1.66–11). Women whose labour started in the night (night time onset of labour ARR = 0.39, 95%CI: 0.18–0.86) and those that were adherent to their ART (ARR = 0.33, 95%CI: 0.13–0.86) were less likely to deliver at home.ConclusionHome delivery remains high among women living with HIV especially those that do not have a partner. We recommend intensified counselling on birth planning and preparedness in the context of HIV and PMTCT especially for women who are: separated, divorced, widowed or never married and those that are not adherent to their ART.

The role of perinatal palliative care following prenatal diagnosis of major, incurable fetal anomalies: a multicentre prospective cohort study.

To describe prenatal decision-making processes and birth plans in pregnancies amenable to planning perinatal palliative care. Multicentre prospective observational study. Nine Multidisciplinary Centres for Prenatal Diagnosis of the Paris-Ile-de-France region. All cases of major and incurable fetal anomaly eligible for TOP where limitation of life-sustaining treatments for the neonate was discussed in the prenatal period between 2015 and 2016. Cases of congenital defects amenable to perinatal palliative care were prospectively included in each centre. Prenatal diagnosis, decision-making process, type of birth plan, birth characteristics, pregnancy and neonatal outcome were collected prospectively and anonymously. Final decision reached following discussions in the antenatal period. We identified 736 continuing pregnancies with a diagnosis of a severe fetal condition eligible for TOP. Perinatal palliative care was considered in 102/736 (13.9%) pregnancies (106 infants); discussions were multidisciplinary in 99/106 (93.4%) cases. Prenatal birth plans involved life-sustaining treatment limitation and comfort care in 73/736 (9.9%) of the pregnancies. The main reason for planning palliative care at birth was short-term inevitable death in 39 cases (53.4%). In all, 76/106 (71.7%) infants were born alive, and 18/106 (17%) infants were alive at last follow-up, including four with a perinatal palliative care birth plan. Only a small proportion of severe and incurable fetal disorders were potentially amenable to limitation of life-sustaining interventions. Perinatal palliative care may not be considered a universal alternative to termination of pregnancy. Perinatal palliative care is planned in 10% of continuing pregnancies with a major and incurable fetal condition eligible for TOP.

How to Make the Hospital an Option Again: Midwives' and Obstetricians' Experiences with a Designated Clinic for Women Who Request Different Care than Recommended in the Guidelines.

Background: An increasing number of maternity care providers encounter pregnant women who request less care than recommended. A designated outpatient clinic for women who request less care than recommended was set up in Nijmegen, the Netherlands. The clinic’s aim is to ensure that women make well-informed choices and arrive at a care plan that is acceptable to all parties. The aim of this study is to make the clinic’s approach explicit by examining care providers’ experiences who work with or within the clinic. Methods: qualitative analysis of in-depth interviews with Dutch midwives (n = 6) and obstetricians (n = 4) on their experiences with the outpatient clinic “Maternity Care Outside the Guidelines” in Nijmegen, the Netherlands. Results: Four main themes were identified: (1) ”Trusting mothers, childbirth and colleagues”; (2) “A supportive communication style”; (3) “Continuity of carer”; (4) “Willingness to reconsider responsibility and risk”. One overarching theme emerged from the data, which was “Guaranteeing women’s autonomy”. Mutual trust is a prerequisite for a constructive dialogue about birth plans and can be built and maintained more easily when there is continuity of carer during pregnancy and birth. Discussing birth plans at the clinic was believed to be successful because the care providers listen to women, take them seriously, show empathy and respect their right to refuse care. A change in vision on responsibility and risk is needed to overcome barriers such as providers’ fear of adverse outcomes. Taking a more flexible approach towards care outside the guidelines demands courage but is necessary to guarantee women’s autonomy. Key conclusions and implications for practice: In order to fulfil women’s needs and to prevent negative choices, care providers should care for women with trust, respect for autonomy, and provide freedom of choice and continuity. Care providers should reflect on and discuss why they are reluctant to support women’s wishes that go against their personal values. The structured approach used at this clinic could be helpful to maternity care providers in other contexts, to make them feel less vulnerable when working outside the guidelines.

Unexpected changes in birth experiences during the COVID-19 pandemic: Implications for maternal mental health.

PurposeThis study examined the rates of unexpected birth experiences due to the COVID-19 pandemic and its association with women’s postpartum mental health symptoms (depression, generalized anxiety, and PTSD).MethodsOur cross-sectional analysis included postpartum women (N = 506) who reported on birth plan changes attributed to the COVID-19 pandemic through the PEACE (Perinatal Experiences and COVID-19 Effects) Study, an online survey that took place between May 2020 and May 2021. Covariates included sociodemographic variables, number of days since the pandemic, pre-pregnancy mental health history, and protective factors such as social support, distress tolerance, and resilience.ResultsPrevalent COVID-19 pandemic changes in the birth experience included not having support people (e.g., partners and friends) permitted to participate in the baby’s delivery (33.5%), reduced access to preferred medications before or after delivery (9.7%), unavailable health care providers for the baby’s birth as planned (9.6%), and other changes (13.8%). The reduced access to medications was associated with those reporting higher levels of depressive (β = .10, p < .01) and PTSD symptoms (β = .07, p < .05). Separation from their baby for a long period after delivery (β = .10, p < .05) and other changes (β = .10, p < .01) were associated with higher levels of PTSD symptoms.ConclusionUnexpected changes to the birth experience due to the COVID-19 pandemic may have small but persistent effects on depressive and PTSD symptoms. Given increased vigilance and its association with subsequent PTSD, acknowledging any fear of viral contagion within the hospital setting but informing women the plans for ensuring safety may be preventive for later mental health symptomatology.

Social media and experiences of maternity care during the Covid-19 pandemic

BackgroundSocial media offer expecting and new mothers a space to discuss birth-related fears, hopes and experiences. This is particularly the case during the Covid-19 pandemic, which has altered delivery of maternity care. Measures to reduce transmission risk in birth facilities and changes in birth plans are likely to have had an impact on new mothers' experiences of birth and birth care. From a feminist epidemiology perspective, seeking to incorporate more the views of the “researched”, we explored themes discussed by (expecting) mothers on social media, hoping that those real-life concerns would find echo in the design of future research instruments for data collection.MethodsUsing content analysis, we identified key themes in 200+ comments posted on a social media public page as a reaction to the dissemination of a research survey on maternity care during the Covid-19 pandemic in Germany.ResultsIn the comments, the most mentioned topics were own mask wearing, having a companion of choice during birth, visiting hours, and the possibility to welcome visitors (e.g. siblings of the newborn, other relatives and friends). Those topics also generated the most reactions, revealing compassion from other women and mixed feeling about health measures (from acceptance to anger). Concerns about quality or appropriateness of care were almost absent from the data.ConclusionsSocial media content analysis shows clearly that women giving birth during the pandemic are most concerned with a specific set of disrupting and potentially upsetting measures. These spontaneous testimonies differ content-wise from what research surveys tend to ask women about (e.g. care standards). Those discrepancies are to some extent inevitable, but integrating more bottom-up generated topics from social media into research instruments could help move forward toward better care.Key messages On social media, women were most concerned with own mask wearing, presence of a birth companion and visits from the newborn’s siblings.Social media analysis brings valuable insights into what matters the most to women who give birth during the pandemic and could inform future research developments.

Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study.

BackgroundThe COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women’s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States.ObjectiveThe aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior.MethodsWe conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared.ResultsA total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups.ConclusionsResults suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic.

'Creating a safe space': how perinatal palliative care coordinators navigate care and support for families.

Families who learn that their unborn baby has a life-limiting fetal condition are often overwhelmed by this news, alongside navigating an unfamiliar healthcare system. A skilled perinatal palliative care coordinator (PPCC) can help these families, yet little is known about their function and roles. This study sought to describe the PPCC's approach to care, their guiding principles and the roles, knowledge and skills that enable them to provide exemplary care. This qualitative descriptive study included interviews of 12 expert PPCCs. Directed content analysis was used to identify major codes. Iterative analysis led to theme identification. Findings include the PPCC's position within the healthcare system, guiding principles, goals, roles and responsibilities, and knowledge and skills. Two figures enhance the understanding of the PPCCs approach to creating a safe space for the family, supporting the interdisciplinary team and facilitating coordinated birth planning. Every perinatal palliative care programme should include a PPCC. Future research on clinical training could examine the effectiveness of an educational intervention, using the detailed knowledge and skills learned in this study as a curriculum.

Preparing for the Rare Birth of Craniopagus Conjoined Twins

Conjoined twins are rare, estimated to be 1 per 200,000 live births. Conjoined twins are characterized on the basis of the location of fusion. Ventral-side fusion is the most common (87%), whereas craniopagus is one of the rarest forms (3%). The fused anatomy is almost always associated with congenital anomalies. The type of attachment affects birth planning and neonatal resuscitation and stabilization. Advances in prenatal care and imaging have led to early diagnosis of conjoined twins. This timely detection enables health care providers to plan for technical difficulties that can be predicted with birth and manage the range of congenital anomalies.

Exploring women\u2019s experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain

BackgroundWomen’s engagement in healthcare decision-making during childbirth has been increasingly emphasised as a priority in maternity care, since it increases satisfaction with the childbirth experience and provides health benefits for women and newborns. The birth plan was developed as a tool to facilitate communication between health professionals and women in Spain, but their value in routine practice has been questioned. Besides, little is known about women’s experiences of participation in decision-making in the Spanish context. Thus, this study aimed to explore women’s experiences of participation in shared decision-making during hospital childbirth.MethodsAn exploratory qualitative study using focus groups was carried out in one maternity unit of a large reference hospital in Barcelona, Spain. Participants were first-time mothers aged 18 years or older who had had a live birth at the same hospital in the previous 12 months. Data collected were transcribed verbatim and analysed using a six-phase inductive thematic analysis process.ResultsTwenty-three women participated in three focus groups. Three major themes emerged from the data: “Women’s low participation in shared decision-making”, “Lack of information provision for shared decision-making”, and “Suggestions to improve women’s participation in shared decision-making”. The women who were willing to take an active role in decision-making encountered barriers to achieving this and some women did not feel prepared to do so. The birth plan was experienced as a deficient method to promote women’s participation, as health professionals did not use them. Participants described the information given as insufficient and not offered at a timely or useful point where it could aid their decision-making. Potential improvements identified that could promote women’s participation were having a mutually respectful relationship with their providers, the support of partners and other members of the family and receiving continuity of a coordinated and personalised perinatal care.ConclusionEnhancing women’s involvement in shared decision-making requires the acquisition of skills by health professionals and women. The development and implementation of interventions that encompass a training programme for health professionals and women, accompanied by an effective tool to promote women’s participation in shared decision-making during childbirth, is highly recommended.

Disparities in Provider Recommendations for Birth Plan Changes to Elective Deliveries during COVID‐19

Research ObjectiveBefore the COVID‐19 pandemic, about one in ten childbirths were elective deliveries – labor induction and cesarean deliveries without medical indications – which evidently increased adverse maternal and neonatal outcomes. Anecdotal evidence shows that during COVID‐19, providers are increasingly recommending these deliveries, but little is known regarding the extent and the patterns of such recommendations across pregnant women in the United States (U.S.).Study DesignWe conducted a nationwide cross‐sectional survey of 740 racial‐diverse U.S. pregnant women with >8‐week pregnancy, and aged 18–44 years during 5/4/2020–5/6/2020 to evaluate maternal and provider characteristics associated with birth plan changes due to the COVID‐19 pandemic. To understand the birth plan changes, we asked each participant, “has a health care professional recommended a change to your birth plan as a result of COVID‐19?” Options include 1) No, there have been no recommended changes to my original birth plan as a result of COVID‐19. 2) Yes, my provider recommended inducing labor as a result of COVID‐19. 3) Yes, my provider recommended a planned cesarean (c‐section) delivery as a result of COVID‐19. 4) I don't know yet. Women who responded, “I don't know yet” were excluded, yielding a total of 678 sample pregnant women in the analysis. Multivariable regressions were used to assess rural–urban differences in the likelihoods of provider recommendations for birth plan changes to labor induction or planned c‐section, controlling for race/ethnicity, age, insurance‐type, education, employment, household income, pregnancy condition, pre‐pregnancy Body Mass Index, parity, trimester, provider specialty, delayed prenatal care initiation, positive‐tested family member, state positivity rates as of 5/6/2020, and census region.Population Studied740 racial‐diverse U.S. pregnant women with >8‐week pregnancy, and aged 18–44 years in 2020.Principal FindingsOf 678 eligible pregnant women, the majority lived in urban communities (87.0%). Rural women reported lower household income, were less likely to initiate prenatal care at the first trimester, visit obstetricians for prenatal care, be privately insured, be employed full‐time than urban women participants. They were similar in age, race/ethnicity, education, pregnancy condition, pre‐pregnancy BMI, and state COVID‐19 positivity rates. Overall, 22.6% were recommended to change delivery plans to either labor induction or planned c‐section due to the pandemic, with a higher rate in rural women (34.5%) than urban women (20.9%). Controlling for other maternal, provider, and state COVID‐19 characteristics, these recommendations were disproportionately prevalent among rural women (Odds ratios [OR]: 1.6), primiparous women (OR: 7.7), women delaying prenatal care initiation (OR: 5.2), those visiting family physicians but no obstetricians for prenatal care (OR: 4.3), Medicaid insured (OR: 3.2), and those with family members tested positive for COVID‐19 (OR: 5.4).ConclusionsIn May 2020, women living in rural areas, Medicaid insured, having delayed prenatal care initiation, and visiting only family physicians for prenatal care were more likely to be recommended for elective procedures.Implications for Policy or PracticeThere is an urgent need for health system and policymakers to establish safe and effective protocols to ensure pregnant women obtain evidence‐based care as needed during the pandemic and beyond to avoid long‐term detrimental effects.Primary Funding SourceUniversity of South Carolina Vice Office of the Vice President for Research.

Pregnant women’s experiences during the COVID-19 pandemic: A mixed method exploration of prenatal depression.

Risk factors associated with prenatal depression have been studied extensively, but it is unclear whether typical risks are relevant during the COVID-19 pandemic. This mixed-method study involved surveys and interviews with women in their third trimester of pregnancy to understand prevalence and correlates of prenatal depression during a pandemic event. Survey participants included 378 pregnant women in the United States with due dates between April and December 2020 who self-reported depressive symptoms using the 10-item Edinburgh Postnatal Depression Scale (EPDS). Participants were predominately white, married, and highly educated. A subset of 21 women participated in qualitative interviews. In total, 56.3% of women reported depressive symptoms consistent with clinical levels of prenatal depression. Correlates of depressive symptoms included younger age, unmarried status, lack of access to paid parental leave, feeling unsafe in current romantic relationship, fear and worry about upcoming childbirth, and change in birth plans due to the COVID-19 pandemic. In-depth interviews with participants revealed key themes around pregnant women’s experiences with fear and anxiety, mixed emotions, and grief and loss. These findings underscore the pervasive impact of the COVID-19 pandemic on women during the perinatal period, with specific implications for the care of women with prenatal depression and their families. The heightened potential for prenatal depression in the context of the COVID-19 pandemic is concerning given the potential adverse effects of maternal depression. Practitioners must work together to engage in additional assessment of risks of prenatal depression to ensure support for expecting families is readily accessible. (PsycInfo Database Record (c) 2021 APA, all rights reserved) © 2021 American Psychological Association

MONITORING PROGRAM PERENCANAAN PERSALINAN DAN PENCEGAHAN KOMPLIKASI (P4K)

Maternal and child mortality remains a challenge in the health sector. One strategy for reducing maternal and infant mortality is to involve the active role of families and communities in planning a safe delivery, facing complications and maternal obstacles for women with the Birth Planning and Complication Prevention Program (P4K). The monitoring design used was descriptive with document review method and interview. Data analysis performed, including: data analysis in quantitative and qualitative. The evaluation results show that the input, process and output components are in accordance with program implementation standards. Problems with the poor number of health personnel, funding, and data collection systems have an impact on program achievement indicators, such as the attainment of pregnant women in labor force maternity, complication help, and family planning services. Key word: monitoring, P4K.

External cephalic version at 38 weeks' gestation at a specialized German single center.

Cesarean section (CS) rates are increasing worldwide. One constant indication is the breech presentation at term. By offering external cephalic version (ECV) and vaginal breech delivery CS rates can be further reduced. This study aimed to analyze the ECV at 38 weeks of gestation with the associate uptake rate, predicting factors, success rate, and complications at a tertiary healthcare provider in Germany specializing in vaginal breech delivery. We conducted a prospective cohort study with retrospective data acquisition. All women with a singleton fetus in breech presentation presenting after 34 weeks of gestation for counseling between 2013 and 2017 were included. ECV impact factors were analyzed using logistic regression. A total of 1,598 women presented for breech birth planning. ECV was performed on 353 patients. The overall success rate was 22.4%. A later week of gestation (odds ratio [OR] 1.69), an abundant amniotic fluid index (AFI score) (OR 5.74), fundal (OR 3.78) and anterior (OR 0.39) placental location, and an oblique lie (OR 9.08) were significantly associated with successful ECV in our population. No major complications were observed. The overall vaginal delivery rates could be increased to approximately 14% with ECV. The demand for alternative birth modes other than CS for breech birth is high in the area of Frankfurt, Germany. Our study offers evidence of the safety of ECV at 38 weeks. Centers with expertise in vaginal breech delivery and ECV can reduce CS-rates. To further establish vaginal breech delivery and ECV as alternate options, the required knowledge and skill should be implemented in the revised curricula.

Update on pulmonary embolism in pregnancy and post-partum: The Society of Obstetric Medicine of Australia and New Zealand Position Statement on Pulmonary Embolism in Pregnancy and Post-partum.

In this clinical review we highlight aspects of the diagnosis and management of pulmonary embolism (PE) in pregnancy and post-partum and how this may impact on antenatal and postnatal management. Investigation for PE in pregnancy is challenging and includes appropriate patient selection and knowledge of the risks and benefits of pulmonary imaging modalities. The complete Society of Obstetric Medicine of Australia and New Zealand Position Statement on Pulmonary Embolism in Pregnancy and Post-Partum comprehensively reviews all aspects of diagnosis, investigation and management and is accessible at https://www.somanz.org/guidelines.asp. It includes a summary of all recommendations and a guide to developing a management plan for birth in women on anticoagulation.

Women\u2019s perspectives on the measures that need to be taken to increase the use of health-care facility delivery service among slums women, Addis Ababa, Ethiopia: a qualitative study

BackgroundGlobal strategies to target high maternal mortality ratios are focused on providing skilled attendance at delivery along with access to emergency obstetric care. Research that examines strategies to increase facility-based skilled birth attendance among slum residents in Addis Ababa, Ethiopia, is limited.ObjectiveThe study aimed to explore women's perspectives on the measures that need to be taken to increase the use of the facility—delivery service among slums women, Addis Ababa, EthiopiaMethodsQualitative exploratory and descriptive research designs were used. Participants in the study were women in the reproductive age group (18–49 years of age) living in the slum areas of Addis Ababa, Ethiopia. A purposive sampling strategy was used to select study participants. Potential participants' names were gathered from health facilities and followed to their homes for the study. Four audio-recorded focus group discussions [FGDs] were conducted with 32 participants from the three public health centers and one district hospital. The number of participants in FGDs was between 6 and 10 women. Data were analyzed simultaneously with data collection. Thematic analysis was used in data analysis, which entails three interconnected stages: data reduction, data display, and data conclusion. In addition, thematic analysis entailed evaluating the structure and content of textual data, identifying data themes, coding the themes, and then interpreting the structure and content of the themes. A codebook was first devised, discussed, and adopted by the writers before they could use this technique. Using the codebook, the theme codes were then manually produced. To explain the study results, verbatim excerpts from participants were given. The researcher used Techs' eight steps of qualitative data analysis method for analyzing the data. A multi-level life-course framework of facility-based delivery in low- and middle-income countries (LMICs) developed by Bohren et al. was used to frame the current study and link the findings of the study to the body of knowledge.ResultsThe FGDs included a total of 32 participants. The mean age of the overall sample was 32.6 years (± SD = 5.2). Participants' educational characteristics indicate that the majority (24 out of 32) was found to have no formal education, and two-thirds of participants were found to have one to five children. Three-fourths of them attended the ANC twice and they all gave birth to their last child at home. Two themes emerged from the analysis of focus group data, namely provision of quality, respectful and dignified midwifery care, and lack of awareness about facility delivery. These themes were described as a rich and comprehensive account of the views and suggestions made by focused antenatal care [FANC] participants on measures required to improve the use of the facility-delivery services. The findings of the study raise concerns about the effectiveness of FANC in encouraging facility-deliveries since FANC participants had not used health facilities for their last childbirth. According to the findings of the focus groups, women who took part in this study identified measures required to increase the use of health facility-delivery services among FANC participants in Addis Ababa's slum residents. It is to be expected that diligent counseling during antenatal care about birth plans would facilitate prompt arrival at facilities consistent with the desires of women.

PEMANFAATAN BUKU KIA UNTUK PERSIAPAN PERSALINAN DAN PERENCANAAN KONTRASEPSI PASCA SALIN PADA IBU HAMIL

Background: One of the government's efforts to reduce MMR, IMR and reduce complications during pregnancy include the activities of the Mother Love Movement, Strategy Making Pregnancy Safer and the Duplication of Mother and Child Health Books. The KIA handbook as an educational tool and an effort to increase information on pregnant women.&#x0D; Objective: This study aims to explore related to the use of the KIA handbook as a source of information, Birth Plan and Postpartum Contraception Planning.&#x0D; Methods: This study uses a concurrent triangulation strategy by collecting quantitative and qualitative data together. The sample in this study was 30 pregnant women with total sampling technique. Data analysis with a comparison of quantitative data and qualitative data.&#x0D; Results: The results of the study showed that out of the 15 respondents who had good use of the KIA handbook, the majority had good labor preparation. While of the 9 respondents who used the KIA handbook with sufficient categories, the majority also had good childbirth preparations. Of the 15 respondents who had good use of the KIA handbook, the majority had made contraceptive preparations. While of the 6 respondents who had less use of the KIA handbook, none planned for postpartum contraception.&#x0D; Conclusion: The conclusion is that the better the use of the KIA handbook, the better the preparation of labor and post-partum contraceptive planning.