Fourth Stage Of Labor Research Articles

Effects of Warm Compresses on the Perineal Area During the Active Phase of Labor: A Quasi-Experimental Study.

Background A perineal tear refers to any injury to the female genitalia during labor, which can occur spontaneously or with the use of instruments. An episiotomy, a surgical procedure, is sometimes performed to enlarge the vaginal orifice to facilitate delivery. Ineffective management of labor pain can result in negative physiological and psychosocial outcomes. Objective This study aims to investigate the effect of warm compresses on the perineal area during active labor. Methods This quasi-experimental study utilized a convenience sample, dividing 80 mothers into intervention and control groups. Participants were randomly assigned to groups after meeting the inclusion criteria and signing consent forms. The inclusion criteria encompassed pregnant women aged 18 years or older with a healthy singleton pregnancy, a cephalic presentation, and a gestational age of 37 weeks or more. The women were in the active phase of the first stage of labor (6-7 cm cervical dilation). In Part I, a data collection tool was developed to gather sociodemographic data, obstetrical history, and initial assessment information. Part II assessed perineal pain using the Visual Analogue Scale. Part III collected data on the perineal status post-delivery, and Part IV gathered information about the newborns. The research was conducted in the labor unit at East Jeddah Hospital, with data collection occurring from November 2022 to February 2023. Results The results of this study revealed that the mean second-stage labor pain score was 9.73 for the control group and 8.68 for the intervention group. In the third stage of labor, the mean pain score was 4.52 for the control group and 2.75 for the intervention group. During the fourth stage of labor, the mean pain score for the control group was 2.90, compared to 1.50 for the intervention group. In terms of perineal outcomes, 17 participants (42.5%) in the intervention group had an intact perineum, compared to 11 participants (27.5%) in the control group. However, there was no significant difference in the episiotomy rate between the two groups. Conclusions The findings of this study indicate that applying a warm compress to the perineal area during active labor can enhance perineal intactness and significantly reduce perineal pain. Future research could explore the challenges nurses encounter when applying warm compresses to the perineum during labor.

Tranexamic acid in preventing postpartum blood loss in vaginal delivery: a double-blinded randomized controlled trial

Postpartum hemorrhage (PPH) is an obstetrical emergency that occurs in 1% to 10% of all deliveries and contributes to nearly one-quarter of all maternal deaths worldwide. Tranexamic acid has been established as an adjunct in the treatment of PPH but its role in its prevention of PPH following vaginal delivery has not been widely studied. This study aimed to assess the effect of prophylactic tranexamic acid (1 g) along with active management of the third stage of labor in reducing postpartum blood loss and the incidence of postpartum hemorrhage after vaginal delivery. In this randomized controlled trial, 650 women with singleton pregnancies at ≥34 weeks of gestation who were undergoing vaginal delivery were included. Eligible women were randomly assigned to receive either 1 g of tranexamic acid or placebo intravenously along with active management of the third stage of labor. Calibrated blood collection bags were used to measure postpartum blood loss during the third and fourth stages of labor. Of 886 women approached for the study, 650 who met the inclusion criteria were enrolled, and 320 in group A and 321 in group B were analyzed. The maternal characteristics were similar between the groups. The mean blood loss did not differ significantly between the intervention and placebo groups (378.5±261.2 mL vs 383.0±258.9 mL; P=.93). The incidence of primary postpartum hemorrhage was comparable in both groups (15.9% in group A and 15.3% in group B; P=.814). The median quantitative decreases in hemoglobin levels within 12 to 24 hours after delivery were 0.60 g% (interquartile range, 0.40-0.90) in group A and 0.60 g% (interquartile range, 0.40-0.80) in group B, which were comparable in both groups (P=.95). The most common adverse effect reported was dizziness, and there was no thromboembolic event at 3 months follow-up in either group. The use of tranexamic acid as a prophylactic measure along with active management of the third stage of labor does not provide additional benefit in reducing the postpartum blood loss and incidence of postpartum hemorrhage after vaginal delivery. El resumen está disponible en Español al final del artículo.

Weight Gain During Pregnancy Based on Pre-Pregnancy Body Mass Index with Duration of Labor

Chronic Energy Deficiency and being overweight in pregnancy is a severe problem because it could cause many risks in labor. This study aimed to determine the association between weight gain during pregnancy based on Body Mass Index before pregnancy with the duration of labor. The type of research was analytical observational with a cross-sectional approach. Thirty respondents used the quota sampling technique. The Spearman-rank test showed a significant value of 0,039, so there was a significant relationship between weight gain during pregnancy and the duration of the first stage of labor in the latent phase. The significant value was 0,016, indicating a relationship between weight gain during pregnancy and the duration of the first stage of labor in the active phase. However, a significant value of more than 0,05 in the variable duration of the second, third, and fourth stages of labor. So, it was necessary to monitor weight gain and provide counseling on the impact of excessive weight gain during labor. In addition, women with excessive weight gain should be given more time during the first stage because the duration in the second until the fourth stage of labor would generally run so that it could reduce unnecessary interventions.

Pengaruh Inisiasi Menyusu Dini (IMD) terhadap Jumlah Perdarahan Kala IV Persalinan di Desa Bangunrejo Kecamatan Tanjung Morawa Kabupaten Deli Serdang Tahun 2024

One of the MGDS global targets is to reduce MMR and IMR. The maternal mortality rate in Indonesia is still high at 390 per 100,000 live births. Referring to the link between birth management and various countermeasures for the biggest cause of AKI is postpartum hemorrhage. Efforts have been made in problems related to bleeding, even several studies have carried out IMD in treating bleeding problems considering that the presence of IMD can affect the hormone oxytocin which is associated with bleeding. The purpose of this study was to see how IMD influences the amount of bleeding in the fourth stage.This research is a Quasi Experiment using primary data. The population and sample were all primiparous women with a total of 46 respondents using the purposive sampling method. The data analysis was univariate and bivariate using the Independent t-test. The results showed that there was a significant effect between IMD on the amount of bleeding in the fourth stage. The average number of bleeding in the fourth stage of respondents who underwent Early Breastfeeding Initiation was 150.63 with a standard deviation of 22.149. Meanwhile, for respondents who did not undergo Early Breastfeeding Initiation, the average number of bleeding in the fourth stage was 166.09 with a standard deviation of 21.580. In the statistical test, the value of P = 0.000 was obtained. With this study, it was found that there was an effect of IMD on the amount of bleeding in the fourth stage of labor. It is hoped that midwives and doctors will implement IMD in order to reduce morbidity and mortality of mothers and babies.

PENGARUH (INISIASI MENYUSU DINI) IMD TERHADAP JUMLAH PERDARAHAN KALA IV DI KLINIK PRATAMA TANJUNG KECAMATAN DELI TUA TAHUN 2023

One of the MGDS global targets is to reduce MMR and IMR. The maternal mortality rate in Indonesia is still high at 390 per 100,000 live births. Referring to the link between birth management and various countermeasures for the biggest cause of AKI is postpartum hemorrhage. Efforts have been made in problems related to bleeding, even several studies have carried out IMD in treating bleeding problems considering that the presence of IMD can affect the hormone oxytocin which is associated with bleeding. The purpose of this study was to see how IMD influences the amount of bleeding in the fourth stageThis research is a quasi-experimental study using control and experimental groups. The population and sample were all mothers who gave birth as many as 16 respondents using the Purposive Sampling method. The data were analyzed univariately and bivariately using the Mann-Whitney test.The results showed that there was a significant effect between IMD on the amount of bleeding in the fourth stage. The average number of bleeding in the fourth stage of respondents who underwent Early Breastfeeding Initiation was 4.50 with a standard deviation of 12.683. Meanwhile, respondents in the control group averaged the amount of bleeding in the fourth stage was 12.50 with a standard deviation of 19.291. In the statistical test, the value of P = 0.001 <a0.05 was obtained With this study, it was found that there was an effect of IMD on the amount of bleeding in the fourth stage of labor. It is hoped that midwives and doctors will implement IMD in order to reduce morbidity and mortality of mothers and babies.

Timing of Colostrum Expulsion Based on Type of Labor in Fourth Period Laboring Mothers

Colostrum is the best food and is an antibody for babies. Breast milk is a nutritional requirement for newborns, colostrum is yellow, low in fat but high in carbohydrates, protein and especially antibody content. This study aims to determine the relationship between the type of delivery and colostrum excretion in women in the fourth stage of labor. This type of research is a quantitative study using observational analytic methods. The population in this study were all mothers giving birth in the fourth stage at EMC Pulomas Hospital as many as 80 respondents. The statistical test uses the chi-square test. There is a significant relationship between the type of delivery and the time the colostrum comes out at the EMC Pulomas Hospital, Jakarta. evident from the value of p = 0.002. There is a significant relationship between the type of delivery and the time colostrum is released at EMC Pulomas Hospital, Jakarta, so it is necessary to provide counseling on types of delivery and its side effects

Factors Associated with Postpartum Care during the Fourth Stage of Labor in Nepal: A Hospital-based Cross-sectional Study

Postnatal care is an important part of maternal and neonatal care, and life-threatening complications can occur during the postpartum period. Empirical information on the level of postpartum care services is generally scarce in Nepal. Key elements of postpartum care during the fourth stage of labor include providing proper nutrition, promoting breastfeeding, and helping the mother manage any physical discomforts or challenges that may arise. This study investigated the level of postpartum care services delivered during the fourth stage of labor in a tertiary-level hospital in the Chitwan district of Nepal. A descriptive cross-sectional hospital-based study was conducted among 148 women admitted for vaginal delivery. A set of structured observation checklists was developed and finalized based on the WHO Recommended Interventions for Improving Maternal and Newborn Health: Integrated Management of Pregnancy and Childbirth. The structured observation checklist had twenty-two items, including twelve critical steps. A good level of care was valid with a score of ≥ 90% based on total items, including all twelve critical steps of care, and a poor level of care was valid with a score <90%. The purpose of the study was explained to and written informed consent was obtained from all respondents. Ethical approval was received from the Institutional Review Committee of Chitwan Medical College. One third (33.8%) of the women received a good level of postpartum care services. Women’s residence (<em>p</em> = .021), number of pregnancies (<em>p</em> =.002), and number of antenatal visits (<em>p</em> =.029) were significantly associated with the level of postpartum care during the fourth stage of labor. Going forward, it will be important for Nepal to enhance the capacity of clinicians or nurses to provide postpartum care as per WHO guidelines.

Postpartum Hemorrhage: Integrative Healthcare Services: A Comprehensive Review

Background: Postpartum bleeding (PPB) and its clinical management (i.e., skin-to-skin contact and breastfeeding) are the essential parameters in which healthcare services are mandatory to promote maternal and fetal well-being. Aim: The researcher aims to investigate the broader perspectives regarding immediate skin-to-skin initial contact between baby and mother. Besides, breastfeeding significance would encourage the development of clinical outcomes' well-being. Across various institutions and globally, several integrative practices are established to promote and preserve maternal and fetal mortality and morbidity. Hence, comprehensive literature aimed to probe the cause-and-effect relationship association. Methods: The literature search was adopted using appropriate keywords and followed a standard scientific data search system. The search included PubMed and Google Scholar databases. All publications associated with immediate newborn care and bonding with mothers were the highlights of this paper. Results: The results indicate that newborn close bonding through skin-to-skin contact and breastfeeding are the cost-effective paradigm to prevent bleeding after delivery. It was also explored that the critical stages of the PPH are the transitional and fourth stages of labor.

Effect of Therapeutic Touch on Maternal and Neonatal Outcomes in Primiparous Women: A Systematic Review and Meta-Analysis

Introduction: Childbirth is one of the most wonderful yet painful experiences in a woman’s life. Non pharmacological interventions like Therapeutic Touch (TT) can improve labour experiences in women. Aim: To assess the effect of TT on labour pain intensity, neonatal Appearance, Pulse, Grimace, Activity, Respiration (APGAR) score and admission to neonatal intensive care unit in primiparous women. Materials and Methods: In this review, PubMed-MEDLINE, Google Scholar, Cochrane CENTRAL databases were searched till February 2022, for prospective studies fulfilling inclusion and exclusion criteria. Randomised controlled trials comparing TT and massage therapy with usual intranatal care in primiparous women with singleton foetus and without any risk factors for pregnancy were included in this review. Two independent reviewers extracted data and assessed the quality of the trials. The results were presented in form of forest plots. Results: A total of 13 studies, including 1302 primiparous women, were included in the review for qualitative analysis. Amongst them ten studies involving 621 women included meta-analysis of labour pain intensity. Nine studies were included in the metaanalysis of the active phase of labour and four studies included in the transitional phase and one study in the fourth stage of labour. Eight studies used the Visual Analogue Scale (VAS) to assess pain intensity. Overall, there was a small reduction in pain intensity of primiparous women receiving massage/TT compared to routine care {SMD: -0.96 (95% CI: -1.33, -0.60)}. Significant reduction of pain intensity was found in active {SMD: -0.79 (95% CI: -1.26, -0.32)} and transitional phase of labour {SMD: -1.18 (95% CI: -1.67, -0.69)}. No significant reduction of neonatal admission to the intensive care unit and APGAR score <7 at 5 minutes {RR: 0.71 (95% CI: 0.31, 1.62)} was found. Conclusion: TT has beneficial effect on reduction of Labour pain intensity in primiparous women. But no detectable effect was found for neonatal outcomes.

Intraumbilical versus intramuscular oxytocin in the management of the third stage of labor.

To compare the effect of intraumbilical vein oxytocin injection with standard management in reducing blood loss during the third and fourth stages of labor. Acute complications threaten the mother's life during the third and fourth stages of labor. The most common complication is postpartum hemorrhage, which remains a leading cause of maternal mortality, particularly in developing countries. A randomized controlled trial was conducted in the Gynecology and Obstetrics Department of Leonardo Martínez Valenzuela Hospital from January to June 2021. A probabilistic sample was used: 332 pregnant patients were enrolled in the study and randomized into the case (166 patients) and control (166 patients) groups. The volume of blood lost was compared between the groups. The median estimated blood loss was 120 mL (interquartile range [IQR], 80-218.75 mL). There was a statistically significant difference between the groups, showing less estimated blood loss in the international unit group with a median of 80 mL (IQR, 60-100 mL) (P<0.001), and 200 mL (IQR, 143.75-300 mL) in the intramuscular (IM) group, highlighting that 66.8% of the IM group had an estimated blood loss >251 mL. Any reduction in bleeding during labor is clinically relevant because it improves patient prognosis. The use of intraumbilical oxytocin injection with active management of the third stage of labor significantly reduced postpartum blood loss and the duration of the third stage compared with the IM group.

Assess the knowledge about new-born care among the primi mothers at a selected hospital, Vadodara, Gujarat

Introduction: The postnatal period has been termed as fourth stage of labour. It has three distinct but continuous phases.1 postnatal period begins after the third stage of labour and includes first six weeks after delivery. During this time women’s reproductive organs gradually returns to the normal size and shape. Postnatal period is a crucial period in woman’s life and lot of physiological changes used to occur. They are in need of special care during pregnancy, at the time of labour as well as after delivery of child in order to prove safe motherhood and healthy living. The postnatal period is a critical transitional time for a woman and her new born physiologically, emotionally, and socially.2 postnatal mothers used to have physical and emotional discomforts, lack of sleep due to new born baby, visitors, noise, and discomfort with episiotomy. Due to child birth, mother becomes tired and weak. However, taking care of hygiene is also important for all postnatal mothers. Hygiene includes self care as well menstrual careMethod: The Parul Sevashram Hospital in Vadodara served as the study's location. A practical simple random sampling procedure was used to select 60 primi mothers in total. Multiple choice questions and a checklist were included in the questionnaire used to gather the data. Age, religion, degree of education, place of residence, and other socio-demographic characteristics were taken into account when formulating the questions. For this examination, a quantitative descriptive research design was adopted.Results: In this study, the majority of participants, Regarding age of the mother 11(22%) are the age group of 18-25 years, followed by in the age group of 26-30 years17(34%) and most of them were in the age group of 31-36 years 22(44%), no mother belongs to the age group of 36 and above. The results indicated that age of the mother and educational status are significant at the p0.05 level, socio-demographic variables like the mother's age, residence, employment status, family monthly income, marital status, family type, parity are not significant at that level.Conclusion: It is important to give primi mothers regarding newborn care knowledge and practice after delivering the planned teaching programme.

A randomized clinical trial on the effect of foot reflexology performed in the fourth stage of labor on uterine afterpain\xa0

BackgroundUterine afterpains are among the most prevalent complaints after natural vaginal delivery. Non-pharmacological treatment modalities to relieve afterpains are an important care priority. This study was conducted to investigate the effect of foot reflexology in the fourth stage of labor on afterpains in multiparous women.MethodsThis single-blind, randomized, clinical trial recruited 80 eligible pregnant women presenting to Allameh Bohlool Hospital in Gonabad and 17-Shahrivar Hospital in Mashhad, Iran, in 2019. In the first and second hours postpartum, the reflexology group received 10 min of general massage and specific reflexology massage on each foot on the uterine, pituitary, and solar plexus points. The control group received 10 min of general massage, and then rotational massage on a neutral point on the lateral side of the heel. The pain was measured every hour up to 4 h postpartum using a visual analogue scale. The collected data were analyzed in SPSS-16 software at a significance level of P < 0.05.ResultsThe median of the afterpain score in the first hour (P = 0.05) and second hour (P = 0.274) postpartum did not differ significantly between the two groups, but this score was lower in the reflexology group at the third hour (P < 0.001) and fourth hour (P < 0.001) postpartum. The mean total afterpain score in the 4 h postpartum was significantly lower in the reflexology group (P < 0.001).ConclusionThe results revealed that foot reflexology in the fourth stage of labor has positive effects on relief from uterine afterpain. Reflexology is therefore recommended as a measure to reduce postpartum uterine afterpains.

Literature Review: Physiological Management for Preventing Postpartum Hemorrhage.

The aim of this paper was to summarize the existing literature regarding postpartum hemorrhage (PPH) and its physiological management (i.e., skin-to-skin contact and breastfeeding). The background surrounding PPH and the role of skin-to-skin contact (SSC) and breastfeeding (BF) in PPH are identified, and these interventions are supported as a crucial means of preventing or minimizing the incidence of PPH. Despite its importance, to the best of my knowledge, an evaluation of this relationship has not yet been undertaken. The narrative literature review approach was used to summarize topic related researches. The search included three databases: CINAHL, PubMed, and Google Scholar. All articles related to the role of SSC and BF in PPH were chosen from the different databases. The findings demonstrate that SSC and BF are cost-effective methods that could be considered practices for the prevention of PPH. Immediate Skin-to-skin contact (SSC) and breastfeeding (BF) are central mediators of the psychophysiological process during the first hour after delivery (the third and fourth stages of labor).

The effect of therapeutic touch on labour pain, anxiety and childbirth attitude: A randomized controlled trial

IntroductionTouching ensures physical, emotional and spiritual relaxation, confidence, peace, calmness and well-being, and increases self-esteem. The aim of this study was to determine the effect of therapeutic touch on labour pain, anxiety and childbirth attitude. MethodsThis randomized controlled trial consisted of 80 (intervention group: 40; control group: 40) women attending the maternity unit of a public hospital in Sivas, Turkey between 1 July and 30 December 2019. The first therapeutic touch application was performed in the active phase of the first stage of labour, for 15 min and the second was conducted during the second stage of labour. Data were collected using a Personal Information Form, Visual Analogue Scale, State Anxiety Inventory and Childbirth Attitudes Questionnaire. The forms were completed twice, in the latent phase of the first stage of labour (first follow-up) and in the fourth stage of labour (second follow-up). The results were evaluated with a 95% confidence interval and effect size. ResultsEffect size at 95% confidence interval after therapeutic touch was determined as -1.65 (-2.14 / -1.13) for Visual Analogue Scale, -3.33 (-3.96 / -2.62) for State Anxiety Inventory and -2.98 (-3.59 / -2.32) for Childbirth Attitudes Questionnaire. ConclusionWomen in the intervention group reported a decrease in pain and anxiety levels, and more positive attitudes towards childbirth after therapeutic touch. The control group showed an increase in pain scores, and no change in anxiety and attitude scores.

Transfusion therapy optimization at an acute obstetric blood loss

Objective. To define the role of the cryoprecipitate (CP) and prothrombin complex concentrate (PCC) in the acute obstetric blood loss treatment via the assessment of the water sectors’ state, hemostasis, and frequency and severity of clinical manifestations of the multiple organ dysfunction syndrome (MODS).&#x0D; Materials and methods. 140 women had been examined (over the years 2006-2018), whose child delivery or early postnatal period (fourth stage of labor) had got complicated by an acute severe blood loss with a circulating blood volume deficit of 40 to 60 %. Based on the intensive treatment (IT) characteristics, the patients had been divided into three groups. In the group 1 (post-hoc analysis, n=50), a normal acute blood loss intensive treatment as per the relevant clinical protocols of the Health Ministry of Ukraine had been being provided. In the group 2 (n=44), an acute blood loss intensive treatment as per the abovementioned clinical protocols of the Health Ministry of Ukraine with use of the CP as the first-line drug had been being provided. In the group 3 (n=46), the PCC (Octaplex 20 IU/kg) had been added within the treatment. Thereat, there had been assessed such criteria as follows: RBC count, Hb, Ht, prothrombin index (PI), activated partial thromboplastin time, fibrinogen; the water sectors of the human body had been assessed noninvasively, via the integral impedance method; as well as the clinical signs of the MODS.&#x0D; Results and discussion. The use of the CP as the first-line drug at a dose of 8 to 10 units had enabled to get decreased the total volume of the infusion and transfusion media by 13.7 % (p&lt;0.05), and the total volume of the administered fresh frozen plazma (FFP) – by 12 % (p&lt;0.05) respectively. The adding of the PCC to the relevant IT guidelines had been resulting in a reduction of the total volume of the infusion and transfusion media by 24.5 % (p&lt;0.01), of the administered plasma volume – by 22 % (p&lt;0.01), and of the corpuscular volume – by 9.1 % (p&lt;0.05) respectively. Furthermore, a decrease in the vasopressor support rate (by 5.1 times, p&lt;0.01) and in the vasopressor support duration (by 1.5 natural days, p&lt;0.01), as well as in the adaptive lung ventilation rate and duration (by 5.7 times, p&lt;0.01), had been being observed; thereat, the number of the patients needing the use of the diuretics had been being reduced (by 2.9 times, p&lt;0.01), as well as the duration of their administration (by 1.7 natural days, p&lt;0.01 respectively). The PI and fibrinogen rate had been corresponding to the norms by the end of the 1st natural day of treatment.&#x0D; Conclusions. The use of the CP as the first-line drug in the IT of an acute obstetric blood loss ensures a verifiable lessening of need for the infusion and transfusion media. The PCC as the first-line drug prevents the development and progress of the coagulopathy at the treatment of an acute obstetric blood loss, what decreases the frequency and severity of clinical manifestations of the MODS credibly.

The effect of foot reflexology in the fourth stage of labor on postpartum hemorrhage and after pain: Study protocol for a randomized controlled trial

BackgroundPostpartum hemorrhage is the most common midwifery hemorrhage that occurs in 1 %–5 % of childbirths, causing an estimated 140,000 deaths per year. After pain is also one of the common postpartum pains and approximately 70 % of women with vaginal delivery complain of it. Due to the side-effects of chemical medications, researchers have a particular interest in using traditional and complementary therapies. Reflexology is one such method. The present randomized clinical trial will be conducted to assess the effectiveness of reflexology on hemorrhage and after pain following vaginal delivery. MethodsThe present randomized controlled trial will be conducted on women presenting to the maternity wards of Allameh Bohlool Gonabadi and 17th Shahrivar hospitals in Gonanbd and Mashhad, Iran. After obtaining informed consent from the eligible women, sampling will begin through the convenience method. The subjects will be randomly divided into intervention and control groups by permuted blocks of four. The sample size will be 40 per group. After the removal of the placenta, the intervention group will be given a four-minute general massage on each foot, followed by two minutes of specific reflexology on the uterus, pituitary and solar plexus points by exerting rotational pressure. The control group will also be given a four-minute general massage on each foot, followed by six minutes of rotational pressure on a point on the outer edge of the heel. Ten minutes are required for each foot, and this procedure is to be repeated two hours after childbirth. After pain will be measured using the Visual Analogue Scale (VAS) and bleeding by weighing the pads every one to four hours. Data will be analyzed in SPSS 16. DiscussionThe results will provide accurate scientific evidence for the use of reflexology to control postpartum hemorrhage and after pain. If the results are favorable, the routine use of this technique will be recommended for women in the fourth stage of labor.

A review of the quality of midwifery care in Iran

Introduction: About half a million women worldwide die annually from complications of pregnancy or lack of midwifery care, 99% of which occur in developing countries. High-quality service often leads to customer satisfaction. Staff play a significant role in improving the quality of care. Given the importance of this issue in improving macroeconomic and international indicators, we decided to review the quality of midwifery care in Iran. Materials and Methods: After searching 950 articles with these keywords: quality, care, midwifery and satisfaction in the search engines of Sciencedirect, Iranmedex, SID, Magiran, Google Scholar, Pubmed and IranDoc, about 28 articles were finally selected and the results were filmed. Results: Studies reported the quality of prenatal care, pregnancy, postpartum and family planning at a moderate level, so that the weakest quality was observed in the fourth stage of labor. Satisfaction of pre-natal services, labor and childbirth, post-partum and family planning was stated at a high and very high level, and the satisfaction with the pre-natal period was higher than the labor. Conclusion: The quality of midwifery care was at a moderate level and its satisfaction was high. Therefore, high satisfaction does not always mean high quality of service, as mothers' satisfaction may be due to their low expectation. Therefore, in order to evaluate the quality of midwifery services, in addition to obtaining satisfaction, international standards must always be considered.

Efektivitas Pijat Oksitosin Dan Breast Care Pada Ibu Bersalin Terhadap Pengeluaran ASI Di Puskesmas Kamonji

Breastfeeding is one of the global health issues in the 21st century, given that breastfeeding has a significant effect on infant mortality. The absence of breastfeeding in the first days after giving birth is one of the reasons for not creating exclusive breastfeeding. The inhibition of breastmilk secretion can be caused by inhibition of oxytocin secretion which is very instrumental in smoothing out ASI expenditure. Stimulation of the hormone prolactin and oxytocin can be done through breast care and oxytocin massage. Kamonji Health Center is the health center with the lowest exclusive breastfeeding coverage in Palu City, which is 57.3%. The purpose of this study was to find out the comparative time of mother's milk delivery which was given oxytocin massage and breast care within 2 hours postpartum in the Kamonji Community Health Center work area. This study is a quasi-experimental study with the design of The posttest-only control group. The number of samples was 30 people, taken by consecutive sampling technique and divided by 15 respondents into the oxytocin and breast care massage groups. The intervention was carried out within 2 hours postpartum and then observed when the first ASI was discharged after the third stage ended. Data normality test using Shapiro-Wilk test, data analysis using Mann Whitney test obtained a significance value of 0.044, with the average time of mother's breastmilk given oxytocin massage was 14.19 hours and breast care 5.57 hours. The conclusion of the study is that there is a difference in the time of mother's milk to be given oxytocin massage and breast care in the fourth stage of labor. Based on the results of this study it is recommended to do breast care to help accelerate the release of breast milk.

Investigate parturient women's self- reported measures compared with nurses compliance with supportive measures during labour

This study aimed to investigate parturient women's self- reported measures compared with nurses compliance with supportive measures during labour. Setting: This study was conducted at labour and delivery units in the Mansoura University Hospitals, Egypt. Design: A comparative descriptive study. Subjects: Two sampling were used (18 nurses) that had direct worked with parturient women in labor and delivery unit, sample type was convenient sample and a ninety parturient woman who had given birth in Mansoura university hospital, sample type was purposive sample. Tools: For parturient women, an interviewing questionnaire schedule, labor supportive measures questionnaire, and woman's satisfaction questionnaire, for nurses, observational checklist of labor support measures and barriers questionnaire sheet. Results: The study findings showed that based on the parturient women's self report,the most supportive measures received were physical followed by emotional supportive measures during second, third and fourth stage of labour (64.6 ± 25.21, 60.3 ± 25.67, respectively) and received less emotional and physical support during first stage (38.1 ± 27.92, 32.5 ± 14.16, respectively). The overall total score of labor supportive measures were (46.4 ± 11.16) based on a self report by parturient women. Also, the majorty of nurses did not comply with providing labor supportive measures and the overall total score of labor supportive measures were low (31.1 ± 10.30). Else, there was a highly a statistically significant relation between women's self-reported supportive measures and nurses compliance with supportive measures in all domains (P<0.001) except physical supportive measures during first stage of labor (P = 0.247). Too much emergency situation and administrative work were the main barrier that prevents nurses to comply with providing supportive measures. Most of parturient women were unsatisfied with the perceived supportive measures. Conclusion: The results of the study concluded that there was a highly statistically significant relationship between parturient women's self- reported measures and nurses, compliance with supportive measures in all domains except physical supportive measures during first stage of labor. Recommendation: Designed and implemented program for enhancing nurses, compliance with supportive measures during labour by woman health and midwifery nursing department staff.

Nursing Care of The Third and Fourth Stages of Labor : Protocol Of Care

Aim: Aim of this study is to determine the effect of nursing protocol on the third and fourth stages of labor. Setting: The study was conducted at obstetric and gynecology department in benha university hospital. Design: A quasi experimental design was utilized. Sampling: A purposive sample included (80) nurse. Tools: The tools of data collection were interviewing questionnaire sheet and observational checklist. Results:. More than two thirds of the studied nurses had poor knowledge regarding third and fourth stage of labor was poor in pre intervention test and improved to more than three quarter in post intervention test P value<0.001**..Majority of nurses had unsatisfactory practices in pre test as compared with post intervention test P value <0.001** .Conclusion: More than two thirds of the studied nurses had poor score of knowledge in pre test and improved to more than three quarter had good knowledge in post test. Majority of studied nurses had unsatisfactory practices and in pre intervention test as compared with post intervention test and majority of them had satisfactory practice. Recommendation: Educational program for nurses to upgrade their knowledge and practices regarding the third and fourth stages of labor.