Birth Interventions Research Articles

The ABA intervention for improving breastfeeding initiation and continuation: Feasibility study results.

The UK has low breastfeeding rates, with socioeconomic disparities. The Assets‐based feeding help Before and After birth (ABA) intervention was designed to be inclusive and improve infant feeding behaviours. ABA is underpinned by the behaviour change wheel and offers an assets‐based approach focusing on positive capabilities of individuals and communities, including use of a Genogram. This study aimed to investigate feasibility of intervention delivery within a randomised controlled trial (RCT). Nulliparous women ≥16 years, (n = 103) from two English sites were recruited and randomised to either intervention or usual care. The intervention – delivered through face‐to‐face, telephone and text message by trained Infant Feeding Helpers (IFHs) – ran from 30‐weeks' gestation until 5‐months postnatal. Outcomes included recruitment rates and follow‐up at 3‐days, 8‐weeks and 6‐months postnatal, with collection of future full trial outcomes via questionnaires. A mixed‐methods process evaluation included qualitative interviews with 30 women, 13 IFHs and 17 maternity providers; IFH contact logs; and fidelity checking of antenatal contact recordings. This study successfully recruited women, including teenagers, from socioeconomically disadvantaged areas; postnatal follow‐up rates were 68.0%, 85.4% and 80.6% at 3‐days, 8‐weeks and 6‐months respectively. Breastfeeding at 8‐weeks was obtained for 95.1% using routine data for non‐responders. It was possible to recruit and train peer supporters to deliver the intervention with adequate fidelity. The ABA intervention was acceptable to women, IFHs and maternity services. There was minimal contamination and no evidence of intervention‐related harm. In conclusion, the intervention is feasible to deliver within an RCT, and a definitive trial required.

Listening to women\u2019s voices: the experience of giving birth with paramedic care in Queensland, Australia

BackgroundUnplanned out-of-hospital birth is generally assumed to occur for women who are multiparous, have a history of a short pushing phase of labour or are experiencing a precipitate birth. However, there is little research that examines the woman’s perspective regarding factors that influenced their decision on when to access care. This research aimed to explore women’s experience of unplanned out-of-hospital birth in paramedic care. Due to the size of the data in the larger study of ‘Women’s experience of unplanned out-of-hospital birth in paramedic care’ [1], this paper will deal directly with the women’s narrative concerning her decision to access care and how previous birth experience and interactions with other healthcare professionals influenced her experience.MethodNarrative inquiry, underpinned from a feminist perspective, was used to guide the research. Twenty-two women who had experienced an unplanned out-of-hospital birth within the last 5 years in Queensland, Australia engaged in this research.ResultsThe decision of a woman in labour to attend hospital to birth her baby is influenced by information received from healthcare providers, fear of unnecessary medical intervention in birth, and previous birth experience. All themes and subthemes that emerged in the women’s narratives relate to the notion of birth knowledge. These specifically include perceptions of what constitutes authoritative knowledge, who possesses the authoritative knowledge on which actions are based, and when and how women use their own embodied knowledge to assess the validity of healthcare workers’ advice and the necessity for clinical intervention.ConclusionsThe women interviewed communicated a tension between women’s knowledge, beliefs and experience of the birth process, and the professional models of care traditionally associated with the hospital environment. It is essential that information provided to women antenatally is comprehensive and comprehensible. The decisions women make concerning their birth plan represent the women’s expectations for their birth and this should be used as a means to openly communicate issues that may impact the birth experience.

Routine induction in late-term pregnancies: follow-up of a Danish induction of labour paradigm

ObjectivesFor many years, routine elective induction of labour at gestational week (GW) 42+0 has been recommended in Denmark. In 2011, a more proactive protocol was introduced aimed at reducing stillbirths,...

Gestational age, morbidity and mortality among twin births in New South Wales, Australia 2003-2014: A cohort study.

Evidence suggests that the trend toward early planned births observed among singletons may be evident among twin pregnancies. To describe trends in gestational age at birth, pregnancy characteristics, neonatal morbidity and mortality among twin pregnancies. Population-based data linkage study of twin births of ≥30weeks of gestation without a major congenital anomaly born in 2003-2014 in New South Wales (NSW), Australia. Linked pregnancy and birth, hospital and mortality data were used. Generalised linear regression was used to assess linear trends. Risk difference (RD) and 95% confidence intervals were estimated. Among 28076 eligible twin births (14038 pregnancies), 49% of births occurred prior to 37weeks and 69% of births were planned (pre-labour caesarean or induction of labour). There were increases over time in the proportion of twin births at preterm gestations (30-34weeks (RD 2.1, 95% CI 0.1, 4.0), 35-36weeks (RD 7.5, 95% CI 5.4, 9.7)) and in the rates of planned births (pre-labour caesarean (RD 6.4, 95% CI 4.0, 8.8), induction (RD 4.6, 95% CI 2.6, 6.6)). There was no significant change in stillbirth or neonatal death rates, but there was an increase in neonatal morbidity over the study period. Concurrently, there were increases in the prevalence of gestational diabetes; and decreases in pregnancy hypertension, assisted reproductive technology use, small-for-gestational age and birthweight discordance. Gestational age at birth among twin births is decreasing and birth intervention is increasing. There are increasing rates of neonatal morbidity, but no overall change in perinatal mortality.

Building a birth cohort of births and their outcome in England and Wales using linkage of administrative data

Background/rationaleWhen a baby is born in England and Wales, the event is recorded in several separate systems, each of which contains different data items. Data recorded at birth registration are mainly socio-demographic, while some different data items are recorded when the birth is notified to the NHS. The data recorded in hospital systems in England and in Wales about the majority of babies who are born in NHS maternity units are largely clinical.
 Over a ten year period, a series of three collaborative projects have linked data about 7,013,804 births registered in 2005-14 to establish a birth cohort for use in research and national statistics and to quality assure the linkage. Data about outcomes of birth in terms of death and subsequent readmissions to hospital have also been linked in. The linked data are held in the Secure Research Service at the Office for National Statistics.
 The data have been used for analyses of pattern of births by time of day, day of the week and season and in relation to obstetric intervention in labour and birth. They are now being used by other researchers.
 strong>Challenges encounteredThere were major problems in accessing NHS data for England, compounded by intermittent availability of funding.
 Lessons learnedDespite the many challenges, it proved feasible to construct a linked birth cohort which has increased the scope and range of national maternity data for England and Wales. NHS Digital’s opt-outs are causing gaps in national data and could invalidate linkage.
 RecommendationsThe cohort should be updated with data for more recent years. Linkage should be undertaken within ONS by teams who are not subject to NHS Digital’s opt-out policy. Data access policies should reflect the higher public trust in research uses of NHS data compared to commercial uses.

Characteristics and changes in characteristics of women and babies admitted to residential parenting services in New South Wales, Australia in the first year following birth: a population-based data linkage study 2000–2012

ObjectiveTo examine the characteristics of women and babies admitted to the residential parenting services (RPS) of Tresillian and Karitane in the first year following birth.DesignA linked population data cohort study...

Cervical length and quantitative fetal fibronectin in the prediction of spontaneous preterm birth in asymptomatic women with congenital uterine anomaly

Congenital uterine anomalies are associated with late miscarriage and spontaneous preterm birth. Our aim was 1) to determine the rate of spontaneous preterm birth in each type of congenital uterine anomaly, and 2) to assess the performance of quantitative fetal fibronectin and cervical length measurement by transvaginal ultrasound in asymptomatic women with congenital uterine anomalies for the prediction of spontaneous preterm birth at <34 and <37 weeks of gestation. This was a retrospective cohort of women with congenital uterine anomalies asymptomatic for spontaneous preterm birth, from 4 tertiary referral centers in the United Kingdom (2001-2016). Congenital uterine anomalies were categorized into fusion (unicornuate, didelphic, and bicornuate uteri) or resorption defects (septate, with or without resection, and arcuate uteri), based on prepregnancy diagnosis. All women underwent serial transvaginal ultrasound cervical length assessment in the second trimester (16 to 24 weeks' gestation); a subgroup underwent quantitative fetal fibronectin testing from 18 weeks' gestation. We investigated the relationship between congenital uterine anomalies and predictive test performance for spontaneous preterm birth at <34 and <37 weeks' gestation. A total of 319 women were identified as having congenital uterine anomalies in our high-risk population. Of the women, 7% (23/319) delivered spontaneously at <34 weeks' gestation and 18% (56/319) at <37 weeks' gestation. Rates of spontaneous preterm birth by type were asfollows: 26% (7/27) for unicornuate, 21% (7/34) for didelphic, 16% (31/189) for bicornuate, 13% (7/56) for septate, and 31% (4/13) for arcuate. In all, 80% (45/56) of women who had spontaneous preterm birth at <37 weeks did not develop a short cervical length (<25 mm) during the surveillance period (16-24 weeks). The diagnostic accuracy of short cervical length had a low sensitivity (20.3) for predicting spontaneous preterm birth at <34 weeks. Cervical length had an area under the receiver operating curve of 0.56 (95% confidence interval, 0.48-0.64) and 0.59 (95% confidence interval, 0.55-0.64) for prediction of spontaneous preterm birth at <34 and <37 weeks, respectively. The area under the curve for cervical length to predict spontaneous preterm birth at <34 weeks was 0.48 for fusion defects (95% confidence interval, 0.39-0.57) but 0.78 (95% confidence interval, 0.66-0.91) for women with resorption defects. Overall quantitative fetal fibronectin had an area under the curve of 0.63 (95% confidence interval, 0.49-0.77) and 0.58 (95% confidence interval, 0.49- 0.68) for prediction of spontaneous preterm birth at <34 and <37 weeks, respectively. The area under the curve for prediction of spontaneous preterm birth at <37 weeks with quantitative fetal fibronectin for fusion defects was 0.52 (95% confidence interval, 0.41-0.63) but 0.79 (95% confidence interval, 0.63-0.95) for women with resorption defects. Results were similar when women with intervention were excluded. The commonly used markers cervical length and quantitative fetal fibronectin have utility in prediction of spontaneous preterm birth in resorption congenital uterine defects but not in fusion defects. This is contrary to findings in other high-risk populations. These findings need to be accounted for when planning antenatal care, and have potential implications for predictive tests used in spontaneous preterm birth surveillance and intervention.

Impact of the Combined Diabetes Clinic on HbA1c Changes and Outcomes in Pre-existing Diabetics in Rural Saskatchewan [14A

INTRODUCTION: Pregnant women with pre-existing diabetes have increased risk for poor outcomes such as macrosomia, shoulder dystocia, still birth and intrapartum interventions. The Combined Diabetes Antenatal Clinic (CDAC) in Prince Albert (started in 2012) is a multidisciplinary clinic that serves rural northern Saskatchewan where the prevalence of diabetes in pregnancy is high. The goals of the CDAC are to improve euglycemia and pregnancy outcomes. METHODS: Retrospective cohort chart review to quantify the reduction in HbA1c after CDAC interventions and if the reduction in HbA1c improved pregnancy outcomes. Ethics approval was obtained from University of Saskatchewan. RESULTS: We identified 116 CDAC patients with pre-existing diabetes between 2012-2017. Majority of the population (52%) had to travel over 200 km to reach the CDAC clinic. There were high rates of obesity (71%) and high parity (28% Para 4 or more), majority were Type 2 diabetics and 87% of mothers were on insulin at the time of delivery. Women often (75%) presented to the CDAC after the first trimester. However, over 50% of patients who attended the CDAC reached the target of having an HbA1c below 6.5% prior to delivery. Mean change in HbA1c was -1.0% (SD 0.5-2.4) Mothers with HbA1c below 6.5% at the time of delivery had lower rates of shoulder dystocia (5.9% vs 2.3%) and still birth (11.8% vs 4.5%). CONCLUSION: The CDAC is effective in reducing the HbA1c and reductions below 6.5% is associated with improved pregnancy outcomes. We advocate pre-pregnancy counselling and booking early in pregnancy for pre-existing diabetes in this rural population

Who Is Harmed When Labor Floors Are Busy? A Racial Disparities Analysis [27T

INTRODUCTION: Busyness on labor and delivery floors is associated with higher odds of interventions and adverse maternal outcomes. Other studies suggest that providers' implicit biases are activated during busy times. We test the hypothesis that the “busyness effect” is more pronounced for black women than for white women. METHODS: We ran race-stratified logistic regressions to estimate whether delivering at busier times was associated with higher odds of birth interventions or adverse outcomes for the mother or neonate, controlling for hospital and other factors. The data included linked birth certificate and claims data for all births at 21 hospitals in Philadelphia from 1996-2010 (n=290,169 births). RESULTS: Within a hospital, delivering at a busy time is associated with increased odds of interventions for both white women (OR=1.08, 95% CI (1.03,1.14)) and black women (OR=1.07, 95% CI (1.04,1.12)); however, it is only associated with increased odds of adverse maternal outcomes for black women (OR=1.06, 95% CI (1.02,1.10)), not for white women (OR=1.01, 95% CI (0.96,1.06)). Busyness is not associated with adverse outcomes for neonates. These results hold after excluding hospitals with racially homogenous patient populations. CONCLUSION: Busyness on labor and delivery floors is associated with increased odds of adverse maternal outcomes for black women, but not for white women, which could contribute to racial disparities in maternal outcomes. Further research is needed to better understand this association.

Geography determines cost effectiveness of birth intervention

Geography determines cost effectiveness of birth intervention

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary.

Maternity care in the United States continues to be intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy has decreased but is still higher than it should be. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This paper describes the use and effect of routine interventions on the physiologic process of labor and birth and identifies the unintended consequences resulting from the routine use of these interventions in labor and birth.

The Support for New Mums Project: A protocol for a pilot randomized controlled trial designed to test a postnatal psychoeducation smartphone application.

To report a pilot trial protocol for testing the effectiveness of the Support for New Mums smartphone application in a cohort of first-time mothers. A pilot/feasibility randomized controlled trial using a two-group pre-test and repeated post-test design. This protocol follows the Standard Protocol Items: Recommendations for Intervention Trials (SPIRIT) guidelines. The Intervention group will receive access to the smartphone application for 6weeks post birth. Both Intervention and control groups will receive standardized institutional postnatal care services. Trial funding was gained from respective grant sponsors in May and November 2016. The Support for New Mums smartphone application could be a novel method for addressing the gap in provision of postpartum care services providing psychoeducation and improving maternal parental self-efficacy for Australian childbearing women. Australian New Zealand Clinical Trials Registry ACTRN12618001580268.

The Impact of the Physical Environment on Intrapartum Maternity Care: Identification of Eight Crucial Building Spaces.

This article investigates whether the physical environment in which childbirth occurs impacts the intrapartum intervention rates and how this might happen. The study explores the spatial physical characteristics that can support the design of spaces to promote the health and well-being of women, their supporters, and maternity care professionals. Medical interventions during childbirth have consequences for the health of women and babies in the immediate and long term. The increase in interventions is multifactorial and may be influenced by the model of care adopted, the relationships between caregivers and the organizational culture, which is made up of many factors, including the built environment. In the field of birth architecture research, there is a gap in the description of the physical characteristics of birth environments that impact users' health. A scoping review on the topic was performed to understand the direct and indirect impacts of the physical environment on birth intervention rates. The findings are organized into three tables reporting the influence that the physical characteristics of a space might have on people's behaviors, experiences, practices and birth health outcomes. Eight building spaces that require further investigation and research were highlighted: unit layout configuration, midwives' hub/desk, social room, birth philosophy vectors, configuration of the birth room, size and shape of the birth room, filter, and sensory elements. The findings show the importance of considering the physical environment in maternity care and that further interdisciplinary studies focused on architectural design are needed to enrich the knowledge and evidence on this topic and to develop accurate recommendations for designers.

The Senses of Birth intervention to decrease cesarean and prematurity rates in Brazil.

ObjectiveTo increase knowledge and promote cultural change toward valuing normal birth, and to lower rates of cesarean and unnecessary interventions during childbirth in Brazil via the Senses of Birth (SoB) exhibition.MethodsThe SoB intervention targeted 22 621 participants in three Brazilian cities in 2015. The effects of the exhibition in knowledge, perceptions, and preferences regarding childbirth were analyzed in a multi-method study. Pre- and post-exhibition survey responses of 17 501 (77.0%) visitors, 1947 (8.6%) non-pregnant women, and all pregnant women (n=1287) were collected at the exhibition. A follow-up survey was completed by 555 (43.0%) postpartum women who had participated at SoB while pregnant. Univariate analyses were used to compare before and after changes.ResultsThere was a significant increase in knowledge about normal birth, varying from 10.0% to 25.0% among general visitors (P<0.001) and 27.3% to 42.0% among pregnant women (P<0.001). Perceptions and preferences for normal birth also changed, reaching 83.0% of general visitors and 87.4% of pregnant women.ConclusionSoB was found to effectively improve knowledge about and preference for normal birth. Scaling-up the intervention might contribute to cultural change toward valuing normal birth, and might decrease the rate of unnecessary cesarean and premature birth in Brazil.

Urgency to build a connection: Midwives’ experiences of being ‘with woman’ in a model where midwives are unknown

ObjectiveThe objective of this study was to explore midwives’ experiences of being ‘with woman’ in the intrapartum period within the context of an unknown midwife model. DesignA descriptive phenomenological design was used with individual in-depth interviews. Transcribed interviews were analysed using thematic analysis that incorporated the data analysis framework offered by Amadeus Giorgi. SettingHospitals within Western Australia providing intrapartum care to women where the midwife is not usually known to them. ParticipantsTen midwives were interviewed and recruitment ceased when data saturation was reached. FindingsFindings confirm the importance of building a connection to enable partnership with the woman and provide woman-centred care that is inclusive of her partner. Factors influencing midwives’ ability to be ‘with woman’ included the ‘systems’ approach to childbearing as well as common birth interventions prevalent within the public hospital system. Midwives experienced both rewards and challenges associated with being ‘with woman’ in the unknown midwife model, adaptability and self-awareness were features that enhanced the ability to be ‘with woman’ within this model. Key conclusionsFindings present new knowledge about being ‘with woman’, a phenomenon so central to the profession of midwifery, yet previously unexplored in the empirical domain. Insights gained reveal the intersection between the phenomenon and the unknown midwife model and highlight characteristics of the midwives that facilitate being ‘with woman’ such as adaptive expertise. Implications for practiceUnderstanding the concept of being ‘with woman’ through the lived experience of midwives provides unique insight into the applied practices of the phenomenon. Characteristics of being ‘with woman’ as well as attributes and strengths demonstrated by the midwives provides important data for education and development of the profession. Explicating the challenges faced by midwives seeking to be ‘with woman’ in the unknown midwife model is useful for health leaders of service delivery and policy development to consider innovative ways to enhance this important practice advised by professional philosophy.

Is It Really Mothers’ Choice?

Much of the debate about breastfeeding is framed as the “mother’s choice.” As providers, we must always respect mothers’ choices about how they feed their babies. However, there are provider-level barriers that undermine breastfeeding and, therefore, limit mothers’ feeding choices. We address two systemic/provider-level barriers: birth interventions and providers’ attitudes. Both birth interventions and negative provider attitudes about breastfeeding undermine the oxytocin system, making breastfeeding more difficult. Becoming aware of these barriers, providing mothers with effective support during labor and postpartum and changing provider attitudes are essential for increasing exclusive breastfeeding rates.

Interventions to Try to Prevent Preterm Birth in Women With a History of Conization: A Systematic Review and Meta-analyses.

The most effective preterm birth (PTB) intervention is unknown for women who are at risk of PTB due to a history of conization. The objective of this systematic review was to determine whether PTB interventions, progesterone, cerclage, and pessary decrease the risk of PTB compared to no treatment in singleton-and separately in twin-pregnancies of women with history of conization. We searched Cochrane Central, MEDLINE, EMBASE, CINAHL, and ClinicalTrials.gov from January 1994 until May 2017. In duplicate, we reviewed titles, abstracts, full texts, extracted data, and assessed quality. We included RCTs and observational studies. Our primary outcomes were PTB <34 weeks, PTB <37 weeks, and neonatal mortality. We performed random effects meta-analyses and generated ORs with 95% CIs. We screened 762 nonduplicate titles and abstracts and assessed 91 full texts. After contacting authors, we included nine studies. Women in the cerclage group were more likely to have a short cervix or another risk factor for PTB, raising the possibility of confounding by indication. In women with a history of conization and a singleton who received a cerclage compared to those who did not, the ORs of PTB <34 weeks was 3.99 (95% CI 0.67-23.62, three studies, I2 = 65%); of PTB <37 weeks was 2.10 (95% CI 0.87-5.05, four studies, I2 = 0%); and of neonatal mortality was 8.33 (95% CI 0.22-320.38, two studies, I2 = N/A). We did not find any studies comparing either progesterone or pessary to no treatment. Data for twins were very scarce. In women with a previous conization and a current singleton gestation, the existing evidence, which is likely limited due to confounding by indication, does not support cerclage or other interventions used to try to decrease PTB.

Quantitative insights into televised birth: a content analysis of One Born Every Minute

ABSTRACTThis article explores birth representations through a content analysis of two seasons of the U.K. program, One Born Every Minute (OBEM) (Channel 4, 2010–). Reality television (RTV) has been a fertile ground for the mediation of birth, but has also stoked controversy among feminist critics and the birth community about how birth is represented and the impacts this might have for women and society. International research has explored problematic over-representation of white, heterosexual couples, as well as noting a predominance of medicalized birth experiences. However, this research is formed largely of qualitative studies that are necessarily based on small samples of episodes. To contribute to this literature, we apply a quantitative and interdisciplinary lens through a content analysis of two seasons of the U.K. version of OBEM. Paying attention to the geographical and temporal context of OBEM, this article confirms over-representation of white, heterosexual couples and medicalized birth on RTV birth shows while also providing novel insights into the ambiguous representation of birthplace and lead caregivers, the medicalization of birth through the routinization of supposedly minor birth interventions, and the absence of the representation of women’s choice over such interventions.

Exploration of the Meaning of Spinning Education Program on Naturalistic Birth and Nursing Intervention

Exploration of the Meaning of Spinning Education Program on Naturalistic Birth and Nursing Intervention

A postgraduate Optimum Birth module to increase midwives' readiness to work in midwifery-led settings: A mixed-methods evaluation.

Midwifery-led birth settings have been recommended as the most cost-effective birthplaces for healthy women experiencing uncomplicated pregnancies. However, midwives complete most of their training in obstetric units where birth interventions are common. To prepare for working in a midwifery-led setting training is a key priority. This study evaluated a postgraduate-level midwifery module on Optimum Birth (defined as birth which supports physiology and empowerment, avoiding unnecessary intervention) designed to prepare midwives for supporting women in midwifery-led settings. A mixed-methods design was employed. Pre-module and post-module questionnaires measured attitudes, knowledge, confidence, and learning outcomes. Qualitative data collection included a final-day focus group and 8- to 10-week follow-up interviews. The target for recruitment was 15 postgraduate midwives. Fifteen midwives practicing in three London boroughs enrolled of whom 14 completed the module. Pre-total and post-total scores were analyzed with paired-sample t tests. Qualitative data were analyzed using thematic analysis. Quantitative and qualitative data indicated that the module increased participants' self-reported skills, knowledge, and confidence in practicing Optimum Birth. Qualitative data indicated ways in which midwives were implementing changes to promote Optimum Birth in their place of work. Attitudes were highly positive pre-module and post-module. The Optimum Birth module provided appropriate training for preparing midwives for the shift toward working in midwifery-led settings. Midwifery leaders and managers should implement strategies to develop midwives' philosophy, knowledge, and skills to increase their readiness to work in midwifery-led birth settings.