Women In Labor Research Articles

What makes labor difficult? Predictors and features of difficult labor in women’s and midwives’ perspective

Abstract Aim. The aim of this study was to identify what are the features of ‘difficult labor’ in the perspective of women giving birth and midwives providing care. Material and methods. Cross-section, preliminary study based on the analysis of the labor observation form and level of labor difficulty assessment form designed for the purpose of this study and fi lled in by the midwives participating in the study. The participants were 31 midwives working on the labor unit in one of the hospitals in Warsaw, Poland and 152 women who gave birth. Results. Women who had epidural, larger babies and a negative attitude towards birth and a prolonged fi rst stage of labor, were more likely to assess their labor as difficult. Among midwives labors with a longer second stage, abnormal uterine contraction patterns, and prolonged latent phase and fi rst stage of labor were assessed as more difficult. Conclusions. Some labors, despite being classified as physiological, require more effort on the part of both the midwife and woman giving birth and end with a higher level of fatigue for both. Predictors of difficult labor should be used by healthcare personnel as a guidance to help identify women at risk of negative labor experiences.

Ambiance as a Key for a Better Birth Experience.

This research provides insights into childbirth as a sensitive experience, from the perspective of its user, "woman in labour," as well as from the perspective of the event itself, "the childbirth," and the birth space, with its spatial and ambiantal configurations. By adopting an in-situ approach, we conducted a spatial and ambiantal characterization of two childbirth different contexts; Tunis and Grenoble. Along this work, we used various methods such as ethnographic observation and semistructured interviews with mothers and midwives, when following visits to the birth spaces in Grenoble. Our experimental protocol was refined by introducing the capture of emotions, notably through the analysis of electrodermal activity variation, for the case of the Maternity and Neonatology Center in Tunis. In correlation with observations and interviews, the analysis of electrodermal activity reveals the mother's emotional state. Subsequently, we undertook a transposition and synthesis of significant ambiantal situations encountered in the birth space in Grenoble and Tunis, during labour phase of childbirth. Six ambiantal situations-types are identified and distributed across two dimensions: luminous and kinesthetic. The results of this research are extremely useful to guide the choices in design of birth space while at the same time considering the well-being of woman in labour. We will end with an ambiantal project that proposes interventions on spatial quality by introducing an ambiantal dimension to the birth space.

Systematic Review and Meta-Analysis of Prevalence and Risk Factors for Psychological Birth Trauma.

Psychological birth trauma is common among women in labor and has severe implications for maternal and infant health. Although the prevalence and risk factors of psychological birth trauma have been widely reported, these findings have not been systematically synthesized, limiting screening and interventions. This study aimed to determine the pooled prevalence of and risk factors for psychological birth trauma. The Cochrane Library, Web of Science, PubMed, Embase, and Scopus databases were systematically searched between their inception and October 1, 2023. Pooled prevalence, odds ratio, and 95% confidence intervals were calculated using fixed or random effects models using Stata 15.0. The pooled prevalence rate of psychological birth trauma was 19%. We performed subgroup analysis based on age, parity, region, and measurement tools. The results showed differences in the prevalence of psychological birth trauma between these subgroups, suggesting the need for clinical personalization in different populations. The pooled odds ratio showed that fear of childbirth, cesarean section, operative vaginal birth, pain during labor, and dissatisfaction with support from midwives were significantly associated with psychological birth trauma. The study found that the pooled prevalence of psychological birth trauma was 19%. PBT risk factors are diverse, and understanding the prevalence and risk factors for psychological birth trauma has important implications for health care and social care systems.

Use of the WHO partograph and Zhang’s guideline for labor and delivery in China: implications for clinical practice

BackgroundThere is an unmet need for a large comprehensive population-based dataset documenting national birthing trends in China and a partograph specifically tailored to Chinese women. This study assessed the impact of using the World Health Organization (WHO) partograph or Zhang’s guideline to manage labor and delivery in China and inform the development of a partograph that specifically aligns with the progression of labor in Chinese women.MethodsThis retrospective analysis included low-risk nulliparous women with a singleton, full-term fetus in cephalic presentation entering spontaneous labor at a specialized obstetric hospital in China between January 2010 and June 2022. Pregnant women were managed according to the WHO partograph (January 2010-August 2014, n = 31,286) or Zhang’s guideline (September 2014-June 2022, n = 49,821).ResultsRates of assisted reproduction (4.57% vs. 1.05%; p < 0.0001) and hypertension (7.44% vs. 6.71%; p < 0.0001) were significantly higher for pregnant women managed according to Zhang’s guideline compared to the WHO partograph. Rates of labor intervention (35.31% vs. 13.95%; p < 0.0001), including induction of labor by oxytocin, artificial rupture of membranes, lateral episiotomy and conversion to cesarean section (all, p < 0.0001), were significantly higher for pregnant women managed according to the WHO partograph. Rates of forceps assisted vaginal deliveries (12.67% vs. 6.42%; p < 0.0001) and postpartum hemorrhage (10.9% vs. 6.2%; p < 0.0001) were significantly higher, and birth asphyxia (0.15% vs. 0.09%; p = 0.02) was significantly lower, for pregnant women managed according to Zhang’s guideline.ConclusionsThis study provides valuable insights into the utilization of the WHO partograph and Zhang’s guideline in managing labor and delivery among Chinese women. Findings indicate that women managed according to Zhang’s guideline had higher rates of assisted reproduction and hypertension, suggesting a potentially different demographic profile or underlying health conditions compared to women managed according to the WHO partograph. Notably, the use of the WHO partograph was linked to a significant increase in labor interventions, while Zhang’s guideline resulted in higher rates of forceps-assisted vaginal deliveries and postpartum hemorrhage, yet interestingly, a lower incidence of birth asphyxia. These contrasting outcomes underscore the importance of aligning labor management tools with the specific needs and progression of labor in Chinese women. The results advocate for a tailored partograph that could better reflect the unique characteristics of Chinese women and optimize decision making and maternal and neonatal outcomes.

Vaginal Misoprostol Pharmacokinetic Changes in Obese Parturient Women Who Presented Labor Induction Failure.

Clinical experience shows an increased duration of labor in obese parturient women. It is unclear if this population should receive the same dose of vaginal misoprostol for induction of labor as non-obese parturient women. We investigate the influence of obesity on the pharmacokinetics and placental transfer of the metabolite misoprostol acid in parturient women. Parturient women (n = 40) were enrolled and received misoprostol 25 µg/6 h vaginally and were allocated into two groups according to the pre-pregnancy body mass index (BMI <30 kg/m2 non-obese, n = 18 or BMI >30 kg/m2 obese, n = 22) or according to the labor induction outcome (failure [n = 10] or success [n = 30]). Blood collection for pharmacokinetic study occurred after the first misoprostol dose. The pharmacokinetic parameters obtained in non-obese parturient women were not statistically different from those obtained in obese group (PValue > .05). However, when the parturient women were grouped by the labor induction outcome, the failed labor induction group presented a higher (median [interquartile range]) BMI (44.4 [34.6-47.9] vs 33.7 [28.9-36.5] kg/m2) (PValue = .0017), lower Cmax (11.5 [4.82-22.2] vs 22.8 [14.2-30.8] pg/mL) (PValue = .0308) and not statistically different AUC0-6 (31.8 [13.4-61.5] vs 53.4 [35.4-77.7]) pg·h/mL) (PValue = .0580) and tmax (2.50 [1.19-4.25] vs 3.00 (1.88-5.00) h (PValue = .3198) when compared with parturient women who presented successful labor induction. This data suggests a higher loading dose (higher volume of distribution) and unchanged maintenance dose (unchanged AUC0-6) of misoprostol for this population. Further studies are required to investigate the efficacy and safety of higher misoprostol loading doses for this population.

Effect of using a birth ball on birth satisfaction and pain in pregnant women during labor: a randomized controlled trial.

This study was applied to evaluate the effect of birth ball use on birth satisfaction and pain levels of pregnant women during labor. The type of study is randomized controlled. The data of the study were collected in the delivery room of a state hospital in Konya/Türkiye between March 2020 and December 2021. The sample of the study consisted of 57 pregnant women for the intervention group and 54 pregnant women for the control group. During labor, intervention group was seated on the birth ball in an upright position; control group was laid on the bed in semi-fawler or lateral positions. In the study, Descriptive Information Form, Birth Process Follow-up Form, Visual Analog Scale and Birth Satisfaction Scale-Revised were used as data collection tools. It was determined that the pain scores of the pregnant women in the intervention group were lower during the first and second follow-up than the control group. The duration of the active phase of labor in the intervention group was shorter than in the control group, and a statistically significant difference was found between them. It was found that the Birth Satisfaction Scale-Revised total score, the sub-dimensions of quality of care, women's attributes and stress experienced during labor of the pregnant women in the intervention group were higher than the control group. According to the results of the study, the use of a birth ball during the active phase of labor reduces the pain level during labor and increases the level of birth satisfaction of pregnant women.

The influence of complications of pregnancy, childbirth and comorbid pathology on the level of physical development of children of indigenous peoples of the North of the Khanty-Mansiysk Autonomous Okrug — Yugra

BACKGROUND: The state policy in the field of public health protection is aimed at increasing the birth rate, reducing mortality, and preventing diseases. The topic of the health of the indigenous peoples of the North (IPN) has been and remains relevant today for Russia. AIM: To assess the physical development of children of indigenous small-numbered peoples of the North, depending on the mother’s comorbid pathology, complications of pregnancy and childbirth. MATERIALS AND METHODS: The study examined the physical development of children of indigenous small-numbered peoples of the North, the comorbid pathology of their mothers, the course of their pregnancy and childbirth. Factorial and regression analysis methods were used to identify relationships and interdependencies. RESULTS: In the studied group of children of the IPN, low physical development is observed in 4.49% of children, average in 49.43%, high in 48.31% of children. Girls have a significantly lower physical development (2.12%) compared to boys — 7.14%. In the studied group of children of the IPN, there is not a single case of sharply disharmonious physical development. In pregnant women, representatives of the IPN, anemia, chronic urogenital infections, liver and biliary tract diseases, obesity and diseases of the cardiovascular system are most often observed in the structure of comorbid pathology. Among the pregnancy complications of the mothers of the examined children, fetoplacental insufficiency, gestosis, high/low water intake, the threat of termination of pregnancy, threatening premature birth are observed. Among the complications of childbirth, there are umbilical cord entanglement, labor reinforcement, neonatal jaundice and perinatal lesions of the central nervous system. At the stage of regression analysis, predictors were identified that affect the physical development of the child — these are intrauterine growth retardation and fetal hypotrophy, threatening premature birth in a woman in labor, and the gestational age of the newborn. CONCLUSIONS: A high level of physical development is determined in 48.31% of children of the IPN, average in 49.43%, low in only 2.26%, which indicates the adaptation of the indigenous population to the harsh conditions of the North. The structure of comorbid pathology in women living in the Khanty-Mansiysk Autonomous Okrug — Yugra mainly corresponds to the average indicators in the Russian Federation, both in qualitative and quantitative terms. The exception is a regional pathology with liver and biliary tract damage associated with the epidemiological situation in the opisthorchiasis district. Regression analysis revealed the interdependence of the child’s physical development from intrauterine growth retardation, threatening premature birth, intrauterine hypotrophy and gestational age.

Optimal timing for induction of labor in normotensive women: A retrospective cohort study.

Labor induction is offered to reduce the risk of stillbirth at late term (41+0 to 41+6) but earlier induction in normotensive singleton pregnancies is supported by weak evidence. The aim of the present study was to investigate the optimal timing for induction in normotensive women. This was a retrospective cohort study including 70 293 singleton term births in Iceland during 1997-2018. Women with serious pre-gestational comorbidity, hypertension, stillbirth or previous cesarean birth were excluded. The risk of adverse maternal and neonatal outcomes for induction at each week from gestational age 37-41 weeks was compared with expectant management, defined as deliveries at a later gestational age. Risk ratios (RRs) and 95% confidence intervals (95% CI) were calculated using log-binomial regression adjusting for sociodemographics, parity, and pregnancy complications. The risk of cesarean was lower with induction at ≥40+0 than expectant management, especially at late term (RR 0.73, 95% CI: 0.63-0.83). Respiratory distress was diagnosed in 4.4% of infants after induction from 37+0 to 37+6 but 1.3% in the expectant management group (RR 3.08, 95% CI: 1.97-4.81). Induction between 37+0 and 38+6 compared with expectant management was associated with a reduced risk of shoulder dystocia, but this was non-significant in births of infants with normal birthweight. Labor induction from 40+0 compared with expectant management was associated with reduced risk of cesarean birth in Icelandic women without an increase in risk of adverse maternal or neonatal outcomes. No additional benefit appeared to be from inducing at earlier gestations in low-risk pregnancies.

Interaction between time-of-day and oxytocin efficacy in mice and humans with and without gestational diabetes.

Management of labor in women with diabetes is challenging due to the high risk of peri- and postpartum complications. To avoid cesarean section and assist with labor progression, Pitocin, a synthetic oxytocin, is frequently used to induce and augment labor. However, the efficacy of Pitocin is often compromised in diabetic pregnancies, leading to increased cesarian delivery. As diabetes deregulates the body's circadian timekeeping system and the time-of-day of the first Pitocin administration contributes to labor duration, our objective was to determine how the time of day and the circadian clock gene, Bmal1 , gates oxytocin efficacy. Our studies in mice show that, compared to the rest phase of the day (lights on), the uterotonic efficacy of oxytocin is significantly increased during the active phase (lights off). Using in vitro studies, a myometrium-specific Bmal1 conditional knockout mouse model, and a mouse model of food-induced gestational diabetes, we find that Bmal1 is crucial for maintaining oxytocin receptor expression and response in the myometrium in mice. These findings also translate to humans, where oxytocin-induced human myometrial cell contraction is time-of-day dependent, and retrospective clinical data suggest that administration of Pitocin in the morning should be considered for pregnant women with gestational diabetes.

Evaluating the effects of back massage during labour on delivery outcomes: A prospective study on primigravida mothers

The labor and delivery process can be stressful for parturient women, especially for primigravida mothers. Birth companions providing massage and emotional support can help make more pleasant birthing experience. This study aimed to assess the impact of back massage by trained birth companions on reducing analgesic use, pain intensity scores, and labor duration. The study was conducted on primigravida women. During antenatal care visits, companions in the intervention group were trained in massage techniques, while no training was imparted to companions in the control group. Data were collected using a pre-tested questionnaire during antenatal clinic visits and delivery A multivariable logistic regression model was used to assess the impact of massage on delivery outcomes while adjusting for significant confounding variables.The study demonstrated a positive impact of back massaging on labor and delivery outcomes. Mothers in the massaged group were 2.27 times less likely to receive analgesics and 3.71 times more likely to experience a reduction in pain intensity scores of &amp;#62; 2 compared to those receiving usual care. Additionally, the massaged group had a 2.24 times higher likelihood of reducing labor duration to &amp;#60; 12 hours compared to the usual care group. Back massaging by trained birth companions is an effective intervention for reducing the use of analgesics, pain intensity scores, and the length of labor in primigravida women.

Knowledge and attitudes of health care professionals regarding birth preparedness of women in labour at selected Hospitals in KwaZulu-Natal, South Africa: A qualitative study

Introduction Low and middle-income countries account for the largest proportion of women’s deaths as a result of pregnancy or childbirth-related complications. The sub-Saharan region is the most affected with approximately 70% (202 000) of maternal deaths between 2000 and 2020. These deaths could have been prevented if expectant mothers were prepared for childbirth. Birth preparedness is perceived as a better strategy that helps attain a substantial reduction in maternal mortality. This is achieved by attending early antenatal classes, receiving skilled care during childbirth, and care and support right after birth. The latest survey on antenatal class attendance conducted in South Africa provides an estimated 30.8% of expectant mothers in public healthcare facilities. Methods This study employed a qualitative approach to collect data, as a result, one focus group discussion with five (N=5) participants and two others with six (N=6) participants each (n=6X2=12) and twenty individual interviews were conducted. The study sought to explore and describe the knowledge and attitudes of healthcare professionals regarding the birth preparedness of women in labour at selected hospitals in Durban KwaZulu-Natal. Results Expectant mothers were unprepared for both labour and postnatal care. The unprepared expectant mothers were uncooperative and made the task of midwives difficult to the extent of endangering the life of their expected newborn babies and their own. Factors such as finance, heterogeneity, staff shortage, language barrier, lack of family support, lack of interest, cultural beliefs, and confusion caused by various sources of information were responsible for birth unpreparedness. Conclusion The synergy between expectant mothers and midwives appears to be an important factor in achieving better birth preparedness.

Optimism and resilience among the precariat: a gendered analysis of community home-based care work in South Africa

ABSTRACT Community Home-Based Care (CHBC) workers around the world have not been satisfied with their work over the years. In South Africa, unfair labor practices and poor organization of CHBC work have recently led to strikes and unionization by caregivers. At the frontline of caregiving are black working-class women whose dominance illuminates how the intersections of gender, class and race contribute to care workers’ precariat position. Regardless of the gendered precarious encounters, the 20 female CHBC workers from Soweto, South Africa, who participated in this study, are optimistic and resilient. This article visibilizes the optimism, resilience, positivity, self-empowerment, control, the gendered power, and agency that care workers exercise in response to the challenges that characterize care work. Beyond merely illuminating the gendered oppositional binaries, the article calls for the deconstruction of gendered hierarchies in care work to disrupt the exclusive participation of women in the global labor markets as care workers.

Assessment of Midwives’ Knowledge and Application of the Modified WHO Partograph at Ga South Public Health Facilities, Greater Accra, Ghana

Background The partograph, one of the vital tools available for the midwife, was originally developed from Friedman’s 1954 Cervicograph by Philpott and Castle in 1972. It was later modified and adopted by the WHO as a universal ‘gold standard’ tool for recording and monitoring progress in labour and providing interventions in cases of abnormal labour. The goal of this study was to assess the level of knowledge of midwives and their utilisation of the modified WHO partograph at the Ga South Municipality in the Greater Accra Region of Ghana. Methodology An institution-based quantitative cross-sectional study was conducted within the municipality from February to March 2019. One hundred and ten (110) midwives were recruited using the census approach. Data were collected using a structured self-administered questionnaire. STATA statistical software version 14 was used for descriptive analysis and results were reported in the form of percentages and frequencies using charts and tables. Pearson’s Chi-Square estimation was also performed to test the association between selected variables with a p value &lt;.05 as the threshold for statistical significance. Results Of the 110 participants, 105 (95.5%) of the midwives could properly describe the partograph and 104 (94.5%) understood that it was used as a tool for vital decision-making, while 92 (83.6%) indicated that partograph contributes in reducing maternal and new-born deaths. Almost all participants, 109 (99.09%) knew all the parameters of the partograph and were also aware that plotting the partograph begins at a cervical dilation of 4 cm. Also, while a good number of participants 103 (93.64%) knew that cervical dilation on the partograph is carried out every four hours during the active phase of labour, 110 (100%) indicated that progress of labour is assessed by the degree of cervical dilation and descent of the presenting part. Routine usage of the partograph was recorded among the majority of midwives, 102 (92.7%), to record and monitor the progress of labour in expectant women. Bivariate analysis showed a significant association between the use of the modified WHO partograph and the knowledge of midwives on Ghana Health Service (GHS) policies ( p = .045). There was, however, no positive association determined among age ( p = .66), rank ( p = .77), years of professional experience ( p = 1.00), place of work ( p = .51), work shift and highest qualification ( p = 1.00) as far as knowledge and use of the WHO modified partograph are concerned. Conclusion The findings of the study underscore the desirable level of knowledge and usage of the partograph among study participants. This affirms that the knowledge and usage of the partograph within the facilities in Ga South health facilities hold the prospect of enhancing the safety of expectant mothers.

May the indication for a previous cesarean section affect the outcome at trial of labor in women with induction of labor? Aretrospective cohort study.

Cesarean sections are increasing worldwide and are associated with altered risks of complications for both mother and child. Vaginal birth after cesarean section is associated with lower maternal and neonatal morbidity than in repeat cesarean section. Only a few studies have considered the indication for the previous cesarean section to be of importance for the outcome of subsequent labor. The aim of this study was to evaluate whether the indication for a previous cesarean section affects the outcomes at a subsequent delivery in women with induction of labor. This retrospective cohort study of the four largest delivery units in Stockholm during 2012-2015 included 1150 women with one previous cesarean section with induction of labor. women with induced labor and a previous cesarean section, singleton pregnancy, cephalic presentation, gestational age of ≥34 weeks. The women were grouped by indication for the previous cesarean section. mode of delivery (vaginal birth after previous cesarean section or repeat cesarean section). induction to delivery time, postpartum hemorrhage, uterine rupture. Neonatal outcomes: birth weight, Apgar score <7, arterial umbilical cord blood gas pH <7.0. Our study found that the indication of labor dystocia at the previous cesarean section, increased the risk of repeat cesarean section (aOR 5.35; 95% CI: 1.64-17.50) in women with induction of labor. Other risk factors for repeat cesarean section were birth weight >4000 g, maternal BMI ≥30 or if vaginal prostaglandin was used as the method for induction of labor. A previous vaginal delivery and use of oxytocin increased the chance of a vaginal delivery in this group of women. Our study showed that the indication for the previous cesarean section affects the outcome in the subsequent delivery in women with induction of labor. If the indication for the previous cesarean section was labor dystocia, the risk of repeat cesarean section was increased.

Pregnant Women's Care Needs During Early Labor-A Scoping Review.

Pregnant women face the challenge of managing early labor on their own until they feel the need to seek professional support. However, professional support during such a vulnerable stage of labor may sometimes be insufficient. This study aims to understand pregnant women's care needs during early labor in order to improve the quality of care provided at the onset of labor. A scoping review was conducted following a systematic search strategy in May 2021 and in August 2022 concentrating on pregnant women in early labor with spontaneous onset of labor. A sensitive search strategy was used with five different databases. The articles were screened by two independent researchers. Data were extracted and mapped to answer the research question. 52 articles were included. Major reasons for seeking professional help are to receive reassurance and get advice and information on how to cope with early labor. Furthermore, many women express the need for professional guidance. Several articles demonstrated women's preferences for hospital admission or a continuous care model. While some women want empowerment and empathy from a midwife, others require clear instructions on helpful measures or even clinical interventions within the process. Managing early labor without professional support creates a major challenge for pregnant women and nurtures insecurities and anxiety. Protecting women from unnecessary interventions is a well-intentioned plan, yet a lack of support in early labor may sometimes jeopardize a positive birth experience. New ways need to be elaborated to support women-centred and individualized approaches to providing early labor care.

On the conflict of norms on criminal liability of special subjects for encroachment on life and health of a newborn or unborn child

From the standpoint of Russian criminal law, the life and health of an unborn child are not independent objects of criminal and legal protection. This article shows that the government can use more opportunities to guarantee the life and health of not only a pregnant woman, but also an unborn child, as well as a newborn child. The article pays special attention to the problem of conflict of norms on the responsibility of special subjects of illegal artificial termination of pregnancy. With the actual complicity of subjects of different types in the illegal termination of pregnancy: 1) a pregnant woman; 2) a person who is not a medical professional; and (or) 3) a medical worker – the qualification of the deed must be carried out in accordance with the principle of individual responsibility, by choosing one of the related elements of crimes with the corresponding sign of a special subject. However, at present, the legal question of the basis of a woman’s responsibility for illegal termination of pregnancy has not been resolved, and it is not clear by what criteria the legislation differentiates the administrative and criminal liability of medical workers and other persons for the same acts (Article 6.32 of the Administrative Code of the Russian Federation and Article 123 of the Criminal Code of the Russian Federation). In recent years, scientific studies have appeared justifying the expediency of criminalizing a number of socially dangerous acts committed by pregnant women and women in labor (maternity hospitals). The position of the authors of this article is only partially consistent with the proposals made. The authors of the article do not question the right of a woman to make an independent decision on the birth of a child, but recognize as justified the criminal law prohibition on artificial termination of pregnancy when there are no circumstances of a medical or social nature that exclude or significantly reduce the public danger of this act. The article argues that the range of new types of acts committed by maternity hospitals proposed in the doctrine for the purpose of criminalization is unreasonably expanded, in particular, there are no grounds for criminalizing the murder of a terminally ill newborn child by a mother on the grounds of compassion;intentional infliction by a mother of minor harm to the health of a newborn child, as well as causing death by negligence to a newborn child by a mother who is in a state of intoxication.

Does induction or augmentation of labor increase the risk of postpartum hemorrhage in pregnant women with anemia? A multicenter prospective cohort study in India.

To investigate whether induction/augmentation of labor in pregnant women with anemia increases the risk of postpartum hemorrhage (PPH) and whether this risk varied by indications for labor induction/augmentation and by anemia severity in pregnancy. In a prospective cohort study of 9420 pregnant women from 13 hospitals across India, we measured hemoglobin concentrations at recruitment (≥28 weeks of gestation) and blood loss after childbirth during follow-up and collected clinical information about PPH. Clinical obstetric and childbirth information at both visits were extracted from medical records. Anemia severity in the third trimester was categorized using hemoglobin concentrations (no/mild anemia: hemoglobin ≥10 g/dL; moderate: hemoglobin 7 to 9.9 g/dL; severe: hemoglobin <7 g/dL), while PPH was defined based on blood loss volume (vaginal births: ≥500 mL or cesarean sections: ≥1000 mL) and clinical diagnosis. Indications for labor induction/augmentation were classified as clinically indicated and elective as per guidelines. We performed multivariable modified Poisson regression analyses to investigate the associations of anemia severity and indications for labor induction/augmentation, including their interaction, with PPH, adjusted for potential confounders. PPH was associated with anemia but not with indications for labor induction/augmentation. However, there was a significant interaction between the two factors in relation to PPH (P = 0.003). Among pregnant women with severe anemia, a higher risk of PPH was associated with elective (adjusted risk ratio, 3.44 [95% confidence interval, 1.29-9.18]) but not with clinically indicated (adjusted risk ratio, 1.22 [95% confidence interval, 0.42-3.55]) labor induction/augmentation. No associations were observed among pregnant women with no/mild and moderate anemia. The risk of PPH is higher in women who have moderate-severe anemia in late pregnancy. Induction/augmentation of labor is generally safe for women with anemia, but it can increase the risk of PPH in women with severe anemia if performed electively.

Racialized police use of force and maternal health

IntroductionThere are large racial disparities in maternal health that cannot be explained by education, income, or other individual-level risk factors. This cross-sectional study estimated associations between racial inequity in police use of force (PUOF) at the community level and health outcomes of Black and White women. MethodsBirth records were linked to maternal hospital discharge records and municipal police department data for 326,240 births occurring between 1/1/2012 and 12/31/2016 to Black and White women in New Jersey. Outcomes, identified using diagnosis and procedure codes, were substance use (any/tobacco/alcohol/other), mental health disorders (any/depression/anxiety/ other), asthma, obesity, hypertension (preexisting/gestational), diabetes (preexisting/gestational), severe maternal morbidity, other cardiovascular diseases, and preterm labor. Data were analyzed in 2024. ResultsFor Black women, living in a community with 1% greater racially-disproportionate PUOF was associated with higher odds of any mental health disorder [by 0.18%; 95% CI: 0.08-0.28], depression [0.19%; 95% CI: 0.05-0.33], anxiety [0.25%; 95% CI: 0.09-0.41], other mental health disorder [0.17%; 95% CI: 0.07-0.27], any substance use [0.26%; 95% CI: 0.14-0.38], tobacco use [0.31%; 95% CI: 0.16-0.46], other substance use [0.17%; 95% CI: 0.04-0.30], asthma [0.12%; 95% CI: 0.04-0.21], and preterm labor [0.17%; 95% CI: 0.05-0.29] in adjusted models. There were no robust associations with the other outcomes for Black women or with any of the outcomes for White women. ConclusionsRacially-disproportionate PUOF was significantly associated with mental illness, substance use, asthma, and preterm labor of Black women. Results underscore the potential importance of institutionalized racism as a fundamental cause of health disparities.

Active management of labour versus expectant management of primiparous women with a prolonged latent phase: a randomized trial

Active management of labour versus expectant management of primiparous women with a prolonged latent phase: a randomized trial

Patient controlled epidural analgesia during labor: Protocol for a scoping review.

Childbirth remains one of the most painful experiences for women. Patient-controlled epidural analgesia provides the women in labor with self-control and thereby a shorter time interval between onset of pain and administration of analgesia, thus potentially improving the childbirth experience. This scoping review aims to investigate PCEA during labor involving maternal satisfaction, risks of adverse effects and obstetric interventions by mapping the evidence and identifying gaps in the current evidence base. The forthcoming review will adhere to the Preferred Reporting Items for Systematic reviews and Meta-Analysis extension for Scoping Reviews (PRISMA-ScR) and the JBI methodology for scoping reviews. A systematic search will be carried out across major peer-reviewed databases and gray literature will be sought. All study types involving women in labor receiving PCEA will be eligible for inclusion. The extracted data will be charted regarding trial characteristics, population/participation characteristics, interventions, outcomes, and key findings. The results will be presented through relevant tables, figures, and graphs when appropriate. Alongside this, we present the data descriptively to explain how the results align with the objectives of the review. PCEA offers women greater autonomy during childbirth, making it essential to examine its effects and potential risks. By mapping current evidence regarding PCEA, this review aims to identify knowledge gaps and provide insights to enhance maternal care and improve childbirth experiences.