Labor Unit Research Articles

Mathematical modelling of the impact of poverty on cholera outbreaks

In this paper, we propose and analyze a coupled disease‐economic model to study the impact of poverty on cholera outbreaks. We consider the stock of capital per effective units of labor, reflecting the effect of the stock of capital on cholera outbreak and transmission. The system has positive bounded solutions. We show that the disease‐free equilibrium is globally asymptotically stable whenever , while when , the disease‐free equilibrium is unstable. The sensitivity analysis of the model has been performed in order to determine the impact of related parameters on outbreak severity. We further study various cases for the investment rate upon critical value of the investment in order to describe the effect of poverty on the infected individuals over time. The results we obtained show that increasing of the stock of capital per effective units of labor and the implementation of strategies combining awareness programs and therapeutic treatments will reduce the proportion of the infected population. To verify our analytical results, the numerical simulations on the model are performed.

The impact of transfer from an alongside midwifery unit to labor and delivery on birthing women: A qualitative study

ObjectiveTo explore laboring women's thoughts, feelings, and experiences of transferring from an Alongside Midwifery Unit or free-standing birth center to labor and delivery. DesignA qualitative online survey was used for this research. SettingAn Alongside Midwifery Unit in the southwestern United States. ParticipantsEight women over the age of eighteen who had transferred to labor and delivery from either the AMU or free-standing birth center. FindingsFive themes emerging from the women's transfer experiences. It was important for the women to maintain their physiologic birth ideals. The initiation of transfer, even a discussion, altered the atmosphere in the birthing room. Women experienced a range of emotions surrounding the transfer. The stories spoke to mourning the loss of physiologic birth experience. Some women expressed guilt about the potential effects on their infants. Post-birth women had realizations about their mental and physical capabilities and limitations. Key conclusionsThis pertinent study addressed the effect on women when a transfer needs to occur from an Alongside Midwifery Unit or free-standing Birth Center to the Labor and Delivery Unit. Regardless of the reason, a transfer affected all participants. The psychological impact can have significant consequences on mother and baby's wellbeing. Women need an opportunity to share their story. The fifth theme of learning about themselves mentally and physically is new and not identified in other studies. Implications for practiceClinical recommendations are proposed to improve understanding and integrate into one's mindset, care processes, and clinical practice. Post-birth care should continue for these women until they completely process and come to a resolution of their experience of transferring to labor and delivery.

Labor unit culture and attitudes toward supporting vaginal birth-The Swedish version of the labor culture survey (S-LCS)-Psychometric properties.

In order to evaluate interventions aimed at reducing cesarean births, care practitioners' attitudes are important to measure. The Labor Culture Survey (LCS) is a scale that measures individual and unit attitudes towards supporting vaginal birth. As no equivalent scale exists in Sweden, the aim was to translate, adapt, and validate the LCS and to investigate whether there were differences in attitudes toward supporting vaginal birth between maternity care practitioners. A cross-sectional study including midwives, physicians, and nurse assistants working with intrapartum care in five labor wards in Sweden. The original LCS was translated into Swedish, and six context-specific items were developed for the Swedish setting (SLCS). The translation was tested for face validity. Psychometric analysis was conducted using exploratory factor analysis with principal component analysis, parallel analysis, and principal axis factoring. Reliability was estimated using Cronbach's alpha. One-way ANOVA and Tukey HSD were calculated to analyze differences in attitudes between professions on the subscales of the S-LCS. A total of 539 midwives, physicians, and nurse assistants participated. The final S-LCS showed a five-factor solution with the following subscales: Best Practices to reduce cesarean overuse, Unpredictability of vaginal birth, Unit Microculture, Maternal Agency, and Organizational Oversight. Chronbach alpha values varied from 0.60 to 0.83. Midwives were more supportive towards vaginal birth and less fearful of potential consequences of vaginal birth compared with physicians. The S-LCS demonstrated satisfactory psychometric properties for use in Swedish maternity care. Further work to improve the scale should include additional items reflecting the subscale Maternal Agency.

EFFECT OF PRELABOUR BMI ON THE MODE OF DELIVERY

Aim:To analyze the effect of Body Mass Index on the Mode of Delivery Design : Cross sectional study Methodology : Sample Size : 100 Patients Inclusion Criteria: Antenatal patients in Active phase of Labour proceeding for delivery Procedure: After ethical comittee approval and written consents from the patients, this comparative cross sectional study was conducted at a Tertiary hospital at CHRI and performed on a total of 100 antental patients who attended the pre labour unit. Their basic information such as age, height, weight, gestational age, and cervical dilatation were noted. Maternal Body Mass Index was noted from pre pregnancy weight from the pregnancy health card.This study is completely a non invasive study Study Duration : 4 months Results : The study population included 100 participants admitted in pre labour unit in a tertiary care hospital. The results obtained showed healthy Body mass Index group had the favourable outcome, whereas the antenatal patients with increased Prepregnancy Body Mass Index had the worst outcome like Cesarean delivery, increased duration of first stage labour, increased duration of second stage labour, APGAR 1to 5, NICU admission, postpartum hemorrhage. Conclusion : This study concludes that Antenatal patients with Increased Body Mass Index have poorer outcomes when compared to Antenatal Patients with normal values of Body Mass Index. This study can be useful in assessing and reducing the poorer materno-fetal outcomes.

Prediction of labour outcomes using prelabour computerised cardiotocogram and maternal and fetal Doppler indices: Aprospective cohort study.

To investigate the association and the potential value of prelabour fetal heart rate short-term variability (STV) determined by computerised cardiotocography (cCTG) and maternal and fetal Doppler in predicting labour outcomes. Prospective cohort study. The Prince of Wales Hospital, a tertiary maternity unit, in Hong Kong SAR. Women with a term singleton pregnancy in latent phase of labour or before labour induction were recruited during May 2019-November 2021. Prelabour ultrasonographic assessment of fetal growth, Doppler velocimetry and prelabour cCTG monitoring including Dawes-Redman CTG analysis were registered shortly before induction of labour or during the latent phase of spontaneous labour. Umbilical cord arterial pH, emergency delivery due to pathological CTG during labour and neonatal intensive care unit (NICU)/special care baby unit (SCBU) admission. Of the 470 pregnant women invited to participate in the study, 440 women provided informed consent and a total of 400 participants were included for further analysis. Thirty-four (8.5%) participants underwent emergency delivery for pathological CTG during labour. A total of 6 (1.50%) and 148 (37.00%) newborns required NICU and SCBU admission, respectively. Middle cerebral artery pulsatility index (MCA-PI) and MCA-PI z-score were significantly lower in pregnancies that required emergency delivery for pathological CTG during labour compared with those that did not (1.23 [1.07-1.40] versus 1.40 [1.22-1.64], p = 0.002; and 0.55 ± 1.07 vs. 0.12 ± 1.06), p = 0.049]. This study demonstrated a weakly positive correlation between umbilical cord arterial pH and prelabour log10 STV (r = 0.107, p = 0.035) and the regression analyses revealed that the contributing factors for umbilical cord arterial pH were smoking (p = 0.006) and prelabour log10 STV (p = 0.025). In pregnant women admitted in latent phase of labour or for induction of labour at term, prelabour cCTG STV had a weakly positive association with umbilical cord arterial pH but was not predictive of emergency delivery due to pathological CTG during labour.

The Comparison Between Maternal and Umbilical Cord Blood Levels of Zinc and Copper in Active Labour Versus Elective Caesarean Section

Background: Multivitamin administration in the periconceptional time was correlated with 16% decrement risk of premature deliveries. This study was aimed to investigate maternal and umbilical cord blood levels of zinc and copper in active labour versus elective caesarean. Patients and Methods: A case-control study was carried out in Salah Al-deen general hospital form February to September 2020. The study included full term pregnant ladies with active labour or prepared for elective caesarean attending the labour unit in Salah Al-deen general hospital. A total of 60 full term pregnant ladies divided into two groups consist of: (30) women in active vaginal delivery women, and group of (30) women prepared for elective caesarean section. Trace elements’ levels were evaluated utilizing the spectrophotometry. Results: The mean maternal serum zinc level among vaginal delivery group was (87.45±14.99) μg/dL versus (87.84±13.8) μg/dL among caesarean group. The mean umbilical zinc level among vaginal delivery group was (90.34±22.56) μg/dL and was higher among caesarean group (88.8±31.9) μg/dL. The mean maternal serum copper level among vaginal delivery group (83.82±14.02) μg/dL was lower than among caesarean group (127.57±37.23) μg/dL. Conclusion: There was higher mean umbilical cord zinc than the maternal zinc level. The mean umbilical cord zinc was lower than the maternal zinc among caesarean group. There was significantly lower mean umbilical cord copper than the maternal copper level among vaginal delivery group and the caesarean group. There was a positive significant correlation between maternal zinc level and umbilical zinc level. There was positive significant correlation between maternal copper level and umbilical copper level. Therefore, trace elements may play an essential function in the human parturition process.

A Corner of Control

“A Corner of Control” is a story about “Sarah” (pseudonym), a young woman identifying as Black American who was urgently referred from a routine prenatal visit to the labor and delivery antepartum triage unit for decreased fetal movement and was told by the inpatient obstetrics resident/attending team that she needed to be admitted for induction of labor. Feeling backed into a corner, she decided she wanted to leave against medical advice. I, the medical student, was responsible for mediating between the 2 parties, navigating my position at the bottom of the team’s hierarchy with my duty to listen and provide the best care to my patient. The story ventures into our fear and compulsion in carving a corner of control by implementing treatment courses that could significantly impact not only my medical career and the hospital’s reputation, but most importantly, Sarah and her baby’s life.

A Multicenter Interdisciplinary Survey of Practices and Opinions Regarding Oral Intake During Labor

(Int J Obstet Anesth. 2022;52:103598) Restrictive food policies during labor were originally established to decrease the risk of pulmonary aspiration. Over time, the need for restricting food has been questioned and guidelines currently vary between centers. This multicenter national survey was conducted to determine current practices and opinions by obstetric providers concerning maternal oral intake in labor and delivery units.

Universal Urine Drug Screening with Rapid Confirmation upon Admission to Labor and Delivery.

This study aimed to describe our experience with universal urine drug screening (UDS) with rapid confirmation (RC) via liquid chromatography mass spectrometry (LC-MS) before infant's discharge, in efforts to increase detection of neonates at risk of neonatal opioid withdrawal syndrome (NOWS) while reducing patient burden related to false positive results. Two-phase retrospective study of all pregnant women admitted to our labor and delivery (L&D) unit before (phase 1, April 2018-March 2019) and after (phase 2, October 2019-September 2020) RC of UDS was initiated. Urine samples were obtained on admission and screened for drugs using an enzyme immunoassay with positive results reflexed to confirmation via LC-MS. The turnaround time for LC-MS was 1 week in phase 1 and 24 hours in phase 2. For mothers with positive LC-MS confirmation, the infant's meconium was sent for drug screening. Positive results were determined to be true or false positive based on urinary LC-MS results. The primary outcome was the rate of opioid-positive mothers who were unanticipated. The secondary outcome was the difference in rate of neonates who were observed for NOWS, before and after implementation of RC with LC-MS. In phase 2, a total of 2,395 deliveries occurred of which 2,122 (88.6%) had available UDS results. Fifty-two (2.5%) women had a positive UDS for at least one drug with LC-MS confirmation. Of those, 25 were true positive and 27 were false positive. Twenty-one (84%) true positive mothers were taking opioids and 8 (37%) of them were unanticipated positives. Among mothers with positive UDS for opioids, the neonatal observation rate for development of NOWS was 100% (22/22) and 48% (21/44) before and after implementation of LC-MS RC, respectively. Universal UDS and LC-MS RC in L&D may improve detection of unanticipated positive mothers whose infants are at risk of NOWS. RC of positive results allows intervention only for confirmed cases. · Universal UDS can detect more infants at risk of NOWS.. · Rapid confirmation of positive UDS reduces burden.. · Only confirmed infants should be observed in the neonatal intensive care unit.. · Child Protective Services should only be notified of confirmed opioid-positive results..

Reducing primary cesarean delivery rate through implementation of a smart intrapartum surveillance system

The rapid changes in clinical maternity situations that occur in a labor and delivery unit can lead to unpredictable maternal and newborn morbidities. Cesarean section (CS) rate is a key indicator of the accessibility and quality of a labor and delivery unit. This retrospective cross-sectional study assesses the nulliparous, term, singleton, vertex (NTSV) cesarean delivery rates before and after the implementation of a smart intrapartum surveillance system. Research data were collected from the electronic medical records of a labor and delivery unit. The primary outcome was the CS rate of the NTSV population. The data of 3648 women admitted for delivery were analyzed. Of the studied deliveries, 1760 and 1888 occurred during the preimplementation and postimplementation periods, respectively. The CS rate for the NTSV population was 31.0% and 23.3% during the preimplementation and postimplementation periods, respectively, indicating a significant 24.7% (p = 0.014) reduction in CS rate after the implementation of the smart intrapartum surveillance system (relative risk, 0.75; 95% confidence interval, 0.71–0.80). In the NTSV population, the vaginal and CS birth groups, no significant difference in terms of newborn weight, neonatal Apgar scores, composite neonatal adverse outcome indicator, and the occurrence of the following: neonatal intensive care unit admission, neonatal meconium aspiration, chorioamnionitis, shoulder dystocia, perineal laceration, placental abruption, postpartum hemorrhage, maternal blood transfusion, and hysterectomy before and after the implementation of the smart intrapartum surveillance system. This study reveals that the use of the smart intrapartum surveillance system can effectively reduce the primary CS rate for low-risk NTSV pregnancies without significantly affecting perinatal outcomes.

A Correlational Study Of Midwives' Self-Compassion, Psychosocial Health, and Well-Being During the First Wave of COVID-19. What Have We Learned?

During the first wave of the COVID-19 pandemic, midwives worked in a threatening environment and worried about themselves and their families becoming infected. Self-compassion is defined as an attitude of self-kindness that is supported by a balanced attitude toward negative thoughts or feelings and may contribute to the psychosocial health and well-being. The purpose of this study was to describe midwives' self-compassion, psychosocial health, and well-being and the correlation between them. This was a descriptive correlational study using a survey administered online during May, 2020. Participants included midwives who worked in labor and delivery units across Israel during the beginning of the COVID-19 pandemic. Measures included a demographic questionnaire; the Self-Compassion Scale Short Form (SCS-SF), which has 12 items in 6 subscales; and the psychosocial health and well-being questionnaire, a short version of the Copenhagen Psychosocial Questionnaire, which has 24 items in 6 subscales. Participants (N = 144) reported a moderate-high level of self-compassion with a mean (SD) SCS-SF score of 3.57 (0.69). The mean (SD) psychosocial well-being score was 30.72 (13.57). The burnout subscale score had the highest mean (46.27), representing a high level of burnout. A minority (11.3%) of midwives considered resigning their midwifery positions. A higher level of self-compassion correlated with better psychosocial well-being (r = -0.466; P < .001). The highest correlation was found between the SCS-SF and the psychosocial health and well-being subscale for depressive symptoms (r = -0.574; P < .001). During the first wave of the COVID-19 pandemic, midwives had a moderate-high grade of self-compassion and good psychosocial well-being. Midwives with higher self-compassion had better psychosocial well-being. The findings could inform the development of programs to increase midwives' self-compassion, and psychosocial well-being and the quality of midwifery care, in times of stability and during future pandemics or disasters.

Clinical Equipment as a Potential Impediment to Optimal Intrapartum Monitoring and Delivery for Pregnant Women in South Africa

Clinical equipment is essential in a labour unit to assess, monitor, diagnose, and prevent complications during labour. The availability of good working equipment in the labour unit is needed to enhance optimal intrapartum monitoring and delivery for pregnant women. Thus, this paper employed a cross-sectional descriptive design using a quantitative research approach to ascertain how equipment impedes optimal intrapartum monitoring and delivery for pregnant women. A total of 59 midwives were recruited to participate in the study. Data collected using an electronic structured questionnaire were analysed with descriptive statistics using Statistical Package for Social Sciences (SPSS) version 25.0. The study reported that most midwives (68%) in labour units experienced barriers to using equipment when administering care to pregnant women. The barriers were perpetuated by various factors, such as bed capacity, in meeting patient demands, including examination lights, overhead radiant warmers, and examination weighing scales for newborns. Incorporating mandatory computerized maintenance management software is recommended to improve the quality of maternity equipment. In addition, there is a need for regular equipment inspections and maintenance by skilled technicians in selected hospitals of Limpopo Province, South Africa.

Investigating Racial and Ethnic Disparities in Maternal Care at the System Level Using Patient Safety Incident Reports

Maternal mortality in the United States is high, and women and birthing people of color experience higher rates of mortality and severe maternal morbidity (SMM). More than half of maternal deaths and cases of SMM are considered preventable. The research presented here investigated systems issues contributing to adverse outcomes and racial/ethnic disparities in maternal care using patient safety incident reports. The authors reviewed incidents reported in the labor and delivery unit (L&D) and the antepartum and postpartum unit (A&P) of a large academic hospital in 2019 and 2020. Deliveries associated with a reported incident were described by race/ethnicity, age group, method of delivery, and several other process variables. Differences across racial/ethnic group were statistically evaluated. Almost two thirds (64.8%) of the 528 reports analyzed were reported in L&D, and 35.2% were reported in A&P. Non-Hispanic white (NHW) patients accounted for 43.9% of reported incidents, non-Hispanic Black (NHB) patients accounted for 43.2%, Hispanic patients accounted for 8.9%, and patients categorized as "other" accounted for 4.0%. NHB patients were disproportionally represented in the incident reports, as they accounted for only 36.5% of the underlying birthing population. The odds ratio (OR) demonstrated a higher risk of a reported adverse incident for NHB patients; however, adjustment for cesarean section attenuated the association (OR 1.25, 95% confidence interval 1.01-1.54). Greater integration of patient safety and health equity efforts in hospitals are needed to promptly identify and alleviate racial and ethnic disparities in maternal health outcomes. Although additional systems analysis is necessary, the authors offer recommendations to support safer, more equitable maternal care.

Creating an Interprofessional Approach to Triage in a High-Risk Labor and Delivery Unit

In this high-volume, high-risk labor and delivery unit triage area, the nurses and providers have challenges in communication and teamwork. At times, this results in the lack of a shared mental model regarding prioritization of patient needs and interventions. This can impede timely patient assessment, resulting in a delay in decision making and patient disposition. Over time, nurses and providers have designated their unique pathways for triage workflow and can focus on their to-do list, distracting them from a collaborative approach to what is best for the patient.

Labor and Delivery Unit Residency Program and the Optimization of Care Through Birth Equity

Labor and Delivery Unit Residency Program and the Optimization of Care Through Birth Equity

Mother–Neonate Simulation Immersion Experience for Maternal Safety

This curriculum was designed after implementation of the Advance Life Support in Obstetrics (ALSO) course for labor and delivery unit staff. No staff member had this certification in 2019; to date, 69% of the staff does.

Reducing Trauma on the Labor and Delivery Unit Through Education and Trauma-Informed Care

The lasting effects of birth trauma after it has occurred is well-documented. However, research dedicated to the effects of respectful maternal and trauma-informed care (TIC) on primary prevention of birth trauma does not exist to date.

Quality Assurance and Performance Improvement in the Labor and Delivery Unit

Quality Assurance and Performance Improvement in the Labor and Delivery Unit

Infant Fall Education and Protocol

In the United States, there is not a standardized infant fall–drop protocol in place, but there are approximately 600–1,600 infant falls per year. Infant falls and drops can occur at any point during a parent’s stay on the labor and delivery unit or the NICU.

Bedside Shift Report in the Labor and Delivery Unit

No bedside shift report (BSR).