Hospital Labor Research Articles

Fetal-Maternal Outcomes of Induction of Labour Among Women Delivered at Regional Referral Hospitals In Dar Es Salaam Tanzania

Purpose: Africa has a very low rate of induction of labour with high maternal and perinatal morbidity and mortality. However fetal-maternal outcomes following induction of labour are not well documented in Tanzania. This study aimed to assess fetal-maternal outcomes following induction of labour among women delivered at Dar es Salaam regional referral hospitals in Tanzania.
 Design/methodology/Approach: A total of 301 expectant mothers were recruited in a prospective observational study conducted at all regional referral hospitals in Dar es Salaam, Tanzania. Data on fetal-maternal outcomes were collected using a pre-designed clinical sheet. Demographic data, obstetric history, methods as well as outcomes of labour induction were recorded. The continuous variables were summarized using the median and corresponding interquartile range. Categorical variables were summarized using frequency and proportions and the significance of differences were assessed using Chi-square at P<0.05.
 Results: The leading methods for induction of labour were Oxytocin (48.5%) and a combination of Folley’s catheter with Oxytocin (28.4%). Induction of labour significantly improved fetal outcomes at birth P<0.05. Induction of labour associated with improved Apgar scores in newborn babies. Failure of induction of labour was the largest contributor to the increased Caesarean Section rate observed in this study.
 Research limitation/Implication: This study has therefore explored the fetal-maternal outcomes following induction of labour in Tanzanian regional referral hospitals.
 Practical implication: Induction of labour improves and minimizes neonatal complications in referral regional hospitals in Dar es Salaam.
 Originality/Value: These findings fill a gap of information which was missing on the fetal-maternal outcomes following induction of labour among expectant mothers in Dar es Salaam regional referral hospitals.

Implementation of aseptic technique training and assessment to reduce the incidence of chorioamnionitis in laboring patients

Chorioamnionitis may significantly affect the outcome of positive birth experiences for expecting mothers. The purpose of this quantitative, quasi-experimental quality improvement project was to determine if the implementation of the University of Michigan’s Assessment Tool for Aseptic Technique and Assessment would impact the rate of maternal chorioamnionitis among laboring women admitted in a labor and delivery unit in a local Californian hospital over 30 days. Neuman’s system theory, Watson’s caring theory, and the plan, do, study, act (PDSA) cycle were the theoretical and conceptual underpinnings of the project. Data on chorioamnionitis rates were collected from a sample of women (n=856) using the California Maternal Quality Care Collaborative (CMQCC) source approach. Analyses revealed a statistically significant improvement in chorioamnionitis rates (ꭓ2 (1, n=856) = 29.55, p =.001). The clinical implication was that fewer laboring mothers were diagnosed with maternal infections following the implementation of the Aseptic Technique Intervention.

POTS and PANdemic: Chef wellbeing amidst COVID-19

As most developed nations emerge from the COVID-19 pandemic period, amid exceptionally high hospitality labour shortages, it is timely and important to understand the state of chefs and cooks’ mental health and wellbeing (MH&W) and individual and organisational outcomes of the pandemic. A survey (pending publication) by this article’s authors, of Australasian chefs in Australia and New Zealand during late-2021, aimed to give insights into these two interlinked factors.

A Prospective Cohort Study of Etiology and Neonatal Outcome of Preterm Labor in a Tertiary-care Hospital Attached to a Medical College

A Prospective Cohort Study of Etiology and Neonatal Outcome of Preterm Labor in a Tertiary-care Hospital Attached to a Medical College

Descriptive study of Feto maternal outcomes of obstructed labour in a tertiary care hospital

Introduction: Labour is considered abnormal when the presenting part of the foetus cannot progress in to the birth canal, despite strong uterine contractions which leads to various maternal or foetal complications. Obstructed labour accounts for about 8% of all maternal deaths in developing countries like India. Obstructed labour is the single most important cause of maternal death and is one of the leading causes of perinatal mortality. Materials and methods: This prospective study of obstructed labour was conducted from September 2021 to May 2022 (9 months) in the Department of obstetrics and Gynaecology of M.G.M Medical College, Jamshedpur. All patients admitted with obstructed labour were included in the study. Detailed history regarding age, socioeconomic status, parity, previous obstetric history, past history, antenatal care, duration of labour, details of referral and management were recorded. During admission, the general condition of mother was assessed as well as fetal lie, presentation, position and heart sounds were recorded. Results: During the 9 months study period, there were total of 5845 deliveries of which 100 cases were diagnosed to have obstructed labour, incidence being 1.71%.

Drastic increase in hospital labor costs led to a sustained financial loss for an academic vascular surgery division during the coronavirus disease 2019 pandemic.

ObjectiveThe financial effects of the coronavirus disease 2019 (COVID-19) pandemic have fundamentally changed the healthcare environment, with hospitals expected to have lost billions in 2021. A preexisting nationwide nursing shortage became drastically worse during the pandemic amid dramatically increasing labor costs. We examined the evolution and financial effects of these changes during repeated pandemic surges within a vascular surgery division at a tertiary medical center.MethodsOperating room, inpatient unit, and outpatient clinic financial data were examined retrospectively. The monthly averages for a 14-month control cohort before COVID-19 (January 2019 to February 2020) were compared to the averages for seven interval groups of sequential, 3-month cohorts from March 2020 through November 2021 (groups 1-7).ResultsThe monthly relative value unit (RVU) generation had returned to the mean before the COVID-19 pandemic (2520 RVUs) after an isolated decrease early in the pandemic (group 1; 1734 RVUs). The RVUs ranged from 2540 to 2863 per month for groups 2 to 5, with a slight decline in groups 6 and 7. The average monthly RVUs in the COVID-19 period (2437 RVUs) were nearly equivalent (P = .93) to those for the pre–COVID-19 cohort. An analysis of payor mix demonstrated an increase in commercial and Medicaid payors, with a respective decrease in Medicare payors, during COVID-19. The contribution to indirect, or profit, from inpatient hospital and outpatient clinical revenue showed a drastic decrease in group 1, followed by a swift rebound when the government restrictions were eased (group 2). The total monthly vascular nursing unit expense demonstrated a marked increase with each sequential group during COVID-19, with an average monthly upsurge of +$82,171 (+47%; P < .001). An increase in the nursing labor expenses of +$884 per vascular case (from $1630 to $2514; +54%; P < .001) was observed in the COVID-19 era. The nursing labor costs per patient day had increased from $580 to $852 (+$272; +53%; P < .001). The nursing labor cost per RVU had increased from $69.5 to $107.7 (+$38.2; +55%; P < .001). On a system-wide level, the agency-related nursing costs had increased from $4.9 million to $13.6 million per month (+178%; P < .001) in 2021 compared with 2020.ConclusionsThe COVID-19 pandemic has had severe, nationwide effects on healthcare delivery, exacerbating the deleterious effects of an existing, critical nursing shortage. To the best of our knowledge, the present study is the first detailed analysis of this phenomenon and its effects on a surgical division. Our results have demonstrated a progressive, drastic increase in nursing labor costs during the pandemic, with a resultant sustained erosion of financial margins despite a level of clinical productivity, as measured in RVUs, equal to the prepandemic standards. This precarious trend is not sustainable and will require increased, targeted government funding.

Outcome of Spontaneous Vaginal Delivery and Elective Induction of Labour in Postdated Pregnancy

Background: Postdated pregnancies are associated with increased perinatal morbidity and mortality. The risk increases when pregnancy continues beyond 41 wks. So, the Induction of labor conducted at or beyond 41 wks could help prevent these complications. But there are certain risks associated with Induction of labor. Again, Induction success varies widely and depends on some modifiable and nonmodifiable factors. Objective: To assess the feto-maternal outcome and analyze the factors affecting the outcome of electively induced labour in postdated pregnancy with a low bishop score compared to spontaneous onset labour in a secondary level hospital. Materials and methods: Prospective analytical study involving 220 participants divided into induction (study) and spontaneous labour (control) groups. Data collected on socio-demographic data, characteristics of the study population, causes of failed Induction, maternal complications and neonatal outcomes. Results: Among electively induced postdated pregnancy (study group) vaginal delivery was 45.45% with caesarean section 54.54% compared to 80% and 20% respectively in the spontaneous labour (control group). Cervical dystocia was the commonest indication for caesarean section (P=0.001). Among maternal complications control group had significant perineal lacerations (P=0.016) and study group had a longer duration of hospital stay (P&lt;0.001). The neonatal outcome didn’t show significant difference. Conclusion: The present study showed routine Induction of labor in prolonged pregnancy may encourage higher caesarean section rate with prolonged hospital stay but judicious Induction even in poor bishop score is not associated with any major feto-maternal complication. Further multicentric study with a larger sample size is recommended. J Bangladesh Coll Phys Surg 2022; 40: 175-182

Promoting Vaginal Births Through Labor Support Education for Perinatal Nurses

The Healthy People 2020 obstetric objective is reduction of nulliparous, term, singleton, vertex cesarean sections. Medically induced labor in hospitals has resulted in increased cesarean rates without improving maternal and neonatal outcomes. A 39% cesarean rate in 2009 in the United States propelled action that continues today.

Structural quality of labor and delivery care in government hospitals of Ethiopia: a descriptive analysis

BackgroundEthiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labor and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia.MethodsA facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People’s Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labor and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labor and delivery care.ResultsOne third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.2% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (76.4%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%).ConclusionSubstantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.

How to Foster Effective Midwife-Obstetrician Collaboration on Labor and Birth Units: Qualitative Analysis of Experiences of Clinicians in the United States.

Effective collaboration between midwives and obstetricians on labor and birth units in hospitals has been shown to improve birth outcomes and quality of care. Guidelines for collaborative care in the United States exist; however, studies describing the actual lived experiences of midwives and obstetricians in collaborative practice are lacking. The goal of this study was to explore the experiences and perspectives of midwives and obstetricians working in collaborative practices on labor and birth units across the United States and to identify strategies that foster effective collaboration between them. We performed qualitative analyses of open-ended comments obtained in an instrument validation survey assessing collaboration between midwives and obstetricians on labor and birth in the United States. Certified nurse-midwives, certified midwives, attending general obstetricians, maternal-fetal medicine attending physicians, and fellows across the United States were included in this study, herein called midwives and obstetricians. The final sample in the original validation survey included 232 midwives and 471 obstetricians (n = 703). Of these, 79 midwives and 132 obstetricians (n = 211) provided narrative comments on their perspectives and experiences with collaborative practice on labor and birth units in the United States. The narrative comments were analyzed using inductive techniques derived from grounded theory. Four themes around how to foster effective collaboration were identified: (1) developing trust and respect, (2) promoting effective communication, (3) individual variability and need for clear guidelines, and (4) balancing autonomy. The midwives and obstetricians shared lived experiences that they perceived affected their work satisfaction and clinical outcomes in collaborative practices. These findings hold potential to inform clinicians and health care leaders on ways to foster effective collaboration between midwives and obstetricians on labor and birth units. This in turn can improve quality of care for birthing persons, perinatal outcomes and clinician job satisfaction.

Midwives' communication with non-Swedish-speaking women giving birth: A survey from a multicultural setting in Sweden.

INTRODUCTIONThe European Union faces challenges related to migration, cultural diversity and health. Immigration to Sweden has increased and a third of all women giving birth were born outside Sweden. A higher risk for negative pregnancy outcomes is seen among foreign-born women and one of the explanations given is inadequate communication. Midwives in Sweden have responsibility for normal birth. This study aimed to investigate labor ward midwives’ experiences of caring for and communicating with women who do not speak and understand the Swedish language.METHODSA questionnaire based on the Migrant Friendly Hospital questionnaire was distributed to all 46 midwives working on the Södertälje Hospital labor and postpartum ward in 2018 and 32 completed it (70%).RESULTSMost of the midwives thought communication and giving support to non-Swedish speaking women during birth was difficult or very difficult (n=31; 97%). The quality of the professional interpreters’ work was reported as good or very good by most of the midwives (n=31; 97%). However, the most common resource for facilitating communication during labor was an adult relative (always/often: n=25; 83%). Increased availability was the most common response for improving the interpreter service (n=22; 69%), as well as increasing the number of languages available for interpreter services (n=8; 25%).CONCLUSIONSWhen women are giving birth, it is of the highest priority to improve communication between midwives and non-Swedish-speaking women. Better strategies for improving communication must be implemented in order to comply adequately with Swedish law and achieve equitable care of high quality for all, regardless of linguistic background.

Perception of pregnant women towards midwives: attitude and practice during child delivery in health institutions in Ogbomoso, South-West, Nigeria

&#x0D; Background: This study aims to ascertain pregnant women’s perceptions of the attitudes and practice of midwives during labour in a mission teaching hospital and a state hospital in Ogbomoso, Southwest Nigeria, and to determine whether or not a relationship exists between patients’perceptions of midwives practice during delivery and the occurrence of neonatal deaths.&#x0D; Methods: The survey was conducted by administering the questionnaire adapted from Caring Behaviour Inventory (CBI) to a random sample of five hundred and seventy nine respondent mothers who gave birth in either a Mission teaching hospital or a state hospital in Ogbomoso, Southwest Nigeria. This standardised questionnaire collects demographic data and patient perceptions of nursing attitudes and practice, ranking patients’ responses to a series of statements about the midwives on a four point Likert scale. Data was analysed using Pearson product moment correlation analyses and multiple regression analyses.&#x0D; Results: Our study revealed that there was a positive response on the attitude and practise of midwives during delivery by the respondents. Secondly, there was a positive impression on the influence of the attitude and practice of midwives during delivery by the respondents.&#x0D; Conclusions: There was no evidence of a relationship between patients’ perceptions of midwives practice during delivery and the occurrence of neonatal deaths.&#x0D;

Migrant mobility and value creation in hospitality labour

This study examines diverse forms of value that migrant workers create through their employment in hospitality. The paper draws on insights from valuation studies and research on migrants' transnational resources to consider the experiences of Kenyans who worked in the hospitality sector while abroad. The paper introduces the notion of ‘indefinite capacities’ to conceptualise the amorphous nature of skills, capabilities and resources that may be developed through hospitality work. The findings explore how value is constructed and negotiated within occupational, cultural and psychological domains, examining how and why indefinite capacities are (de)valued in specific moments, and how they are (re)appraised in the wider context of migrants' careers and lives.

The relationship between tourism and employment: evidence from the Alps-Adriatic country

Overlooking the importance of non-stationarity and normally distributed models in previous studies, this paper aims to fill the gap in literature based on time series between 2000 and 2019 for an Alps Adriatic country on tourism-led employment. Before implementing the Granger Causality Test, the vector autoregressive model is applied. The results confirmed that tourist arrivals significantly impact the hospitality labour market in Slovenia as employment in the lodging industry was driven in bi-causal directions to overall tourist arrivals. The demonstrated validity of substantial tourism-led employment has implications for job creation and economic growth, focusing on domestic tourists.

Frequency of Elevated Levels of Serum CRP in Patients with Preterm Labor in a Tertiary Care Hospital, Karachi

Background: Preterm birth is a significant public health problem, occurring in over 10 percent of births world wise, and contributing largely to neonatal mortality and various morbidities in childhood and later in life. Increase level of C-reactive protein (CRP) is associated with increased risk of preterm delivery. This study is designed to determine the elevated level of CRP in patients with preterm labor to establish a local data. Results of my study can be grate help for other care health provider to provide effective antenatal care. Objective: To determine frequency of elevated levels of serum CRP (by blood serum test) in patients with preterm labor in a tertiary care hospital, Karachi. Setting: This Cross Sectional Study was conducted in the Department of Obstetrics and gynecology, Civil hospital Karachi for the duration of six months from January, 2018 to July, 2018. Subject and Methods: A total of 88 pregnant women with pre term delivery were included in this study. Preterm labor was confirmed by uterine contraction (3 contraction in 10 minutes each lasting for 30 second) and cervical dilatation of preterm labor. Blood sample was taken for CRP level whole of this information was documented on predesigned proforma. Results: The average age of the women was 28.26±4.02 years. Frequency of elevated level of serum CRP in patients with preterm labor was 89.77% (79/88). Conclusion: In present study frequency of elevated level of serum CRP in patients with preterm labor was 89.77%. Measurement of the C-reactive protein during pregnancy can be used as a predictive screening biomarker for detection of subclinical infections that cause preterm uterine contraction and hence early intervention and intensive antenatal care to reduce the perinatal morbidity and mortality. Keywords: Preterm labor, Elevated levels of serum CRP, Cervical Dilatation.

Reducing Alarm Fatigue in Maternal Monitoring on Labor and Delivery: A Commentary on Deimplementation in Obstetrics.

Hospital labor and delivery floors frequently operate like intensive care units (ICUs)-with continuous data feeds pouring into central monitoring stations against a background of blaring alarms. Yet the majority of obstetric patients are healthy and do not require ICU-level care. Despite limited organizational recommendations guiding the frequency of vital sign measurement, continuous pulse oximetry is used widely for laboring patients. There is also no evidence that morbidity prevention is linked to specific frequencies of vital sign monitoring in low-risk patients. In fact, studies examining the performance of maternal early warnings systems based on vital signs suggest that these may not reliably provide actionable information regarding maternal physiologic status. Furthermore, it is very possible that intrapartum maternal overmonitoring can impact care negatively by generating alarm fatigue, causing providers to miss actual abnormal vital signs that may precede morbidity. KEY POINTS: · Labor and delivery units may engage in maternal physiologic overmonitoring.. · Overmonitoring increases risk for alarm fatigue.. · Deimplementing low-value care may improve obstetric outcomes..

Neural Tube Defects Trend, is COVID19 Responsible for Increased Rates?

Background: many studies reported the association between NTDs and maternal fever, infection like toxoplasma, rubella and cytomegalovirus, this study aimed to give the trend of the NTDs in Zakho and find if it was related to new epidemic of COVID19. Patient and method: This is study have two lines 1st studying the trend of the prevalence of NTDs depending on the health directorate statistics from Jan. 2013 to December 2021. The 2nd is a case series of 18 case of NTDs with COVID19 infection that reported in Zakho Maternity hospital labour unit. Results: The prevalence of NTD ranged from 32 during 2013 to 35 during 2017 per 10000 births, with sudden n increase to 53 per 10000 births during 2021. The case series study of 18 patient with NTDs and COVID19 infection done to uncover our doubt about the relation of COVID19 infection and NTDs. The general characteristics of mothers had baby with NTDs show that mean age of mothers was (30.5 ± 7.5) most of them from Zakho 12 (66.7%), followed by Shingar 4(22.2%). Only 2(11.1%) they married their consanguinity. Female sex of the affected baby was the common 10(55.6%), the male: female ratio was 0.8:1. Fever during the 1st trimester reported among 15(83.3%) of the patients, most of the mothers had mild COVID19 infection 14(77.8%), and 4(22.2%) had moderate severity, the antibiotics and vitamin supplement was reported among 13(72.2%). Conclusions There were increased prevalence of the NTDs in Iraq during the new epidemic COVID19 period. Keyword: NTDs, maternal hyperthermia, COVID19 infection

Queer subjectivities in hospitality labor

AbstractThis paper explores the experiences of queer workers in the service economy with a focus on hospitality labor. Studies of gender, sexuality and service labor approached mainstream service work as a scene of compulsory heterosexuality, while literature on the position of queer workers has tended to approach work in terms of structural inequalities that prevent queer workers from participating in the labor market, and has therefore focused on notions of diversity and inclusion as frameworks for understanding how the heteronormativity of service relationships can be overcome. This paper shifts focus to examine how queer subjectivities are enacted within the disciplinary requirements of service labor, and on the way that workers negotiate and contest their positioning at work. The paper situates the subjectivities and laboring practices of queer workers at the nexus of tensions between heteronormativity and the politics of diversity in service venues, and examines how workers negotiate and contest their positioning at work. We explore the normativities that shape permissible queer embodiment at work and show how biographical experiences specific to queer workers inform their laboring practices. The paper shows that queer workers in mainstream hospitality venues are enrolled into a specific mode of interactive service labor that capitalizes on their queer biographies, requires highly cultivated relational capacities, and repositions work as a site of political intervention.

425 How often will midwives and obstetricians experience obstetric emergencies or high-risk deliveries: A national cross-sectional study

Introduction and aim: Obstetric emergencies and high-risk deliveries (obstetric events) are potentially life threatening. These events are not always managed according to standards of obstetric care. The rarity of events might challenge healthcare professionals in obtaining the necessary skills. We aimed to estimate how often midwives, specialty trainees, and specialist doctors in obstetrics and gynaecology experience specific obstetric events. Methods: We performed a national cross-sectional study including midwives (n=1300), specialty trainees (n=180), and specialist doctors in obstetrics and gynaecology (n=340) working in hospital labour wards (n=21) in Denmark in 2018.

Online versus face-to-face metacognitive educational counseling program on anxiety and meta-worry in women with a history of miscarriage: A randomized clinical trial.

In the COVID-19 outbreak, women with a history of miscarriage need more mental health. Anxiety and meta-worry as consequences of miscarriage, besides concerns due to pregnancy during coronavirus, show the necessity of appropriate online and face-to-face educational counseling. This study aimed to evaluate the effectiveness of online metacognitive educational counseling versus face-to-face method on anxiety and meta-worry in these women. In this randomized clinical trial, 80 women with a history of miscarriage, anxiety, and meta-worry referred to Imam Jafar Sadegh hospital (labor, women ward and women clinic), Meybod, Iran, were selected conveniently and randomly assigned into two groups (n = 20/each). The participants received 8-session metacognitive educational counseling package online or face-to-face. Data were collected by Beck Anxiety Inventory, Wellz meta-worry questionnaire at baseline, week eight, and follow up as primary outcomes and analyzed via SPSS software (Anova and Repeated measure statistic tests). Anxiety in the 12th week (online group 13.75 ± 3.59 vs. face to face 18.25 ± 5.91, P = 0.04) was statistical significantly less than baseline (respectively 22.15 ± 5.67 vs. 22.35 ± 4.93, P = 0.56); with fewer anxiety scores in the online group. Meta-worry in the 12th week (online group 11.90 ± 2.59 vs. face to face 15.70 ± 4.06, P = 0.03) was statistically significant compared to baseline (respectively 17.15 ± 2.70 vs. 18.50 ± 3.47, P = 0.36); with fewer meta-worry scores in the online group. Belief about worry in 12th week (online group 66.50 ± 14.60 vs. face to face 78.45 ± 9.27, P = 0.01) was statistical significantly less than baseline (respectively 85.50 ± 8.87 vs. 86.05 ± 8.85, P = 0.96); with less score of belief about worry in the online group. Online and face-to-face metacognitive educational counseling methods decreased anxiety, meta-worry, and belief about worry in women with miscarriage. But online educational counseling was more effective. Distance online counseling in COVID-19 can help the mental health of women with miscarriage.