Labor Unit Research Articles

Heterogeneity in management of category II fetal tracings: data from a multihospital healthcare system

Electronic fetal monitoring is widely used to identify and intervene in suspected fetal hypoxia and/or acidemia. Category II fetal heart rate tracings are the most common class of fetal monitoring in labor, and intrauterine resuscitation is recommended given the association of category II fetal heart rate tracings with fetal acidemia. However, limited published data are available to guide intrauterine resuscitation technique selection, leading to heterogeneity in the response to category II fetal heart rate tracings. This study aimed to characterize approaches to intrauterine resuscitation in response to category II fetal heart rate tracings. This was a survey study administered to labor unit nurses and delivering clinicians (physicians and midwives) across 7 hospitals in a Midwestern healthcare system spanning 2 states. The survey posed 3 category II fetal heart rate tracing scenarios (recurrent late decelerations, minimal variability, and recurrent variable decelerations) and asked participants to select first- and second-line intrauterine resuscitation management strategies. The participants were asked to quantify the level of influence certain factors have on their choice using a scale from 1 to 5. Intrauterine resuscitation strategy selection was compared by clinical role and hospital type (nurses vs delivering clinicians and university-affiliated hospital vs non-university-affiliated hospital). Of 610 providers invited to take the survey, 163 participated (response rate of 27%): 37% of participants from university-affiliated hospitals, 62% of nurses, and 37% of physicians. Maternal repositioning was the most selected first-line strategy, regardless of the type of category II fetal heart rate tracing. First-line management varied by clinical role and hospital affiliation for each fetal heart rate tracing scenario, particularly for minimal variability, which was associated with the most heterogeneity in the first-line approach. Previous experience and recommendations from professional societies were the most influential factors in intrauterine resuscitation selection overall. Of note, 16.5% of participants reported that published evidence did not influence their choice at all. Participants from a university-affiliated hospital were more likely than participants from a non-university-affiliated hospital to consider patient preference when selecting an intrauterine resuscitation technique. Nurses and delivering clinicians differed significantly in the rationale for management choices: nurses were more often influenced by advice from other healthcare providers on the team (P<.001), whereas delivering clinicians were more influenced by literature (P=.02) and ease of technique (P=.02). There was significant heterogeneity in the management of category II fetal heart rate tracing. In addition, motivations for choice in intrauterine resuscitation technique varied by hospital type and clinical role. These factors should be considered when creating fetal monitoring and intrauterine resuscitation protocols.

Effect of Gestational Weight Gain on Length of Induction of Labor [ID: 1377561

INTRODUCTION: Review of institutional data found an association between maternal obesity and increased cesarean delivery (CD) among nulliparous, term, single, vertex (NTSV) pregnancies. To identify modifiable risk factors for CD, we evaluated the relationship of gestational weight gain (GWG) to length of induction of labor. METHODS: From January 2020 to May 2021, NTSV inductions were identified via retrospective chart review (IRB#4954). Gestational weight gain according to prepregnancy body mass index (BMI) was categorized using ACOG standards as appropriate, insufficient, or excessive. Time of initial induction agent to delivery time equated to total induction time. Chi square, t test, and regression analyses were performed where appropriate. RESULTS: Of 1,031 inductions, 244 (24%) patients had appropriate, 160 (15%) had insufficient, and 627 (61%) had excessive GWG. 366 (36%) had prepregnancy BMI greater than 30. Average total induction times for appropriate, insufficient, and excessive GWG were 1,179, 1,072, and 1,286 minutes, respectively. Excessive GWG was a positive predictor of length of induction (P&lt;.001). Additionally, those with excessive GWG labored significantly longer with ruptured membranes (84 minutes) than those with appropriate GWG (P=.006). CONCLUSION: Excessive GWG correlated with 107 additional minutes in the induction process and more time with ruptured membranes. These data emphasize the importance of appropriate GWG particularly in patients beginning pregnancy with obesity. Patients with obesity otherwise have worse pregnancy outcomes; therefore, nutrition and exercise counseling during prenatal care could be advantageous. These data also help inform counseling and preparation on labor units, particularly as inductions become more prevalent.

Adapting Obstetric-Capacity Assessments to a Rural Context to Drive System Improvements [ID: 1375979

INTRODUCTION: As part of its Health Resources and Services Administration Maternal Health Innovation, Centers for Disease Control and Prevention (CDC) ERASE MM, and the American College of Obstetricians and Gynecologists Alliance for Innovation on Maternal Health (AIM) awards, Montana assessed capacity to provide risk-appropriate care in Montana's hospitals with labor and delivery (L&amp;D) units as well as critical access hospitals (CAHs) without L&amp;D units that serve remote communities in maternity care deserts. METHODS: Montana conducted the CDC LOCATe assessment in 96% (N=25) of hospitals with an L&amp;D and adapted an assessment used internationally by the World Health Organization to assess emergency obstetric capacity in 94% of CAHs without an L&amp;D. Surveys were conducted in REDCap, and the research team provided facilities with technical support in their completion of the assessments. RESULTS: While half of CAHs without L&amp;D reported an emergency delivery in the last 2 years, just one reported capacity to perform all services necessary to safely manage emergency deliveries. Two-thirds of facilities without L&amp;D units did not have a written transport protocol. In hospitals with L&amp;D who conducted the LOCATe assessment, nearly half (48%) overestimated the level of maternal health care that they were able to provide. Ultrasound and maternal-fetal medicine were the most common capacity insufficiencies. CONCLUSION: The system assessments revealed specific interventions that can expand capacity for quality obstetric care in a rural state like Montana, such as simulation training, adoption of AIM safety bundles through the perinatal quality collaborative, and enhanced access to ultrasound and maternal-fetal medicine services through telemedicine. National assessments like LOCATe should be adapted for the rural context to facilitate targeted resource investments.

Do technical change and mechanisation negatively affect employment in the manufacturing sectors? An empirical assessment for the OECD countries

The present study is aimed at assessing the impacts of technological change and mechanisation on employment in the manufacturing sectors of the OECD countries over the 1995-2018 period. To achieve this goal, the vertically integrated labour productivity and the vertically integrated capital-labour ratio were computed as measures of technological progress and capital intensity per unit of labour, whereas the CS-ARDL and CS-DL approaches were applied to obtain robust results in the presence of cross-sectional dependence and slope heterogeneity. The findings suggest that both technical change and mechanisation may lead to a relative decrease in employment in the short-run and long-run, though for skilled workers the effects appear to be positive. This increase in demand for skilled labour, however, may not be able to compensate for the decline in medium and lesser skilled labourers.

Implementation of Episcissors-60 for Prevention of Obstetric Anal Sphincter Injuries (OASIS) in a Centre with Low Episiotomy Rates

ObjectifCette étude avait pour objectif de déterminer si l’adoption des ciseaux Episcissors-60 à l’unité des naissances diminuerait la fréquence des lésions obstétricales du sphincter anal (LOSA). MéthodeUne étude sur l’amélioration de la qualité pré- et post-intervention a été menée pour la période du 1er avril 2020 au 31 mars 2021. Toutes les patientes ayant accouché par voie vaginale ont été incluses dans cette étude. Tous les fournisseurs de soins qui réalisent des accouchements vaginaux se sont fait offrir une séance de formation. Les ciseaux Episcissors-60 ont été ajoutés aux instruments disponibles à l’unité des naissances. Le critère de jugement principal était le changement de la fréquence des LOSA avant et après l’adoption des ciseaux Episcissors-60. Les critères de jugement secondaires étaient le taux d’épisiotomie avant et après l’adoption de ces ciseaux, le taux d’événements indésirables liés à l’instrument ainsi que le taux de satisfaction et les commentaires des fournisseurs de soins. Les données ont été analysées à l’aide de tests du chi carré, de tests t indépendants et de tests de Mann-Whitney. RésultatsAu total, dans la période à l’étude, il y a eu 1383 accouchements vaginaux avant et 1254 accouchements vaginaux après l’adoption des ciseaux Episcissors-60. Il y a eu une diminution du taux total de LOSA, lequel est passé de 7.37 % à 5.37 % de tous les accouchements vaginaux après l’adoption des ciseaux Episcissors-60 (P = 0,037). Le taux d’épisiotomie était de 11.42 % avant et de 9.97 % après l’adoption des ciseaux Episcissors-60 (P = 0.228). Le taux de LOSA chez les femmes ayant subi une épisiotomie était de 12.02 % avant et de 13.60 % après l’adoption des ciseaux Episcissors-60 (P = 0.421). ConclusionBien que l’adoption des ciseaux Episcissors-60 ait été associée à une diminution statistiquement significative du taux total de LOSA, il n’y avait aucune différence du taux de LOSA dans le sous-groupe d’épisiotomie. Par conséquent, la réduction du taux total de LOSA dans cette étude ne peut pas être attribuée à l’utilisation des ciseaux Episcissors-60.

The impact of epidural analgesia on delivery mode in Robson class 1 women: a retrospective cohort study

The use of epidural analgesia represents the gold standard for pain management during labor, but the influence of the use of epidural analgesia on delivery mode is not fully understood. This study aimed to analyze the impact of epidural analgesia on the delivery mode, namely, cesarean delivery, vaginal delivery, and operative vaginal delivery rates, in Robson class 1 women. A retrospective cohort study was conducted on all Robson class 1 women who delivered from January 1, 2019, to December 31, 2019, in the University Hospital of Modena. The primary outcome was the delivery mode (cesarean delivery, vaginal delivery, and operative vaginal delivery rates), and the secondary outcomes were maternal, anesthesiologic, and neonatal effects of epidural analgesia (duration of labor, duration of the second stage of labor, Apgar score, and neonatal intensive care unit admission). A total of 744 women were included in the final analysis, of which 198 (26.6%) underwent epidural analgesia on request and 546 (73.4%) did not. In women with and without epidural analgesia, the cesarean delivery rate was 8.1% vs 7%, the vaginal delivery rate was 79.3% vs 81.1%, and the operative vaginal delivery rate was 12.6% vs 11.9%, respectively. A significant increase in both the first stage of labor (66.3±38.5 vs 43.8±38.8 minutes; P<.0001) and total duration of labor (328.0±206.7 vs 201.7±168.3 minutes; P<.0001) was found in women receiving epidural analgesia. No change was recorded in the second stage of labor. A shorter duration of labor was observed (P<.0001) when epidural analgesia was started earlier (dilation: 2-4 cm vs >4 cm). No significant difference in Apgar score and neonatal intensive care unit admission was found. The use of epidural analgesia was not associated with an increased risk of cesarean delivery or operative vaginal delivery in Robson class 1 women. Further investigations are needed to evaluate its impact on the duration of labor, namely the duration of the first stage of labor, and on the possible advantages of starting epidural analgesia at an early stage.

Pregnancy Outcomes, Immunophenotyping and Immunohistochemical Findings in a Cohort of Pregnant Patients with COVID-19—A Prospective Study

(1) Background: SARS-CoV-2 infection during pregnancy could determine important maternal and fetal complications. We aimed to prospectively assess placental immunohistochemical changes, immunophenotyping alterations, and pregnancy outcomes in a cohort of patients with COVID-19; (2) Methods: 52 pregnant patients admitted to a tertiary maternity center between October 2020 and November 2021 were segregated into two equal groups, depending on the presence of SARS-CoV-2 infection. Blood samples, fragments of umbilical cord, amniotic membranes, and placental along with clinical data were collected. Descriptive statistics and a conditional logistic regression model were used for data analysis; (3) Results: Adverse pregnancy outcomes such as preterm labor and neonatal intensive care unit admission did not significantly differ between groups. The immunophenotyping analysis indicated that patients with moderate-severe forms of COVID-19 had a significantly reduced population of T lymphocytes, CD4+ T cells, CD8+ T cells (only numeric), CD4+/CD8+ index, B lymphocytes, and natural killer (NK) cells. Our immunohistochemistry analysis of tissue samples failed to demonstrate positivity for CD19, CD3, CD4, CD8, and CD56 markers; (4) Conclusions: Immunophenotyping analysis could be useful for risk stratification of pregnant patients, while further studies are needed to determine the extent of immunological decidual response in patients with various forms of COVID-19.

Multimedia tablet or paper handout to supplement counseling during preterm birth hospitalization.

Parents of premature infants engage in shared decision-making regarding the care of their infant. The process of prenatal counseling typically involves a verbal conversation with a neonatal provider during hospitalization. Support people may not be available, and the pregnant person's memory is impaired by medications, pain, and stress. The American Academy of Pediatrics, American College of Obstetricians and Gynecologists, and the Eunice Kennedy Shriver National Institute of Child Health and Human Development have called for improvements to this process, including the development of educational aids. This study aimed to investigate whether a multimedia tablet would be more effective than a paper handout in supplementing verbal clinician counseling during preterm birth hospitalization. This was a randomized controlled trial including English-speaking pregnant people aged ≥18 years and hospitalized at 22 to 33 weeks' gestation for preterm birth. Exclusion criteria were known fetal or chromosomal anomaly and delivery before study completion. Pregnant people received either a multimedia tablet or a paper handout before verbal clinician counseling. Preintervention assessment included demographics and State-Trait Anxiety Inventory, and postintervention assessment included the Parent Knowledge of Premature Birth Questionnaire and State-Trait Anxiety Inventory. Continuous variables were analyzed by t-test and categorical variables by Fisher exact test. A total of 122 pregnant people referred for counseling were screened; 76 were randomized, and 59 completed the study. Demographics were similar between groups, except that pregnant people in the handout group were older (mean 32 vs 29 years; P=.03). The multimedia tablet group (n=32) was less likely to report reviewing all the educational material than the paper handout group (n=27) (41% vs 72%; P=.037). Both groups correctly answered a similar number of knowledge items (P=.088). Postintervention state anxiety decreased in both groups (P<.0001), with no difference between groups. Computerized tracking showed that the multimedia group spent a median of 37 minutes reviewing the tablet. Contrary to our hypothesis, a paper handout and multimedia tablet were equally effective in the labor unit for supplementing verbal preterm birth counseling, and both decreased parental anxiety.

Closure of Labor & Delivery units in rural counties is associated with reduced adequacy of prenatal care, even when prenatal care remains available.

Closure of rural Labor & Delivery (L&D) units can impact timely access to hospital-based obstetrical care. Iowa has lost over a quarter of its L&D units in the previous decade. Assessing the effect of these closures on prenatal care in those rural communities is important to understanding the full effect of unit closures on maternal health care. Using birth certificate data in Iowa from 2017 to 2019, the initiation of prenatal care and adequacy of prenatal visits were assessed for 47 rural counties in Iowa. Of these, 7 experienced a closure of the only L&D unit between 1/1/2018 and 1/1/2019. The impact of these closures is modeled for all birthing parents and compared for Medicaid versus non-Medicaid recipients. All 7 counties that experienced the loss of their only L&D unit continued to have prenatal care services available. Experiencing a closure of an L&D unit was associated with a lower likelihood of overall adequate prenatal care but not significantly associated with a lower rate of first-trimester prenatal care utilization. Among Medicaid recipients of the communities where an L&D unit closed, there was an association of closure with both a lower likelihood of adequate prenatal care and entry to prenatal care after the first trimester. Utilization of prenatal care is lower in rural communities following L&D unit closure, especially among Medicaid recipients. This suggests that the overall maternal health systems were disrupted by the closure of the L&D unit, impacting the utilization of services that remained available to the community.

Prevalence of maternal complications and neonatal outcomes at a Midwest academic health center

Introduction: The University of Iowa Hospitals and Clinics (UIHC) serves as the main referral center for Iowa and has seen increased delivery volumes following many hospital closures across the state. Maternal characteristics are also shifting as pre-pregnancy obesity of reproductive-age women is increasing nationally and in Iowa; average maternal age at first delivery has also increased over time. The aim of the current study was to characterize the outcomes of the delivering population at UIHC over a one-year period to better understand the population we serve, as well as compare our population to state and national delivering populations. Methods: This study is a secondary analysis of a pre-existing prospectively gathered database related to COVID-19 in pregnancy. The current study included all pregnant patients who delivered or underwent procedures for a spontaneous or induced second-trimester abortion on the labor and delivery unit at UIHC between May 1, 2020, and April 30, 2021. Demographic and clinical data including maternal characteristics, delivery information, maternal complications, and neonatal outcomes were obtained from the electronic medical record and double entered in a Research Electronic Data Capture (REDCap) database. Continuous and categorical variables were summarized using medians and ranges. Results: The median maternal age among the 2497 delivering patients was 30 (IQR 26, 33). The median pre-delivery body mass index (BMI) was 32 (IQR 28, 37), which included 439 patients (17.6%) with BMI &amp;gt;40 at time of delivery. 1769 (70.8%) patients listed White as their self-defined race and 2275 (91.0%) listed English as their preferred language. 23% had hypertensive disease of pregnancy. The patients delivered a total of 2603 neonates, with 907 (34.8%) born by cesarean section. 18.7% of deliveries were preterm and 16.6% of neonates had low birth weight. Discussion: The delivering population at UIHC has a high rate of obesity and preeclampsia, both of which place patients at higher risk for other obstetric complications. The cesarean section rate was significantly higher than the national rate of 31.8% (p=0.0017). Understanding common complications in our changing population will better equip providers to care for these patients; providing these data also creates a resource for other researchers.

Who dismantled nursing mentorship systems and how do we get them back?

Who dismantled nursing mentorship systems and how do we get them back?

Outpatient vs inpatient induction of labor with oral misoprostol: A retrospective study.

Induction of labor is one of the most common obstetrical procedures today, with a successively rising rate. With a limited number of hospital beds, the option of starting induction at home has gained increasing attention. The primary aim of this study was to compare the proportion of women achieving vaginal delivery and the duration of hospital stay before delivery in induction of labor with oral misoprostol starting at home and induction with oral misoprostol at the hospital, in a low-risk population. Women with home induction (n=282) were individually matched to controls induced at the hospital during the same time period regarding parity, age, body mass index, labor unit and indication for induction. The rates of vaginal birth were similar in outpatients and inpatients (84.8% vs 86.2%; p=0.5). Time from hospital admission to delivery in the outpatient group was significantly shorter than in the inpatient group (12.8vs 20.6 h; p < 0.001), as was total hospital stay (2vs 3 days; p < 0.001). There were no significant differences between the groups in neonatal or maternal outcomes. One patient undergoing outpatient induction had an unplanned home birth. Starting induction at home reduced the time spent in hospital without affecting the vaginal delivery rate. Although underpowered to assess safety, this study did not show any differences in adverse maternal and perinatal outcomes between inpatients and outpatients. Further research is needed to evaluate the safety of outpatient induction of labor with misoprostol.

Women and partners' experience of major postpartum haemorrhage: a qualitative study.

To examine women and their partners' experience of major postpartum haemorrhage (PPH). A qualitative interview study. Two Labour and Delivery Units in Denmark. Women who experienced major PPH (≥1 litre within 2hours after vaginal birth). Semi-structured interviews were conducted with 15 women and nine partners (nine joint interviews, six individual interviews). Interviews were analysed using thematic analysis. A qualitative description of women and their partners' experiences. Three major themes were identified. (1) 'From birth to emergency' included factors that increased concern in women and their partners, such as 'incomprehensible' medical terminology, a tense atmosphere, and alarm call. Transfer to the operating theatre was experienced as the most devastating part of major PPH. (2) 'Feeling safe during an emergency' described factors that supported the women and their partners' management of the situation such as brief explanations from a few healthcare professionals and reassurance that the healthcare professionals were in control of the situation. The pain was experienced as severe, but acceptable. (3) 'Family unity challenged' described how family bonding was supported by positioning the partner at the head of the bed and by keeping the baby on the woman's chest. Several factors such as small gestures from healthcare professionals and appropriate organisation of the PPH can make a difference to the woman and her partner's experience of major PPH. Particularly, efforts that support family bonding are greatly valued by women and their partners.

Immediate contact between mother and newborn in the first hour of life: a cross-sectional study

Objective: to compare population and care characteristics of adherence to immediate contact between mother and newborn in the first hour of life in two public maternity hospitals at usual risk. Methods: cross-sectional study with 105 mothers after normal delivery and their respective newborns in the first hour of life in two maternity hospitals with Prepartum, Labor, and Puerperium units. We used an instrument with 36 questions based on the National Guidelines of Assistance to Normal Birth. Analysis was based on the chi-square test for homogeneity and Fisher's exact test to compare the assistance provided in maternity hospitals. Results: both maternity hospitals attended the usual risk binomials. Regarding the assistance provided, only the federal maternity promoted encouragement of immediate contact between mother and newborn in the first hour of life, besides favouring 7.1% (n=3) of the binomials with the golden hour in a correct and significant way (p=0.037). Conclusion: despite the similarity of the assistance profile, only one maternity hospital performed the golden hour, being necessary the insertion of good practices in maternity hospitals. Contributions to practice: direct observation of the assistance provided to binomial identified gaps in the format and and durability of the immediate contact in maternity hospitals.

Early Suckling and Post-Partum Bleeding

CONTEXT When working with parturient women, particular care must be taken at a sensitive phase like the immediate postpartum period. In order to minimise the quantity of vaginal blood loss, it is crucial to emphasise to those mothers the value of frequent breastfeeding and early start-up. The purpose of this study to investigate the effect of early suckling on postpartum bleeding . CONSTRUCTION A quasi experimental research design was utilized. CONTEXT The study was conducted at labor unit of Obstetrics and Gynecology department in Benha University Hospital. A SELECTED SAMPLE A purposive sample of (100) women's (50) in the group in commandwere given routine care and (50) women in the study squad, women encouraged to initiate early suckling immediately after birth. Tool I): A structured interviewing questionnaire II): Observation record on parturient women during stages of labor III): Breastfeeding assessment tool. there were highly statistically significant differences in duration of third stage of labor was at 5 minutes in women of study squad compared to women in the control group.Also, there were highly statistically significant differences found between the total mean score of the early initiation of breastfeeding among the study squad (10.2800±1.789) compared to (8.4800±2.233) of the group in command. It is possible to educate expectant mothers about the benefits of early breastfeeding at hospitals and birthing facilities.

Reduction of racial disparities in urine drug testing after implementation of a standardized testing policy for pregnant patients

Drug use during pregnancy can have implications for maternal and fetal morbidity and mortality and legal ramifications for patients. The American College of Obstetricians and Gynecologists guideline states that drug screening policies during pregnancy should be applied equally to all people and notes that biological screening is not necessary, stating that verbal screening is adequate. Despite this guidance, institutions do not consistently implement urine drug screening policies that reduce biased testing and mitigate legal risks to the patient. This study aimed to evaluate the effects of a standardized urine drug testing policy in labor and delivery on the number of drug tests performed, self-reported racial makeup of those tested, provider-reported testing indications, and neonatal outcomes. This was a retrospective cohort study. A urine drug screening and testing policy was introduced in December 2019. The electronic medical record was queried for the number of urine drug tests performed on patients admitted to the labor and delivery unit from January 1, 2019, to April 30, 2019. The number of urine drug tests performed between January 1, 2019, and April 30, 2019, was compared with the number of urine drug tests performed between January 1, 2020, and April 30, 2020. The primary outcome was the proportion of urine drug tests performed based on race before and after the implementation of a drug testing policy. The secondary outcomes included total number of drug tests, Finnegan scores (a proxy for the neonatal abstinence syndrome), and testing indications. To understand perceived testing indications, pre- and postintervention provider surveys were administered. Chi-square and Fisher exact tests were used to compare categorical variables. The Wilcoxon rank-sum test was used to compare nonparametric data. The Student t test and 1-way analysis of variance were used to compare means. Multivariable logistic regression was used to construct an adjusted model that included covariates. In 2019, Black patients were more likely to undergo urine drug testing than White patients, even after adjusting for insurance status (adjusted odds ratio, 3.4; confidence interval, 1.55-7.32). In 2020, there was no difference in testing based on race after adjusting for insurance status (adjusted odds ratio, 1.3; confidence interval, 0.55-2.95). There was a reduction in the number of drug tests performed between January 2019 and April 2019 compared with between January 2020 and April 2020 (137 vs 71; P<.001). This was not accompanied by a statistically significant change in the incidence of neonatal abstinence syndrome measured by mean Finnegan scores (P=.4). Before the implementation of a drug testing policy, 68% of providers requested patient consent for testing; after the implementation of a drug testing policy, 93% requested patient consent for testing (P=.002). The implementation of a urine drug testing policy improved consent for testing and reduced disparities in testing based on race and the overall rate of drug testing without affecting neonatal outcomes.

An evaluation of implementation climate in inpatient maternity care: a cross-sectional survey study

Objective Researchers in obstetrics and gynecology are continuously generating new evidence to inform clinical care delivery. Yet, much of this newly emerging evidence fails to be rapidly and effectively integrated into routine clinical practice. Implementation climate refers to clinicians’ perceptions of to what degree organizations support and reward use of an evidence-based practice (EBP) and is an important construct in the science of implementation in healthcare. Little is known about implementation climate for EBPs in maternity care. Thus, we aimed to (a) determine the reliability of the Implementation Climate Scale (ICS) for use in inpatient maternity care, (b) describe implementation climate in inpatient maternity care overall, and (c) compare individual perceptions of implementation climate between physician and nursing clinicians on these units. Study design We performed a cross-sectional survey of clinicians in inpatient maternity units across 2 urban, academic hospitals in the northeastern United States in 2020. Clinicians completed the 18-question validated ICS [scored 0–4]. Scale reliability by role was evaluated using Cronbach’s α. Subscale and total scores were described overall and compared by physician versus nursing role using independent t-tests, as well as linear regression to control for confounders. Results 111 clinicians completed the survey (physicians = 65; nursing = 46). Physicians were less likely to identify as female (75.4% vs. 100.0%, p < .001), but were of similar age and years of experience as nursing clinicians. Reliability of the ICS was excellent, with Cronbach’s α of 0.91 and 0.86 among physicians and nursing clinicians, respectively. Scores were notably low for implementation climate in maternity care overall and for all subscales. ICS total scores were also higher among physicians as compared to nurses (2.18(±0.56) vs. 1.92(±0.50), p = .02), which remained significant in multivariable modeling (p = .02). Unadjusted subscale scores were higher among physicians in Recognition for EBP (2.68(±0.89) vs. 2.30(±0.86), p = .03) and Selection for EBP (2.24(±0.93) vs. 1.62(±1.04), p = .002). After adjustment for potential confounders, subscale scores for Focus on EBP (p = .04) and Selection for EBP (p = .002) were all higher among physicians. Conclusions This study supports the ICS as a reliable scale for measuring implementation climate in the inpatient maternity care setting. Notably lower implementation climate scores across subscales and roles compared to other settings may underlie the vast evidence to practice gap in obstetrics. In order to successfully implement practices that reduce maternal morbidity, we may need to focus on building educational support and rewarding EBP utilization on labor and delivery units, with an emphasis on nursing clinicians.

Urine Drug Screening for Isolated Marijuana Use in Labor and Delivery Units.

Friends Research Institute, Baltimore, Maryland Guidelines for Letters. Letters posing a question or challenge to an article appearing in Obstetrics & Gynecology should be submitted within 8 weeks of the article’s publication online. Letters received after 8 weeks will rarely be considered. Letters should not exceed 350 words, including signatures and 5 references. Letters will be published at the discretion of the Editor. The Editor may send the letter to the authors of the original paper so their comments may be published simultaneously. The Editor reserves the right to edit and shorten letters. Letters should be submitted using the Obstetrics & Gynecology online submission and review system, Editorial Manager (http://ong.edmgr.com). Financial Disclosure The author did not report any potential conflicts of interest.

Healthcare providers’ perceptions and expectations of video-assisted debriefing of real-life obstetrical emergencies: a qualitative study from Denmark

ObjectivesVideo-assisted debriefing (VAD) of real-life obstetrical emergencies provides an opportunity to improve quality of care, but is rarely used in clinical practice. A barrier for implementation is the expected mental...

Kelly K. Ward, MD

Clinical Associate Professor of Obstetrics and Gynecology, Division of General Obstetrics and Gynecology. Medical Director, Labor and Delivery Unit and Mother-Baby Care, Department of Obstetrics and Gynecology. Associate Residency Director, Department of Obstetrics and Gynecology