Maternity Ward Staff Research Articles

Getting breastfeeding started under pandemic visiting restrictions: lessons learned in Germany

BackgroundThe COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions.MethodsIn the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth.ResultsIn almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part.ConclusionsThe unprecedented visiting restrictions in hospitals during the pandemic were like an “experiment” born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital.Trial registrationGerman Clinical Trials Register (DRKS) (DRKS00027975).

Maternity ward staff perceptions of exclusive breastfeeding in Finnish maternity hospitals: A cross-sectional study.

INTRODUCTIONThis study aimed to describe exclusive breastfeeding (EBF, Step 6 of the Baby-Friendly Hospital Initiative) in Finnish maternity hospitals and identify factors that promote or limit EBF.METHODSA cross-sectional study design was used, and data were collected from eight maternity hospitals in Finland during a 10-day period in May 2014. The staff completed questionnaires (n=1554) from separate work shifts. The data were analyzed using descriptive statistics, and chi-squared and Fisher’s tests. Responses to open-ended questions were analyzed using content analysis.RESULTSMaternity ward staff reported that 72% (n=1105) of the infants were exclusively breastfed during their work shift. The strongest promoting factors of exclusive breastfeeding were: maternity ward staffs’ profession and education in breastfeeding counselling; multiparity; vaginal delivery; early skin-to-skin contact between mother and infant; initial breastfeeding after birth; rooming-in; and initial success of breastfeeding. The use of a nipple shield, the need for additional breastfeeding counselling, and infants’ blood tests were limiting factors to exclusive breastfeeding. Open-ended answers revealed that exclusive breastfeeding was mainly delayed because of medical issues for the mother or infant.CONCLUSIONSFinnish maternity hospitals could improve exclusive breastfeeding rates by focusing attention and resources on breastfeeding counselling and evidence-based maternity care practices related to immediate care after birth, promoting vaginal delivery, rooming-in and availability of skilled counselling.

Implementation of Step 7 of the Baby-Friendly Hospital Initiative (BFHI) in Finland: Rooming-in according to mothers and maternity-ward staff.

INTRODUCTIONRooming-in is an evidence-based practice during which postpartum mothers and infants stay together. Rooming-in benefits both the mother and infant, and is especially important for breastfeeding. This study aims to describe rooming-in (Step 7 of the BFHI), according to mothers and maternity-ward staff in Finnish maternity hospitals, as well as the factors associated with its implementation.METHODSThe presented research adopted a cross-sectional study approach. Questionnaires were used to collect data from mothers (n=111) who had given birth and the attending maternity-ward staff (f=1554 reported events) at 8 Finnish maternity hospitals. The data were analysed using descriptive statistics, as well as chi-squared, t-test, and Fisher, Mann-Whitney, Kruskal-Wallis tests. Answers to the open-ended questions were analysed using content specifications.RESULTSRooming-in was utilised to a satisfactory extent, especially after vaginal birth. Most of the mothers regarded it as a very positive experience. Rooming-in was delayed mainly because of a mother’s tiredness and the infant’s condition. Factors such as a staff member’s age, work experience, and completion of breastfeeding counselling training (WHO 20-h), a mother’s parity, need for supplementation, and mode of childbirth, were found to be associated with the decision to implement rooming-in.CONCLUSIONSRooming-in should be used more with infants born by caesarean section and primiparous mothers. The need for supplementation clearly increased when roomingin was not employed. The presented information could be crucial for effectively allocating maternity ward resources and demonstrating the importance of rooming-in to a diverse audience of health care professionals.

The best encouraging persons in labor: A content analysis of Iranian mothers' experiences of labor support.

Background and aimsThe process of giving birth is very stressing for the mother. Meanwhile, maternity ward staff’s lack of awareness of mothers’ fears make mothers feel lonely and helpless. This study aimed to explore women’s perceptions of labor support during vaginal delivery.Materials and methodsThis exploratory qualitative study used qualitative content analysis to explore Iranian mothers’ experiences of labor support. Data were collected using observations and semi-structured interviews with 25 individuals. The participants were recruited through a purposive sampling method.ResultsThree categories, including “involvement of the spouse in the labor process”, “asking for a companion during labor”, and “mother’s self-care to cope with labor pain”, emerged during data analysis. These categories were merged to form the main theme of “trying to comply with the labor process”.ConclusionWomen believed that the presence of a companion, e.g. their husband, a family member, or a doula, during labor helped them better deal with the labor process, particularly when they felt lonely. Health care providers are expected to consider the needs of mothers and try to provide holistic support for mothers during labor pain.Implications for practiceIt seems that some mothers adopted particular coping strategies without receiving any relevant training. It is noteworthy that although mothers may make every effort to minimize their pain, health professionals should also practice medical approaches to help them through the process of labor.

Nursing and midwife staffing needs in maternity wards in Burkina Faso referral hospitals.

BackgroundIn 2006, Burkina Faso set up a policy to subsidize the cost of obstetric and neonatal emergency care. This policy has undoubtedly increased attendance at all levels of the health pyramid. The aim of this study was to measure the capacity of referral hospitals’ maternity services to cope with the demand for health services after the implementation of this policy.MethodsThis study was conducted in three referral health centres (CMAs, CHRs, and CHUs). The CHU Yalgado Ouédraogo (tertiary level) and the CMA in Sector 30 (primary level) were selected as health facilities in the capital, along with the Kaya CHR (secondary level). At each health facility, the study included official maternity ward staff only. We combined the two occupational categories (nurses and midwives) because they perform the same activities in these health facilities. We used the WISN method recommended by WHO to assess the availability of nurses and midwives.ResultsNurses and midwives represented 38% of staff at the University Hospital, 65% in the CHR and 80% in the CMA. The number of nurses and midwives needed for carrying out the activities in the maternity ward in the University Hospital and the CMA is greater than the current workforce, with WISN ratio of 0.68 and 0.79 respectively. In the CHR, the current workforce is greater than the number required (WISN ratio = 2).This medical centre is known for performing a high number curative and preventive activities compared to the Kaya CHR. Like the CHU, the delivery room is a very busy unit. This activity requires more time and more staff compared to other activities.ConclusionThis study showed a shortage of nurses and midwives in two health facilities in Ouagadougou, which confirms that there is considerable demand. At the Kaya CHR, there is currently enough staff to handle the workload in the maternity ward, which may indicate a need to expand the analysis to other health facilities to determine whether a redistribution of health human resources is warranted.

Why do primigravidae request caesarean section in a normal pregnancy? A qualitative study in Iran

Objectiveto gain a deeper understanding of why Iranian primigravidae request caesarean section without any medical indication. Designqualitative study. Data were gathered through semi-structured interviews, and thematic analysis was undertaken. Settingfour health care centres at Hamadan University of Medical Sciences, Hamadan, Iran. Participants14 primigravidae who requested caesarean section without any medical indication. Findingsreasons for requesting caesarean section were related to fear of childbirth (labour pain, injury to mother or infant), complications after vaginal delivery (vaginal prolapse, urinary incontinence, sexual dysfunction), trust in obstetricians, and lack of trust in maternity ward staff. Key conclusions and implications for practicethe main reasons given for requesting caesarean section show that there is urgent need for effective antenatal assessment to enable pregnant women to ask questions and express their concerns. In order to promote vaginal birth, there is a need to develop antenatal education and strategies to enhance women's knowledge, confidence and competence about vaginal birth. Health care providers should be re-educated about the observance of medical ethics and professional rules in their practices, and change their attitudes and behaviours to vaginal birth. Evaluation, improvement and change in maternity care policies are recommended to promote natural childbirth.

Personalschulung als Interventionsansatz auf Klinikebene zur Stillförderung: Evaluationsergebnisse der ersten Phase der STELLA-Studie

The health-promoting short- and long-term effects of breast-feeding are supported by a vast scientific literature. The Bavarian prospective cohort study 2005/2006 showed regional variations of breast-feeding rates. Furthermore, improvement in counselling mothers, particularly with regard to prevention and handling of breast-feeding problems, has a great potential for health promotion. The objective of this study is to promote breast-feeding in maternity clinics by improving the surrounding conditions. A clinic-based and community-related intervention trial was carried out in Lower Bavaria as a model region with below average breast-feeding rates. (1) INTERVENTION: an advanced training of maternity ward professionals of 10 hospitals and after-care midwives was performed from May until December 2008. The training programme was based on the WHO/UNICEF criteria of the "Ten Steps to Successful Breastfeeding" to deepen the breast-feeding knowledge and to improve the breast-feeding management. (2) EVALUATION: A singular assessment of the advanced training programme was undertaken concerning an increase of knowledge and the practicability in clinical everyday life by participants; improvements of the maternity wards were assessed via structural interviews with maternity ward staff before and after intervention. Approximately 85% (n=378) of the staff of the 10 maternity clinics attended the training course. The survey after the training programme (response rate 83%) indicated that more than 80% of the participants stated to have learned something new and to be able to use the knowledge acquired for their own practice. Results of the clinic interviews showed a transfer of training contents into clinical work routines. Improvements at interview date were shown best for bonding (all 10 maternity clinics), for additional feeding (8 maternity clinics) as well as for 24-h rooming-in and mother counselling (7 maternal clinics each). Training of maternity ward professionals accounts for baby-friendly conditions in maternity clinics. Most willingness for improvements was shown by maternity ward staff particularly for bonding between mother and child as well as for additional feeding. Considerable differences between the hospitals were observed for the promotion of infant formulas before and after the intervention.

Expectations of post-partum care among pregnant women living in the north of Sweden

Objectives. To describe expectations of post-partum care among pregnant women living in the north of Sweden and whether personality determines preference for care systems. The time for post-partum care on maternity wards has been reduced in Western countries. This, along with the reduction in special medical treatments offered and the closure of small hospitals has affected pregnant women and their families. Study Design. Data was extracted from a questionnaire and a personality instrument (SSP) that were completed during November 2002.Methods. In the northernmost county of Sweden, 140 pregnant women completed the questionnaire; of these, 120 completed the SSP instrument. Results. Of the women who participated, 61.3% wanted to be discharged 72 hours after childbirth, irrespective of the distance between the hospital and home. To have access to maternity ward staff and the decision to be discharged were described as being the most important issues in maternity ward care. The infant’s father was expected to be the most important person in the post-partum period.Conclusions. Women ranked the opportunity to decide for themselves when to be discharged from the maternity ward as important, which can be interpreted as a strong signal that the women want to be in control of the care they receive. Midwives have to focus more on the woman and her family’s individual needs, and to include the father as a person who also needs support and to provide resources for him.

Newborn Care Practices at Home: Effect of a Hospital-based Intervention in Sri Lanka

The aim of the present study was to evaluate the effect of an essential newborn care (ENC) training programme for maternity ward staff in improving newborn care practices after hospital discharge. A before-and-after study was conducted in the community involving mothers who had given birth in two hospitals in the Puttalam district in Sri Lanka. The intervention was a 4-day training programme and primarily aimed at increasing knowledge and skills of ENC among health care providers in the maternity units of these hospitals. Before the intervention, 144 mother-newborn pairs were followed-up and interviewed at their households within 28-35 days of delivery. Three months after the intervention, 150 mother-newborn pairs were interviewed at home. Results revealed that there was a significant improvement in umbilical cord care practices at home following the intervention. Application of 'surgical spirit' on umbilical cord has declined from 71.5% in the pre-intervention to 45.3% in the post-intervention samples (p < 0.001). Pre-intervention breastfeeding rates were high, and there wasn't any further improvement in the post-intervention. There was a 35% reduction in the proportion of newborns who developed any undesirable health events at home (p < 0.05). Findings suggest that the implementation of a comprehensive 4-day training programme of ENC for maternity ward health professionals can be followed by a significant improvement in mothers' practices on care of umbilical cord and clinical outcomes of newborns.

Efficacy of Breastfeeding Support Provided by Trained Clinicians During an Early, Routine, Preventive Visit: A Prospective, Randomized, Open Trial of 226 Mother-Infant Pairs

Despite growing evidence of the benefits of prolonged breastfeeding for mother and infant health, the rate of breastfeeding at infant age of 6 months remains below the Healthy People 2010 goal. The greatest decrease in the breastfeeding rate occurs during the first 4 postpartum weeks. Mothers who discontinue breastfeeding early are more likely to report lack of confidence in their ability to breastfeed, problems with the infant latching or suckling, and lack of individualized encouragement from their clinicians in the early postdischarge period. Observational studies suggest that primary care physicians can increase breastfeeding rates through specific advice and practices during routine preventive visits. However, robust scientific evidence based on randomized, controlled trials is currently lacking. The purpose of this study was to determine whether attending an early, routine, preventive, outpatient visit delivered in a primary care physician's office would improve breastfeeding outcomes. The study was a prospective, randomized, parallel-group, open trial. Participants were recruited at a level 3 maternity facility, with an average of 2000 births per year, in France. A total of 231 mothers who had delivered a healthy singleton infant (gestational age: > or =37 completed weeks) and were breastfeeding on the day of discharge were recruited and randomized (116 were assigned to the intervention group and 115 to the control group) between October 1, 2001, and May 31, 2002; 226 mother-infant pairs (112 in the intervention group and 114 in the control group) contributed data on outcomes. Support for breastfeeding in the control group included the usual verbal encouragement provided by the maternity ward staff members, a general health assessment and an evaluation for evidence of successful breastfeeding behavior by the pediatrician working in the obstetrics department on the day of discharge, provision of the telephone number of a peer support group, mandatory routine, preventive, outpatient visits at 1, 2, 3, 4, 5, and 6 months of infant age, and 10 weeks of paid maternity leave (extended to 18 weeks after the birth of the third child). In addition to the usual predischarge and postdischarge support, the mothers in the intervention group were invited to attend an individual, routine, preventive, outpatient visit in the office of 1 of the 17 participating primary care physicians (pediatricians or family physicians) within 2 weeks after the birth. The participating physicians received a 5-hour training program on breastfeeding, delivered in 2 parts in 1 month, before the beginning of the study. The primary outcome was the prevalence of exclusive breastfeeding reported at 4 weeks (defined as giving maternal milk as the only food source, with no other foods or liquids, other than vitamins or medications, being given). The secondary outcomes included any breastfeeding reported at 4 weeks, breastfeeding duration, breastfeeding difficulties, and satisfaction with breastfeeding experiences. Classification into breastfeeding categories reported at 4 weeks was based on 24-hour dietary recall. Ninety-two mothers (79.3%) assigned to the intervention group and 8 mothers (7.0%) assigned to the control group reported that they had attended the routine, preventive, outpatient visit in the office of 1 of the 17 primary care physicians participating in the study. Mothers in the intervention group were more likely to report exclusive breastfeeding at 4 weeks (83.9% vs 71.9%; hazard ratio: 1.17; 95% confidence interval [CI]: 1.01-1.34) and longer breastfeeding duration (median: 18 weeks vs 13 weeks; hazard ratio: 1.40; 95% CI: 1.03-1.92). They were less likely to report any breastfeeding difficulties (55.3% vs 72.8%; hazard ratio: 0.76; 95% CI: 0.62-0.93). There was no significant difference between the 2 groups with respect to the rate of any breastfeeding at 4 weeks (89.3% vs 81.6%; hazard ratio: 1.09; 95% CI: 0.98-1.22) and the rate of mothers fairly or very satisfied with their breastfeeding experiences (91.1% vs 87.7%; hazard ratio: 1.04; 95% CI: 0.95-1.14). Although we cannot exclude the possibility that findings might differ in other health care systems, this study provides preliminary evidence of the efficacy of breastfeeding support through an early, routine, preventive visit in the offices of trained primary care physicians. Our findings also suggest that a short training program for practicing physicians might contribute to improving breastfeeding outcomes. Multifaceted interventions aiming to support breastfeeding should involve primary care physicians.

Informations portées dans les carnets de santé en maternité

Objectives. – To study the frequency with which maternity ward staff complete the perinatal information section of infants’ permanent pediatric health records. Methods. – In 2000, 71 pediatricians in private practice and on staff in a general pediatric ward in a tertiary hospital in Paris carried out an observational study to assess which indicators were reported at what rates. Pediatricians were also asked which information about the perinatal admission they would find helpful in these records. Results. – One thousand seven hundred and eighty-five pediatric health records were studied. The frequency of completed information varied from 5 to 100%, depending on the item. Of the items reported rarely, some, such as thoracic circumference, were obsolete, while others were very important (response to noise, light reflex). The new information desired by office-based pediatricians involved mainly risk factors for vertical infections (maternal fever during delivery, prolonged rupture of the membranes). Conclusion. – Although the rate of completion of information in the pediatric health record was globally good, some important data should be reported more often (sensorial screening), while other items could be deleted. New information about the pregnancy and delivery would be useful.

Inter-observer Variation in Assessment of 845 Labor Admission Tests: Comparison Between Midwives and Obstetricians in the Clinical Setting and Two Experts

The labor admission tests entails 20-30 minutes of cardiotocographic (CTG) recording on entry to the maternity ward. Because observer variability reflects the reliability of any clinical test, this study was done to determine the degree of agreement between midwives and obstetricians in evaluating labor admission tests. Two expert consultant obstetricians from other centers also participated. The study group included 845 high- and low-risk women who were admitted in labor and gave birth within 24 hours of the test. Test findings were rated as reactive, equivocal, or ominous. The kappa (κ) value is the difference between observed and expected agreement, or the proportion of potential agreement beyond change. Values exceeding 0.75 reflect excellent agreement, and values between 0.4 and 0.75 reflect fair to good agreement. Weighted kappa (κW) was used in this analysis. The proportion of agreement (Pa) also was calculated. Agreement between the two experts was κw 0.38; Pa for a reactive labor admission test, 0.86; and Pa for an equivocal or ominous test, 0.33. The respective values for agreement between one expert and midwives/obstetricians were 0.25, 0.89, and 0.18. For the other expert, the respective figures were 0.28, 0.85, and 0.20. Nearly 6% of newborn infants had fetal distress. At a cutoff of an equivocal test, sensitivity values for the 2 expert observers were 0.22 and 0.31. Positive predictive values were 0.13 and 0.11. The likelihood ratios for a positive test were 2.3 and 1.92, and for a negative test, 0.86 and 0.83. Despite little evidence that it is beneficial, labor admission testing remains routine practice in most obstetrical units in the Western world. The present findings should prompt reconsideration of this practice, and they suggest the relevance of educational programs for maternity ward staff so that they will more accurately interpret CTG recordings.

Women's experiences of smoking during and after pregnancy as ascertained two to three years after birth

Objective: to ascertain the significant factors that influence women to stop/not stop smoking during pregnancy and the postnatal period. Design: Twenty-four women were interviewed two-three years after delivery with regard to their smoking habits during and after pregnancy. The material was analysed based on a phenomenological approach in order to provide an accurate description of lived experience. Findings: women who still smoked at their first visit to the antenatal clinic often had an established smoking pattern. They had vague knowledge about the risks of smoking during pregnancy. All women interviewed stated that the midwife played an important role in their motivation to stop/reduce smoking during pregnancy. Many women, however, lacked the support from doctors, delivery and maternity ward staff and district nurses. Conclusion: during pregnancy midwives and doctors have a unique opportunity to influence and help women who smoke to give up smoking. It is necessary that the different personnel have a similar approach to counselling.

Evaluation of a training program for healthcare professionals about breast-feeding

Objective: To assess the impact of a continuing medical education program based on the WHO’s 10 steps to successful breast-feeding. Study design: An observational before-and-after study at a teaching hospital. Data for two random samples of 50 women before and 50 after the intervention were collected from medical records and completed by a mail questionnaire. Results: Seventy-six percent of mothers initiated breast-feeding in the two samples. The median duration of breast-feeding was 12 weeks and did not differ between the before and after groups. The percentage of newborns separated from their mother more than 4 h a night decreased substantially after the intervention (13% versus 52% before the intervention, P<0.01). In-hospital formula provision also decreased after the intervention (63% of newborns versus 82% before intervention, P=0.07). Conclusion: This pilot study has enabled authors to document the feasibility of evaluating the impact of continuing education of maternity ward staff.

Using Practical Quality Improvement Approaches and Tools in Reproductive Health Services in East Africa

A nonprofit, nongovernment organization, AVSC International provides technical assistance worldwide, including a range of reproductive health services and quality improvement (QI) approaches and tools. Current activities in East Africa involve several hundred sites, including referral hospitals, district-level hospitals, and individual family planning clinics. THE QI PACKAGE: AVSC and its local partners developed Client-Oriented, Provider-Efficient Services (COPE), a problem-solving process and set of tools to involve all levels of site staff members in assessing and improving the services. The COPE tools--self-assessment guides, client interview guides, client flow analyses, and action plans--promote involvement, ownership, and commitment to the QI process. Facilitative supervision and whole-site training complemented AVSC's traditional approaches of medical monitoring and informed choice. Facilitative supervision encourages supervisors and managers to consider staff members as internal customers, whose needs they must meet for staff to be able to meet the needs of external customers (clients). Whole-site training was developed to meet the needs of staff members and providers, who needed to function as a team responsible for providing high-quality services. A government hospital that has adopted the entire package of QI approaches, has used the Quality Improvement Quotient self-assessment surveys to track its progress in several elements of high-quality care, including management and supervision, safety, and information and client--provider interactions. For example, maternity ward staff learned how to pass on to their clients information about clients' rights and family planning methods through posters, pamphlets, sample contraceptives, and health talks. AVSC's work with local organizations suggests a number of lessons learned, including the following: easy-to-use tools that promote staff involvement and ownership are essential in the QI process, QI requires considerable staff development and capacity building at all levels, and although the QI approaches were initially introduced for a relatively narrow field of services, they are applicable to and have increasingly been used in other departments and wards. (It is difficult, may be impossible, and certainly undesirable, to limit QI activities to one ward or service.) Activities in East Africa have shown that QI is possible even in very resource-poor settings. The same principles have guided the process in all the different programs, with some adaptation of the tools used. AVSC program activities are to continue to disseminate the experiences of sites implementing the package of tools and approaches, to advocate for investment in supervision and management capacity building as a means to support continuous quality improvement, and to further study the impact of the QI approaches on service quality.