Cesarean Birth Rate Research Articles

Racial and Ethnic Trends in Cesarean Delivery on Maternal Request.

To evaluate race and ethnicity differences in rates of cesarean delivery on maternal request (CDMR) in nulliparous, term, singleton, vertex presentation (NTSV) cesarean deliveries. We conducted a retrospective cohort study of NTSV cesarean deliveries within our institution from 2016 to 2020. The primary outcome was CDMR and the primary predictor was maternal race and ethnicity. Multivariable logistic regression models were used to evaluate associations between race and ethnicity, CDMR, and various maternal and perinatal factors. Among 12,351 NTSV cesarean deliveries, 594 (4.81%) underwent CDMR; 4605 (37.28%) identified as non-Hispanic White, 3731 (30.21%) as Asian/Hawaiian/Pacific Islander, 2840 (22.99%) as Hispanic, 785 (6.36%) as Black, and 390 (3.16%) as multiple races/American Indian/Alaskan Native. Adjusted models showed increased odds of CDMR among non-Hispanic White people. Multiple races/American Indian/Alaskan Native people had the lowest odds of CDMR compared to non-Hispanic White people (adjusted OR [aOR] = 0.48, 95% CI 0.26-0.82), followed by Asian/Hawaiian/Pacific Islander (aOR = 0.58, 95% CI 0.47-0.72), Black (aOR = 0.61, 95% CI 0.40-0.89), and Hispanic (aOR = 0.70, 95% CI 0.55-0.88) people. Non-Hispanic White people undergo CDMR more frequently compared to Asian/Hawaiian/Pacific Islander, Black, and Hispanic people. Our findings are notable in light of the growing body of research demonstrating that White people have the lowest odds of cesarean delivery overall. Profound racial disparities in maternal obstetric outcomes exist in the United States. It is well established that non-Hispanic Black people have disproportionately higher cesarean birth rates and higher rates of birth complications, including maternal death. Racial and ethnic differences in rates of primary elective cesarean delivery, or cesarean delivery on maternal request, are not well understood. This research shows that non-Hispanic White people have more cesarean deliveries on maternal request than other racial and ethnic groups among low-risk nulliparous patients.

Patterns of cesarean birth rates in the public and private hospitals of Romania

Caesarean sections (CSs) are essential surgical procedures that can save lives during childbirth, but can also pose health risks for mothers and infants. However, CS rates continue to rise globally beyond recommended values. This study provides a national and regional analysis of CS rates in Romania in 2020 across public and private hospitals, probing the influence of financial incentives on CS overuse, under the Romanian Diagnosis-Related Group (Ro-DRG) payment system. Ro-DRG data was aggregated from all 191 Romanian hospitals (171 public, 20 private) that reported deliveries in 2020, and described using quantitative methods. For each hospital, the Ro-DRG data included the total number of deliveries, the distribution across relevant Ro-DRG codes, and the average length of hospital stay. In 2020, 149,466 childbirth cases were reported through the Ro-DRG system; 89% in public and 11% in private hospitals. The national CS rate was 52.9%, with public hospitals reporting a rate of 49.7% compared to 79.8% in private hospitals. Regionally, CS incidence ranged from 29.89 to 71.42%. The Ro-DRG analysis revealed a high prevalence of high-complexity codes for both CS and natural deliveries, associated with higher payments. Additionally, the average length of hospital stay for CSs was longer in public (5.24 days) than in private hospitals (3.31 days), raising questions about hospital practices and resource utilization. The study suggests that financial incentives might be a contributing factor increasing Romanian CS rates. Targeted policy interventions are essential for aligning financial incentives with clinical necessity and ensuring the efficient use of healthcare resources.

Unplanned Cesarean for Abnormal or Indeterminate Fetal Heart Tracing Varies Significantly by Race and Ethnicity.

The US maternity care system achieves worse outcomes for birthing people identifying as Black versus White. Assessment of fetal well-being in labor is an area of perinatal care subject to significant interobserver variability and therefore may be at particular risk of medical racism influencing care. Statewide collaborative quality initiative data, focused on decreasing the nulliparous, term, singleton, vertex (NTSV) cesarean birth rate, were used to conduct a retrospective cohort study to assess differences in cesarean birth for nonreassuring fetal status between birthing people identifying as Black compared with White. Generalized linear mixed modeling with hospital as a random intercept was used for multivariate analyses accounting for birthing people clustering within hospitals. Between March 1, 2020, and December 31, 2022, 69,622 births were identified, 8291 (11.9%) of which were an unplanned cesarean with a primary indication of nonreassuring fetal heart tracing (cesarean for FHT). Race and ethnicity were significantly associated with a higher risk, after controlling for covariates: compared with White birthing people, birthing people of unknown race or ethnicity had 1.23 (95% CI 1.13-1.35) and Asian Pacific Islander birthing people had 1.55 times the odds (95% CI 1.37-1.76), whereas Black birthing people had 1.71 times the odds (95% CI 1.59-1.83) of birthing via unplanned cesarean for FHT. In adjusted analysis, prepregnancy diabetes, positive COVID-19 status at admission, elevated body mass index, and birthing in the Detroit Metro area were associated with cesarean for FHT. In an unplanned subgroup analysis of births within the Detroit Metro region, Black individuals remained significantly more likely to have an unplanned cesarean for FHT (aOR 1.63, 95% CI 1.48-1.79). After controlling for individual and hospital-level factors, cesarean for FHT was more common among non-Hispanic Black vs non-Hispanic White birthing people in this statewide cohort of NTSV births.

Survivors of Placenta Accreta: What Their Blogs Can Tell Us

Prior cesarean birth is the most significant predictor of placenta accreta which can place the woman and her infant’s lives at risk. With the continuing increase in cesarean birth rate, it is essential that childbirth educators inform women of this life-threatening risk. Insightful information from blogs written by survivors of placenta accreta pregnancies can help guide clinical practice and childbirth education. Content analysis of 22 blogs posted on the internet identified seven themes that provide an insider’s view of placenta accreta: the shock of it all, living in constant fear, advocate for yourself to get some sense of control, my mental health is deteriorating, you saved our lives!, recommendations, and posttraumatic growth.

Sociodemographic and Health-Related Risk Factors Associated With Planned and Emergency Cesarean Births in Mexico.

Cesarean delivery is a contributing factor to many delivery care and postpartum maternal morbidities, especially when a cesarean delivery is unnecessary. Mexico has one of the highest cesarean birth rates in Latin America, and as such, our objective was to identify the sociodemographic, reproductive, maternal care, and health-related characteristics associated with the prevalence of planned and emergency cesarean births in Mexico. Using nationally representative data from a Mexican probabilistic survey (ENSANUT 2021), we examined and developed a cross-sectional analysis of women aged 12 to 19 with a live-birth and women 20 to 49 years who had their last live-birth within five years before the survey (n = 1330). We used multinomial logistic regression analysis to examine predictors associated with planned and emergency cesarean births. The live-births within our sample included 50.7% vaginal, 27.5% emergency cesarean births, and 21.8% planned cesarean births. Younger age groups at delivery, speaking an indigenous language, and receiving delivery care at open public services are negatively associated with having any cesarean birth. Receiving delivery care at private institutions and having hypertension during pregnancy increases the odds of having both planned and emergency cesarean births. Emergency cesarean births are positively associated with tertiary education and negatively correlated with the parity of three or more children, while planned cesarean births are more likely for women with a parity of two. Efforts to reduce unnecessary cesarean births should include evidence-based medicine recommendations, actions to avoid the first cesarean birth, and providing pregnant women with counseling to support informed decisions.

Variation in organisational factors across high- and low-performing hospitals with regard to spontaneous vaginal birth for Black women in four states: a cross-sectional descriptive study

ObjectiveTo describe variation in hospital organisational factors across high- and low-performing hospitals with regard to spontaneous vaginal birth (SVB) for Black women.DesignCross-sectional descriptive.SettingWe conducted a cross-sectional study using three datasets...

What is an Ideal Cesarean Birth Rate? The Use of the C-Model and the Further Interpretation with the Robson Classification System, A Retrospective Analysis

What is an Ideal Cesarean Birth Rate? The Use of the C-Model and the Further Interpretation with the Robson Classification System, A Retrospective Analysis

A double-blind, randomized, placebo-controlled trial of melatonin as an adjuvant agent for induction of labor: TheMILO trial.

Melatonin has been suggested to have a biological role in the onset and progress of labor. We tested the hypothesis that the addition of melatonin during an induction of labor will reduce the need for a cesarean birth. This trial underwent protocol amendments that are detailed in the main text of the article. This trial is registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12616000311459). At a multi-center health service including secondary and tertiary obstetric hospitals, we performed a randomized, double-blind, placebo-controlled trial in women with a singleton cephalic pregnancy, free of significant maternal or perinatal complications who were undergoing induction of labor (with or without cervical ripening). Women were randomized to 10 mg melatonin vs placebo, with cervical ripening as required, and then 6-h during their induction of labor to a maximum of four doses or until birth. The primary outcome was cesarean birth. Secondary outcomes included labor, maternal, and neonatal outcomes. Data were analyzed using intention to treat. Sub-group analyses based on mode of ripening and parity were also performed. Between 2019 and 2021 we randomized 189 women (103 to melatonin and 86 to placebo). The study was prematurely terminated due to logistical complications resulting from the COVID-19 pandemic. Cesarean rates were 28/103 (27.2%) in the melatonin group vs 20/84 (23.3%) in the placebo group (RR 1.17 95% CI 0.71-1.92). There were no significant differences in rate of cesarean birth between the melatonin and placebo groups for failure to progress (13.4% and 9.3%, respectively, RR 1.46; 95% CI 0.64-3.32) or suspected fetal distress (10.7% and 10.5%, respectively, RR 1.02; 95% CI 0.44-2.34). The melatonin group had significantly lower rates of spontaneous vaginal birth within 24 h (35.0% vs. 50.0%; RR 0.70 95% CI 0.50-0.98). The rates of secondary outcomes such as total length of labor, rate of postpartum hemorrhage, and instrumental birth were comparable. Babies born in the melatonin group were more likely to need admission to the special care nursery, namely for hypoglycemic monitoring (18.5% vs. 8.1% RR 2.26; 95% CI 1.00-5.10). In women undergoing induction of labor, melatonin does not reduce the cesarean section rate. Melatonin use intrapartum may also be associated with neonatal hypoglycemia.

The Outcomes of Second Trimesteric Induction of Abortion in Previously Scarred Uterus at Ain Shams Maternity Hospital

Abstract Back Ground Termination of pregnancy by induced abortion is one of the commonest procedures, Pregnancy termination in case with prior cesarean delivery becomes an increasingly common situation facing obstetricians due to progressive increase in the rate and incidence of cesarean births. The aim of the Study was to assess and evaluate the outcomes of second trimesteric induction of abortion in previously scarred uterus. Methods this was a retrospective study curried at Ain Shams Maternity Hospital at the period from the 1st of January 2018 till the 31st of December 2020. Results Patients subjected to hysterotomy received significantly higher dosed of misoprostol compared with those who did not undergo hysterotomy (median [IQR] = 1100 [800 – 2400] mg versus 800 [500 – 1600] mg, respectively; p= .047). Conclusion There were 15.5% suffered failed medical abortion and 1.5% rupture uterus with difficulty to correlate this event to the dose of the medication used for induction. Increased gestational age, history of 3 or more CS, and presence of > 1 gestational sac was independently associated with decreased probability of successful medical abortion. Higher total dose of misoprostol was only marginally associated with decreased probability of success. On the other hand, higher hemoglobin level is independent predictor of successful medical abortion. Patients subjected to hysterotomy received significantly higher dosed of misoprostol compared with those who did not undergo hysterotomy.

Brain Training to Facilitate Labor and Birth: Impact of a Mobile Health Application

The purpose of this study was to evaluate the effects of cognitive training strategies, inclusive of mindfulness-based techniques and pain neuroscience education (PNE), during pregnancy. Using a pre–posttest design, primiparous women seeking a physiological birth used a novel mobile application (GentleBirth) and a web-based PNE course as a means of labor/birth preparation. Self-report questionnaires at baseline, prebirth, and postbirth assessed all studied outcomes (pain knowledge, pain and birth self-efficacy, and birth outcomes). Use of the GentleBirth app combined with PNE during pregnancy was associated with improved pain knowledge, χ2(2) = 95.9,p< .001, and birth self-efficacy,F(2, 268) = 71.54,p< .001; high rates of labor coping, 7.48 (standard deviation 2.29); and lower rates of cesarean births and epidural use.

Increasing the number of midwives is necessary but not sufficient: using global data to support the case for investment in both midwife availability and the enabling work environment in low- and middle-income countries

BackgroundMost countries are off-track to achieve global maternal and newborn health goals. Global stakeholders agree that investment in midwifery is an important element of the solution. During a global shortage of health workers, strategic decisions must be made about how to configure services to achieve the best possible outcomes with the available resources. This paper aims to assess the relationship between the strength of low- and middle-income countries’ (LMICs’) midwifery profession and key maternal and newborn health outcomes, and thus to prompt policy dialogue about service configuration.MethodsUsing the most recent available data from publicly available global databases for the period 2000–2020, we conducted an ecological study to examine the association between the number of midwives per 10,000 population and: (i) maternal mortality, (ii) neonatal mortality, and (iii) caesarean birth rate in LMICs. We developed a composite measure of the strength of the midwifery profession, and examined its relationship with maternal mortality.ResultsIn LMICs (especially low-income countries), higher availability of midwives is associated with lower maternal and neonatal mortality. In upper-middle-income countries, higher availability of midwives is associated with caesarean birth rates close to 10–15%. However, some countries achieved good outcomes without increasing midwife availability, and some have increased midwife availability and not achieved good outcomes. Similarly, while stronger midwifery service structures are associated with greater reductions in maternal mortality, this is not true in every country.ConclusionsA complex web of health system factors and social determinants contribute to maternal and newborn health outcomes, but there is enough evidence from this and other studies to indicate that midwives can be a highly cost-effective element of national strategies to improve these outcomes.

Maternal and neonatal outcomes associated with breech presentation in planned community (home and birth center) births in the United States: A prospective observational cohort study.

Investigate maternal and neonatal outcomes associated with breech presentation in planned community births in the United States, including outcomes associated with types of breech presentation (i.e., frank, complete, footling/kneeling). Secondary analysis of prospective cohort data from a national perinatal data registry (MANA Stats). Planned community birth (homes and birth centers), United States. Individuals with a term, singleton gestation (N = 71,943) planning community birth at labor onset. Descriptive statistics to calculate associations between types of breech presentation and maternal and neonatal outcomes. Maternal: intrapartum/postpartum transfer, hospitalization, cesarean, hemorrhage, severe perineal laceration, duration of labor stages and membrane rupture Neonatal: transfer, hospitalization, NICU admission, congenital anomalies, umbilical cord prolapse, birth injury, intrapartum/neonatal death. One percent (n = 695) of individuals experienced breech birth (n = 401, 57.6% vaginally). Most fetuses presented frank breech (57%), with 19% complete, 18% footling/kneeling, and 5% unknown type of breech presentation. Among all breech labors, there were high rates of intrapartum transfer and cesarean birth compared to cephalic presentation (OR 9.0, 95% CI 7.7-10.4 and OR 18.6, 95% CI 15.9-21.7, respectively), with no substantive difference based on parity, planned site of birth, or level of care integration into the health system. For all types of breech presentations, there was increased risk for nearly all assessed neonatal outcomes including hospital transfer, NICU admission, birth injury, and umbilical cord prolapse. Breech presentation was also associated with increased risk of intrapartum/neonatal death (OR 8.5, 95% CI 4.4-16.3), even after congenital anomalies were excluded. All types of breech presentations in community birth settings are associated with increased risk of adverse neonatal outcomes. These research findings contribute to informed decision-making and reinforce the need for breech training and research and an increase in accessible, high-quality care for planned vaginal breech birth in US hospitals.

Analysis of the appropriateness of using the Robson Classification in a high-risk maternity ward in Brasília, Brazil

The Robson Classification is a tool designed to monitor cesarean section rates in diverse populations and assess the impact of management changes. This study aimed to evaluate the application of the Robson Classification in a high-risk maternity ward in Brasília, Brazil. A cross-sectional observational study was conducted, analyzing 1813 deliveries between January and June 2019 at the Materno Infantil Hospital in Brasília. The overall cesarean section rate was 55.7%, and Robson Group 5 significantly contributed to the global rate at 33.3%. It was concluded that there is an association with the type of delivery, newborn weight, and fetal disease, irrespective of the type. Regarding maternal conditions, an association was observed in Robson Group 10, which exhibited a 51.4% cesarean section rate. The use of the Robson Classification within the maternity context, despite being a local reference for high-risk pregnancies, indicated the potential for reducing cesarean rates in specific cases. A protocol based on the Robson Classification is proposed as an instrument for adjusting cesarean birth rates in all public maternity hospitals in the Federal District, Brasília, Brazil.

A Qualitative Study Exploring Women's Experiences of Unplanned Cesarean Surgery and Their Suggestions for Improving Care

The rate of unplanned cesarean birth is increasing and there is a growing body of evidence regarding the associated psychosocial harms. A phenomenological study exploring eight women's lived experiences of intrapartum cesarean birth in Nova Scotia was undertaken. Two groups of women were recruited, three receiving care from a midwife with transfer from a planned home birth and five women under the care of a physician. Semi-structured interviews were tape-recorded and transcribed. These data, combined with participantdiariesande-mails,wereanalyzedusingColazzi'smethod. Threemajorthemesemerged:1) Immediate and lingering emotional reactions, which were wide ranging, the majority negative, particularly fear, disappointment and self-doubt, 2) Mediating factors, most significantly, continuous contact with the baby and provider support, especially from midwives, and 3) Participant suggestions for improving care which included prenatal operating room (OR) tours, family-friendly OR policies, postnatal medical review with extended follow-up and peer support. This study adds to the already substantial evidence of associated psychosocial harms which can be mediated by concurrently reducing unnecessary cesarean surgery and implementing measures to improve the quality of cesarean care.

Homebirth and the National Health Service in Italy. A qualitative study in the Emilia- Romagna Region

Introduction: Medicalization of birth has increased all over the world in the past decades. The Italian caesarean birth rate (38%) is among the highest in the world. Could be birth at home as a public model of care a superior alternative to current practices? This paper focuses on the experience of the Emilia-Romagna region, where the National Health Service (NHS) has carried out a home birth service for more than 13 years. The aim is to discuss the strengths and weaknesses of homebirth as a public health model compared to homebirth within the private practice system. Methods: Qualitative data were collected between 2010 and 2013, as part of a wider anthropological research project on out-of-hospital birth in Italy and Spain. Seventy participants were interviewed in total. In Emilia-Romagna, in- depth interviews were conducted with 21 participants; these included midwives, women, doctors and health managers. Focus groups, a field diary and participant observation were also used for data collection. Data were analyzed using ethnographic method and content analysis. Results: Main findings suggest that the added value provided by the NHS home birth service in the Emilia-Romagna region (home births attended by community- based or hospital-based midwives) compared to the private care model encompass increasing of the social legitimacy of homebirth, the transfer of best practices from homebirth to hospital birth, increasing the continuity of care when the woman is referred to the hospital, increasing the continuity of training and the autonomy of midwives in caring for normal births in the hospital and providing free services. Homebirth managed by the NHS contributes to the promotion of a physiological model of care also in the hospital.

Induction Method Combination in Patients With Hypertensive Disorders of Pregnancy [ID 2683632

INTRODUCTION: We aim to evaluate cesarean birth (CB) rates according to induction method combinations in patients with hypertensive disorders of pregnancy (HDP). METHODS: We conducted a retrospective study including singleton pregnancies with HDP admitted to labor and delivery at a tertiary center from January 2018 to December 2019. Clinical and sociodemographic data were extracted from electronic medical records. Pregnancies with incomplete data and those who declined a trial of labor were excluded. Hypertensive disorder of pregnancy was defined according to the American College of Obstetricians and Gynecologists classification. Cesarean birth rates were compared among induction agent combinations using binary logistic regression. A value of P<.05 was considered significant. RESULTS: A total of 552 pregnancies met inclusion criteria. Of these, 113 were induced with oxytocin, 112 with mechanical agents and oxytocin, 58 with a mechanical method and prostaglandins, 31 received prostaglandins alone, 54 received oxytocin and prostaglandins, 80 received oxytocin, prostaglandins, and a mechanical agent, 35 were induced with mechanical methods, and 69 were in spontaneous labor. Demographic and baseline characteristics were not different by induction agent combination. After logistic regression, the combination of prostaglandins and mechanical agents was associated with a decreased CB rate; odds ratio, 0.4 (95% CI: 0.1–0.9), using those in spontaneous labor as reference. No other agent combination was associated with an increased or decreased in CB rate. CONCLUSION: Induction of labor with a combination of prostaglandins and mechanical agents may decrease CB rates compared with other combination methods for induction in pregnancies with HDP.

Strengthening caesarean birth: Sub-Saharan Africa health system evaluation: Scoping review.

Promoting safe caesarean birth (CB) is a challenge in sub-Saharan Africa (SSA) where maternal and neonatal mortality rates are high due to inadequate maternal health services. Although the CB rate in SSA is lower than the World Health Organization (WHO) recommendation, it is often associated with high maternal and neonatal mortality. The aim of this scoping review was to report on the extent to which SSA health systems deliver safe CB. A systematic search across various databases identified 53 relevant studies, comprising 30 quantitative, 10 qualitative and 16 mixed methods studies. These studies focused on clinical protocols, training, availability, accreditation, staff credentialing, hospital supervision, support infrastructure, risk factors, surgical interventions and complications related to maternal mortality and stillbirth. CB rates in SSA varied significantly, ranging from less than 1% to a high rate of 29.7%. Both very low as well as high rates contributed to significant maternal and neonatal morbidity. Factors influencing maternal and perinatal mortality include poor referral systems, inadequate healthcare facilities, poor quality of CBs, inequalities in access to maternity care and affordable CB intervention. The inadequate distribution of healthcare facilities, and limited access to emergency obstetric care impacted the quality of CBs. Early access to quality maternity services with skilled providers is recommended to improve CB safety.Contributions:This scoping review contributes to the body of knowledge motivating for the prioritization of maternal service across SSA.

Expanding Labor Support Education to Nurses Caring for Women in Labor.

The ability to provide emotional and physical support to a patient during one of the most significant moments of her life is a privilege afforded to intrapartum nurses who attend to laboring and delivering patients. Labor support improves birth outcomes, reduces cesarean birth rates, and decreases anesthesia use. Within the hospital context, this quality improvement project investigated the effects of educating intrapartum nurses about labor support and providing them with hands-on training. Surveys, including the Self-Efficacy Labor Support Scale, were given preeducation and posteducation to evaluate and document knowledge acquisition. Results support teaching intrapartum nurses learning evidence-based labor comfort strategies to support a woman's labor preference.

Increased Maternal BMI at Time of Delivery Associated with Poor Maternal and Neonatal Outcomes.

Current literature on the risks and outcomes of obesity in pregnancy almost exclusively utilizes prepregnancy body mass index (BMI). Given the rising obesity rate across the United States along with a paucity of available information on the relationship between delivery BMI and maternal and neonatal outcomes, our study aimed to determine the association of maternal BMI at delivery with antepartum, intrapartum, and neonatal complications at an academic referral hospital. This study is a secondary analysis of data collected for a prospective cohort study of Coronavirus Disease-2019 (COVID-19) in pregnancy. This analysis included all patients who delivered term singleton infants between May 1, 2020, and April 30, 2021, at the University of Iowa Hospitals and Clinics. Demographic and clinical data were obtained from the electronic medical record. The relationship between maternal BMI and maternal and neonatal characteristics of interest was assessed using logistic regression models. A statistical significance threshold of 0.05 was used for all comparisons. There were 1,996 women who delivered term singleton infants during the study period. The median BMI at delivery was 31.7 kg/m2 (interquartile range: 27.9, 37.2), with 61.1% of women having a BMI ≥ 30.0 kg/m2. Increasing BMI was significantly associated with nonreassuring fetal status, unscheduled cesarean birth, overall cesarean birth rate, postpartum hemorrhage, prolonged postpartum stay, hypertensive diseases of pregnancy, neonatal hypoglycemia, neonatal intensive care unit admission, decreased APGAR score at 1 minute, and increasing neonatal birth weight. Even when controlling for preexisting hypertension in a multivariate model, increasing BMI was associated with gestational hypertension and preeclampsia. Increased maternal BMI at delivery was associated with adverse perinatal outcomes. These findings have implications for clinical counseling regarding risks of pregnancy and delivery for overweight and obese patients and may help inform future studies to improve safety, especially by examining reasons for high cesarean rates. · Sixty-one percent of delivering patients had a BMI330 kg/m2 at delivery.. · There was a higher cesarean rate with increasing delivery BMI.. · For every 5-unit increase in maternal BMI, neonatal weight increased by 0.47 g..

Psychosocial outcomes from one cohort participating in the STan Australian Randomised controlled Trial (START).

In an Australian randomized controlled trial (RCT), two techniques for intrapartum fetal surveillance were compared: ST analysis (STan) as an adjunct to cardiotocography (CTG), compared with CTG alone. The aim was to determine whether CTG + STan could reduce emergency cesarean birth rates while maintaining or improving neonatal outcomes. Secondary aims were to compare clinical, economic, and psychosocial outcomes. The purpose of this paper was to present psychosocial outcomes from one cohort enrolled in the trial. The study was conducted at one tertiary referral hospital. Participants who had taken part in the trial from the outset were invited to complete a questionnaire between March 2018 and January 2020, approximately 8 weeks after giving birth. Outcomes included depression, psychological distress, health-related quality of life, and infant feeding practices. Analysis was by intention to treat. N = 207/527 participants completed the questionnaire (n = 113, STan; n = 94, CTG alone). Overall, no statistically significant or clinically meaningful differences were found in the two groups for symptoms of depression, psychological distress, quality of life, or infant feeding. A statistically significant difference was observed for the subscale of pain-discomfort, where scores were higher on average in the CTG alone arm relative to that in the CTG + STan arm. Although STan as an adjunct to CTG constitutes a different clinical technology from CTG alone, both monitoring types appeared to produce similar results in terms of postnatal psychosocial outcomes for women. Findings from this study provide service users and staff with a comprehensive assessment of STan that can be used to make evidence-informed decisions about monitoring options should STan become more widely available.