Rise In Birth Rate Research Articles

The hypothermic term infant

Neonatal hypothermia in the term infant is an ongoing, avoidable and inexcusable complication, and is a prominent cause for readmissions to neonatal units. The systemic functions that enable the infant to adapt to extrauterine life are not inexhaustible, and the subtle signs and symptoms of hypothermia are frequently mistaken for sepsis. Whether professional negligence is to blame has been questioned: staff shortages, rising birth rates and increasing complex conditions are not acceptable justifications. While controversial, using early warning scoring systems for healthy term infants with risk factors combined with promotion of family centered care, may reduce incidences of neonatal hypothermia, thus protecting the infant from further complications.

The Lime Tree School endeavour: healthy body, brain and heart.

Imagine what fun pupils would have at a school where the head dresses up as Dennis the Menace for World Book Day? And equally beneficial to the school, where parents can achieve a sustainable win-win by donating unwanted clothing, which is then sold to recyclers to boost school funds? These are the values that sustain Lime Tree Primary, Kingston's newest school which opened its doors in September 2012. Central to the school's ethos is the unique partnership between health and education that has transformed this fledgling primary school into a real community asset. The problem was a real one facing many local authorities today: a rising birth rate and too few classroom places; a new build seemed the obvious solution - and a real opportunity. Local children, their families, residents and professionals were interviewed and their ideas translated into proposals for the new school. A magical learning environment for local youngsters was created, embodied by the school motto, which recognises that a healthy body sustains better learning, and better learning leads to enhanced health benefits. The school lives and breathes 'Healthy Body, Brain and Heart' and transfers this into all its daily activities. And what of the future? There is no doubt that this type of initiative could be adopted in other parts of the new NHS. Wouldn't it be marvellous if other examples of like collaboration could help us jointly tackle the challenges of modern-day living?

PL.51 Seven in One Year: Lessons Learned from a Review of Peripartum Hysterectomy in a District General Hospital

Following an unusual number of peripartum hysterectomies performed in the calendar year August 2011 to August 2012 in our district general hospital, we undertook a detailed review of the seven...

Maternal Critical Care: Who Cares?

With rising birth rates, and greater numbers of increasingly challenging mothers, the need for maternal critical care is rising. In the light of several major reports, this article looks at current provision, as well as areas for future development.

Maternal age ≥45 years and maternal and perinatal outcomes: A review of the evidence

Objectiveto examine the evidence in relation to very advanced maternal age (≥45 years) and maternal and perinatal outcomes in high-income countries. Backgroundthis review was conducted against a background of increasing fertility options for women aged ≥=45 years and rising birth rates among this group of women. Methodsestablished health databases including SCOPUS, MEDLINE, CINAHL, EMBASE and Maternity and Infant Care were searched for journal papers, published 2001–2011, that examined very advanced maternal age (VAMA) and maternal and perinatal outcomes. Further searches were based on references found in located articles. Keywords included a search term for maternal age ≥45 years (very advanced maternal age, pregnancy aged 45 years and older) and a search term for maternal complications (caesarian section, hypertension, pre-eclampsia, gestational diabetes) and/or adverse perinatal outcome (preterm birth, low birth weight, small for gestational age, stillbirth, perinatal death). Of 164 retrieved publications, 10 met inclusion criteria. Data extractiondata were extracted and organised under the following headings: maternal age ≥45 years; maternal characteristics such as parity and use of artificial reproductive technology (ART); and pre-existing maternal conditions, such as diabetes and hypertension. Additional headings included: gestational conditions, such as pre-eclampsia and gestational diabetes (GDM); and perinatal outcomes, including fetal/infant demise; gestational age and weight. Study quality was assessed by using the Critical Appraisal Skills Programme (CASP) guidelines. Findingsthis review produced three main findings: (1) increased rates of stillbirth, perinatal death, preterm birth and low birth weight among women ≥45 years; (2) increased rates of pre-existing hypertension and pregnancy complications such as GDM, gestational hypertension (GH), pre-eclampsia and interventions such as caesarian section; and (3) a trend of favourable outcomes, even at extremely advanced maternal age (50–65 years), for healthy women who had been screened to exclude pre-existing disease. Key conclusionsalthough there is strong evidence of an association between very advanced maternal age and adverse maternal and perinatal outcomes, the absolute rate of stillbirth/perinatal death remains low, at less than 10 per 1000 births in most high-income countries. Therefore, although women in this age group encounter greater pregnancy risk, most will achieve a successful pregnancy outcome. Best outcomes appear to be linked to pre-existing maternal health, and pregnancy care at tertiary centres may also contribute. This information should be used to counsel women aged ≥45 years who are contemplating pregnancy.

Safeguarding against maternal obesity

British Journal of Midwifery • october 2012 • Vol 20, No 10 Earlier this month, the BJM held another successful study day designed to offer concentrated educational updates for busy midwives. This particular programme focused on the issue of obesity and nutrition in pregnancy. The health implications of maternal obesity for both the mother and baby are well known, yet the incidence of obesity in the UK is still alarmingly high. Just over a quarter of adults were classified as obese in 2010 (Body Mass Index >30kg/ m2) (NHS Information Centre, 2012). This has an enormous monetary impact on the already strained NHS. David Cameron, Prime Minister said: ‘[obesity] already costs our NHS a staggering £4 billion a year. But within 4 years, that figure is expected to rise to £6.3 billion.’ The question is, what can we do about this? In this issue of BJM, Helen Williams explores the value of antenatal interventions (p698) in the second of two articles discussing whether midwives are missing a health promotion opportunity. Helen concludes that despite the wealth of evidence on maternal obesity, there is a definite gap in the research on optimal weight gain during pregnancy. In the UK, there are no guidelines for this and so it is very difficult for midwives to provide evidence-based advice. The only guidance available is the one from the US developed by the Institute of Medicine (2009); however, evidence behind it is lacking. The National Institute for Health and Clinical Excellence (NICE) (2010) clearly state that weight loss during pregnancy should be avoided. But with many women presenting as obese at the time of booking, is raising awareness then already too late? It is worth noting, however, that there are still many women who, at booking, are not overweight and so nutrition guidance and health promotion at this point may help safeguard against obesity in future pregnancies. It is estimated that about 50% of normal-weight women and 65% of overweight or obese women gain too much weight during pregnancy, which is associated with high postpartum weight retention, long-term obesity, and a range of adverse maternal and fetal outcomes. The ‘eating for two myth’ needs dispelling and women should be informed early on that they only need to consume about 200 extra calories in the third trimester. In today’s climate of increasing obesity and rising birth rates, the need for evidence-based guidelines and advice becomes ever more pressing and surely must be driven from practice. BJM

Is midwifery still a labour of love?

Sitting next to a woman on the tube recently, I noticed she was engrossed in an article entitled ‘Women hire own midwives after trauma of NHS births’ (Goodchild, 2012)’. At my next stop, I got the paper and perused it over the obligatory latte. It stated that London mothers are resorting to private midwives because they fear giving birth on the NHS, the reasons they gave were the rising birth rate and the shortfalls in midwives. The story also provided private midwives views on why hers and similar services are being increasingly used. She highlighted that reality shows such as ‘One Born Every Minute’ showing women being left by the midwife for long periods of time or not seeing the same midwife twice were partly to blame. I think we all understand that a women’s previous experiences can affect subsequent pregnancies and choice place of birth as well as service provider. So what is being done? Many NHS trusts provide services to support women who have had difficult or traumatic births. These services include debriefing interventions to help reduce psychological problems in the postnatal period or VBAC (vaginal birth after caesarean section) clinics to offer information and support for women who have had previous caesarean sections and who want a vaginal birth. These obviously do not go far enough to meet the needs of all women. What we may now see is a group of women in their first pregnancy who have a dread of childbirth because of other people’s experiences via reality shows. True, women have often relayed scary birth stories to me from friends and relatives giving rise to concern but they were just that, ‘stories’ which often become embellished over time. As a midwife it was usually easy to discuss these anxieties and offer appropriate support. However, women are now ‘living through’ the ups and downs of a number of births via the media, which are edited for entertainment value, and do little to allay the fears of pregnant women. A quick scan of the programme’s forum postings shows that women are shocked by some of the content, which leaves them stressed and anxious. It is clear that midwives need to be aware of the impact of these shows, rather than avoiding watching them (as a lot of us do). We should be in a position to try to explain what has happened if women ask. I hope every midwife watches these reality shows with a critical eye, again we can learn from observing care from a different perspective. Although private and NHS provision might differ, all midwives want to offer the best service they can. In the NHS, it might not be one-to-one care that midwives wish for, but women need to be able to feel they have access to a midwife whenever they need one. Better communication is fundamental, informing women about what they can expect from the NHS so they can make a decision to engage private services in light of this information. Lawrence (2012) reported that women are paying independent midwives to support them during hospital birth providing information, arguing their case and being a constant presence during labour. This raises the question of advocacy. Why might NHS midwives have lost this skill? Is it that they lack the resources, the ability to promote normal birth or fail to listen to women’s needs? Even in light of limited resources there is still a lot of good will in the NHS, only last week I heard that midwives who are experts in home birth are providing voluntary support for inexperienced midwives in an attempt to increase the service. This echoes the feelings of Cathy Warwick CBE, General Secretary of the Royal College of Midwives, who stated that great work is being done by midwives in relation to increasing home and water birth figures (Dabrowski, 2011). Has midwifery changed so much that the NHS cannot provide women with the care and support they need or have women’s expectations changed? Either way the service needs modernising to meet these needs and this can only be done if there are adequate midwives available. It appears that women want the traditional role of the midwife back, to communicate effectively and encourage them to make their own choices. Let us make sure these are in our everyday practice and remember that midwifery will always be a labour of love regardless of who provides the service. BJM

Comparing midwife‐led and doctor‐led maternity care: a systematic review of reviews

A report of a systematic review of reviews which examines the impact of having midwives-led maternity care for low-risk women, rather than physicians. A rising birth rate, increasing complexity of births, and economic constraints pose difficulties for maternity services in the UK. Evidence about the most effective, cost-effective, and efficient ways to give maternity services is needed. Searches were carried out in August-September 2009 of ten electronic databases, 16 key nursing and research websites, and reference lists of 56 relevant reviews. We also contacted 38 experts for information. No date restrictions were employed. A narrative review of systematic reviews or 'meta review' was conducted using transparent and systematic procedures to limit bias at all stages. Systematic reviews that compared midwife-led care during pregnancy and birth with physician-led care were eligible for inclusion. Three meta-analytic reviews were included. Midwife-led care for low-risk women was found to be better for a range of maternal outcomes, reduced the number of procedures in labour, and increased satisfaction with care. For some maternal, foetal, and neonatal outcomes reviews found no evidence that care led by midwives is different to that led by physicians. No adverse outcomes associated with midwife-led care were identified. For low-risk women, health and other benefits can result from having their maternity care led by midwives rather than physicians. Moreover, there appear to be no negative impacts on mothers and infants receiving midwife-led care.

Task shifting in maternity services requires additional mind shifting

Staffing in Maternity Units, the latest report from the King’s Fund (2011), puts in writing what many managers of maternity services have long suspected, that the increasing demand for more midwives and consultant obstetricians is unattainable and unaffordable. The maternity services budget must contribute to the savings expected from the NHS, leaving maternity at a crossroads between crisis and opportunity, depending which way you look at it. It is estimated that in the next 15 years, 50% of midwives will be eligible to retire (King’s Fund, 2011). Fifteen years is not a long time in terms of strategic forward planning for a maternity service that is likely to need to deliver increasingly complex care unless some drastic action on promoting normality is taken. Already the rising birth rate, obesity, increased medical complexity, increasing maternal age, and the rising caesarean section rate are making staffing maternity services difficult and costly. Yet despite calls for increased staffing due to safety concerns, the latest report from the Centre for Maternal and Chile Enquiries (CMACE) (2011) indicates that

Midwives, mothers and healthy citizens

With a rising birth rate over the past decade, concerns have been raised over midwifery staffing levels. Mary Nolan comments on the effect this is having on the wellbeing of both mothers and their babies

Midwives, mothers and healthy citizens

With a rising birth rate over the past decade, concerns have been raised over midwifery staffing levels. Mary Nolan comments on the effect this is having on the wellbeing of both mothers and their babies

The need for public involvement when operating a regionalized neonatal care system at maximum capacity

Regionalization of neonatal and perinatal care is a widely used strategy to provide access to optimal care for a geographically dispersed population while using resources effectively (1). Despite being highly regionalized, the Canadian system is experiencing mounting pressure on neonatal intensive care unit (NICU) beds due to a combination of increasing overall birth rates (Figure 1), increasing rates of late preterm birth, and increasing survival rates of previously nonviable premature and term infants. The rise in birth rate is the result of two colliding events: the baby boomers’ children are now giving birth to their own children, and rising fertility rates due to delayed child-bearing. We present an argument in support of the need for public involvement in decisions regarding health care resource allocation (2). Figure 1) Annual births in British Columbia, 1971 to 2007. Note: Plotted line shows actual annual births; solid line shows linear regression. Since 2001, there has been a rise in the birth rate as a result of the baby boom generation’s children now having ...

Midwives should perform the routine examination of the newborn

Research indicates that midwives are equally effective as senior house officers, if not more so, in performing the routine examination of the newborn. When midwives performed this examination their level of job satisfaction was increased and the mother's satisfaction with the examination was also increased. However, studies have also highlighted that midwives are concerned that they might be pressurized into taking on new roles as well as being worried that they may have no control over their workload. Furthermore, it has also been shown that the majority of maternity units do not have enough staff to cope with the rising birth rate and that midwives already have to deal with an increasing workload, resulting in them struggling to provide a safe, quality service to women and babies without taking on new roles. By delegating some of a midwife's workload to another category of skilled worker may enable midwives to re-evaluate their existing role, and take on new roles that support the midwifery philosophy of care. This philosophy of care views pregnancy, childbirth and the postnatal period as a continuum, with the woman and baby being the primary focus of the midwives' practice, stresses the importance of the midwife working in partnership with the woman and her family. Such a philosophy enables the woman to make informed decisions about her care. The pregnancy continuum is also viewed as a normal life event, which is supported by midwives. If research indicates that midwives are better at performing the examination of the newborn, then why is it that more maternity units do not have midwives who are able to carry out this skill, since midwives in the UK have been able to undertake this examination for more than 10 years? In addition, in units which do have midwives who can perform the examination, why are these midwives not using their skills?

Group dynamics and the challenge of redesigning maternity services

We are in financial recession and cutbacks in the NHS are without question. How to design affordable maternity services that are fit for purpose not just today but well into 2020, taking account of the rising birth rate and increasing expectations, is under the spotlight. What seems incredibly obvious but so difficult to convey, is that the ‘one size fits all’ approach actually fits very few, and an obstetric-driven service is financially exorbitant.

Reducing length of stay for women who present as outpatients to delivery suite: A clinical practice improvement project

Access block is an increasing problem in delivery suites due to the rising birth rates. As well as more labouring women, more women are presenting to delivery suite with pregnancy concerns (at 18 weeks gestation and over). Waiting times for women with pregnancy concerns were prolonged because, prior to the implementation of the present project, these women were required to be assessed by a midwife and then a medical officer. The aim of this project was to safely and effectively reduce the length of stay of pregnant women presenting with pregnancy concerns who were managed as outpatients in the delivery suite. PROJECT SETTING: The project was undertaken in the Delivery Suite of a major tertiary referral hospital, NSW, Australia. The project team used clinical practice improvement methodology (clinical audit, outpatient flow mapping, flowcharting, cause and effect diagrams, brainstorming, multi-voting and Pareto charting) to investigate and propose recommendations to improve the clinical process for this group of women. Five hundred thirty two pregnant women who were not in labour. The interventions involved developing the new clinical midwifery pathways and standing orders for the categories of cases where the midwives were able to assess, order tests and make independent clinical decisions; selecting, training and accrediting the advanced practice midwives; implementing the new clinical pathways; and evaluating the effectiveness, cost and stakeholder satisfaction levels with the changes. The average length of stay was reduced from 178.4 to 91.5min (49%) p<0.001. Approximately 8h a week of midwifery specialist time (AU$33.75 per hour) was estimated to have been saved each week during the project at a cost saving of about AU$270.00 per week. The yearly projected saving would be AU$14,040.00 per annum. The use of advanced practice midwives reduced the overall length of stay for women with pregnancy concerns. There were no adverse events or complaints. Women, midwives and doctors all evaluated the change positively. These findings provide evidence to support this advanced practice midwifery model in other similar maternity services.

Australia closes maternity wards despite a rising birth rate

Lack of funding and difficulties retraining staff has led to the closure of birth centres meaning women living in remote areas must travel greater distances to receive maternity care, putting them at a disadvantage.

Women's views of postnatal care in the context of the increasing pressure on postnatal beds in Australia

Despite limited evidence evaluating early postnatal discharge, length of hospital stay has declined dramatically in Australia since the 1980s. The recent rising birth rate in Victoria, Australia has increased pressure on hospital beds, and many services have responded by discharging women earlier than planned, often with little preparation during pregnancy. We aimed to explore the views of women and their partners regarding a number of theoretical postnatal care 'packages' that could provide an alternative approach to early postnatal care. Eight focus groups and four interviews were held in rural and metropolitan Victoria in 2006 with participants who had experienced a mix of public and private maternity care. These included 8 pregnant women, 42 recent mothers and 2 male partners. All were fluent in English. Focus groups explored participants' experiences and/or expectations of early postnatal care in hospital and at home and their views of alternative packages of postnatal care where location of care shifted from hospital to home and/or hotel. This paper describes the packages and explores and describes what 'value' women placed on the various components of care. Overall, women expressed a preference for what they had experienced or expected, which may be explained by the 'what is must be best' phenomenon where women place value on the status quo. They generally did not respond favourably towards the alternative postnatal care packages, with concerns about any shorter length of hospital stay, especially for first time mothers. Women were concerned about the safety and wellbeing of their new baby and reported that they lacked confidence in their ability to care for their baby. The physical presence and availability of professional support was seen to alleviate these concerns, especially for first time mothers. Participants did not believe that increased domiciliary visits compensated for forgoing the perceived security and value of staying in hospital. Women generally valued staying in hospital for the length of time they felt they needed above all other factors. Women were concerned about shortened postnatal length of hospital stay and these concerns must be considered when changes are planned in maternity service provision. Any moves towards shorter postnatal length of stay must be comprehensively evaluated with consideration given to exploring consumer views and satisfaction. There is also a need for flexibility in postnatal care that acknowledges women's individual needs.

New hope for women struggling to conceive

Time and again we hear stories in the press about teenagers getting pregnant and rising birth rates in the younger population but there are some women who might consider these young girls lucky; these women are the ones struggling to conceive and who are more likely to be at the other end of the age spectrum. What must it feel like to read stories about people who become pregnant accidentally or within one or two cycles, almost as soon as the decision to start a family is made, when you have been trying yourself. Some may have been trying for years and might have spent thousands on failed cycles of IVF. So they didn't try to have children in their twenties and only felt the time was right in their thirties, perhaps through career choices, financial circumstances or other commitments. Perhaps they didn't meet a man they could have children with until they reached the grand old age of forty. Indeed, should they be fortunate enough to experience the joy of a yearned-for positive pregnancy test result, they would end up being labelled as ‘older mothers’. It must be difficult as the months go by, turning into years, to feel your chances of conceiving are dimishing by the day, especially if repeated IVF attempts or even just the one are beyond your budget.

Making birth safer

Safety is probably the primary concern of most couples anticipating the birth of their child, be it their first or fifth. Anxiety levels are naturally going to be high if this is a new experience, if the woman has had a complicated pregnancy or has other health issues. But in the UK, and in contrast to most third world countries such as in Africa, the majority of births are safe. This is in spite of the fact that there has been insufficient focus on supporting maternity services, coupled with a rise in birth rate and more complicated pregnancies. As more women are able to have children through advances in medical science, be it through improved management of certain conditions such as cardiac disease or diabetes, or through the advances in IVF and its wider availability, midwives face greater challenges in caring for these women and ensuring their safety.

Changing Patterns of Infant Mortality and Maternal Fertility among Pumé Foragers and Horticulturalists

National census data show that the modern demographic transition—the recent trend toward declining mortality and fertility—is well underway in most countries. A different picture emerges when data from small‐scale societies in unindustrialized parts of the world are considered. Many of these small‐scale societies are also adapting to rapid changes in their subsistence economies. In this article, we examine the relationship between the pace of acculturation, infant mortality, and fertility levels among Pumé foragers and horticulturalists, two related groups of native South Americans. During the earliest stages of acculturation, Pumé horticulturalists experience not only a rapid drop in infant mortality but also a rise in birth rates. An anthropological view of demographic transitions provides important insight into how small‐scale societies are affected by exposure to the labor market economy and has practical applications to effective development initiatives and public health policies.