Standard Maternity Care Research Articles

Interventions for women who report domestic violence during and after pregnancy in low- and middle-income countries: a systematic literature review

BackgroundDomestic violence is a leading cause of social morbidity and may increase during and after pregnancy. In high-income countries screening, referral and management interventions are available as part of standard maternity care. Such practice is not routine in low- and middle-income countries (LMIC) where the burden of social morbidity is high.MethodsWe systematically reviewed available evidence describing the types of interventions, and/or the effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC. Published and grey literature describing interventions for, and/or effectiveness of such interventions for women who report domestic violence during and/or after pregnancy, living in LMIC was reviewed. Outcomes assessed were (i) reduction in the frequency and/or severity of domestic violence, and/or (ii) improved physical, psychological and/or social health. Narrative analysis was conducted.ResultsAfter screening 4818 articles, six studies were identified for inclusion. All included studies assessed women (n = 894) during pregnancy. Five studies reported on supportive counselling; one study implemented an intervention consisting of routine screening for domestic violence and supported referrals for women who required this. Two studies evaluated the effectiveness of the interventions on domestic violence with statistically significant decreases in the occurrence of domestic violence following counselling interventions (488 women included). There was a statistically significant increase in family support following counselling in one study (72 women included). There was some evidence of improvement in quality of life, increased use of safety behaviours, improved family and social support, increased access to community resources, increased use of referral services and reduced maternal depression. Overall evidence was of low to moderate quality.ConclusionsScreening, referral and supportive counselling is likely to benefit women living in LMIC who experience domestic violence. Larger-scale, high-quality research is, however, required to provide further evidence for the effectiveness of interventions. Improved availability with evaluation of interventions that are likely to be effective is necessary to inform policy, programme decisions and resource allocation for maternal healthcare in LMIC.Trial registrationSystematic review registration number: PROSPERO CRD42018087713.

Midwives' use of best available evidence in practice: An integrative review.

Aims and objectivesTo synthesise international research that relates to midwives' use of best available evidence in practice settings and identify key issues relating to the translation of latest evidence into everyday maternity care.BackgroundMidwifery is a research‐informed profession. However, a gap persists in the translation of best available evidence into practice settings, compromising gold standard maternity care and delaying the translation of new knowledge into everyday practice.DesignA five‐step integrative review approach, based on a series of articles published by the Joanna Briggs Institute (JBI) for conducting systematic reviews, was used to facilitate development of a search strategy, selection criteria and quality appraisal process, and the extraction and synthesis of data to inform an integrative review.MethodsThe databases CINAHL, MEDLINE, Web of Science, Implementation Science Journal and Scopus were searched for relevant articles. The screening and quality appraisal process complied with the PRISMA 2009 checklist. Narrative analysis was used to develop sub‐categories and dimensions from the data, which were then synthesised to form two major categories that together answer the review question.ResultsThe six articles reviewed report on midwives' use of best available evidence in Australia, the UK and Asia. Two major categories emerged that confirm that although midwifery values evidence‐based practice (EBP), evidence‐informed maternity care is not always employed in clinical settings. Additionally, closure of the evidence‐to‐practice gap in maternity care requires a multidimensional approach.ConclusionCollaborative partnerships between midwives and researchers are necessary to initiate strategies that support midwives' efforts to facilitate the timely movement of best available evidence into practice.Relevance to clinical practiceUnderstanding midwives' use of best available evidence in practice will direct future efforts towards the development of mechanisms that facilitate the timely uptake of latest evidence by all maternity care providers working in clinical settings.

Interventions for fear of childbirth (tocophobia)

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: The primary objective of this review is to investigate the effectiveness of non‐pharmacological interventions on reducing fear of childbirth (FOC) compared with standard maternity care in pregnant women with FOC.

Vesico-Vaginal Fistula a leading cause of Traumatic Stress In sufferers

Aims: To evaluate psychological constraints among patients presenting with vesico-vaginal fistula (VVF).
 Methods: An Observational exploratory study was carried out to explore the experiences of women suffering from VVF. The study included 16 women hospitalized with the diagnosis of VVF at Kohi Goth Women's Hospital, Karachi, Pakistan. All patients presenting with VVF were administered a structured questionnaire followed by an in-depth interview while Sadaf Stress Scale was utilized for the evaluation of psychological condition.
 Results: The average age of patients was 25.4 years, range 24-30 years. A total of 5 patients were diagnosed with severe traumatic stress, only 1 patient was found in moderate level. While non to of the patients were unable to find proper mental health treatment due to poverty & illiteracy. Severity of traumatic stress was found greater in early years of the disease. All patients were affected by untrained Midwives.
 Conclusions: VVF is leading to traumatic stress, if not treated in early stages could lead to post traumatic stress disorder. The need to empower patients to timely access standard maternity and emergency obstetric care & mental health care is recommended.

Disaster in pregnancy: midwifery continuity positively impacts infant neurodevelopment, QF2011 study

BackgroundResearch shows that continuity of midwifery carer in pregnancy improves maternal and neonatal outcomes. This study examines whether midwifery group practice (MGP) care during pregnancy affects infant neurodevelopment at 6-months of age compared to women receiving standard hospital maternity care (SC) in the context of a natural disaster.MethodsThis prospective cohort study included 115 women who were affected by a sudden-onset flood during pregnancy. They received one of two models of maternity care: MGP or SC. The women’s flood-related objective stress, subjective reactions, and cognitive appraisal of the disaster were assessed at recruitment into the study. At 6-months postpartum they completed the Ages and Stages Questionnaire (ASQ-3) on their infants’ communication, fine and gross motor, problem solving, and personal-social skills.ResultsGreater maternal objective and subjective stress predicted worse infant outcomes. Even when controlling for maternal stress from the flood, infants of mothers who were in the MGP model of maternity care performed better than infants of mothers in SC on two of the five ASQ-3 domains (fine motor and problem solving) at 6-months of age. Furthermore, infants in the SC model were more likely to be identified as at risk for delayed development on these domains than infants in the MGP model of care.ConclusionsContinuity of midwifery care has positive effects on infant neurodevelopment when mothers experience disaster-related stress in pregnancy, with significantly better outcomes on two developmental domains at 6 months compared to infants whose mothers received standard hospital care.

Cardiac function in newborns of obese women and the effect of exercise during pregnancy. A randomized controlled trial.

BackgroundThe prevalence of maternal obesity is rising. Pre-pregnancy obesity is associated with later cardiovascular disease in the child and the underlying pathogenesis begins in early life. Therefore, pregnancy and infancy are key periods for potential intervention. The aim of this study was to study the cardiac function in newborns of obese women compared to newborns of normal-weight women, and to determine if exercise intervention during pregnancy could have an effect on cardiac function of newborns to obese women.Material and methodsFifty-five pregnant women, 51 obese (BMI ≥ 30 kg/m2) and four overweight (BMI 28–30 kg/m2), were randomized to an exercise training group (n = 27) or a control group (standard maternity care, n = 28). From gestational week 14 until delivery participants in the intervention group were offered supervised training sessions three times weekly. In addition, they were told to exercise at home once weekly. All newborns had an echocardiogram performed 1–3 days and 6–8 weeks after delivery. The results were compared with newborns of normal weight women (n = 20, standard maternity care).ResultsNewborns of obese women had an impaired systolic and diastolic cardiac function with reduced global strain, strain rate, tissue Doppler velocities and a thicker intraventricular septum at birth and after 6–8 weeks after delivery compared to newborns of normal weight women. Exercise had no statistically significant effect on either of the cardiac function parameters. The mean (± standard deviation) adherence to the exercise protocol was 1.3 ± 0.8 sessions per week for supervised training and 0.8 ± 0.7 sessions per week for home-based exercise training.ConclusionsNewborns of obese women had reduced cardiac function and thicker intraventricular septum compared to newborns of normal weight women. Exercise training during pregnancy had no significant effect, potentially due to a low number of subjects and low adherence to the exercise protocol.Trial registrationClinicalTrials.gov NCT01243554.

Effects of lay support for pregnant women with social risk factors on infant development and maternal psychological health at 12 months postpartum.

BackgroundThe ELSIPS (Evaluation of Lay Support in Pregnant Women with Social Risk) RCT showed that lay support for women with social risk had a positive effect on maternal mental health and mother-infant bonding. This exploratory study examined whether these observed benefits would impact infant development at 1 year.MethodsA sub-sample of women whose infants were under one year who had participated in the ELSIPS RCT which randomised women to receive either standard care or the services of a Pregnancy Outreach Worker (POW), and who were contactable, were eligible to participate in the follow up. At home visits, the Bayley Scales of Infant Development (3rd Edition) and standardised measures of depression, self efficacy, mind-mindedness and bonding were completed.Results486 women were eligible for follow up, of whom 154 agreed to participate. 61/273 were successfully followed up in the standard maternity care arm and 51/213 in the POW arm. Women who completed follow up were less depressed and had higher selfefficacy scores at 8–12 weeks postpartum than those who did not complete follow up. There were no significant differences in maternal outcomes, infant cognitive development, receptive communication, expressive communication, fine motor development or social/emotional functioning between groups at 12 month follow up. Infants of mothers who received the POW intervention had significantly better gross motor development than infants whose mothers received standard care (p<0.03).ConclusionsThe provision of lay support to women with social risk may facilitate infant gross motor skill development at one year but there were no other demonstrable benefits. The effects of the intervention may be underestimated given that those women who completed follow up had better mental health than the original study sample.Trial registrationControlled-Trials.com ISRCTN35027323.

Exercise Training and Weight Gain in Obese Pregnant Women: A Randomized Controlled Trial (ETIP Trial).

BackgroundThe effectiveness of exercise training for preventing excessive gestational weight gain (GWG) and gestational diabetes mellitus (GDM) is still uncertain. As maternal obesity is associated with both GWG and GDM, there is a special need to assess whether prenatal exercise training programs provided to obese women reduce the risk of adverse pregnancy outcomes. Our primary aim was to assess whether regular supervised exercise training in pregnancy could reduce GWG in women with prepregnancy overweight/obesity. Secondary aims were to examine the effects of exercise in pregnancy on 30 outcomes including GDM incidence, blood pressure, blood measurements, skinfold thickness, and body composition.Methods and FindingsThis was a single-center study where we randomized (1:1) 91 pregnant women with a prepregnancy body mass index (BMI) ≥ 28 kg/m2 to exercise training (n = 46) or control (standard maternity care) (n = 45). Assessments were done at baseline (pregnancy week 12–18) and in late pregnancy (week 34–37), as well as at delivery. The exercise group was offered thrice weekly supervised sessions of 35 min of moderate intensity endurance exercise and 25 min of strength training. Seventeen women were lost to follow-up (eight in the exercise group and nine in the control group). Our primary endpoint was GWG from baseline testing to delivery. The principal analyses were done as intention-to-treat analyses, with supplementary per protocol analyses where we assessed outcomes in the women who adhered to the exercise program (n = 19) compared to the control group. Mean GWG from baseline to delivery was 10.5 kg in the exercise group and 9.2 kg in the control group, with a mean difference of 0.92 kg (95% CI −1.35, 3.18; p = 0.43). Among the 30 secondary outcomes in late pregnancy, an apparent reduction was recorded in the incidence of GDM (2009 WHO definition) in the exercise group (2 cases; 6.1%) compared to the control group (9 cases; 27.3%), with an odds ratio of 0.1 (95% CI 0.02, 0.95; p = 0.04). Systolic blood pressure was significantly lower in the exercise group (mean 120.4 mm Hg) compared to the control group (mean 128.1 mm Hg), with a mean difference of −7.73 mm Hg (95% CI −13.23, −2.22; p = 0.006). No significant between-group differences were seen in diastolic blood pressure, blood measurements, skinfold thickness, or body composition in late pregnancy. In per protocol analyses, late pregnancy systolic blood pressure was 115.7 (95% CI 110.0, 121.5) mm Hg in the exercise group (significant between-group difference, p = 0.001), and diastolic blood pressure was 75.1 (95% CI 71.6, 78.7) mm Hg (significant between-group difference, p = 0.02). We had planned to recruit 150 women into the trial; hence, under-recruitment represents a major limitation of our results. Another limitation to our study was the low adherence to the exercise program, with only 50% of the women included in the intention-to-treat analysis adhering as described in the study protocol.ConclusionsIn this trial we did not observe a reduction in GWG among overweight/obese women who received a supervised exercise training program during their pregnancy. The incidence of GDM in late pregnancy seemed to be lower in the women randomized to exercise training than in the women receiving standard maternity care only. Systolic blood pressure in late pregnancy was also apparently lower in the exercise group than in the control group. These results indicate that supervised exercise training might be beneficial as a part of standard pregnancy care for overweight/obese women.Trial RegistrationClinicalTrials.gov NCT01243554

Exercise Training In Pregnancy For Women With Bmi ≥ 28. A Randomized Controlled Trial.

PURPOSE: Maternal obesity is a risk factor for adverse pregnancy outcomes, and excessive gestational weight gain (GWG) is further increasing the risk. Previous lifestyles interventions during pregnancy have shown conflicting results, and have often combined effects of physical activity with dietary guidance. Our aim was to assess the effects of regular exercise training during pregnancy on gestational weight gain (GWG) and incidence of gestational diabetes mellitus (GDM) in women with pre-pregnancy body mass index (BMI) of 28 kg/m2 or more. METHODS: This was a randomized controlled trial, which included women with a pre-pregnancy BMI (kg/m2) ≥ 28. Baseline testing and randomization to exercise or control were done in gestational week 12-18. We measured weight at baseline and at birth, GDM at baseline and gestational week 36 (late pregnancy). GDM was defined by a fasting oral 75 g glucose tolerance test ≥ 6,9 mmol/L and/or 2 hours ≥ 7,8 mmol/L. The exercise was supervised, 3 times per week; 35 minutes of moderate treadmill walking/running and 25 minutes of resistance training for large muscle groups. The control group received standard maternity care. Statistical analyses were done on basis of «intention to treat», with use of linear mixed model and mixed-effect logistic regression. RESULTS: 91 participants were randomized; 46 to exercise and 45 to control. 18 women were lost to follow up (8 exercise, 10 control). 47,7 % in the exercise group performed the training per protocol. At baseline mean weight in the exercise group was 95,5 ± 12,3 kg (BMI 33,9 ± 3,8 kg/m2), in the control group 98,3 ± 14,2 kg (BMI 35,2 ± 4,4 kg/m2). There was no difference in GWG between the exercise and control group (98,3 10,2 ± 5,2 kg and 9,36 ± 7,5 kg, respectively, p = 0.84). At baseline, 3 women in each group had GDM, whereas 2 women in exercise and 8 women in the control group had GDM in late pregnancy (p = 0.086). 2 of the women with GDM at baseline did not fulfill the criteria for GDM at late pregnancy. CONCLUSIONS: Regular exercise during the pregnancy among overweight/obese women did not reduce GWG, compared to a non-exercising control group. The women in the training group had a tendency of lower incidence of GDM in late pregnancy.

Lay support for pregnant women with social risk: a randomised controlled trial

ObjectivesWe sought evidence of effectiveness of lay support to improve maternal and child outcomes in disadvantaged families.DesignProspective, pragmatic, individually randomised controlled trial.Setting3 Maternity Trusts in West Midlands, UK.ParticipantsFollowing routine midwife...

Comparison between continuing midwifery care and standard maternity care in vaginal birth after cesarean.

Objective:To determine whether continuing midwifery care has more benefits than standard maternity care in vaginal birth after cesarean (VBAC).Methods:This study was conducted on women in labour who had history of previous cesarean section and received vaginal birth in obstetrical department of our hospital from May 2013 to November 2014. The included patients were divided randomly into observation group and control group. The women in labour allocated to the observation group received continuing midwifery care, and those to control group received standard maternity care in all the stages of labour. The duration of labor stage together with the rate of fetal distress, neonatal asphyxia, vaginal birth and postpartum bleeding were compared between the two groups.Results:Ninety-six participants were included in the current study, forty-eight in each group. The length of labor was significantly longer (p<0.05), the vaginal birth rate was significantly lower (p<0.05) and the postpartum hemorrhage rate was significantly higher (p<0.05) in the control group than the observation group. In addition, the rate of fetal distress and neonatal asphyxia were higher in the control group, but there was no significant difference between the two groups (p>0.05).Conclusion:The continuing midwifery care has more benefits than the standard maternity care in vaginal birth after cesarean (VBAC).

The effect of primary midwife-led care on women's experience of childbirth: results from the COSMOS randomised controlled trial.

To determine the effect of primary midwife-led care ('caseload midwifery') on women's experiences of childbirth. Randomised controlled trial. Tertiary care women's hospital in Melbourne, Australia. A total of 2314 low-risk pregnant women. Women randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a 'back-up' midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care. The primary outcome of the study was caesarean section. This paper presents a secondary outcome, women's experience of childbirth. Women's views and experiences were sought using seven-point rating scales via postal questionnaires 2 months after the birth. A total of 2314 women were randomised between September 2007 and June 2010; 1156 to caseload and 1158 to standard care. Response rates to the follow-up questionnaire were 88 and 74%, respectively. Women in the caseload group were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22-1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain. Compared with standard maternity care, caseload midwifery may improve women's experiences of childbirth. Primary midwife-led care ('caseload midwifery') improves women's experiences of childbirth.

Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study.

Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to the neonatal intensive care unit, low birth weight infants, and artificial feeding. To determine if caseload midwifery or young women's clinic are associated with improved perinatal outcomes when compared to standard care. A retrospective cohort study. A tertiary Australian hospital where routine maternity care is delivered alongside two community-based maternity care models specifically for young women aged 21 years or less: caseload midwifery (known midwife) and young women's clinic (rostered midwife). All pregnant women aged 21 years or less, with a singleton pregnancy, who attended a minimum of two antenatal visits, and who birthed a baby (without congenital abnormality) at the study hospital during May 2008 to December 2012. Caseload midwifery and young women's clinic were each compared to standard maternity care, but not with each other, for four primary outcomes: preterm birth (<37 weeks gestation), low birth weight infants (<2500g), neonatal intensive care unit admission, and breastfeeding initiation. Two analyses were performed on the primary outcomes to examine potential associations between maternity care type and perinatal outcomes: intention-to-treat (model of care at booking) and treatment-received (model of care on admission for labour/birth). 1908 births were analysed by intention-to-treat and treatment-received analyses. Young women allocated to caseload care at booking, compared to standard care, were less likely to have a preterm birth (adjusted odds ratio 0.59 (0.38-0.90, p=0.014)) or a neonatal intensive care unit admission adjusted odds ratio 0.42 (0.22-0.82, p=0.010). Rates of low birth weight infants and breastfeeding initiation were similar between caseload and standard care participants. Participants allocated to young women's clinic at booking, compared to standard care, were less likely to have a low birth weight infant adjusted odds ratio 0.49 (0.24-1.00, p=0.049), however when analysed by treatment-received, this finding was not significant. There was no difference in the other primary outcomes. Young women who were allocated to caseload midwifery at booking, and/or were receiving caseload midwifery at the time of admission for birth, were less likely to experience preterm birth and neonatal intensive care unit admission.

An investigation of the relationship between the caseload model of midwifery for socially disadvantaged women and childbirth outcomes using routine data – A retrospective, observational study

Objectivethe objective of this study was to describe and compare childbirth outcomes and processes for women with complex social factors who received caseload midwifery care, and standard maternity care in the UK. Backgroundwomen with complex social factors experience high rates of morbidity, mortality and poor birth outcomes. A caseload team was established to support these women throughout pregnancy and childbirth by providing continuity and individualised care. Methodsdata was collected from computerised birth details of 194 women with complex social factors who presented for maternity care between May 2012 and June 2013; 96 received standard care and 98 caseload care. SPSS v21 was used to calculate descriptive and inferential statistics. Logistic regression modelling found no differences in demographics, therefore unadjusted statistics are presented. Comparative analysis between women receiving caseload care and those receiving standard care was accomplished using χ2 test, relative risk (RR) and 95% confidence intervals (CI). Resultsthe relationship between type of care and outcome was not changed by the inclusion of confounding factors. Women receiving caseload care were more likely to experience; spontaneous vaginal childbirth (80% versus 55% RR 1.88, 95% CI 1.27–2.77, P=<0.001), use water for pain relief (32% versus 10%, RR 4.10 95% CI 1.95–8.64, p=<0.001), birth in the midwife led centre (26% versus 13% RR 1.48 95% CI 1.12–1.95, p=0.023), assessment by 10 weeks gestation (24% versus 8% RR 1.61 95% CI 1.24–2.10, p=0.008), shorter postnatal stay (1 day versus 3 days SD 1.2 versus 2.2, p=<0.001), and know their midwife (90% versus 8% RR 8.98 95% CI 4.97–16.2, p=<0.001). More women in the caseload group were referred to multidisciplinary support services; psychiatry (56% versus 19% RR 2.06 95% CI 1.59–2.65, p=<0.001), domestic violence advocacy (42% versus 18% RR 1.68 CI 1.31–2.15, p=<0.001) and other services (56% versus 31% RR 1.58 95% CI 1.15–2.16, p=0.03). They were less likely to have a caesarean section (11% versus 33% RR 0.26 95% CI 0.12–0.55, P=<0.001), an epidural/spinal for pain relief (35% versus 56%, RR 0.64 95% CI 0.46–0.86, p=0.004), give birth on the labour ward (70% versus 88% RR 0.63 95% CI 0.49–0.83, p=0.006), and had fewer antenatal admissions (0.9(SD 1.1) versus 1.3(SD1.5), p=0.036) and neonatal unit admissions (4% versus 18%, RR 0.35 95% CI 0.15–0.85, p=0.005). Conclusioncaseload midwifery care appeared to confer increased benefit and reduced harmful outcomes. Findings for individual outcomes differed from previous literature depending on outcome, suggesting caseload care may affect women in different ways depending on their individual needs.

Professional breastfeeding support enhances breastfeeding continuation

Fu I1, Fong D, Heys M, Lee I, Sham A, Tarrant M. Professional breastfeeding support for first-time mothers: a multicentre cluster randomised controlled trial. BJOG. 2014 May 26. doi: 10.1111/1471-0528.12884. Among breastfeeding women, what is the therapeutic efficacy of professional breastfeeding follow-up support, compared with standard care, in enhancing breastfeeding continuation? Randomized controlled trial. Three geographically distributed public hospitals in Hong Kong, China. 722 primiparous breastfeeding mothers with uncomplicated, full-term pregnancies. (1) Standard postnatal maternity care; (2) standard care plus three in-hospital professional breastfeeding support sessions; or (3) standard care plus weekly post-discharge breastfeeding telephone support for 4 weeks. Prevalence of any and/or exclusive breastfeeding at 1, 2, and 3 months postpartum. Compared with standard care only, participants receiving telephone support were significantly more likely to continue any breastfeeding at: 1 month (76.2% versus 67.3%; number needed to treat [NNT] 12, 95% CI 6-83); and 2 months: (58.6 versus 48.9%; NNT 10, 95% CI 6-60); and to be exclusively breastfeeding at 1 month: (28.4% versus 16.9%; NNT 9, 95% CI 6-23). There were no other statistically significant relationships among the 3 groups. Professional breastfeeding telephone support provided early in the postnatal period, and continued for the first month postpartum, improves breastfeeding duration among first-time mothers.

Intervention during pregnancy to reduce excessive gestational weight gain—a randomised controlled trial.

To evaluate if a feasible, low-cost intervention could decrease the percentage of women gaining weight above the Institute of Medicine (IOM) recommendations on gestational weight gain (GWG) compared with standard maternity care. A randomised controlled interventional design. Antenatal clinics (n = 14) in Örebro county, Sweden, participated. Healthy women with a body mass index (BMI) ≥19 kg/m(2), age ≥18 years and adequate knowledge of Swedish language who signed in for maternity care at ≤16 weeks of gestation. Standard care was compared with a composite intervention consisting of education on recommended GWG according to IOM, application of personalised weight graph, formalised prescription of exercise and regular monitoring of GWG at every antenatal visit. The proportion of women gaining weight above IOM guidelines (1990) and mean GWG (kg) was compared between groups. In all, 445 women were randomised and 374 women remained for analysis after delivery. A majority of the women analysed were normal weight (72%). The intervention reduced the proportion of women who exceeded the IOM guidelines (41.1% versus 50.0%). The reduction was, however, not statistically significant (P = 0.086). Mean GWG was significantly lower among women receiving the intervention, 14.2 kg (SD 4.4) versus 15.3 kg (SD 5.4) in the standard care group (P = 0.029). The low-cost intervention programme tested did significantly reduce the mean GWG but the proportion of women who exceeded the IOM recommendations for GWG was not significantly lower. ClinicalTrials.gov Id NCT00451425 http://clinicaltrials.gov.

PA.04 ­Effects of additional lay support for pregnant women with social risk factors on antenatal attendance and maternal psychological health: a randomised controlled trial (ELSIPS)

BackgroundMaternal, perinatal and child health outcomes appear worse in families with social risk factors. The current increase in use of lay support in this area lacks evidence.MethodsFollowing routine midwife systematic...

Professional breastfeeding support for first-time mothers: a multicentre cluster randomised controlled trial.

To evaluate the effect of two postnatal professional support interventions on the duration of any and exclusive breastfeeding. Multicentre, three-arm, cluster randomised controlled trial. A cohort of 722 primiparous breastfeeding mothers with uncomplicated, full-term pregnancies. The three study interventions were: (1) standard postnatal maternity care; (2) standard care plus three in-hospital professional breastfeeding support sessions, of 30-45minutes in duration; or (2) standard care plus weekly post-discharge breastfeeding telephone support, of 20-30minutes in duration, for 4weeks. The interventions were delivered by four trained research nurses, who were either highly experienced registered midwives or certified lactation consultants. Prevalence of any and exclusive breastfeeding at 1, 2, and 3months postpartum. Rates of any and exclusive breastfeeding were higher among participants in the two intervention groups at all follow-up points, when compared with those who received standard care. Participants receiving telephone support were significantly more likely to continue any breastfeeding at 1month (76.2 versus 67.3%; odds ratio, OR1.63, 95% confidence interval, 95%CI 1.10-2.41) and at 2months (58.6 versus 48.9%; OR1.48, 95%CI 1.04-2.10), and to be exclusively breastfeeding at 1month (28.4 versus 16.9%; OR1.89, 95%CI 1.24-2.90). Participants in the in-hospital support group were also more likely to be breastfeeding at all time points, but the effect was not statistically significant. Professional breastfeeding telephone support provided early in the postnatal period, and continued for the first month postpartum, improves breastfeeding duration among first-time mothers. It is also possible that it was the continuing nature of the support that increased the effectiveness of the intervention, rather than the delivery of the support by telephone specifically.

Interventions to reduce and prevent obesity in pre-conceptual and pregnant women: a systematic review and meta-analysis.

BackgroundThe increasing prevalence of obesity in pregnant women is associated with adverse maternal and neonatal outcomes, and increased costs to healthcare, the economy and broader society.ObjectivesTo assess the efficacy of behavioural interventions for managing gestational weight gain (GWG) in the pre-conceptual and pregnancy period in overweight, obese and morbidly obese women.Search MethodsA search was performed for published studies in the English language, from date? 2000–31 December 2012 in five electronic databases; PubMed, Scopus, Cochrane Library, CINAHL and PsycINFO.Selection criteriaStudies were included if they compared the efficacy or effectiveness of a particular behavioural intervention in pregnant or pre-conceptual women with standard maternity care. Studies that included women with co-morbid conditions such as diabetes mellitus and polycystic ovarian syndrome were excluded to help isolate the effect of the intervention.ResultsFifteen studies involving 3,426 participants were included. One study (n = 692) focused on the pre-conceptual period and the remaining 14 (n = 2,734) in the pregnancy period. Pooled mean difference for GWG indicated a lower GWG in the intervention groups when compared to standard maternity care groups (n = 1771, mean difference (MD) −1.66 kg, 95% CI −3.12 to −0.21 kg). With respect to the types of participants, considerable heterogeneity between studies was shown in the obese subgroup [Tau2 = 15.61; Chi2 = 40.80, df = 3 (P<0.00001); I2 = 93%].ConclusionsBehavioural interventions in pregnancy may be effective in reducing GWG in obese women without comorbid conditions, but not overweight or morbidly obese women. Behavioural interventions had no effect on postpartum weight loss or retention, gestation week of delivery and infant birth weight in overweight, obese and morbidly obese women.

‘It's a good thing…’: Women's views on their continuity experiences with midwifery students from one Australian region

Backgroundmidwifery relationships, especially ones developed over time, are viewed and valued as practical and political health interventions that increase the likelihood of good health for women and infants and assist with health challenges. Thus the continuity relationships with women required for each Bachelor of Midwifery student are used, not only to expand students' learning but also, in a fragmented maternity care system, to provide opportunities for women to experience the care of a known person through their pregnancy, labour and early parenting time. Aim of the studywe sought understandings of women's experiences of their continuity relationships with midwifery students. Methoda survey was posted to all women (n=1008) who had agreed to continuity in the first years of our undergraduate program 2009–2011. We analysed 354 completed surveys (34% response rate). SPSS was used for quantitative data and content analysis identified themes expressed in the qualitative responses from a selected sub-set of 27 participants. Ethical approval was obtained from the authors' institution and research funding from the local registration board. Findingswomen's satisfaction of being with a student in a continuity relationship was high. On a scale from one (not at all satisfied) to 10 (extremely satisfied), the mean score was 8.88. The women, more than half of whom received standard maternity care, stated they valued the opportunity for a constant presence across their childbearing experience and will recommend student continuity to their friends. Conclusions and implicationsthis study shows that our curriculum emphasis on continuity is valued by women. Pairing a woman and a student gives women a relationship with a named person in the maternity health field that provides valued extras: care, time, patience, effort, information, advocacy, support and kindness. It raises the profile of midwifery in the community, especially the profile of continuity of midwifery care for women in standard models of care. It increases communication for and with women in a variety of useful and desirable ways and it allows an opportunity for women to contribute to students' learning. It also provides the university sector a chance to value and privilege the continuity of midwifery relationship.