Labor Unit Research Articles

Labor and delivery unit practices and racial and ethnic disparities in severe maternal and neonatal morbidity among nulliparous individuals with low-risk pregnancies.

Persistent racial and ethnic disparities exist in severe maternal and neonatal morbidity, which may be due in part to differences in labor and delivery unit practices across hospitals. We used data collected from 184 hospitals in California (2015-2018) to assess whether nulliparous individuals with low-risk pregnancies differ by race and ethnicity in giving birth at hospitals that tend to use lower-interventional labor and delivery unit practices, and whether such differences contribute to disparities in severe maternal and neonatal morbidity. We classified labor and delivery units as higher- or lower-interventional based on a latent class analysis of survey responses about the frequency of using lower-interventional practices. We used a modified doubly robust g-estimator to estimate counterfactual disparity measures, setting all hospitals to be lower-interventional. Among 348,990 low-risk livebirths, the proportion occurring at lower-interventional hospitals was lowest in Black and Latino individuals (17% and 16%, respectively) and highest in American Indian and Alaska Native (AI/AN) and White individuals (29% in both). Severe maternal and neonatal morbidity occurred most frequently among AI/AN individuals. Counterfactual disparity measures suggested that if all births occurred at lower-interventional hospitals, racial and ethnic disparities in the outcomes would modestly increase, except for severe neonatal morbidity among AI/AN individuals.

Preserving the Midwifery Model of Care on a High Acuity Labor and Delivery Unit: Midwives' Perspectives Working in a US Tribal Health System.

Today nearly 9 out of 10 certified nurse-midwives/certified midwives (CNMs/CMs) attend births in hospitals. As the demand for hospital midwifery care has increased over the last quarter century, CNM/CMs' scope of practice has expanded to include care for high-risk patients. Hospital CNMs/CMs are faced with the challenge of balancing support for physiologic birth with an increasingly complex pregnant population cared for in a medicalized ecosystem. Varied perceptions of patient risk and unique philosophies of care can lead to complex discussions between midwives and physicians on the most appropriate care plan for patients. This article shares the experiences and successes of a hospital midwifery practice in the Alaska Native Tribal Health System and explores strategies for promoting the midwifery model of care (MMOC). Midwives in this Tribal Health System experience robust interprofessional collaboration and an organizational focus on patient-centered relationship-based care. Interprofessional collaboration is noted to be among the most critical elements for protecting a MMOC in a hospital setting. Although distinct from one another, the medical and midwifery models can be complementary in the care of high-risk patients, and the Indigenous concept of Two-Eyed Seeing is offered as an approach to integrating the 2 models of care to achieve optimal care for birthing people and their families.

What makes labor difficult? Predictors and features of difficult labor in women’s and midwives’ perspective

Abstract Aim. The aim of this study was to identify what are the features of ‘difficult labor’ in the perspective of women giving birth and midwives providing care. Material and methods. Cross-section, preliminary study based on the analysis of the labor observation form and level of labor difficulty assessment form designed for the purpose of this study and fi lled in by the midwives participating in the study. The participants were 31 midwives working on the labor unit in one of the hospitals in Warsaw, Poland and 152 women who gave birth. Results. Women who had epidural, larger babies and a negative attitude towards birth and a prolonged fi rst stage of labor, were more likely to assess their labor as difficult. Among midwives labors with a longer second stage, abnormal uterine contraction patterns, and prolonged latent phase and fi rst stage of labor were assessed as more difficult. Conclusions. Some labors, despite being classified as physiological, require more effort on the part of both the midwife and woman giving birth and end with a higher level of fatigue for both. Predictors of difficult labor should be used by healthcare personnel as a guidance to help identify women at risk of negative labor experiences.

Addressing a Labor and Delivery Unit Practice Gap Through a Count Sheet Revision.

Unintentionally retained surgical items are never events that can be costly to patients and health care facilities. A labor and delivery unit quality improvement team at a southwestern Pennsylvania facility identified an opportunity for improvement associated with preventing retained surgical items. After reviewing the available literature, they identified a practice gap and decided to revise the count sheet. They standardized the existing sheet, shared it with frontline nurses for feedback and approval, and submitted it to leaders and the hospital's Forms Committee for approval. After an adequate quantity of the revised sheet was available for use, one member of the improvement team provided an educational session for nurses with practice time to use the revised count sheet. The team implemented the revised sheet and monitored compliance with its use. Compliance during and after the transition was 100%, and nurses provided positive feedback associated with using the revised sheet.

The 2023 Gerard W. Ostheimer Lecture. A Contemporary Narrative Review of Maternal Mortality and Morbidity: Opportunities to Improve Peripartum Outcomes.

The Gerard W. Ostheimer lecture is given annually to members of the Society for Obstetric Anesthesia and Perinatology. This lecture summarizes new and emerging literature that informs the clinical practice of obstetric anesthesiology. This is a narrative review of 2022 literature pertinent to maternal morbidity and mortality in all income settings globally. Themes associated with worse maternal mortality rate (MMR), challenges health care workers face, public health priority areas, and initiatives to help countries achieve the United Nations Sustainable Development Goal targets for MMR are discussed. MMRs are higher in low- and middle-income countries (LMICs) compared to high-income countries (HICs). Cesarean delivery rates are rising most rapidly in LMICs, warranting urgent maternal health care workforce planning efforts in these settings. Globally racial, ethnic, and geographical disparities in maternal mortality continue to be evident in global health care settings. In the United States, the MMR is rising. The evolving changes in abortion legislation in the United States may further negatively impact maternal morbidity and mortality. The need to implement American Society of Anesthesiologists-recommended obstetric anesthesia quality metrics to facilitate benchmarking and to improve patient experience and outcomes is discussed as well as the need for professional society guidance on minimum staffing levels in American labor and delivery units.

Implementing a Labor and Delivery Cell Salvage Protocol in Patients at Increased Risk of Hemorrhage: A Pilot Study.

Postpartum hemorrhage (PPH) contributes significantly to maternal morbidity and mortality. The use of cell salvage has been implemented in operating rooms across the world, but only a limited number of institutions have protocols for use of cell salvage during vaginal hemorrhage at the time of vaginal delivery. Observations suggest that blood salvaged from vaginal delivery is comparable to blood salvaged during cesarean delivery. Using pre-validated protocols of cell salvage, we sought to assess the feasibility and potential benefit of implementing cell salvage in our Labor and Delivery unit in all patients at high risk of hemorrhage. This was a prospective pilot study conducted from April 2022 to December 2022 on the Labor and Delivery floor at Mount Sinai Hospital in New York City. A total of 50 participants were identified for cell salvage after vaginal delivery during the study period.The mean age of participants was 34.4 years (SD 5.5).We utilized acell salvage technique at the time of vaginal delivery in patients at high risk of PPH. We employed simple descriptive statistics and examined sums and percentages (and means and standard deviations, where appropriate). A simple equation was used to determine the average cell salvaged volume in each delivery and describe potential values. The HEMAsavR™device (Ecomed Solutions, Mundelein, IL, USA) was used as a standby system to be used at the time of the vaginal delivery. Fifty participants were identified for the cell salvage protocol as described. Despite a diversity of clinical risk factors, the sample consisted ofpredominately non-Hispanic White patients. The mean quantitative blood lossof cell salvaged samples was 157.2 mL(SD 153.0). We identified that, on average, >33% of vaginally shed blood could be used for cell salvage and improve patient blood management. The implementation of cell salvage in our Labor and Delivery unit was feasible and easy to perform. We identified that a significant volume of blood would be available for cell salvage. Further studies should be done to evaluate the benefit of cell salvage to improve postpartum recovery.

Xylazine Positivity in Opioid-Positive Drug Screens on an Inpatient Labor Unit.

Untreated opioid use disorder (OUD) is associated with significant morbidity in pregnancy. Recent reports have highlighted the rise of xylazine in the nonprescribed fentanyl supply. The frequency with which pregnant people with OUD are exposed to xylazine has not been characterized. We sought to describe the rate of xylazine detection in urine drug screens (UDS) from pregnant people admitted to a labor unit. We performed a cross sectional study of all UDS results from an inpatient obstetric unit at an urban tertiary care center from December 2022, when xylazine was added to the detection panel, through July 2023. We perform universal verbal drug screening, with subsequent urine drug screening only performed after a positive verbal screen and consent. The trend of opioid-positive urine drug screens also positive for xylazine from December to July was measured with the Cochran-Armitage test. Of 5662 people admitted to Labor and Delivery during the study period, 138 UDS were sent for 123 unique individuals. Ninety-eight (71%) of UDS were positive for nonprescribed substances. Of positive UDS, 36 (37%) were positive for nonprescribed opioids, and of these, 17 (47.2%) were positive for xylazine among 14 pregnant people. The trend of UDS positive for opioids that were also positive for xylazine increased significantly over time (P = 0.030), from 0% in December 2022 to 100% in July 2023. Over 8 months, xylazine positivity significantly increased in UDSs positive for nonprescribed opioids in an urban Midwestern hospital. These results underscore the critical need to study the impact of xylazine on obstetric outcomes.

Optimizing Bt Cotton Yields with Canopy Management in Rainfed Environments

Cotton, the ‘White gold’ is an important commercial crop in India and central India in particular. Sustainable yield can be achieved by increasing plant density and canopy management. Hence an experiment was conducted at Cotton Research Station, Nanded, (Vasantrao Naik Marathwada Krishi Vidyapeeth, Parbhani, M.S., India) during kharif 2023 on medium black cotton soil in randomized block design. The field trail was conducted with three replications and seven treatments viz.,T1 : Cotton in HDPS - 90 x 30 cm (37,037 plants ha-1), T2 : HDPS + De-topping at 90 DAS, T3 : HDPS + De-topping at 75 DAS, T4 : HDPS + Pruning of monopodia at square formation stage, T5 : HDPS + Pruning of monopodia at square formation stage and de-topping at 75 DAS, T6 : HDPS + two sprays of Mepiquat chloride @ 25 g a.i. at square formation followed by 15 days and T7: HDPS + Polymulch + pruning of monopodia at square formation stage and de-topping at 75 DAS. The results showed that growing of cotton with polythene mulch along with pruning of monopodia at square formation stage and de-topping at 75 DAS treatment recorded highest plant height (109.80 cm), no. of sympodia plant-1 (16.53), leaf area (58.16 dm2 and 109.99 dm2 at 60 and 90 DAS, respectively), leaf area index at 120 DAS (0.2107), seed cotton yield (2734 kg ha-1) and GMR (` 1,87,767 ha-1) as compared to all other treatments. Seed cotton yield was increased by 48.66 per cent, significantly over HDPS planting (90 x 30 cm spacing). While treatment HDPS + pruning of monopodia at square formation stage and de-topping at 75 DAS recorded highest NMR (` 48,896 ha-1) and HDPS + de-topping at 90 DAS recorded highest B:C ratio (1.60) as compared to all other treatments respectively. Treatment HDPS + poly mulch + pruning of monopodia and de-topping recorded highest labour requirement per hectare (112.8 man days) as well as seed cotton yield per labour unit (24.24 kg). Thus, adoption of canopy management practice viz., poly mulch, monopodia pruning, de-topping or use f PGR can improve seed cotton yield with high density planting in rainfed areas where it is very low.

Comparative study between the roles of intrauterine misoprostol versus the sublingual route for prevention of postpartum blood loss in elective cesarean sections: a randomized controlled trial

BackgroundThe prostaglandin E1 analog “misoprostol” is a drug that has powerful ecbolic effects and can be beneficial in the prevention and treatment of postpartum hemorrhage, which is the leading cause of maternal mortality worldwide.ObjectivesTo assess the value of adding intrauterine misoprostol together with intravenous oxytocin injection compared with sublingual misoprostol together with intravenous oxytocin injection during elective cesarean section to reduce blood loss intraoperatively and prevent postpartum hemorrhage.MethodsA total of 192 pregnant women were counseled and recruited from the labor and delivery unit at Kasr Al Aini Hospital, Cairo University, and equally randomized into two groups. Group (A) included 96 women who received intrauterine misoprostol (400 mg) + oxytocin. Group (B) included 96 women who received sublingual misoprostol (400 mg) + oxytocin. The primary outcome of our study was estimation of the amount of blood loss during and after cesarean delivery. The secondary outcomes were the incidence of PPH within the first 6 h after labor, the need for blood transfusion, the need for any supplementary ecbolic drugs, the need for additional surgical intervention for PPH, changes in hematocrit and hemoglobin in both groups after delivery, and the incidence of side effects of the study medications.ResultsWe observed a significant discrepancy between the two groups in terms of postoperative Hb and Hct, postoperative differences (pre- and post-Hb and post-Hct) and EBL favoring the intrauterine group. However, no significant difference was observed between the groups with respect to excessive blood loss > 1000 ml in the 1st six hours, the need for supplementary ecbolics, the necessity for blood or blood prod, the need for additional surgical intervention (for PPH) or side effects.ConclusionIntrauterine misoprostol combined with oxytocin intravenous infusion is more effective than sublingual misoprostol combined with oxytocin intravenous infusion in lowering intraoperative blood loss and preventing postpartum hemorrhage in elective cesarean section.Trial registrationThis trial was retrospectively registered with the ClinicalTrials.gov Registry on 12-April-2024 (registration number: NCT06364098).

Peripheral Use of Vasopressors in Shock: Clinical Considerations and Recommendations for Use in Obstetrics.

This study aimed to evaluate the safety of peripheral administration of vasopressor agents among patients with circulatory shock. We reviewed the published literature evaluating the use of peripheral norepinephrine in patients with shock and proposed a protocol for use in labor and delivery units. Peripheral administration of norepinephrine is a safe and potentially lifesaving intervention for patients in labor and delivery with extremely low complication rates. Adoption of a protocol for peripheral administration of vasopressors in labor and delivery is safe and may prevent life threatening delays in hemodynamic resuscitation. · Administering vasopressors through a peripheral line is safe and helps avoid delays in care.. · An established protocol is essential for the safe peripheral administration of vasopressors.. · Understanding continuous blood pressure monitoring is crucial for managing critically ill patients..

Where do all the ewes go? Ewe culling and mortality in 34 sheep flocks in New Zealand

ABSTRACT Aims To describe rates of and reasons for culling and mortality of ewes between breeding and mid-lactation on New Zealand sheep farms; to investigate associations of these variables with farm demographic variables; and to describe rates of and reasons for culling of ewes at weaning. Methods Participants were a convenience sample of 34 farms from across New Zealand. Demographic data were initially collected for each farm via a questionnaire administered in-person to the flock owner or manager. During approximately 8 months from breeding to mid-lactation, ewe tally, culling and mortality data were collected and used to calculate various parameters related to flock performance and to investigate associations. During the main ewe-culling event at weaning, ewe-culling data were collected from 29/34 flocks participating in the study. Results There was considerable variation between flocks, but the between-flock mean replacement percentage was 29.2 (SD 5.0)%. Overall, a between-flock mean of 10.5 (SD 4.6)% of ewes presented for breeding were culled or dead/missing by mid-lactation and thus did not rear any lambs. Additionally, from 27 flocks that reported data on ewes’ success at rearing lambs, a between-flock mean of 3.9 (SD 2.5)% of ewes that remained alive at mid-lactation failed to rear any lambs, resulting in an overall between-flock mean loss of 23.1 (SD 6.3) potential lambs per 100 ewes. Two-thirds of ewe mortalities between breeding and mid-lactation occurred during the lambing period. Model results showed flocks with higher pregnancy scanning percentages had lower rates of culling and mortality between breeding and mid-lactation. However, apart from farm contour, from breeding to mid-lactation there were no associations for culling and mortality with farm size, flock size, number of ewes per labour unit, whether ewe hoggets (7–9 months of age) were presented for breeding, or duration of the breeding period. A between-flock mean of 16.5 (SD 8.3)% of ewes present at weaning were culled, and among mixed-age ewes, the most common reasons for culling at this time were age, incisor teeth defects and udder defects. Conclusions To reduce unnecessary ewe culling and mortality, attention should be focused on maximising conception rates, ensuring judicious culling decisions, optimising body condition score, and identifying farm-specific causes of death over the lambing period to facilitate targeted intervention strategies. Clinical relevance Identifying why and when ewes exit flocks, and comparing it with the data presented here, will facilitate the development of flock-specific interventions to reduce ewe culling and mortality. Abbreviations BCS: Body condition score; NI: North Island; SI: South Island

Removal of Isolated Cannabis Use as an Order Indication for Urine Drug Screening (UDS) Eliminates Racial Inequity in Maternal UDS Testing and Reporting to Child Protective Services

Abstract Black patients on labor and delivery (L&D) units are more likely to undergo urine drug screening (UDS) and subsequent mandated reporting to child protective services (CPS), which can result in increased separation of the parent and infant, contributes to systemic inequities, and erodes the patient/provider relationship. These disparities are driven by a testing indication of isolated cannabis use (ICU), which based on previous data from our institution, disproportionately selects Black patients for testing. In October 2022, the Barnes-Jewish Hospital (St. Louis, MO) L&D unit removed ICU as a UDS indication; concurrently, we implemented an electronic health record (EHR)-based order question requiring providers to select an indication for testing. The objective of this study was to analyze the impact of this intervention on racial equity in UDS testing and CPS reporting. Data on deliveries, UDS testing, and CPS reports were obtained from the EHR, and data for deliveries occurring during the pre- (1/1/2020-9/30/2022; 33 months) vs. post-implementation (10/1/2022-2/1/2024; 16 months) periods was compared. There were a total of 9,187 and 4,757 deliveries during the pre- and post-implementation periods, respectively. At baseline, there were more deliveries by Black patients in the pre-implementation (47.8%) vs. post-implementation (44.0%) period (p<0.001); there was no difference in age, multiparity, or neonatal outcomes between the two periods. In the pre-intervention period, 29.2% of Black and 13.8% of White patients had UDS testing (p<0.001), and 7.6% of Black and 4.1% of White patients underwent reporting to CPS (p<0.001); in the post-intervention period, 4.5% of Black and 3.6% of White patients had UDS testing (p=0.52), and 4.2% of Black and 3.5% of White patients underwent reporting to CPS (p=0.52). 34.6% vs. 67.8% of UDSs in the pre- and post-implementation were positive for any non-cannabis compound, respectively (p<0.001). In conclusion, removing ICU as an order indication dramatically improves racial equity in UDS testing and CPS reporting on a L&D floor, and improves the pre-test probability of UDS testing for non-cannabis compounds.

Labor Nurses' Experiences During the COVID-19 Pandemic

Abstract Purpose: The purpose of this study was to describe labor and delivery nurses' experiences in caring for patients during the COVID-19 pandemic. Methods: We used a descriptive phenomenological design and purposeful sampling to recruit experienced labor and delivery nurses for flexible semi-structured face-to-face audiotaped interviews. Constant comparison was used to analyze data. Results: Ten nurses employed in a labor and delivery unit in two acute care hospitals in southern Texas participated and were interviewed from June through August 2022. The mean age of nurse participants was 36.5 years. Seven had over 5 years' experience as a labor and delivery nurse before the pandemic. Five distinct themes were identified: Psychological stress during COVID-19; Feelings of satisfaction and gratitude; Resilience and readiness for positive change; Patient-centered care; and Interprofessional collaboration. Clinical Implications: These findings build on our understanding of key determinants contributing to labor and delivery nurses' ability to adjust to the unprecedented and chaotic working conditions during the COVID-19 pandemic and highlighted several factors that could influence nurses' resilience and job satisfaction.

Perception of Women Toward Childbirth Positions Among Women on Postnatal Unit at Jimma Medical Center, South West Ethiopia: A Phenomenological Qualitative Study

Objective: To explore the perceptions of women toward child birthing positions among women on the postnatal unit at Jimma Medical Center, Jimma town, Ethiopia, in 2020. Design: A descriptive phenomenological approach was employed among women from the postnatal unit and maternity care providers from the labor and delivery unit. Setting: Jimma Medical Center, south-west Ethiopia Participants: 40 study participants were selected purposively. 30 postnatal women were recruited for both an in-depth interview and a focus group discussion. From maternity health care providers, 10 health professionals were interviewed. Results: This study involved 30 study participants for in-depth interviews and one focus group discussion with 10 participants. Regarding the variables influencing the use of alternative birth positions in the medical facility, responses were obtained from both women and medical professionals. The women were placed in common supine positions because they were ignorant of other birth positions, because they were passive in allowing themselves to be in the position that they preferred, and because medical professionals lacked the necessary knowledge and expertise to provide alternative birth positions. Conclusion and Recommendations: The women were coerced to take birth positions against their will by healthcare providers. Thus, evidence-based alternative birth positions should be made available and implemented in order to enhance the practice of healthcare providers.

Preoperative Multidisciplinary Team Huddle Improves Communication and Safety for Unscheduled Cesarean Deliveries: A System Redesign Using Improvement Science.

Optimal communication between care teams is a critical component in providing safe, timely, and appropriate patient care. Labor and delivery (L&D) units experience rapidly changing clinical scenarios often requiring escalation in care and unplanned cesarean deliveries (CDs). The University of Cincinnati Medical Center (UCMC) is a 550-bed academic level 4 maternal care center with a 13-bed L&D unit in Cincinnati, OH. There are approximately 2500 deliveries/y with a CD rate of 33%. The L&D unit is staffed with dedicated anesthesia personnel 24 hours a day. In our L&D unit, there was widespread dissatisfaction with multidisciplinary communication surrounding unscheduled CD. Near-miss safety events in our obstetric unit were attributed to preoperative communication failures. Initial surveys identified challenges in preoperative communication among nursing, anesthesiology, and obstetric teams leading to potential risk for compromised care. Using the UC Health Performance Improvement Way, we first sought to understand the process leading up to unscheduled CD. Change ideas were developed based on observed failures in communication. Interventions were tested and refined through iterative plan-do-study-act (PDSA) cycles. One key intervention was the introduction of a bedside, multidisciplinary, patient-centered, pre-CD huddle attended by nursing, anesthesia, and obstetrics representatives using a standard checklist for critical information. Qualitative patient feedback was elicited to inform change efforts. We compared patient and procedure characteristics from the baseline and huddle implementation phases. Our primary outcome measure was the satisfaction of care team members with communication around unscheduled CD. A secondary outcome was the general anesthesia (GA) rate for unscheduled CD. Our key process measure was adherence to the preoperative huddle. We tracked decision-to-incision interval (DTI) as a balancing measure. Huddle adherence reached 96% for unscheduled CD within 6 months of testing and implementation. A combined survey of anesthesia, nursing, and obstetrics showed that satisfaction scores related to unscheduled CD communication improved from 3.3/5 to 4.7/5 after huddle implementation. The rate of GA use and the median DTI remained unchanged. Patients felt more engaged and reported positive experiences by being a part of the huddle discussion. In an academic obstetric unit, communication failures surrounding unscheduled CD were identified as a contributor to staff dissatisfaction and perception of safety risk. Implementation of a bedside multidisciplinary pre-CD huddle improved communication between teams and contributed to creating a culture of safety without causing significant delays in care.

Obstetric outcomes among rural parturients across US urban and rural hospitals.

The objective of this study is to evaluate severe maternal morbidity (SMM) of rural parturients delivering at rural compared to urban hospitals in the US. We identified patients aged 18-40 years in a multi-institutional claims database who lived in a rural ZIP code and delivered at a rural or urban hospital between October-December of 2015 and October-December of 2022. The primary outcome was SMM, and the secondary outcome was SMM exclusive of blood transfusions. We combined exact ZIP code matching and propensity score matching to compare SMM risk among patients living in the same rural community and delivering in urban as compared to rural hospitals. A total of 214 296 patients from 571 ZIP codes were identified, including 47% delivering at rural facilities and 53% delivering at urban facilities. The SMM rate was 1.1% (0.3% excluding blood transfusions). After matching, urban versus rural delivery was associated with increased odds of SMM other than blood transfusion (odds ratio 2.44; 95% confidence interval 1.81-3.28), but was not associated with differences in risk of any SMM. There was no evidence of reduced SMM for rural patients delivering at an urban rather than a rural hospital. SMM exclusive of blood transfusions was increased for rural patients delivering at urban hospitals after matching on ZIP code and predictors of urban hospital delivery. Our findings undermine the assumption that delivery at a rural facility has inherently greater risks relative to delivery at an urban facility. As some health systems face challenges to maintain rural labor and delivery units, patient safety must be considered if confronted with the possibility of unit or hospital closures.

Globalisation and Performance of Manufacturing Sector in Punjab and Tamil Nadu: Implications for Employment and Wages

The present study is a comparative analysis of the performance of the organised manufacturing sector of Punjab and Tamil Nadu. The aggregate and the disaggregate picture reveals that globalisation-led growth of the manufacturing sector in Tamil Nadu has transformed its economy to a highly industrialised economy in Indian Union, and Punjab remained far behind in this context. However, the implications of the performance of the manufacturing sector on employment and wage share have shown common characteristics in both states. The increased capital intensity in the globalisation era has widened the gap between labour productivity and wage share in both states. Since 1991, the emoluments (capitalist share) have increased at a higher rate than the real wages. The decomposition analysis of wage share shows that the falling labour–capital ratio and increased contractualisation of the labour market are some of the important reasons behind the low growth of employment and fall in the wage share. Moreover, the disaggregated analysis reveals a secular increase in the use of capital per unit of labour in labour-intensive industries that has further reduced the employment elasticity of gross value added (GVA) in both states. It also highlights that regional heterogeneity plays an important role in the performance of a particular industry with respect to employment and wage share. JEL Codes: F60, J24, L60

Effects of Warm Compresses on the Perineal Area During the Active Phase of Labor: A Quasi-Experimental Study.

Background A perineal tear refers to any injury to the female genitalia during labor, which can occur spontaneously or with the use of instruments. An episiotomy, a surgical procedure, is sometimes performed to enlarge the vaginal orifice to facilitate delivery. Ineffective management of labor pain can result in negative physiological and psychosocial outcomes. Objective This study aims to investigate the effect of warm compresses on the perineal area during active labor. Methods This quasi-experimental study utilized a convenience sample, dividing 80 mothers into intervention and control groups. Participants were randomly assigned to groups after meeting the inclusion criteria and signing consent forms. The inclusion criteria encompassed pregnant women aged 18 years or older with a healthy singleton pregnancy, a cephalic presentation, and a gestational age of 37 weeks or more. The women were in the active phase of the first stage of labor (6-7 cm cervical dilation). In Part I, a data collection tool was developed to gather sociodemographic data, obstetrical history, and initial assessment information. Part II assessed perineal pain using the Visual Analogue Scale. Part III collected data on the perineal status post-delivery, and Part IV gathered information about the newborns. The research was conducted in the labor unit at East Jeddah Hospital, with data collection occurring from November 2022 to February 2023. Results The results of this study revealed that the mean second-stage labor pain score was 9.73 for the control group and 8.68 for the intervention group. In the third stage of labor, the mean pain score was 4.52 for the control group and 2.75 for the intervention group. During the fourth stage of labor, the mean pain score for the control group was 2.90, compared to 1.50 for the intervention group. In terms of perineal outcomes, 17 participants (42.5%) in the intervention group had an intact perineum, compared to 11 participants (27.5%) in the control group. However, there was no significant difference in the episiotomy rate between the two groups. Conclusions The findings of this study indicate that applying a warm compress to the perineal area during active labor can enhance perineal intactness and significantly reduce perineal pain. Future research could explore the challenges nurses encounter when applying warm compresses to the perineum during labor.

Comparing birth experiences and satisfaction with midwifery care before and after the implementation of Canada's first Alongside Midwifery Unit (AMU).

Globally, midwifery-led birthing units are associated with favourable clinical outcomes and positive birth experiences. As part of our evaluation of Canada's first Alongside Midwifery Unit (AMU) at Markham Stouffville Hospital, we sought to explore and compare birth experiences and satisfaction among midwifery clients who gave birth on the AMU with midwifery clients who gave birth on the traditional obstetric unit prior to AMU implementation. We conducted a structured, online, cross-sectional survey of midwifery clients in the six months before, and up to 18 months after, opening of the AMU at Markham Stouffville Hospital, Ontario Canada. The survey contained validated measures of satisfaction including personal capacity and participation; perceived safety, control, and security; professional support; and satisfaction. Descriptive statistics and tests of significance were completed in SPSS. A total of 193 responses were included in our analyses (pre-AMU n = 47, post-AMU n = 146). All participants had positive experiences in the four domains assessed. Compared to those who gave birth with midwives on the Labour unit, those who gave birth on the AMU indicated more positive experiences for some measures. Perceptions pertaining to being an active participant in care, to security and sense of control were more positive among those who gave birth on the AMU. The AMU in Ontario is associated with high levels of satisfaction during birth, particularly the perception of being actively engaged in decision making, having a sense of control and safety, and having confidence in the care provider team. Care received on the AMU does not compromise birth experiences or satisfaction and may be associated with greater autonomy and agency for the person giving birth.

A narrative review of factors affecting the welfare of dairy cows in larger Australasian pasture-based production systems

On the basis of current growth trajectories, pasture-based dairies of the future are likely to be bigger, have higher stocking rates and feed more concentrate to cows. This review uses the five-domains framework to consider risks to the welfare of dairy cows in these larger intensified pasture-based production systems. The factors considered in this review can be broadly categorised as (1) emerging welfare risks that can be managed, (2) emerging welfare risks that require research to be managed, or (3) persisting and/or exacerbated welfare risks. First, large herds could be subject to welfare risks associated with more stock per labour unit, longer milking times and longer distances walked to and from the dairy. To counter this, the time that cows in large herds spend off pasture can be reduced by splitting the herd into several more manageable groups, and animal-monitoring technologies can help identify health challenges with a reduced stockperson to animal ratio. Cow body condition and productivity can be maintained at high stocking rates by improving pasture production and feeding a higher proportion of concentrate. The risk of ruminal acidosis may then be reduced by appropriate transition feeding regimes and rumen buffers. Second, ensuring social stability and reducing competition may become difficult as herd sizes increase and feeding becomes more intensive. The resulting variability in feed intake, increased agonistic behaviour and social stress present emerging risks to cow welfare. Research is needed to better understand the social behaviour of cows in large intensive pasture-based herds, and how the design of the pre-milking area, the feeding pad and pasture feeding regimes (i.e. quantity and timing of pasture allocation) can improve accessibility for more vulnerable animals. Finally, intensive pasture-based dairies of the future will continue to face welfare challenges relating to lameness, mastitis and cull-cow management, whereas risks due to environmental exposure may be exacerbated by the removal of shelterbelts to facilitate irrigation. These require continued efforts in research (e.g. ways of incorporating shelter into intensive grazing systems), development (e.g. pathway to market for aged beef) and extension (e.g. improved record keeping and benchmarking of lameness and mastitis).