Alternative versus conventional institutional settings for birth

Background: Alternative institutional settings have been established for the care of pregnant women who prefer and require little or no medical intervention. The settings may offer care throughout pregnancy and birth, or only during labour; they may be part of hospitals or freestanding entities. Specially designed labour rooms include bedroom-like rooms, ambient rooms, and Snoezelen rooms. Objectives: Primary: to assess the effects of care in an alternative institutional birth environment compared to care in a conventional institutional setting. Secondary: to determine if the effects of birth settings are influenced by staffing, architectural features, organizational models or geographical location. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2010). Selection criteria: All randomized or quasi-randomized controlled trials which compared the effects of an alternative institutional maternity care setting to conventional hospital care. Data collection and analysis: We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors evaluated methodological quality. We performed double data entry and have presented results using risk ratios (RR) and 95% confidence intervals (CI). Main results: Nine trials involving 10684 women met the inclusion criteria. We found no trials of freestanding birth centres or Snoezelen rooms. Allocation to an alternative setting increased the likelihood of: no intrapartum analgesia/anaesthesia (five trials, n = 7842; RR 1.17, 95% CI 1.01 to 1.35); spontaneous vaginal birth (eight trials; n = 10,218; RR 1.04, 95% CI 1.02 to 1.06); breastfeeding at six to eight weeks (one trial, n = 1147; RR 1.04, 95% CI 1.02 to 1.06); and very positive views of care (two trials, n = 1207; RR 1.96, 95% CI 1.78 to 2.15). Allocation to an alternative setting decreased the likelihood of epidural analgesia (seven trials, n = 9820; RR 0.82, 95% CI 0.75 to 0.89); oxytocin augmentation of labour (seven trials, n = 10,020; RR 0.78, 95% CI 0.66 to 0.91); and episiotomy (seven trials, n = 9944; RR 0.83, 95% CI 0.77 to 0.90). There was no apparent effect on serious perinatal or maternal morbidity/mortality, other adverse neonatal outcomes, or postpartum hemorrhage. No firm conclusions could be drawn regarding the effects of variations in staffing, organizational models, or architectural characteristics of the alternative settings. Authors' conclusions: When compared to conventional settings, hospital-based alternative birth settings are associated with increased likelihood of spontaneous vaginal birth, reduced medical interventions and increased maternal satisfactio

Communicating choice: an exploration of mothers' experiences of birth

YesObjective: This article gives an in-depth insight into the ways in which communication between midwives and the birthing woman shape the birth experience. Background: Birth is a significant life event for many women that can have profound, long-lasting effects on how they see themselves as women and mothers. Within the literature the importance of control over the birth experience and the support that the birthing woman receives from midwives is stressed. Methods: Six women who had recently given birth participated in one-to-one semi-structured interviews designed to explore the kinds of support they received before, during and after their birth. An inductive thematic analysis was employed in order to identify and explore key issues which ran throughout the interviews. Results: Within the interviews the importance of being an active mother, someone who made decisions in relation to her labour, was stressed. The analysis explores the ways in which communication style and compassionate care either enabled or prevented women from adopting the position of ‘active’ mother. Conclusion: It is argued that a personal connection with midwives and clear and open communication which places the birthing woman in a position of control are key to positive birth experiences

High-resolution hydraulic parameter maps for surface soils in tropical South America

Modern land surface model simulations capture soil profile water movement through the use of soil hydraulics sub-models, but good hydraulic parameterisations are often lacking, especially in the tropics. We present much-improved gridded data sets of hydraulic parameters for surface soil for the critical area of tropical South America, describing soil profile water movement across the region to 30 cm depth. Optimal hydraulic parameter values are given for the Brooks and Corey, Campbell, van Genuchten–Mualem and van Genuchten–Burdine soil hydraulic models, which are widely used hydraulic sub-models in land surface models. This has been possible through interpolating soil measurements from several sources through the <i>SOTERLAC</i> soil and terrain data base and using the most recent pedotransfer functions (PTFs) derived for South American soils. All soil parameter data layers are provided at 15 arcsec resolution and available for download, this being 20x higher resolution than the best comparable parameter maps available to date. Specific examples are given of the use of PTFs and the importance highlighted of using PTFs that have been locally parameterised and that are not just based on soil texture. We discuss current developments in soil hydraulic modelling and how high-resolution parameter maps such as these can improve the simulation of vegetation development and productivity in land surface models

Effect of peer support on prevention of postnatal depression among high risk women: multisite randomised controlled trial

Objective To evaluate the effectiveness of telephone based peer support in the prevention of postnatal depression

A Qualitative Analysis of Women's Short Accounts of Labour and Birth in a Western Australian Public Tertiary Hospital

This paper reports the findings of the postnatal qualitative arm of a larger study,which investigated women's prenatal and postnatal levels of childbirth fear. Women's expectations and experiences of labour and birth in a Western Australian public tertiary hospital were identified following thematic analysis of short written accounts from 141 participants who had given birth in the previous 6 to 14 weeks. Four major categories emerged to describe features and mediating factors in the trajectory of childbirth and the early puerperium "Anticipating Labour and Birth", "Labour and birth Depicted", "Mediating Factors and their consequences" and "Evaluating, Resolving, and Looking Ahead" portray women's comparative reflections on expectations and realities of birth, on mediating influences, and on moving on from their experience. These findings will provide maternity care professionals with insight into the personal and environmental features of the childbirth setting which colours women's recollections. Being aware of what women value during labour and birth will reinforce the need for professionals to provide care using a mindful approach that considers the potential psychological, emotional and behavioural implications of events

Effect on birth outcomes of a formalised approach to care in hospital labour assessment units: international, randomised controlled trial

Objective To determine if a complex nursing and midwifery intervention in hospital labour assessment units would increase the likelihood of spontaneous vaginal birth and improve other maternal and neonatal outcomes

Further experimental evidence that condensation is a major cause of airflow

This paper further explores the physics of water condensation, using an experimental structure designed for that purpose. The data show a highly significant correlation (R2 >0.94, p value <0.001) between observed airflows and partial pressure changes from condensation, when the results of different experiments are pooled. Changes in air density on cooling provide insufficient energy to account for the airflow. The finding is that the kinetic energy of the chilled air falls short by an order of magnitude, even to move a relatively small proportion of the 20 kg of air contained within the structure. Meanwhile the physics of condensation indicate a surplus of kinetic energy is made available from the air surrounding the locus of condensation. At low rates of condensation a considerable proportion of the available kinetic energy in the enclosed air is absorbed in friction and turbulence. That proportion reduces with higher rates of condensation

(E)-4-[(4-Bromo­benzyl­idene)amino]phenol

In the title compound, C13H10BrNO, the dihedral angle between the benzene rings is 35.20 (8)°. In the crystal, mol­ecules are linked by O—H⋯N hydrogen bonds, forming a zigzag chain along the a axis. A weak C—H⋯π inter­action is observed between the chains