Reduction of perineal trauma and improved perineal comfort during and after childbirth : the Perineal Warm Pack Trial

University of Technology, Sydney. Faculty of Nursing, Midwifery and Health.The Perineal Warm Pack Trial investigated the effects of applying warm packs to the perineum during the late second stage of labour on perineal trauma and maternal comfort. A randomised controlled method was used. In the late second stage of labour, primiparous 1 women (n = 717) giving birth were randomly allocated to having warm packs (n = 360) applied to their perineum or standard care (n = 357). Analysis was on an intention-to-treat basis. The primary outcome measure was the requirement for perineal suturing and the secondary outcome measure was maternal comfort. There was no statistically significant difference in the number of women who required suturing following birth. There were significantly fewer third-and fourth-degree tears in the warm pack group. However, the study was underpowered to assess the uncommon outcome of severe perineal trauma. Women in the warm pack group had significantly lower perineal pain scores when giving birth, on day one and day two following the birth. At twelve weeks, women in the warm pack group were significantly less likely to have urinary incontinence compared to the women in the standard care group. Warm packs were highly acceptable to both women and midwives as a means to relieve pain during the late second stage of labour. Almost the same number of women (79.7%) and midwives (80.4%) felt that the warm packs reduced perineal pain during the birth. Both women and midwives were positive about using warm packs in the future. The majority of women (85.7%) said they would like to use perineal warm packs again for their next birth and similarly would recommend them to friends (86.1%). Likewise, 91% of midwives were positive about using the warm packs, with 92.6% considering using them in the future as part of care in the second stage of labour. Both women and health professionals place a high value on minimising perineal trauma during childbirth and the potential associated morbidity. Perineal warm packs are widely used in the belief that they reduce perineal trauma and increase comfort during the late second stage of labour. This study demonstrated that the application of perineal warm packs in the late second stage does not reduce the likelihood of primiparous women requiring perineal suturing but significantly reduces perineal pain during the birth and on day one and two following the birth. Urinary incontinence also appears reduced at twelve weeks postpartum, though it is unclear as to the reason for this. The practice of applying perineal warm packs in the late second stage was highly acceptable to mothers and midwives in helping to relieve perineal pain and increase comfort and should be incorporated into second-stage pain relief options available to women during childbirth

Is it time to ask whether facility based birth is safe for low risk women and their babies?

Despite evidence to the contrary, homebirth remains a controversial choice in maternity care, with strong opinions expressed by consumers, health providers and the media [1]. There is rarely any differentiation between the media reporting of adverse outcomes associated with freebirth or homebirth attended by registered health providers [2]. This can cause health services to resist consumer demand for system integrated homebirth [3]. Research shows that homebirth is as safe as hospital birth for women who are low risk and attended by professional midwives who, in turn, are well networked into a responsive health system [4]. It can be less safe for the baby when women with significant risk factors choose homebirth, or when they give birth without regulated health providers in attendance. When systems are overly restrictive and there is significant variation in guidance on homebirth [5], confusion and conflict inevitably arises amongst and between consumers, policy makers and health providers. Internationally, rates of homebirth attended by registered health professionals (usually a midwife) range from 13% in the Netherlands [6] to 0.3% in Australia [7]. In some countries, homebirth is deemed illegal and midwives are being prosecuted or jailed for supporting women who make this choice [8]

Cost analysis of the CTLB Study, a multitherapy antenatal education programme to reduce routine interventions in labour

Objective: To assess whether the multitherapy antenatal education ‘CTLB’ (Complementary Therapies for Labour and Birth) Study programme leads to net cost savings. Design: Cost analysis of the CTLB Study, using analysis of outcomes and hospital funding data. Methods: We take a payer perspective and use Australian Refined Diagnosis-Related Group (AR-DRG) cost data to estimate the potential savings per woman to the payer (government or private insurer). We consider scenarios in which the intervention cost is either borne by the woman or by the payer. Savings are computed as the difference in total cost between the control group and the study group. Results: If the cost of the intervention is not borne by the payer, the average saving to the payer was calculated to be $A808 per woman. If the payer covers the cost of the programme, this figure reduces to$A659 since the average cost of delivering the programme was $A149 per woman. All these findings are significant at the 95Conclusion: The CTLB antenatal education programme leads to significant savings to payers that come from reduced use of hospital resources. Depending on which perspective is considered, and who is responsible for covering the cost of the programme, the net savings vary from$A659 to $A808 per woman. Compared with the average cost of birth in the control group, we conclude that the programme could lead to a reduction in birth-related healthcare costs of approximately 9%. Trial registration number: ACTRN12611001126909

Birthing outside the system : the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia

Background: Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system – that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional. Method: This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time. Results: The core category was ‘wanting the best and safest,’ which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was ‘finding a better way’. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies. Conclusion: Shortfalls in the Australian maternity care system is the major contributing factor to women’s choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk

More than needles : the importance of explanations and self-care advice in treating primary dysmenorrhea with acupuncture

Background. Primary dysmenorrhea is a common gynaecological condition. Traditional Chinese medicine (TCM) acupuncturists commonly treat primary dysmenorrhea and dispense specific self-care advice for this condition. The impact of self-care advice on primary dysmenorrhea is unknown. Methods. 19 TCM acupuncture practitioners from New Zealand or Australia and 12 New Zealand women who had recently undergone acupuncture treatment for primary dysmenorrhea as part of a randomised controlled trial participated in this qualitative, pragmatic study. Focus groups and semistructured interviews were used to collect data. These were recorded, transcribed, and analysed using thematic analysis. Results. The overarching theme was that an acupuncture treatment consisted of “more than needles” for both practitioners and participants. Practitioners and participants both discussed the partnership they engaged in during treatment, based on openness and trust. Women felt that the TCM self-care advice was related to positive outcomes for their dysmenorrhea and increased their feelings of control over their menstrual symptoms. Conclusions. Most of the women in this study found improved symptom control and reduced pain. A contributing factor for these improvements may be an increased internal health locus of control and an increase in self-efficacy resulting from the self-care advice given during the clinical trial. (** PLEASE NOTE: a corrigendum for this article is available via https://doi.org/10.1155/2018/8468376

Sistem Hirarki Kelembagaan Badan Pengelola Zakat di Indonesia (Tinjauan terhadap Pelaksanaan Undang-undang No. 23 Tahun 2011)

: Government support for the existence and role of zakat management organization indicated by the issuance of legislation on the management of zakat that Act No. 38 of 1999 and the decision of the Minister of Religion No. 581 of 1999 on the implementation of Act No. 38 of 1999 which was amended by Act No. 23 of 2011 concerning the management of zakat. Many factors of causing non-optimal zakat as legislation, mostly related to the system and institutional factors. In this case, should the government as well as amil zakat organization has a strategic role to establish an institutional system of zakat and charity empowerment and support the establishment of the implementation of the charity as a binding regulation. This can occur if the control system of zakat management organization operating effectively, as well as the existence of legislation on the management of zakat either No. 38 of 1999 and No. 23 of 2011. In other words, the optimization of the implementation of zakat is affected by the system and the effective management of zakat management in addition to firmness of government in enforcing the implementation of zakat either written in the legislation and are implementable in order to achieve good governance zakat (alms good governance)

Pregnancy-Related Lumbopelvic Pain: Listening to Australian Women

Objective. To investigate the prevalence and nature of lumbo-pelvic pain (LPP), that is experienced by women in the lumbar and/or sacro-iliac area and/or symphysis pubis during pregnancy. Design. Cross-sectional, descriptive study. Setting. An Australian public hospital antenatal clinic. Sample population: Women in their third trimester of pregnancy. Method. Women were recruited to the study as they presented for their antenatal appointment. A survey collected demographic data and was used to self report LPP. A pain diagram differentiated low back, pelvic girdle or combined pain. Closed and open ended questions explored the experiences of the women. Main Outcome Measures. The Visual Analogue Scale and the Oswestry Disability Index (Version 2.1a). Results. There was a high prevalence of self reported LPP during the pregnancy (71%). An association was found between the reporting of LPP, multiparity, and a previous history of LPP. The mean intensity score for usual pain was 6/10 and four out of five women reported disability associated with the condition. Most women (71%) had reported their symptoms to their maternity carer however only a small proportion of these women received intervention. Conclusion. LPP is a potentially significant health issue during pregnancy

Expectations of the upcoming birth : a survey of women's self-efficacy and birth positions

Background: Adopting an upright sacrum flexible position may facilitate physiological childbirth, which many pregnant women wish for. A positive association between women's choice on birthing position and birthing experience has been found. Objective: The aim of this study was to examine women's preferred birth position, self-efficacy at term and their actual birth position at time of birth. Methods: A survey of 554 pregnant Danish women at gestational week 38. Data was collected using an online survey and information was retracted from the woman's medical record. Descriptive statistics and non-parametric tests were used and univariate and multivariate logistic regression models were used to analyse the association between self-efficacy and fulfilled wish of birth position. Findings: The majority of women (>70 %) wished to give birth in a sacrum flexible position but more than 80 % gave birth in a non-flexible position. Less than 50 % had their wish of birth position fulfilled. All women reported overall high self-efficacy. No difference in having wish for birth position fulfilled was found comparing women with high and low self-efficacy. Conclusions: Most women wished for a sacrum flexible position but more than 80% gave birth in a sacrum non-flexible position and less than 50% had their wish for birth position fulfilled. Level of self-efficacy did not affect the likelihood of having wish of birth position fulfilled indicating that the culture at the birth setting and skills and attitudes among birth providers may have a considerable impact on women's choice of birth position

"You are either with me on this or not" : a meta-ethnography of the influence birth partners and care-providers have on coping strategies learned in childbirth education and used by women during labour

Background: Childbirth education, which includes providing information and practical techniques to help manage childbirth, aims to support women and their birth partners. It is unknown how birth partners and care providers influence the utilisation of childbirth education information and techniques during women's labour and birth. Aim: To explore the literature that investigates the influence that birth partners and care-providers have on the application of childbirth education information and techniques used by women during childbirth. Methods: A meta-ethnography was performed using a systematic synthesis of reciprocal translation and refutational investigation. There were 22 papers included in the final synthesis. Quality appraisal was undertaken using the Joanna Briggs Institute Qualitative Assessment and Review Instrument (JBIQARI) quality appraisal tool for qualitative studies. Findings: An over-arching theme of ‘you are either with me on this or not’ emerged from the data, which expressed the positive and negative influences on the use of childbirth education information and techniques during labour and birth. The influence of birth partners was captured in the themes ‘stepping up to their full potential’ and ‘a spare part’. The themes ‘in alignment with the woman’ and ‘managed by another’ were conceptualised from the data in relation to care-providers’ influence. A theme, ‘the right fit’, described organisational and contextual influences. Conclusion: Birth partners and care-providers who are present during a woman's labour have significant potential to influence her use of childbirth education strategies in labour, which provides important insights for translation of evidence into practice

Midwife-centred management : a qualitative study of midwifery group practice management and leadership in Australia

Background Midwifery group practice (MGP) has consistently demonstrated optimal health and wellbeing outcomes for childbearing women and their babies. In this model, women can form a relationship with a known midwife, improving both maternal and midwife satisfaction. Yet the model is not widely implemented and sustained, resulting in limited opportunities for women to access it. Little attention has been paid to how MGP is managed and led and how this impacts the sustainability of the model. This study clarifies what constitutes optimal management and leadership and how this influences sustainability. Methods This qualitative study forms part of a larger mixed methods study investigating the management of MGP in Australia. The interview findings presented in this study are part of phase one, where the findings informed a national survey. Nine interviews and one focus group were conducted with 23 MGP managers, clinical midwife consultants, and operational/strategic managers who led MGPs. Transcripts of the audio-recordings were analysed using inductive, reflexive, thematic analysis. Results Three themes were constructed, namely: The manager, the person, describing the ideal personal attributes of the MGP manager; midwifing the midwives, illustrating how the MGP manager supports, manages, and leads the group practice midwives; and gaining acceptance, explaining how the MGP manager can gain acceptance beyond group practice midwives. Participants described the need for MGP managers to display midwife-centred management. This requires the manager to have qualities that mirror what is generally accepted as requirements for good midwifery care namely: core beliefs in feminist values and woman-centred care; trust; inclusiveness; being an advocate; an ability to slow down or take time; an ability to form relationships; and exceptional communication skills. Since emotional labour is a large part of the role, it is also necessary for them to encourage and practice self-care. Conclusions Managers need to practice in a way that is midwife-centred and mimics good midwifery care. To offset the emotional burden and improve sustainability, encouraging and promoting self-care practices might be of value