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

Midwifery care for late termination of pregnancy : integrative review

Midwives provide reproductive healthcare to women, including during termination of pregnancy (TOP) after 12 weeks (late TOP). Their expertise, knowledge and woman-centred care approach sees them ideally placed for this role. However, the medical, social and emotional complexities of late TOP can cause midwives significant distress. An integrative review methodology was used to examine the research on midwifery care for late TOP and identify support strategies and interventions available to midwives in this role. Five databases and reference lists were searched for relevant studies published between 2000 and 2021. A total of 2545 records were identified and 24 research studies included. Synthesis of research findings resulted in three themes: Positive aspects, negative aspects and carers need care. Midwives reported a high level of job satisfaction when caring for women during late TOP. Learning new skills and overcoming challenges were positive aspects of their work. Yet, midwives felt unprepared to deal with challenging aspects of late TOP care such as the grief and the psychological burden of the role. Caring for the baby with dignity had both positive and negative aspects. Midwives relied predominantly on close colleagues for help and debriefing as they felt poorly supported by management, judged by co-workers and lacked appropriate support to reduce the emotional effects of late TOP care. Midwives need support, although current evidence has not identified the most appropriate and effective strategy to support them in this role

From coercion to respectful care : women’s interactions with health care providers when planning a VBAC

Background: In many countries caesarean section rates are increasing and this impacts on choices made around mode of birth in subsequent pregnancies. Having a vaginal birth after caesarean (VBAC) can be a safe and empowering experience for women, yet most women have repeat caesareans. High caesarean section rates increase maternal and neonatal morbidity, health costs and burden on hospitals. Women can experience varied support from health care providers when planning a VBAC. The aim of this paper is to explore the nature and impact of the interactions between women planning a VBAC and health care providers from the women’s perspective. Methods: A national Australian VBAC survey was undertaken in 2019. In total 559 women participated and provided 721 open-ended responses to six questions. Content analysis was used to categorise respondents’ answers to the open-ended questions. Results: Two main categories were found capturing the positive and negative interactions women had with health care providers. The first main category, ‘Someone in my corner’, included the sub-categories ‘belief in women birthing’, ‘supported my decisions’ and ‘respectful maternity care’. The negative main category ‘Fighting for my birthing rights’ included the sub-categories ‘the odds were against me’, ‘lack of belief in women giving birth’ and ‘coercion’. Negative interactions included the use of coercive comments such as threats and demeaning language. Positive interactions included showing support for VBAC and demonstrating respectful maternity care. Conclusions: In this study women who planned a VBAC experienced a variety of positive and negative interactions. Individualised care and continuity of care are strategies that support the provision of positive respectful maternity care