Experiences of physical activity during pregnancy in Danish nulliparous women with a physically active life before pregnancy. A qualitative study

<p>Abstract</p> <p>Background</p> <p>National guidelines recommend that healthy pregnant women take 30 minutes or more of moderate exercise a day. Most women reduce the level of physical activity during pregnancy but only a few studies of women's experiences of physical activity during pregnancy exist. The aim of the present study was to elucidate experiences and views of leisure time physical activity during pregnancy in nulliparous women who were physically active prior to their pregnancy.</p> <p>Methods</p> <p>A qualitative study was conducted by means of personal interviews. Nineteen women, all with a moderate pre-pregnancy level of physical activity but with different levels of physical activity during pregnancy, participated in the study. Content analysis was applied.</p> <p>Results</p> <p>In the analyses of experiences and views of physical activities during pregnancy, four categories and nine sub-categories were developed: <it>Physical activity as a lifestyle </it>(Habit and Desire to continue), <it>Body awareness </it>(Pregnancy-related discomfort, Having a complicated pregnancy and A growing body), <it>Carefulness </it>(Feelings of worry and Balancing worry and sense of security) and <it>Sense of benefit </it>(Feelings of happiness and Physical well-being).</p> <p>Conclusion</p> <p>As other studies have also shown, women find that the discomfort and complications associated with pregnancy, the growing body, and a sense of insecurity with physical activity are barriers to maintaining former levels of physical activity. This study adds a new perspective by describing women's perceptions of these barriers and of overcoming them - thus, when pregnant, the majority of the women do not cease to be physically active but continue to be so. Barriers are overcome by applying one's own experience, looking to role models, mirroring the activities of other pregnant women and following the advice of experts (midwives/physiotherapists). Women then continue to be physically active during pregnancy, most often to a lesser extent or in alternative activities, and derive considerable enjoyment and physical well-being from this.</p

Patient safety culture improvements depend on basic healthcare education:a longitudinal simulation-based intervention study at two Danish hospitals

BACKGROUND: A growing body of evidence supports the existence of an association between patient safety culture (PSC) and patient outcomes. PSC refers to shared perceptions and attitudes towards norms, policies and procedures related to patient safety. Existing literature shows that PSC varies among health professionals depending on their specific profession and specialty. However, these studies did not investigate whether PSC can be improved. This study investigates whether length of education is associated with improvements in PCS following a simulation intervention. METHODS: From April 2017 to November 2018, a cross-sectional intervention study was conducted at two regional hospitals in Denmark. Two groups with altogether 1230 health professionals were invited to participate. One group included nurses, midwives and radiographers; the other group included doctors. A train-the-trainer intervention approach was applied consisting of a 4-day simulation instructor course that emphasised team training, communication and leadership. Fifty-three healthcare professionals were trained as instructors. After the course, instructors performed in situ simulation in their own hospital environment. OUTCOMES: The Safety Attitude Questionnaire (SAQ), which has 6 dimensions and 32 items, was used to collect main outcome variables. All employees from both groups were surveyed before the intervention and again four and nine months after the intervention. RESULTS: Mean baseline scores were higher among doctors than among nurses, midwives and radiographers for all SAQ dimensions. At the second follow-up, four of six dimensions improved significantly (p ≤ 0.05) among nurses, midwives and radiographers, whereas no dimensions improved significantly among doctors. CONCLUSION: Over time, nurses, midwives and radiographers improved more in PSC attitudes than doctors did

Experiences of non-progressive and augmented labour among nulliparous women: a qualitative interview study in a Grounded Theory approach

<p>Abstract</p> <p>Background</p> <p>Non-progressive labour is the most common complication in nulliparas and is primarily treated by augmentation. Augmented labour is often terminated by instrumental delivery. Little qualitative research has addressed experiences of non-progressive and augmented deliveries. The aim of this study was to gain a deeper understanding of the experience of non-progressive and augmented labour among nulliparas and their experience of the care they received.</p> <p>Methods</p> <p>A qualitative study was conducted using individual interviews. Data was collected and analysed according to the Grounded Theory method. The participants were a purposive sample of ten women. The interviews were conducted 4–15 weeks after delivery.</p> <p>Results</p> <p>The women had contrasting experiences during the birth process. During labour there was a conflict between the expectation of having a natural delivery and actually having a medical delivery. The women experienced a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. Reconciliation between the contrasting feelings during labour was achieved. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control.</p> <p>Conclusion</p> <p>A dialectical process was identified in these women's experiences of non-progressive labour. The process is susceptible to interaction with the midwife; especially her support to the woman's feeling of being in control. Midwives should secure that the woman's recognition of the fact that the labour is non-progressive and augmentation is required is handled with respect for the dialectical process. Augmentation of labour should be managed as close to the course of natural labour and delivery as possible.</p

DYSTOCIA IN NULLIPAROUS WOMEN - Incidence, outcomes, risk indicators, and women’s experiences

Aim: To estimate the incidence of dystocia, to describe outcomes of labour with dystocia and augmentation, to identify anthropometrical-, life style-, obstetric- and clinical risk indicators for dystocia, to elucidate nulliparous women’s experiences of prolonged labours and to describe some aspects of the midwifery care during labour and delivery. Design: A multi-centre cohort study with prospectively collected data within nine obstetric departments in Denmark. Study group: Nulliparous women in term spontaneous labour with a singleton infant in cephalic presentation. Methods: Follow up of 2810 nulliparas using data from self-administered questionnaires supplemented with clinical data-records and interviews with ten mothers post partum, analysed in Grounded Theory. Inclusion: May 2004-July 2005. Findings: The cumulative incidence of dystocia was 37%. The diagnosis was given in 42% of cases in the labour's first stage and in 58% in second stage. Increasing incidence of dystocia was seen with increasing maternal age, lower height and higher BMI. Women with dystocia had more caesarean deliveries, more ventouse, more non-clear amniotic fluid and more post partum haemorrhage than women delivered without dystocia, and their neonates were more often given lower Apgar scores after 1 minute, but not after 5 minutes. Increasing maternal age, small stature ( 4 hours per week appeared ‘protective’ for dystocia whereas intensive physical training was associated with higher risk. The following variables, present at admission to hospital, were associated with dystocia during labour: dilatation of cervix < 4 cm, tense cervix, thick lower segment, fetal head above the inter-spinal diameter, and poor fetal head-to-cervix contact. Birth weight 4000-4499 gr and epidural analgesia were also associated with dystocia. Women with dystocia experienced less midwifery care, less participating in decision making and less presence of the midwife in the delivery room, a conflict between the expectation of having a natural delivery and actually having a medical delivery and a feeling of separation between mind and body. Interacting with the midwife had a major influence on feelings of losing and regaining control. The core category was named Dialectical Birth Process and comprised three categories: Balancing natural and medical delivery, Interacting, Losing and regaining control. Conclusions: A dystocia incidence of 37% in this selected group of term nulliparas with no indication for induction or caesaran delivery contributes to reflection on the need for reconsidering the criteria for diagnosing dystocia and for examining if the negative outcomes are related to the cause of dystocia or to the augmentation. There may be avoidable causes of dystocia opening up avenues for prevention. Having a better understanding of the specific mechanisms between the identified anthropometrical and life style risk indicators and dystocia should however be addressed in future studies. The strongest risk indicator was use of epidural analgesia. Further studies on this exposure are recommended. A dialectical process was identified in the women’s experiences of non-progressive labour. The process was susceptible to interaction with the midwife; especially her support to the woman’s feeling of being in control

Risk indicators for dystocia in low-risk nulliparous women: A study on lifestyle and anthropometrical factors

We examined background information and course of labour from a cohort of 2,810 low-risk nulliparas to identify possible lifestyle and anthropometrical risk indicators for dystocia. Criteria for dystocia: cervical dilatation = 4 h per week appeared protective for dystocia (OR 0.63, CI 0.45-0.89), contrary to a non-significant finding of intensive physical training (OR 1.57, CI 0.84-2.93). Caffeine intake of 200-299 mg/day was associated with dystocia (OR 1.37, CI 1.04-1.80); also high maternal age (OR 2.25, CI 1.58-3.22), small stature (OR 2.18, CI 1.51-3.15) and pre-pregnancy overweight (OR 1.28, CI 1.02-1.61). No association was found between dystocia and alcohol intake, smoking, night sleep and options for resting during the day