Perceptions of labour pain management of Dutch primary care midwives : a focus group study

Background: Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour. Methods: We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management. Results: We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role. Conclusion: Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity

Satisfaction with caregivers during labour among low risk women in the Netherlands : the association with planned place of birth and transfer of care during labour

Background: The caregiver has an important influence on women's birth experiences. When transfer of care during labour is necessary, care is handed over from one caregiver to the other, and this might influence satisfaction with care. It is speculated that satisfaction with care is affected in particular for women who need to be transferred from home to hospital. We examined the level of satisfaction with the caregiver among women with planned home versus planned hospital birth in midwife-led care. Methods: We used data from the prospective multicentre DELIVER (Data EersteLIjns VERloskunde) cohort-study, conducted in 2009 and 2010 in the Netherlands. Women filled in a postpartum questionnaire which contained elements of the Consumer Quality index. This instrument measures 'general rate of satisfaction with the caregiver' (scale from 1 to 10, with cut-off of below 9) and 'quality of treatment by the caregiver' (containing 7 items on a 4 point Likert scale, with cut-off of mean of 4 or lower). Results: Women who planned a home birth (n = 1372) significantly more often rated 'quality of treatment by caregiver' high than women who planned a hospital birth (n = 829). Primiparous women who planned a home birth significantly more often had a high rate (9 or 10) for 'general satisfaction with caregiver' (adj.OR 1.48; 95% CI 1.1, 2.0). Also, primiparous women who planned a home birth and had care transferred during labour (331/553; 60%) significantly more often had a high rate (9 or 10) for 'general satisfaction' compared to those who planned a hospital birth and who had care transferred (1.44; 1.0-2.1). Furthermore, they significantly more often rated 'quality of treatment by caregiver' high, than 276/414 (67%) primiparous women who planned a hospital birth and who had care transferred (1.65; 1.2-2.3). No differences were observed for multiparous women who had planned home or hospital birth and who had care transferred. Conclusions: Planning home birth is associated to a good experience of quality of care by the caregiver. Transferred planned home birth compared to a transferred planned hospital birth does not lead to a more negative experience of care received from the caregiver

CIVIL JURISDICTION, INTELLECTUAL PROPERTY AND THE INTERNET

At the core of the civil litigation system is the notion of jurisdiction. In a narrow sense it refers to whether a court has the authority to hear a case in relation to specific people and activities (subject matter) but in a broader sense it also encompasses what law should be applied (choice of law), whether the court is a suitable court to hear the case (choice of court) and the enforcement of judgements. The notion of jurisdiction provides a tool for efficiently managing litigation and traditionally has been based upon notions of connection to a particular territory. In the global transnational world of the Internet the concept of jurisdiction has struggled to find a sensible meaning.1 Does jurisdiction lie everywhere that the Internet runs or is it more narrowly defined? In this chapter we examine recent cases concerning jurisdiction and the Internet before the courts of the People’s Republic of China (PRC) in matters relating to intellectual property. We also consider decisions in Australia and the United States of America (US) and international developments in the area

Maternal Prenatal Distress, Maternal Pre- and Postnatal Bonding and Behavioral and Emotional Problems in Toddlers. A Secondary Analysis of the IRIS Study

Maternal prenatal distress (i.e., anxiety and depressive symptoms) increases the risk for childhood behavioral and emotional problems. So far, the potential role of maternal bonding in this association still needs further study. Maternal prenatal distress can affect the development of maternal bonding from pregnancy onwards. Maternal prenatal and postnatal bonding in turn have been shown to predict child behavioral functioning. We aimed to investigate whether maternal prenatal and postnatal bonding mediate the association between maternal prenatal distress and toddlers’ internalizing and externalizing problems. Data from a Dutch prospective longitudinal sample (N = 666) were used to conduct single and multiple mediation models. Mothers reported prenatal anxiety (State Anxiety Inventory) and prenatal depressive symptoms (Edinburgh Postnatal Depression Scale) at 24 weeks’ gestation and maternal prenatal bonding (Maternal Antenatal Attachment Scale) at 32 weeks’ gestation. At 6 weeks and 6 months postpartum mothers completed questionnaires to assess maternal postnatal bonding (Maternal Postnatal Attachment Scale). Mothers reported child internalizing and externalizing problems (Child Behavior Checklist) at 28 months postpartum. Maternal prenatal and postnatal bonding mediated the link between maternal prenatal anxiety and child externalizing problems but not internalizing problems. Only maternal bonding 6 months postpartum mediated the link between maternal prenatal depressive symptoms and child internalizing problems but not externalizing problems. Our study showed that maternal postnatal bonding more consistently mediated links between measures of maternal prenatal distress and child behavioral and emotional problems than maternal prenatal bonding. Interventions reducing maternal prenatal distress and promoting maternal bonding should be developed.</p

Maternal Prenatal Distress, Maternal Pre- and Postnatal Bonding and Behavioral and Emotional Problems in Toddlers. A Secondary Analysis of the IRIS Study

Maternal prenatal distress (i.e., anxiety and depressive symptoms) increases the risk for childhood behavioral and emotional problems. So far, the potential role of maternal bonding in this association still needs further study. Maternal prenatal distress can affect the development of maternal bonding from pregnancy onwards. Maternal prenatal and postnatal bonding in turn have been shown to predict child behavioral functioning. We aimed to investigate whether maternal prenatal and postnatal bonding mediate the association between maternal prenatal distress and toddlers’ internalizing and externalizing problems. Data from a Dutch prospective longitudinal sample (N = 666) were used to conduct single and multiple mediation models. Mothers reported prenatal anxiety (State Anxiety Inventory) and prenatal depressive symptoms (Edinburgh Postnatal Depression Scale) at 24 weeks’ gestation and maternal prenatal bonding (Maternal Antenatal Attachment Scale) at 32 weeks’ gestation. At 6 weeks and 6 months postpartum mothers completed questionnaires to assess maternal postnatal bonding (Maternal Postnatal Attachment Scale). Mothers reported child internalizing and externalizing problems (Child Behavior Checklist) at 28 months postpartum. Maternal prenatal and postnatal bonding mediated the link between maternal prenatal anxiety and child externalizing problems but not internalizing problems. Only maternal bonding 6 months postpartum mediated the link between maternal prenatal depressive symptoms and child internalizing problems but not externalizing problems. Our study showed that maternal postnatal bonding more consistently mediated links between measures of maternal prenatal distress and child behavioral and emotional problems than maternal prenatal bonding. Interventions reducing maternal prenatal distress and promoting maternal bonding should be developed.</p

Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women : a cohort study in the Netherlands

Background: The use of interventions in childbirth has increased the past decades. There is concern that some women might receive more interventions than they really need. For low-risk women, midwife-led birth settings may be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place of birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in obstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in midwife-led care. Methods: Women from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495 were low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and outcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation, episiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the national midwife-led care perinatal database, and a postpartum questionnaire. Results: Women who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI 1.08-1.76, parous women aOR 2.29, 95 % CI 1.21-4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58-0.91, parous women aOR 0.47, 0.33-0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42-0.80, parous women aOR 0.47, 0.37-0.60) compared to women who planned hospital birth. Nulliparous women more often had anal sphincter damage (aOR 1.75, 1.01-3.03), but the difference was not statistically significant if women who had caesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36-0.82) and more often an intact perineum (aOR 1.65, 1.34-2.03). There were no differences in rates of vacuum/forceps birth, unplanned caesarean section and postpartum haemorrhage >1000 ml. Conclusions: Women who planned home birth were more likely to give birth spontaneously and had fewer medical interventions. © 2016 The Author(s)