Exploring the effects of second stage management from the maternal and midwifery perspectives: are there any benefits to directing women?

Background: The management of second stage varies considerably, with directed pushing, by recourse to Valsalva Technique or a variation of this, being frequently utilised as a replacement for progression through spontaneous maternal effort. The evidence for directed management versus spontaneous is unclear. Objectives: This review aims to consider the effects of directed pushing on maternal perspectives of second stage management and to assess midwives’ attitudes in relation to this in direct comparison to how spontaneous pushing affects the above measures. The effects on maternal and fetal outcomes of such practice are also evaluated. Search Methods: The electronic databases MIDIRS Research Database, CINAHL, Wiley Online, Cochrane Library, PubMed, NHS Evidence and Google Scholar were searched. Additionally reference list, author and hand searches were completed. No restrictions were placed on parity, age or gestation of the women although all selected studies comprised women of 37-42 weeks gestation. English language studies only were accessed. Epidural usage was excluded. Selection Criteria and Data Collection: RCTs and non-randomised qualitative literature was accessed to gain statistically comparative data and understanding of maternal perspectives and midwifery practice and attitudes. Outcome measures relating to maternal perspectives, midwives’ behaviours, length of second stage, mode of delivery, APGARs, cord blood pH and base excess and perineal trauma were assessed. Main Results: Eleven studies were included. One study observed a statistically significant increase in length of second stage with spontaneous pushing (t = 3.455, p < 0.002), another study contradicted this finding it to be shorter with spontaneous effort (t = 2.028, p < 0.05). Two studies demonstrated a reduction in instrumental deliveries with spontaneous pushing. No other statistically significant differences were discovered in maternal outcomes. One study found a statistically significant increased risk of fetal acidosis related to Valsalva pushing (r = 0.040, p = 0.020). Maternal satisfaction was demonstrated to be increased by midwifery support of spontaneous effort; disempowerment was observed when unsolicited direction was given. Midwives felt they provided such support (82.4%); observation of practice supported this in one study but contradicted this in two studies. Conclusion: The evidence of this review does not support the practice of directed pushing, as it does not appear to confer any tangible benefits to mother or infant and has a negative effect on the autonomy of women. The evidence is limited and recommendations are made for further research. At present, the practice should be discouraged and women should be supported to choose their own method. N.B. The care givers involved include midwives and nurse-midwives dependent on geographical location of the study; for the purposes of clarity in this review they are categorised as midwives

"It was like being torn apart". The experiences of young men who become fathers while at school. A critical interpretive analysis of discourses of Young Fatherhood.

This is an exploratory study that reports the experiences of a sample of five participants, young men who became fathers while still at school. I talked to these young men about their personal stories which relate their personal introspection on interactions with institutions and relationships with people in their lives, set within a socially constructed reality that positions young men who become fathers in a certain way. Discourse and hegemony are collaborative constructive processes that shape and sculpt the conditions of the lives of everyone and it is the intention of this study to illuminate the workings of particular discourses in the context of these young men’s lives. This research is interested in how or whether the assumptions underpinning the socially dominating discourses of youth, gender, marriage and family were reflected in the participants’ experiences. The study aims to critique this social situation, which assumes immaturity when it comes to the experiences of young men who father children while still at school. The invisibility of these young men’s experiences in the current research literature as well as in society generally, except in pejorative ways, brings focus upon both the research landscape and the lens that is being looked through. It is not the intention of this research to make sweeping statements or to pretend that the findings of the study represent the findings of all who have an experience similar to the participants’. What this enquiry does intend to achieve is to bring alive the humanity of five personal stories of real people and shed light on the processes that played a part in their construction. The importance of the research is to gain a greater understanding of and insight into the experiences of these young men and what the reality is for them as they see it

Acceptability of a Parental Early Warning Tool: Outcomes from a Feasibility Study of Parental Home Monitoring and Assessment

Aim: to explore the feasibility and acceptability of a Congenital Heart Assessment Tool (CHAT) as part of a home monitoring programme (HMP) for parents going home with their infant between stage 1 & 2 surgery for complex CHD. Background: HMPs were developed to encourage early recognition of deterioration in infants at risk of potentially life threatening events between stage 1 & 2. In this study, the HMP was compared with the CHAT, a traffic light system enabling assessment of the infant’s condition through individualised parameters. Method: A mixed methods approach including: data collected at four time points: at discharge [T0]; 2 weeks after [T1], 8 weeks after [T2] & after stage 2 surgery [T3] using self-report tools, interviews & daily diaries. Parents were recruited between August 2013 & February 2015 & randomised to either Gp A: HMP & CHAT; Gp B: CHAT or Gp C: standard discharge care. Results: 13 mothers, 4 fathers of 13 infants consented (A =5; B =4; C =4). The time period T0 to T3 ranged from 62-228 days; all infants survived stage 1 & 2 of surgery. The qualitative data set included 38 interviews. Four themes emerged regarding the CHAT: prepared parents for the signs to look for at home; easy to use; increased parental confidence & gave them reassurance to call for advice when something was different. Themes emerging regarding the HMP: parents felt daily wt. were not needed; the scales were ‘a hindrance more than helpful’, SpO2 was more reassuring. Gp C parents described normalisation of going home & recognition that the HMP may have made them more reliant & anxious. Only 2 diaries were completed; CHAT amber triggers (n=7 occasions, no admissions); red triggers & drop in SpO2 (n=1, 1 local hospital readmission); calls to ward staff (n=13); other contact with HCP (n=7) no contacts were cardiac in origin. Conclusions: The CHAT gave parents confidence regarding changes in their infant’s condition. No early admissions for stage 2 based on trigger of CHAT or HMP

Psychosocial Adjustment and Adaptation in Parents of Infants with Complex Congenital Heart Disease Going Home for the First Time Following First Stage Cardiac Surgery: A Prospective Review

Aim: The study presented here prospectively explored psychosocial adaptation and adjustment (anxiety, depression & confidence) in parents going home for the first time with their infants following first stage cardiac surgery for complex congenital heart disease (CHD). Method: 17 parents (13 mothers, 4 fathers) of infants (n=13) being discharged from a specialist cardiac centre in the UK were recruited into a mixed methods feasibility study, from August 2013 until September 2015. Parents were randomised into either: Group A: home monitoring using weighing scales, an oxygen saturation monitor and a Congenital Heart Assessment Tool (CHAT); Group B: the CHAT tool only, or Group C: standard discharge care. Parents were interviewed at 4 time points: T0 before discharge, T1 2 weeks post discharge, T2 8 weeks post discharge and T3 after stage 2 surgery. Baseline demographic data was collected at T0 and parents completed PHQ9, GAD7 and Maternal Confidence score (MCS) at each interview. Results: A fear response was evident in all interviews at T0; 3 mothers and 1 father displayed signs of post-traumatic stress disorder at T0. Mean GAD7 scores were significantly higher before discharge (T0) compared to T3 (p<0.01, d=0.77). There was no significant difference in scores whilst the parents were at home with their infant (T1, T2). Mean PHQ9 scores were significantly higher at T0 than at T1 (p<0.01, d=1.03); T2 (p<0.05, d=0.87); T3 (p<0.01, d=1.1). Mean MCS were significantly higher at T1 (p<0.01, d=1.1), T2 (p<0.01, d=1.3), T3 (p<0.0005, d=1.6) than at T0. Conclusion: Signs of acute stress disorder: anxiety, depression, shock were evident in all interviews at T0. 4 parents showed signs of PTSD however these symptoms decreased over time as their confidence increased. Despite the small number of families recruited into the study, the results provide an important insight into the psychosocial support that parents require between stage 1 and 2 of their infants’ cardiac surgery

Effects of etelcalcetide on fibroblast growth factor 23 in patients with secondary hyperparathyroidism receiving hemodialysis

Background: Etelcalcetide is an intravenous calcimimetic approved for treatment of secondary hyperparathyroidism (sHPT) in patients receiving hemodialysis. Besides lowering parathyroid hormone (PTH), etelcalcetide also significantly reduces fibroblast growth factor 23 (FGF23), but the mechanisms are unknown. Methods: To investigate potential mediators of etelcalcetide-induced FGF23 reduction, we performed secondary analyses of the 26-week randomized trials that compared the effects on PTH of etelcalcetide (n = 509) versus placebo (n = 514) and etelcalcetide (n = 340) versus cinacalcet (n = 343) in adults with sHPT receiving hemodialysis. We analyzed changes in FGF23 in relation to changes in PTH, calcium, phosphate and bone turnover markers. We also investigated how concomitant treatments aimed at mitigating hypocalcemia altered the FGF23-lowering effects of etelcalcetide. Results: Etelcalcetide reduced FGF23 [median % change (quartile 1-quartile 3)] from baseline to the end of the trial significantly more than placebo [-56% (-85 to -7) versus +2% (-40 to +65); P < 0.001] and cinacalcet [-68% (-87 to -26) versus -41% (-76 to +25); P < 0.001]. Reductions in FGF23 correlated strongly with reductions in calcium and phosphate, but not with PTH; correlations with bone turnover markers were inconsistent and of borderline significance. Increases in concomitant vitamin D administration partially attenuated the FGF23-lowering effect of etelcalcetide, but increased dialysate calcium concentration versus no increase and increased dose of calcium supplementation versus no increase did not attenuate the FGF23-lowering effects of etelcalcetide. Conclusion: These data suggest that etelcalcetide potently lowers FGF23 in patients with sHPT receiving hemodialysis and that the effect remains detectable among patients who receive concomitant treatments aimed at mitigating treatment-associated decreases in serum calcium

GrOW National Study of Grandfamilies During COVID-19: Wave I and Wave II Results and Recommendations

The COVID-19 pandemic has impacted families across the globe. This study highlights how a multidisciplinary workgroup, Grandfamilies Outcome Workgroup (GrOW) operationalized a caregiver-centered data cycle to learn how COVID-19 has impacted grandfamilies across the United States. The National Grandfamilies and COVID-19 Wave I (n=600, June 2020) and Wave II (n=225, July 2021) surveys recruited grandfamilies nationwide through GrOW’s network of kinship community partners. Wave I survey results illuminated that all sources of social support were reduced for grandfamilies during the pandemic, except for online support groups. Wave II provided an opportunity to revise the survey to capture emergent issues relevant to a later stage of the pandemic for grandfamilies. Results indicated that 73% of caregivers were vaccinated. Results also identified gaps in caregiver knowledge of kinship navigator programs and supports in their communities. Recommendations for future research are provided. Keywords Kinship, COVID-19, Grandfamilies’ Outcome Workgroup, Culturally Responsive Research, Translational Disseminatio

Complete genome sequences of Campylobacter jejuni strains RM3196 (233.94) and RM3197 (308.95) isolated from patients with Guillain-Barré syndrome

Infections with Campylobacter jejuni subsp. jejuni are a leading cause of foodborne gastroenteritis and the most prevalent infection preceding Guillain-Barré syndrome (GBS). This study describes the genomes of C. jejuni subsp. jejuni HS:41 strains RM3196 (233.94) and RM3197 (308.95) that were isolated from patients with GBS in Cape Town, South Africa

Managed moves: schools collaborating for collective gain

Government guidance in the United Kingdom encourages groups of schools to take collective responsibility for supporting and making provision for excluded pupils and those at risk of exclusion. Managed-moves are one way that some schools and authorities are enacting such guidance. This paper presents the results of an evaluation of one such scheme. The scheme, involving seven neighbouring secondary schools, was nearing its first year of completion. The paper draws primarily on interview data with pupils, parents and school staff to describe a number of positive outcomes associated with the scheme and to explore how these were achieved. We found that while some of these could be attributed directly to the managed-move, others arose from the more inclusive ethos and practices of particular schools. The concepts of tailored support, care and commitment emerged as strong themes that underpinned the various practical ways in which some schools in the cluster were able to re-engage 'at-risk' pupils. As managed moves become more widely practiced it will be important to remember that it is how the move proceeds and develops rather than the move itself that will ultimately make the difference for troubled and troublesome pupils