Designing data collection for decision-making: shaping the coastal First Nations regional monitoring system to meet the needs of the Nations

The Coastal First Nations (CFN) Regional Monitoring System (RMS) was redeveloped to support decisions related to threats to ecological and cultural values, resulting from changes to existing and impending resource use on the North and Central Coast of British Columbia. As First Nations reassert their governance authority, participate in shared decision-making with other governments, undertake land and marine use planning, and manage their territories and resources, the need for coordinated regional monitoring efforts are increasingly important. We used a systematic and inclusive strategy to determine a suitable monitoring approach to meet the needs of a diverse group of Nations across a broad geographic region. Linking data collection to decision-making and planning processes was central to our strategy. We began with engaging individuals at each Nation’s resource management office to gain a comprehensive understanding of the monitoring activities undertaken, the data being collected, the data desired, and the way data are used to support decision-making and planning processes. Concurrently, we worked with the member Nations to develop a decision-making framework to identify the monitoring activities best suited for the RMS based on the goals of the system. Applying the framework to the suite of monitoring activities being undertaken or desired resulted in a suite of monitoring activities that was further refined in a workshop with the Nations. We produced monitoring cards for each monitoring activity, which detail the monitoring research question(s), the data to collect, the sampling design and data collection protocols, and the decision-making and planning processes the data support. The RMS is designed to be adaptable as new priorities emerge. It is the only system of its kind on the coast of British Columbia, and it is increasingly looked to as a model for how First Nations-led monitoring programs can inform planning and decision-making processes

Media Representations of Breech Birth: A Prospective Analysis of Web-Based News Reports

© 2017 by the American College of Nurse-Midwives Introduction: Recent research has demonstrated that the media presentation of childbirth is highly medicalized, often portraying birth as risky and dramatic. Media representation of breech presentation and birth is unexplored in this context. This study aimed to explore the content and tone of news media reports relating to breech presentation and breech birth. Methods: Google alerts were created using the terms breech and breech birth in online English-language news sites over a 3-year period from January 1, 2013, to December 31, 2015. Alerts were received daily and filed for analysis, and data were analyzed to generate themes. Results: A total of 138 web-based news reports were gathered from 9 countries. Five themes that arose from the data included the problem of breech presentation, the high drama of vaginal breech birth, the safe option of cesarean birth versus dangers of vaginal breech birth, the defiant mother versus the saintly mother, and vaginal breech birth and medical misadventure. Discussion: Media reports in this study predominantly demonstrated negative views toward breech presentation and vaginal breech birth. Cesarean birth was portrayed as the safe option for breech birth, while vaginal breech birth was associated with poor outcomes. Media presentations may impact decision making about mode of birth for pregnant women with a breech fetus. Health care providers can play an important role in balancing the media depiction of planned vaginal breech birth by providing nonjudgmental, evidence-based information to such women to facilitate informed decision making for birth

Birth and the Bush: Untangling the Debate Around Women\u27s Pubic Hair

When Andrew Kotaska asked Birth readers if they recalled “the days of physician-dictated obstetrical care” [1] that resulted in perineal shaves, he invited us to celebrate the end of dogma-driven medical practice and the dawning of a new era of evidence-based, patient-centered care. Diony Young, too, reminded us of the “unnecessary indignities of the day” that resulted in her “partial shave (with a very blunt razor)” [2] almost five decades ago as a way to mark just how far we have come in women-centered birth care. The practice of pre-labor perineal shaving has indeed become emblematic of all that was wrong with mid-20th-century birth, and its demise is a continued testament to the power of birth activism. With the right to pubic hair so ardently fought for just decades ago, how do we make sense of women\u27s decisions to increasingly be shaved, waxed, or otherwise depilated when giving birth today

Expertise in physiological breech birth: A mixed-methods study

Background The safety of vaginal breech birth depends on the expertise of birth attendants, yet the meaning of “expertise” remains unclear and subjectively defined. The objective of this study was to define expertise and the roles experts may play in expanding access to this service. Methods We performed an integrative analysis of two strands of data concerning expertise in physiological breech birth, including the following: survey data from a Delphi study involving 26 very experienced clinicians (mean experience = 135 breech births) and 2 service user representatives, and interviews from a grounded theory study of 14 clinicians more moderately experienced with physiological methods (5-30 upright breech births). Data were pooled and analyzed using constant comparative methods. Results Expertise is defined by its ongoing function, the generation of comparatively good outcomes, and confidence and competence among colleagues. Although clinical experience is important, expertise is developed and expressed in social clinical roles, which expand as experience grows: clinician, mentor, specialist, and expert. To develop expertise within a service, clinicians who have an interest in breech birth should be supported to perform these roles within specialist teams. Conclusions Specialist breech teams may facilitate the development of expertise within maternity care settings. Evaluation of expertise based on enablement of women and colleagues, as well as outcomes, will potentially avoid the pitfalls of alienation produced by some forms of specialist authority

Risk factors associated with adverse perinatal outcome in planned vaginal breech labors at term : a retrospective population-based case-control study

Background: Vaginal breech delivery is associated with adverse perinatal outcome. The aim of this study was to identify factors associated with adverse perinatal outcome in term breech pregnancies, and to provide clinicians an aid in selecting women for a trial of vaginal labor with the fetus in breech position. Methods: We conducted a retrospective, nationwide, Finnish population-based case-control study. All planned singleton vaginal deliveries at term with the fetus in breech position between the years 2005 and 2014 were analyzed. The study's end point was a composite set of adverse perinatal outcomes. All infants with an adverse outcome were compared to the infants with normal outcomes. A multivariate logistic regression model was used to analyze the data. Results: An adverse perinatal outcome was recorded for 73 (1.5%) infants. According to the study results fetal growth restriction (adjusted odds ratio, 2.94; 95% CI, 1.30-6.67), oligohydramnios (adjusted odds ratio, 2.94; 95% CI, 1.15-7.18), a history of cesarean section (adjusted odds ratio, 2.94; 95% CI, 1.28-6.77, gestational diabetes (adjusted odds ratio, 2.89; 95% CI, 1.54-5.40), epidural anesthesia (adjusted odds ratio, 2.20; 95% CI, 1.29-3.75) and nulliparity (adjusted odds ratio, 1.84; 95% CI, 1.10-3.08) were associated with adverse perinatal outcome. Conclusions: Adverse perinatal outcome in planned vaginal breech labor at term is associated with fetal growth restriction, oligohydramnios, previous cesarean delivery, gestational diabetes, nulliparity and epidural anesthesia.Peer reviewe

Norwegian Physicians' Knowledge of and Opinions about Evidence-Based Medicine: Cross-Sectional Study

Objective: To answer five research questions: Do Norwegian physicians know about the three important aspects of EBM? Do they use EBM methods in their clinical practice? What are their attitudes towards EBM? Has EBM in their opinion changed medical practice during the last 10 years? Do they use EBM based information sources? Design: Cross sectional survey in 2006. Setting: Norway. Participants: 966 doctors who responded to a questionnaire (70% response rate). Results: In total 87% of the physicians mentioned the use of randomised clinical trials as a key aspect of EBM, while 53% of them mentioned use of clinical expertise and only 19% patients' values. 40% of the respondents reported that their practice had always been evidence-based. Many respondents experienced difficulties in using EBM principles in their clinical practice because of lack of time and difficulties in searching EBM based literature. 80% agreed that EBM helps physicians towards better practice and 52% that it improves patients' health. As reasons for changes in medical practice 86% of respondents mentioned medical progress, but only 39% EBM. Conclusions: The results of the study indicate that Norwegian physicians have a limited knowledge of the key aspects of EBM but a positive attitude towards the concept. They had limited experience in the practice of EBM and were rather indifferent to the impact of EBM on medical practice. For solving a patient problem, physicians would rather consult a colleague than searching evidence based resources such as the Cochrane Library

Dealing with Missing Outcomes: Lessons from a Randomized Trial of a Prenatal Intervention to Prevent Early Childhood Caries

Severe early childhood caries (S-ECC) affects 17% of 2-3 year old children in South Australia impacting on their general health and well-being. S-ECC is largely preventable by providing mothers with anticipatory guidance. Randomised controlled trials (RCTs) are the most decisive way to test this, but that approach suffers from near inevitable loss to follow-up that occurs with preventative strategies and distant outcome assessment

Authors' reply re: Wide differences in mode of delivery within Europe: risk-stratified analyses of aggregated routine data from the Euro-Peristat study

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageTo use data from routine sources to compare rates of obstetric intervention in Europe both overall and for subgroups at higher risk of intervention.Retrospective analysis of aggregated routine data.Thirty-one European countries or regions contributing data on mode of delivery to the Euro-Peristat project.Births in participating countries in 2010.Countries provided aggregated data about overall rates of obstetric intervention and about caesarean section rates for specified subgroups.Mode of delivery.Rates of caesarean section ranged from 14.8% to 52.2% of all births and rates of instrumental vaginal delivery ranged from 0.5% to 16.4%. Overall, there was no association between rates of instrumental vaginal delivery and rates of caesarean section, but similarities were observed between some countries that are geographically close and may share common traditions of practice. Associations were observed between caesarean section rates for women with breech and vertex births and with singleton and multiple births but patterns of association for women who had and had not had previous caesarean sections were more complex.The persisting wide variations in caesarean section and instrumental vaginal delivery rates point to a lack of consensus about practice and raise questions for further investigation. Further research is needed to explore the impact of differences in clinical guidelines, healthcare systems and their financing and parents' and professionals' attitudes to care at delivery.info:eu-repo/grantAgreement/EC/FP7/2010130