Using a birth ball in the latent phase of labour to reduce pain perception; a randomised controlled trial.

Hospital admission in the latent phase of labour is associated with higher rates of obstetric intervention, with increased maternal and fetal morbidity. Women sent home from hospital in the latent phase to 'await events' feel anxious and cite pain as their main drive to seeking hospital admission. Using a birth ball to assume upright positions and remain mobile in the latent phase of labour in hospital is associated with less pain and anxiety. However, no research has examined the effect of using birth balls at home in the latent phase on pain perception, hospital admission or obstetric intervention. An animated infomercial was developed to promote birth ball use at home in the latent phase of labour to enhance women's self-efficacy, in order to reduce their pain perception. As a pragmatic randomised controlled single centre trial, 294 low risk women were randomly allocated to two groups. At 36 weeks’ gestation the Intervention Arm accessed the infomercial online and completed a modified Childbirth Self- Efficacy Inventory before and after viewing. They were also offered the loan of a birth ball to use at home. The Control Arm received standard care. On admission to hospital in spontaneous labour, all participants were asked to provide a Visual Analogue Scale score. Both groups were followed up six weeks postpartum with an online questionnaire. Data were analysed on an Intention To Treat basis. A significant increase was found in Outcome Expectancy and Self-efficacy Expectancy after accessing the infomercial and Intervention Arm participants were more likely to be admitted in active labour. No significant differences were found between the VAS scores, or intervention rates. Most respondents (89.2%) described the birth ball as helpful and reported high satisfaction, with comfort, empowerment and progress. The birth ball is a promising intervention to support women in the latent phase. Further research should consider a randomised cluster design

How are fitness to practise processes applied in UK higher education institutions? - A systematic review.

AIM: This systematic review will establish how Fitness to Practise (FtP) processes are applied in UK Higher Education Institutions (HEI), in relation to both Health and Care Profession Council or Nursing and Midwifery Council approved programmes. BACKGROUND: Healthcare students are required to complete both practice and theory elements, in order to gain their degree and qualify as a healthcare practitioner such as a nurse. It is a requirement of UK HEIs which provide healthcare programmes, to provide evidence to the appropriate regulatory body that FtP policies and processes are in place, and that they review and manage any concerns in relation to a student's standard of practice. Regulatory bodies provide HEIs with strategic guidance on policy which can be interpreted and incorporated into existing policies; this means that there is no standard approach to the FtP process in HEI settings, allowing individual policies and procedures to exist. DESIGN: A systematic review, registered on PROSPERO (CRD42022291532 on the 21st January 2022). DATA SOURCES: Peer reviewed studies published in ten databases were used which included: Medline, Cochrane Library, PubMed, ScienceDirect, Education Source, PsycInfo and Cumulative Index of Nursing and Allied Health Literature (CINAHL) Complete. Citation searching also occurred. REVIEW METHODS: This systematic review utilised Preferred Reporting items for Systematic reviews and Meta-Analysis (PRISMA) techniques. The Critical Appraisal Skills Programme (CASP) checklists were used to appraise the quality of the research. RESULTS: In total twenty-five articles were retrieved including five papers that were finally selected for review. A thematic analysis identified three themes: a lack of identification of what FtP expectations are; the importance of collaborative working between Higher Education Institutions and practice; the inconsistencies with Higher Education Institution processes in managing FtP concerns. CONCLUSIONS: A lack of understanding of what FtP expectations are for students was identified. Collaborative working between Higher Education Institutions and practice is necessary to ensure healthcare students meet FtP requirements consistently in order to protect the public. Although HEIs FtP processes contain similar principles, it has been identified that there are inconsistencies in this process across universities in the UK. These differences include: what initiates the FtP process, to the outcomes. This could have an impact on patient care and safety, the need for review of national guidance, and potential amendments being required to the policies and procedures of both NHS Trusts and private organisations

Using a birth ball to reduce pain perception in the latent phase of labour: a randomised controlled trial.

BACKGROUND: Admission in the latent phase of labour is associated with higher rates of obstetric intervention. Women are frequently admitted due to pain. This study aimed to determine whether using a birth ball at home in the latent phase of labour reduces pain perception on admission. METHOD: A prospective, pragmatic randomised controlled trial of 294 low risk pregnant women aged 18 and over planning a hospital birth. An animated educational video was offered at 36 weeks' gestation along with a birth ball. The primary outcome was pain on a Visual Analogue Scale on admission in labour. Participants who experienced a spontaneous labour were invited to respond to an online questionnaire 6 weeks' postpartum. RESULTS: There were no differences in the mean pain scores; (6.3 versus 6.5; 90%CI -0.72 to 0.37 p = 0.6) or mean cervical dilatation on admission (4.7 cm versus 5.0 cm; 95% CI -1.1 to 0.5 p = 0.58). More Intervention participants were admitted in active labour (63.6% versus 55.7%; p = 0.28) and experienced an unassisted vaginal birth (70.3% v. 65.8%; p = 0.07) with fewer intrapartum caesarean sections (7.5% v. 17.9%; p = 0.07) although the trial was not powered to detect these differences in secondary outcomes. Most participants found the birth ball helpful (89.2%) and would use it in a future labour (92.5%). CONCLUSION: Using the birth ball at home in the latent phase is a safe and acceptable strategy for labouring women to manage their labour, potentially postpone admission and reduce caesarean section. Further research is warranted

What information is available to women regarding coronavirus and childbirth in Italy? A mixed-methods exploration of the web during the COVID-19 lockdown

Problem: The world is fighting against the COVID-19 pandemic and an infodemic; Italy is one of the most severely affected countries. Background: The internet represents a popular source of health information. In Italy, its use amongst pregnant women and new mothers has increased during the lockdown. No research has examined the nationally accessible information related to childbirth in these unprecedented circumstances. Aim: To explore online information accessible to Italian users concerning childbirth and coronavirus-related issues. Methods: A mixed methods exploration of the web was conducted involving searches on Google, peer discussion forums and midwifery association webpages. Data were analysed both quantitatively and qualitatively. A cross-consultation analysis of themes was performed to identify macro categories of information. Findings: A total of 720 results from free searches, 635 interventions from 97 forums and 68 posts from four midwifery association webpages were analysed. Informative/divulging sources were the most prevalent in Google; pregnancy-related topics appeared more in discussion forums and midwifery association webpages. ‘Prevention’; ‘risks and outcomes’; ‘users’ experiences’ and ‘reorganisation of maternity services’ represent the cross-consultation categories of information. Discussion: Google emerges as the main contributor to the infodemic; national systems of alert and ranking of web sources are needed. Women’s pragmatic needs are more likely to be addressed by peer-discussion forums and midwifery association webpages during and after COVID-19. Conclusion: This is the first study to investigate childbirth-related web information during COVID-19 in Italy; findings may impact on education, research and practice

The importance of pain histories for latent phase labour

Latent phase labour has been identified as a challenging time for women (Cheyne et al 2007, Barnett et al 2008, Hundley et al 2020) and midwives (Cheyne & Hundley 2009, Hanley et al 2016). A key question is how best to support women during this period without increasing their risk of unnecessary interventions; managing labour pain is an important aspect. In this paper we suggest that midwives can draw on lessons from the field of musculoskeletal conditions, where it is well-acknowledged that there are multiple factors that contribute to constructing perceptions of chronic or long-term pain across the lifespan. We draw on knowledge around a woman’s previous pain experiences and how this may contribute to perceptions of labour pain. We propose that midwives have an early discussion with women about their previous pain experiences. This paper is presented as one of two papers aimed at ‘unpicking’ elements of pain perception in labour