Alternative versus conventional institutional settings for birth

Background: Alternative institutional settings have been established for the care of pregnant women who prefer and require little or no medical intervention. The settings may offer care throughout pregnancy and birth, or only during labour; they may be part of hospitals or freestanding entities. Specially designed labour rooms include bedroom-like rooms, ambient rooms, and Snoezelen rooms. Objectives: Primary: to assess the effects of care in an alternative institutional birth environment compared to care in a conventional institutional setting. Secondary: to determine if the effects of birth settings are influenced by staffing, architectural features, organizational models or geographical location. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2010). Selection criteria: All randomized or quasi-randomized controlled trials which compared the effects of an alternative institutional maternity care setting to conventional hospital care. Data collection and analysis: We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors evaluated methodological quality. We performed double data entry and have presented results using risk ratios (RR) and 95% confidence intervals (CI). Main results: Nine trials involving 10684 women met the inclusion criteria. We found no trials of freestanding birth centres or Snoezelen rooms. Allocation to an alternative setting increased the likelihood of: no intrapartum analgesia/anaesthesia (five trials, n = 7842; RR 1.17, 95% CI 1.01 to 1.35); spontaneous vaginal birth (eight trials; n = 10,218; RR 1.04, 95% CI 1.02 to 1.06); breastfeeding at six to eight weeks (one trial, n = 1147; RR 1.04, 95% CI 1.02 to 1.06); and very positive views of care (two trials, n = 1207; RR 1.96, 95% CI 1.78 to 2.15). Allocation to an alternative setting decreased the likelihood of epidural analgesia (seven trials, n = 9820; RR 0.82, 95% CI 0.75 to 0.89); oxytocin augmentation of labour (seven trials, n = 10,020; RR 0.78, 95% CI 0.66 to 0.91); and episiotomy (seven trials, n = 9944; RR 0.83, 95% CI 0.77 to 0.90). There was no apparent effect on serious perinatal or maternal morbidity/mortality, other adverse neonatal outcomes, or postpartum hemorrhage. No firm conclusions could be drawn regarding the effects of variations in staffing, organizational models, or architectural characteristics of the alternative settings. Authors' conclusions: When compared to conventional settings, hospital-based alternative birth settings are associated with increased likelihood of spontaneous vaginal birth, reduced medical interventions and increased maternal satisfactio

Emotions and support needs following a distressing birth: Scoping study with pregnant multigravida women in North West England

Objective: To identify the emotional and support needs of pregnant multigravida women who have experienced adverse responses associated with a previous childbirth experience. Setting: Four maternity hospitals in North-West England. Design: 100 surveys were distributed at an anomaly scan clinic in each of four maternity hospitals (total n=400). The survey included an adapted version of a Post-Traumatic Stress Disorder Symptom Scale to explore trauma responses at two broad time points: a) following a previous birth and b) during the current pregnancy. Participants were also asked about the optimal time to receive support post-birth, and the type and provider of support they had accessed/would have liked to access. Descriptive and inferential statistics were undertaken on the quantitative data. The qualitative data was analysed using a basic thematic approach. Participants: Multigravida pregnant women aged 18+ years. Findings: The overall response rate was 28% (n=112); 43% (n=46) of these had experienced negative/trauma responses associated with a previous birth, 74% of whom (n=34) continued/re-experienced adverse responses in their current pregnancy. Most commonly reported trauma responses were difficulties in recalling the previous birth(s), avoiding memories associated with it, and the distress associated with these memories when they were recalled. Approximately 54% (n=25) had received some form of support post-birth, and variations in preferred timing of postnatal support provision were reported. Information on available support and opportunities to discuss the birth with a maternity professional were identified most frequently as preferred support options. Conclusion & Implications for Practice: Women’s views about what might work should form the basis for effectiveness studies in this area. Among the participants in this study there was evidence of unmet support needs relating to negative or traumatic responses to a previous birth. The range of preferred timing and types of support indicate that flexible needs-based support options should be provided. Further research should assess if these findings are reinforced in a more diverse sample with a higher response rate

Insider Action research as an approach and a method – Exploring institutional encounters from within a birthing context

The aim of this paper was to describe the first person perspective of being a peer midwife and a novice researcher initiating collaborative AR in her own organization to develop knowledge about the first encounters between the labouring woman and her care-givers in a hospital birthing context. It was motivated by the author’s longstanding professional clinical experience of observing and hearing parents’ stories of vulnerability and fear of childbirth, and how staff’s attitudes affected the childbirth experience negatively. Data were collected between 2010 and 2013 and included the researcher’s log with reflections from clinical work, as well as interviews, participant observation, and research group communications. A reflective interpretative lifeworld research approach was used to analyze the data. The experience of being a novice insider action researcher (IARr) consisted of three thematic meanings: ‘‘the struggle to initiate a clinical insider action research project,’’ ‘‘standing alone at the messy front line,’’ and ‘‘being a catalytic counterbalance to the prevailing medico technical focus.’’ The comprehensive understanding was ‘‘learning how to clinically reflect on and to voice the tacit components of care.’’ The strategy used in undertaking this study was influenced by the philosophies of both midwifery care and AR

Investigation of the use of thermography for research and clinical applications in pregnant women

Background: The possibility of using thermal imaging, as a non-invasive method, in medicine may provide potential ability of advanced imaging. Objective: The conduction of a preliminary study in healthy non-pregnant females in order to investigate the imaging ability of thermography and its implementation; and to determine hot and cold areas in order to create a “map” of temperature distribution of the abdomen and the torso. Methods: Participants were 18–45 years old non-pregnant women (n = 10), who were measured at 4 different distances. Two thermal imaging cameras and their corresponding software were used to measure abdomen, low back, left and right side of the torso. Results: There were no statistically significant differences in the mean values of the exported temperatures according the distance and the angle between the camera and the subject. The inferior part of the rectus abdominis muscle recorded the coldest zone and the umbilicus appeared as the most prominent hot spot. Conclusions: Thermography shows to be a potential non-invasive technique offering new options in the evaluation of pregnant and laboring women

COVID-19 and maternal mental health: Are we getting the balance right?

This paper presents a rapid evidence review into the clinical and psychological impacts of COVID-19 on perinatal women and their infants. Literature search revealed that there is very little formal evidence on the impact of COVID-19 on pregnant, labouring and postnatal women or their babies. The clinical evidence to date suggests that pregnant and childbearing women, and their babies are not at increased risk of either getting infected, or of having severe symptoms or consequences than the population as a whole. There is no evidence on the short- and longer-term psychological impacts of restrictive practices or social and personal constraints for childbearing women during COVID-19 in particular, or infection pandemics in general. The potential for adverse mental health consequences of the pandemic should be recognised as a critical public health concern, together with appropriate care and support to prevent and ameliorate any negative impacts

Moral and mental health challenges faced by maternity staff during the COVID-19 pandemic

The current COVID-19 pandemic places maternity staff at risk of engaging in clinical practice that may be in direct contravention with evidence; professional recommendations; or, more profoundly, deeply held ethical or moral beliefs and values, as services attempt to control the risk of cross-infection. Practice changes in some settings include reduction in personal contacts for tests, treatments and antenatal and postnatal care, exclusion of birth partners for labor and birth, separation of mother and baby in the immediate postnatal period, restrictions on breastfeeding, and reduced capacity for hands-on professional labor support through social distancing and use of personal protective equipment. These enforced changes may result in increasing levels of occupational moral injury that need to be addressed at both an organizational and a personal level