Women’s, partners’ and healthcare providers’ views and experiences of assisted vaginal birth: a systematic mixed methods review

Background When certain complications arise during the second stage of labour, assisted vaginal delivery (AVD), a vaginal birth with forceps or vacuum extractor, can effectively improve outcomes by ending prolonged labour or by ensuring rapid birth in response to maternal or fetal compromise. In recent decades, the use of AVD has decreased in many settings in favour of caesarean section (CS). This review aimed to improve understanding of experiences, barriers and facilitators for AVD use. Methods Systematic searches of eight databases using predefined search terms to identify studies reporting views and experiences of maternity service users, their partners, health care providers, policymakers, and funders in relation to AVD. Relevant studies were assessed for methodological quality. Qualitative findings were synthesised using a meta-ethnographic approach. Confidence in review findings was assessed using GRADE CERQual. Findings from quantitative studies were synthesised narratively and assessed using an adaptation of CERQual. Qualitative and quantitative review findings were triangulated using a convergence coding matrix. Results Forty-two studies (published 1985–2019) were included: six qualitative, one mixed-method and 35 quantitative. Thirty-five were from high-income countries, and seven from LMIC settings. Confidence in the findings was moderate or low. Spontaneous vaginal birth was most likely to be associated with positive short and long-term outcomes, and emergency CS least likely. Views and experiences of AVD tended to fall somewhere between these two extremes. Where indicated, AVD can be an effective, acceptable alternative to caesarean section. There was agreement or partial agreement across qualitative studies and surveys that the experience of AVD is impacted by the unexpected nature of events and, particularly in high-income settings, unmet expectations. Positive relationships, good communication, involvement in decision-making, and (believing in) the reason for intervention were important mediators of birth experience. Professional attitudes and skills (development) were simultaneously barriers and facilitators of AVD in quantitative studies. Conclusions Information, positive interaction and communication with providers and respectful care are facilitators for acceptance of AVD. Barriers include lack of training and skills for decision-making and use of instruments

A survey of Australian sonographer psychomotor teaching practices

Objective: To report on the findings of a survey of sonographer skill-teaching practices in Australia using the SonoSTePs tool. Method: A cross-sectional survey of all qualified sonographers registered with the Australian Sonographer Accreditation Registry. Results: The 528 responses showed the use of a two-step skill-teaching approach to teach scanning skills and the incorporation of additional instructional practices to support a learner’s initial acquisition of scanning skills, which include: providing coaching and guidance as the skill is practised; performing physical guidance; providing immediate error correction; and providing end-task feedback. Based on our findings, sonographer skill-teaching practices fall short of best pedagogical approaches. Conclusion: There is a pressing need to identify the optimal pedagogical approaches to teach complex psychomotor scanning skills. Research is required to ensure that the scanning skills are taught efficiently and that the pedagogical approaches to teach scanning skills foster the learner’s long-term retention of the skill. There is also an accompanying need for sonographers involved in teaching scanning skills to have knowledge of the motor-learning theories and principles related to teaching a complex psychomotor skill

A modified early obstetric warning system

Early warning scoring tools are embedded in the routine care of most hospitalised patients in the NHS. The underlying principles are that patients who develop serious illness will usually display abnormalities in simple physiological parameters and that if these early signs are recognised and appropriate escalation and intervention occurs., patient outcomes will be improved. Constructing a system for use in childbearing women presents a unique set of challenges. This article details how the national early warning scoring system can be adapted and used in the routine care of hospitalised pregnant and postnatal women