Birth-Issues in Perinatal Care最新文献

{"title":"Physiological plateaus during normal labor and birth: A novel definition","authors":"Marina Weckend RM, MSc, PhD,&nbsp;Kylie McCullough RN, BSc(hons), Grad Cert Remote Health, PhD,&nbsp;Christine Duffield RN, BScN, MHP, PhD,&nbsp;Sara Bayes RM, RN, Dip HE (Adult Nursing), PG Dip (Midwifery), MMid, PhD,&nbsp;Clare Davison RM, RN, PG Dip (Midwifery), MPhil, PhD","doi":"10.1111/birt.12843","DOIUrl":"10.1111/birt.12843","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Diagnoses of labor dystocia, and subsequent labor augmentation, make one of the biggest contributions to childbirth medicalization, which remains a key challenge in contemporary maternity care. However, labor dystocia is poorly defined, and the antithetical concept of physiological plateaus remains insufficiently explored.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aim</h3>\u0000 \u0000 <p>To generate a definition of physiological plateaus as a basis for further research.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This qualitative study applied grounded theory methods and comprised interviews with 20 midwives across Australia, conducted between September 2020 and February 2022. Data were coded in a three-phase approach, starting with inductive line-by-line coding, which generated themes and subthemes, and finally, through axial coding.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Physiological plateaus represent a temporary slowing of one or multiple labor processes and appear to be common during childbirth. They are reported throughout the entire continuum of labor, typically lasting between a few minutes to several hours. Their etiology/function appears to be a self-regulatory mechanism of the mother-infant dyad. Physiological plateaus typically self-resolve and are followed by a self-resumption of labor. Women with physiological plateaus during labor appear to experience positive birth outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Despite appearing to be common, physiological plateaus are insufficiently recognized in contemporary childbirth discourse. Consequently, there seems to be a significant risk of misinterpretation of physiological plateaus as labor dystocia. While findings are limited by the qualitative design and require validation through further quantitative research, the proposed novel definition provides an important starting point for further investigation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>A better understanding of physiological plateaus holds the potential for a de-medicalization of childbirth through preventing unjustified labor augmentation.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 1","pages":"55-65"},"PeriodicalIF":2.8,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12843","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Parent-identified gaps in preparation for the postpartum period in the United States: An integrative review","authors":"Danielle N. Nazarenko MSN, CNM, IBCLC,&nbsp;Ariel L. Daniel MSN, RN, FNP-BC,&nbsp;Stephanie Durfee MSNed, RNC, C-EFM,&nbsp;Kafuli Agbemenu PhD, MPH, RN, CTN-A","doi":"10.1111/birt.12832","DOIUrl":"10.1111/birt.12832","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>In the United States, 35% of all pregnancy-related deaths occur between 24 h and 6 weeks after delivery, yet the first outpatient visit is not typically scheduled until 6 weeks postpartum. Thus, the ability to independently navigate this period is critical to maternal well-being and safety. However, previous research suggests that many women feel unprepared to manage the challenges they encounter during this time, and there is a current need to synthesize the existing evidence. Therefore, the purpose of this integrative review is to describe parent-identified gaps in preparation for the postpartum period in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Integrative Review framework by Whittemore and Knafl, a systematic search of Medline, CINAHL, PsychInfo, Web of Science, and a hand-search was conducted for peer-reviewed articles published in English between 1995 and 2023. Results were reported according to PRISMA 2020 guidelines. Studies that met eligibility criteria were synthesized in a literature matrix.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Twenty-two studies met inclusion criteria. Four themes were identified: Mental Health Concerns, Physical Concerns, Infant Feeding and Care Concerns, and General Concerns and Recommendations. Many women, regardless of parity, reported feeling unprepared for numerous postpartum experiences, including depression, anxiety, physical recovery, breastfeeding, and infant care. Parents reported difficulty differentiating normal postpartum symptoms from complications. Hospital discharge teaching was viewed as simultaneously overwhelming and inadequate. Parent recommendations included the need for earlier and more comprehensive postpartum preparation during pregnancy, delivered in multiple formats and settings. Parents also reported the need for earlier postpartum visits and improved outpatient support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Our findings indicate that many parents in the United States feel unprepared to navigate a wide variety of emotional, physical, breastfeeding, and infant-care experiences. Future research should explore innovative educational approaches to postpartum preparation during pregnancy as well as outpatient programs to bridge the current gaps in postpartum care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 4","pages":"669-689"},"PeriodicalIF":2.8,"publicationDate":"2024-05-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141155822","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neonatal morbidity and mortality in birth centers in the United States 2018–2021: An observational study of low-risk birthing individuals","authors":"Lauren Hoehn-Velasco PhD,&nbsp;Lisa Ross DNP,&nbsp;R. David Phillippi PhD,&nbsp;Nancy A. Niemczyk PhD,&nbsp;Dominic Cammarano DO,&nbsp;Steven Calvin MD,&nbsp;Julia C. Phillippi PhD,&nbsp;Jill Alliman DNP,&nbsp;Susan Rutledge Stapleton DNP,&nbsp;Jennifer Wright MA,&nbsp;Stanley Fisch MD,&nbsp;Diana Jolles PhD","doi":"10.1111/birt.12823","DOIUrl":"10.1111/birt.12823","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Many studies reporting neonatal outcomes in birth centers include births with risk factors not acceptable for birth center care using the evidence-based CABC criteria. Accurate comparisons of outcomes by birth setting for low-risk patients are needed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Data from the public Natality Detailed File from 2018 to 2021 were used. Logistic regression, including adjusted and unadjusted odds ratios, compared neonatal outcomes (chorioamnionitis, Apgar scores, resuscitation, intensive care, seizures, and death) between centers and hospitals. Covariates included maternal diabetes, body mass index, age, parity, and demographic characteristics.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The sample included 8,738,711 births (8,698,432 (99.53%) in hospitals and 40,279 (0.46%) in birth centers). There were no significant differences in neonatal deaths (aOR 1.037; 95% CI [0.515, 2.088]; <i>p</i>-value 0.918) or seizures (aOR 0.666; 95% CI [0.315, 1.411]; <i>p</i>-value 0.289). Measures of morbidity either not significantly different or less likely to occur in birth centers compared to hospitals included chorioamnionitis (aOR 0.032; 95% CI [0.020, 0.052]; <i>p</i>-value &lt; 0.001), Apgar score &lt; 4 (aOR 0.814, 95% CI [0.638, 1.039], <i>p</i>-value 0.099), Apgar score &lt; 7 (aOR 1.075, 95% CI [0.979, 1.180], <i>p</i>-value 0.130), ventilation &gt;6 h (aOR 0.349; [0.281,0.433], <i>p</i>-value &lt; 0.001), and intensive care admission (aOR 0.356; 95% CI [0.328, 0.386], <i>p</i>-value &lt; 0.001). Birth centers had higher odds of assisted neonatal ventilation for &lt;6 h as compared to hospitals (aOR 1.373; 95% CI [1.293, 1.457], <i>p</i>-value &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Neonatal deaths and seizures were not significantly different between freestanding birth centers and hospitals. Chorioamnionitis, Apgar scores &lt; 4, and intensive care admission were less likely to occur in birth centers.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 3","pages":"659-666"},"PeriodicalIF":2.8,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12823","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Midwifery continuity of care for women with perinatal mental health conditions: A cohort study from Australia","authors":"Allison Cummins RM, PhD,&nbsp;Alison Gibberd PhD,&nbsp;Karen McLaughlin RM, RN, PhD,&nbsp;Maralyn Foureur RM, RN, PhD","doi":"10.1111/birt.12838","DOIUrl":"10.1111/birt.12838","url":null,"abstract":"&lt;div&gt;\u0000 \u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Background&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;Perinatal mental health (PMH) conditions are associated with adverse outcomes such as maternal suicide, preterm birth and longer-term childhood sequelae. Midwifery continuity of care (one midwife or a small group of midwives) has demonstrated benefits for women and newborns, including a reduction in preterm birth and improvements in maternal anxiety/worry and depression.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Aim&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;To determine if midwifery care provided through a Midwifery Group Caseload Practice model is associated with improved perinatal outcomes for women who have anxiety and depression and/or other perinatal mental health conditions. An EPDS ≥ 13, and/or answered the thought of harming myself has occurred to me and/or women who self-reported a history compared to standard models of care (mixed midwife/obstetric fragmented care).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Methods&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;A retrospective cohort study using data routinely collected via an electronic database between 1 January 2018 31st of January 2021. The population were women with current/history of PMH, who received Midwifery Caseload Group Practice (MCP), or standard care (SC). Data were analysed using descriptive statistics for maternal characteristics and logistic regression for birth outcomes. One-to-one matching of the MCP group with the SC group was based on propensity scores.&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Results&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;7,359 births were included MCP 12% and SC 88%. Anxiety was the most common PMH with the same proportion affected in MCP and SC. Adjusted odds of preterm birth and adverse perinatal outcomes were lower in the MCP group than the SC group (aOR (95%CI): 0.77 (0.55, 1.08) and 0.81 (0.68, 0.97), respectively) and higher for vaginal birth and full breastfeeding (aOR (95% CI): 1.87 (1.60, 2.18) and 2.06 (1.61, 2.63), respectively). In the matched sample the estimate of a relationship between MCP and preterm birth (aOR (95% CI): 0.88 (0.56, 1.42), adverse perinatal outcomes (aOR (95% CI): 0.83 (0.67, 1.05)) and breastfeeding at discharge (aOR (95% CI): 1.82 (1.30, 2.51)), stronger for vaginal birth (aOR (95% CI): 2.22 (1.77, 2.71)).&lt;/p&gt;\u0000 &lt;/section&gt;\u0000 \u0000 &lt;section&gt;\u0000 \u0000 &lt;h3&gt; Conclusion&lt;/h3&gt;\u0000 \u0000 &lt;p&gt;This study supports positive associations between MCP and breastfeeding and vaginal birth. MCP was also associated with lower risk of adverse perinatal outcomes, though in the matched sample with a smaller sample size, the confidence interval included 1. The dir","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 4","pages":"728-737"},"PeriodicalIF":2.8,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12838","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Birth “outside of guidance”—An exploration of a Birth Choices Clinic in the United Kingdom","authors":"Sophie McAllister BSc (Hons), MSc, RM,&nbsp;Claire Litchfield LLb (Hons), MSc, RM","doi":"10.1111/birt.12827","DOIUrl":"10.1111/birt.12827","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Decision-making around birthplace is complex and multifactorial. The role of clinicians is to provide unbiased, evidence-based information to support women and birthing people to make decisions based on what matters to them. Some decisions may fall outside of clinical guidance and recommendations. Birth Choices Clinics can provide an opportunity for extended discussion and personalized birthplace planning.</p>\u0000 \u0000 <p>This study aimed to explore the rationale behind choosing birthplace “outside of guidance” and examine the outcomes for women who attended a Birth Choices Clinic.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The study was descriptive using data extracted from clinical documentation and consultation. The data included demographic information, maternal characteristics, reason for choosing a midwifery-led birth setting, birthplace preference, and outcome.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Eighty-two women used the Birth Choices Clinic between April 2022 and February 2023 in one large maternity unit in the UK. Reasons for choosing birth in a midwifery-led setting included having access to a birthing pool, to reduce the chance of obstetric interventions and pragmatic reasons. Sixty-five percent of women experienced a spontaneous vaginal birth, 10% experienced an assisted vaginal birth, and 23% experienced a cesarean birth. Of the 33 women who ultimately commenced labor care in a midwifery-led setting, 76% (<i>n</i> = 25/33) birthed in this setting without complications. Transfer rates in labor were similar to those in a “low-risk” pregnant population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Birth choice clinics may facilitate an understanding of material risk and support individualizing birth planning. There is evidence that women changed their planned birthplace, possibly in recognition of a move along the risk spectrum.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 1","pages":"46-54"},"PeriodicalIF":2.8,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12827","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141082817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validity and reliability of an Arabic-language version of the postpartum specific anxiety scale research short-form in Jordan","authors":"Heba H. Hijazi MSc, PhD,&nbsp;Main N. Alolayyan MSc, PhD,&nbsp;Rabah M. Al Abdi MSc, PhD,&nbsp;Ahmed Hossain MSc, PhD,&nbsp;Victoria Fallon BSc (Hons), PhD,&nbsp;Sergio A. Silverio MPsycholSci (Hons), MSc","doi":"10.1111/birt.12840","DOIUrl":"10.1111/birt.12840","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>The English-language Postpartum Specific Anxiety Scale (PSAS) is a valid, reliable measure for postpartum anxiety (PPA), but its 51-item length is a limitation. Consequently, the PSAS Working Group developed the PSAS Research Short-Form (PSAS-RSF), a statistically robust 16-item tool that effectively assesses PPA. This study aimed to assess and validate the reliability of an Arabic-language version of the PSAS-RSF in Jordan (PSAS-JO-RSF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using a cross-sectional methodological design, a sample of Arabic-speaking mothers (<i>N</i> = 391) with infants aged up to 6 months were recruited via convenience sampling from a prominent tertiary hospital in northern Jordan. Factor analysis, composite reliability (CR), average variance extracted (AVE), McDonald's ω, and inter-item correlation measures were all examined.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Explanatory factor analysis revealed a four-factor model consistent with the English-language version of the PSAS-RSF, explaining a cumulative variance of 61.5%. Confirmatory factor analysis confirmed the good fit of the PSAS-JO-RSF (<i>χ</i>²/<i>df</i> = 1.48, CFI = 0.974, TLI = 0.968, RMSEA = 0.039, SRMR = 0.019, <i>p</i> &lt; 0.001). The four factors demonstrated acceptable to good reliability, with McDonald's ω ranging from 0.778 to 0.805, with 0.702 for the overall scale. The CR and AVE results supported the validity and reliability of the PSAS-JO-RSF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study establishes an Arabic-language version of the PSAS-JO-RSF as a valid and reliable scale for screening postpartum anxieties in Jordan.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 4","pages":"708-718"},"PeriodicalIF":2.8,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066277","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pregnancy experiences of transgender and gender-expansive individuals: A systematic scoping review from a critical midwifery perspective.","authors":"Elias G Thomas, Bahareh Goodarzi, Hannah Frese, Linda J Schoonmade, Maaike E Muntinga","doi":"10.1111/birt.12834","DOIUrl":"https://doi.org/10.1111/birt.12834","url":null,"abstract":"<p><strong>Background: </strong>Evidence suggests that transgender and gender-expansive people are more likely to have suboptimal pregnancy outcomes compared with cisgender people. The aim of this study was to gain a deeper understanding of the role of midwifery in these inequities by analyzing the pregnancy experiences of transgender and gender-expansive people from a critical midwifery perspective.</p><p><strong>Methods: </strong>We conducted a systematic scoping review. We included 15 papers published since 2010 that reported on pregnancy experiences of people who had experienced gestational pregnancy at least once, and were transgender, nonbinary, or had other gender-expansive identities.</p><p><strong>Results: </strong>Three themes emerged from our analysis: \"Navigating identity during pregnancy,\" \"Experiences with mental health and wellbeing,\" and \"Encounters in the maternal and newborn care system.\" Although across studies respondents reported positive experiences, both within healthcare and social settings, access to gender-affirmative (midwifery) care and daily social realities were often shaped by trans-negativity and transphobia.</p><p><strong>Discussion: </strong>To improve care outcomes of transgender and gender-expansive people, it is necessary to counter anti-trans ideologies by \"fixing the knowledge\" of midwifery curricula. This requires challenging dominant cultural norms and images around pregnancy, reconsidering the way in which the relationship among \"sex,\" \"gender,\" and \"pregnancy\" is understood and given meaning to in midwifery, and applying an intersectional lens to investigate the relationship between gender inequality and reproductive inequity of people with multiple, intersecting marginalized identities who may experience the accumulated impacts of racism, ageism, and classism. Future research should identify pedagogical frameworks that are suitable for guiding implementation efforts.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066276","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cesarean reduction efforts undercut by not attempting vaginal birth","authors":"Ellen Kauffman MD","doi":"10.1111/birt.12826","DOIUrl":"10.1111/birt.12826","url":null,"abstract":"&lt;p&gt;Cesarean birth (CB) is likely overused&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; as no evidence of benefit to newborn morbidity or mortality and increasing maternal morbidity and mortality have spurred national and global efforts to reduce its use.&lt;span&gt;&lt;sup&gt;2, 3&lt;/sup&gt;&lt;/span&gt; The increasing risks to the birthing person are “a significant maternal health safety issue.”&lt;span&gt;&lt;sup&gt;4&lt;/sup&gt;&lt;/span&gt; While potentially lifesaving, CB does have both short- and long-term risks for both mother and newborn.&lt;span&gt;&lt;sup&gt;5-7&lt;/sup&gt;&lt;/span&gt; In the United States (US), the CB rate has risen from 16.5% in 1980,&lt;span&gt;&lt;sup&gt;8&lt;/sup&gt;&lt;/span&gt; to 20.7% in 1996,&lt;span&gt;&lt;sup&gt;9&lt;/sup&gt;&lt;/span&gt; to &gt;30% from 2005 to the present&lt;span&gt;&lt;sup&gt;10&lt;/sup&gt;&lt;/span&gt; with a rate of 32.2% reported for 2022 and the first quarter of 2023.&lt;span&gt;&lt;sup&gt;11&lt;/sup&gt;&lt;/span&gt; Since 2012, labor management guidelines&lt;span&gt;&lt;sup&gt;1&lt;/sup&gt;&lt;/span&gt; have been a core tool designed to help lower the CB rate in the United States. In January 2024, the American College of Obstetrics and Gynecology (ACOG) reaffirmed labor management guidelines as the principal mechanism for reducing CB.&lt;span&gt;&lt;sup&gt;2&lt;/sup&gt;&lt;/span&gt;&lt;/p&gt;&lt;p&gt;And yet, publicly available data&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; show that 72% of all CB between 2016 and 2021 in the United States occurred among women and birthing people with no trial of labor in pursuit of vaginal birth. Because the ACOG guidelines &lt;i&gt;by definition&lt;/i&gt; only reduce CB among individuals who labor, they necessarily exclude the majority of CBs. As such, the ability of these guidelines to reduce CBs is significantly diminished.&lt;/p&gt;&lt;p&gt;The purpose of this commentary is to describe the disconnect between where cesarean reduction efforts are focused and where the majority of cesareans are actually occurring in the United States. Next, I propose a strategy for collecting and reporting data that would enable a more thorough analysis of this disconnect and that might also indicate ways to eliminate it. I close with some reflections on associated issues surrounding the provision of maternity care in the United States today.&lt;/p&gt;&lt;p&gt;Centers for Disease Control and Prevention (CDC) national vital statistics natality records distinguish between two clinical circumstances for CB: (i) CB that interrupts labor and (ii) CB without a trial of labor. The CDC data for the 6 years between 2016 and 2021&lt;span&gt;&lt;sup&gt;12&lt;/sup&gt;&lt;/span&gt; indicate that of the 21,821,747 women who gave birth, 21,727,755 (99.6%) have data on whether vaginal birth was attempted or not. Most women (77%, &lt;i&gt;n&lt;/i&gt; = 16,757,753) attempted a vaginal birth (the labor group), while 23% (&lt;i&gt;n&lt;/i&gt; = 4,970,002) did not attempt a vaginal birth (the no-labor group). Figure 1 shows the percentage of the population in each group.&lt;/p&gt;&lt;p&gt;Of the 21,727,755 women who gave birth between 2016 and 2021, 6,847,320 did so by cesarean, with 72% of CBs occurring in the group of women who did not attempt a vaginal birth (no labor, &lt;i&gt;n&lt;/i&gt; = 4,970,002). This means that only 28% of CBs (&lt;i&gt;n&lt;/i&gt; ","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 3","pages":"471-474"},"PeriodicalIF":2.8,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12826","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When facts become feelings","authors":"Alice M. Abernathy MD, MSHP","doi":"10.1111/birt.12830","DOIUrl":"10.1111/birt.12830","url":null,"abstract":"<p>I have long maintained that equipoise between empathy and the rational, decisive nature of obstetric care is central to good doctoring. I had exacting standards for how to communicate facts with feeling while shielding my own. Then, after experiencing my own obstetric emergency and preterm birth, this changed. In this reflection, I explore how recognizing the intersections between facts and feelings has made me a better physician.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 1","pages":"3-4"},"PeriodicalIF":2.8,"publicationDate":"2024-05-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11576487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141066296","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Client-centered flexible planning of home-based postpartum care: A randomized controlled trial on the quality of care","authors":"Fleur J. Lambermon PhD,&nbsp;Noortje T. L. van Duijnhoven PhD,&nbsp;Christine Dedding PhD,&nbsp;Jan A. M. Kremer PhD","doi":"10.1111/birt.12824","DOIUrl":"10.1111/birt.12824","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Standardization of health systems often hinders client-centered care. This study investigates whether allowing more flexibility in the planning range of the Dutch home-based postpartum care service improves its quality of care, as innovative approach to client-centered care.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A randomized controlled trial was conducted (2017–2019), in which pregnant women who intended to breastfeed were assigned into two groups (1:1). The intervention group was allowed to receive care up to the 14th-day postpartum, instead of the first 8–10 consecutive days (“usual care”). Primary outcome measure was the proportion of newborns still receiving exclusively breastmilk on final caring day of the service. This so-called <i>successful breastfeeding rate</i> is currently used by the Dutch health sector to measure the quality of care. Secondary outcome measures were <i>self-care experience</i>, <i>overall care experience</i>, and <i>exclusive breastfeeding duration rate</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Based on data from 1275 participants, there was no difference in exclusive breastfeeding on final caring day (86,7% intervention group vs. 88,9% control group, RR: 1.03, 95% CI: 0.98–1.07). Both groups showed similar <i>self-care experiences</i>. Women in the intervention group had slightly poorer <i>overall care experience</i> and lower <i>exclusive breastfeeding duration rates</i>.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This study found no effect on the quality of care when allowing more flexibility in the planning range of home-based postpartum care. Women can, therefore, be offered more flexibility to suit them. Given the confusion in interpreting the sector's current main quality indicator, we call for an inclusive dialogue on how to best measure the quality of home-based postpartum care.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 3","pages":"649-658"},"PeriodicalIF":2.8,"publicationDate":"2024-05-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12824","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140877968","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}