Birth-Issues in Perinatal Care最新文献

Introduction: This study was performed to compare childbirth experiences in the United Kingdom (UK) and the Netherlands (NL) and identify determinants of positive childbirth experiences in both countries.

Methods: Women who gave birth in the UK (n = 1303) or the NL (n = 900) between January 2017 and December 2020 who filled in the cross-sectional Babies Born Better survey were included in this study. Fully adjusted logistic regression models were used to assess differences in the odds of a positive childbirth experience between the two countries. Hierarchical logistic regression analyses were performed to identify determinants of a positive childbirth experience, including socio-demographic factors, pregnancy and childbirth outcomes, and care-related determinants.

Results: Respondents giving birth in the UK had decreased odds of a positive childbirth experience compared to NL respondents (66% vs. 85%, AOR 0.45, CI 0.35-0.57). Significant determinants for a positive childbirth experience were multiparity, absence of pregnancy complications, a spontaneous vaginal birth, and giving birth at home. UK respondents who had a planned caesarean section had a higher likelihood of reporting a positive childbirth experience when adjusted for confounders. Having a doctor as the primary birth care provider was less likely to be associated with a positive childbirth experience in the UK.

Conclusions: Most women in both the NL and the UK reported positive childbirth experiences, but NL respondents were more likely to do so. Determinants of a positive birth experience were mostly factors associated with uncomplicated labor and birth, or linked with fulfilled choices and with being multiparous.

Background: Intermittent auscultation is the gold standard for fetal assessment in uncomplicated pregnancies and labors and is used universally in the community birth setting. Great variation exists in intermittent auscultation practices and language used by community birth midwives across the country. Current standards, as defined by midwifery schools, state midwifery licensing boards, and individual midwifery practices, differ significantly and sometimes contradict each other. Community birth midwives, nurses and birth assistants, midwifery educators and those working in community birth quality improvement have been in need of common language and guidance on best practices in intermittent auscultation.

Objective: Develop and disseminate consensus standards for intermittent auscultation in the community birth setting in the United States.

Methodology: Creation of guidelines through a 21-month consensus process with a workgroup of educators, leaders, quality improvement experts, and practicing midwives by identifying practices supported by evidence or clinical experience, evaluating current evidence and guidelines, eliciting feedback from education, midwifery, nursing, and birth center organizations, and incorporating revisions to create the final document.

Results: Consensus was reached on various elements of intermittent auscultation and guidelines were created. These guidelines address readiness, assessment, interpretation, and documentation of fetal heart tones, clinical decision making, and areas for future research. These guidelines provide a minimum standard for performance and documentation of intermittent auscultation in community birth midwifery practice.

Background: Sexual violence (SV) history is associated with various birth outcomes. Yet, the underlying mechanisms of these associations have not been sufficiently explained. Disclosure of SV history to a maternity care provider may play an important role in maternity care providers' choice for birth interventions and in women's birth experience.

Methods: A cross-sectional nationwide survey was conducted among women who had given birth in the 5 years prior to completing the questionnaire. Logistic regression analysis was performed to compare the associations between SV history (total, disclosed, and undisclosed) and birth outcomes.

Results: Of 10,867 respondents, 1121 (10.3%) reported SV, of whom 582 (52%) disclosed to their maternity care provider. Respondents who disclosed their SV history had lower adjusted odds of episiotomy than respondents without an SV history (adjusted odds ratio [AOR] 0.71, 95% confidence intervals [95% CI] 0.56-0.90). Primiparous respondents who disclosed their SV history had increased odds of unplanned cesarean birth compared to spontaneous (OR 1.37, 95% CI 1.04-1.81) and assisted vaginal birth (OR 1.75, 95% CI 1.17-2.61). Primiparous respondents with both a disclosed and undisclosed SV history had increased adjusted odds of negative birth (AOR 1.78, 95% CI 1.50-2.12). There were no differences in referral to obstetrician-led care, home birth, preterm labor, and pharmaceutical pain relief between groups.

Conclusions: When people disclose their SV history, maternity care providers are less likely to perform an episiotomy, and more likely to choose an unplanned cesarean birth over vaginal birth. However, disclosure of SV history does not ameliorate the birth experience and we therefore recommend better implementation of trauma-informed birth support for women with an SV history.

Background: Asian birthing people have the second highest rates of cesarean birth (CB), lowest rates of community (home and birth center), and midwife-attended births compared to other racial and ethnic groups in the United States.

Methods: The American Association of Birth Centers Perinatal Data Registry (PDR) was used to abstract socio-demographic and clinical data. Logistic regression analyses identified the drivers of cesarean birth among Asian birthing people in the overall and community birth eligible samples.

Results: Between 2007 and 2021, 2983 people self-identified as Asian within the PDR. The Asian sample had a lower percentage of birth center births and a higher percentage of hospital births, CB, gestational diabetes, and postpartum hemorrhage compared to the overall sample. The cesarean rate in the Asian sample was 12.4%. Asian multiparous birthing people were at 1.5 greater odds of CB compared to White multiparous birthing people (OR = 1.54; 95% CI, 1.19-2.03; p < 0.01). Asians in the community birth eligible group had higher odds of CB compared to their White counterparts (OR = 1.54; 95% CI, 1.23-1.93; p < 0.01). Asian and White multiparous birthing people admitted to the hospital from the community birth eligible group had five times higher odds of CB compared to the total sample of Asian and White multiparous birthing people (OR = 5.18; 95% CI, 3.77-7.12; p < 0.01).

Discussion: There were lower rates of CB among Asians who birthed in PDR user sites compared to the national average. Future research is needed in community birth outcomes among different Asian ethnicities and Asian birthing people's perspective on community birth.

Background: The POOL study explored intrapartum water immersion and associated maternal and neonatal outcomes at 26 UK sites 2015-2022.

Methods: Retrospective and prospective data captured in electronic maternity and neonatal UK National Health Service (NHS) information systems. Analysis-(a) proportions of women using and factors associated with water immersion during labour or birth; (b) outcomes among "low-risk" women who used water immersion during labour or birth; (c) management and outcomes of the third stage of labour following waterbirth.

Results: Among 869,744 included births, 10% (n = 87,040) used water immersion during labour or birth and 4.6% (n = 39,627) gave birth in water, with rates falling over time. Being of white or multi-ethnicity, fluent in English, non-smokers or ex-smokers, from more affluent areas, and nulliparous were associated with higher rates of water use. Overall, 39.6% of nulliparous and 9.9% of parous women at low risk at labour onset, and who used water immersion during labour, received obstetric or anesthetic care during the intrapartum period. Physiological third stage management was used following 27.1% (n = 10,737) of waterbirths and following 8.6% (n = 2260) of waterbirths the placenta was delivered into water. The rate of recorded blood loss ≥ 1000 mL was not significantly different when the placenta was delivered in water compared to placental delivery out of water.

Conclusion: This large UK study of water immersion during labour and birth provides important information for policymakers, maternity health professionals, and for women and families considering the option of intrapartum water immersion. Care providers need to ensure equal access to intrapartum water immersion across demographic groups and provide women with evidence-based rates of obstetric interventions that take into account their risk status and birth choices.

Trial registration: ISRCTN13315580.

Introduction: Cultural brokers bridge cultural and linguistic differences between patients and healthcare teams, but their role in pregnancy care is not well understood. We aimed to identify and describe the roles cultural brokers fulfill throughout pregnancy care, moments of impact when they enhance care for patients with limited English proficiency (LEP), and how to integrate cultural brokering into pregnancy care teams.

Methods: We conducted a descriptive qualitative study nested within a human centered design process. We conducted 21 semi-structured, qualitative interviews among Spanish-speaking pregnancy care patients with LEP, cultural brokers, and pregnancy care clinicians in the Boston metropolitan area between December 2022 and May 2023. Data were coded and analyzed using qualitative content analysis to summarize themes about cultural brokering within pregnancy care. Data were used to create a journey map of an illustrative pregnancy experience.

Results: Cultural brokers played five key roles in pregnancy care for Spanish-speaking patients with LEP: cultural bridging, language support, social support, health system navigation, and advocacy. The journey map highlighted moments of impact when cultural brokers enhanced patient care: connecting patients to care, meeting the care team, making informed decisions, connecting to resources, childbirth, and transitioning to parenthood. Most participants wanted cultural brokers to be integrated into pregnancy care teams to diversify teaming and enable shared decision-making; however, additional training, clarifying cultural broker roles, and adequate compensation for cultural brokers would be needed to achieve integration.

Conclusion: Cultural brokers fulfill a critical role during pregnancy care for patients with LEP. However, more work is needed to recognize, value, and integrate cultural brokering into pregnancy care.