Merle R. van Dijk, Lotte van Wijk, Leonie E. Van Rheenen-Flach, Etelka Moll, Wessel Ganzevoort, Joost Velzel
Objective
To assess healthcare professionals' preferences for antepartum counseling on the mode of delivery for patients with term breech presentation and their preferences for intrapartum management of vaginal breech delivery (VBD).
Study Design
A web-based international survey and Discrete Choice Experiment (DCE) were conducted among gynecologists and midwives. In the DCE for antepartum counseling, participants were presented with scenarios for antepartum counseling and asked to choose between VBD and elective cesarean delivery (CD). The scenarios differed in four attributes: maternal age, BMI, parity, and estimated fetal weight. Intrapartum management of VBD was evaluated through a questionnaire involving four distinct clinical scenarios.
Results
In antepartum counseling, the likelihood of being advised for a VBD was 43.9%. The strongest factors to opt for a CD compared to a VBD were a history of vaginal birth (OR 0.25, 95% CI 0.19–0.32) and a large estimated fetal weight (OR 5.89, 95% CI 4.07–8.54). Intrapartum management during breech deliveries did not differ among professionals and their annual number of self-reported VBD.
Conclusions
The key factors driving professionals to recommend CD are a history of vaginal birth and average estimated fetal weight. Intrapartum management approaches during breech deliveries were consistent across professionals. Those with more experience managing VBDs were more likely to counsel patients towards VBD antepartum and proceed with VBD intrapartum.
目的：了解医护人员对足月臀位分娩方式产前咨询的偏好，以及对阴道臀位分娩（VBD）产时处理的偏好。研究设计：一项基于网络的国际调查和离散选择实验（DCE）在妇科医生和助产士中进行。在产前咨询的DCE中，参与者被告知产前咨询的场景，并被要求在VBD和选择性剖宫产（CD）之间进行选择。这些情况在四个方面有所不同：母亲年龄、身体质量指数、胎次和估计的胎儿体重。通过涉及四种不同临床情景的问卷调查来评估VBD的产时管理。结果：在产前咨询中，被告知VBD的可能性为43.9%。与VBD相比，选择CD的最强因素是阴道分娩史（OR 0.25, 95% CI 0.19-0.32）和估计胎儿体重大（OR 5.89, 95% CI 4.07-8.54）。产后分娩的产中管理在专业人员和他们每年自我报告的VBD数量之间没有差异。结论：促使专业人员推荐乳糜泻的关键因素是阴道分娩史和平均估计胎儿体重。产后分娩的产中管理方法在各专业人员中是一致的。那些有更多经验处理VBD的人更有可能在产前建议患者处理VBD，并在分娩时继续处理VBD。
{"title":"Professional Preferences Towards Vaginal Breech Delivery at Term: An International Discrete Choice Experiment","authors":"Merle R. van Dijk, Lotte van Wijk, Leonie E. Van Rheenen-Flach, Etelka Moll, Wessel Ganzevoort, Joost Velzel","doi":"10.1111/birt.70011","DOIUrl":"10.1111/birt.70011","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To assess healthcare professionals' preferences for antepartum counseling on the mode of delivery for patients with term breech presentation and their preferences for intrapartum management of vaginal breech delivery (VBD).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Study Design</h3>\u0000 \u0000 <p>A web-based international survey and Discrete Choice Experiment (DCE) were conducted among gynecologists and midwives. In the DCE for antepartum counseling, participants were presented with scenarios for antepartum counseling and asked to choose between VBD and elective cesarean delivery (CD). The scenarios differed in four attributes: maternal age, BMI, parity, and estimated fetal weight. Intrapartum management of VBD was evaluated through a questionnaire involving four distinct clinical scenarios.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In antepartum counseling, the likelihood of being advised for a VBD was 43.9%. The strongest factors to opt for a CD compared to a VBD were a history of vaginal birth (OR 0.25, 95% CI 0.19–0.32) and a large estimated fetal weight (OR 5.89, 95% CI 4.07–8.54). Intrapartum management during breech deliveries did not differ among professionals and their annual number of self-reported VBD.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The key factors driving professionals to recommend CD are a history of vaginal birth and average estimated fetal weight. Intrapartum management approaches during breech deliveries were consistent across professionals. Those with more experience managing VBDs were more likely to counsel patients towards VBD antepartum and proceed with VBD intrapartum.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"174-180"},"PeriodicalIF":2.5,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.70011","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979048","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}
Evelien Cellissen, Marijke J. C. Hendrix, Luc Budé, Naaz Shareef, Maaike Vogels-Broeke, Marianne J. Nieuwenhuijze
Background
Continuity of maternity care contributes to improved birth experiences and health outcomes among women and newborns. To improve continuity of maternity care in the Netherlands, the Integrated maternity care standard recommends a maternity care plan and a coordinating care professional for all care settings. This study aimed to gain insights into women's experiences of continuity during antenatal care in the Netherlands in both community and hospital settings and whether a maternity care plan and coordinating care professional are associated with continuity of care as experienced by women.
Methods
We conducted a cross-sectional study in 2019 to 2020 among pregnant women (> 32 weeks) in the Netherlands. Experienced continuity of care was measured using the Nijmegen Continuity Questionnaire. We used regression analyses to explore the association between a maternity care plan, coordinating care professional, and experience of continuity during the antenatal period in multiple care settings.
Results
We included 1165 women in this study. Most women reported moderate to high levels of continuity, with higher scores reported for care provided by community midwives compared to hospital staff. Having a maternity care plan, a coordinating care professional, and experiencing few care professionals were significantly associated with higher scores on continuity when care was provided by community midwives, but these associations were not found when care was provided by hospital staff.
Discussion
Our findings emphasize the critical role of community midwives in promoting antenatal continuity. A maternity care plan, coordinating care professionals, and fewer care professionals contribute to this experience of continuity.
{"title":"Women's Experience of Continuity During Antenatal Care: A Cross-Sectional Study in The Netherlands","authors":"Evelien Cellissen, Marijke J. C. Hendrix, Luc Budé, Naaz Shareef, Maaike Vogels-Broeke, Marianne J. Nieuwenhuijze","doi":"10.1111/birt.70008","DOIUrl":"10.1111/birt.70008","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Continuity of maternity care contributes to improved birth experiences and health outcomes among women and newborns. To improve continuity of maternity care in the Netherlands, the Integrated maternity care standard recommends a maternity care plan and a coordinating care professional for all care settings. This study aimed to gain insights into women's experiences of continuity during antenatal care in the Netherlands in both community and hospital settings and whether a maternity care plan and coordinating care professional are associated with continuity of care as experienced by women.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We conducted a cross-sectional study in 2019 to 2020 among pregnant women (> 32 weeks) in the Netherlands. Experienced continuity of care was measured using the Nijmegen Continuity Questionnaire. We used regression analyses to explore the association between a maternity care plan, coordinating care professional, and experience of continuity during the antenatal period in multiple care settings.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We included 1165 women in this study. Most women reported moderate to high levels of continuity, with higher scores reported for care provided by community midwives compared to hospital staff. Having a maternity care plan, a coordinating care professional, and experiencing few care professionals were significantly associated with higher scores on continuity when care was provided by community midwives, but these associations were not found when care was provided by hospital staff.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Our findings emphasize the critical role of community midwives in promoting antenatal continuity. A maternity care plan, coordinating care professionals, and fewer care professionals contribute to this experience of continuity.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"145-154"},"PeriodicalIF":2.5,"publicationDate":"2025-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.70008","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979409","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}
Min Yang, Caiyun Wang, Linlin Cao, Xiu Zhu, Jie Lu
Background
Early Essential Newborn Care (EENC) is a highly beneficial and cost-effective set of evidence-based interventions for newborns and their mothers. However, the implementation of EENC as part of routine clinical practice in the delivery room has not yet been achieved in China. The purpose of this study was to describe the adoption of EENC in general hospitals in China and to evaluate its implementation impacts.
Methods
This study was an implementation study. The design of the implementation process was guided by a Knowledge-to-Action Framework and the conceptual model of implementation research. Mixed methods were used to evaluate the implementation of EENC with qualitative and quantitative data collection methods, including implementation outcomes, service outcomes, and patient outcomes.
Results
A total of 279 patients and 25 nurse-midwives were evaluated in this study. Both the implementation and service outcomes in this study were satisfactory. Obstacles were reported in the acceptability, feasibility, adoption, and fidelity of EENC, such as the acceptance of evidence by nurse-midwives, the support of managers to implement EENC in staff under their management, and the allocation of adequate resources. For patient outcomes, the rates of exclusive breastfeeding during hospitalization (27.1% vs. 39.6%, p < 0.05) and early initiation of breastfeeding (51.4% vs. 64.0%, p < 0.05) improved after EENC was implemented. Furthermore, the amount of vaginal bleeding after 2 h by subjects in the EENC implementation group [(283.92 ± 71.31 mL) vs. (308.78 ± 84.42 mL), t = 2.694, p < 0.05] was also significantly reduced.
Conclusion
EENC can be effectively implemented in general hospitals, but some factors affecting the implementation of EENC included the acceptance of evidence by nurse-midwives, support from managers, and resource allocation. The implementation of EENC was found to be beneficial to newborns and their mothers. Our findings indicate that EENC should be incorporated as part of routine maternity care and nursing practice.
{"title":"Adopting Early Essential Newborn Care (EENC) in the Delivery Room: An Implementation Study From China","authors":"Min Yang, Caiyun Wang, Linlin Cao, Xiu Zhu, Jie Lu","doi":"10.1111/birt.70009","DOIUrl":"10.1111/birt.70009","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Early Essential Newborn Care (EENC) is a highly beneficial and cost-effective set of evidence-based interventions for newborns and their mothers. However, the implementation of EENC as part of routine clinical practice in the delivery room has not yet been achieved in China. The purpose of this study was to describe the adoption of EENC in general hospitals in China and to evaluate its implementation impacts.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study was an implementation study. The design of the implementation process was guided by a Knowledge-to-Action Framework and the conceptual model of implementation research. Mixed methods were used to evaluate the implementation of EENC with qualitative and quantitative data collection methods, including implementation outcomes, service outcomes, and patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 279 patients and 25 nurse-midwives were evaluated in this study. Both the implementation and service outcomes in this study were satisfactory. Obstacles were reported in the acceptability, feasibility, adoption, and fidelity of EENC, such as the acceptance of evidence by nurse-midwives, the support of managers to implement EENC in staff under their management, and the allocation of adequate resources. For patient outcomes, the rates of exclusive breastfeeding during hospitalization (27.1% vs. 39.6%, <i>p</i> < 0.05) and early initiation of breastfeeding (51.4% vs. 64.0%, <i>p</i> < 0.05) improved after EENC was implemented. Furthermore, the amount of vaginal bleeding after 2 h by subjects in the EENC implementation group [(283.92 ± 71.31 mL) vs. (308.78 ± 84.42 mL), <i>t</i> = 2.694, <i>p</i> < 0.05] was also significantly reduced.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>EENC can be effectively implemented in general hospitals, but some factors affecting the implementation of EENC included the acceptance of evidence by nurse-midwives, support from managers, and resource allocation. The implementation of EENC was found to be beneficial to newborns and their mothers. Our findings indicate that EENC should be incorporated as part of routine maternity care and nursing practice.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"155-163"},"PeriodicalIF":2.5,"publicationDate":"2025-08-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979008","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}
Karin Windsperger, Tim Dorittke, Dana A. Muin, Herbert Kiss, Wilhelm Oberaigner, Hermann Leitner, Alex Farr
Background
Light changes during the lunar cycle affect rhythms in diverse species. Human studies focusing on whether the moon influences human health have so far neglected the effects of light/dark cycles. The purpose of this study was to investigate whether lunar phases impact perinatal outcomes by considering illumination levels due to day/night rhythms.
Methods
To assess the influence of moon phases, this nationwide cohort study identified cases with a singleton pregnancy that involved daytime (06:00 a.m. to 08:59 p.m.) and nighttime (09:00 p.m. to 05:59 a.m.) delivery at ≥ 23 + 0 gestational weeks with a birthweight of ≥ 500 g. Data on women who underwent elective cesarean or labor induction were excluded from the analyses. The lunar cycle was categorized as full moon, new moon, or other lunar phases. The standardized birth ratio (SBR) was chosen as the primary outcome parameter, while the duration of labor and adverse neonatal short-term health (pH of < 7.2 and/or a 5-min Apgar score of < 7) were chosen as the secondary outcome variables.
Results
We identified a total case number of 462,947 births, of which 242,518 (52.4%) occurred during the day and 220,429 (47.6%) at night. Different moon phases did not appear to influence either the SBR or adverse neonatal outcomes. However, nighttime births may show a trend toward a prolonged maximum duration of labor related to moon phases (62 vs. 65 vs. 70 h for new/full/other moon phases, p = 0.05).
Discussion
Considering illumination levels, some moon phases may increase the risk for prolonged births during nighttime. However, assessing the effect of lunar phases on health variables is complex. Co-environmental agents should be incorporated into future analyses.
{"title":"The Impact of Lunar Phases During Day and Night Cycles on Perinatal Outcomes: A Nationwide Cohort Study","authors":"Karin Windsperger, Tim Dorittke, Dana A. Muin, Herbert Kiss, Wilhelm Oberaigner, Hermann Leitner, Alex Farr","doi":"10.1111/birt.70013","DOIUrl":"10.1111/birt.70013","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Light changes during the lunar cycle affect rhythms in diverse species. Human studies focusing on whether the moon influences human health have so far neglected the effects of light/dark cycles. The purpose of this study was to investigate whether lunar phases impact perinatal outcomes by considering illumination levels due to day/night rhythms.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>To assess the influence of moon phases, this nationwide cohort study identified cases with a singleton pregnancy that involved daytime (06:00 a.m. to 08:59 p.m.) and nighttime (09:00 p.m. to 05:59 a.m.) delivery at ≥ 23 + 0 gestational weeks with a birthweight of ≥ 500 g. Data on women who underwent elective cesarean or labor induction were excluded from the analyses. The lunar cycle was categorized as full moon, new moon, or other lunar phases. The standardized birth ratio (SBR) was chosen as the primary outcome parameter, while the duration of labor and adverse neonatal short-term health (pH of < 7.2 and/or a 5-min Apgar score of < 7) were chosen as the secondary outcome variables.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We identified a total case number of 462,947 births, of which 242,518 (52.4%) occurred during the day and 220,429 (47.6%) at night. Different moon phases did not appear to influence either the SBR or adverse neonatal outcomes. However, nighttime births may show a trend toward a prolonged maximum duration of labor related to moon phases (62 vs. 65 vs. 70 h for new/full/other moon phases, <i>p</i> = 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Considering illumination levels, some moon phases may increase the risk for prolonged births during nighttime. However, assessing the effect of lunar phases on health variables is complex. Co-environmental agents should be incorporated into future analyses.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"192-200"},"PeriodicalIF":2.5,"publicationDate":"2025-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144979148","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}
Sharon D. Weerasingha, Roshan J. Selvaratnam, Mary-Ann Davey, Sarah E. Butler, Kirsten R. Palmer, Miranda L. Davies-Tuck
Background
Induction of labor (IOL) has been suggested to mitigate the elevated risks of perinatal mortality in migrant women. The aim was to estimate the rates of perinatal mortality, cesarean, instrumental birth, and admission to the special care nursery or neonatal intensive care unit (SCN/NICU) for births following IOL compared to expectant management at 37–41 weeks' gestation by maternal region of birth.
Methods
A population-based retrospective cohort of all vertex singleton, uncomplicated pregnancies, 37 to 41 weeks' gestation in Victoria, Australia, from 2012 to 2019. Perinatal mortality rates were reported by region of birth. Multivariable log binomial regression models were used to estimate the association between outcomes and IOL compared to expectant management by region of birth.
Results
There was no improvement in the perinatal mortality rate with IOL at any gestation for non-Australian region of birth groups. IOL at 38 weeks was associated with an increasing risk of cesarean birth for Australian, New Zealand, Oceanic, African, and South-East Asian and East Asian-born women, with a higher risk for South Asian-born women at 39 weeks. Compared to expectant management, the risk of instrumental birth was similar at each gestational week for Australian-born women; whereas for African and South Asian-born women, the risk was highest at 37 weeks; for Oceanic-born women, this occurred at 38 weeks. An inverse relationship between the week of IOL and admission to the SCN/NICU was observed for all births.
Conclusions
IOL was associated with an increased risk of cesarean birth, instrumental birth, and admission to the SCN/NICU in many situations without an improvement in perinatal mortality rates.
{"title":"Optimal Timing of Term Births by Maternal Region of Birth: Elective Induction of Labor Compared to Expectant Management in Victoria, Australia","authors":"Sharon D. Weerasingha, Roshan J. Selvaratnam, Mary-Ann Davey, Sarah E. Butler, Kirsten R. Palmer, Miranda L. Davies-Tuck","doi":"10.1111/birt.70003","DOIUrl":"10.1111/birt.70003","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Induction of labor (IOL) has been suggested to mitigate the elevated risks of perinatal mortality in migrant women. The aim was to estimate the rates of perinatal mortality, cesarean, instrumental birth, and admission to the special care nursery or neonatal intensive care unit (SCN/NICU) for births following IOL compared to expectant management at 37–41 weeks' gestation by maternal region of birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A population-based retrospective cohort of all vertex singleton, uncomplicated pregnancies, 37 to 41 weeks' gestation in Victoria, Australia, from 2012 to 2019. Perinatal mortality rates were reported by region of birth. Multivariable log binomial regression models were used to estimate the association between outcomes and IOL compared to expectant management by region of birth.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was no improvement in the perinatal mortality rate with IOL at any gestation for non-Australian region of birth groups. IOL at 38 weeks was associated with an increasing risk of cesarean birth for Australian, New Zealand, Oceanic, African, and South-East Asian and East Asian-born women, with a higher risk for South Asian-born women at 39 weeks. Compared to expectant management, the risk of instrumental birth was similar at each gestational week for Australian-born women; whereas for African and South Asian-born women, the risk was highest at 37 weeks; for Oceanic-born women, this occurred at 38 weeks. An inverse relationship between the week of IOL and admission to the SCN/NICU was observed for all births.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>IOL was associated with an increased risk of cesarean birth, instrumental birth, and admission to the SCN/NICU in many situations without an improvement in perinatal mortality rates.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"108-119"},"PeriodicalIF":2.5,"publicationDate":"2025-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.70003","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144857106","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}
Elizabeth Armari, Sunil S. Vernekar, Yeshita Pujar, Veronica Pingray, Fernando Althabe, Luz Gibbons, Mabel Berrueta, Alvaro Ciganda, Rocio Rodriguez, Jayashree Ashok Kumar, Shruti Bhavi Patil, Aravind Karinagannanavar, Raveendra R. Anteen, Pavithra M. R., Savitri Bendigeri, Shukla Shetty, B. Latha, Megha H. M., Suman S. Gaddi, Shaila Chikkagowdra, Bellara Raghavendra, Caroline S. E. Homer, Manjunath Somannavar, Shivaprasad S. Goudar, Joshua P. Vogel
Introduction
Nearly half of all perinatal deaths occur during the intrapartum period due to inadequate labor monitoring and intervention. The partograph, a paper-based labor monitoring tool, can assist providers in recognizing and acting on early signs of fetal–maternal distress if used effectively. In 2020, the World Health Organization (WHO) developed a “next generation” partograph called the Labour Care Guide. There is limited evidence of how to optimize the use and impact of this new tool. This study describes the development of a co-designed LCG implementation strategy in Karnataka, India.
Methods
A targeted literature review, primary research across four public maternity hospitals (provider survey and facility assessment), and a 2-day co-design workshop with stakeholders were conducted. Findings were mapped to six target behaviors using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation-Behavior (COM-B) model to identify potential barriers and facilitators to LCG use. Consultations with local stakeholders explored these factors, and a 1-week pilot informed final refinements of the strategy.
Results
The LCG implementation strategy comprised an evidence-based provider training program centered on “low dose, high frequency” principles, and monthly audit and feedback cycles, which in turn, relies on an enabling practice environment (supportive national policy frameworks, facility-level guidelines, external partnerships, senior support, defining provider roles and expectations and adequate equipment and resources) to support its implementation.
Conclusion
Effective use of the LCG needs a robust, context-sensitive implementation strategy. We present the first evidence-based, co-designed LCG implementation strategy which can be used to support LCG dissemination and uptake.
{"title":"Developing a Co-Designed Strategy to Improve Labor Monitoring and Management in India Using the World Health Organization Labour Care Guide: A Mixed-Methods Formative Study","authors":"Elizabeth Armari, Sunil S. Vernekar, Yeshita Pujar, Veronica Pingray, Fernando Althabe, Luz Gibbons, Mabel Berrueta, Alvaro Ciganda, Rocio Rodriguez, Jayashree Ashok Kumar, Shruti Bhavi Patil, Aravind Karinagannanavar, Raveendra R. Anteen, Pavithra M. R., Savitri Bendigeri, Shukla Shetty, B. Latha, Megha H. M., Suman S. Gaddi, Shaila Chikkagowdra, Bellara Raghavendra, Caroline S. E. Homer, Manjunath Somannavar, Shivaprasad S. Goudar, Joshua P. Vogel","doi":"10.1111/birt.70004","DOIUrl":"10.1111/birt.70004","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Nearly half of all perinatal deaths occur during the intrapartum period due to inadequate labor monitoring and intervention. The partograph, a paper-based labor monitoring tool, can assist providers in recognizing and acting on early signs of fetal–maternal distress if used effectively. In 2020, the World Health Organization (WHO) developed a “next generation” partograph called the Labour Care Guide. There is limited evidence of how to optimize the use and impact of this new tool. This study describes the development of a co-designed LCG implementation strategy in Karnataka, India.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A targeted literature review, primary research across four public maternity hospitals (provider survey and facility assessment), and a 2-day co-design workshop with stakeholders were conducted. Findings were mapped to six target behaviors using the Theoretical Domains Framework (TDF) and the Capability, Opportunity, and Motivation-Behavior (COM-B) model to identify potential barriers and facilitators to LCG use. Consultations with local stakeholders explored these factors, and a 1-week pilot informed final refinements of the strategy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The LCG implementation strategy comprised an evidence-based provider training program centered on “low dose, high frequency” principles, and monthly audit and feedback cycles, which in turn, relies on an enabling practice environment (supportive national policy frameworks, facility-level guidelines, external partnerships, senior support, defining provider roles and expectations and adequate equipment and resources) to support its implementation.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Effective use of the LCG needs a robust, context-sensitive implementation strategy. We present the first evidence-based, co-designed LCG implementation strategy which can be used to support LCG dissemination and uptake.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"120-128"},"PeriodicalIF":2.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.70004","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838616","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}
Lauri M. M. van den Berg, Jens Henrichs, Jeroen van Dillen, Soo Downe, Corine Verhoeven, Ank de Jonge
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.
本研究旨在比较英国（UK）和荷兰（NL）的分娩经历，并确定两国积极分娩经历的决定因素。方法：2017年1月至2020年12月期间在英国（n = 1303）或英国（n = 900）分娩的妇女（n = 900）填写了横断面婴儿出生更好的调查。完全调整的逻辑回归模型被用来评估两国之间积极分娩经历的几率差异。进行了分层逻辑回归分析，以确定积极分娩经历的决定因素，包括社会人口因素、妊娠和分娩结局以及与护理相关的决定因素。结果：与NL受访者相比，在英国分娩的受访者积极分娩经历的几率降低（66%对85%，AOR 0.45, CI 0.35-0.57）。积极分娩经历的重要决定因素是多胎、无妊娠并发症、自然阴道分娩和在家分娩。在调整混杂因素后，计划剖腹产的英国受访者报告积极分娩经历的可能性更高。在英国，有医生作为初级分娩保健提供者不太可能与积极的分娩经历联系在一起。结论：美国和英国的大多数女性都报告了积极的分娩经历，但美国的受访者更有可能这样做。积极的分娩经历的决定因素主要是与简单的分娩和分娩有关的因素，或者与完成的选择和多胞胎有关。
{"title":"Childbirth Experiences in the United Kingdom Compared to the Netherlands: A Cross-Sectional Survey Study","authors":"Lauri M. M. van den Berg, Jens Henrichs, Jeroen van Dillen, Soo Downe, Corine Verhoeven, Ank de Jonge","doi":"10.1111/birt.70006","DOIUrl":"10.1111/birt.70006","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Women who gave birth in the UK (<i>n</i> = 1303) or the NL (<i>n</i> = 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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"129-138"},"PeriodicalIF":2.5,"publicationDate":"2025-08-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.70006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144838615","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}
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.
{"title":"Consensus Guidelines for Intermittent Auscultation in United States Community Birth Settings","authors":"Silke Akerson, Sarah Bradbury, Rosanna Davis, Wendy Gordon, Amy Romano, Holly Scholles","doi":"10.1111/birt.70002","DOIUrl":"10.1111/birt.70002","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Develop and disseminate consensus standards for intermittent auscultation in the community birth setting in the United States.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methodology</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"100-107"},"PeriodicalIF":2.5,"publicationDate":"2025-07-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12894500/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144562075","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}
Hannah de Klerk, Janneke Gitsels, Ank de Jonge, Elsa Montgomery, Janneke van't Hooft, Marit van der Pijl, Martine Hollander, Corine Verhoeven
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.
背景：性暴力（SV）史与各种出生结局有关。然而，这些关联的潜在机制尚未得到充分解释。向产科保健提供者披露SV病史可能在产科保健提供者选择分娩干预措施和妇女分娩经验方面发挥重要作用。方法：在全国范围内对填写问卷前5年内生育的妇女进行横断面调查。采用Logistic回归分析比较SV史（总、公开和未公开）与出生结果之间的关系。结果：在10867名受访者中，1121名（10.3%）报告了性侵犯，其中582名（52%）向产科保健提供者披露了性侵犯。有SV病史的被调查者比没有SV病史的被调查者进行会阴切开术的调整后几率更低（调整后优势比[AOR] 0.71, 95%可信区间[95% CI] 0.56-0.90）。与自然分娩（OR 1.37, 95% CI 1.04-1.81）和辅助阴道分娩（OR 1.75, 95% CI 1.17-2.61）相比，披露其SV史的初产妇发生计划外剖宫产的几率更高。无论是公开的还是未公开的SV史的初产应答者均增加了负出生的调整后几率（AOR 1.78, 95% CI 1.50-2.12）。在产科医生主导的护理、家庭分娩、早产和药物疼痛缓解方面，两组之间没有差异。结论：当人们透露他们的SV病史时，产科护理提供者不太可能进行外阴切开术，更有可能选择计划外剖宫产而不是阴道分娩。然而，披露SV史并不能改善分娩体验，因此我们建议对有SV史的妇女更好地实施创伤知情分娩支持。
{"title":"Birth Outcomes After Sexual Violence and the Role of Disclosure to the Maternity Care Provider","authors":"Hannah de Klerk, Janneke Gitsels, Ank de Jonge, Elsa Montgomery, Janneke van't Hooft, Marit van der Pijl, Martine Hollander, Corine Verhoeven","doi":"10.1111/birt.70001","DOIUrl":"10.1111/birt.70001","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>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.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"53 1","pages":"88-99"},"PeriodicalIF":2.5,"publicationDate":"2025-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.70001","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144546266","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}
Episiotomy is still commonly practiced during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increased risk of serious maternal morbidity and no improvements in neonatal outcomes. We sought to analyze this gap between evidence-based knowledge and implementation surrounding reducing episiotomy practice. We systematically reviewed the literature to identify practices that have resulted in a change in episiotomy rates.
Methods
We searched three databases (PubMed/MEDLINE, CINAHL Complete, Embase) using key words and subject headings with no time restriction. Any studies published in English and reporting an original empirical analysis in any global, regional, or country-specific context that examined practice changes that were implemented and reported episiotomy as an outcome were included in our review. Studies were excluded if they only reported on trends or changes in episiotomy rates without examining the specific practices implemented. We sought to identify practices that resulted in a change in episiotomy rates, rather than to evaluate or compare the effectiveness of these practices.
Results
Search results returned 1265 records; 40 papers met the inclusion criteria for a full review. Twenty-five papers were included in our final analysis. All included studies documented a decrease in episiotomy rates, with 21 studies reporting a statistically significant reduction. Most studies were mixed interventions, often a combination of an educational intervention and audit and feedback.
Conclusions
Specific practice changes have been shown to effectively decrease the incidence of episiotomy. The findings from our review provide actionable insights for implementing evidence-based interventions to improve obstetric care. Prioritizing respectful birthing practices and reducing the routine use of episiotomy are critical steps toward addressing obstetric violence and promoting equitable, patient-centered maternity care globally.
{"title":"Interventions and Strategies for Reducing Episiotomy Rates Globally: A Systematic Review","authors":"Angela W. Chen, Maiah J. Hall, Molly R. Altman","doi":"10.1111/birt.70000","DOIUrl":"10.1111/birt.70000","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Episiotomy is still commonly practiced during childbirth worldwide, despite decades of scientific evidence that indicates no justification for its routine use. Routine episiotomy is associated with increased risk of serious maternal morbidity and no improvements in neonatal outcomes. We sought to analyze this gap between evidence-based knowledge and implementation surrounding reducing episiotomy practice. We systematically reviewed the literature to identify practices that have resulted in a change in episiotomy rates.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We searched three databases (PubMed/MEDLINE, CINAHL Complete, Embase) using key words and subject headings with no time restriction. Any studies published in English and reporting an original empirical analysis in any global, regional, or country-specific context that examined practice changes that were implemented and reported episiotomy as an outcome were included in our review. Studies were excluded if they only reported on trends or changes in episiotomy rates without examining the specific practices implemented. We sought to identify practices that resulted in a change in episiotomy rates, rather than to evaluate or compare the effectiveness of these practices.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Search results returned 1265 records; 40 papers met the inclusion criteria for a full review. Twenty-five papers were included in our final analysis. All included studies documented a decrease in episiotomy rates, with 21 studies reporting a statistically significant reduction. Most studies were mixed interventions, often a combination of an educational intervention and audit and feedback.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Specific practice changes have been shown to effectively decrease the incidence of episiotomy. The findings from our review provide actionable insights for implementing evidence-based interventions to improve obstetric care. Prioritizing respectful birthing practices and reducing the routine use of episiotomy are critical steps toward addressing obstetric violence and promoting equitable, patient-centered maternity care globally.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"52 4","pages":"539-552"},"PeriodicalIF":2.5,"publicationDate":"2025-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144477969","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}
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