Medicine › Obstetrics and Gynecology

Maternal and Perinatal Health Interventions

Works Count: 66441

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This cluster of papers explores the maternal and neonatal outcomes associated with cesarean section delivery, including its comparison with vaginal birth, the impact of labor induction, the influence of maternal age, and the experiences of childbirth. It also delves into post-traumatic stress disorder following childbirth, the role of midwifery care, and global trends in cesarean section rates.

Keywords

Cesarean Section; Vaginal Birth; Maternal Outcomes; Perinatal Outcomes; Labor Induction; Maternal Age; Childbirth Experience; Post-Traumatic Stress Disorder; Midwifery Care; Global Trends

Induction of labour for improving birth outcomes for women at or beyond term

2018-05-09

Philippa Middleton , Emily Shepherd , Caroline A Crowther

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Preventing the First Cesarean Delivery

2012-11-01

Catherine Y. Spong , Vincenzo Berghella , Katharine D. Wenstrom +2 more

With more than one third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver … With more than one third of pregnancies in the United States being delivered by cesarean and the growing knowledge of morbidities associated with repeat cesarean deliveries, the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the Society for Maternal-Fetal Medicine, and the American College of Obstetricians and Gynecologists convened a workshop to address the concept of preventing the first cesarean delivery. The available information on maternal and fetal factors, labor management and induction, and nonmedical factors leading to the first cesarean delivery was reviewed as well as the implications of the first cesarean delivery on future reproductive health. Key points were identified to assist with reduction in cesarean delivery rates including that labor induction should be performed primarily for medical indication; if done for nonmedical indications, the gestational age should be at least 39 weeks or more and the cervix should be favorable, especially in the nulliparous patient. Review of the current literature demonstrates the importance of adhering to appropriate definitions for failed induction and arrest of labor progress. The diagnosis of “failed induction” should only be made after an adequate attempt. Adequate time for normal latent and active phases of the first stage, and for the second stage, should be allowed as long as the maternal and fetal conditions permit. The adequate time for each of these stages appears to be longer than traditionally estimated. Operative vaginal delivery is an acceptable birth method when indicated and can safely prevent cesarean delivery. Given the progressively declining use, it is critical that training and experience in operative vaginal delivery are facilitated and encouraged. When discussing the first cesarean delivery with a patient, counseling should include its effect on future reproductive health.

Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study

2011-11-23

Peter Brocklehurst , Pollyanna Hardy , Jennifer Hollowell +7 more

Objective To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design … Objective To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design Prospective cohort study. Setting England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units. Participants 64 538 eligible women with a singleton, term (≥37 weeks gestation), and “booked” pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. Main outcome measure A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units). Results There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%). Conclusions The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

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Improving the Delivery of Prenatal Care and Outcomes of Pregnancy: A Randomized Trial of Nurse Home Visitation

1986-01-01

David L. Olds , Charles Henderson , Robert Tatelbaum +1 more

We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to … We evaluated a comprehensive program of prenatal and postpartum nurse home visitation. The program was designed to prevent a wide range of health and developmental problems in children born to primiparous women who were either teenagers, unmarried, or of low socioeconomic status. During pregnancy, women who were visited by nurses, compared with women randomly assigned to comparison groups, became aware of more community services; attended childbirth classes more frequently; made more extensive use of the nutritional supplementation program for women, infants, and children; made greater dietary improvements; reported that their babies' fathers became more interested in their pregnancies; were accompanied to the hospital by a support person during labor more frequently; reported talking more frequently to family members, friends, and service providers about their pregnancies and personal problems; and had fewer kidney infections. Positive effects of the program on birth weight and length of gestation were present for the offspring of young adolescents (less than 17 years of age) and smokers. In contrast to their comparison-group counterparts, young adolescents who were visited by nurses gave birth to newborns who were an average of 395 g heavier, and women who smoked and were visited by nurses exhibited a 75% reduction in the incidence of preterm delivery. (P less than or equal to .05 for all findings.)

The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review

2015-06-30

Meghan A. Bohren , Joshua P. Vogel , Erin Hunter +7 more

Background Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are … Background Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon. Methods and Findings We searched PubMed, CINAHL, and Embase databases and grey literature using a predetermined search strategy to identify qualitative, quantitative, and mixed-methods studies on the mistreatment of women during childbirth across all geographical and income-level settings. We used a thematic synthesis approach to synthesize the qualitative evidence and assessed the confidence in the qualitative review findings using the CERQual approach. In total, 65 studies were included from 34 countries. Qualitative findings were organized under seven domains: (1) physical abuse, (2) sexual abuse, (3) verbal abuse, (4) stigma and discrimination, (5) failure to meet professional standards of care, (6) poor rapport between women and providers, and (7) health system conditions and constraints. Due to high heterogeneity of the quantitative data, we were unable to conduct a meta-analysis; instead, we present descriptions of study characteristics, outcome measures, and results. Additional themes identified in the quantitative studies are integrated into the typology. Conclusions This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels. We propose this typology be adopted to describe the phenomenon and be used to develop measurement tools and inform future research, programs, and interventions.

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<scp>WHO</scp> Statement on Caesarean Section Rates

2015-07-22

Ana Pilar Betrán , MR Torloni , JJ Zhang +1 more

In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment … In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment was considered an unjustified and remarkable increase of caesarean section (CS) rates worldwide.1 Based on the evidence available at that time, the experts in Fortaleza concluded: 'there is no justification for any region to have a caesarean section rate higher than 10–15%'.1 Over the years, this quote has become ubiquitous in scientific literature, being interpreted as the ideal CS rate. Although this reference range was intended for 'populations', which are defined by geopolitical boundaries, in many instances it has been mistakenly used as the measurement for healthcare facilities regardless of their complexity or other characteristics. In addition to the case mix of the obstetric population served, the use of CS at healthcare facilities is also affected by factors such as their capacity to handle cases, availability of resource and the clinical management protocols used locally. Since its publication and for the last 30 years, this reference rate for CS has received intense criticism and has led to controversy, concern, polarised opinions and heated debates, while in parallel, the use of CS as a mode of delivery has continued its worrying rise worldwide. The need to revisit the recommended CS rate has been considered more and more necessary in view of the significant improvements in clinical obstetric care and in the methodology to assess evidence and issue recommendations in the last three decades. The global concern around CS rates is understandable. When medically justified, a CS can prevent maternal and perinatal mortality and morbidity. There is no evidence, however, showing the benefits of the procedure for women or infants where it is not required. CS is associated with short- and long-term risk, which can extend beyond the current delivery and affect future pregnancies. In addition, the increase in CS rates seems uncontrollable, with no signs that it is slowing down. The situation is aggravated by the fact that the causes of the rise are not fully understood but emerge as a complex multifactorial labyrinth involving health systems, health care providers, women, societies, and even fashion and media.2-6 Lastly, non-clinical interventions to reduce unnecessary CS have shown limited effectiveness to date.7 In light of these issues, WHO convened a meeting in Geneva, Switzerland, on 8–9 October 2014 with the objective of (1) establishing the current WHO position on the CS rate or range for optimal maternal and perinatal outcomes at population level, and (2) agreeing on a proposal for a tool to monitor CS rates at facility level. The Statement on Caesarean Section Rates recently released by WHO summarises the results of the systematic reviews and analyses conducted for this purpose and conveys the thinking emerging from the discussions of the meeting.8 A systematic review and an ecological analysis were performed and concluded that at population level, CS rates higher than 10% were not associated with reductions in maternal and newborn mortality rates.9, 10 The Statement notes, however, that the association between CS rates and other relevant outcomes such as stillbirths, maternal and perinatal morbidity, paediatric outcomes and psychological or social well-being could not be determined due to the lack of data on these other outcomes at the population level. This lack of data represents a limitation of these analyses that needs to be borne in mind. Beyond numbers and rates, the Statement emphasises that the critical role played by the quality of care in this equation cannot be overstated. As with any surgery, CS is associated with short- and long-term risks, particularly in settings that lack the facilities or capacity to conduct safe surgery or treat surgical complications properly, or where access to labour care or repeat CS in subsequent pregnancies cannot be taken for granted. On the other hand, inadequate access to timely CS may result in perinatal asphyxia, stillbirth, uterine rupture or obstetric fistula, a marker for exceptionally prolonged, obstructed labour.11 Thus, CS should be undertaken when medically necessary, and rather than striving to achieve a specific rate, efforts should focus on providing caesarean section to all women in need. How to define the woman 'in need' can only be ascertained by the health care providers caring for the woman on a case-by-case basis. Most importantly, at the healthcare facility level, clinicians and administrators struggle to monitor CS rates in a meaningful, reliable and action-oriented manner. Historically, caesarean sections have often been categorised using its indications as the unit being classified. Using indications to classify CS has always been problematic due to the lack of uniform definitions for most common indications and has resulted in poor reproducibility and unsatisfactory comparisons.12 In 2001, Dr Michael Robson proposed a system of 10 groups that classifies all women admitted for delivery (and not indications) according to five obstetric characteristics that are generally routinely collected in most maternities.13 Two systematic reviews conducted at WHO identified this classification as the most appropriate system to fulfil current international and local needs.12, 14 The WHO Statement proposes the use of the Robson classification as the global standard for assessing, monitoring and comparing CS rates within healthcare facilities over time, and between facilities. In the last decade, this classification has witnessed an extraordinary expansion in its use worldwide, particularly in healthcare facilities, due to its intrinsic appealing characteristics: simplicity of design, validity of purpose, ease of implementation and directness of initial interpretation.14 WHO envisions that the information stemming from the classification can be a powerful tool to inform practice. The classification will allow not only for stratification of CS rates in more uniform groups of women but also the assessment of CS rates in relation to other perinatal outcomes and processes (e.g. rates of oxytocin usage, postpartum haemorrhage, newborn outcomes, length of labour). WHO will guide and support countries in the use, implementation and interpretation of the classification so that we can start comparing CS rates in a meaningful, targeted, transparent and useful manner. By endorsing the Robson classification, this Statement should become a catalyst for action. The time has come to put the debate about the preferable rate of CS on hold. Let's start to collect data uniformly so that in the near future we will be able to move our focus from CS rates at population level to monitoring and discussing CS rates and outcomes in each group of the Robson classification. Only then will we have the data and evidence that will lead us more clearly to actions to improve care.15 Ultimately, we hope the debate can recommence with more valuable, solid and informative data to support our discussions. None declared. Completed disclosure of interests form available to view online as supporting information. All authors contributed to the writing of the commentary. This commentary has been written without any external funding. No ethical approval was sought for the writing of this commentary. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or policies of the World Health Organization or other organizations. WHO Working Group on Caesarean Section: HA Aleem (Department of Obstetrics and Gynecology, Women's Health Center, Assiut University Hospital, Assiut, Egypt), F Althabe (Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina), T Bergholt (Department of Obstetrics, University of Copenhagen, Copenhagen, Denmark), L de Bernis (United Nations Population Fund, Geneva, Switzerland), G Carroli (Centro Rosarino de Estudios Perinatales, Rosario, Argentina), C Deneux-Tharaux (INSERM U1153, Obstetrical, Perinatal and Pediatric Epidemiology Research Team, Center for Epidemiology and Statistics Sorbonne Paris Cité, Paris Descartes University, Paris, France), R Devlieger (UZLeuven, Campus Gasthuisberg, Department of Obstetrics and Gynecology, Leuven, Belgium), S Debonnet (International Confederation of Midwives, 2517 AN The Hague, the Netherlands), T Duan (Shanghai No.1 Maternal & Infant Health Hospital, Shanghai, China), C Hanson [International Federation of Gynecology & Obstetrics (FIGO), London, UK], J Hofmeyr (Department of Health, Effective Care Research Unit, University of Fort Hare, East London, Eastern Cape, South Africa), R Gonzalez Pérez (Department of Maternal and Gynaecological Health, Pontificia Universidad Catolica de Chile, Santiago de Chile, Chile), A de Jonge (Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Center, Amsterdam, the Netherlands), K Khan (Women's Health Research Unit, Multi-disciplinary Evidence Synthesis Hub, The Blizard Institute, London, UK), S Lansky (Ministry of Health, Belo Horizonte Minas Gerais, Brazil), G Lazdane (WHO Regional Office for Europe, Copenhagen, Denmark), P Lumbiganon (Department of Obstetrics and Gynecology, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand), D Mackeen (Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, Geisimger Health System, Danville, PA, USA), R Mahaini (WHO Office for the Eastern Mediterranean Region, Cairo, Egypt), S Manyame (Department of Obstetrics & Gynaecology, Harare Hospital & University of Zimbabwe, Harare, Zimbabwe), M Mathai (Department of Maternal and Child Health, World Health Organization, Geneva, Switzerland), R Mikolajczyk (ESME – Epidemiological and Statistical Methods Research Group, Helmholtz Centre for Infection Research, Braunschweig, Germany), R Mori (Department of Health Policy, National Center for Child Health and Development, Tokyo, Japan), B De Mucio (Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), WHO Regional Office for the Americas, Montevideo, Uruguay), OT Oladapo (UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland), E Ortiz-Panozo (Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico), L Ouedraogo (WHO Regional Office for Africa, Brazzaville, Congo), C Parker (Obstetrics and Gyneacology Department, Baragwanath Maternity Hospital, Johannesburg, South Africa), M Robson (National Maternity Hospital, Dublin, Ireland), S Serruya (Latin American Center for Perinatology, Women and Reproductive Health (CLAP/WR), WHO Regional Office for the Americas, Montevideo, Uruguay), JP Souza [Department of Social Medicine, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto (SP), Brazil], CY Spong (Deputy Director, Eunice Kennedy Shriver National Institute of Child Health and Human Development National Institutes of Health, Bethesda, MD, USA), C Stanton (Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA), ME Stanton (USAID, Washington DC, USA), EA Sullivan (Faculty of Health, University of Technology, Sydney, Australia), M Temmerman (UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland), A Tita (Department of Obstetrics and Gynecology, Division of Maternal–Fetal Medicine, University of Alabama at Birmingham, Birmingham, AL, USA), Ӧ Tunçalp (UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland), P Velebil (Perinatal Center of the Institute for the Care of Mother and Child, Prague, Czech Republic), JP Vogel (UNDP-UNFPA-UNICEF-WHO-World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO, Geneva, Switzerland), M Weber (WHO Regional Office for Europe, Copenhagen, Denmark), D Wojdyla (Duke Clinical Research Institute, Durham, NC, USA), J Ye (Ministry of Education–Shanghai Key Laboratory of Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China), K Yunis (Department of Pediatrics & Adolescent, Medicine and Department of Pediatrics, American University of Beirut, Beirut, Lebanon), J Zamora (Clinical Biostatistics Unit, Hospital Ramón y Cajal, Madrid, Spain), A Zongo (Research Institute for Development, Université Paris Descartes, Sorbonne Paris Cité, UMR 216, Paris, France and Direction de la santé de la famille, Ministère de la Santé, Ouagadougou, Burkina Faso) Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

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Effective Care in Pregnancy and Childbirth

1990-09-01

Edward R. Newton

Pain and women's satisfaction with the experience of childbirth: A systematic review

2002-05-01

Ellen Hodnett

Caesarean delivery rates and pregnancy outcomes: the 2005 WHO global survey on maternal and perinatal health in Latin America

2006-05-25

José Villar , Eliette Valladares , Daniel Wojdyla +7 more

Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care

2014-06-22

Mary J. Renfrew , Alison McFadden , Maria Helena Bastos +7 more

Risk of Uterine Rupture during Labor among Women with a Prior Cesarean Delivery

2001-07-05

Mona T. Lydon‐Rochelle , Victoria L. Holt , Thomas R. Easterling +1 more

Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may … Each year in the United States, approximately 60 percent of women with a prior cesarean delivery who become pregnant again attempt labor. Concern persists that a trial of labor may increase the risk of uterine rupture, an uncommon but serious obstetrical complication.

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Safe prevention of the primary cesarean delivery

2014-02-22

Aaron B. Caughey , Alison G. Cahill , Jeanne‐Marie Guise +1 more

Birth as an American rite of passage

1993-03-01

Robbie Davis‐Floyd

Why do so many American women allow themselves to become enmeshed in the standardized routines of technocratic childbirth - routines that can be insensitive, unnecessary and even unhealthy? And why, … Why do so many American women allow themselves to become enmeshed in the standardized routines of technocratic childbirth - routines that can be insensitive, unnecessary and even unhealthy? And why, in spite of the natural childbirth movement, has hospital birth become even more intensively technologized? Robbie Davis-Floyd argues that these obstetrical procedures are rituals that enact the core values of American society. Hospital birth, she says, is a rite of passage that reflects and transmits our cultural belief in the superiority of science over nature, machines over bodies, men over women, institutions over individuals. Most women hold these beliefs, and therefore choose such births. Davis-Floyd's interviews with mothers and health care professionals, interpreted from the perspective of symbolic anthropology, reveal both the trauma and the satisfaction women derive from technocratic birth. The author also explores the ritual socialization of obstetricians, showing how their beliefs and choices, too, are culturally constructed. Pointing to the advantages women can gain from technocratic birth, Davis-Floyd also calls for greater cultural and medical tolerance of the alternative beliefs and rituals of home-birthers. Only when the phenomenon of technocratic childbirth is fully understood can women's birth choices be consciously made.

Comparison of a Trial of Labor with an Elective Second Cesarean Section

1996-09-05

Michael McMahon , E.R. Luther , Watson Bowes +1 more

In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a trial … In an attempt to reduce the rate of cesarean section, obstetricians now offer a trial of labor to pregnant women who have had a previous cesarean section. Although a trial of labor is usually successful and is relatively safe, few studies have directly addressed the maternal and perinatal morbidity and mortality associated with this method of delivery.

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The Risks of Lowering the Cesarean-Delivery Rate

1999-01-07

Benjamin P. Sachs , CINDY GAIL KOBELIN , M. A. Castro +1 more

In 1995, the rate of cesarean delivery in the United States was 21 percent.1 The goal of Healthy People 2000, a project of the Department of Health and Human Services, … In 1995, the rate of cesarean delivery in the United States was 21 percent.1 The goal of Healthy People 2000, a project of the Department of Health and Human Services, is to reduce this rate to 15 percent by the year 2000.2 The advantages of a safe vaginal delivery over a cesarean delivery are clear: a vaginal delivery is associated with lower maternal and neonatal morbidity, and it costs less. We contend that these advantages apply only to safe vaginal deliveries and that reducing the rate of cesarean delivery may lead to higher costs and more complications for mothers and . . .

Obstetric Care Consensus No. 1

2014-02-20

Gynecologists

ACOG.org ACOG Clinical Green Journal For Patients Store ACOG.org ACOG Clinical Green Journal For Parents Store ACOG.org ACOG Clinical Green Journal For Patients Store ACOG.org ACOG Clinical Green Journal For Parents Store

Maternal Morbidity Associated With Multiple Repeat Cesarean Deliveries

2006-06-01

Robert M. Silver , Mark B. Landon , Dwight J. Rouse +7 more

Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate … Although repeat cesarean deliveries often are associated with serious morbidity, they account for only a portion of abdominal deliveries and are overlooked when evaluating morbidity. Our objective was to estimate the magnitude of increased maternal morbidity associated with increasing number of cesarean deliveries.Prospective observational cohort of 30,132 women who had cesarean delivery without labor in 19 academic centers over 4 years (1999-2002).There were 6,201 first (primary), 15,808 second, 6,324 third, 1,452 fourth, 258 fifth, and 89 sixth or more cesarean deliveries. The risks of placenta accreta, cystotomy, bowel injury, ureteral injury, and ileus, the need for postoperative ventilation, intensive care unit admission, hysterectomy, and blood transfusion requiring 4 or more units, and the duration of operative time and hospital stay significantly increased with increasing number of cesarean deliveries. Placenta accreta was present in 15 (0.24%), 49 (0.31%), 36 (0.57%), 31 (2.13%), 6 (2.33%), and 6 (6.74%) women undergoing their first, second, third, fourth, fifth, and sixth or more cesarean deliveries, respectively. Hysterectomy was required in 40 (0.65%) first, 67 (0.42%) second, 57 (0.90%) third, 35 (2.41%) fourth, 9 (3.49%) fifth, and 8 (8.99%) sixth or more cesarean deliveries. In the 723 women with previa, the risk for placenta accreta was 3%, 11%, 40%, 61%, and 67% for first, second, third, fourth, and fifth or more repeat cesarean deliveries, respectively.Because serious maternal morbidity increases progressively with increasing number of cesarean deliveries, the number of intended pregnancies should be considered during counseling regarding elective repeat cesarean operation versus a trial of labor and when debating the merits of elective primary cesarean delivery.II-2.

Maternal and neonatal individual risks and benefits associated with caesarean delivery: multicentre prospective study

2007-10-30

José Villar , Guillermo Carroli , Nelly Zavaleta +7 more

Objective To assess the risks and benefits associated with caesarean delivery compared with vaginal delivery. Design Prospective cohort study within the 2005 WHO global survey on maternal and perinatal health. … Objective To assess the risks and benefits associated with caesarean delivery compared with vaginal delivery. Design Prospective cohort study within the 2005 WHO global survey on maternal and perinatal health. Setting 410 health facilities in 24 areas in eight randomly selected Latin American countries; 123 were randomly selected and 120 participated and provided data Participants 106 546 deliveries reported during the three month study period, with data available for 97 095 (91% coverage). Main outcome measures Maternal, fetal, and neonatal morbidity and mortality associated with intrapartum or elective caesarean delivery, adjusted for clinical, demographic, pregnancy, and institutional characteristics. Results Women undergoing caesarean delivery had an increased risk of severe maternal morbidity compared with women undergoing vaginal delivery (odds ratio 2.0 (95% confidence interval 1.6 to 2.5) for intrapartum caesarean and 2.3 (1.7 to 3.1) for elective caesarean). The risk of antibiotic treatment after delivery for women having either type of caesarean was five times that of women having vaginal deliveries. With cephalic presentation, there was a trend towards a reduced odds ratio for fetal death with elective caesarean, after adjustment for possible confounding variables and gestational age (0.7, 0.4 to 1.0). With breech presentation, caesarean delivery had a large protective effect for fetal death. With cephalic presentation, however, independent of possible confounding variables and gestational age, intrapartum and elective caesarean increased the risk for a stay of seven or more days in neonatal intensive care (2.1 (1.8 to 2.6) and 1.9 (1.6 to 2.3), respectively) and the risk of neonatal mortality up to hospital discharge (1.7 (1.3 to 2.2) and 1.9 (1.5 to 2.6), respectively), which remained higher even after exclusion of all caesarean deliveries for fetal distress. Such increased risk was not seen for breech presentation. Lack of labour was a risk factor for a stay of seven or more days in neonatal intensive care and neonatal mortality up to hospital discharge for babies delivered by elective caesarean delivery, but rupturing of membranes may be protective. Conclusions Caesarean delivery independently reduces overall risk in breech presentations and risk of intrapartum fetal death in cephalic presentations but increases the risk of severe maternal and neonatal morbidity and mortality in cephalic presentations.

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A Negative Birth Experience: Prevalence and Risk Factors in a National Sample

2004-03-01

Ulla Waldenström , Ingegerd Hildingsson , Christine Rubertsson +1 more

A woman's dissatisfaction with the experience of labor and birth may affect her emotional well-being and willingness to have another baby. The aim of this study was to investigate the … A woman's dissatisfaction with the experience of labor and birth may affect her emotional well-being and willingness to have another baby. The aim of this study was to investigate the prevalence and risk factors of a negative birth experience in a national sample.A longitudinal cohort study of 2541 women recruited from all antenatal clinics in Sweden during 3 weeks spread over 1 year was conducted. Data were collected by three questionnaires, which measured women's global experience of labor and birth 1 year after the birth, and obtained information on possible risk factors during pregnancy and 2 months after the birth.Seven percent of the women had a negative birth experience. The following risk factors were found: (1) factors related to unexpected medical problems, such as emergency operative delivery, induction, augmentation of labor, and infant transfer to neonatal care; (2) factors related to the woman's social life, such as unwanted pregnancy and lack of support from partner; (3) factors related to the woman's feelings during labor, such as pain and lack of control; and (4) factors that may be easier to influence by the caregivers, such as insufficient time allocated to the woman's own questions at antenatal checkups, lack of support during labor, and administration of obstetric analgesia.Many risk factors were related to unexpected medical problems and participants' social background. Of the established methods to improve women's birth experience, childbirth education and obstetric analgesia seemed to be less effective, whereas support in labor and listening to the woman's own issues may be underestimated.

Use of the Robson classification to assess caesarean section trends in 21 countries: a secondary analysis of two WHO multicountry surveys

2015-04-11

Joshua P. Vogel , Ana Pilar Betrán , Nadia Vindevoghel +7 more

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Midwife-led versus other models of care for childbearing women

2008-10-08

Marie Hatem , Jane Sandall , Declan Devane +2 more

Background Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and … Background Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife‐led and other models of care. Objectives To compare midwife‐led models of care with other models of care for childbearing women and their infants. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (January 2008), Cochrane Effective Practice and Organisation of Care Group's Trials Register (January 2008), Current Contents (1994 to January 2008), CINAHL (1982 to August 2006), Web of Science, BIOSIS Previews, ISI Proceedings, (1990 to 2008), and the WHO Reproductive Health Library, No. 9. Selection criteria All published and unpublished trials in which pregnant women are randomly allocated to midwife‐led or other models of care during pregnancy, and where care is provided during the ante and intrapartum period in the midwife‐led model. Data collection and analysis All authors evaluated methodological quality. Two authors checked data extraction. Main results We included 11 trials (12,276 women). Women who had midwife‐led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96), and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), feeling in control during childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76), although there were no statistically significant differences between groups for caesarean births (RR 0.96, 95% CI 0.87 to 1.06). Women who were randomised to receive midwife‐led care were less likely to experience fetal loss before 24 weeks' gestation (RR 0.79, 95% CI 0.65 to 0.97), although there were no statistically significant differences in fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53) or in fetal/neonatal death overall (RR 0.83, 95% CI 0.70 to 1.00). In addition, their babies were more likely to have a shorter length of hospital stay (mean difference ‐2.00, 95% CI ‐2.15 to ‐1.85). Authors' conclusions Most women should be offered midwife‐led models of care and women should be encouraged to ask for this option although caution should be exercised in applying this advice to women with substantial medical or obstetric complications.

Factors related to childbirth satisfaction

2004-03-30

Petra Goodman , Marlene C. Mackey , Abbas Tavakoli

A woman's satisfaction with the childbirth experience may have immediate and long-term effects on her health and her relationship with her infant, but there is a lack of current research … A woman's satisfaction with the childbirth experience may have immediate and long-term effects on her health and her relationship with her infant, but there is a lack of current research in this area.This paper reports a study to examine multiple factors for their association with components of childbirth satisfaction and with the total childbirth experience.A correlational descriptive study was conducted with 60 low-risk postpartum women, aged 18-46 years, with uneventful vaginal deliveries of healthy full-term infants at two medical centres in the south-eastern United States. The Labor Agentry Scale, McGill Pain Questionnaire and Mackey Childbirth Satisfaction Rating Scale and a background questionnaire were completed by women. Obstetrical data were collected from the medical record.Personal control was a statistically significant predictor of total childbirth satisfaction (P = 0.0045) and with the subscale components of satisfaction (self, partner, baby, nurse, physician and overall). In addition, having expectations for labour and delivery met was a significant predictor of satisfaction with own performance during childbirth.Personal control during childbirth was an important factor related to the women's satisfaction with the childbirth experience. Helping women to increase their personal control during labour and birth may increase the women's childbirth satisfaction.

Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007–08

2010-01-12

Pisake Lumbiganon , Malinee Laopaiboon , A. Metin Gülmezoĝlu +7 more

Contemporary Patterns of Spontaneous Labor With Normal Neonatal Outcomes

2010-11-23

Jun Zhang , Helain J. Landy , D. Ware Branch +7 more

To use contemporary labor data to examine the labor patterns in a large, modern obstetric population in the United States. To use contemporary labor data to examine the labor patterns in a large, modern obstetric population in the United States.

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Midwife-led continuity models versus other models of care for childbearing women

2013-08-20

Jane Sandall , Hora Soltani , Simon Gates +2 more

Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, … Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care.To compare midwife-led continuity models of care with other models of care for childbearing women and their infants.We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies.All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth.Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach.We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence). Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.07; participants = 16,687; studies = 12; high quality). There were no differences between groups for caesarean births or intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (average RR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = four), episiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants = 17,674; studies = 14) and fetal loss less than 24 weeks and neonatal death (average RR 0.81, 95% CI 0.67 to 0.98; participants = 15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = seven), have a longer mean length of labour (hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = three) and more likely to be attended at birth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = seven). There were no differences between groups for fetal loss equal to/after 24 weeks and neonatal death, induction of labour, antenatal hospitalisation, antepartum haemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birthweight infant, five-minute Apgar score less than or equal to seven, neonatal convulsions, admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models.This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and all fetal loss/neonatal death associated with midwife-led continuity models of care.

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Risk of respiratory morbidity in term infants delivered by elective caesarean section: cohort study

2007-12-11

Anne Kirkeby Hansen , Kirsten Wisborg , Niels Uldbjerg +1 more

Objective To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections. Design Cohort study with prospectively collected data from … Objective To investigate the association between elective caesarean sections and neonatal respiratory morbidity and the importance of timing of elective caesarean sections. Design Cohort study with prospectively collected data from the Aarhus birth cohort, Denmark. Setting Obstetric department and neonatal department of a university hospital in Denmark. Participants All liveborn babies without malformations, with gestational ages between 37 and 41 weeks, and delivered between 1 January 1998 and 31 December 2006 (34 458 babies). Main outcome measures Respiratory morbidity (transitory tachypnoea of the newborn, respiratory distress syndrome, persistent pulmonary hypertension of the newborn) and serious respiratory morbidity (oxygen therapy for more than two days, nasal continuous positive airway pressure, or need for mechanical ventilation). Results 2687 infants were delivered by elective caesarean section. Compared with newborns intended for vaginal delivery, an increased risk of respiratory morbidity was found for infants delivered by elective caesarean section at 37 weeks’ gestation (odds ratio 3.9, 95% confidence interval 2.4 to 6.5), 38 weeks’ gestation (3.0, 2.1 to 4.3), and 39 weeks’ gestation (1.9, 1.2 to 3.0). The increased risks of serious respiratory morbidity showed the same pattern but with higher odds ratios: a fivefold increase was found at 37 weeks (5.0, 1.6 to16.0). These results remained essentially unchanged after exclusion of pregnancies complicated by diabetes, pre-eclampsia, and intrauterine growth retardation, or by breech presentation. Conclusion Compared with newborns delivered vaginally or by emergency caesarean sections, those delivered by elective caesarean section around term have an increased risk of overall and serious respiratory morbidity. The relative risk increased with decreasing gestational age.

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Caesarean section without medical indications is associated with an increased risk of adverse short-term maternal outcomes: the 2004-2008 WHO Global Survey on Maternal and Perinatal Health

2010-11-10

João Paulo Souza , AM Gülmezoglu , Pisake Lumbiganon +4 more

There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication … There is worldwide debate about the appropriateness of caesarean sections performed without medical indications. In this analysis, we aim to further investigate the relationship between caesarean section without medical indication and severe maternal outcomes. This is a multicountry, facility-based survey that used a stratified multistage cluster sampling design to obtain a sample of countries and health institutions worldwide. A total of 24 countries and 373 health facilities participated in this study. Data collection took place during 2004 and 2005 in Africa and the Americas and during 2007 and 2008 in Asia. All women giving birth at the facility during the study period were included and had their medical records reviewed before discharge from the hospital. Univariate and multilevel analysis were performed to study the association between each group's mode of delivery and the severe maternal and perinatal outcome. A total of 286,565 deliveries were analysed. The overall caesarean section rate was 25.7% and a total of 1.0 percent of all deliveries were caesarean sections without medical indications, either due to maternal request or in the absence of other recorded indications. Compared to spontaneous vaginal delivery, all other modes of delivery presented an association with the increased risk of death, admission to ICU, blood transfusion and hysterectomy, including antepartum caesarean section without medical indications (Adjusted Odds Ratio (Adj OR), 5.93, 95% Confidence Interval (95% CI), 3.88 to 9.05) and intrapartum caesarean section without medical indications (Adj OR, 14.29, 95% CI, 10.91 to 18.72). In addition, this association is stronger in Africa, compared to Asia and Latin America. Caesarean sections were associated with an intrinsic risk of increased severe maternal outcomes. We conclude that caesarean sections should be performed when a clear benefit is anticipated, a benefit that might compensate for the higher costs and additional risks associated with this operation.

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Maternal and Perinatal Outcomes Associated with a Trial of Labor after Prior Cesarean Delivery

2004-12-15

Mark B. Landon , John C. Hauth , Kenneth J. Leveno +7 more

The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety. The absolute and relative risks associated with a trial of … The proportion of women who attempt vaginal delivery after prior cesarean delivery has decreased largely because of concern about safety. The absolute and relative risks associated with a trial of labor in women with a history of cesarean delivery, as compared with elective repeated cesarean delivery without labor, are uncertain.

Continuous support for women during childbirth

2012-10-11

Ellen Hodnett , Simon Gates , G Justus Hofmeyr +1 more

Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine. Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine.

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Timing of Indicated Late-Preterm and Early-Term Birth

2011-07-21

Catherine Y. Spong , Brian M. Mercer , Mary E. D’Alton +3 more

The growing public health awareness of prematurity and its complications has prompted careful evaluation of the timing of deliveries by clinicians and hospitals. Preterm birth is associated with significant morbidity … The growing public health awareness of prematurity and its complications has prompted careful evaluation of the timing of deliveries by clinicians and hospitals. Preterm birth is associated with significant morbidity and mortality, and affects more than half a million births in the United States each year. In some situations, however, a late-preterm or early-term birth is the optimal outcome for the mother, child, or both owing to conditions that can result in worse outcomes if pregnancy is allowed to continue. These conditions may be categorized as placental, maternal, or fetal, including conditions such as placenta previa, preeclampsia, and multiple gestations. Some risks associated with early delivery are common to all conditions, including prematurity-related morbidities (eg, respiratory distress syndrome and intraventricular hemorrhage) as well as maternal intrapartum morbidities such as failed induction and cesarean delivery. However, when continuation of the pregnancy is associated with more risks such as hemorrhage, uterine rupture, and stillbirth, preterm delivery maybe indicated. In February 2011, the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Society for Maternal-Fetal Medicine held a workshop titled "Timing of Indicated Late Preterm and Early Term Births." The goal of the workshop was to synthesize the available information regarding conditions that may result in medically indicated late-preterm and early-term births to determine the potential risks and benefits of delivery compared with continued pregnancy, determine the optimal gestational age for delivery of affected pregnancies when possible, and inform future research regarding these issues. Based on available data and expert opinion, optimal timing for delivery for specific conditions was determined by consensus.

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Contemporary cesarean delivery practice in the United States

2010-08-13

Jun Zhang , James Troendle , Uma M. Reddy +7 more

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Planned caesarean section versus planned vaginal birth for breech presentation at term: a randomised multicentre trial

2000-10-01

Mary E. Hannah , Walter J. Hannah , Sheila Hewson +3 more

Maternal mortality and severe morbidity associated with low-risk planned cesarean delivery versus planned vaginal delivery at term

2007-02-12

S. Liu , Robert M. Liston , K.S. Joseph +3 more

The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women.Using the … The rate of elective primary cesarean delivery continues to rise, owing in part to the widespread perception that the procedure is of little or no risk to healthy women.Using the Canadian Institute for Health Information's Discharge Abstract Database, we carried out a retrospective population-based cohort study of all women in Canada (excluding Quebec and Manitoba) who delivered from April 1991 through March 2005. Healthy women who underwent a primary cesarean delivery for breech presentation constituted a surrogate "planned cesarean group" considered to have undergone low-risk elective cesarean delivery, for comparison with an otherwise similar group of women who had planned to deliver vaginally.The planned cesarean group comprised 46,766 women v. 2,292,420 in the planned vaginal delivery group; overall rates of severe morbidity for the entire 14-year period were 27.3 and 9.0, respectively, per 1000 deliveries. The planned cesarean group had increased postpartum risks of cardiac arrest (adjusted odds ratio [OR] 5.1, 95% confidence interval [CI] 4.1-6.3), wound hematoma (OR 5.1, 95% CI 4.6-5.5), hysterectomy (OR 3.2, 95% CI 2.2-4.8), major puerperal infection (OR 3.0, 95% CI 2.7-3.4), anesthetic complications (OR 2.3, 95% CI 2.0-2.6), venous thromboembolism (OR 2.2, 95% CI 1.5-3.2) and hemorrhage requiring hysterectomy (OR 2.1, 95% CI 1.2-3.8), and stayed in hospital longer (adjusted mean difference 1.47 d, 95% CI 1.46-1.49 d) than those in the planned vaginal delivery group, but a lower risk of hemorrhage requiring blood transfusion (OR 0.4, 95% CI 0.2-0.8). Absolute risk increases in severe maternal morbidity rates were low (e.g., for postpartum cardiac arrest, the increase with planned cesarean delivery was 1.6 per 1000 deliveries, 95% CI 1.2-2.1). The difference in the rate of in-hospital maternal death between the 2 groups was nonsignificant (p = 0.87).Although the absolute difference is small, the risks of severe maternal morbidity associated with planned cesarean delivery are higher than those associated with planned vaginal delivery. These risks should be considered by women contemplating an elective cesarean delivery and by their physicians.

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The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014

2016-02-05

Ana Pilar Betrán , Jianfeng Ye , Anne-Beth Moller +3 more

Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks … Caesarean section (CS) rates continue to evoke worldwide concern because of their steady increase, lack of consensus on the appropriate CS rate and the associated additional short- and long-term risks and costs. We present the latest CS rates and trends over the last 24 years.

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Indications Contributing to the Increasing Cesarean Delivery Rate

2011-06-04

Emma L. Barber , Lisbet S. Lundsberg , Kathleen Belanger +3 more

To examine physician-documented indications for cesarean delivery in order to investigate the specific factors contributing to the increasing cesarean delivery rate. To examine physician-documented indications for cesarean delivery in order to investigate the specific factors contributing to the increasing cesarean delivery rate.

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Continuous Support for Women During Childbirth

2005-03-01

Ellen Hodnett , Simon Gates , G Justus Hofmeyr +1 more

ABSTRACT Background: Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather … ABSTRACT Background: Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour. Objectives: Primary: to assess the effects, on mothers and their babies, of continuous, one‐to‐one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). Selection criteria: All published and unpublished randomized controlled trials comparing continuous support during labour with usual care. Data collection and analysis: Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. Main results: Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available. Reviewers’ conclusions: All women should have support throughout labour and birth. Citation: Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library , Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. ••• The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464‐780X) . The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons, Ltd .

Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes

2009-01-07

Alan T. Tita , Mark B. Landon , Catherine Y. Spong +7 more

Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective … Because of increased rates of respiratory complications, elective cesarean delivery is discouraged before 39 weeks of gestation unless there is evidence of fetal lung maturity. We assessed associations between elective cesarean delivery at term (37 weeks of gestation or longer) but before 39 weeks of gestation and neonatal outcomes.

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Midwives’ contribution to normal childbirth care. Cross-sectional study in public health Settings. MidconBirth Study protocol

2017-09-21

Ramón Escuriet , Laura García-Lausin , Isabel Salgado-Poveda +7 more

1. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue … 1. Sandall J, Soltani H, Gates S, Shennan A, Devane D. Midwife led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004667. doi: 10.1002/14651858.cd004667.pub3 CrossRef Google Scholar

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Long-term risks and benefits associated with cesarean delivery for mother, baby, and subsequent pregnancies: Systematic review and meta-analysis

2018-01-23

Oonagh Keag , Jane E. Norman , Sarah J. Stock

Background Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of … Background Cesarean birth rates continue to rise worldwide with recent (2016) reported rates of 24.5% in Western Europe, 32% in North America, and 41% in South America. The objective of this systematic review is to describe the long-term risks and benefits of cesarean delivery for mother, baby, and subsequent pregnancies. The primary maternal outcome was pelvic floor dysfunction, the primary baby outcome was asthma, and the primary subsequent pregnancy outcome was perinatal death. Methods and findings Medline, Embase, Cochrane, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases were systematically searched for published studies in human subjects (last search 25 May 2017), supplemented by manual searches. Included studies were randomized controlled trials (RCTs) and large (more than 1,000 participants) prospective cohort studies with greater than or equal to one-year follow-up comparing outcomes of women delivering by cesarean delivery and by vaginal delivery. Two assessors screened 30,327 abstracts. Studies were graded for risk of bias by two assessors using the Scottish Intercollegiate Guideline Network (SIGN) Methodology Checklist and the Risk of Bias Assessment tool for Non-Randomized Studies. Results were pooled in fixed effects meta-analyses or in random effects models when significant heterogeneity was present (I2 ≥ 40%). One RCT and 79 cohort studies (all from high income countries) were included, involving 29,928,274 participants. Compared to vaginal delivery, cesarean delivery was associated with decreased risk of urinary incontinence, odds ratio (OR) 0.56 (95% CI 0.47 to 0.66; n = 58,900; 8 studies) and pelvic organ prolapse (OR 0.29, 0.17 to 0.51; n = 39,208; 2 studies). Children delivered by cesarean delivery had increased risk of asthma up to the age of 12 years (OR 1.21, 1.11 to 1.32; n = 887,960; 13 studies) and obesity up to the age of 5 years (OR 1.59, 1.33 to 1.90; n = 64,113; 6 studies). Pregnancy after cesarean delivery was associated with increased risk of miscarriage (OR 1.17, 1.03 to 1.32; n = 151,412; 4 studies) and stillbirth (OR 1.27, 1.15 to 1.40; n = 703,562; 8 studies), but not perinatal mortality (OR 1.11, 0.89 to 1.39; n = 91,429; 2 studies). Pregnancy following cesarean delivery was associated with increased risk of placenta previa (OR 1.74, 1.62 to 1.87; n = 7,101,692; 10 studies), placenta accreta (OR 2.95, 1.32 to 6.60; n = 705,108; 3 studies), and placental abruption (OR 1.38, 1.27 to 1.49; n = 5,667,160; 6 studies). This is a comprehensive review adhering to a registered protocol, and guidelines for the Meta-analysis of Observational Studies in Epidemiology were followed, but it is based on predominantly observational data, and in some meta-analyses, between-study heterogeneity is high; therefore, causation cannot be inferred and the results should be interpreted with caution. Conclusions When compared with vaginal delivery, cesarean delivery is associated with a reduced rate of urinary incontinence and pelvic organ prolapse, but this should be weighed against the association with increased risks for fertility, future pregnancy, and long-term childhood outcomes. This information could be valuable in counselling women on mode of delivery.

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Labor Induction versus Expectant Management in Low-Risk Nulliparous Women

2018-08-08

William A. Grobman , Madeline Murguia Rice , Uma M. Reddy +7 more

The perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain. The perinatal and maternal consequences of induction of labor at 39 weeks among low-risk nulliparous women are uncertain.

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Short-term and long-term effects of caesarean section on the health of women and children

2018-10-01

Jane Sandall , Rachel M. Tribe , Lisa Avery +7 more

Global epidemiology of use of and disparities in caesarean sections

2018-10-01

Ties Boerma , Carine Ronsmans , Dessalegn Y. Melesse +7 more

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The Giving Voice to Mothers study: inequity and mistreatment during pregnancy and childbirth in the United States

2019-06-10

Saraswathi Vedam , Kathrin Stoll , Tanya Khemet Taiwo +7 more

Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with … Recently WHO researchers described seven dimensions of mistreatment in maternity care that have adverse impacts on quality and safety. Applying the WHO framework for quality care, service users partnered with NGOs, clinicians, and researchers, to design and conduct the Giving Voice to Mothers (GVtM)-US study.

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Pelvic Scoring for Elective Induction

2021-01-01

C. Sola Ajewole , Jodi Abbott

This article reviews the commonly known Bishop score and how it was derived from the Pelvic Scoring for Elective Induction study. The study observed women in spontaneous labor, their initial … This article reviews the commonly known Bishop score and how it was derived from the Pelvic Scoring for Elective Induction study. The study observed women in spontaneous labor, their initial cervical exams, as well as the development and implementation of pelvic scoring for labor induction. It reviews the components of the original Bishop score and compares it to a Simplified Bishop score and how their applications compare when determining the likelihood of success of vaginal delivery. It demonstrates how a cervix is determined to be favorable or unfavorable. This article includes a figure that displays time to delivery and the content is intended for providers in obstetrics and gynecology.

Trends and projections of caesarean section rates: global and regional estimates

2021-06-01

Ana Pilar Betrán , Jiangfeng Ye , Ann‐Beth Moller +2 more

Background The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. … Background The caesarean section (CS) rate continues to increase across high-income, middle-income and low-income countries. We present current global and regional CS rates, trends since 1990 and projections for 2030. Methods We obtained nationally representative data on the CS rate from countries worldwide from 1990 to 2018. We used routine health information systems reports and population-based household surveys. Using the latest available data, we calculated current regional and subregional weighted averages. We estimated trends by a piecewise analysis of CS rates at the national, regional and global levels from 1990 to 2018. We projected the CS rate and the number of CS expected in 2030 using autoregressive integrated moving-average models. Results Latest available data (2010–2018) from 154 countries covering 94.5% of world live births shows that 21.1% of women gave birth by caesarean worldwide, averages ranging from 5% in sub-Saharan Africa to 42.8% in Latin America and the Caribbean. CS has risen in all regions since 1990. Subregions with the greatest increases were Eastern Asia, Western Asia and Northern Africa (44.9, 34.7 and 31.5 percentage point increase, respectively) while sub-Saharan Africa and Northern America (3.6 and 9.5 percentage point increase, respectively) had the lowest rise. Projections showed that by 2030, 28.5% of women worldwide will give birth by CS (38 million caesareans of which 33.5 million in LMIC annually) ranging from 7.1% in sub-Saharan Africa to 63.4% in Eastern Asia . Conclusion The use of CS has steadily increased worldwide and will continue increasing over the current decade where both unmet need and overuse are expected to coexist. In the absence of global effective interventions to revert the trend, Southern Asia and sub-Saharan Africa will face a complex scenario with morbidity and mortality associated with the unmet need, the unsafe provision of CS and with the concomitant overuse of the surgical procedure which drains resources and adds avoidable morbidity and mortality. If the Sustainable Development Goals are to be achieved, comprehensively addressing the CS issue is a global priority.

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Caesarean Delivery Rates and Pregnancy Outcomes: The 2005 WHO Global Survey on Maternal and Perinatal Health in Latin America

2006-11-01

The following abstracts of articles from leading journals have been selected on the basis of their importance to the practice of obstetrics and gynecology. The following abstracts of articles from leading journals have been selected on the basis of their importance to the practice of obstetrics and gynecology.

Obstetrics and Gynecology

2023-10-16

Incidence And Prevalence Of Birth Injuries In Instrumental Vaginal Deliveries

2025-06-24

Irfan Ali Bacha , Ayesha Mahmood , Syed Sadaf Ali +2 more | Journal of Neonatal Surgery

Background: Instrumental vaginal deliveries, utilizing forceps or vacuum devices, remains a critical intervention for expediting delivery in select maternal or fetal conditions. However, these interventions carry risks of neonatal and … Background: Instrumental vaginal deliveries, utilizing forceps or vacuum devices, remains a critical intervention for expediting delivery in select maternal or fetal conditions. However, these interventions carry risks of neonatal and maternal complications, most notably birth injuries. Objective: To determine the incidence and prevalence of birth injuries in instrumental vaginal deliveries and to compare maternal and neonatal outcomes between forceps and vacuum-assisted deliveries. Methods: This retrospective cross-sectional study analyzed 268 cases of term singleton pregnancies delivered via forceps or vacuum at our center. Data were collected on maternal demographics, comorbidities, delivery method, and outcomes. Neonatal variables included type of birth injury, need for resuscitation, NICU admission, and discharge status. Maternal outcomes such as perineal trauma, postpartum hemorrhage, and fever were also recorded. Statistical analysis was performed using SPSS 25, with Chi-square tests used to assess associations between variables. Results: Of the 268 instrumental vaginal deliveries, vacuum extraction was more commonly employed (57.5%) than forceps (42.5%). The overall incidence of birth injuries was 19.8%, with cephalohematoma, brachial plexus injury, clavicle fracture, facial nerve palsy, intracranial hemorrhage, and skull fracture observed at low individual frequencies. Most neonates (80.2%) had no birth injury. The type of instrument used did not significantly affect the incidence or pattern of birth injuries (p = 0.730). However, the type of injury was significantly associated with neonatal outcomes at discharge (p = 0.008), with more severe injuries linked to higher rates of mortality and ongoing treatment. NICU admission was required for 54.1% of infants, with higher rates seen in those with clavicle fractures, intracranial hemorrhage, or no injury. Maternal complications-including fever (20.9%), perineal tears (20.5%), and postpartum hemorrhage (20.9%)-were evenly distributed between forceps and vacuum groups. The maternal population had a mean age of 29.86 years, with high rates of hypertension (52.2%) and diabetes (48.1%). Conclusion: The incidence of birth injuries in instrumental vaginal deliveries at our center was 19.8%. The choice between forceps and vacuum did not significantly influence the risk or severity of neonatal injuries, resuscitation needs, NICU admissions, or maternal complications

Women's Childbirth Experiences in the WILL Randomised Trial (When to Induce Labour to Limit Risk in Pregnancy Hypertension): A Mixed Methods Analysis

2025-06-24

Sue Tohill , Katie Kirkham , Eleni Gkini +7 more | BJOG An International Journal of Obstetrics & Gynaecology

ABSTRACT Objective To compare childbirth satisfaction in women with chronic or gestational hypertension, randomised to ‘planned early term birth at 38 +0–3 weeks' gestation’ (intervention) or ‘usual care at term’ … ABSTRACT Objective To compare childbirth satisfaction in women with chronic or gestational hypertension, randomised to ‘planned early term birth at 38 +0–3 weeks' gestation’ (intervention) or ‘usual care at term’ (control). Design Randomised trial. Setting Forty‐two consultant‐led maternity units, United Kingdom. Population 357/403 women randomised completed the Childbirth Experience Questionnaire (CEQ). Methods Mixed‐methods analysis of the 22‐item CEQ, assessing: ‘Own capacity’, ‘Professional support’, ‘Perceived safety’ and ‘Participation’. Directed content analysis sorted free‐text comments into themes covered by the CEQ and two additional themes. Main Outcome Measures CEQ scores overall and by domain. Results In intervention (vs. control) groups, the CEQ was completed by 177/202, 88.1% (vs. 180/202, 89.1%) participants, and 378 free‐text comments were made by 93/177, 52.5% (vs. 98/180, 54.4%) participants. There was no significant difference in CEQ scores overall (3.1 ± 0.4 vs. 3.1 ± 0.4, respectively) or by domain (‘Own capacity’ [2.8 ± 0.5 vs. 2.7 ± 0.5, respectively]; ‘Professional support’ [3.7 ± 0.5 vs. 3.7 ± 0.6, respectively]; ‘Perceived safety’ [3.2 ± 0.6 vs. 3.1 ± 0.6, respectively]; and ‘Participation’ [2.6 ± 0.7 vs. 2.7 ± 0.6]). Most comments were positive (222/378, 58.7%), and about ‘Relational care and care interactions’ (CEQ ‘Professional support’). Neither the number nor positivity of comments appeared to differ between groups. Conclusion For women with chronic or gestational hypertension who remain well at term, we found no difference in childbirth experience between women randomised to planned early term birth versus usual care at term. Shared decisions about timing of birth may be more influenced by differences in clinical outcomes and costs. Trial Registration ISRCTN : 77258279

What trans-vaginal ultrasound parameters are better correlated with a shorter labor induction to vaginal delivery interval? A prospective observational cohort study

2025-06-24

Serena Xodo , Maria De Martino , Giovanni Baccarini +6 more | The Journal of Maternal-Fetal & Neonatal Medicine

During the induction of labor (IOL) planning, it is important to provide patients with information regarding how long the induction process might take. This study aimed to determine which ultrasonographic … During the induction of labor (IOL) planning, it is important to provide patients with information regarding how long the induction process might take. This study aimed to determine which ultrasonographic cervical parameters are independently associated with a shorter IOL-to-vaginal delivery (VD) interval. This was a prospective observational cohort study. For enrollment purposes, women with single pregnancy, fetus in cephalic presentation, age between 18 and 45 years and good Italian proficiency were included. Women with a history of uterine surgery, in active labor, and cases of fetal growth abnormalities were excluded. The enrolled women underwent a transvaginal ultrasound within 7 days from the scheduled labor induction in order to measure the following parameters: the cervical length (CL), the utero-cervical angle (UCA), the cervical sliding sign (CSS) and the cervical consistency index (CCI). Before starting the labor induction process, patients were also digitally evaluated, acquiring the Bishop score (BS). The method of IOL was determined based on the BS. Ultrasound assessments and Bishop score evaluations were performed independently and in a blinded manner to reduce bias. Statistical analyses were performed using STATA 18.0. Between June 2023 and November 2024, 400 women were nonconsecutively enrolled in the study. Of these, 83 experienced spontaneous labor before the scheduled labor induction, resulting in 317 women who underwent IOL. The median IOL-to-VD interval was 1264 min (IQR 694-1940). Univariable regression analysis demonstrated significant associations between the IOL-to-VD interval and CL (β = 29.15; 95% CI 16.16, 42.23; p < 0.001), CCI (β = 12.60; 95% CI 3.93, 21.24; p = 0.004), and BS (β = -211.15; 95% CI -271.59, -150.71; p < 0.001). Multivariable analysis confirmed independent associations with CL (β = 13.89; 95% CI 0.35,27.44; p = 0.044) and BS (β = -183.96; -249.66, -118.27; p < 0.001). When stratified by parity, univariable regression in parous women showed significant associations between the IOL-to-VD interval and CL (β = 37.44; 95% CI 20.17, 54.72; p < 0.001), CSS (β = -582; 95% CI -1014.05, 151.20; p = 0.009), CCI (β = 15.43; 95% CI 1.75, 29.11; p = 0.027), and BS (β = -227.96; -315.57, -140.35; p < 0.001). In summary, among the evaluated parameters, CL consistently showed the strongest and most independent association with a shorter IOL-to-VD interval across analyses, supporting its role as the most reliable predictor. Future research should explore multivariable prediction models incorporating various ultrasonographic cervical parameters to enhance the predictive accuracy of transvaginal ultrasound.

North Carolina Trends in Prenatal Care: The Need for Greater Equity in Prenatal Care Access for Women of Color

2025-06-24

Cynthia Williams , Ceri Battle , Wei-Ling Chou +1 more | Journal of Racial and Ethnic Health Disparities

SỰ CO HỒI TỬ CUNG CỦA SẢN PHỤ SAU ĐẺ 24 GIỜ TẠI BỆNH VIỆN THANH NHÀN NĂM 2024

2025-06-23

Trần Hồng Quang , Quỳnh Nguyễn Thị Ngọc , Trang Nguyễn Thị Thùy | Tạp chí Y học Việt Nam

Mục tiêu: (1)Mô tả một số đặc điểm của sản phụ sau đẻ 24 giờ tại Bệnh viện Thanh Nhàn năm 2024, (2) Mô tả sự co hồi tử cung … Mục tiêu: (1)Mô tả một số đặc điểm của sản phụ sau đẻ 24 giờ tại Bệnh viện Thanh Nhàn năm 2024, (2) Mô tả sự co hồi tử cung của sản phụ sau đẻ 24 giờ tại Bệnh viện Thanh Nhàn năm 2024. Phương pháp nghiên cứu: nghiên cứu mô tả tiến cứu trên 107 sản phụ tại khoa Sản, Bệnh viện Thanh Nhàn. Kết quả: trong 24 giờ đầu, 64,5% sản phụ nuôi con bằng sữa mẹ và cho con bú trong 1 giờ sau sinh, sản phụ có thể di chuyển quanh giường trong giờ đầu (12,1%), lượng sản dịch trung bình là 275,70 ± 8,818 ml, chiều cao tử cung sau sinh 24 giờ giảm 1 cm, mật độ tử cung cứng (53,2%), 86,9% co hồi sử cung tốt sau sinh 24 giờ đầu. Kết luận: Tỷ lệ sản phụ cho con bú sữa mẹ và bú sớm khá cao. Tỷ lệ sản phụ di chuyển sớm quanh giường còn ít. Sự co hồi tử cung của các sản phụ sau sinh tốt.

Midwifery care attachments: shaping childbirth agency through care techniques

2025-06-23

Annekatrin Skeide | Frontiers in Global Women s Health

Midwifery care has been shown to effectively enhance birth outcomes and improve childbirth experiences. It has, however, not yet been sufficiently articulated how exactly. This study explores how trustful and … Midwifery care has been shown to effectively enhance birth outcomes and improve childbirth experiences. It has, however, not yet been sufficiently articulated how exactly. This study explores how trustful and empowering relationships are crafted through midwifery birthing care techniques. To do so, it builds on insights derived from feminist science and technology studies’ engagements with caring in terms of empirical ethics, namely as situated practices of “doing good”. Using reflexive thematic analysis, I examine semi-structured interviews with midwives alongside ethnographic fieldwork conducted across various midwifery care settings in Germany. Setting two birthing stories in dialogue, I illustrate how bodies-in-labor emerge through collective, active, persistent and adaptive engagements with these dynamic entities in midwifery practice to make physiological childbirth happen. Specifically, I argue that through the midwifery care techniques of “spooning” and “labor and birth positioning” midwifery birthing care attachments are fostered. I conceptualize these attachments as co-responsive, active-passive commitments aimed at sustaining endurable or even pleasurable relationships between embodied selves and bodies-in-labor. Investigating situated midwifery care techniques enables a detailed understanding of their specific qualities in particular childbirth situations, extending conventional notions of being-with and non-intervention. This approach allows to articulate, critically engage with, and strengthen midwifery-specific childbirth care practices.

Césariennes

2025-06-23

D. Riethmuller , A. Buisson , Nicolas Mottet +2 more | EMC - Obstétrique

South Asian women's experiences of maternity care in the United Kingdom: A systematic review and thematic synthesis

2025-06-23

Aditi Sharma , Vyv Huddy , Emma Williamson | British Journal of Health Psychology

Abstract Purpose Little is known about South Asian (SA) women's experiences of maternity care in the United Kingdom (UK). Previous research has often grouped ethnic minority women as a homogenous … Abstract Purpose Little is known about South Asian (SA) women's experiences of maternity care in the United Kingdom (UK). Previous research has often grouped ethnic minority women as a homogenous group. Therefore, differences between ethnicities may not be sufficiently explored. Many SA women underutilize antenatal support offered by maternity services and are at an increased risk of adverse pregnancy outcomes, compared with White women. Therefore, this systematic review aimed to explore SA women and birthing people's experiences of maternity care in the UK. Methods Three databases were searched for published peer‐reviewed qualitative studies. The Critical Appraisal Skills Programme checklist for qualitative research was used to appraise the quality of included articles. Thomas and Harden's ( BMC Medical Research Methodology , 2008, 8, 45) approach for thematic synthesis informed qualitative synthesis. Results Twelve articles met the inclusion criteria. Four themes were developed ‘(in)ability to express maternity needs’, ‘uncompassionate relationships with maternity healthcare professionals’, ‘integrating maternity care with cultural identity’, and ‘family being a part of maternity care’. Conclusions This was an original review using a comprehensive search strategy with transparent reporting. Most SA women perceived difficulties with expressing maternity needs. Relational experiences with maternity care professionals were perceived as uncompassionate, discriminatory, and with varied sensitivity to their cultural identity. SA women viewed their maternity care to incorporate family. Research implications included an urgent need to increase the quality of ethical qualitative research focused on SA women/birthing people. Clinical implications included maternity healthcare professionals and systems to improve the relational experience with SA women/birthing people.

Labour Pain: A Comprehensive Review of Perceptions, Experiences, and Sociocultural Influences on Pain and Its Management Practices

2025-06-22

Archita Tandon , Kanwal Gujral , Vipin Gupta | Cureus

Postpartum Sterilization after a Preterm Delivery Is Not Associated with Decision Regret

2025-06-21

Marika Toscano , Sarah Betstadt , Sara Spielman +2 more | Medical Decision Making

Background Although sterilization is one of the most effective methods of birth control, some physicians may hesitate to perform postpartum sterilizations on patients after preterm birth, as preterm labor and … Background Although sterilization is one of the most effective methods of birth control, some physicians may hesitate to perform postpartum sterilizations on patients after preterm birth, as preterm labor and delivery may preclude adequate counseling. Methods This is a cross-sectional study conducted at a single, tertiary care, academic institution of adult pregnant patients who experienced a spontaneous or iatrogenic preterm delivery between March 15, 2011, and May 10, 2014 and underwent postpartum female surgical sterilization within 12 wk of delivery. A validated Decision Regret Scale was administered 7 to 11 y later. Univariate and bivariate analyses were conducted. Unadjusted and multivariate logistic regression analyses identified factors associated with moderate to severe decision regret. Results Most participants (75.5%) with a preterm delivery reported no or mild regret associated with their sterilization. Circumstances surrounding the sterilization decision were positive, as 85.7% reported having enough information, 81.6% reported enough emotional support, and 75.5% reported adequate decision time. Adjusting for maternal and gestational age at delivery plus other covariates, only those reporting they had adequate time to make their sterilization decision remained significantly associated with no or mild regret (odds ratio: 0.002, 95% confidence interval: <0.001–0.61). Discussion Study results indicated high confidence in the sterilization decision, which was not affected by maternal age at delivery or the fact that the individual had a preterm delivery, emphasizing the importance of individualized counseling and support for patients during the decision-making process. Conclusion Providing adequate time for patients to decide on postpartum surgical sterilization was the most important factor for decreased sterilization regret. Implications The decision for sterilization should be made using a patient-centered, shared decision-making framework. Highlights Among patients with a preterm delivery who underwent postpartum surgical sterilization, maternal age at delivery was not associated with increased decision regret. Providing adequate time for patients to decide on postpartum surgical sterilization was the most important factor for decreased sterilization regret among patients with a preterm delivery. We must trust the patient knows they are making the right decision for themselves in that moment, even if this is at the time of a preterm delivery.

OBSTETRIC VIOLENCE IN FINLAND: ANALYZING THE ACTIONS OF HEALTHCARE STAFF IN BIRTHING NARRATIVES?

2025-06-20

Johanna Westergård , Jari Kylmä , Eija Paavilainen | Midwifery

Obstetric violence is a form of gender-based violence rooted in structural inequality and discrimination. It is a globally prevalent phenomenon, affecting up to 59 % of birthing individuals globally and … Obstetric violence is a form of gender-based violence rooted in structural inequality and discrimination. It is a globally prevalent phenomenon, affecting up to 59 % of birthing individuals globally and approximately 45 % in high-income countries. Despite its prevalence, research in Finland remains scarce, and little is known about how birthing individuals describe this phenomenon. Most research on obstetric violence has focused on structural and professional perspectives, with less attention to birthing individuals' experiences. Their accounts are essential for understanding how obstetric violence manifests and impacts maternity care. Studies highlight the role of communication, power dynamics, and institutional practices in shaping birthing experiences. However, research on these perceptions in Finland is limited. This study aims to describe birthing individuals' experiences of healthcare staff actions in situations perceived as obstetric violence, providing insights to support ethical, patient-centered care. This study employed a qualitative descriptive design with an inductive approach. Written birth narratives (n = 30) were analyzed using inductive content analysis. Background details such as age, number of births, or time elapsed since birth were unavailable. The narratives were coded and categorized to identify how healthcare staff actions were perceived. Four categories emerged from the data: (1) ignoring, (2) manipulating, (3) showing aggression, and (4) nurturing. The findings demonstrate that obstetric violence in Finland is experienced through being ignored, manipulated, or subjected to aggression by healthcare staff. At the same time, nurturing care, characterized by compassion, professionalism, and responsible communication, was seen to protect birthing individuals' sense of dignity and sense of participation in care. These results support international evidence and underscore the importance of consistent, respectful care practices. Preventing obstetric violence requires ethical decision-making and respect for birthing individuals' autonomy. Clinical expertise alone is insufficient; compassionate, respectful care is essential in matemity healthcare.

Effect of collaborative psychological care on negative emotions, vaginal delivery, and labor duration in primiparas: A retrospective cohort study

2025-06-20

Guangxia Mei , Jing Yang , Weiquan Xie | Medicine

This study evaluates the effect of collaborative psychological care during childbirth on reducing negative emotions, increasing vaginal delivery rates, and shortening the labor process. A retrospective cohort study was conducted … This study evaluates the effect of collaborative psychological care during childbirth on reducing negative emotions, increasing vaginal delivery rates, and shortening the labor process. A retrospective cohort study was conducted at The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture using medical records from May 2019 to July 2021. A total of 108 primiparas who met the inclusion criteria were identified and categorized into 2 groups based on the type of care received: the conventional group (n = 54) and the study group (n = 54). The conventional group received standard routine care, including environmental support, health education, vital sign monitoring, psychological guidance, and pain management. The study group received collaborative psychological care in addition to routine nursing, which included the selection of a responsible family member, family-based psychological support training, prenatal psychological diary maintenance, environmental modifications, and continuous labor companionship. Negative emotions were assessed using the Symptom Checklist-90, which evaluates 9 dimensions of psychological distress, with higher scores indicating greater distress. Negative emotion scores, vaginal delivery rates, and labor duration were retrospectively analyzed and compared between the 2 groups. Before the intervention, there was no significant difference in negative emotion scores between the 2 groups (P > .05). Before delivery, the negative emotion scores in the study group were significantly lower than those in the conventional group (P < .05). The number of vaginal deliveries in the study group was 50 (92.59%), significantly higher than 38 (70.39%) in the conventional group (P < .05). Additionally, the 1st stage and total duration of labor in the study group were (447.95 ± 53.45) minutes and (498.15 ± 35.14) minutes, respectively, both significantly shorter than those in the conventional group (P < .05). The implementation of collaborative psychological care during childbirth can significantly reduce negative emotions, increase vaginal delivery rates, and shorten the labor process in primiparas. These findings suggest that integrating psychological support into routine obstetric care can improve maternal well-being and promote better delivery outcomes, making it a valuable approach for clinical practice.

Cross-cultural adaptation and psychometric evaluation of the Chinese version of Childbirth Experience Questionnaire 2.0

2025-06-20

Jiahui Wu , Hong Yan , Haixia Guan +5 more | Frontiers in Psychiatry

Background Childbirth experience is a key determinant of maternal psychological well-being, and WHO emphasize promoting positive birth experiences. The Childbirth Experience Questionnaire (CEQ) is a widely used measure of women’s … Background Childbirth experience is a key determinant of maternal psychological well-being, and WHO emphasize promoting positive birth experiences. The Childbirth Experience Questionnaire (CEQ) is a widely used measure of women’s perceptions of labor and delivery. An improved version of this instrument, the CEQ 2.0, has not yet been adapted or psychometrically validated for use in mainland China. This study aimed to validate a Mainland version of CEQ 2.0 (CEQ 2.0-M) among Chinese postpartum women. Methods A three-stage cross-sectional psychometric study was conducted among 700 postpartum women recruited from a tertiary hospital in mainland China (350 for EFA, 350 for CFA). Item analysis and dimensional refinement were applied to revise the original 25-item Chinese CEQ 2.0 before factor analyses. Structural validity was evaluated using parallel analysis, exploratory factor analysis (EFA), and confirmatory factor analysis (CFA). Reliability was assessed via Cronbach’s α and McDonald’s ω , and validity evidence included convergent, discriminant, concurrent, and known-group analyses. Results In Stage 1, item analysis and theoretical review led to the refinement of the original Chinese CEQ 2.0, resulting in a four-factor version with improved conceptual clarity. In Stage 2, exploratory factor analysis supported this four-factor structure, explaining 53.2% of the total variance. Confirmatory factor analysis in Stage 3 indicated acceptable model fit ( χ 2 / df = 2.590; AGFI = 0.892; GFI = 0.927; CFI = 0.949; TLI = 0.934 and RMSEA = 0.068). Internal consistency was satisfactory, with Cronbach’s α = 0.65–0.91 and McDonald’s ω = 0.65–0.91 across subscales, and 0.84 and 0.80 respectively for the total scale. Evidence of convergent, discriminant, concurrent, and known-group validity further supported the scale’s psychometric robustness. Conclusions The CEQ 2.0-M shows satisfactory psychometric properties and offers a valid, reliable instrument for assessing childbirth experiences among Chinese postpartum women. Its concise structure and established construct validity support its use in both clinical practice and research, particularly in developing countries seeking culturally appropriate tools for perinatal care evaluation.

Efficacy of intrapartum ultrasound in the management of maternal labor: A meta‐analysis

2025-06-20

Meng Song , Hongping Zheng , Qian Wu +4 more | International Journal of Gynecology & Obstetrics

China expands epidural access to boost birth rate

2025-06-20

Flynn Murphy | BMJ

Cesarean Section Scar Niche: Contributing Factors, Consequences, and Protective Measures

2025-06-19

Sabina Parveen , Mahmudur Rahman , Sabrina Sarah Alam | Scholars Journal of Applied Medical Sciences

Background: Cesarean section (CS) rates have risen globally, leading to increased attention on associated complications. One such complication is the formation of a cesarean scar niche, a defect at the … Background: Cesarean section (CS) rates have risen globally, leading to increased attention on associated complications. One such complication is the formation of a cesarean scar niche, a defect at the site of the uterine incision, which can result in various gynecological and obstetric issues. Aim: This study aims to identify the contributing factors, consequences, and protective measures related to cesarean scar niche formation in Bangladesh. Method: A retrospective study was conducted at the Tertiary Medical College Hospital, Bangladesh, from January 2024 to December 2024. One hundred women with a history of cesarean section were evaluated using transvaginal sonography to detect the presence of a niche. Data on patient demographics, surgical details, and postoperative outcomes were collected and analyzed. Results: Out of 100 women, 38% were found to have a cesarean scar niche. Significant contributing factors included multiple cesarean deliveries, single-layer uterine closure, and a retroflexed uterus. Common consequences observed were abnormal uterine bleeding, pelvic pain, and secondary infertility. Protective measures such as double-layer uterine closure and proper surgical techniques were associated with a reduced incidence of niche formation. Conclusion: Cesarean scar niches are a notable concern in Bangladesh, with specific surgical and anatomical factors contributing to their formation. Implementing protective surgical techniques and thorough postoperative monitoring can mitigate associated complications.

VIABILIDADE DO PARTO VAGINAL EM CASOS DE APRESENTAÇÃO PÉLVICA: ANÁLISE DOS FATORES DE RISCO E BENEFÍCIOS

2025-06-19

Kaline Malu Gerônimo Silva dos Santos , L. Silva , Elsa Brandão | Revista fisio&terapia.

Maternal satisfaction and birth experiences after elective induction vs. spontaneous onset in late-term pregnancy: a register-based study

2025-06-19

Şahruh Türkmen , Linnea Binfare | BMC Pregnancy and Childbirth

Abstract Background Earlier studies highlight that a positive birth experience enhances both short-term recovery and long-term maternal well-being. However, the factors influencing this experience are complex and not yet fully … Abstract Background Earlier studies highlight that a positive birth experience enhances both short-term recovery and long-term maternal well-being. However, the factors influencing this experience are complex and not yet fully understood. We aimed to investigate the influence of labour commencement method on late-term pregnant women’s satisfaction with care and the birth experience, and to determine whether women’s perception of their birth experience changes over time. Methods In this register-based retrospective cohort study, we included pregnant women in late term (≥ 41 + 0 to < 42 + 0) who gave birth in Sweden during 2020–2021. Eligible women were classified into two groups: spontaneous onset of labour (SOL) and induced onset of labour (IOL). Women’s satisfaction with care at birth and the childbirth experience at 8 weeks and 1 year postpartum were measured with a visual analogue scale, where 0 indicates “very unsatisfied” and 10 “very satisfied”. Results Satisfaction with care at the time of discharge from the hospital was significantly different between the IOL and SOL groups, with mean scores of 6.53 ± 3.34 and 6.97 ± 3.34, respectively ( P = 0.007). Furthermore, the IOL group reported a less positive birth experience at 8 weeks (7.15 ± 2.37 and 7.74 ± 2.17, respectively, P = 0.004) and 1 year postpartum (6.87 ± 2.40 and 7.53 ± 2.15, respectively, P = 0.002) compared to the SOL group. Both groups experienced a decline in birth experience positivity from 8 weeks to 1 year postpartum ( P < 0.001 in both groups). Common factors influencing satisfaction with care and birth experience included parity, heavy bleeding during labour, and the mode of delivery. Conclusion Satisfaction with care during labour and women’s childbirth experiences differed between the SOL and IOL groups, indicating a relationship between labour commencement method and satisfaction scores. Women in the SOL group were more satisfied with care at birth and reported a more positive birth experience at both 8 weeks and 1 year postpartum compared to the IOL group. Over time, women’s childbirth experience scores in both groups may change, becoming less positive 1 year after birth compared to 8 weeks postpartum. Trial registration Retrospectively registered.

Unassisted home births in Norway: A growing concern

2025-06-19

Solveig Bjellmo , Johanne Kolvik Iversen | Acta Obstetricia Et Gynecologica Scandinavica

Development and validation of context-specific components of obstetric violence: Experiences from the central zone of Tanzania

2025-06-18

Theresia J. Masoi , Stephen M. Kibusi , Nathanael Sirili +1 more | PLoS ONE

Background Despite the known consequences of obstetric violence, studies have encountered challenges in defining and fully understanding obstetric violence. This difficulty arises from a relative scarcity of research addressing the … Background Despite the known consequences of obstetric violence, studies have encountered challenges in defining and fully understanding obstetric violence. This difficulty arises from a relative scarcity of research addressing the definition of obstetric violence across various cultures and contexts. As a result, there is a lack of consensus regarding the operational definitions of the components of obstetric violence and variations that may be influenced by geographical and cultural factors. Objective This study describes the process of developing and validating the context specific components of obstetric violence in the Central Zone of Tanzania. Methods An iterative mixed-methods design was used, using the following stages; 1. collecting and analysing qualitative data on context specific components of obstetric violence along with a literature review 2. assessing the content validity with 24 maternal health experts and face validity with 27 postnatal mothers and nine health care providers. Descriptive analysis was employed to analyse participants’ characteristics and Likert scale responses from experts, postnatal mothers and health care providers. Item-level Content Validity Index (I-CVI) and Item-face Validity Index (I-FVI) was computed for each component. Results Seven categories of obstetric violence components were identified through this process.These included: physical violence, lack of supportive care and treatment, subjugation care, an unfavourable care environment, sexual violence, verbal violence, emotional and psychological violence. In addition, 24 subcategories of obstetric violence were identified. The Item-Level Content Validity Index (I-CVI) ranged from 0.791 to 0.958, while the Item-Face Validity Index (I-FVI) ranged from 0.777 to 0.925. Conclusion The validated components of obstetric violence in Tanzania will contribute to a better understanding of the issue within the Tanzanian context.This in turn, may facilitate a more accurate assessment of the magnitude and impact of obstetric violence while helping to identify key areas for intervention and policy development to promote respectful maternity care.

Development of a Postpartum Follow-up Program in a Fetal Center

2025-06-18

Shelly Soni , Sarah Sneller , Susan S. Spinner +1 more | Fetal Diagnosis and Therapy

Introduction: Patients delivering in a highly specialized fetal center often travel a distance from their homes and primary care providers leaving the potential for significant gaps in comprehensive postpartum care. … Introduction: Patients delivering in a highly specialized fetal center often travel a distance from their homes and primary care providers leaving the potential for significant gaps in comprehensive postpartum care. Objective: To evaluate the implementation, engagement, and outcomes of a nurse-led postpartum follow-up program during its first year of inception. Methods: A registered nurse conducted outreach via phone, text, or email at 2–3 and 6–8 weeks postpartum for all patients who delivered in a Special Delivery Unit of a Children’s hospital. Standardized scripts included medical and mental health concerns to assess engagement, postpartum complications, care utilization, contraception use, lactation, and follow-up completion. Results: Of 407 patients, 503 total outreach calls were completed. The engagement rate was high, with contact established for 89.9% of participants. At least one clinical concern was identified in over 25% of patients, prompting further follow-up. Only 1.7% required readmission and 94.3% visited an emergency department, rates comparable to national postpartum benchmarks. At 6–8 weeks, 75% had attended or scheduled a postpartum visit. Contraception use was reported by 65% of patients, and 67% reported active lactation. Mental health screening flagged 6.4% of patients, with a significantly higher rate (26.5%) among those who experienced fetal or neonatal loss compared to those who did not (4.3%, p<0.00001). Conclusion: The implementation of a comprehensive nurse-led postpartum program in a fetal therapy center achieved high engagement rate and demonstrated feasibility and value in bridging care gaps supporting the expansion of telehealth-based postpartum follow-up in fetal therapy centers.

Intervenções não farmacológicas utilizadas por enfermeiros obstétricos no trabalho de parto: revisão das práticas assistenciais

2025-06-18

João Paulo Malta da Silva , Carolyn Cristina Reis , Izadora Nunes da Silva +5 more | Contribuciones a las Ciencias Sociales

Introdução: O trabalho de parto ainda é conduzido, em grande parte, por práticas medicalizadas e intervencionistas. Objetivo: Identificar as principais intervenções não farmacológicas utilizadas por enfermeiros obstétricos durante o trabalho … Introdução: O trabalho de parto ainda é conduzido, em grande parte, por práticas medicalizadas e intervencionistas. Objetivo: Identificar as principais intervenções não farmacológicas utilizadas por enfermeiros obstétricos durante o trabalho de parto. Método: Trata-se de uma revisão integrativa da literatura, conduzida por meio de buscas nas bases de dados eletrônicas: Base de Dados de Enfermagem, United States National Library of Medicine e Literatura Latino-Americana do Caribe em Ciências da Saúde. A seleção dos descritores foi realizada com base na consulta aos Descritores em Ciências da Saúde, utilizando-se os termos: “trabalho de parto”, “enfermeiros obstétricos”, “sala de parto” e “cuidados de enfermagem”. Resultados: Foram identificados um total de 141 artigos nas bases de dados consultadas. Após a aplicação dos critérios de inclusão e exclusão, a amostra final foi composta por 17 artigos, distribuídos da seguinte forma: 6 na Lilacs, 3 na BDENF e 8 na PubMed. Conclusão: Evidenciou-se que práticas como massagens, banho morno, uso de bola obstétrica, rebozo e a deambulação são realizadas por enfermeiros obstétricos.

Evaluation of the prevalence of obstetric violence during child birth: A Meta-analysis study

2025-06-18

Esra Özer , Yeşim Çetinkaya Şen , Serap Canlı | Aggression and Violent Behavior

Uterine Rupture Trends in Patients Pursuing Trial of Labor After Cesarean in the United States From 2010 to 2022

2025-06-18

Ann M. Bruno , Lillian H. Goodman , Torri D. Metz | Obstetrics and Gynecology

Uterine Rupture Trends in Patients Pursuing Trial of Labor After Cesarean in the United States From 2010 to 2022

2025-06-18

Melissa G. Rosenstein , Miriam Kuppermann , Nicholas Rubashkin | Obstetrics and Gynecology

Aplicabilidade das práticas integrativas e complementares em saúde na assistência ao parto hospitalar

2025-06-18

Rocío Elizabeth Castillo Andrade , João Paulo Assunção Borges , Francine Ramos de Miranda | Enfermagem Brasil

Introdução: A assistência obstétrica ao trabalho de parto no ambiente hospitalar tem sido marcada por intervenções consideradas desnecessárias. As Práticas Integrativas e Complementares emergem como estratégias preventivas ou terapêuticas de … Introdução: A assistência obstétrica ao trabalho de parto no ambiente hospitalar tem sido marcada por intervenções consideradas desnecessárias. As Práticas Integrativas e Complementares emergem como estratégias preventivas ou terapêuticas de atendimento individualizado e humanizado ao TP. Objetivo: Identificar na literatura científica nacional a aplicabilidade das Práticas Integrativas e Complementares em Saúde no manejo do trabalho de parto. Métodos: Trata-se de revisão integrativa da literatura, na qual utilizou-se a Biblioteca Virtual de Saúde (BVS) como veículo de pesquisa, selecionando as evidências em saúde nas seguintes bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Base de Dados em Enfermagem (BDENF) e Medical Literature and Retrieval System Online (MEDLINE). A busca dos estudos foi realizada por meio dos Descritores em Ciências da Saúde (DeCs) combinados com a expressão booleana AND: 1) terapias complementares AND parto; 2) métodos não farmacológicos AND humanização. Foram incluídas as publicações dos últimos dez anos, em língua portuguesa e disponíveis na íntegra. Extraíram-se informações acerca da autoria, ano de publicação, título principal, objetivos, modalidade da pesquisa, nível de evidência e resultados relevantes. Resultados: Obteve-se uma amostra final composta por 12 artigos. Encontrou-se que as PICS podem ser empregadas para o alívio da dor, para a redução do tempo do trabalho de parto, da ansiedade e estresse, promovendo relaxamento, conforto, concentração e empoderamento às mulheres. Conclusão: As Práticas Integrativas e Complementares em Saúde ainda são utilizadas de forma limitada no manejo do trabalho de parto. Novas pesquisas devem ser conduzidas com vistas a explorar sua aplicabilidade e efetividade como práticas alternativas às intervenções comumente realizadas na assistência obstétrica. Poucos estudos evidenciaram o conhecimento dos profissionais da área da saúde acerca das PICS, assim como sua adesão a essas práticas.

Cervical Ripening in Pregnancy

2025-06-18

| Obstetrics and Gynecology

PURPOSE: The purpose of this document is to review current methods for cervical ripening and to summarize the effectiveness of these approaches based on appropriately conducted outcomes-based research. This document … PURPOSE: The purpose of this document is to review current methods for cervical ripening and to summarize the effectiveness of these approaches based on appropriately conducted outcomes-based research. This document focuses on cervical ripening in individuals with term, singleton, vertex pregnancies with membranes intact, because this is the population in whom most studies were conducted. For more information on recommended timing of delivery based on maternal, fetal, and obstetric conditions and on labor management, refer to: American College of Obstetricians and Gynecologists (ACOG) Committee Opinion No. 831, Medically Indicated Late-Preterm and Early-Term Deliveries (1); Practice Bulletin No. 217, Prelabor Rupture of Membranes (2); Obstetric Care Consensus No. 10, Management of Stillbirth (3); Practice Bulletin No. 205, Vaginal Birth After Cesarean Delivery (4); and Clinical Practice Guideline No. 8, First and Second Stage Labor Management (5). TARGET POPULATION: Individuals with term, singleton, vertex pregnancies with membranes intact. METHODS: This guideline was developed using an a priori protocol in conjunction with a writing team consisting of two maternal–fetal medicine subspecialists and one specialist in obstetrics and gynecology appointed by the ACOG Committee on Clinical Practice Guidelines–Obstetrics. ACOG medical librarians completed a comprehensive literature search for primary literature within the Cochrane Library, Cochrane Database of Systematic Reviews, ClinicalTrials.gov, Ovid MEDLINE, and PubMed and searched for guidelines from ACOG and other organizations. Studies that moved forward to the full-text screening stage were assessed by the writing team based on standardized inclusion and exclusion criteria. Included studies underwent quality assessment, and a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) evidence-to-decision framework was applied to interpret and translate the evidence into recommendation statements. RECOMMENDATIONS: This Clinical Practice Guideline includes an overview of cervical ripening indications, contraindications, and methods and provides recommendations for pharmacologic, mechanical, and combination method cervical ripening in individuals with term, singleton, vertex pregnancies with membranes intact. Recommendations are classified by strength and evidence quality.

Kiến thức và thái độ của sinh viên điều dưỡng đối với chăm sóc người bệnh tiểu không tự chủ NURSING STUDENT'S KNOWLEDGE AND ATT

2025-06-17

Thị Như Xuân Hà , Thị Diễm Quỳnh Phạm | Y HOC TP HO CHI MINH

Đặt vấn đề: Kiến thức và thái độ về chăm sóc người bệnh tiểu không tự chủ là yếu tố quan trọng giúp điều dưỡng hỗ trợ người bệnh tiểu … Đặt vấn đề: Kiến thức và thái độ về chăm sóc người bệnh tiểu không tự chủ là yếu tố quan trọng giúp điều dưỡng hỗ trợ người bệnh tiểu không tự chủ một cách hiệu quả, cải thiện chất lượng cuộc sống của họ. Sinh viên điều dưỡng – lực lượng tương lai của ngành y tế, cần được trang bị kiến thức đầy đủ về tiểu không tự chủ trước khi ra trường để đáp ứng tốt hơn nhu cầu chăm sóc của người bệnh tiểu không tự chủ, đặc biệt trong bối cảnh dân số già hóa. Mục tiêu: Xác định mức độ kiến thức, điểm trung bình thái độ và mối tương quan giữa kiến thức với thái độ của sinh viên điều dưỡng đối với chăm sóc người bệnh tiểu không tự chủ. Đối tượng và phương pháp nghiên cứu: Nghiên cứu cắt ngang mô tả có phân tích trên 221 sinh viên điều dưỡng năm 3 và năm 4 khoa Điều dưỡng – Kỹ thuật Y học, Đại học Y Dược Thành phố Hồ Chí Minh được tiến hành từ tháng 08/2024 đến tháng 04/2025. Công cụ thu thập dữ liệu sử dụng 2 bộ câu hỏi của tác giả Yuan HB bao gồm “Thang đo kiến thức tiểu không tự chủ” và “Thang đo thái độ tiểu không tự chủ”. Kết quả: Nghiên cứu chỉ ra tỉ lệ kiến thức của sinh viên về chăm sóc người bệnh tiểu không tự chủ ở mức kém chiếm 38,9%, nhóm có kiến thức trung bình chiếm 48% và đạt mức kiến thức tốt là 13,1%. Tổng điểm trung bình của thái độ là 43,1±4,1 điểm. Chưa ghi nhận được mối tương quan giữa kiến thức và thái độ của sinh viên đối với việc chăm sóc người bệnh tiểu không tự chủ với (r = -0,001; p = 0,493). Kết luận: Nhìn chung sinh viên có thái độ tích cực đối với chăm sóc người bệnh tiểu không tự chủ nhưng kiến thức của sinh viên còn chưa đầy đủ. Do đó, cần nâng cao kiến thức cho sinh viên điều dưỡng thông qua khóa đào tạo liên tục, cải thiện và tăng thời lượng giảng dạy về TKTC tại trường cho sinh viên đồng thời khuyến khích sinh viên tìm hiểu và ôn tập thêm các nội dung về TKTC. Từ khóa: tiểu không tự chủ; kiến thức; thái độ; sinh viên điều dưỡng

INFECÇÃO DO TRATO URINÁRIO DURANTE A GESTAÇÃO

2025-06-16

Estéfane Mendes de Melo , Zilmara Xavier da Silva , Gustavo Tavares de Queiroz +1 more | Revista CPAQV - Centro de Pesquisas Avançadas em Qualidade de Vida

Introdução: A infecção urinaria é uma doença infecciosa que acomete o trato urinário e pode levar a sérias complicações durante uma gestação, e pode acarretar partos prematuros e até abortos. … Introdução: A infecção urinaria é uma doença infecciosa que acomete o trato urinário e pode levar a sérias complicações durante uma gestação, e pode acarretar partos prematuros e até abortos. Objetivo: Sendo assim, oobjetivo deste estudo é verificar a ocorrência de infecção urinária durante a gestação de mulheres que tiveram bebês internados em uma UTI e verificar a ocorrencia de partos prematuros. Métodos: O estudo é de caráter qualitativo e descritivo, e teve uma amostra composta de 27 mulheres com idade entre 18 e 40 anos que tiveram seus filhos internados na UTI NEONATAL do Hospital de Base Doutor Ary Pinheiro em Porto Velho, Rondônia. Os dados foram coletados através de uma entrevista de forma presencial e os dados foram analisados através da bioestatística descritiva. Resultados: Os resultados da coleta de dados mostraram que 74% das mulheres tiveram incontinência urinária durante a gestação, mostrando uma alta incidência. Dos principais sintomas que essas mulheres relataram ter sentido e que as levaram a procurar ajuda do médico, se destacam os sintomas de sensação de ardência ao urinar, aumento da frequência urinária e dor na região pélvica. Sobre a prematuridade, foi verificado que 85% das mulheres tiveram parto prematuro e 68% destas não tinham conhecimento do risco que a incontinência urinária acarreta na gestação, podendo levar ao parto prematuro. Conclusão: A infecção urinária em mulheres gestantes é um problema significativo, pois pode levar a complicações tanto para a mãe quanto para o feto. A falta de conhecimento sobre os sintomas e as consequências potenciais pode aumentar os riscos, tornando fundamental o acompanhamento médico durante a gestação para prevenir complicações graves. A educação sobre sinais de infecção urinária, junto com exames regulares e tratamento adequado, é crucial para a saúde da gestante e do bebê.

Authors' Reply

2025-06-16

Milla Juhantalo , Tuija Hautakangas , Outi Palomäki +1 more | BJOG An International Journal of Obstetrics & Gynaecology

Risk of early childhood overweight/obesity following cesarean section: A systematic review and meta‐analysis

2025-06-16

Chuhui Zhou , Linghong Tang , Lepeng Zhou +4 more | International Journal of Gynecology & Obstetrics

The Efficacy of Misoprostol and Prostaglandin E2 in Induction of Labor

2025-06-14

Samreen Burhan , Seniwaty Anwar | Indus journal of bioscience research.

Background: In fact, induction of labor (delivery) is commonly performed as an obstetric intervention when the risks of continuing the pregnancy outweigh the benefits. For cervical ripening and labor induction, … Background: In fact, induction of labor (delivery) is commonly performed as an obstetric intervention when the risks of continuing the pregnancy outweigh the benefits. For cervical ripening and labor induction, the pharmacological agents most used are misoprostol (prostaglandin E1 analogue) and dinoprostone (prostaglandin E2). The objective of this study was to compare the efficacy of misoprostol versus prostaglandin E2 in induction of labour in term pregnant women at a tertiary care hospital. Methods: It was an interventional randomized controlled trial lasting three months duration at Mercy Teaching Hospital and Kuwait Hospital, Peshawar from 25 Feb 2025 to 25 March 2025. Random assignment of 230 women who fulfilled the inclusion criteria was undertaken to receive misoprostol (25 µg vaginally every 6 hours, max 4 doses) or Prostaglandin E2 (2 mg vaginally every 12 hours, max 2 doses). Onset of labour with no further intervention was defined as successful induction. SPSS version 25 was used to analyze the data and the p-value < 0.05 was considered significant. Results: The success rate of induction was 97.4% with misoprostol compared with 90.4% with prostaglandin E2 (p = 0.031). Among the significant variables included in subgroups analysis by age, parity, BMI, gestational age and residence, misoprostol consistently demonstrated higher efficacy. Conclusion: Prostaglandin E2 was less effective in inducing labor than was misoprostol. Because of its low cost, ease of storage and high success rate, this reduces the use of its broader use, especially in low resource settings. We recommend further studies evaluating safety outcomes and long term maternal and neonatal implication.

An interpretative phenomenological study on the experiences of women receiving special physical and psychological support during pregnancy and childbirth

2025-06-14

Merve İdem , Osman Söner | Current Psychology

Enablers and barriers to practice planned home birth for midwives in Spain: A qualitative study

2025-06-13

Alba Sola-Martinez , Vanesa Gutiérrez‐Puertas , Trinidad María Galera‐Barbero +1 more | Women and Birth

Beyond the Scar: A Qualitative Study on the Physical, Psychosocial and Economic Impacts of Caesarean Section in Keonjhar District of Odisha

2025-06-13

Sameer Kumar Jena , Moatula Ao | Research Square (Research Square)

<title>Abstract</title> Background According to World Health Organization (WHO), globally, there is an increasing rate of Cesarean section (CS) with 1 in 5(21%) deliveries, and it is expected to increase to … <title>Abstract</title> Background According to World Health Organization (WHO), globally, there is an increasing rate of Cesarean section (CS) with 1 in 5(21%) deliveries, and it is expected to increase to 29% by 2030. While CS is lifesaving, it often imposes significant physical, psychological, and financial burdens on women. These impacts are particularly pronounced in rural and tribal populations, where access to adequate healthcare and support is limited. Thus, this study explores the multifaceted consequences of CS in Keonjhar district of Odisha focusing on physical recovery, psychosocial well-being, and economic strain. Methods The study used qualitative method of data collection during November to December 2024. A, semi-structured interview approach was used to gather in-depth accounts from 35 women who had recently undergone CS in Keonjhar District, Odisha. The information on CS deliveries were collected from public and private health care and the women were were traced who had delivered through CS in the last two weeks. Information on on physical recovery, emotional experiences, and economic challenges associated with CS. Data were collected and analyzed using MaxQDA 07 to identify recurring patterns and themes. Results The study revealed that women in Keonjhar faced significant physical pain and postoperative complications, such as delayed wound healing, infections, and anemia. Many struggled to resume household chores or fieldwork, exacerbating recovery. Psychosocial impacts included postpartum depression, feeling of regret and feelings of guilt, as many women believed that a vaginal birth was the ideal outcome. Financially, CS resulted in substantial out-of-pocket costs, including hospital fees, transportation, and follow-up care, leading many families into debt. These burdens were compounded by the lack of insurance and financial protection schemes. Conclusions The findings highlight the urgent need for improved postpartum care, particularly home visits by health workers to monitor recovery and provide mental health support. Additionally, integrating mental health screening and counselling into postpartum care can alleviate the emotional toll. To ensure holistic care, culturally sensitive, context-specific interventions are required to support women recovering from CS in rural areas of India.

The effectiveness of care bundles for reducing caesarean section safely: A systematic review and meta-analysis

2025-06-13

Kate C. O'Doherty , A. Rothwell , Valerie Smith | PLoS ONE

Care bundles, which consist of three or more interventions implemented together, may help address the global rise in caesarean births. The aim of this systematic review is to evaluate the … Care bundles, which consist of three or more interventions implemented together, may help address the global rise in caesarean births. The aim of this systematic review is to evaluate the effectiveness of care bundles designed to reduce caesarean section (CS). MEDLINE, CINAHL, CENTRAL and Embase were searched from January 2000 to June 2024 using terms related to CS and care bundles. Grey literature and professional body websites were also searched. Randomised or non-randomised studies reporting on pregnant or labouring women who received a care bundle designed to reduce CS safely were eligible. Data were extracted by two reviewers independently. Pre-specified outcomes included CS (overall, elective, and emergency), assisted vaginal birth, neonatal admission to intensive care, and care bundle compliance. Meta-analyses were undertaken using Review Manager 5.4 and a random effects model. Odds Ratio (OR) with 95% Confidence Interval (CI) were calculated. The certainty of the evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Ten non-randomised studies were included. Care bundles reduced CS overall (OR 0.83, 95% CI 0.72 to 0.97) and emergency CS (OR 0.82, 95% CI 0.68 to 0.98). No differences were observed in assisted vaginal birth (OR 1.10, 95% CI 0.91 to 1.33) or neonatal admission to intensive care (OR 1.06, 95% CI 0.56 to 2.02). Compliance to the care bundles ranged from 50% to 92%. The certainty of the evidence for all outcomes was very low. Randomised trial research is required to better assess care bundle use in reducing CS safely.

IDENTIFICANDO INSTRUMENTOS TIPO CHECKLISTS COM ENFOQUE NOS CUIDADOS AO PARTO VAGINAL SEGURO

2025-06-12

Tamires Alves Dias , Ana Karoline Alves da Silva , Simony de Freitas Lavor +3 more | Revista Enfermagem Atual In Derme

Objetivou-se identificar a existência de checklists disponíveis na literatura científica com enfoque nos cuidados ao parto vaginal seguro. Trata-se de uma revisão integrativa, realizada em janeiro de 2024, por meio … Objetivou-se identificar a existência de checklists disponíveis na literatura científica com enfoque nos cuidados ao parto vaginal seguro. Trata-se de uma revisão integrativa, realizada em janeiro de 2024, por meio das bases de dados: Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Medical Literature Analysis and Retrievel System Online (MEDLINE), Base de Dados em Enfermagem (BDENF). Empregou-se os Descritores em Ciências da Saúde (DeCS): “Checklist”, “Parto normal”, “Segurança do Paciente” e o uso de conectores booleanos “AND”. Posteriormente, foram expostas as principais informações contidas nos seis artigos selecionados. Os estudos demonstraram-se relevantes, ao apontar que a utilização do checklist destacou-se por ser uma ferramenta capaz de apontar as recomendações a serem seguidas pelos profissionais, como também, por proporcionar às mulheres que receberam os cuidados seguros e de qualidade durante do trabalho de parto. Contudo, ressalta-se que não foi encontrado nenhum estudo que apresentasse especificamente dados sobre a utilização de um checklist, com enfoque nos cuidados de Enfermagem durante a assistência ao parto vaginal seguro. Desse modo, valoriza-se a relevância social e científica da realização de novos estudos voltados a essa lacuna.

Not Closing Compared With Closing the Endometrial Layer During Cesarean Delivery

2025-06-12

Gabriel Moreira Lino , Pauliana Valéria Machado Galvão , Maria Luíza Ferreira da Silva +1 more | Obstetrics and Gynecology

OBJECTIVE: To perform a meta-analysis of randomized and quasi-randomized trials investigating whether endometrial closure is associated with the risk of uterine scar defects, menstrual symptoms, and associated surgical morbidity. DATA … OBJECTIVE: To perform a meta-analysis of randomized and quasi-randomized trials investigating whether endometrial closure is associated with the risk of uterine scar defects, menstrual symptoms, and associated surgical morbidity. DATA SOURCES: The Medline, EMBASE, Cochrane Library, and ClinicalTrials.gov databases were searched until February 10, 2025. Only randomized controlled trials (RCTs) or quasi-randomized trials comparing not closing with closing the endometrium during cesarean delivery were included. METHODS OF STUDY SELECTION: We identified 266 records in our search and two records by citation searching. Of these, 106 were considered for eligibility, and six were ultimately included in the review. TABULATION, INTEGRATION, AND RESULTS: We used a random-effects meta-analysis reporting relative risk (RR) and absolute risk and 95% CIs. The risk of bias was evaluated with the Cochrane risk-of-bias tool for randomized trials 2, and findings were presented according to the GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. We included six RCTs (491 women). Not including the endometrium in uterine closure reduces the risk of intermenstrual bleeding (RR 0.34, 95% CI, 0.15–0.77; two RCTs, 272 women; 6 months of follow-up; high-certainty evidence) and uterine scar defect (RR 0.53, 95% CI, 0.34–0.82; four RCTs, 392 women; I 2 =0.0%; 3–12 months of follow-up; high-certainty evidence). There were no differences in heavy uterine bleeding, dysmenorrhea, pelvic pain, postpartum endometritis, and residual myometrial thickness (low- to very low-certainty evidence). CONCLUSION: Not suturing the endometrium reduces the risk of intermenstrual bleeding and uterine scar defect after cesarean delivery. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42025650124.

Obstetric Unit Closure Effects on Child Academic Achievement, Infant Health, and Maternal Care

2025-06-12

George L. Wehby | Maternal and Child Health Journal

Prevalence of Mistreatment in Maternity Care: a population-based comprehensive multi-indicator approach

2025-06-01

Zaira Reyes-Amargant , Marta Roqueta-Vall-llosera , Josep Garre‐Olmo +3 more | Midwifery