Decision Making about Hospital Arrival among Low-Risk Nulliparous Women after Spontaneous Labor Onset at Home

2018 ◽  
Vol 63 (4) ◽  
pp. 455-461 ◽  
Author(s):  
Joyce K. Edmonds ◽  
Kathleen Miley ◽  
Kimberly J. Angelini ◽  
Neel T. Shah
Keyword(s):  
Decision Making ◽  
Low Risk ◽  
Hospital Arrival ◽  
Nulliparous Women ◽  
Labor Onset ◽  
At Home

Pilot Study of Physiologic Partograph Use Among Low-Risk, Nulliparous Women With Spontaneous Labor Onset

2016 ◽  
Vol 61 (2) ◽  
pp. 235-241 ◽  
Author(s):  
Jeremy L. Neal ◽  
Nancy K. Lowe ◽  
Amy S. Nacht ◽  
Kate Koschoreck ◽  
Jessica Anderson
Keyword(s):  
Pilot Study ◽  
Low Risk ◽  
Nulliparous Women ◽  
Labor Onset

scholarly journals “Active Labor” Duration and Dilation Rates Among Low-Risk, Nulliparous Women With Spontaneous Labor Onset: A Systematic Review

2010 ◽  
Vol 55 (4) ◽  
pp. 308-318 ◽  
Author(s):  
Jeremy L. Neal ◽  
Nancy K. Lowe ◽  
Karen L. Ahijevych ◽  
Thelma E. Patrick ◽  
Lori A. Cabbage ◽  
...  
Keyword(s):  
Systematic Review ◽  
Low Risk ◽  
Labor Duration ◽  
Nulliparous Women ◽  
Active Labor ◽  
Labor Onset

scholarly journals Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Vanessa L. Scarf ◽  
Rosalie Viney ◽  
Serena Yu ◽  
Maralyn Foureur ◽  
Chris Rossiter ◽  
...  
Keyword(s):  
New South ◽  
New South Wales ◽  
Home Birth ◽  
Vaginal Birth ◽  
Low Risk ◽  
Birth Centre ◽  
South Wales ◽  
Nulliparous Women ◽  
Multiparous Women ◽  
At Home

Abstract Background In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. Aim The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW. Methods Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37–41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. Results Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a birth centre birth and 5.1% of nulliparous women planning a homebirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively). Conclusions Women who plan to give birth at home or in a birth centre have high rates of vaginal birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give birth at home or in birth centres will assist the planning, costing and expansion of models of care in NSW.

scholarly journals Perceptions of partial gland ablation for prostate cancer among men on active surveillance: a qualitative study

2021 ◽  
Vol 3 (1) ◽  
pp. e000068
Author(s):  
Sonia Hur ◽  
Michael Tzeng ◽  
Eliza Cricco-Lizza ◽  
Spyridon Basourakos ◽  
Miko Yu ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Qualitative Study ◽  
Active Surveillance ◽  
Treatment Modality ◽  
Tertiary Care ◽  
Low Risk ◽  
Intermediate Risk ◽  
Perceptions And Attitudes ◽  
Partial Gland Ablation

ObjectivesPartial gland ablation (PGA) therapy is an emerging treatment modality that targets specific areas of biopsy-proven prostate cancer (PCa) to minimize treatment-related morbidity by sparing benign prostate. This qualitative study aims to explore and characterize perceptions and attitudes toward PGA in men with very-low-risk, low-risk, and favorable intermediate-risk PCa on active surveillance (AS).Design92 men diagnosed with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS were invited to participate in semistructured telephone interviews on PGA.SettingSingle tertiary care center located in New York City.Participants20 men with very-low-risk, low-risk, and favorable intermediate-risk PCa on AS participated in the interviews.Main outcome measuresEmerging themes on perceptions and attitudes toward PGA were developed from transcripts inductively coded and analyzed under standardized methodology.ResultsFour themes were derived from 20 interviews that represent the primary considerations in treatment decision-making: (1) the feeling of psychological safety associated with low-risk disease; (2) preference for minimally invasive treatments; (3) the central role of the physician; (4) and the pursuit of treatment options that align with disease severity. Eleven men (55%) expressed interest in pursuing PGA only if their cancer were to progress, while nine men (45%) expressed interest at the current moment.ConclusionsAlthough an emerging treatment modality, patients were broadly accepting of PGA for PCa, with men primarily debating the risks versus benefits of proactively treating low-risk disease. Additional research on men’s preferences and attitudes toward PGA will further guide counseling and shared decision-making for PGA.

The level of unpleasantness of pain influences the choice of home treatment during medical abortion

2011 ◽  
Vol 2 (1) ◽  
pp. 19-23 ◽  
Author(s):  
Satu Suhonen ◽  
Marja Tikka ◽  
Seppo Kivinen ◽  
Timo Kauppila
Keyword(s):  
Medical Abortion ◽  
Nulliparous Women ◽  
Home Based ◽  
Vaginal Deliveries ◽  
Multiparous Women ◽  
Induced Abortions ◽  
Pain Drawings ◽  
Nonopioid Analgesics ◽  
Post Abortion ◽  
At Home

AbstractBackground and aimsMedical abortion is often performed at outpatient clinics or gynaecological wards. Yet, some women may stay at home during medical abortion. Pain has been reported to be one of the main side effects of the procedure.MethodsWe studied whether perceived abortion pain was related to the subjectively evaluated ability to stay at home during medical abortion. The size of the study group was 29 women. We also studied how well these women remembered the intensity and unpleasantness of the abortion pain in a control visit performed 3–6 weeks after abortion.ResultsEspecially, the unpleasantness associated with the pain during abortion was an important predictor when women evaluated their ability to stay at home during medical abortion. In those women who might have been able to stay at home in their own view, midwives looking after these women at the outpatient clinic estimated the pain intensity and unpleasantness also about 50% lower than in those who were not able to stay home in their own view. There were no significant differences in intensity, unpleasantness in hindsight of menstruation pain, or the area of this pain in the pain drawings in those women who considered that they might have stayed at home during medical abortion when compared with those who did not. No difference was found in age, gestational age, magnitude of previous pregnancies, miscarriages, vaginal deliveries, induced abortions, Beck’s Depression Index (BDI), Beck’s Anxiety Index (BAI) or AUDIT scores between those who could have stayed at home or those who would not have been able to stay at home during abortion. Components of abortion pain decreased significantly during the second post-abortion day. The more deliveries the subject had experienced the less pain she had during abortion. Multiparous women reported less than a fourth of the pain magnitude of the nulliparous women during abortion. Parity explained both intensity and unpleasantness of abortion pain better than the expected ability to stay at home. The remembrance of the intensity or unpleasantness of abortion pain correlated with actual pain reported at the time of abortion. However, this remembrance did not correlate with the ability to stay at home during the medical abortion.ConclusionsThe unpleasantness of pain during and immediately after abortion was recalled, not as a measure of the pain itself, but as a deciding factor in their judgement of whether or not they would be able to undergo medical abortion at home. Abortion pain is an important factor in enhancing home-based management of medical abortions. Medical staff may be able to detect those women who do not cope at home during the process by observing the intensity of pain. Therefore, proper treatment of pain might reduce the need for hospital-based medical abortions.ImplicationsThese patients need better care and guidelines for the care of women undergoing medical abortions should include clear recommendations for analgesic treatments, at the least adequate doses of nonopioid analgesics such as paracetamol in combination with NSAIDs like ibuprofen or diclofenac.

DEATH AT HOME

PEDIATRICS ◽  
1982 ◽  
Vol 70 (1) ◽  
pp. 78-78
Author(s):  
Keyword(s):  
Decision Making ◽  
Parental Involvement ◽  
Neonatal Care ◽  
Life And Death ◽  
The Past ◽  
Changing Patterns ◽  
At Home

Paediatricians responsible for neonatal care have been increasingly involved in, and aware of, the importance of parent infant interactions. These interactions are of major importance when concerned with the dying newborn. Over the past few years parental involvement in decision making related to life and death of newborn babies is becoming increasingly accepted ... more and more parents are opting to take their baby home to die. As changing patterns of birthing increasingly involve fathers and children, so death is once again becoming a family affair.

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