Maternal and neonatal outcome of births in alongside midwifery units: A cohort study from a tertiary center in Germany

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate without compromising the maternal or health of the neonate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of all births in the AMU at our hospital from 2010 to 2017 with a matched group of low-risk women who gave birth during the same period of time in standard obstetric care. Methods We used a retrospective cohort study design. The study group consists of all women admitted to labor ward who had registered for birth in AMU. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth, postpartum hemorrhage, and obstetric injury was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.20 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural analgesia, duration of the second stage of labor, and episiotomy rate. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Except for birth injuries, non-inferiority could be established for the primary outcomes. Secondary outcomes occurred less common in the study group, including a shorter duration of the second stage of labor. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Our investigation confirms comparable maternal and neonatal outcome with less interventions for women giving birth in AMU at our institution. Currently, obstetric services in Germany are almost exclusively provided by consultant-led units. Our results support the integration of AMU as complementary models of care for low-risk women.

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Maternal and neonatal outcome of births planned in alongside midwifery units: A cohort study from a tertiary center in Germany

10.21203/rs.2.15294/v3 ◽

2020 ◽

Author(s):

Waltraut Maria Merz ◽

Laura Tascon-Padron ◽

Marie-Therese Puth ◽

Andrea Heep ◽

Sophia L. Tietjen ◽

...

Keyword(s):

Regression Analysis ◽

Cohort Study ◽

Primary Outcome ◽

Obstetric Care ◽

Low Risk ◽

Control Group ◽

Study Group ◽

Second Stage Of Labor ◽

Second Stage ◽

Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of women registered for planned birth in the AMU at our hospital with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time. Methods We used a retrospective cohort study design. The study group consisted of all women admitted to labor ward who had registered for birth in AMU from 2010 to 2017. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.10 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural anesthesia, duration of the second stage of labor, episiotomy, obstetric injury, and postpartum hemorrhage. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI; birthweight was on average 95 g higher. Non-inferiority could be established for the primary outcome parameters. Epidural anesthesia and episiotomy rates were lower, and the mean duration of the second stage of labor was shorter in the study group; second-degree perineal tears were less common, higher-order obstetric lacerations occurred more frequently. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Compared to births in our consultant-led obstetric unit, the outcome of births planned in the AMU was not inferior, and intervention rates were lower. Our results support the integration of AMU as a complementary model of care for low-risk women.

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Maternal and neonatal outcome of births planned in alongside midwifery units: A cohort study from a tertiary center in Germany

10.21203/rs.2.15294/v2 ◽

2020 ◽

Author(s):

Waltraut Maria Merz ◽

Laura Tascon-Padron ◽

Marie-Therese Puth ◽

Andrea Heep ◽

Sophia L. Tietjen ◽

...

Keyword(s):

Cohort Study ◽

Epidural Anesthesia ◽

Postpartum Hemorrhage ◽

Primary Outcome ◽

Obstetric Care ◽

Control Group ◽

Study Group ◽

Second Stage Of Labor ◽

Second Stage ◽

Low Risk Women

Abstract Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the maternal and perinatal outcome of women registered for planned birth in the AMU at our hospital with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time. Methods We used a retrospective cohort study design. The study group consisted of all women admitted to labor ward who had registered for birth in AMU from 2010 to 2017. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.10 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural anesthesia, duration of the second stage of labor, episiotomy, obstetric injury, and postpartum hemorrhage. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results 612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI. Birthweight was on average 95 g higher in the study group. Non-inferiority could be established for the primary outcome parameters. In the study group, less interventions were performed (epidural anesthesia rate 19.1% vs. 41.2%; episiotomy rate 4.7% vs. 8.6%). The duration of the second stage of labor was shorter (47.4 min. vs. 55.6 min.), and second-degree perineal tears were less common in the study group (34.4% vs. 46.4%), higher-order obstetric lacerations occurred more frequently in the study group (2.3% vs. 0.9%). There was no difference in the postpartum hemorrhage rate.

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The application value of midwifery leading companion doula in puerpera birth nursing

International Journal of Electrical Engineering Education ◽

10.1177/0020720920984006 ◽

2021 ◽

pp. 002072092098400

Author(s):

Lei Zhang ◽

Dan Tian

Keyword(s):

Pain Score ◽

Sampling Method ◽

Conventional Group ◽

Control Group ◽

Study Group ◽

Second Stage Of Labor ◽

Second Stage ◽

Intervention Measures ◽

Significant Difference ◽

Total Labor

Purpose To evaluate the effect of midwifery-led doula companion care in puerpera delivery nursing. Methods 126 primiparas were admitted to our hospital from June 2018 to November 2019 by random sampling method. According to the order of admission of primiparas, they were divided into conventional group (63 cases) and study group (63 cases). The routine group of primiparas were given routine delivery care, while the research group of primiparas were given doula accompanied care by midwives. The time of labor, pregnancy outcome, delivery pain score, delivery control and anxiety score of the two groups were compared and analyzed. Results Compared with the conventional group, the time of the first, second and total labor was significantly shorter in the study group (P < 0.05). The amount of postpartum hemorrhage in the study group was significantly less than that in the conventional group (P < 0.05). The rate of perineal incision and perineal laceration in the study group was significantly lower than that in the conventional group (P < 0.05). There was no significant difference in Apgar score <8 points compared with the control group (P > 0.05). The scores of pain and anxiety in the second stage of labor were significantly lower in the study group than in the conventional group (P < 0.05). The control score of the puerpera in the study group was significantly higher than that in the conventional group (P < 0.05). Conclusion The intervention measures of companion doula led by midwives can effectively shorten the time of labor, reduce the anxiety and pain score and improve the sense of control during labor of primiparas. This nursing method has clinical promotion and application value.

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Birthing Positions During Second Stage of Labor and Long-Term Psychological Outcomes in Low-Risk Women

International Journal of Childbirth ◽

10.1891/2156-5287.1.4.242 ◽

2011 ◽

Vol 1 (4) ◽

pp. 242-253

Author(s):

Ank de Jonge ◽

Marlies Rijnders ◽

Mariet Th. van Diem ◽

Peer L. H. Scheepers ◽

Antoine L. M. Lagro-Janssen

Keyword(s):

Depression Scale ◽

Well Being ◽

Self Esteem ◽

Psychological Outcomes ◽

Low Risk ◽

Negative Experience ◽

Second Stage Of Labor ◽

Second Stage ◽

Low Risk Women

PURPOSE: To examine the long-term influence of birthing positions during the second stage of labor, as well as other factors, on birth satisfaction, self-esteem (based on the Rosenberg Self-esteem Scale [RSE]) and emotional well-being (based on the Edinburgh Postnatal Depression Scale [EPDS]).STUDY DESIGN: Three to four years after delivery, a postal questionnaire was sent to all 3,200 women who received care in eight midwifery care practices from all over the country in 2001. Of those who responded (44%), we included 591 low-risk women in the study who were in midwife-led care at the time of birth.MAJOR FINDINGS: Birthing positions were not related to childbirth satisfaction, self-esteem, or emotional well-being. Age between 26 and 35 years was associated with being very satisfied and with enhanced emotional well-being. Pain, fear for own or baby’s life, and negative experience with the midwife were associated with reduced satisfaction. Only age between 26 and 35 years and higher education were related to higher self-esteem.MAIN CONCLUSION: Concern about long-term psychological outcomes is not a reason to recommend either supine or nonsupine positions. Women should use positions that are most comfortable. Further research should clarify whether having a choice in the use of birthing positions rather than the type of position influences psychological outcomes.

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EFFECT OF PREGNANCY EXERCISE ON DURATION OF THE FIRST AND SECOND STAGE OF LABOR IN PRIMIGRAVIDA MOTHERS DURING THE THIRD TRIMESTER OF PREGNANCY

Belitung Nursing Journal ◽

10.33546/bnj.304 ◽

2017 ◽

Vol 3 (6) ◽

pp. 765-770

Author(s):

Iin Wahyuni ◽

Noor Pramono ◽

Titi Suherni ◽

Melyana Nurul Widyawati

Keyword(s):

Community Health ◽

Health Center ◽

Average Duration ◽

Community Health Center ◽

Control Group ◽

Third Trimester ◽

Second Stage Of Labor ◽

Second Stage ◽

The Third ◽

And Control

Objective: This study aimed to examine the pregnancy exercise during the third trimester of pregnancy on duration of the first and second stage of labor in primigravida at the Community Health Center of Sukamaju, Bandar lampung, Indonesia.Methods: This study employed a quasy experimental design with posttest-only non-equivalent control group. This study was conducted from 8 January 2017 to 12 February 2017 at the Community Health Center of Sukamaju. Forty-eight primigravida mothers were selected using consecutive sampling, with 24 assigned in the experiment and control group. Data were analyzed using Mann whitney and Chi square test.Results: The average duration of the first stage of labor in the experiment group was 495 minutes and in the control group was 685 minutes (p= 0.000); while the average duration of the second stage of labor in the experiment group was 42.5 minutes and in the control group was 68.75 minutes (p=0.000).Conclusion: There was a statistically significant difference in the duration of the first and second stage of labor between experiment and control group. It is expected for midwives in the community health centers to implement pregnancy exercise program to help mothers in accelerating the delivery process.

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Vacuum assisted delivery in Ecuador for prolonged second stage of labor: Maternal–neonatal outcome

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.1080/14767050701227927 ◽

2007 ◽

Vol 20 (5) ◽

pp. 381-384 ◽

Cited By ~ 19

Author(s):

Xavier Chang ◽

Peter Chedraui ◽

Michael G. Ross ◽

Luis Hidalgo ◽

Jaime Peñafiel

Keyword(s):

Neonatal Outcome ◽

Second Stage Of Labor ◽

Second Stage ◽

Assisted Delivery

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The Effects of an External Nasal Dilator on Labor

American Journal of Rhinology ◽

10.1177/194589240501900218 ◽

2005 ◽

Vol 19 (2) ◽

pp. 221-224 ◽

Cited By ~ 3

Author(s):

Oscar Sadan ◽

Sagit Shushan ◽

Ido Eldar ◽

Shmuel Evron ◽

Samuel Lurie ◽

...

Keyword(s):

Active Phase ◽

Well Being ◽

Control Group ◽

Second Stage Of Labor ◽

Second Stage ◽

Satisfaction Rate ◽

Several Variables ◽

Active Labor ◽

Meconium Stained Amniotic Fluid

Background The aim of this study was to assess the effect of an external nasal dilator on several variables characterizing labor in both mother and fetus. Methods One hundred and fifty primigravida women in active labor were randomized to wear, throughout labor, either a dilator spring-loaded nasal strip or a placebo device. Data were obtained during labor and compared between the groups. After delivery, the satisfaction rate was assessed. Results No differences were found between the study and the control group regarding rate of induction or augmentation of labor as well as Montevideo units reached, frequency of rupture of membranes, duration of the active phase and second stage of labor, usage of epidural analgesia, normal fetal heart pattern, meconium-stained amniotic fluid, and neonatal well being. Length of maternal and neonatal hospitalization also did not differ between the groups. Satisfaction rate was significantly higher in parturient women wearing nasal strips with a dilator spring than in parturient women wearing a placebo spring (P < 0.0001). Conclusion Nasal strips do not change the course but ameliorate the quality of labor by improving the ease of breathing. Nasal dilators sustain the respiratory effort associated with the long process of labor and may control the switch from nasal to oronasal breathing during delivery.

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Normal labour: second stage

10.1093/med/9780198754787.003.0017 ◽

2017 ◽

Author(s):

Janet Medforth ◽

Linda Ball ◽

Angela Walker ◽

Sue Battersby ◽

Sarah Stables

Keyword(s):

Female Genital Mutilation ◽

Evidence Base ◽

Low Risk ◽

Current Evidence ◽

Genital Mutilation ◽

Second Stage ◽

Second Stage Of Labour ◽

Current Evidence Base ◽

Low Risk Women ◽

Female Genital

This chapter covers the second stage of labour, from onset through to latent and active phases. It describes the physiology and diagnosis of the second stage of labour for low-risk women. It considers the mechanism of normal labour which underpins the principles of care and conduct of a normal vaginal birth. The care of the perineum in line with the current evidence base is also described. Categorization of perineal trauma is given and the performance of an episiotomy described. The incidence and management of female genital mutilation are discussed.

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Maternal Outcome with Discontinuation of Magnesium Sulfate immediately Postpartum in Severe Preeclampsia

Journal of SAFOG with DVD ◽

10.5005/jp-journals-10006-1464 ◽

2017 ◽

Vol 9 (2) ◽

pp. 84-87 ◽

Cited By ~ 1

Author(s):

Imam Bano ◽

Pramod R Gade ◽

Yasir Alvi

Keyword(s):

Magnesium Sulfate ◽

Primary Outcome ◽

Randomized Study ◽

Study Groups ◽

Maternal Outcome ◽

Severe Preeclampsia ◽

Control Group ◽

Study Group ◽

Medical College ◽

Jawaharlal Nehru

ABSTRACT Objective To assess the effectiveness of discontinuation of magnesium sulfate (MgSO4) infusion in patients with severe preeclampsia immediately postdelivery. Materials and methods In a prospective-randomized study, women with severe preeclampsia attending the Jawaharlal Nehru Medical College, Aligarh, India, between January 2013 and September 2014 were enrolled. The inclusion criteria were blood pressure of at least 160/110 mm Hg after 24 weeks and either of the following: Proteinuria (dipstick value. 1), platelet <100,000, and serum transaminase levels twice as normal. Participants were assigned to control and study groups according to the time of enrollment (6-month blocks). All patients received MgSO4 loading dose (4 gm intravenously), followed by maintenance doses (1 gm/hour) until delivery (study group) and 24 hours (control group). The primary outcome was occurrence of convulsions after completion of MgSO4 therapy. Patients with treatment failure were excluded from analyses. Results Analyses included 48 patients in the study group and 43 patients in the control group. No convulsions occurred in either group after the completion of treatment. Conclusion: For women with severe preeclampsia, discontinuing MgSO4 immediately after delivery could effectively prevent convulsions. How to cite this article Anjum S, Gade PR, Garg N, Bano I, Alvi Y. Maternal Outcome with Discontinuation of Magnesium Sulfate immediately Postpartum in Severe Preeclampsia. J South Asian Feder Obst Gynae 2017;9(2):78-81.

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Effects of the Timing of Labour Induction on Maternal and Neonatal Outcomes in Low-risk Nulliparous Chinese Women

10.21203/rs.3.rs-133412/v1 ◽

2020 ◽

Author(s):

Qiang WEI ◽

Qin-yan CAO ◽

Li ZHANG ◽

Yi XU ◽

Mei-fan DUAN

Keyword(s):

Neonatal Intensive Care ◽

Chinese Women ◽

Low Risk ◽

Neonatal Outcomes ◽

Labour Induction ◽

Control Group ◽

Study Group ◽

Retrospective Case ◽

Maternal And Neonatal Outcomes ◽

Control Study

Abstract Backgroud: When labour induction should be offered to women at or beyond term is unclear. This work aimed to investigate the effects of the timing of labour induction on maternal and neonatal outcomes in low-risk pregnancies. Methods: This retrospective case-control study involved low-risk primigravid pregnant mothers in whom labour was induced at 40-41+6 weeks at our two hospitals between January and December 2017. According to the gestational age at labour induction, participants were categorized into the study group (40-40+6 weeks, n=284) or to the control group (41-41+6 weeks, n=172), and maternal and neonatal outcomes were compared.Results: The study group showed significantly shorter labour in the first stage (391.8±225.7 vs. 472.0±268.9 min, P=0.006), second stage (65.41±38.66 vs. 53.73±31.58 min, P= 0.008) and total stage (453.0±235.8 vs. 535.7±259.8 min, P=0.005). The two groups showed no significant differences in the methods of labour induction or in the rates of failure of labour induction, of caesarean delivery, of postpartum haemorrhage, or of admission to the neonatal intensive care unit.Conclusions: Our retrospective study suggests that inducing labour at 40-40+6 weeks does not increase the risk of adverse maternal or foetal outcomes, and that it shortens labour. These results suggest that labor induction at 40-40+6 weeks was feasible for low-risk primiparas.Trial registration: The research has been approved by the Ethics Committee of West China Second Hospital of Sichuan University and Chengdu Women and Children's Central Hospital, China. Patients gave written informed consent for their anonymized medical data to be analyzed and published for research purposes.

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