Maternal and Neonatal Outcome following Day Two versus Day Five or Seven Discharge after an Uncomplicated Elective Caesarean Section: A Randomized Control Study

Background. In recent times, it has become a common practice to discharge a woman early after an uncomplicated caesarean section (CS), to satisfy their wishes, reduce cost, and maximize efficient use of healthcare system resources. Objective. To conduct a comparative analysis of maternal and neonatal outcomes following day two hospital discharge versus day 5 or 7 discharge after an uncomplicated CS. Materials and Methods. Eligible parturient (228) who met the inclusion criteria were randomized into two groups between 1st October 2018 and 30th September 2019 in two different maternity centers in Ebonyi state. The study group (114) was discharged two days after an uncomplicated CS while the control group (114) was discharged on the 5th or 7th postoperative day. Their satisfaction, cost, morbidities, and breastfeeding practices were evaluated using a pretested questionnaire. Data were analyzed using IBM SPSS version 22. Results. Day 2 discharge was not associated with a higher rate of readmission as compared with day 5-7 discharge ( χ 2 = 0.95 , P = 0.329 ). There were no statistically significant differences in cost incurred by patients discharged on day 2 after uncomplicated CS compared to the control group ( χ 2 = 1.65 , P = 0.649 ). Maternal satisfaction was high following day 2 discharge compared with day 5-7 discharge ( χ 2 = 16.64 , P = 0.0001 , OR = 0.857 , 95 % CI = 0.59 – 1.25 ). The majority of mothers (79.6%) discharged on day 2 were able to initiate and sustain breastfeeding with no statistically significant difference in the initiation and sustenance of breastfeeding with those discharged on days 5-7 ( χ 2 = 4.45 , P = 0.108 ). Early hospital discharge did not have any significant negative impact on neonatal health ( χ 2 = 1.063 , P = 0.303 ). Conclusion. Early discharge of patients after an uncomplicated CS is not associated with increased rate of readmission. It is associated with good maternal satisfaction, adequate initiation and sustenance of breastfeeding, and good neonatal wellbeing. We advocate early discharge of women following uncomplicated CS.

Maternal satisfaction with intrapartum care and associated factors among postpartum women at public hospitals of North Shoa Zone Ethiopia

Background Maternal satisfaction is an essential indicator of the quality and the efficiency of the health care systems. At a time when efforts are being made globally to reduce maternal and neonatal mortality and morbidity, assessing maternal satisfaction is essential. There is a dearth of studies on maternal satisfaction with intrapartum care, particularly in the study area. This study aimed to assess maternal satisfaction with intrapartum care and associated factors among postpartum women at public hospitals of North Shoa Zone Ethiopia. Methods A facility-based cross-sectional study with a systematic random sampling technique was conducted from May1-30/ 2020. Data were entered into EpiData version 4.6 and analyzed using a statistical package for the social sciences version 25. Bivariate and multivariable logistic regression were employed. In multivariable logistic regression analysis, level of statistical significance was declared at variables with p < 0.05 and the strength of the association was measured by an adjusted odds ratio and 95% confidence interval. Result Of the total 394 participants, 111 (28.2%) [95% CI: 23.9, 32.5] of postpartum women were satisfied with the intrapartum care. Place of residence [AOR: 1.934; 95% CI (1.183, 3.162)], planned status of the pregnancy [AOR: 2.245; 95% CI, (1.212, 4.158)], number of antenatal care visit [AOR: 2.389; 95% (1.437, 3.974)] and duration of labour [AOR: 2.463; 95% (1.378, 4.402)] were factors significantly associated with maternal satisfaction with intrapartum care. Conclusion The proportion of maternal satisfaction with intrapartum care was low. Therefore, designing strategies to enhance maternal satisfaction by strengthening adherence to antenatal care visits, provision of family planning to prevent unplanned pregnancy, and strict utilization of partograph to prevent prolonged labour and childbirth-related complications are crucial.

Assessment of maternal birth satisfaction and intra-partum experiences among the women of rural areas of Tamil Nadu- a cross sectional study

Background: Childbirth, though a physiological process, has been associated with multiple risks and stress on the women, even before the time of conception till the post-partum. Every woman around the world has a right to receive respectful maternity care. Birth satisfaction and respectful maternal care has direct impact on percentage of institutional deliveries. There is paucity of studies conducted among the women of rural Tamil Nadu regarding birth satisfaction and intrapartum experiences.Methods: A cross-sectional study was conducted in primary health center area, red hills among the post-partum women attending the immunization OPD at 6, 10 and 14th week after delivery during the months of March to June 2018. By simple random sampling technique 195 subjects were included. A semi-structured questionnaire was administered to collect the data. Ethical clearance was obtained from our Institutional Ethics Committee. Data was entered in MS Excel and analysis was done using SPSS Software version 23.Results: The study shows the importance of maternal satisfaction and intrapartum experiences of women in rural areas. It concluded that the overall satisfaction was 85.5%. The transport facility available at the health care set up which satisfied the mothers was around 91.4%. The interaction of health care providers with mothers during delivery was around 64.5%. Cleanliness and comfort of the delivery area was around 64%. Equality of care provided at the health care set up was around 83%.Conclusions: Reasons for delivery visit, duration of labour, and mode of delivery are independent predictors of maternal satisfaction.

Becoming a Homebirther, Smooth Sailing or Rocky Road? An Exploration of Pakeha Women's Experience on the Path to Homebirth

<p>This study explores the experiences of primiparous women on the path to planning the homebirth of their first child. There are many challenges along the way and although there are many supports, society does not generally view homebirth as a safe option. This study highlights the themes emerging about the relative ease or disease of the journey. Was the experience smooth sailing on an undulating ocean or a testing trek along a rocky road? There is a vast body of evidence about homebirth, with much of the quantitative literature being outcome focussed and most of the qualitative literature exploring women's experience of the homebirth-day. Birthing at home has been linked with increased maternal satisfaction compared with other birth venues and correlates with a feeling of maintaining power and control during the birth process. Homebirth has also been shown to have similar rates of intrapartum and neonatal mortality, as well as lower maternal intervention rates, in low risk populations. This study principally investigates the experience of Pakeha New Zealand women on their way to planning a homebirth for their first baby. The findings of this narrative inquiry include that women make the journey to becoming a homebirther both before pregnancy and during pregnancy, and that they need good support and information. Hearing positive homebirth stories, having a midwife who professes a preference for homebirth, and having access to homebirth resources play integral roles in becoming a homebirther.</p>

Becoming a Homebirther, Smooth Sailing or Rocky Road? An Exploration of Pakeha Women's Experience on the Path to Homebirth

<p>This study explores the experiences of primiparous women on the path to planning the homebirth of their first child. There are many challenges along the way and although there are many supports, society does not generally view homebirth as a safe option. This study highlights the themes emerging about the relative ease or disease of the journey. Was the experience smooth sailing on an undulating ocean or a testing trek along a rocky road? There is a vast body of evidence about homebirth, with much of the quantitative literature being outcome focussed and most of the qualitative literature exploring women's experience of the homebirth-day. Birthing at home has been linked with increased maternal satisfaction compared with other birth venues and correlates with a feeling of maintaining power and control during the birth process. Homebirth has also been shown to have similar rates of intrapartum and neonatal mortality, as well as lower maternal intervention rates, in low risk populations. This study principally investigates the experience of Pakeha New Zealand women on their way to planning a homebirth for their first baby. The findings of this narrative inquiry include that women make the journey to becoming a homebirther both before pregnancy and during pregnancy, and that they need good support and information. Hearing positive homebirth stories, having a midwife who professes a preference for homebirth, and having access to homebirth resources play integral roles in becoming a homebirther.</p>

Comparison of L-Shape and Side-Lying Positions on Breastfeeding Outcomes among Mothers Delivered by Cesarean Section: A Randomized Clinical Trial

Introduction: Ineffective breastfeeding techniques is one of the factors contributing to poor breastfeeding outcomes in post-cesarean mothers. To assist post-cesarean mothers to find a comfortable breastfeeding position, a trial was conducted to compare different positions of breastfeeding in these individuals. Methods: A randomized clinical parallel trial was carried out on primipara post-cesarean mothers admitted to All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India. Participants were enrolled by convenience sampling technique, which was further randomized (block size= 4) and allocated to receive either "L" shape (n= 30) or side-lying (n= 30) position for breastfeeding. The assigned intervention was provided at least six times a day for four consecutive days. Data were collected using breastfeeding assessment Tool, maternal breastfeeding evaluation scale and numeric pain rating scale. Data were analyzed using SPSS software version 23. Results: The baseline characteristics of participants in both groups were similar. The mean comparison of breastfeeding outcome and maternal satisfaction indicated no significant difference between the two positions. However, the mean scores of maternal pain were statistically significant. Hence, it was inferred that the maternal pain was significantly less in post-cesarean mothers in "L" shape compared to side-lying. Conclusion: There is significantly less pain in post-cesarean mothers during breastfeeding in "L" shape than side-lying. Furthermore, maternal satisfaction and breastfeeding outcomes were found to be similar in both positions.

Validation of the Arabic Maternal Breastfeeding Evaluation Scale (MBFES-A) among Lebanese women

Background Maternal satisfaction with the breastfeeding experience is an important determinant of breastfeeding success. There is currently no valid tool to measure perceived maternal satisfaction with breastfeeding in the Arab context. Methods This cohort study tested the Maternal Breastfeeding Evaluation Scale (MBFES) on 450 healthy Lebanese mothers for internal consistency reliability and construct validity. Participants were recruited between April 2018 and February 2020. Results The Cronbach’s alpha reliability coefficient of the Arabic MBFES (MBFES-A) was 0.87. Exploratory factor analysis revealed that it has three components: Infant Satisfaction/Growth, Maternal Enjoyment/Role Attainment, and Lifestyle/Body Image with reliability coefficients of 0.88, 0.87, and 0.68, respectively. Four items were deleted because of low factor loadings and three items were relocated to the Infant Satisfaction/Growth subscale based on their factor loadings. Participants who were exclusively breastfeeding at one and/or 3 months had higher mean MBFES-A total and Infant Satisfaction/Growth and Maternal Enjoyment/Role Attainment subscale scores than participants who were partially breastfeeding, and significantly higher mean scores than mothers who were not breastfeeding (all p values < 0.001), findings that support the scale’s construct validity. Moreover, scores on the Infant Satisfaction/Growth subscale correlated with exclusive breastfeeding at one (r = 0.37, p < 0.001) and 3 months (r = 0.31, p < 0.001). The MBFES-A score had positive modest correlations with maternal attitude towards breastfeeding (r = 0.30, p < 0.001), exclusive breastfeeding at one (r = 0.27) and at 3 months (r = 0.26, p < 0.001 for both), as well as with the longest previous exclusive breastfeeding (r = 0.27, p < 0.001). Conclusions The 26-item MBFES-A is a reliable and valid instrument to use in future breastfeeding research in Middle East North Africa countries. There is a need for replication of our findings in other Arab contexts using new constructs to establish stronger construct validity.