Companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19: a mixed-methods analysis of national and organisational responses and perspectives

ObjectivesTo explore stakeholders’ and national organisational perspectives on companionship for women/birthing people using antenatal and intrapartum care in England during COVID-19, as part of the Achieving Safe and Personalised maternity care In Response to Epidemics (ASPIRE) COVID-19 UK study.SettingMaternity care provision in England.ParticipantsInterviews were held with 26 national governmental, professional and service-user organisation leads (July–December 2020). Other data included public-facing outputs logged from 25 maternity Trusts (September/October 2020) and data extracted from 78 documents from eight key governmental, professional and service-user organisations that informed national maternity care guidance and policy (February–December 2020).ResultsSix themes emerged: ‘Postcode lottery of care’ highlights variations in companionship and visiting practices between trusts/locations, ‘Confusion and stress around ‘rules’’ relates to a lack of and variable information concerning companionship/visiting, ‘Unintended consequences’ concerns the negative impacts of restricted companionship or visiting on women/birthing people and staff, ‘Need for flexibility’ highlights concerns about applying companionship and visiting policies irrespective of need, ‘‘Acceptable’ time for support’ highlights variations in when and if companionship was ‘allowed’ antenatally and intrapartum and ‘Loss of human rights for gain in infection control’ emphasises how a predominant focus on infection control was at a cost to psychological safety and human rights.ConclusionsPolicies concerning companionship and visiting have been inconsistently applied within English maternity services during the COVID-19 pandemic. In some cases, policies were not justified by the level of risk, and were applied indiscriminately regardless of need. There is an urgent need to determine how to sensitively and flexibly balance risks and benefits and optimise outcomes during the current and future crisis situations.

PEMBERDAYAAN PRAKTIK MANDIRI BIDAN DALAM MENINGKATKAN PENGALAMAN PERSALINAN YANG POSITIF MELALUI SOSIALISASI REKOMENDASI WORLD HEALTH ORGANIZATION (WHO) INTRAPARTUM CARE FOR POSITIVE CHILDBIRTH EXPERIENCE

Pemberdayaan Praktik Mandiri Bidan Dalam Meningkatkan Pengalaman Persalinan Yang Positif melalui Sosialisasi Rekomendasi World Health Organization (WHO) Intrapartum Care For Positive Childbirth Experience. Asuhan persalinan selalu berkembang dari waktu ke waktu. banyaknya asuhan persalinan tertuang dalam bukti evidence based. Namun demikian tidak semua hasil penelitian di rekomendasikan untuk dilaksanakan. World Health Organization (WHO) telah menerbitkan katalog yang merekomendasikan asuhan persalinan untuk meningkatkan pengalaman persalinan yang positif yang telah di review sehingga menjadi pedoman pelaksanaan asuhan untuk seluruh dunia. Sayangnya katalog masih berbahasa Inggris dan belum banyak di ketahui terutama di Praktik Mandiri Bidan Kabupaten Pringsewu. Kabupaten Pringsewu merupakan salah satu Kabupaten di Lampung dengan kondisi kultur yang masih pedesaan. Bidan sebagian besar adalah lulusan D III yang belum mempelajari asuhan kebidanan berbasis bukti sehingga belum terpapar Rekomendasi World Health Organization (WHO) Intrapartum Care For Positive Childbirth Experience. Bentuk kegiatan berupa sosialisasi rekomendasi apasaja dalam persalinan dan apa saja yang tidak direkomendasikan dalam persalinan. Pengabdian Masyarakat dilakukan dengan menggunakan daring karena adanya pandemi covid 19 di Indonesia dan seluruh dunia. Proses pelaksanaannya menggunakan zoominar. Hasil Pengabdian didapatkan pengetahuan tentang WHO intrapartum Care For Positive Experience sebelum kegiatan adalah 60,71 (2,53), dan setelah penelitian adalah 85,3 (1,68). Hasil uji statistik menunjukkan p value = 0,000 yang berarti bahwa ada Pemberdayaan Praktik Mandiri Bidan Dalam Meningkatkan Pengalaman Persalinan Yang Positif melalui Sosialisasi Rekomendasi World Health Organization (WHO) Intrapartum Care For Positive Childbirth Experience Di Kabupaten Pringsewu

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.

Collaborative model of intrapartum care: qualitative study on barriers and facilitators to implementation in a private Brazilian hospital

IntroductionA collaborative (midwife-obstetrician) model of intrapartum care (CMIC) is associated with lower caesarean section (CS) rates than physician-led models. In 2019, the largest private maternity hospital in Latin America (14.000 deliveries/year, 89% CS) created a quality improvement initiative to optimise intrapartum care and safely reduce CS in low-risk women managed by its internal team of healthcare providers (HCP). We conducted formative research to identify potential barriers and facilitators to the implementation of a CMIC.MethodsThree groups of stakeholders participated in focus groups and interviews: hospital managers and clinical coordinators, HCP working in labour/delivery wards and pregnant women intending to give birth in the hospital. We explored participants’ views about the acceptability of implementing a CMIC where a nurse-midwife (NM) on shift would be the main intrapartum HCP, with continuous support/supervision of a dedicated, in-house, obstetrician-gynaecologist (OB-GYN). A thematic analysis approach was used.Results12 HCPs, 5 clinical coordinators, 2 hospital managers and 7 women participated. OB-GYNs, coordinators and managers highlighted health system, organisational and structural factors (NMs’ limited experience/skills, professional roles, financial reimbursement) as potential barriers. NMs identified logistical and human resources as additional barriers. Women viewed the CMIC with perplexity and insecurity because of cultural beliefs about the dominant role of OB-GYNs, and limited information about NM’s capabilities. All professionals agreed that women’s acceptance of a CMIC will require educational interventions and communication strategies to inform potential users about the advantages and safety of this model.ConclusionThere are important barriers and facilitators to implement a CMIC in a private Brazilian maternity hospital. Factors related to health system structure and organisation may have the greatest impact. A CMIC is more likely to succeed if stakeholders’ concerns about responsibilities, power and financial revenues are addressed, and educational interventions targeted at users are deployed prior to its implementation.

Die S3-Leitlinie zur vaginalen Geburt am Termin – Zusammenfassung

Die Deutsche Gesellschaft für Hebammenwissenschaft (DGHWi) und die Deutsche Gesellschaft für Gynäkologie und Geburtshilfe (DGGG) haben zusammen mit weiteren Akteur*innen die S3-Leitlinie „Die vaginale Geburt am Termin“ entwickelt 3. Im Mittelpunkt der aktuellen S3-Leitlinie steht die evidenzbasierte Betreuung der vaginalen Geburt am Termin. Insbesondere werden Interventionen kritisch reflektiert. Zu diesen zählen die CTG-Kontrolle, die Fetalblutanalyse, der Ultraschall im Kreißsaal, das Schmerzmanagement, der Betreuungsprozess in der Eröffnungsphase, Austrittsphase und Nachgeburtsphase. Die inhaltlichen Empfehlungen sind zum größten Teil an die Empfehlungen der NICE-Guideline CG190 „Intrapartum Care for healthy women and babies“ 1 adaptiert.

COVID-19 preventive practices during intrapartum care- adherence and barriers in Ethiopia; a multicenter cross- sectional study

Background Coronavirus disease 19 (COVID-19) is a newly emerging pandemic affecting more than 120 million people globally. Compliance with preventive practices is the single most effective method to overcome the disease. Although several studies have been conducted regarding COVID-19, data on healthcare provider’s adherence to COVID-19 preventive practices during childbirth through direct observation is limited. Therefore, this study aimed to assess healthcare provider’s adherence to COVID-19 preventive practices during childbirth in northwest Ethiopia. Methods A multicenter study was conducted at hospitals in northwest Ethiopia among 406 healthcare providers from November 15 /2020 to March 10 /2021. A simple random sampling technique was employed to select the study subjects. Data were collected via face-to-face interviews and direct observation using a structured questionnaire and standardized checklist respectively. EPI INFO version 7.1.2 and SPSS 25 were used for data entry and analysis respectively. Binary logistic regression analyses were undertaken to identify associated factors. The level of significance was decided based on the adjusted odds ratio (AOR) with a 95% confidence interval at a p-value of ≤ 0.05. Results The proportion of healthcare providers having good adherence to COVID-19 preventive practices during intrapartum care was 46.1% (95% CI: 41.2, 50.9). Healthcare providers who had job satisfaction (AOR = 3.18; 95% CI: 1.64, 6.13), had smartphone and/or computer (AOR = 2.75; 95% CI: 1.62, 4.65), ever received training on infection prevention (AOR = 3.58; 95% CI: 2.20, 5.84), earned higher monthly income (AOR = 2.15; 95% CI: 1.30, 3.57), and worked at health facility in the urban area (AOR = 1.72; 95% CI: 1.07, 2.77) had a significant association with adherence to COVID-19 preventive practices. Moreover, the most commonly mentioned barriers for not adhering to the preventive practice of COVID-19 were crowdedness of the delivery room, non-availability of personal protective equipment, and shortage of alcohol or sanitizer. Conclusion The healthcare provider’s adherence to COVID-19 preventive practices was low. Hence, stakeholders need to pay special attention to increase healthcare provides’ job satisfaction. In addition, the provision of continuous training on infection prevention would be helpful. Furthermore, personal protective equipment, alcohol, and sanitizer supply must be provided for healthcare providers.

Implementation Outcomes Assessment of a Digital Clinical Support Tool for Intrapartum Care in Rural Kenya: An Observational Analysis (Preprint)

BACKGROUND To support quality of care improvements, iDeliver, a digital clinical support system for maternal and neonatal care, was developed. OBJECTIVE Taking an implementation research lens, we evaluated the adoption and fidelity of iDeliver and assessed the feasibility of its use to provide routine Ministry of Health reports. METHODS We analyzed routinely collected data from the iDeliver implemented at Trans Mara West sub-county Hospital (Kenya), from December 2018 to October 2020. To evaluate its adoption, we assessed the proportion of total facility deliveries over time. To examine the fidelity of iDeliver usage, we studied data completion to assess the plausibility of data entry by care providers during each stage of the labor and delivery workflow and if the usage reflected iDeliver’s envisioned function. We also examined the data completeness of maternal and neonatal indicators prioritized by the Kenyan Ministry of Health. RESULTS 1164 deliveries were registered in iDeliver, capturing 47.3% of the facility’s deliveries over 22 months. Registration improved significantly from 32.3% in the first to 62.2% in the second phase of implementation (P=0.003). Across iDeliver’s workflow, the overall completion rate of all variables improved significantly from 34.1% to 48.0% in the second phase (P<0.001). Data completion was highest for the Discharge-Labor Summary (67.7%) and was lowest for Labor Signs (14.4%). The completion rate of the key Ministry of Health indicators also improved significantly (P<0.001). CONCLUSIONS iDeliver’s adoption and data completeness improved significantly over time. Assessment of iDeliver’ usage fidelity suggested that some features were more easily utilized because providers had time to enter data, versus lower utilization during active childbirth when providers are necessarily engaged with the woman and baby. These insights on the adoption and fidelity of iDeliver usage prompted the team to adapt the application to reflect the users’ culture of use and further improve the implementation of iDeliver. CLINICALTRIAL newborn; neonatal health; maternal health; intrapartum care; labor and delivery; Kenya; digital clinical decision support; health information systems; digital health; implementation research

Postpartum haemorrhage and synthetic oxytocin dilutions in labour

This study investigated postpartum haemorrhage and historic oxytocin usage, because haemorrhage rates are rising. During the evolution of practice from intravenous bovine post-pituitary extract to synthetic oxytocin, experimental interventions had produced improved outcomes in certain cases and the postpartum haemorrhage rate was low. In this study, current synthetic oxytocin regimes from across the UK were compared with the 1977 (unchanged) licensed instructions for infusion. As a result of the pain-inducing properties of synthetic oxytocin, epidural analgesia prior to infusion is now standard for unlicensed regimes, adding complexity to intrapartum care and greater risks of complex births, as the fetus may be adversely affected by epidural drugs and acidosis. Unlicensed synthetic oxytocin dilutions and increments, the desensitising of oxytocin receptors, and unmeasured error factors in infusion pumps affect labour progress and outcomes. Today's rates of postpartum haemorrhage are associated with these changes to obstetric practice. Failure to inform women of intended unlicensed practices with synthetic oxytocin, or obtain consent for such, or offer licensed practice as standard constitutes neglect of the legal obligations outlined for doctors and midwives by professional Codes of Practice, intended to protect patients from predictable dangers.