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Objective:To analyze the implementation of early essential newborn care (EENC) in baby-friendly hospitals in China.Methods:This is an investigation carried out using convenience sampling method. People in charge of labor ward, obstetric wards or neonatology department of the selected hospitals, such as baby-friendly hospitals with birth facilities, primary or higher level of hospitals, or general hospitals or those specialized in obstetrics and gynecology or materal and child health care centers, were selected as the subjects of the survey. Information about EENC practices in these hospitals was collected using a self-designed questionnaire sent through WeChat from April 1 to 30, 2021. Chi-square test was used for statistical analysis. Results:A total of 126 questionnaires were distributed and 124 (124 baby-friendly hospitals) were withdrawn. There were 74 hospitals in the eastern, 18 in the central and 32 in the western region. Among the 124 hospitals, tertiary hospitals, general hospitals, and maternity and child care hospitals accounted for 72.6% ( n=90), 64.5% ( n=80) and 35.5% ( n=44), respectively. There were no significant differences in the hospital type, levels, EENC coverage and training, or implementation of mainly recommended EENC practices among the hospitals in the eastern, central and western regions (all P>0.05). The implementation rate of at least one mainly recommended EENC practice was 79.0% (98/124) and there was no significant difference in the implementation rates among eastern, central and western regions [86.4% (64/74), 13/18 and 65.6% (21/32), χ2=6.60, P=0.159]. A total of 80 (64.5%) hospitals implemented 10 or more recommended EENC practices, and the implementation rates in eastern, central and western regions were 71.6% (53/74), 10/18 and 53.1% (17/32), respectively ( χ2=4.08, P=0.130). Among the 17 mainly recommended measures of EENC, in eastern, central and western hospitals, the implementation rates were 10.8% (8/74), 2/18 and 18.8% (6/32) for mother-infant skin-to-skin contact for 90 min after birth; 66.2% (49/74), 11/18 and 68.8% (22/32) for delayed umbilical cord clamping; and 25.7% (19/74), 7/18 and 21.9% (7/32) for delayed routine care following skin-to-skin contact, respectively ( χ2=6.57, 0.34 and 4.53, all P>0.05). Conclusions:There is a big gap between the implementation of EENC in most baby-friendly hospitals in eastern, central and western China and the recommendation of the World Health Organization. It is necessary to further strengthen and standardize the implementation of EENC practices in baby-friendly hospitals in our country to continuously improve the health of newborns.
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Objective To establish a midwife-obstetrician collaboration-based management model for pregnant women after caesarean sections and to evaluate its effectiveness on women′s childbirth outcomes. Methods A panel of experts including obstetricians and midwives was established. A revised management scheme for women after cesarean sections was finally formed through multiple expert consultation method. A historical control method was implemented in our study. Women giving birth before the implementation of collaboration-based management scheme between 2011 and 2013 were recruited in the control group;and women giving birth afterwards between 2014 and 2016 were recruited in the intervention group. Childbirth outcomes such as the mode of delivery, rate of trial of labor after cesarean sections, and vaginal birth rate after cesareans were compared between the two groups. Results A total of 3326 women in intervention group, of those women 281 (8.4%) under trial of labor after cesarean, of the women who under trial of labor 264(94.0%) had successful vaginal birth. A total of 1625 women in control group, of those women 28(1.7%) under trial of labor after cesarean, of the women who under trial of labor 22(78.6%) had successful vaginal birth. The trial of labor after cesarean sections rate and the vaginal birth rate after cesareans rate was significantly higher in intervention group than that in control group (P<0.01). Conclusions The midwife-obstetrician collaboration-based management model can promote vaginal birth for women after cesarean sections, and has no adverse effect on other childbirth outcomes, which is worthy of being implemented more widely in China.
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Decision on mode of delivery (MOD) is a process involved by both clients and health care providers, based on specific clinical situations and women′s values. To help each woman obtain the best MOD is crucial for obstetric health professionals to provide women-centered high quality of care. There is a steep upward trend in cesarean sections in China due to the introduced advanced technologies, overused antenatal monitoring methods, flexible indications for cesarean sections, delayed childbearing ages and people′s misconceptions, etc.. Recently the conditional and comprehensive two-child policy have been implemented in China, which might initiate changes in fertility and birth intentions of many families, and in subsequent decisions on MOD. This review illustrates the pros and cons of MOD, decision process on MOD, influencing factors and strategies to promote decision on MOD, in order for the obstetric professionals to provide evidence-based best care for women and their families in the process of decision-making.
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Objective To establish a midwife-obstetrician collaboration-based management model for pregnant women after caesarean sections and to evaluate its effectiveness on women′s childbirth outcomes. Methods A panel of experts including obstetricians and midwives was established. A revised management scheme for women after cesarean sections was finally formed through multiple expert consultation method. A historical control method was implemented in our study. Women giving birth before the implementation of collaboration-based management scheme between 2011 and 2013 were recruited in the control group;and women giving birth afterwards between 2014 and 2016 were recruited in the intervention group. Childbirth outcomes such as the mode of delivery, rate of trial of labor after cesarean sections, and vaginal birth rate after cesareans were compared between the two groups. Results A total of 3326 women in intervention group, of those women 281 (8.4%) under trial of labor after cesarean, of the women who under trial of labor 264(94.0%) had successful vaginal birth. A total of 1625 women in control group, of those women 28(1.7%) under trial of labor after cesarean, of the women who under trial of labor 22(78.6%) had successful vaginal birth. The trial of labor after cesarean sections rate and the vaginal birth rate after cesareans rate was significantly higher in intervention group than that in control group (P<0.01). Conclusions The midwife-obstetrician collaboration-based management model can promote vaginal birth for women after cesarean sections, and has no adverse effect on other childbirth outcomes, which is worthy of being implemented more widely in China.
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Objective To conduct in‐depth job analysis and needs assessment on advanced midwifery practitioner (AMP) set up at a tertiary hospital .Methods The appraisal structure was designed by the needs assessment framework .Information on AMP′s job needs was collected via in‐depth interviews ,field notes and midwives′diaries .Colaizzi analysis method was used to sort out and analyze all the data .Results Seven themes through AMP′s job needs assessment were presented in the form of6W1H ,including :(1) who was AMP ;(2) whom did AMP serve;(3) what was AMP′s job content ;(4) what scope did AMP work in ;(5) how was the AMP′s practice model ;(6) where was the practical site;(7) why was the job post launched .Conclusions AMP practice at current stage is in its embryonic form of exploration but with huge potential demand ,which still needs to be improved using the needs assessment framework so that a scientific and standard job description can be formed to guide the AMP clinical practice .
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Objective To develop a three-stage standardized and systematic training program framework and indicator systems for clinical midwives.Methods Based upon literature review,Delphi technique was used to formulate index system and indicators for midwives' training program through tworound expert consultation among 29 experts.Results After two-round expert consultation,the response rates were 96.7％ and 100.0％,respectively.Experts' authority coefficient was 0.874.The training program framework consisted of a three-level index system.Average importance scores of the three-level indexes were 4.10 to 4.97,4.07 to 4.97,and 4.00 to 5.00,respectively.And their variance coefficients were 0.037 to 0.119,0.037 to 0.130,and 0 to 0.141,respectively.Then a progressive and integrated three-year standardized training framework and index system for clinical midwives was finally formed,which totally contained 5 first-level indicators or training modules,including professional competence and safety awareness,specialized and basic knowledge,specialized practical skills,emergency management,and basic capacity for teaching and research.Conclusions The three-level framework and indicators for clinical midwives' training program has been proved to be acceptable,reliable and scientific,thus providing a theoretical and referential basis for training clinical midwives and improving teaching quality.