A critical review of the birth plan use in Catalonia.

INTRODUCTION: The birth plan allows the woman to express her expectations and needs with regards to the childbearing continuum but its use has been debated in the clinical context and in published literature. The birth plan was first introduced in the Spanish Health Service in 2008 through the Strategy for the Care in Normal Childbirth. In Catalonia, the Normal Childbirth Care Programme has promoted the use of birth plans in hospitals participating in this Programme. OBJECTIVE: This works describes and analyses the birth plans produced by the participating hospitals in order to gather knowledge about the options available to women. METHOD: Qualitative study in which the content of birth plans is systematically and quantitatively described in order to evaluate options available to women. The final sample includes all the birth plans provided by 30 Catalonian public hospitals. Following an initial assessment, it was decided to devise a grading scale which allowed to code and assign a value to each of the items contained in the birth plans. RESULTS: Three different types of birth plan are identified: a) those which present a list of items with no (or very little) associated explanations, b) list of items with some explanations and c) plans without items which only explain normal working practices in the hospital and/or protocols.

Cross-sectional study comparing public and private hospitals in Catalonia: is the practice of routine episiotomy changing?

BACKGROUND: In Spain, the Strategy for Assistance in Normal Childbirth (SANC) promoted a model of care, which respects the physiological birth process and discards unnecessary routine interventions, such as episiotomies. We evaluated the rate of episiotomy use and perineal trauma as indicators of how selective introduction of the SANC initiative has impacted childbirth outcomes in hospitals of Catalonia. METHODS: Cross-sectional study of all singleton vaginal term deliveries without instrument registered in the Minimum Basic Data Set (MBDS) of Catalonia in 2007, 2010 and 2012. Hospitals were divided into types according to funding (public or private), and four strata were differentiated according to volume of births attended. Episiotomies and perineal injury were considered dependent variables. The relationship between qualitative variables was analysed using the chi-squared test, and Student's t-test was used for quantitative variables. Comparison of proportions was performed on the two hospital groups between 2007 and 2012 using a Z-test. Logistic regression models were used to analyse the relationship between episiotomy or severe perineal damage and maternal age, volume of births and hospital type, obtaining odds ratios (OR) and 95% confidence intervals (CI). RESULTS: The majority of normal singleton term deliveries were attended in public hospitals, where maternal age was lower than for women attended in private hospitals. Analysis revealed a statistically significant (P < 0.001) decreasing trend in episiotomy use in Catalonia for both hospital types. Private hospitals appeared to be associated with increased episiotomy rate in 2007 (OR = 1.099, CI: 1,057-1,142), 2010 (OR = 1.528, CI: 1,472-1,587) and 2012 (OR = 1.459, CI: 1,383-1,540), and a lower rate of severe perineal trauma in 2007 (OR = 0.164, CI: 0.095-0.283), 2010 (OR = 0.16, CI: 0.110-0.232) and 2012 (OR = 0.19, CI: 0.107-0.336). Regarding severe perineal injury, when independent variables were adjusted, maternal age ceased to have a significant correlation in 2012 (OR = 0.994, CI: 0.970-1.018). CONCLUSIONS: Episiotomy procedures during normal singleton vaginal term deliveries in Catalonia has decreased steadily since 2007. Study results show a stable incidence trend below 1% for severe perineal trauma over the study period.

La atención al parto en diferentes países de la Organización para la Cooperación y el Desarrollo Económico (OCDE) / Childbirth care in different countries of the Organization for Economic Co-operation and Development (OECD)

El desarrollo científico-tecnológico ha comportado una progresiva medicalización del proceso de embarazo, parto y puerperio y la institucionalización de la atención al parto en los hospitales en la mayoría de países industrializados. Existen diferentes modelos organizativos y de atención al parto y se pueden encontrar diferencias en cuanto a los resultados de esta atención. OBJETIVO: Describir diferentes modelos organizativos y de atención al parto en países seleccionados de la Organización para la Cooperación y el Desarrollo Económico (OCDE) e identificar variaciones en la estructura organizativa de los modelos observados. METODOLOGÍA: Búsqueda bibliográfica y cuestionario a informantes clave de diferentes países para identificar los aspectos relevantes sobre financiación de los servicios, lugar en que se presta la atención y distribución de competencias. RESULTADOS: Se describe la organización y el modelo de atención al parto, en el contexto de los sistemas de salud de cada país. Países incluidos: Reino Unido, Australia, Holanda, Irlanda, Francia, España y Canadá. Se presentan indicadores de la OCDE sobre la actividad sanitaria, el comportamiento del sistema de salud y el estado de salud de la población. CONCLUSIONES: Se observan diferentes formas de organizar la atención a la maternidad entre los países seleccionados y se evidencian diferencias en los resultados de la atención. Existen varios tipos de localización para la atención a las mujeres con bajo riesgo obstétrico durante el proceso de maternidad. En los sistemas de salud observados, la atención a las muje-res durante el embarazo se suele realizar en un entorno no hospitalario, mientras que para la atención al parto existen diferentes opciones sobre los tipos de localización y de atención que, en algunos casos, pueden ser elegidos por las mujeres. Los indicadores seleccionados muestran un am-plio rango de resultados entre los países elegidos, y parece conveniente investigar la posible relación de esta variabilidad con el tipo de organiza-ción y de atención durante el proceso de maternidad, así como identificar criterios comunes sobre los aspectos específicos para la atención a las mujeres que no presentan riesgos obstétricos

Scientific and technological advances have entailed an increased influence of medicine in the process of pregnancy, childbirth and post-partum with the institutionalisation this entails for childbirth care in the hospitals of most industrialised countries. Several organisational and childbirth care models are in place and differences can be observed between them with regard to the outcomes of such care. AIM: To describe differing organisational and childbirth care models in the chosen countries of the Organization for Economic Co-operation and Development (OECD) and identify variations in the organisational structure of the models observed. METHODOLOGY: To conduct a bibliographical search and questionnaire on key informers from various countries to identify relevant aspects concerning service funding, care settings and distribution of authority in this sphere. RESULTS: A description is given of the organisation and childbirth care model on the context of the health systems of each country. The countries studed are: Australia, Canada, France, Ireland, the Netherlands, Spain and the United Kingdom. OECD indicators are presented on healthcare activity, the operation of the health system and the state of health of thepopulation. CONCLUSIONS: Several forms of organising maternity care have been observed from the countries chosen and differences have been identified in the outcomes of care. There are numerous kinds of settings for providing care to women with a low obstetric risk during the maternity process. In the healthcare systems analysed, care for women during pregnancy is often provided in a non-hospital setting; however, when it comes to childbirth care, several options are available in terms of the setting and care which can even be chosen by women themselves in certain cases. The indicators selected point to a broad range of results among the chosen countries and it would be appropriate to research the possible link between this variation in terms of the kind of organisation and care provided during maternity and, accordingly, to identify common criteria relating to specific aspects in care for women with low obstetric risks

Obstetric interventions in two groups of hospitals in Catalonia: a cross-sectional study.

BACKGROUND: Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions.To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age. METHODS: Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal. RESULTS: The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81). CONCLUSIONS: In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery.