Women's reasons and perceptions around planning a homebirth with a registered midwife in Western Australia.

BACKGROUND: Qualitative evidence has provided rich descriptions around reasons for planning a homebirth with a midwife. Reasons and the importance, confidence and support around this option have not been examined by parity with a larger cohort. AIM: Examine women's characteristics, reasons and perceptions of the importance, confidence and support around choosing homebirth based upon parity. METHODS: A mixed method approach was undertaken within a prospective cohort study in Western Australia where women planning a homebirth have the option of a publicly funded model or care from privately practising midwives. At recruitment a questionnaire collected demographic data, perceived importance, confidence and support plus reasons for choosing homebirth. A qualitative component included an open ended question that encouraged sharing of opinions providing textual data explored by content analysis. FINDINGS: Reasons noted by 211 pregnant women for choosing homebirth were: avoidance of unnecessary intervention (58.8%), comfort and familiarity of home (34.1%), freedom of making own choices (25.6%), and having more continuity of care (24.2%). Reasons for planning homebirth were similar by parity, except for comfort of home being more important (44.0% vs 28.7%, p=0.025) and continuity of care (13.3% vs 30.1%, p=0.006) being less important to primigravid women. Themes revealed common beliefs around childbirth, appreciation for access to homebirth and a desire for greater awareness and less negativity around homebirth. CONCLUSION: Regardless of parity, homebirth was believed to be safe and supported by partners. Reasons identified from qualitative research to avoid intervention, the comfort of home, choice and continuity of care were supported.

Obstetric and neonatal outcomes for women intending to use immersion in water for labour and birth in Western Australia (2015-2016): A retrospective audit of clinical outcomes.

BACKGROUND: Research supports water immersion for labour if women are healthy, with no obstetric or medical risk factors. AIMS: To evaluate the obstetric and neonatal outcomes of women intending to use immersion in water for labour or birth. METHODS: Retrospective audit of clinical outcomes for women intending to labour or birth in water conducted between July 2015 and June 2016, at a tertiary maternity hospital in Western Australia. Obstetric and neonatal data were collected from medical records. Multivariable logistic regression was utilised to investigate women who laboured in water stratified by those who birthed in water. RESULTS: A total of 502 women intended to labour or birth in water; 199 (40%) did not and 303 (60%) did. The majority of women using water immersion (179 of 303; 59%) birthed in water. Multiparous women were more likely than primparous to birth in water (73% vs 46%; P < 0.001). Women who birthed in water were at increased odds of: a first stage labour ≤240 min (odds ratio (OR) 2.56, 95% CI 1.34-4.87, P = 0.004); a second stage ≤60 min (OR 3.53, 95% CI 1.82-6.84, P < 0.000); a third stage labour of 11-30 min (OR 2.15, 95% CI 1.23-3.78, P = 0.008); and having an intact perineum (OR 3.10, 95% CI 1.70-5.64, P < 0.000). CONCLUSION: Not all women who set out to labour and birth in water achieve their aim. There is a need for high-quality collaborative research into this option of labour and birth, so women can make an informed choice around this birth option.

Utilisation of preconception care in women with pregestational diabetes in Western Australia.

This study investigated the level of awareness of the availability of preconception care in a tertiary obstetric hospital for women with type 1 and 2 diabetes, the willingness of these women to attend for preconception counselling and the barriers that may impact upon access to preconception care in Western Australia. The results show greater effort is needed to improve the awareness of women about the importance of preconception care and their willingness to attend the clinic. Access to consistent preconception care should be available for all women with diabetes. The counselling process should be individualised to accommodate different needs.

The audience response system and knowledge gain: a prospective study.

INTRODUCTION: The introduction of an audience response system (ARS) in the obstetrics and gynaecology course for medical students at The University of Western Australia provided an opportunity to measure knowledge gain by ARS lecture formats compared with didactic lectures. METHODS: The study was conducted over four obstetrics and gynaecology terms, alternating the ARS and didactic format between two selected lectures each term. Students completed multiple-choice quizzes immediately post-lectures and 5 weeks later. RESULTS: Immediate post-lecture quiz mean scores for the ARS lectures were significantly higher compared with scores for the didactic lectures (7.5 vs. 6.7, p < 0.001). Pairwise comparisons between ARS and didactic lectures for each lecture topic showed significantly higher quiz scores for ARS lectures (preterm labour 8.3 vs. 7.4, p = 0.032; and prenatal diagnosis 6.9 vs. 6.0, p = 0.014). Quiz scores for the didactic preterm labour lecture were significantly higher than scores for the didactic prenatal diagnosis lecture (6.0 vs. 7.4, p < 0.001). Quiz results at 5 weeks showed no differences in scores between the ARS and the didactic lectures and no differences between lecture topics. CONCLUSIONS: Use of the ARS in lectures appeared to improve knowledge gain immediately post-lecture but no difference was found after retesting at 5 weeks.

The Growth Restriction Intervention Trial: long-term outcomes in a randomized trial of timing of delivery in fetal growth restriction.

OBJECTIVE: The Growth Restriction Intervention Trial found little difference in overall mortality or 2-year outcomes associated with immediate or deferred delivery following signs of impaired fetal health in the presence of growth restriction when the obstetrician was unsure whether to deliver. Because early childhood assessments have limited predictive value, we reevaluated them. STUDY DESIGN: Children were tested with standardized school-based evaluations of cognition, language, motor performance, and behavior. Analysis and interpretation were Bayesian. RESULTS: Of 376 babies, 302 (80%) had known outcome: either dead or evaluated at age 6-13 years. Numbers of children dead, or with severe disability: 21 (14%) immediate and 25 (17%) deferred groups. Among survivors, the mean (SD) cognition scores were 95 (15) and 96 (14); motor scores were 8·9 (7·0) and 8·7 (6·7); and parent-assessed behavior scores were 10·5 (7·1) and 10·5 (6·9), respectively, for the 2 groups. CONCLUSION: Clinically significant differences between immediate and deferred delivery were not found.

Small for gestational age preterm infants and relationship of abnormal umbilical artery Doppler blood flow to perinatal mortality and neurodevelopmental outcomes.

AIM: To determine the outcomes of preterm small for gestational age (SGA) infants with abnormal umbilical artery (UA) Doppler studies. METHODS: A retrospective cohort study of SGA singleton infants delivered between 24 and 32 weeks gestation at King Edward Memorial Hospital, Perth, who had UA Doppler studies performed within seven days of birth. Main outcomes assessed were perinatal mortality and morbidity, and neurodevelopmental outcomes at >or= 1 year of age. Outcomes were compared by normality of UA blood flow. RESULTS: There were 119 infants in the study: 49 (41%) had normal UA Doppler studies, 31 (26%) had an increased systolic-diastolic ratio >or= 95th centile, 19 (16%) had absent end diastolic blood flow (AEDF) and 20 (17%) had reversed end-diastolic flow (REDF). Infants in the AEDF and REDF groups were delivered significantly more preterm (P = 0.006) and had lower birthweights (P < 0.001). Ninety four per cent (110 of 117) of live born infants survived. Neurodevelopmental follow-up at 12 months of age or more (median 24 months) was available on 87 of 108 (81%) of live children. Twenty-eight per cent (11 of 39) of fetuses who had had AEDF or REDF died or were classified with moderate or severe disability. There was no significant association between abnormality of UA blood flow, perinatal morbidity, perinatal mortality and neurodevelopmental disability after correction for gestational age. CONCLUSION: Fetuses that are SGA with abnormal UA Doppler studies remain at significant risk of perinatal death, perinatal morbidity and long-term neurodevelopmental disability, associated with their increased risk of preterm birth.