An interprofessional model of care for oral health during pregnancy.

The study aim was to appraise the relevance and appropriateness of an interprofessional prenatal oral care model among pregnant women and healthcare providers in British Columbia (BC), Canada. Audio-recorded semi-structured interviews with 39 purposefully selected participants (13 pregnant women and 26 healthcare professionals) were used qualitatively to appraise relevance of an existing model. The existing model emphasizes communication and collaboration among multiple health providers for the delivery of integrated prenatal oral care. All interviews were transcribed verbatim and analyzed using an inductive thematic approach and N-Vivo® software. During the first round of interviews, most participants considered the existing model as simple and well-defined but not fully relevant to the BC context. The participants suggested revisions to Steven's model to incorporate facilitators of integrated care, including interprofessional education, oral health funding, and advocacy for oral healthcare. Participants suggested a different graphical portrayal for the revised model; an implementation guide was also suggested. A revised model based on participants' feedback, was shared with 14 of the initial participants during secondary interviews. Further evaluation of the appropriateness of the revised model is warranted.

Pregnant women's perspectives on integrating preventive oral health in prenatal care.

BACKGROUND: Oral diseases are considered a silent epidemic including among pregnant women. Given the prevalence of oral conditions among pregnant women and the reported association with adverse pregnancy outcomes, there have been suggestions for the inclusion of preventive oral care in routine prenatal care. However, due to the different administrative and funding structure for oral health and prenatal care in Canada, progress towards this integration has been slow. Our study sought to qualitatively explore the views of pregnant women in British Columbia (BC) on the strategies for integrating preventive oral health care into prenatal care services. METHODS: A qualitative approach was utilized involving semi-structured interviews with fourteen (14) purposefully selected pregnant women in Vancouver and Surrey, BC. The interviews were audio-recorded and transcribed. The transcripts were analyzed using an inductive thematic approach. Study validity was ensured via memoing, field-notes, and member checking. RESULTS: Interviews ranged from 28 to 65 min producing over 140 pages of transcripts. Analysis resulted in three major themes: oral health experiences during pregnancy, perspectives on integration and integrated prenatal oral care, and strategies for addressing prenatal oral health care. A majority of participants were supportive of integrating preventive oral care in routine prenatal services, with referrals identified as a critical strategy. Oral health education was recognized as important before, during, and after pregnancy; oral health assessments should therefore be included in the prenatal care checklist. Limited funding was acknowledged as a barrier to oral health care access, which may explain why few participants visited their dentists during pregnancy. Interprofessional education surfaced as a bridge to provide prenatal oral health education. CONCLUSION: Pregnant women interviewed in this study support the inclusion of educational and preventive oral care during prenatal care, although their views differed on how such inclusion can be achieved in BC. They advocated the establishment of a referral system as an acceptable strategy for providing integrated prenatal oral health care.

A Qualitative Study of Health Care Providers' Views on Integrating Oral Health into Prenatal Care.

OBJECTIVE: Providing preventive oral health during prenatal care is a recognized strategy for improving pregnant women's access to oral health care. This study sought to qualitatively explore the views of health care providers in British Columbia (BC), Canada, on strategies for integrating preventive oral health into prenatal care. METHODS: Twenty-four purposefully selected health care providers (13 oral health and 11 prenatal care providers) in Vancouver and Surrey BC participated in audio-recorded semistructured interviews. Interviews lasted from 31 to 61 min, were transcribed verbatim, and were analyzed using an inductive thematic analysis with N-Vivo software. Study validity was ensured via memoing, fieldnotes, member checking, and external audit. RESULTS: Thematic analysis revealed 5 major themes: perception of integrated care, relevance of integrated prenatal oral health, strategies for achieving integrated prenatal oral health, drivers of the integration process, and barriers to integrating oral health during pregnancy. Interprofessional collaboration based on information sharing and communication was identified as a critical factor for integrated care. Oral health checks should be a component of prenatal assessments for achieving integrated prenatal oral health. Participants recommended that prenatal providers should offer oral health education and use screening questions to identify the pregnant woman's oral health needs. The establishment of referral systems was advocated, while dental assessments and oral prophylaxis via the medical services plan were proposed. The inclusion of dental providers in prenatal teams and educating health care providers on interprofessional collaboration were also supported. CONCLUSION: Oral health and prenatal providers in BC are positively disposed to adopting integrated preventive prenatal oral health care based on interprofessional collaborative practices. The inclusion of oral health providers in prenatal teams was suggested. KNOWLEDGE TRANSFER STATEMENT: The results of this study can be used by policymakers for advocacy and decision making when planning care delivery programs for women during pregnancy. Including the suggested strategies could lead to increased access to, and utilization of, oral health services among pregnant women.

Vulvar application of lidocaine for pain relief in spontaneous vaginal delivery.

OBJECTIVE: To evaluate the effect of topical perineal lidocaine on immediate postpartum perineal pain. METHODS: Two hundred three volunteers randomly received either 2% lidocaine jelly or chlorhexidine gluconate topically to the perineum during the second stage of labor in a double-blind study. A four-point analogue pain scale was used to rate perineal pain 30 minutes after delivery. Parametric data were evaluated with the unpaired Student t test. Nonparametric data were analyzed using Mann-Whitney, Pearson chi 2, and Mantel-haenzel tests, and forward stepwise logistic regression. RESULTS: Women receiving topical lidocaine reported less overall perceived pain (48%, P < .05) and less moderate to severe pain (52%, odds ratio 1.83, P < .04) at delivery than those receiving placebo (33 and 67%, respectively). The incidence of perineal lacerations was similar in the two groups. A logistic regression found topical lidocaine and multiparity as significant correlates of diminished peripartum pain (P < .007). CONCLUSIONS: Topical application of 2% lidocaine gel was associated with decreased pain perception in the immediate postpartum interval. If confirmed by other investigators, this technique may offer improved analgesia while minimizing the injection route with local analgesia.