Developing and evaluating an online learning tool to improve midwives' accuracy of visual estimation of blood loss during waterbirth: An experimental study.

OBJECTIVE: The principal objective was to test the effectiveness of an online learning tool to improve midwives' accuracy of blood loss estimations in a birthing pool environment. The secondary objective was to assess the acceptability of the online learning tool to the midwives using it. DESIGN: A one group pre-test, post-test experiment with immediate and six weeks follow-up to test ability together with an online questionnaire to assess perceived usefulness of an online learning tool. SETTING: A large NHS maternity hospital comprising an acute care obstetric unit, a small district unit labour ward, one alongside midwifery-led unit and three freestanding midwifery-led units. PARTICIPANTS: Volunteer NHS employed midwives who had experience in caring for women labouring and giving birth in water (n = 24). INTERVENTION: An online learning tool comprising six randomly ordered short video simulations of blood loss in a birthing pool in real time, and a tutorial giving verbal and pictorial guidance on making accurate blood loss estimations in water was developed then piloted. Midwives' accuracy scores for estimating blood loss in each of the videos were calculated at three timepoints; pre and immediately post the learning component, and six weeks later. The estimated blood loss volume was subtracted from the actual blood loss volume, to give the difference between estimated and real blood loss in millilitres (ml) which was then converted to percentage difference to standardise comparison across the six volumes. The differences between pre- and post-learning for each of the six blood volumes was analysed using a repeated measures ANOVA. Statistical significance was set at p < 0.05. An online questionnaire incorporated questions using Likert scales to gauge confidence and competence and free text. Free text responses were analysed using a modified form of inductive content analysis. FINDINGS: Twenty-two midwives completed the online learning and immediate post-test, 14 completed a post-test after six weeks, and 15 responded to the online questionnaire. Pre-test results showed under-estimation of all blood loss volumes and particularly for the two largest volumes (1000 and 1100 ml). Across all volumes, accuracy of estimation was significantly improved at post-test 1. Accuracy diminished slightly, but overall improvement remained, at post-test 2. Participants rated the online tool positively and made suggestions for refining it. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: This is the first study measuring the accuracy of midwives' blood loss estimations in a birthing pool using real-time simulations and testing the effectiveness of an online learning tool to improve this important skill. Our findings indicate a need to develop interventions to improve midwives' accuracy at visually estimating blood loss in water, and the potential of an online approach. Most women who labour and/or give birth in water do so in midwifery-led settings without immediate access to medical support. Accuracy in blood loss estimations is an essential core skill.

New birthweight charts according to parity and type of delivery for the Spanish population / Nuevas curvas de peso al nacer por paridad y tipo de parto para la población española

Objective: Birthweight by gestational age charts enable fetal growth to be evaluated in a specific population. Given that maternal profile and obstetric practice have undergone a remarkable change over the past few decades in Spain, this paper presents new Spanish reference percentile charts stratified by gender, parity and type of delivery. They have been prepared with data from the 2010-2014 period of the Spanish Birth Statistics Bulletin. Methods: Reference charts have been prepared using the LMS method, corresponding to 1,428,769 single, live births born to Spanish mothers. Percentile values and mean birth weight are compared among newborns according to gender, parity and type of delivery. Results: Newborns to primiparous mothers show significantly lower birthweight than those born to multiparous mothers (p<0.036). Caesarean section was associated with a substantially lower birthweight in preterm births (p<0.048), and with a substantially higher birthweight for full-term deliveries (p<0.030). Prevalence of small for gestational age is significantly higher in newborns born by Caesarean section, both in primiparous (p<0.08) and multiparous mothers (p<0.027) and, conversely, the prevalence of large for gestational age among full-term births is again greater both in primiparous (p<0.035) and in multiparous mothers (p<0.007). Conclusions: Results support the consideration of establishing parity and type of delivery-specific birthweight references. These new charts enable a better evaluation of the impact of the demographic, reproductive and obstetric trends currently in Spain on fetal growth (AU)

Objetivo: Las tablas de peso al nacer por edad gestacional permiten evaluar el crecimiento fetal en una población específica. Dado que el perfil materno y la práctica obstétrica han experimentado un sustancial cambio en las últimas décadas en España, este trabajo propone nuevas tablas de referencia de percentiles estratificadas por sexo, paridad y tipo de parto, elaboradas con los datos del periodo 2010-2014 del Boletín Estadístico de Partos. Métodos: Las curvas de referencia han sido elaboradas mediante el método LMS, correspondientes a 1.428.769 nacidos vivos de partos simples y madres españolas. Se comparan los valores por percentiles y la media del peso al nacer, por sexo, paridad y tipo de parto. Resultados: Los nacidos de madres primíparas muestran un peso menor que los nacidos de multíparas (p<0,036). Los nacidos pretérmino por cesárea tienen un peso menor que los nacidos pretérmino por parto vaginal (p<0,048), mientras que ocurre lo contrario en los nacidos a término (p<0,030). La prevalencia de nacidos pequeños para la edad gestacional es mayor entre los nacidos por cesárea de madres tanto primíparas (p<0,08) como multíparas (p<0,027), y la prevalencia de nacidos grandes para la edad gestacional es mayor entre los nacidos a término de madres tanto primíparas (p<0,035) como multíparas (p<0,007). Conclusiones: Los resultados apoyan establecer referencias de peso al nacer por paridad y tipo de parto. Estas nuevas curvas permiten una mejor evaluación del impacto de las actuales tendencias demográficas, reproductivas y obstétricas en España sobre el crecimiento fetal (AU)

Taxonomy for complexity theory in the context of maternity care.

BACKGROUND: The linear focus of 'normal science' is unable to adequately take account of the complex interactions that direct health care systems. There is a turn towards complexity theory as a more appropriate framework for understanding system behaviour. However, a comprehensive taxonomy for complexity theory in the context of health care is lacking. OBJECTIVE: This paper aims to build a taxonomy based on the key complexity theory components that have been used in publications on complexity theory and health care, and to explore their explanatory power for health care system behaviour, specifically for maternity care. METHOD: A search strategy was devised in PubMed and 31 papers were identified as relevant for the taxonomy. FINDINGS: The final taxonomy for complexity theory included and defined 11 components. The use of waterbirth and the impact of the Term Breech trial showed that each of the components of our taxonomy has utility in helping to understand how these techniques became widely adopted. It is not just the components themselves that characterise a complex system but also the dynamics between them.

Inmersión en agua durante el parto: revisión bibliográfica / Immersion in water during labor: a review

La investigación en métodos alternativos para el alivio del dolor durante el trabajo de parto está experimentando muchos avances. Entre ellos, la hidroterapia. Su seguridad durante el trabajo de parto y su uso durante el periodo expulsivo es un tema muy debatido actualmente. Esta revisión bibliográfica tiene el objetivo de conocer la evidencia científica disponible sobre los beneficios y posibles complicaciones de la hidroterapia, tanto en los factores obstétricos como neonatales. La búsqueda bibliográfica se ha llevado a cabo en las bases de datos PubMed, Cinahl, Biblioteca Cochrane y Scopus, entre los años 2004 y 2014. Se seleccionaron 30 referencias bibliográficas. En el uso de hidroterapia durante el parto no se han detectado efectos perjudiciales sobre los parámetros obstétricos maternos estudiados, sino que disminuye la percepción del dolor y el uso de analgesia, se realizan menos episiotomías y aumenta la satisfacción del parto. Las repercusiones neonatales en cuanto a morbilidad por realizar un parto en agua es el aspecto más controvertido, en especial las complicaciones por aspiración de agua o rotura de cordón

Research into alternative methods of pain relief during labor is a field in which many advances are been made. Including hydrotherapy during labor is a controversial topic among professional associations. It seems proven its safety during labor, but its use during delivery is a hot topic today. There has been a literature review in order to know the available scientific evidence on the benefits and possible complications in both obstetric and neonatal factors. The literature search was conducted in PubMed, Cinahl, Cochrane Library, Scopus data between the years 2004-2014; 30 literature alerts were selected. In the use of hydrotherapy during labor were not detected harmful effects on maternal obstetric parameters studied, instead decreases pain perception and use of analgesia, fewer episiotomies are performed and increases satisfaction birth. The neonatal repercussions, in terms of morbidity for making a water birth, is the most controversial aspect, especially complications aspiration of water or cord breakage

Prevalencia de la lactancia materna en el Área Básica de Salud Sant Feliu-2 (Barcelona) / No disponible

Objetivo: estudiar la prevalencia del tipo de lactancia y de sus factores condicionantes en nuestra Área Básica de Salud (ABS). Material y métodos: estudio descriptivo transversal, mediante encuesta telefónica, en 200 niños nacidos en el año 2003. Variables estudiadas: tipo y duración de la lactancia materna (LM), uso de pezonera, suplementos de biberón, edad materna, nivel de estudios, procedencia, situación laboral, número de hijos, tipo de parto, hábito tabáquico, fuente de información y motivo de abandono de la LM. Análisis de los datos: estadísticos descriptivos, prueba de chi al cuadrado y análisis multivariante. Resultados: el 74% de mujeres inicia LM, el 25,5% sigue LM a los 6 meses, y el 3,5% a los 12 meses. La duración media de la LM exclusiva (LME) fue de 3,21 meses (desviación estándar [DE]: 3,32 meses). Se ha encontrado una asociación significativa entre ser inmigrante y la LM al mes de vida (p = 0,0022) y LM a los 6 meses [p < 0,0005, odds ratio (OR) de 6,9 (intervalo de confianza [IC] 95%: 2,23-23,05]. También entre un mayor nivel de estudios y LM al mes de vida (p = 0,007). OR = 1,7 (IC 95%: 1,05-2,75). El resto de variables estudiadas no tiene significación estadística. Conclusiones: el porcentaje de inicio de LM es ligeramente inferior al de otros estudios de nuestro entorno; las mujeres que inician LM la mantienen durante más tiempo. Factores favorecedores son un mayor nivel de estudios y ser inmigrante. Debemos potenciar la LM antes y en los primeros días después del parto (AU)

Objective: to study the prevalence of maternal lactation of our health area, and its conditioning factors. Methodology: cross-sectional descriptive study, by means of telephone survey, of 200 children born in 2003. Studied variables: type of lactation and duration of the breastfeeding, use of nipple protector, supplements of baby’s bottle, maternal age, level of studies, origin, work situation, number of children, type of childbirth, smoking habit, information on breastfeeding and reason for abandonment. Analysis of data: statistical descriptive, chi square test, and multivariate analysis. Results: 74% of women initiate breastfeeding, 25.5% follow breastfeeding at 6 months, and 3.5% maintain it until 12 months. The average duration of exclusive breastfeeding was of 3.21 months (standard deviation [SD]: 3.32). A significant association has been found between being immigrant and breastfeeding at one month of life (p = 0, 0022) and breastfeeding at 6 months (p < 0, 0005). Odds Ratio (OR) of 6.9 (confidence interval [CI] 95%: 2, 23-23, 05). Also between mothers with higher level of studies and breastfeeding at one month of life (p = 0,007). OR = 1.7 (CI 95%: 1, 05-2,75). The rest of the studied variables do not have statistical meaning. Conclusions: the percentage of mothers who initiate breastfeeding is slightly inferior to other studies of our surroundings; women who initiate breastfeeding, maintain it for longer. A higher level of studies and being an immigrant are helping factors for breastfeeding. We must promote maternal education before and during the first days after hospital discharge (AU)

Method of Patient Classification System in obstetric staff scheduling. II. Demand for direct nursing in the delivery room among mothers who deliver by natural birth.

After the development of categories and criteria of nursing mothers who give birth in the delivery room, the direct nursing time provided for women at childbirth by the midwives in individual categories of care was determined. The model time which should be provided for mothers according to their actual needs was also determined. The results of the study showed that among women who delivered naturally, statistically significant differences were observed between two variables: the nursing time provided and the model time. Hence, for women who deliver naturally it would be advisable that the nursing time standard for midwives resulted from the model times.

Porcentaje de partos normales y cesáreas en las usuarias que acuden al Hospital Regional de Caaguazú

Estudio exploratorio descriptivo de 1250 mujeres embarazadas que acudieron al Hospital Regional de Caaguazú entre enero y diciembre de 1997, para hacer uso del servicio de parto. Presenta el porcentaje de partos normales y por cesárea teniendo en cuenta las causas y sus indicadores