| 1. |
- Begley, Cecily, 1954, et al.
(författare)
-
Evaluation of an intervention to increase vaginal birth after caesarean section through enhanced women-centred care: The OptiBIRTH randomised trial (ISRCTN10612254)
- 2017
-
Ingår i: 31th ICM Triennial Congress.
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Vaginal birth after a previous caesarean (VBAC) is a safe alternative to repeat caesarean section (CS), is the preferred option of most women and may reduce overall CS rates.1 However, VBAC rates vary; e.g., rates in Germany, Ireland and Italy are considerably lower (29-36%) than those in the Netherlands, Sweden and Finland (45-55%). Purpose/Objective: To evaluate the effectiveness of an intervention to maximise VBAC rates. The OptiBIRTH Project was funded by a European Union Grant: FP7-HEALTH-2012-INNOVATION-1-HEALTH.2012.3.2-1. Agreement No:305208 Method: A cluster randomised trial was used. A sample size of 12 maternity units was required, each recruiting 120 consenting women, to detect an absolute 15% difference in successful VBACs (increase from 25% in control to 40% in intervention groups), using an ICC of 0.05, with power of >80% and an alpha of 0.05. To allow for loss to follow-up, 15 trial units were randomised across three countries with low VBAC rates (Germany, Ireland and Italy) and the trial commenced April 2014. An evidence-based intervention was introduced in all intervention sites. Control sites had usual care. Interim analysis by an independent Data Monitoring Committee at mid-point permitted continuation. Data were analysed using intention to treat. Key Findings: Recruitment closed October 2015, with the last babies born in December 2015, and data analysis will be completed in April 2016. The primary outcome, comparison of annual VBAC rates for each hospital before and after introduction of the intervention will be presented, and selected secondary outcomes for the recruited women including: mode of birth, perineal trauma, breastfeeding, uterine rupture, wound breakdown, perinatal mortality, Apgar scores, and admission to neonatal intensive care unit. Discussion: If the OptiBIRTH intervention increases VBAC rates safely, its introduction across Europe could prevent 160,000 unnecessary CSs every year, saving maternity services >€150 million annually and contributing to the normalisation of birth for thousands of women. References: 1 Cunningham et al (2010). National Institute of Health Consensus Development Conference Statement: Vaginal birth after caesarean. Obstet & Gynecol 115(6): 1279-1295. 2 EURO-PERISTAT 2008: CD006066.EURO-PERISTAT Project (2008). European Perinatal Health Report. (www.europeristat.com).
|
|
| 2. |
- Berg, Marie, 1955, et al.
(författare)
-
A midwifery model of intrapartum care - development and implementation
- 2014
-
Ingår i: Leadership, learning and research in nursing and midwifery. Sigma Theta Tau International Honor Society, 2nd European regional conference. 16-18 June 2014 Gothenburg, Sweden..
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)
|
|
| 3. |
- Clarke, Mike, et al.
(författare)
-
OptiBIRTH: a cluster randomised trial of acomplex intervention to increase vaginalbirth after caesarean section
- 2020
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393.
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Despite evidence supporting the safety of vaginal birth after caesarean section (VBAC), rates are lowin many countries.Methods: OptiBIRTH investigated the effects of a woman-centred intervention designed to increase VBAC ratesthrough an unblinded cluster randomised trial in 15 maternity units with VBAC rates < 35% in Germany, Ireland andItaly. Sites were matched in pairs or triplets based on annual birth numbers and VBAC rate, and randomised, 1:1 or 2:1, intervention versus control, following trial registration. The intervention involved evidence-based education ofclinicians and women with one previous caesarean section (CS), appointment of opinion leaders, audit/peer review,and joint discussions by women and clinicians. Control sites provided usual care. Primary outcome was annualhospital-level VBAC rates before the trial (2012) versus final year of the trial (2016). Between April 2014 and October2015, 2002 women were recruited (intervention 1195, control 807), with mode-of-birth data available for 1940women.Results: The OptiBIRTH intervention was feasible and safe across hospital settings in three countries. There was nostatistically significant difference in the change in the proportion of women having a VBAC between interventionsites (25.6% in 2012 to 25.1% in 2016) and control sites (18.3 to 22.3%) (odds ratio adjusted for differences betweenintervention and control groups (2012) and for homogeneity in VBAC rates at sites in the countries: 0.87, 95% CI:0.67, 1.14, p = 0.32 based on 5674 women (2012) and 5284 (2016) with outcome data. Among recruited womenwith birth data, 4/1147 perinatal deaths > 24 weeks gestation occurred in the intervention group (0.34%) and 4/782in the control group (0.51%), and two uterine ruptures (one per group), a rate of 1:1000.Conclusions: Changing clinical practice takes time. As elective repeat CS is the most common reason for CS inmultiparous women, interventions that are feasible and safe and that have been shown to lead to decreasingrepeat CS, should be promoted. Continued research to refine the best way of promoting VBAC is essential. Thismay best be done using an implementation science approach that can modify evidence-based interventions inresponse to changing clinical circumstances.Trial registration: The OptiBIRTH trial was registered on 3/4/2013. Trial registration number ISRCTN10612254.
|
|
| 4. |
- Dencker, Anna, 1956, et al.
(författare)
-
Measuring women's experiences of decision-making and aspects of midwifery support: a confirmatory factor analysis of the revised Childbirth Experience Questionnaire
- 2020
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 20:1
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundWomen's experiences of labour and birth can have both short- and long-term effects on their physical and psychological health. The original Swedish version of the Childbirth Experience Questionnaire (CEQ) has shown to have good psychometric quality and ability to differentiate between groups known to differ in childbirth experience. Two subscales were revised in order to include new items with more relevant content about decision-making and aspects of midwifery support. The aim of the study was to develop new items in two subscales and to test construct validity and reliability of the revised version of CEQ, called CEQ2.MethodA total of 11 new items (Professional Support and Participation) and 14 original items from the first CEQ (Own capacity and Perceived safety), were answered by 682 women with spontaneous onset of labour. Confirmatory factor analysis was used to analyse model fit.ResultsThe hypothesised four-factor model showed good fit (CMIN=2.79; RMR=0.33; GFI=0.94; CFI=0.94; TLI=0.93; RMSEA=0.054 and PCLOSE=0.12) Cronbach's alpha was good for all subscales (0.82, 0.83, 0.76 and 0.73) and for the total scale (0.91).ConclusionsCEQ2, like the first CEQ, yields four important aspects of experience during labour and birth showing good psychometric performance, including decision-making and aspects of midwifery support, in both primiparous and multiparous women.
|
|
| 5. |
- Dencker, Anna, 1956, et al.
(författare)
-
Neonatal outcomes associated with mode of subsequent birth after a previous caesarean section in a first pregnancy: A Swedish population-based register study between 1999 and 2015
- 2022
-
Ingår i: BMJ Paediatrics Open. - : BMJ. - 2399-9772. ; 6:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objective To investigate neonatal outcomes within 28 days in the subsequent birth in women who gave birth to their first baby by caesarean section (CS). Design and setting National retrospective population-based register study. A cohort of 94 451 neonates who were born in Sweden between 1999 and 2015 as a second child to a mother who had her first birth by emergency or planned caesarean. Methods Data were retrieved from the national registers held by Statistics Sweden and the National Board of Health and Welfare. Logistic regression was used to calculate unadjusted and adjusted ORs (aOR) with 95% CIs for each outcome. Main outcome measures Neonatal infection, neonatal asphyxia/respiratory distress, neonatal hospital care and neonatal death within 28 days. Results Emergency CS and instrumental vaginal birth were associated with a doubled risk of neonatal infection (aOR 2.0) and planned CS with a decreased risk (aOR 0.7) compared with spontaneous vaginal birth. Compared with spontaneous vaginal birth, an increased risk of birth asphyxia and/or respiratory distress was identified with all other modes of birth (aOR 2.2-3.2). Emergency CS and instrumental vaginal birth, but not planned CS, were associated with neonatal hospital care (aOR 1.8 and 1.7) and an increased mortality rate during the neonatal period (aOR 2.9 and 3.2), compared with spontaneous vaginal birth. Conclusions In childbirth following a previous birth by CS, spontaneous vaginal birth appears to confer better neonatal outcomes within 28 days after birth overall than other modes of birth.
|
|
| 6. |
- Hildingsson, Ingegerd, et al.
(författare)
-
A longitudinal survey of childbirth-related fear and associated factors
- 2011
-
Ingår i: Journal of Obstetric, Gynecologic, & Neonatal Nursing. - : Elsevier BV. - 1552-6909 .- 0884-2175. ; 40:5, s. 532-543
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the prevalence of childbirth-related fear from pregnancy to one year after childbirth and to identify factors associated with being cured of childbirth-related fear. Design: A longitudinal regional survey. Setting: Three hospitals in a northern part of Sweden. Participants: Six hundred ninety-seven (697) women who completed four questionnaires. Methods: Data were collected by questionnaires in mid and late pregnancy and at 2 months and one year after birth. Childbirth related fear was measured 3 times. Results: There was a statistically significant increase in childbirth fear from 12.4% in mid-pregnancy to 15.1% one year after childbirth (p < .001). Women who were cured of childbirth fear reported a better birth experience and would prefer a vaginal birth in a subsequent pregnancy. These women were also more likely to experience a feeling of control during birth and were more satisfied with information about the progress of labor, but there was no difference in prenatal counseling or having an elective cesarean between the groups. Conclusion: Women with prenatal fear of childbirth may be cured of this fear by having a better birth experience. If women feel in control of their bodies and are well informed about the progress of labor, the chances of being cured will increase. Prenatal counseling or having an elective cesarean birth does not seem to be a solution for relieving childbirth fear.
|
|
| 7. |
- Lundgren, Ingela, 1957, et al.
(författare)
-
Clinician-centred interventions to increase vaginal birth after caesarean section (VBAC): a systematic review
- 2015
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 15:16
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundThe number of caesarean sections (CS) is increasing globally, and repeat CS after a previous CS is a significant contributor to the overall CS rate. Vaginal birth after caesarean (VBAC) can be seen as a real and viable option for most women with previous CS. To achieve success, however, women need the support of their clinicians (obstetricians and midwives). The aim of this study was to evaluate clinician-centred interventions designed to increase the rate of VBAC.MethodsThe bibliographic databases of The Cochrane Library, PubMed, PsychINFO and CINAHL were searched for randomised controlled trials, including cluster randomised trials that evaluated the effectiveness of any intervention targeted directly at clinicians aimed at increasing VBAC rates. Included studies were appraised independently by two reviewers. Data were extracted independently by three reviewers. The quality of the included studies was assessed using the quality assessment tool, `Effective Public Health Practice Project¿. The primary outcome measure was VBAC rates.Results238 citations were screened, 255 were excluded by title and abstract. 11 full-text papers were reviewed; eight were excluded, resulting in three included papers. One study evaluated the effectiveness of antepartum x-ray pelvimetry (XRP) in 306 women with one previous CS. One study evaluated the effects of external peer review on CS birth in 45 hospitals, and the third evaluated opinion leader education and audit and feedback in 16 hospitals. The use of external peer review, audit and feedback had no significant effect on VBAC rates. An educational strategy delivered by an opinion leader significantly increased VBAC rates. The use of XRP significantly increased CS rates.ConclusionsThis systematic review indicates that few studies have evaluated the effects of clinician-centred interventions on VBAC rates, and interventions are of varying types which limited the ability to meta-analyse data. A further limitation is that the included studies were performed during the late 1980s-1990s. An opinion leader educational strategy confers benefit for increasing VBAC rates. This strategy should be further studied in different maternity care settings and with professionals other than physicians only.
|
|
| 8. |
- Lundgren, Ingela, 1957, et al.
(författare)
-
Clinicians views of factors of importance for improving the rate of vaginal births after caesarean section (VBAC) - A study from countries with high and low VBAC-rates
- 2014
-
Ingår i: Optimising Childbirth Across Europe, 9-10 April 2014. Brussels, Belgium..
-
Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: This study is a part of the ongoing 4-year OptiBIRTH project, which is funded by EU and involving eight European countries. The key aim of the project is to promote increased VBAC rates across Europe. Repeat caesarean section (CS) following previous CS is one of the most significant factors contributing to increased CS rates in the EU. Even though VBAC is the recommended option associated with better outcomes for both mothers and babies, vaginal birth rates after CS vary widely through healthcare settings and countries across Europe. It is important to obtain a deeper knowledge about clinician’s views on VBAC in different countries to understand important factors for improving VBAC rates. The findings of this study will assist in the development of educational interventions targeted towards both clinicians and women, and tested in an upcoming randomised trial in three European countries with low VBAC rates. Aim of the study: The aim with this study was to investigate clinicians’ views on important factors for improving the rate of VBAC in women. Research methodology: Individual interviews, telephone interviews and focus groups interviews with clinician’s (doctors and midwives as well as GPs in different maternity care settings and in rural and urban regions) have been conducted in six countries during 2012-2013; Finland, the Netherlands, Sweden (high VBAC rate), Ireland, Italy, Germany (low VBAC rate). In total about 115 clinicians were interviewed. They answered five questions about VBAC and participation in decision-making. The interviews were analysed using content analysis. Ethical approval: Approval was obtained from study sites in each country. Study findings and conclusions: Findings from this ongoing study will be presented at the congress under the domains: important factors for VBAC, barriers for VBAC, views on decision-making, and support for VBAC.
|
|
| 9. |
- Lundgren, Ingela, 1957, et al.
(författare)
-
Clinicians' views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section) : a study from countries with low VBAC rates.
- 2016
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393 .- 1471-2393. ; 16:1
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Caesarean section (CS) rates are increasing worldwide and the most common reason is repeat CS following previous CS. For most women a vaginal birth after a previous CS (VBAC) is a safe option. However, the rate of VBAC differs in an international perspective. Obtaining deeper knowledge of clinicians' views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Focus group interviews with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of "OptiBIRTH", an ongoing research project. The study reported here aims to explore the views of clinicians from countries with low VBAC rates on factors of importance for improving VBAC rates.METHODS: Focus group interviews were held in Ireland, Italy and Germany. In total 71 clinicians participated in nine focus group interviews. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country.RESULTS: The findings are presented in four main categories with several sub-categories: 1) "prameters for VBAC", including the importance of the obstetric history, present obstetric factors, a positive attitude among those who are centrally involved, early follow-up after CS and antenatal classes; 2) "organisational support and resources for women undergoing a VBAC", meaning a successful VBAC requires clinical expertise and resources during labour; 3) "fear as a key inhibitor of successful VBAC", including understanding women's fear of childbirth, clinicians' fear of VBAC and the ways that clinicians' fear can be transferred to women; and 4) "shared decision making - rapport, knowledge and confidence", meaning ensuring consistent, realistic and unbiased information and developing trust within the clinician-woman relationship.CONCLUSIONS: The findings indicate that increasing the VBAC rate depends on organisational factors, the care offered during pregnancy and childbirth, the decision-making process and the strategies employed to reduce fear in all involved.
|
|
| 10. |
- Lundgren, Ingela, 1957, et al.
(författare)
-
Clinicians’ views of factors of importance for improving the rate of VBAC (vaginal birth after caesarean section): a qualitative study from countries with high VBAC rates
- 2015
-
Ingår i: BMC Pregnancy and Childbirth. - : Springer Science and Business Media LLC. - 1471-2393. ; 15:196
-
Tidskriftsartikel (refereegranskat)abstract
- Background The most common reason for caesarean section (CS) is repeat CS following previous CS. Vaginal birth after caesarean section (VBAC) rates vary widely in different healthcare settings and countries. Obtaining deeper knowledge of clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Interview studies with clinicians and women in three countries with high VBAC rates (Finland, Sweden and the Netherlands) and three countries with low VBAC rates (Ireland, Italy and Germany) are part of ‘OptiBIRTH’, an ongoing research project. The study reported here is based on interviews in high VBAC countries. The aim of the study was to investigate the views of clinicians working in countries with high VBAC rates on factors of importance for improving VBAC rates. Methods Individual (face-to-face or telephone) interviews and focus group interviews with clinicians (in different maternity care settings) in three countries with high VBAC rates were conducted during 2012–2013. In total, 44 clinicians participated: 26 midwives and 18 obstetricians. Five central questions about VBAC were used and interviews were analysed using content analysis. The analysis was performed in each country in the native language and then translated into English. All data were then analysed together and final categories were validated in each country. Results The findings are presented in four main categories with subcategories. First, a common approach is needed, including: feeling confident with VBAC, considering VBAC as the first alternative, communicating well, working in a team, working in accordance with a model and making agreements with the woman. Second, obstetricians need to make the final decision on the mode of delivery while involving women in counselling towards VBAC. Third, a woman who has a previous CS has a similar need for support as other labouring women, but with some extra precautions and additional recommendations for her care. Finally, clinicians should help strengthen women’s trust in VBAC, including building their trust in giving birth vaginally, recognising that giving birth naturally is an empowering experience for women, alleviating fear and offering extra visits to discuss the previous CS, and joining with the woman in a dialogue while leaving the decision about the mode of birth open. Conclusions This study shows that, according to midwives and obstetricians from countries with high VBAC rates, the important factors for improving the VBAC rate are related to the structure of the maternity care system in the country, to the cooperation between midwives and obstetricians, and to the care offered during pregnancy and birth. More research on clinicians’ perspectives is needed from countries with low, as well as high, VBAC rates
|
|
