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- Carlsson, Jenny, et al.
(författare)
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Management of intrapartum care in expected normal childbirth: A prospective cross-sectional survey at a university hospital in Nepal
- 2016
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Ingår i: NJF (Nordiskt Jordemoderförbund) Congress. Programme and abstracts. Gothenburg, May 12-14, 2016. - 9789163742699
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Women and children die needlessly in childbirth every day. Appropriate care may prevent this, and keeping birth normal is crucial to reduce the risk of complications. Nepal has radically reduced maternal and neonatal mortality in the last decade, yet the numbers remain high. Of the initiatives implemented by the government to ensure safe motherhood, none focuses on improving normal, physiological processes of childbirth. Aim To study the quality of intra-partum care in expected normal childbirth at a university hospital in Nepal Methods: Following ethical approval, a prospective cross-sectional study using a structured questionnaire was conducted in November 2013. Over three weeks, nurses employed at the labor ward collected data from 292 consecutive women giving birth. Of these, 164 were expected to have a normal childbirth and 107 (65%) were nulliparous. The questionnaire covered; background variables, previous pregnancies and births, current pregnancy, and current labor and birth. Care management was assessed using nine items, including the five that constitute the Bologna score: presence of a companion, use of partograph, absence of augmentation, non-supine position, and skin-to-skin care. Results Births were assisted by physicians (56%), nurses (41%), and medical or nursing students under supervision (2%). The mean Bologna score was 1.43 (variance 0-3, min 0, max 5). Circa half of the women had an episiotomy and two had a postpartum hemorrhage of >500 ml. All women were well after birth, and all infants had an Apgar score ≥7 at five minutes. Conclusion Intra-partum care in expected normal childbirth must be continuously assessed to safe-guard the normal, physiological process. Results indicate a medicalized perspective in the studied setting, including an over-use of medico-technical intervention. One important activity to support normal childbirth is to establish the professional midwife, educated with the right competencies. To support such initiative, further activities including research are needed.
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| 2. |
- Dencker, Anna, 1956, et al.
(författare)
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Support to adopt a healthy lifestyle for pregnant women with BMI > 30
- 2016
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Ingår i: The NJF Congress (Nordiskt Jordemorförbund), Gothenburg, 12-14 May 2016. - 9789163742699
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Konferensbidrag (refereegranskat)abstract
- Background A change towards healthy habits during pregnancy and in early motherhood, including weight control, increased physical activity and optimal diet habits will promote health for the woman with body mass index (BMI) ≥ 30 kg/m2, her fetus/ child, as well as for the whole family. To optimise a healthy lifestyle from early pregnancy in women with BMI ≥ 30 kg/m2 an intervention called Mighty Mums, including advice and support on diet and physical activity was carried out in the maternity health care in Gothenburg, Sweden. . Aim To explore women´s experiences 3 years after participating in a lifestyle intervention targeting pregnant women with BMI ≥ 30 kg/m2. Methods Qualitative interviews were performed with 17 mothers who had participated in a lifestyle intervention 3 years earlier. The interviews were semi-structured and thematic analysis was used. Results All interviews were transcribed verbatim and read in full in the first analysis step. Second, initial codes were identified in the data. All features with a meaning were coded and initial codes were condensed and formed four themes. Conclusions The expected child was the main motivation for the women to participate in the intervention. The women needed to be seen and get personal support from the antenatal health care midwife and receive help to be able to control the selection and implementation of healthy activities. Extra support during pregnancy helped temporarily but there was still a need of support to maintain a healthy lifestyle in the long run.
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| 3. |
- Lundgren, Ingela, 1957, et al.
(författare)
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Evaluation of a midwifery model of woman-centred care during childbirth
- 2016
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Ingår i: NJF (Nordiskt Jordemoderförbund) Congress. Programme and abstracts. Gothenburg, May 12-14, 2016. - 9789163742699
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background: Based on a synthesis of 12 qualitative studies on women’s and midwives’ experiences of childbearing, a model of woman-centred care has been developed. The model has three central intertwined themes: a reciprocal relationship, a birthing atmosphere, and grounded knowledge; and two overall themes: the cultural context and the balancing act. Aim: To evaluate the use and effects of the model of woman-centred care provided by midwives during childbirth. Methods: A mixed methods, before-after controlled study is currently underway at two units for normal deliveries at Sahlgrenska University Hospital, Sweden, and an ethnographic actions research study is ongoing at the labour ward of Landspitali, University Hospital in Iceland. The intervention in Sweden comprises a one-day (8 hours) education about the model together with regularly scheduled reflection groups for midwives. The effects are studied by evaluating delivery outcomes, mothers’ childbirth experiences and midwives’ work-related experiences. The primary outcomes are augmentation with oxytocin and mothers’ childbirth experiences assessed with the Childbirth Experience Questionnaire (CEQ 2.0). The secondary outcomes are midwives’ experiences, assessed by means of questionnaires, including stress, burn-out, work satisfaction, and sense of coherence before and one year after the intervention. The qualitative part will study if the model is considered applicable by midwives, obstetricians, assistant nurses and managers at delivery wards, and to the content of midwifery care. An ethnographic field study with midwives and a focus-group study with assistant nurses, obstetricians, midwives and managers have been conducted before start and will be performed after the intervention. The ethnographic action research study in Iceland is focusing on midwives’ experiences and the development of guidelines for implementing the model in practice. Results: Preliminary findings from the study will be presented at the conference. Conclusion: A midwifery model of woman-centred care based on previous research is now evaluated in clinical practice.
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| 4. |
- Lundgren, Ingela, 1957, et al.
(författare)
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Vaginal birth after a previous CS –what is the best option and how decide?
- 2016
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Ingår i: NJF Congress, May 12-14, 2016, Göteborg, Sverige.. - 9789163742699
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)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 knowledge about the differences across Europe, and women´s and clinicians’ views on VBAC can help in understanding the factors of importance for increasing VBAC rates. Aim: The aim is to discuss the best birthing option for women with a previous CS and the decision-making process between VBAC or CS, based on a summary of research and findings from OptiBIRTH, an ongoing study. Methods: OptiBIRTH is a cluster randomised trial, funded by the European Commission, aiming to increase VBAC rates across Europe through enhanced woman-centred maternity care. An intervention is being tested in Italy, Germany and Ireland based on two systematic reviews and interviews with 71 women and 115 clinicians (midwives and obstetricians) in these countries as well as in countries with high VBAC rates (Finland, Sweden and the Netherlands). 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 European perspective related to best option and decision-making, derived from systematic reviews of interventions for clinicians and interventions for women, will be presented and led by Cecily Begley. Women´s views and clinicans´views of best option and how to decide will be presented and led by Christina Nilsson (women) and Ingela Lundgren (clinicians). Findings showed that both women and clinicians wished to have more knowledge about the benefits and drawbacks of VBAC and repeat CS. Conclusion: The evidence-based intervention now includes education of women and information-giving to clinicians, and then bringing both groups together to discuss future birthing plans.
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| 8. |
- Selin, Lotta, et al.
(författare)
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High Dose versus Low Dose Oxytocin for Augmentation of Delayed Labour: a randomized controlled trial
- 2016
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Ingår i: NJF (Nordiskt Jordemoderförbund) Congress. Programme and abstracts. Gothenburg, May 12-14, 2016. - 9789163742699
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Background Delay in labour due to ineffective uterine contractions is a major problem in obstetric care and a main reason for the increased rate of caesarean deliveries, particularly among nulliparous women. Infusion with synthetic oxytocin is a commonly used treatment of hypotonic uterine contractions however there is a gap of knowledge concerning which dosage of oxytocin should be used, both starting dose and increment dose of oxytocin. Aim To compare dosage of oxytocin treatment in nulliparous women with delayed labour progress in active phase of labour. The hypothesis is that augmentation by high dose of oxytocin improves labour outcomes compared with a low dose of oxytocin, without affecting neonatal or maternal outcomes including birth experiences negatively. Methods In a randomized double-blind controlled trial conducted in six labour wards in Sweden, consenting nulliparous women in active labour and with a defined delayed progress are randomized to receive a regimen of either high dose or low dose of oxytocin (33.2 respectively 16,6 microgram oxytocin in 1000 ml isotone saline solution). Randomization is computergenerated, with allocation concealment by a coding system. Primary outcome is caesarean delivery rate. Based on a sample size calculation (α=0.05, β=0.80), a minimum of 1 045 women will be included in each group in order to reduce caesarean section rate from 17.5 % to 13 %. The study is approved by the regional Ethics Board in Gothenburg (dnr: 090-12), by the Medical Products Agency –Sweden (Eudra-CTnr:2012-00035633) and registered at ClinicalTrials.gov. Identifier: NCT01587625. Results Data collection started 15th of August 2013 and data is still under collection. This presentation will describe the study protocol and the first half period of the data collection. Conclusion The study will contribute to establishment of evidence based routines regarding oxytocin treatment of delayed labour progress.
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