Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review.

PROBLEM: Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. BACKGROUND: There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously. AIM: To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy. METHODS: Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded. FINDINGS: Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13%-99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal. DISCUSSION: Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research. CONCLUSION: Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.

Determinants of nutrition practice and food choice in UK construction workers.

The workplace is considered an effective setting for health and wellbeing interventions, including programmes focusing on nutrition, and provides opportunities to tailor programmes to meet the specific needs of industry and employees. This study explored nutrition practices amongst construction workers and managers to inform the design of a nutrition intervention. Five focus groups were conducted on three construction sites: two with managers (n = 11) and three with workers (n = 27). Construction workers and managers identified several unhealthy nutrition-related behaviours, including high consumption of convenient and fast foods, excessive coffee, alcohol, energy drinks and low fruit and vegetable intake. These behaviours were often attributed to high workloads, long working hours and physically demanding jobs. Snacking and skipping meals were repeatedly reported, attributed to short breaks and poor accessibility to food outlets. The nutritional quality of meals differed between individuals (homemade vs fast food), depending on the type of sites (temporary vs permanent) and site location. Nutrition knowledge, establishing routines, meal planning and preparation were recognized as important in sustaining healthy nutrition habits. However, meal preparation depended on the facilities available, which differed between managers and workers, highlighting the complex relationship between the workplace context and eating behaviours. Construction workers were interested in learning about nutrition and improving their eating habits through nutrition intervention. However, they highlighted that better cooking and storage facilities on site, together with fewer job demands and longer break times, would enhance the sustainability of the intervention and their ability to make healthier food choices.

Fish oil supplementation, resting blood flow and markers of cellular metabolism during incremental exercise.

Dietary supplementation of fish oils (n-3 PUFA) have been observed to affect insulin action and hence metabolism, affecting the ability to carry out work. Here we examine the effects of fish oil supplementation in conjunction with a glucose load during exertion, on markers of substrate utilization. A pre-test, post-test design was performed on ten healthy young males to assess the effects of 4 weeks fish oil supplementation on muscle metabolism during incremental exertion. Breath-by-breath analysis for respiratory exchange ratio (RER) along with blood lactate and blood glucose were determined at baseline, during exercise following an acute glucose bolus (10% solution at 4 mL/kg/bw), and again following supplementation of 4.2 g.day(-1) (2.2 g EPA, 1.4 g DHA). To examine the effect of fish oil on blood flow, Doppler ultrasound was used to assess femoral blood flow at rest. Following consumption of fish oils, exercising blood glucose and RER were seen to change significantly (4.66±0.44 vs. 4.58±0.31 mmol.L(-1) and 0.97±0.03 vs. 0.99±0.04; p<0.05). Resting femoral arterial blood flow was seen to increase significantly (p<0.05) pre- to post- test; 0.26±0.02-0.30±0.03 L.min(-1). Specific population groups such as those undertaking high-intensity exercise, and clinical groups such as intermittent claudicants, may benefit from the effects of fish oil supplementation.