Effect of Acupoint Hot Compress on Postpartum Urinary Retention After Vaginal Delivery: A Randomized Clinical Trial.

Importance: Acupoint hot compress during the early postpartum period may benefit patients after a vaginal delivery, but the evidence of this effect is limited. Objective: To assess whether acupoint hot compress involving the abdominal, lumbosacral, and plantar regions could reduce the incidence of postpartum urinary retention, relieve postpartum uterine contraction pain, prevent emotional disorders, and promote lactation. Design, Setting, and Participants: This multicenter randomized clinical trial was conducted at 12 hospitals in China. Pregnant patients were screened for eligibility (n = 13 949) and enrolled after vaginal delivery (n = 1200) between January 17 and August 15, 2021; data collection was completed on August 18, 2021. After vaginal delivery, these participants were randomized 1:1 to either the intervention group or control group. Statistical analysis was based on per-protocol population. Interventions: Participants in the control group received routine postpartum care. Participants in the intervention group received routine postpartum care plus 3 sessions of a 4-hour acupoint hot compress involving the abdominal, lumbosacral, and plantar regions within 30 minutes, 24 hours, and 48 hours after delivery. Main Outcomes and Measures: The primary outcome was the incidence of postpartum urinary retention, defined as the first urination occurring more than 6.5 hours after delivery and/or use of an indwelling catheter within 72 hours after delivery. The secondary outcomes were postpartum uterine contraction pain intensity (assessed with the visual analog scale [VAS]), depressive symptoms (assessed with the Edinburgh Postnatal Depression Scale), and lactation conditions (including lactation initiation time, breastfeeding milk volume, feeding mood and times, and newborn weight). Results: Of the 1200 participants randomized, 1085 completed the study (537 in the intervention group and 548 in the control group, with a median [IQR] age of 26.0 [24.0-29.0] years). Participants in the intervention group compared with the control group had significantly decreased incidence of postpartum urinary retention (relative risk [RR], 0.58; 95% CI, 0.35-0.98; P = .03); improved postpartum uterine contraction pain when measured at 6.5 hours (median [IQR] VAS score, 1 [1-2] vs 2 [1-2]; P < .001), 28.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [1-2]; P < .001), 52.5 hours (median [IQR] VAS score, 1 [0-1] vs 1 [0-1]; P < .001), and 76.5 hours (median [IQR] VAS score, 0 [0-1] vs 0 [0-1]; P = .01) after delivery; reduced depressive symptoms (RR, 0.73; 95% CI, 0.54-0.98; P = .01); and increased breastfeeding milk volume measured at 28.5, 52.5, and 76.5 hours after delivery. No adverse events occurred in either of the 2 groups. Conclusions and Relevance: Results of this trial showed that acupoint hot compress after vaginal delivery decreased postpartum urinary retention, uterine contraction pain, and depressive symptoms and increased breastfeeding milk volume. Acupoint hot compress may be considered as an adjunctive intervention in postnatal care that meets patient self-care needs. Trial Registration: Chinese Clinical Trial Registry Identifier: ChiCTR2000038417.

Development of a peer review process to reduce maternal and infant adverse events associated with midwifery.

OBJECTIVES: The aim of this study was to establish a midwifery peer review (MPR) process to continuously improve and standardize the midwifery delivery process, thereby reducing maternal and infant adverse events. MATERIAL AND METHODS: First, the MPR committee (MPRC) was established. The co-chairs of our MPRC were the Head of the Nursing Department and the Nursing Director of the Obstetrics Department. Peer review targets included preventing the occurrence of nursing adverse events, improving nursing quality, and optimizing nursing management. We have established a specially digitized case submission system. All cases that met the evaluation criteria formed corresponding midwifery process improvement measures after a discussion at the meeting to continuously improve the level of midwifery. RESULTS: Between 2014 and 2017, a total of 240 referrals were received by our committee, 211 of which met the criteria for peer review. Our analysis showed that the proportion of adverse events evaluated gradually decreased over time. The percentage of reviewed cases in 2014 was 7.543% of all deliveries (n = 63), which decreased to 6.747% in 2015 (n = 46). The rates in 2016 and 2017 were 5.310% (n = 51) and 5.280% (n = 51), respectively, and the MPRC recommendations resulted in positive practice changes. After reviewing more than 200 cases, the committee recommended the implementation of 20 new rules and regulations through summary and discussion, thus reducing or preventing many problems that are easily ignored during clinical service. CONCLUSIONS: MPR could be an effective tool to improve obstetric quality and midwifery skills. The implementation of MPR promoted a safer environment for mothers and infants and led to a decrease in adverse events related to midwifery.

'Hands-off/poised' or 'Hands-on' method among Chinese midwives: A cross-sectional survey.

AIMS AND OBJECTIVES: To determine midwives' preference for "Hands-on" and "Hands-off/poised" methods and to explore the impact factors. BACKGROUND: With the increasing rate of obstetric anal sphincter injuries, great controversy surrounds the "Hands-on" or "Hands-off" method during childbirth to decrease obstetric anal sphincter injuries incidence. Without regular records and related research, determining the use of this technique in China is difficult. DESIGN: This study used a quantitative study design, following the EQUATOR guidelines (STROBE). METHODS: A nationwide cross-sectional online survey was conducted using respondent-driven sampling across 31 provinces in China from 1st October 2017-31st December 2017. A total of 6,425 midwives were involved. Descriptive analyses, chi-square test and binary logistic regression were undertaken. RESULTS: A total of 5,225 questionnaires were returned; 55.8% of the participants preferred the "Hands-off/poised" method. The impact factors included hospital categories, total work experience in a birth unit in years, theoretical education and skill training. In the study, for situations with increased OASI risk, 100% of the midwives in the "Hands-off" group expressed willingness to change to the "Hands-on" method whether there was concern about impending obstetric anal sphincter injuries. CONCLUSION: The "Hands-off/poised" method is heavily practised by Chinese midwives. However, majority of the midwives adopt "Hands-on" method in the face of high risk for obstetric anal sphincter injuries. Further studies are needed to determine the association between obstetric anal sphincter injuries rate and perineal management for low-risk birth. RELEVANCE TO CLINICAL PRACTICE: The result indirectly illustrates the application of "Hands-off/poised" technique in China and provides evidence for the international midwifery organisation to understand the status of Chinese midwifery to some extent. It also provides the latest data for further study of these two methods and the study of the relationship between hands-off/poised method and obstetric anal sphincter injuries.

An exploratory study of the effect of labor pain management on postpartum depression among Chinese women.

OBJECTIVES: The purpose of this study was to investigate the effects of pain relief during labor on the occurrence of potential postpartum depression in early postpartum among Chinese women. MATERIAL AND METHODS: A quasi-experimental study used, with a convenience sample of 565 women who delivered at the Women's Hospital, School of Medicine. Three types of pain relief were administered based on the women's preference (doula, n = 301; transcutaneous electrical nerve stimulation, n = 51; epidural analgesia, n = 213). Pain scores of participants were assessed using a 10-point visual analog scale during labor. The Edinburgh Postnatal Depression Scale was administered in person and by phone at three days and two to four weeks after delivery, respectively. All data were analyzed using SPSS 20.0. RESULTS: Visual analog scale pain scores in the epidural analgesia group decreased significantly during labor compared to those of the other two groups. The occurrence of potential postpartum depression at three days was 6.6% in the epidural analgesia group, 1.3% in the doula group, and 2% in the transcutaneous electrical nerve stimulation group (P = 0.04). Furthermore, potential postpartum depression occurred at two to four weeks after childbirth in 16% (34/213) of the participants in the epidural analgesia group, 7.3% (22/301) of those who received doula support, and in 7.8% (4/51) of those in the transcutaneous electrical nerve stimulation group (P = 0.006). CONCLUSIONS: The results indicated that epidural analgesia was an effective pain relief method during labor. However, it did not reduce the occurrence of potential postpartum depression and was associated with higher postnatal depression scores.