Management of late-term pregnancy in midwifery- and obstetrician-led care.

Management of late-term pregnancy in midwifery- and obstetrician-led care. BACKGROUND: Since there is no consensus regarding the optimal management in late-term pregnancies (≥41.0 weeks), we explored the variety of management strategies in late-term pregnancy in the Netherlands to identify the magnitude of this variety and the attitude towards late-term pregnancy. METHODS: Two nationwide surveys amongst all midwifery practices (midwifery-led care) and all hospitals with an obstetric unit (obstetrician-led care) were performed with questions on timing, frequency and content of consultations/surveillance in late-term pregnancy and on timing of induction. Propositions about late-term pregnancy were assessed using Likert scale questions. RESULTS: The response rate was 40% (203/511) in midwifery-led care and 92% (80/87) in obstetrician-led care. All obstetric units made regional protocols with their collaborating midwifery practices about management in late-term pregnancy. Most midwifery-led care practices (93%) refer low-risk women at least once for consultation in obstetrician-led care in late-term pregnancy. The content of consultations varies among hospitals. Membrane sweeping is performed more in midwifery-led care compared to obstetrician-led care (90% vs 31%, p < 0.001). Consultation at 41 weeks should be standard care according to 47% of midwifery-led care practices and 83% of obstetrician-led care units (p < 0.001). Induction of labour at 41.0 weeks is offered less often to women in midwifery-led care in comparison to obstetrician-led care (3% vs 21%, p < 0.001). CONCLUSIONS: Substantial practice variation exists within and between midwifery-and obstetrician-led care in the Netherlands regarding timing, frequency and content of antenatal monitoring in late-term pregnancy and timing of labour induction. An evidence based interdisciplinary guideline will contribute to a higher level of uniformity in the management in late- term pregnancies.

Birth Outcomes for Midwifery Clients Who Begin Postdates Induction of Labour Under Midwifery Care Compared With Those Who Are Transferred to Obstetrical Care.

OBJECTIVE: This study sought to compare clinical outcomes of midwifery clients who had postdates induction of labour with oxytocin under midwifery care with those transferred to obstetrical care. METHODS: This was a retrospective cohort study using 2006-2009 Ontario Midwifery Program data. All low-risk Ontario midwifery clients who had postdates oxytocin induction were included. Groups were established according to the planned care provider at onset of induction. The primary outcome was Cesarean section (CS). The secondary outcome was a composite of stillbirth, neonatal death, or serious morbidity. Other outcomes included assisted vaginal delivery, pharmaceutical pain relief, and use of episiotomy. We stratified by parity and used logistic regression to conduct analyses controlling for maternal age (Canadian Task Force Classification II-2). RESULTS: For nulliparas, postdates induction with oxytocin under midwifery care decreased the odds of interventions including assisted vaginal delivery (OR 0.68; 95% CI 0.48-0.97), episiotomy (OR 0.49; 95% CI 0.34-0.70), and pharmaceutical pain relief (OR 0.57; 95% CI 0.36-0.90), with no difference in odds of neonatal morbidity or mortality (OR 0.71; 95% CI 0.25-2.04) when compared with induction under obstetrical care. For multiparas, the use of pharmaceutical pain relief was significantly lower in the midwifery group (OR 0.65; 95% CI 0.44-0.96). CONCLUSION: For low-risk midwifery clients at 41 weeks or more gestation, the odds of Caesarean section and neonatal morbidity and mortality are similar when induction of labour with oxytocin under the care of a midwife is compared with induction of labour under obstetrical care, and rates of intervention are decreased.

Acupuncture in Postdate Pregnancy Management.

OBJECTIVES: Pharmacological labor induction is obtained through prostaglandins application and/or oxytocin infusion; however, the use seems to be related to fetal and maternal side effects. Traditional Chinese Medicine advocates the use of acupuncture to soften the cervix and induce uterine contractions. at which presented for The primary outcome was the rate of women admitted for labour induction in case of prolonged pregnancy at 41 + 5 weeks, and the secondary outcome was the rate of induction planning for other indications. METHODS: After obtaining informed consent, 375 undelivered women after 40 + 2 gestational age were enrolled for the study: 112 women received acupuncture and 263, routine care. Acupuncture was applied every odd day starting from 40 + 2 weeks up to 41 + 4 weeks. Women allocated to the control group received standard care. At 41 + 5 weeks, a pharmacological induction was planned. RESULTS: The rate of labor induction significantly differed between acupuncture and observation groups (19.6% vs. 38%; p < 0.01); in particular, women receiving acupuncture showed a lower rate of induction, indicating prolonged pregnancy (5.3% vs. 10.1%; p < 0.01). As far as the pharmacological device is concerned, no differences were observed with regard to the prostaglandins use, whereas oxytocin infusion rate was lower in the acupuncture group than in the observation group. CONCLUSIONS: The present study suggested that acupuncture applied at term of pregnancy seems to be effective in reducing the rate of labor induction which is performed for prolonged pregnancy at 41 + 5 weeks. Moreover, acupuncture also seems to be able to reduce oxytocin use; such a "saving" effect could play a role in childhood, considering that a recent study underlined the adverse effect of oxytocin on birth outcomes.

Midwives' personal use of complementary and alternative medicine (CAM) influences their recommendations to women experiencing a post-date pregnancy.

Complementary and Alternative Medicine (CAM) have increasingly been used by pregnant women with a steady rise in interest by midwives. Literature describing CAM and self-help options midwives recommend to women experiencing a post-date pregnancy is sparse. This study aimed to investigate if Australian midwives' personal CAM use impacts on discussions and recommendations of CAM/Self-help strategies. METHODOLOGY/DESIGN: A survey of a national midwifery association midwifery members (n=3,552) was undertaken at a midwifery conference (October 2015) and via e-bulletins (November 2015-March 2016). The self-administered survey included questions on what self-help and CAM strategies midwives discuss and recommend to women with a post-date pregnancy, midwives' confidence levels on discussing or recommending CAM, midwives' own personal use of CAM. FINDINGS: A total of 571 registered midwives completed the survey (16%). Demographics (age, years as a midwife, state of residence) reflected Australian midwives and the midwifery association membership. Most respondents discuss (91.2%) and recommend (88.6%) self-help/CAM strategies to women with a post-date pregnancy. The top five CAM recommended were Acupuncture (65.7%), Acupressure (58.1%), Raspberry Leaf (52.5%), Massage (38.9%) and Hypnosis/Calmbirthing/Hypnobirthing (35.7%). Midwives were more likely to discuss strategies if they personally used CAM (p<.001), were younger (p<.001) or had worked less years as midwives (p=.004). Midwives were more likely to recommend strategies if they used CAM in their own pregnancies (p=.001). CONCLUSION: Midwives' personal use of CAM influenced their discussions and recommendations of CAM/self-help strategies to women experiencing a post-date pregnancy. This study has implications for inclusion of CAM in midwifery education curricula.

Acupuncture in post-date pregnancy: a pilot study.

AIM: Pharmacological labor induction is obtained through intracervical/vaginal prostaglandins and/or oxytocin infusion; however, the use of these agents produces fetal and maternal side effects. Traditional Chinese medicine advocates the use of acupuncture to soften the cervix and induce uterine contractions. The aim of the present study is to investigate the effect of acupuncture to induce labor. Acupuncture was applied in post-date pregnancies one week before a planned induction; the primary outcome was the rate of women submitted to labor induction for prolonged pregnancy at week 41 + 5. METHODS: After informed consent, 221 undelivered women ranging between 40 + 2/40 + 6 gestational age were considered eligible for the study and 202 were randomized to receive acupuncture or observation. Sessions of acupuncture were planned every odd day from the randomization till 41a week plus 4 days. At 41 + 5 week a pharmacological induction of labor was planned. RESULTS: The total rate of labor induction did not significantly differ between observation and acupuncture group (20% versus 17%). Moreover no differences were found as far as the indications to induce labor, in particular "prolonged pregnancy" was similar between groups (8/96 versus 5/99). To investigate between-group differences in time elapsed between inclusion and delivery, survival analysis was performed excluding women requiring labor induction: women receiving acupuncture showed a trend to deliver earlier than women in the observation group (p < 0.09). CONCLUSION: The present study demonstrated that acupuncture applied every odd day for one week seems ineffective in reducing the rate of labor induction performed for prolonged pregnancy at 41 + 5 weeks. Previous reports reached similar conclusions, independently of the different timing, duration and mode of stimuli application.

Evaluation effect of shiatsu technique on labor induction in post-term pregnancy.

OBJECTIVES: Labor induction in post-term pregnancy is considered as a conventional process of mothers' care. Shiatsu technique is one of the complementary methods which use for post-term pregnancy induction. Therefore, the researchers decided to examine the effect of Shiatsu technique on the induction of post-term pregnancy. MATERIALS & METHODS: This is a randomized control trials which conducted on 288 women with post-term pregnancy who referred to consulting clinic at Ali- Ibn- Abi -Talib Hospital, in Zahedan-Iran in 2010-2011. Participants were selected based on random table. The participants divided into two groups: the first was shiatsu technique and the second group was control group (routine procedure). Shiatsu technique was conducted on the participants of intervention group for 30s on three points by an experienced midwife. The gathered data analyzed by SPSS version 15.00 and comparing tests were t-students tests, chi-square. RESULTS: Mothers ages range were between 16 to 42 years (mean 26.5-5.7) in shiatsu and 17 to 43 years (mean 24.5-5.1) in control group. Regarding spontaneous initiation of labor, 82 women (56.9%) in Shiatsu group had spontaneous initiation of labor, whereas the number of women was only 12 (8.3%) in control group. Women who have used Shiatsu technique were significantly more likely to have spontaneous labour than those women who did not. CONCLUSIONS: Results of the study showed that shiatsu technique can be used as one of safe complementary methods for post-term pregnancy induction.

Acupuncture and/or sweeping of the fetal membranes before induction of labor: a prospective, randomized, controlled trial.

AIMS: To evaluate the efficacy of acupuncture, and sweeping of the fetal membranes, as methods for induction of labor. METHODS: Four hundred and seven pregnant women with normal singleton pregnancies and cephalic presentations were randomized at three delivery wards in Denmark at day 290 of gestation into groups of acupuncture, sweeping, acupuncture and sweeping and controls. The primary objective was to compare the proportion of women going into labor before induction of labor at 294 days in the four groups. The secondary objective was to compare the combined groups: with and without acupuncture, and with and without sweeping of the fetal membranes. The midwives, completing the forms for the trial at labor or induction, were blinded to group assessments. RESULTS: Four hundred and seventeen women were randomized. Ten were excluded after randomization. One hundred and four women were randomized to acupuncture, 103 to sweeping of the membranes, 100 to both acupuncture and sweeping, and 100 were randomized to the control group. Comparison of the four groups demonstrated no significant difference in the number of women achieving spontaneous labor before planned induction. No difference was demonstrated by comparing the combined groups treated with acupuncture with the groups not treated with acupuncture (P=0.76). However, significantly more women went into labor before planned induction (P=0.02) in the combined groups receiving sweeping, compared with the groups not treated with sweeping. CONCLUSIONS: Acupuncture at 41+ weeks of gestation did not reduce the need for induction. The study was of a sufficient size to demonstrate, in parallel, that sweeping of the fetal membranes significantly reduced the need of induction, sparing about 15% for formal induction of labor.

Efectividad del extracto de hoja de frambueso en la estimulación del parto / Effectiveness of raspberry leaf extract in labor induction

Objetivo: Evaluar la efectividad de la administración de 2,16 g/día de extracto de hoja de frambueso en el inicio del parto espontáneo y en la duración de éste, en comparación con la administración de placebo. Diseño: Estudio experimental, multicéntrico, paralelo, prospectivo y doble ciego, con asignación aleatoria al grupo control y experimental. Ámbito de estudio: Centros de Atención a la Salud Sexual y Reproductiva (ASSIR) de Sabadell y Barcelona, y salas de partos del Hospital Parc Taulí de Sabadell y del Hospital de Sant Pau de Barcelona. Sujetos: La muestra de estudio estará formada por 136 gestantes nulíparas que se encuentren en el tercer trimestre del embarazo, antes de la semana 37 de gestación; serán asignadas aleatoriamente 68 al grupo control y 68 al experimental. Intervención: Las gestantes del grupo experimental tomarán 6 cápsulas diarias (2 c/8 h; 2,16 g/día) de extracto de hoja de frambueso y las del grupo control tomarán, siguiendo la misma pauta, unas cápsulas de idéntica forma y color con un placebo (fructosa). Instrumentación: La matrona del ASSIR rellenará el registro de captación en la consulta de seguimiento del embarazo. La recogida de datos se realizará en la sala de partos. La gestante rellenará el diario de cumplimiento y lo entregará el día del parto. Determinación: Se estudiará si hay diferencias en el inicio del parto y en la duración de éste entre el grupo control y el experimental. Para el análisis de los datos, se utilizará el programa estadístico PASW 18.0 (AU)

To evaluate the effectiveness of the administration of 2.16 g / day of raspberry leaf extract at the beginning of spontaneous labor and duration of it, compared to placebo administration. Design: Experimental, multicenter, parallel, double-blind, prospective, randomized to the control group and experimental study assignment. Field of study: Centers of Attention to Sexual and Reproductive Health (ASSIR) of Sabadell and Barcelona, ​​and delivery rooms of the Hospital Parc Tauli de Sabadell and the Hospital de Sant Pau in Barcelona. Subjects: The study sample will consist of 136 nulliparous pregnant women who are in the third trimester of pregnancy before 37 weeks of gestation; 68 will be randomly assigned to the control group and 68 to the experimental. Intervention: Pregnant women in the experimental group will take 6 capsules daily (2 C / 8 h, 2.16 g / day) of raspberry leaf extract and the control group shall, following the same pattern, capsules of identical shape and color placebo (fructose). Instrumentation: Matron of ASSIR filled registration uptake in the pregnancy follow-up visit. Data collection will take place in the delivery room. Pregnant women fill the daily compliance and deliver the day of delivery. Determination: We will study whether there are differences in the onset of labor and the duration of the between control and experimental groups. For data analysis, the SPSS 18.0 statistical program was used (AU)

Acupuncture for the induction of labour: a double-blind randomised controlled study.

OBJECTIVE: To investigate whether acupuncture is effective for the induction of labour in post-term pregnancies. DESIGN: A double-blind multicentre randomised controlled study. SETTINGS: Aarhus University Hospital and Herning Regional Hospital, Denmark. POPULATION: One hundred and twenty-five healthy women with uneventful pregnancies at gestational week 41(+6) were randomised into two groups. METHODS: The intervention group was given acupuncture twice on the same day at acupuncture point GV20 and bilaterally at points BL67, LI4 and SP6. The control group received sham acupuncture at the same points. MAIN OUTCOME MEASURES: At effect evaluation, which was carried out 24 hours after randomisation, the primary endpoint was labour or delivery. RESULTS: The primary endpoint was achieved in seven women (12%) in the acupuncture group and eight women (14%) in the control group (P = 0.79). Stratification for parity and fetal gender did not alter the results. CONCLUSION: Under the treatment regimen investigated in this study, acupuncture for the induction of labour in post-term women at gestational age 41(+6) weeks may not be effective.

Postdates pregnancy and complementary therapies.

This paper explores the contribution of self-help techniques and complementary therapies within the management of postdates pregnancy. The most common reason for induction of labour is postdates pregnancy and not as one would imagine, associated with complex cases that would result in fetal or maternal morbidity without timely intervention. As such this adds to the rising concerns of many health care professionals who question the needless intervention of uncomplicated pregnancies, whilst also detracting from keeping labour and birth normal. Induction of labour is not without its risks and may well contribute to iatrogenic complications when used more widely and in normal, unwarranted cases. As in other procedures or treatments used within conventional medicine for complex/abnormal cases, there is a tendency for them to be incorporated as routine practice. In contrast there also needs to be a change in society's expectations of 'the expected date' and 'being overdue' so that it is not viewed as abnormal. The role of self-help techniques and the safe use of complementary therapies is critically explored within a model of enhancing hormonal activity and reduction of stress hormones during the postdates period, in conjunction with a more conservative approach of care for uncomplicated postdates pregnancy.