Obstetric Violence from a Midwife Perspective.

This study examines and determines the prevalence of obstetric violence (OV) as perceived by midwives, as well as their knowledge of it and the professional factors that could be associated with the perception of OV. A cross-sectional study was conducted of 325 midwives in 2021 in Spain. Almost all (92.6%, 301) the midwives knew the term OV, but 74.8% (214) did not believe OV to be the same as malpractice. Moreover, 56.9% (185) stated they had rarely observed OV, and 26.5% (86) regularly observed OV. Most midwives consider physical aggression to be OV, in comparison, not providing information to women was only considered unacceptable treatment. The clinical practice considered the most grave within the context of OV was an instrumental birth or cesarean section without clinical justification. In addition, 97.5% (317) believed that raising awareness on the subject is one of the fundamental points to reducing this problem. Certain factors, such as less work experience, female gender, attendance at home births, and previous training in OV, were associated with an increased perception of situations as OV (p < 0.005). A high percentage of midwives perceived specific clinical practices (e.g., indicate cesarean section without clinical justification or perform the Kristeller maneuver) as OV, and certain characteristics of the professional profile, such as the professional experience or the sex of the midwife, were associated with an increased perception of OV. Most midwives knew the term OV but did not consider that it could pertain to some behaviors included in the international definitions of OV, such as the lack of information provided to a woman or the non-identification of the midwife, among others.

Factors that influence mothers' prenatal decision to breastfeed in Spain.

BACKGROUND: Parents' decisions about how to feed their newborns are influenced by multiple factors. Our objective was to identify the factors that can influence the decision to breastfeed. METHODS: Cross-sectional observational online study was conducted in Spain on women who gave birth between 2013 and 2018. The total number of participants was 5671. Data collection was after approval by the ethics committee in 2019. The data were collected retrospectively because the information was obtained from women who were mothers during the years 2013-2018. An online survey was distributed to breastfeeding associations and postpartum groups. Multivariate analysis with binary logistic regression was done to calculate the Adjusted Odds Ratios (aOR). The main result variable was "intention to breastfeed". RESULTS: Ninety-seven percent (n = 5531) of women made the decision to breastfeed prior to giving birth. The internet played a role in deciding to breastfeed in 33.7% (n = 2047) of women, while 20.1% (n = 1110) said the same thing about their midwife. We identified five significant factors associated with the mother's prenatal decision to breastfeed: attending maternal education (aOR 2.10; 95% CI 1.32, 3.34), having two (aOR 0.52; 95% CI 0.28, 0.99) and three children (aOR 0.24; 95% CI 0.10, 0.59), previous breastfeeding experience (aOR 6.99; 95% CI 3.46, 14.10), support from partner (aOR 1.58; 95% CI 1.09,2.28) and having a condition during pregnancy (aOR 0.62; 95% CI 0.43, 0.91). CONCLUSIONS: Factors related with previous breastfeeding experience and education for mothers are decisive when it comes to making the decision to breastfeed. Given the proven influence that partners have in decision-making, it is important for them to be fully involved in the process.

Effects of cord milking in late preterm infants and full-term infants: A systematic review and meta-analysis.

BACKGROUND: Umbilical cord milking (UCM) consists of performing several milkings of the cord from the placenta to the newborn. The objective was to evaluate the effects of UCM on newborns ≥34 weeks' gestation. METHODS: Searches were conducted in MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, and the clinicaltrails.gov database for randomized clinical trials (RCT), with no time or language restrictions, and for articles that compared UCM with other strategies. The main results were initial hemoglobin and hemoglobin after 6 weeks. The data were collected by two reviewers and the quality of the studies was assessed using the Cochrane Manual methodology. RESULTS: The sample included 1845 newborns in 10 RCTs. The use of UCM in ≥34 weeks' gestation newborns was not related to initial hemoglobin levels (pooled weighted mean difference: (PWMD = 0.40 g/L [-0.16 to 0.95]) or after 6 weeks (PWMD = 0.07 g/L [-0.29 to 0.27]). A reduction in hemoglobin levels was also observed at 6 weeks when the control group had undergone late clamping (PWDM = 0.16g/L [-0.26 to -0.06]). CONCLUSIONS: UCM produced no differences in hematologic variables for newborns with ≥34 weeks of gestation relative to controls. However, a slight decrease in hemoglobin levels is observed at 6 weeks when the control group is made up of newborns with late clamping.

Relationship between maternal body mass index with the onset of breastfeeding and its associated problems: an online survey.

BACKGROUND: Obesity is a worldwide public health problem that demands significant attention. Several studies have found that maternal obesity has a negative effect on the duration of breastfeeding and delayed lactogenesis. The World Health Organization has classified Body Max Index (BMI) as normal weight (normoweight) (BMI:18.5-24.9), overweight (BMI:25-29.9), obesity grade I (30.0-34.9), obesity grade II (BMI: 35.0-39.9) and obesity grade III (BMI ≥ 40.0). The objective of this study is to describe the relationship between maternal BMI and breastfeeding rates, as well as breastfeeding-associated problems and discomfort in women assisted by the Spanish Health System. METHODS: To this end, a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain was developed. The data was collected through an online survey of 54 items that was distributed through lactation associations and postpartum support groups between March and June 2019. Five thousand eight hundred seventy one women answered the survey. In the data analysis, Crude Odds Ratios (OR) and Adjusted Odds Ratios (AOR) were calculated through a multivariate analysis through binary and multinomial regression. RESULTS: A linear relationship was observed between the highest BMI figures and the reduction of the probability of starting skin-to-skin contact (AOR for obesity type III of 0.51 [95% CI 0.32, 0.83]), breastfeeding in the first hour (AOR for obesity type III of 0.58 [95% CI 0.36, 0.94]), and exclusive breastfeeding to hospital discharge (AOR for obesity type III of 0.57 [95% CI 0.35, 0.94]), as compared to women with normoweight. CONCLUSIONS: Women with higher BMI are less likely to develop successful breastfeeding than women with normoweight.

Umbilical Cord Milking in Infants Born at <37 Weeks of Gestation: A Systematic Review and Meta-Analysis.

Umbilical cord milking (UCM) could be an alternative in cases where delayed umbilical cord clamping cannot be performed, therefore our objective was to evaluate the effects of UCM in newborns <37 weeks' gestation. In this systematic review and meta-analysis, we searched MEDLINE, EMBASE, CINAHL, the Cochrane Database of Clinical Trials, the clinicaltrails.gov database for randomized UCM clinical trials with no language restrictions, which we then compared with other strategies. The sample included 2083 preterm infants. The results of our meta-analysis suggest that UCM in premature infants can reduce the risk of transfusion (relative risk (RR)= 0.78 [95% confidence interval (CI),0.67-0.90]) and increase hemoglobin(pooled weighted mean difference (PWMD)= 0.89 g/L[95%CI 0.55-1.22]) and mean blood pressure (PWMD=1.92 mmHg [95% CI 0.55-3.25]). Conversely, UCM seems to increase the risk of respiratory distress syndrome (RR = 1.54 [95% CI 1.03-2.29]), compared to the control groups. In infants born at <33 weeks, UCM was associated with a reduced risk of transfusion (RR= 0.81 [95%CI 0.66-0.99]), as well as higher quantities of hemoglobin (PWMD= 0.91 g/L[95%CI 0.50-1.32]). UCM reduces the risk of transfusion in preterm infants, and increases initial hemoglobin, hematocrit, and mean blood pressure levels with respect to controls.

Relationship between Maternal Body Mass Index and Obstetric and Perinatal Complications.

Over the past few decades, overweight and obesity have become a growing health problem of particular concern for women of reproductive age as obesity in pregnancy has been associated with increased risk of obstetric and neonatal complications. The objective of this study is to describe the incidence of obstetric and perinatal complications in relation to maternal body mass index (BMI) at the time prior to delivery within the Spanish Health System. For this purpose, a cross-sectional observational study was conducted aimed at women who have been mothers between 2013 and 2018 in Spain. Data were collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. A total of 5871 women answered the survey, with a mean age of 33.9 years (SD = 4.26 years). In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated through a multivariate analysis. A linear relationship was observed between the highest BMI figures and the highest risk of cephalopelvic disproportion (AOR of 1.79 for obesity type III (95% CI: 1.06-3.02)), preeclampsia (AOR of 6.86 for obesity type III (3.01-15.40)), labor induction (AOR of 1.78 for obesity type III (95% CI: 1.16-2.74)), emergency C-section (AOR of 2.92 for obesity type III (95% CI: 1.68-5.08)), morbidity composite in childbirth (AOR of 3.64 for obesity type III (95% CI: 2.13-6.24)), and macrosomia (AOR of 6.06 for obesity type III (95% CI: 3.17-11.60)), as compared with women with normoweight. Women with a higher BMI are more likely to develop complications during childbirth and macrosomia.

Variability and associated factors in the management of cord clamping and the milking practice among Spanish obstetric professionals.

Clinical practice guides recommend delayed clamping of the umbilical cord. If this is not possible, some authors suggest milking as an alternative. The objective of this study was to determine the variability in professional practice in the management of umbilical cord clamping and milking and to identify factors or circumstances associated with the different methods. An observational cross-sectional study done on 1,045 obstetrics professionals in Spain in 2018. A self-designed questionnaire was administered online. The main variables studied were type of clamping and use of milking. Crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. 92.2% (964) performed delayed clamping. 69.3% (724) clamped the cord when it stopped beating. 83.8% (876) had heard of milking, and 55.9% (584) had never performed it. Professionals over 50 were less likely to perform delayed clamping, with an ORa of 0.24 (95% CI: 0.11-0.52), while midwives were more likely to perform delayed clamping than obstetricians, with an ORa of 14.05 (95% CI: 8.41-23.49). There is clinical variability in the management of umbilical cord clamping and the use of milking in normal births. Part of this variability can be attributed to professional and work environment factors.

Obstetric and perinatal complications associated with assisted reproductive treatment in Spain.

BACKGROUND: Although most newborns conceived through assisted reproductive treatments are healthy, there are concerns about the safety of reproductive techniques and their effect on foetal/maternal well-being. OBJECTIVE: This study aims to describe the incidence of obstetric and perinatal complications in women undergoing assisted reproductive treatments in the Spanish Health System. METHOD: This is a cross-sectional observational study aimed at women who have been mothers between 2013 and 2018 in Spain. The data was collected through an online survey of 42 items that was distributed through lactation associations and postpartum support groups. In the data analysis, crude odds ratios (OR) and adjusted odds ratios (AOR) were calculated, through a multivariate analysis with binary logistic regression and multinomial logistic regression. RESULTS: Five thousand nine hundred forty-two women participated, 2.3% (139) through artificial insemination and 8.2% (486) through in vitro fertilisation (IVF) techniques. Women who underwent IVF had a higher likelihood of suffering problems during pregnancy (OR = 1.71; 95% confidence intervals (95% CI), 1.37-2.13), delivery (OR = 1.43; 95% CI, 1.01-2.02), and postpartum (OR = 1.94; 95% CI, 1.40-2.69) than women with spontaneous pregnancy. No increased likelihood of neonatal problems was observed in this group except for twin pregnancy (OR = 9.17; 95% CI, 6.02-13.96) and prematurity (OR = 1.43; 95% CI, 1.01-2.02). No differences were observed between spontaneous pregnancies and those achieved by artificial insemination. CONCLUSIONS: Pregnancies achieved through IVF present a higher risk of complications before, during and after delivery. However, there is no increased risk of neonatal problems except for a higher likelihood of twin pregnancy and prematurity.

Variability of Clinical Practice in the Third Stage of Labour in Spain.

Clinical practice guidelines recommend the active management of the third stage of labour, but it is currently unknown what practices professionals actually perform. Therefore, the aim of this study was to determine the variability of professional practices in the management of the third stage of labour and to identify any associated professional and work environment factors. A nationwide cross-sectional study was performed with 1054 obstetrics professionals between September and November 2018 in Spain. A self-designed questionnaire was administered online. The crude odds ratios (OR) and adjusted odds ratios (ORa) were estimated using binary logistic regression. The main outcome measures were included in the clinical management of the third stage of labour and they were: type of management, drugs, doses, routes of administration, and waiting times used. The results showed that 75.3% (783) of the professionals used uterotonic agents for delivery. Oxytocin was the most commonly administered drug. Professionals who attend home births were less likely to use uterotonics (ORa: 0.23; 95% confidence interval (CI): 0.12-0.47), while those who completed their training after 2007 (ORa: 1.57 (95% CI: 1.13-2.18) and worked in a hospital that attended >4000 births per year (ORa: 7.95 CI: 4.02-15.72) were more likely to use them. Statistically significant differences were also observed between midwives and gynaecologists as for the clinical management of this stage of labour (p < 0.005). These findings could suggest that there is clinical variability among obstetrics professionals regarding the management of delivery. Part of this variability can be attributed to professional and work environment factors.