Newborn Screening Knowledge and Attitudes Among Midwives and Out-of-Hospital-Birth Parents.

Midwifery and nursing are collaborative partners in both education and practice. Understanding needs and barriers to clinical services such as newborn screening is essential. This study examined knowledge and attitudes of midwives and out-of-hospital-birth parents about newborn blood spot screening (NBS). Descriptive and cross-sectional surveys were distributed to midwives and out-of-hospital-birth parents from birth center registries and the Utah Health Department of Vital Records. Seventeen midwife surveys (response rate: 17%) and 113 parent surveys (response rate: 31%) were returned. Most midwives and out-of-hospital-birth parents reported satisfactory knowledge scores about NBS. Only 5% of parents (n = 6) did not participate in NBS. Most midwives reported that NBS is important and encouraged patients to consider undergoing NBS. Some concerns included the lack of education for both midwives and out-of-hospital patients and the trauma and accuracy of the heel prick soon after birth. Both midwives and out-of-hospital-birth parents expressed a need for improved NBS education. Additional studies are needed to ascertain whether this trend is seen with similar populations throughout the United States, to further elucidate the factors that drive NBS nonparticipation, and to develop educational resources for midwives and their patients.

Trends in Perinatal Care and Implications for Frontline Nurse Leaders.

The perinatal trends presented in this article are based on recent topics from conferences, journals, the media, as well as from input from perinatal nurses. Trends in patient care are influenced by evidence known for decades, new research, emerging and innovative concepts in healthcare, patient and family preferences, and the media. Trends discussed in this article are rethinking the due date, birth outside the hospital setting, obstetric hospitalists as birth attendants, nitrous oxide for pain in childbirth, hydrotherapy and waterbirth in the hospital setting, delayed cord clamping, disrupters of an optimal infant microbiome, skin-to-skin care during cesarean surgery, and breast-sleeping and the breast-feeding dyad. In addition, the authors developed implications for perinatal nurses related to each trend. The goal is to stimulate reflection on evidence that supports or does not support current practice and to stimulate future research by discussing some of the current trends that may influence the care that perinatal nurses provide during the birthing year.

Midwifery: home and away.

The challenges faced by birthing women and maternity healthcare professionals in developing countries cannot not be over estimated. The experience of a midwife in a rural Tanzanian hospital described in this article gives a small insight into these challenges. With intermittent electricity, no running water, three beds, 20 births per day and lack of midwifery or obstetric education, morbidity and mortality rates are high, and teaching is difficult. Conversely, where monitoring is minimalistic and time limits are not applied, 'normal birth' is truly the norm and the trust in women to grow and birth their babies is consistent and commendable. Reflection upon midwifery in developing countries can help inform attitudes and practice in the UK.

Hospital birth: are we giving women the facts?

An article published last year in the Journal of Medical Ethics compares giving birth at home to being as reckless as driving without putting a seatbelt on your child (de Crespigny and Savulescu 2014). Planning to give birth at home is often thought of as quite an 'alternative' decision, with just 2.4 per cent of women in England and Wales opting for this in 2011 (Office for National Statistics (ONS) 2013). The politics surrounding place of birth in contemporary maternity care are highly contentious and not at all as clear cut as one may initially presume. As a midwife working in a busy UK unit, I would liken the assumption that a low risk birth is inherently safer in a high risk unit to investing in ill-fitting metaphorical seat belts, which may give the whole family whiplash.

Promoting normality through choice in Blackburn.

This article offers the reader insight drawing on three different perspectives of how it feels to work at a freestanding birth centre in the north west of England. These perspectives are from a supervisor of midwives, a band six midwife and a student midwife and reveal different views of birth at different stages of midwifery. However, all three are certain that the birth centre enables them to promote normal birth and all three are keen to broaden accessibility of birth centres to all women. In this way, they argue, there is a greater likelihood of women achieving physiological births.

A qualitative study exploring newborn care behaviours after home births in rural Ethiopia: implications for adoption of essential interventions for saving newborn lives.

BACKGROUND: Ethiopia is among seven high-mortality countries which have achieved the fourth millennium development goal with over two-thirds reduction in under-five mortality rate. However, the proportion of neonatal deaths continues to rise and recent studies reported low coverage of the essential interventions saving newborn lives. In the context of low uptake of health facility delivery, it is relevant to explore routine practices during home deliveries and, in this study, we explored the sequence of immediate newborn care practices and associated beliefs following home deliveries in rural communities in Ethiopia. METHODS: Between April-May 2013, we conducted 26 semi-structured interviews and 2 focus group discussions with eligible mothers, as well as a key informant interview with a local expert in traditional newborn care practices in rural Basona woreda (district) near the urban town of Debrebirhan, 120 km from Addis Ababa, Ethiopia. RESULTS: The most frequently cited sequence of newborn care practices reported by mothers with home deliveries in the rural Basona woreda was to tie the cord, immediately bath then dry the newborn, practice 'Lanka mansat' (local traditional practice on newborns), give pre-lacteal feeding and then initiate breastfeeding. For 'Lanka mansat', the traditional birth attendant applies mild pressure inside the baby's mouth on the soft palate using her index finger. This is performed believing that the baby will have 'better voice' and 'speak clearly' later in life. CONCLUSION: Coverage figures fail to tell the whole story as to why some essential interventions are not practiced and, in this study, we identified established norms or routines within the rural communities that determine the sequence of newborn care practices following home births. This might explain why some mothers delay initiation of breastfeeding and implementation of other recommended essential interventions saving newborn lives. An in-depth understanding of established routines is necessary, and community health extension workers require further training and negotiation skills in order to change the behaviour of mothers in practicing essential interventions while respecting local values and norms within the communities.

Is attendant at delivery associated with the use of interventions to prevent postpartum hemorrhage at home births? The case of Bangladesh.

BACKGROUND: Hemorrhage is the leading cause of maternal mortality in Bangladesh, the majority of which is due to postpartum hemorrhage (PPH), blood loss of 500 mL or more. Many deaths due to PPH occur at home where approximately 77% of births take place. This paper aims to determine whether the attendant at home delivery (i.e. traditional birth attendant (TBA) trained on PPH interventions, TBA not trained on interventions, or lay attendant) is associated with the use of interventions to prevent PPH at home births. METHODS: Data come from operations research to determine the safety, feasibility, and acceptability of scaling-up community-based provision of misoprostol and an absorbent delivery mat in rural Bangladesh. Analyses were done using data from antenatal care (ANC) cards of women who delivered at home without a skilled attendant (N =66,489). Multivariate logistic regression was used to assess the likelihood of using the interventions. RESULTS: Overall, 67% of women who delivered at home without a skilled provider used misoprostol and the delivery mat (the interventions). Women who delivered at home and had a trained TBA present had 2.72 (95% confidence interval, 2.15-3.43) times the odds of using the interventions compared to those who had a lay person present. With each additional ANC visit (maximum of 4) a woman attended, the odds of using the interventions increased 2.76 times (95% confidence interval, 2.71-2.81). Other sociodemographic variables positively associated with use of the interventions were age, secondary or higher education, and having had a previous birth. CONCLUSION: Findings indicate that trained TBAs can have a significant impact on utilization of interventions to prevent PPH in home births. ANC visits can be an important point of contact for knowledge transfer and message reinforcement about PPH prevention.

Haemorrhage after home birth: audit of decision making and referral.

In the Netherlands, 20 per cent of women give birth at home. In 0.7 per cent, referral to secondary care because of postpartum haemorrhage (PPH) is indicated. Midwives are regularly trained in managing obstetric emergencies. A postgraduate training programme developed for Dutch community-based midwives called 'CAVE' (pre-hospital obstetric emergency course) focuses on the identification and management of obstetric emergencies, including timely and adequate referral to hospital. This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of PPH reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of which seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor and major substandard care.

Haemorrhage after home birth: audit of decision making and referral. Part 2: Results and discussion.

This descriptive study aims to identify substandard care (SSC) in PPH after home birth in the Netherlands. Sixty seven cases of postpartum haemorrhage (PPH) reported by community-based midwives were collected. After applying selection criteria, seven cases were submitted to audit. The audit panel consisted of 12 midwives (of whom seven contributed a case), 10 obstetricians, an educational expert and an ambulance paramedic. First, an individual assessment was performed by all members. Subsequently, at a plenary audit meeting, SSC factors were determined and assigned incidental, minor or major status. Major SSC was identified in two out of seven cases. We conclude that communication between different healthcare providers should be optimised and a proactive attitude taken to select women who plan to give birth at home, taking into account the possibility of timely referral in case of PPH or retained placenta. National multidisciplinary guidelines on managing obstetric haemorrhage in home birth are urgently needed.

[Planned home births assisted by nurse midwives: maternal and neonatal transfers]. / Partos domiciliares planejados assistidos por enfermeiras obstétricas: transferências maternas e neonatais.

The objective of this explorative and descriptive study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descriptive statistics. The transfer rate was 11%, most of the women were nulliparous (63.6%), and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dilation, arrested progress of the fetal head and cephalopelvic disproportion. Apgar scores were >7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed.

In pursuit of the benefits of physiological birth.

This article discusses the physical, emotional and societal benefits of physiological birth. The motivation behind women seeking this type of birth and non-labor ward birth settings, such as homebirth, is explored as well as models of intellectual versus intuitive/embodied knowledge of personal health. The emerging field of human rights in childbirth is also examined.

Midwifery homeopathy in Ghana.

This is a personal account of my visit to Ghana, through a UK run charity which promotes and teaches homeopathy and community health education. As a midwife volunteer, my primary aim was to become familiar with local customs, advising on childbirth and pregnancy care and teaching local Traditional Birth Attendants (TBAs) some basic homeopathy for potential use in labour. I reflect on my community experience and contrast it with typical institutional care within Ghana and my own independent midwifery practice in the UK. I have outlined the indications for some commonly used homeopathic remedies.

Volunteering to save lives.

Experienced health professionals are sharing their skills with midwives and nurses in Ethiopia to improve the education their counterparts receive and help reduce the risks expectant mothers face. In Ethiopia, there are 676 deaths per 100,000 live births compared with an average of 290 per 100,000 in other developing countries and only 6 per cent of women have medical support during labour. International development organisation, Voluntary Service Overseas (VSO) is working with the Ethiopian Government to help them address this workforce shortage by placing experienced volunteer midwives in hospitals, universities and midwifery education institutions. There are many challenges, but volunteers can play a vital role in improving the country's maternal healthcare by teaching midwifery tutors and students and supporting permanent staff.

Emergencies during home births.

This article reflects on how community midwifery skills days have assisted community midwives to develop confidence in managing unexpected emergencies at home births, and how team work, communication and working in partnership have supported women in their choices for birth.

Northampton homebirth team.

Northampton Homebirth Team commenced in April 2010, with a group of midwives dedicated to supporting women choosing to birth at home. Twenty seven months since the team commenced, the home birth rate has continued to rise at a steady sustainable rate, at the time of writing this feature reaching a monthly all time high of 9.6 per cent. The team believe that the key to their success is promoting normality, management support, maternity incident review forums and a multi professional team approach for women choosing to birth at home against medical advice. Whilst the number of women cared for is somewhat smaller that the recent Birthplace study, our statistics continually support the theory that a dedicated home birth team is more likely to limit adverse outcomes in relation to planned home births.

[An unexpected delivery in Mayotte]. / Un accouchement inopiné a Mayotte.

The particular social-cultural context of Mayotte is resulting in an increase in the number of unexpected home births. When a secondary emergency response vehicle is dispatched, A & E nurses are involved in providing prehospital care, sometimes in difficult conditions, as one nurse testifies in this account.

Management of true shoulder dystocia at attended homebirth.

At attended homebirth, shoulder dystocia poses less of a challenge and has better outcomes compared to hospital birth. If you don't panic, but do call someone into the room to help you with suprapubic pressure if needed and run thru the maneuvers systematically, you will get the baby out by six minutes avoiding damaging long-term consequences. At hospital birth, it is estimated to take a minimum of two minutes to turn the woman onto all fours from the usual position in a hospital bed while connected to a monitor, IV and epidural. An epidural anesthetizes the woman making it impossible to push optimally. Epidural also anesthetizes the baby, making spontaneous breathing less likely and making resuscitation more challenging. Suprapubic pressure is difficult at the height of the hospital bed, so time is lost while the bed is lowered. Vacuum and forceps vaginal deliveries, which are not used at home-birth but accompany about 8% of hospital births, are independent risk factors for true shoulder dystocia.

Utilization of village midwives and other trained delivery attendants for home deliveries in Indonesia: results of Indonesia Demographic and Health Survey 2002/2003 and 2007.

This study aimed to examine factors associated with utilization of village midwife and other trained delivery attendants for home deliveries. Information from 14,672 cases of the most recent home deliveries of mothers in the 5 year-period prior to the Indonesia Demographic and Health Survey 2002/2003 and 2007 were analysed. Multinomial logistic regression analysis was performed. The association between 26 factors categorised into external environment, predisposing, enabling, need and previous utilization of maternal health services, and utilization of village midwife and other trained delivery attendants, such as nurses, other midwives and doctors, for home deliveries was examined. The population attributable risk of selected significant predictors was calculated. The odds of using village midwives and other trained delivery attendants at childbirth for home deliveries increased with increasing household wealth index and levels of parental education. The odds increased among first birth, mothers who were exposed to mass media, mothers with knowledge of delivery complications, and mothers who had any delivery complications. However, mothers who attended less than four antenatal care visits, who had high parity, or who reported distance and transportation to health facilities was a major problem, had significantly reduced odds for utilizing any trained delivery attendants. Health promotion strategies to raise community awareness about the importance of safe delivery should target low educated parents, mothers from low household economic status, as well as high parity mothers. Efforts to promote antenatal care visits are likely to increase utilization of trained delivery attendants for home deliveries in Indonesia.