Swedish midwives' experiences and views of amniotomy: An interview study.

OBJECTIVE: To explore midwives' experiences and views of amniotomy. DESIGN: A qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12. SETTING AND PARTICIPANTS: Sixteen midwives working at delivery wards at three hospitals in the south of Sweden. FINDINGS: Three categories emerged: "Promote, protect and support the physiological process of labour", "To make the decision -to do or not to do" and "Unpredictable response". The overall theme linking the three categories was "We become our decisions", portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy. CONCLUSIONS: Amniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.

Hospital obstetric practices and their repercussions on maternal welfare. / Práticas obstétricas hospitalares e suas repercussões no bem-estar materno.

OBJECTIVE: To analyze the association of care practices performed by obstetric professionals with maternal welfare/malaise levels. METHOD: A quantitative study conducted in a Prepartum/Childbirth/Postpartum Unit of a Teaching Hospital with puerperal women who underwent vaginal births. An association was performed between obstetric practices and maternal welfare/malaise levels. RESULTS: There were 104 puerperal women who participated. Obstetric practices which caused mothers to feel unwell and which obtained statistical significance were: amniotomy (p = 0.018), episiotomy (p = 0.05), adoption of horizontal positions in the expulsive period (p = 0.04), the non-use of non-invasive care technologies (p = 0.029), and non-skin-to-skin contact between mother and child (p = 0.002). For most women, the presence of a companion favored welfare, even though it did not have a statistically significant association. After performing logistic regression, non-performance of amniotomy was the only variable which showed significance in maternal welfare. CONCLUSION: Humanized obstetric practices have greater potential to promote maternal welfare. The importance of obstetric nurses conducting practices which provide greater welfare to mothers is emphasized.

Association of Oxytocin Use and Artificial Rupture of Membranes With Cesarean Delivery in France.

OBJECTIVE: To evaluate whether the decrease in the frequency of oxytocin administration and artificial rupture of membranes observed between the 2010 and 2016 French Perinatal Surveys was associated with a change in the frequency of cesarean delivery or cesarean delivery indications among women who entered labor spontaneously. METHODS: This cross-sectional study included women who participated in the 2010 and 2016 French National surveys who had singleton pregnancies and who gave birth at at least 37 weeks of gestation after spontaneous labor to a liveborn neonate in cephalic presentation. To test whether the observed decrease of oxytocin administration and artificial rupture of membranes between the two study years was explained by the women's individual characteristics and maternity units' organizational characteristics change, multivariable analyses were performed. The same strategy was applied for the change in intrapartum cesarean delivery rates between the 2 years. These analyses were repeated in nulliparous, low obstetric risk women, multiparous low obstetric risk women, and women with a previous cesarean delivery. The cesarean delivery indications were compared in 2010 and 2016. RESULTS: Oxytocin administration decreased significantly from 58.3% in 2010 to 45.2% in 2016 (adjusted odds ratio [aOR] 0.51; 95% CI 0.47-0.55), as did artificial rupture of membranes, from 52.4% to 42.6% (aOR 0.66; 95% CI 0.62-0.71). The intrapartum cesarean delivery rate remained stable-6.9% compared with 6.6% (aOR 0.93; 95% CI 0.82-1.06). The same patterns were observed in low risk groups and women with a previous cesarean delivery. The cesarean delivery indications were similar in both years. CONCLUSION: The significant decrease in oxytocin administration and artificial rupture of membranes in 2016 compared with 2010 was not accompanied by an increase in the intrapartum cesarean delivery rate for women in France who entered labor spontaneously. These results support the recent international guidelines.

Factors affecting labor duration in Chinese pregnant women.

The aim of the study was to explore the role of parity, maternal age, medical interventions, and birth weight with respect to labor duration and cervical dilation.A total of 1601 pregnant women who had a singleton term gestation, spontaneous onset of labor, vertex presentation, vaginal delivery, and a normal perinatal outcome were reviewed. The retrospective study was conducted in patients from West China Second University Hospital of Sichuan University during June 2008 to June 2013.There were 1367 nulliparous women and 234 multiparous women analyzed. The first stage (8.3 ±â€Š3.8 vs 5.0 ±â€Š2.6 hours), latent phase (5.1 ±â€Š3.2 vs 3.5 ±â€Š2.4 hours), active phase (3.2 ±â€Š1.8 vs 1.5 ±â€Š1.0 hours), second stage (44 ±â€Š31 vs 18 ±â€Š14 minutes), and total stage of labor (9.1 ±â€Š3.9 vs 5.4 ±â€Š2.6 hours) were all longer in nulliparous than in multipara women (all P < .05); but no significant difference in the third stage of labor (both 7 ±â€Š4 minutes). In nulliparous women, the average time of first stage of labor increased by 58.257, 171.443, and 56.581 minutes due to artificial rupture of membranes, labor analgesia, and birth weight increased by 1 kg, respectively, but it decreased to 63.592 minutes by oxytocin usage, and the difference was significant. The average time of first stage of labor in nulliparous women aged from 26 to 30 years increased by 2.356 minutes compared to one in 20 to 26 years, but it increased by 1.802 minutes to the one in 30 to 39 years, compared to 20 to 26 years and the difference was not significant. The results were basically similar after multipara women were included.Labor was significantly shorter in multiparous women than that in nulliparous women. Increased birth weight significantly increased in the length of the active phase and the second stage among nulliparous women. The increase of age, artificial rupture of membranes, labor analgesia, and the increase of birth weight tends to increase the time of first stage of labor and total labor duration, whereas oxytocin could shorten it.

Obstetric practices in planned home births assisted in Brazil.

OBJECTIVE: To describe obstetric practices in planned home births, assisted by qualified professionals in Brazil. METHOD: This is a descriptive study, with data collected in an online bank maintained by 49 professionals from December 2014 to November 2015, in which the target population was women and newborns assisted in home births. Data were analyzed through descriptive statistics. RESULTS: A total of 667 women and 665 newborns were included. Most of the women gave birth at home (84.4%), in a nonlithotomic position (99.1%); none underwent episiotomy; 32.3% had intact perineum; and 37.8% had first-degree lacerations, some underwent amniotomy (5.4%), oxytocin administration (0.4%), and Kristeller's maneuver (0.2%); 80.8% of the women with a previous cesarean section had home birth. The rate of transfer of parturients was 15.6%, of puerperal women was 1.9%, and of neonates 1.6%. The rate of cesarean section in the parturients that started labor at home was 9.0%. CONCLUSION: The obstetric practices taken are consistent with the scientific evidence; however, unnecessary interventions are still performed. The rates of cesarean sections and maternal and neonatal transfers are low. Home can be a place of birth option for women seeking a physiological delivery.

Early amniotomy after dinoprostone insert used for the induction of labor: a randomized clinical trial.

PURPOSE: We assessed whether early amniotomy, after ripening with a dinoprostone insert, reduces the duration of labor or increases the rate of delivery within the following 24 h. METHODS: A prospective randomized controlled study was conducted on 200 consenting, term pregnant women at the Zeynep Kamil Maternity and Children's Training and Research Hospital. Each participant received vaginal inserts of 10 mg dinoprostone. The women were randomly assigned to one of two groups: early amniotomy (artificial rupture of membranes when cervical dilation was at 3 cm) or standard amniotomy (the membranes were left to rupture spontaneously). The primary outcome measures were the time from induction to delivery, and the proportion of women who delivered within 24 h. RESULTS: The median time interval from induction to delivery (13.72 h compared to 22.73 h) was significantly shorter for women who underwent early amniotomy (p < 0.05). The frequency of vaginal delivery within 24 h was higher in women with early amniotomy (89% compared with 45% in the standard amniotomy, p < 0.05). CONCLUSIONS: Early amniotomy, after ripening with a dinoprostone insert, is a safe and efficient method for speeding up delivery times without increasing caesarian rates during labor inductions.

Does Early Artificial Rupture of Membranes Speed Labor in Preterm Inductions?

OBJECTIVE: In full-term patients, early artificial rupture of membranes (AROMs) decreases time in labor. We assessed the impact of early AROM in preterm patients undergoing indicated induction of labor. STUDY DESIGN: We conducted a retrospective cohort study of all patients undergoing indicated preterm induction (23-34 weeks) at a single tertiary care center from 2011 to 2014. Early AROM was defined as <4 cm and late AROM was defined as ≥4 cm. The primary outcomes evaluated were cesarean delivery and time in labor. Secondary outcomes were chorioamnionitis and a composite of maternal and neonatal adverse outcomes. RESULTS: Of the 149 women included, 65 (43.6%) had early AROM. Early AROM was associated with an increased time from the start of induction to delivery (25.7 ± 13.0 vs. 19.0 ± 10.3 hours, p < 0.01) and with an increase in the risk of cesarean (53.4 vs. 22.6%, adjusted odds ratio: 3.5, 95% confidence interval: 1.60-7.74). Early AROM was not associated with an increased risk of chorioamnionitis or adverse maternal or fetal outcomes. CONCLUSION: In this observational cohort, early AROM was associated with an increased risk of cesarean. A randomized controlled trial is necessary to determine the optimal timing of AROM in preterm patients requiring delivery.

Birth plans-Impact on mode of delivery, obstetrical interventions, and birth experience satisfaction: A prospective cohort study.

OBJECTIVE: To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction. METHODS: This was a prospective cohort study of singleton pregnancies greater than 34 weeks' gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi-squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables. RESULTS: Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61-2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan. CONCLUSION: Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth-related patient satisfaction.

Early versus delayed amniotomy during labor induction with oxytocin in women with Bishop's score of ≥6: a randomized trial.

OBJECTIVE: To study the effect of "early amniotomy" {initiating induction of labor (IOL) with amniotomy followed by oxytocin} versus "late amniotomy" (initiating IOL with oxytocin followed by amniotomy 4-8 h later) in induced labor. METHODS AND MATERIALS: One hundred and fifty women with Bishop's score of ≥6 undergoing IOL were randomized into "early amniotomy" and "delayed amniotomy". RESULTS: Early amniotomy resulted in a reduced induction-delivery interval (IDI) (7.35 versus 11.66 h with delayed amniotomy, p = .000) but higher the caesarean section (CS) rate was observed (10.7 versus 2.7% with delayed amniotomy, p = .049). With early amniotomy, the proportion of women delivering within 12 h was higher (86.7 versus 60%, p = .000) and the maximum oxytocin concentration used was lower (30.05 versus 39.68 mU/min, p = .001) as compared to delayed amniotomy. The neonatal outcomes were similar in the two groups. Early amniotomy detected meconium prior to initiating uterine contractions with oxytocin in three women who underwent CS for meconium. CONCLUSION: Initiating IOL with amniotomy in women with a favorable cervix was efficacious in expediting delivery, but it resulted in a higher CS rate. The higher CS rate was partly due to CS for meconium detected as a result of early amniotomy. Clinical Trials Registry (CTRI), India: Registration number CTRI/2015/01/005418.