Experiencia de una mujer mexicana que dedicó su vida a la partería / Experience of a Mexican woman who dedicated her life to midwifery

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Implementing a Safety Bundle to Improve Screening and Care for Perinatal Mood and Anxiety Disorders.

OBJECTIVE: To improve screening and care of individuals with perinatal mood and anxiety disorders (PMAD) through the implementation of a perinatal mental health safety bundle. DESIGN: Rapid-cycle quality improvement model using four plan-do-study-act cycles over the course of 90 days. Individuals between 28 and 32 weeks gestation and at their 6-week postpartum follow-up visit were screened and offered stage-based care for PMAD. SETTING/LOCAL PROBLEM: At baseline, only 15% of clients of a suburban, private-practice women's health clinic were receiving PMAD screening with a validated tool, and the site lacked standardized PMAD care practices among health care providers. PARTICIPANTS: Health care providers (n = 2), staff (n = 4), and eligible patients (n = 78) at a private-practice women's health clinic. INTERVENTION/MEASUREMENTS: A screening, brief intervention, referral, and treatment/follow-up (SBIRT) model was used to screen eligible patients, provide treatment options, and appropriately refer for follow-up to mental health services. Team engagement occurred via weekly meetings. Measurements included pre-post maternal and team engagement survey results, biweekly chart review, and run chart analysis. RESULTS: Effective PMAD screening and right care were achieved for 85% of eligible individuals; this included receiving screening, referral to treatment, a scheduled mental health appointment, and clinic follow-up to ensure mental health care uptake. CONCLUSION: Use of the SBIRT model to implement a safety bundle may contribute to improved mental health outcomes for individuals receiving perinatal care in a private-practice outpatient health care setting. Education and engagement among clinicians, staff, and patients are key to successful implementation of a safety bundle.

O olhar de residentes em Enfermagem Obstétrica para o contexto da violência obstétrica nas instituições / The obstetric nursing residents' view on obstetric violence in institutions / La visión de residentes en enfermería obstétrica para el contexto de la violencia obstétrica en las instituciones

Este trabalho pretendeu compreender a percepção de residentes em Enfermagem Obstétrica sobre violência obstétrica em uma maternidade referência do município de Belo Horizonte, estado de Minas Gerais, Brasil. Trata-se de estudo descritivo e exploratório de abordagem qualitativa. A coleta dos dados foi realizada por meio de grupo focal. Para análise dos dados foi utilizada a análise de conteúdo de Bardin, da qual emergiram três categorias: condutas inadequadas de assistência ao parto; procedimentos desnecessários com finalidades didáticas e/ou iatrogênicas; e preconceito de gênero, raça/etnia e de classe socioeconômica. O estudo aponta que as residentes reconhecem a prática da violência obstétrica no processo de formação e suas repercussões para a mulher e, ainda, evidencia a necessidade premente de investimento institucional em espaços que promovam discussões sobre a violência obstétrica.(AU)

This article aims to understand the obstetric nursing residents' perception of obstetric violence in a reference maternity hospital in the Brazilian city of Belo Horizonte. It is a descriptive, exploratory, and qualitative study. Data was collected through a focus group. Bardin's content analysis was used to analyze data, from which three categories emerged: inadequate birth assistance conducts; unnecessary procedures with educational and/or iatrogenic purposes; and gender, race/ethnicity, and socioeconomic class bias. The study indicates that residents acknowledge obstetric violence in the educational process and its repercussions to women. It also evidences the pressing need for institutional investment in spaces that foster discussions on obstetric violence.(AU)

El objetivo de este artículo es comprender la percepción de los residentes en Enfermería Obstétrica sobre la violencia obstétrica en una maternidad referencia del municipio de Belo Horizonte, Brasil. Se trata de un estudio descriptivo, exploratorio de abordaje cualitativo. La colecta de datos se realizó por medio de un grupo focal. Para el análisis de datos se utilizó el análisis de contenido de Bardín, del cual surgieron tres categorías: conductas inadecuadas de asistencia al parto; procedimientos innecesarios con finalidades didácticas y/o iatrogénicas, prejuicio de género, raza/etnia y de clase socioeconómica. El estudio señala que las residentes reconocen la práctica de la violencia obstétrica en el proceso de formación y sus repercusiones para la mujer y, también, muestra la necesidad urgente de inversión institucional en espacios que promuevan discusiones sobre la violencia obstétrica.(AU)

Peanut ball for decreasing length of labor: A systematic review and meta-analysis of randomized controlled trials.

INTRODUCTION: Prolonged length of labor is associated with increased maternal and neonatal complications. Therefore, great attention has been given to interventions aimed at reducing the length of labor. One such intervention is the peanut ball, a large elongated exercise ball placed between a woman's legs during labor. OBJECTIVE: The aim of this systematic review and meta-analysis of randomized controlled trials (RCTs) was to assess the effect of the use of peanut ball in reducing length of labor. STUDY DESIGN: Data sources: MEDLINE, EMBASE, Web of Sciences, Scopus, ClinicalTrial.gov, OVID and Cochrane Library were searched from inception until January 2019. SELECTION CRITERIA: Selection criteria included RCTs of laboring women with singleton gestations in cephalic presentation at term (≥37weeks) who were randomized to either use of peanut ball or control group (no peanut ball). DATA COLLECTION AND ANALYSIS: Four trials with 648 nulliparous and multiparous women in spontaneous or induced labor were identified and included. 330 women were randomized to the intervention (peanut ball between the knees during labor) and 318 women to the control. Summary measures were reported as mean difference (MD) with 95% of confidence interval (CI) using the random effects model of DerSimonian and Laird. The primary outcome was total length of labor. PROSPERO Registration Number: CRD42018082438 RESULTS: Total length of labor was 79min shorter in the peanut ball group, but this was not significant (MD -79.1 min, 95% CI -204.9, 46.7). Peanut ball use showed trends toward higher incidence of spontaneous vaginal deliveries (RR 1.1, 95% CI 1.0, 1.2) and lower incidence of cesarean deliveries (RR 0.8, 95% CI 0.6, 1.0). CONCLUSIONS: Peanut ball use was not associated with a significant decrease in total length of labor. Since there were trends toward reductions in length of labor, an increased incidence in spontaneous vaginal deliveries, and lower incidence of cesarean deliveries, more research is needed.

Implementation of a Perinatal Depression Care Bundle in a Nurse-Managed Midwifery Practice.

OBJECTIVE: To implement a perinatal depression care bundle at a midwifery practice to help certified nurse-midwives (CNMs) educate women about perinatal depression and direct those affected to mental health services. DESIGN: Quality improvement project to implement a perinatal depression care bundle for care of pregnant women between 24 and 29 weeks gestation. SETTING/LOCAL PROBLEM: CNMs practicing in a nurse-managed midwifery practice systematically screen all women for perinatal depression during pregnancy and the postpartum period but do not have a consistent method of providing anticipatory guidance about perinatal depression. PARTICIPANTS: All CNMs in the midwifery practice providing prenatal care (n = 16) participated in implementation. INTERVENTION/MEASUREMENTS: The perinatal depression care bundle included three elements: (a) an educational handout; (b) a brief, provider-initiated discussion about perinatal depression; and (c) lists of local and online mental health resources. Four weeks after the care bundle was implemented, we conducted a retrospective chart review to assess CNMs' adherence to the new bundle. RESULTS: Over 4 weeks, 51 prenatal visits met eligibility criteria for participation. CNMs implemented the perinatal depression care bundle for 22 (43.1%) eligible visits. CNM feedback indicated that the care bundle was brief, easy to incorporate into routine care, and well received by women. CONCLUSION: This project incorporated the use of a perinatal depression care bundle for women seen during routine prenatal care. Using a systematic approach to deliver perinatal depression education and resources reduces process variability and may destigmatize the illness, allowing women to feel empowered to seek help before depression symptoms become severe.

Knowledge and use of sterile water injections amongst midwives in the United Kingdom: A cross-sectional study.

BACKGROUND: The use of sterile water injections (SWI) for the relief of pain in labour is popular amongst midwives in countries such as Sweden and Australia. Anecdotal reports suggest the procedure is used less commonly in the United Kingdom (UK) and that a number of barriers to introducing the practice may exist. OBJECTIVE: The objective of this study was to explore the awareness and use of SWI amongst midwives in the UK. DESIGN: A cross-sectional study using an internet-based questionnaire. PARTICIPANTS: Midwives with Nursing and Midwifery Council Registration and currently practicing. SETTING: The questionnaire was distributed via the Royal College of Midwives Facebook page and Twitter account. Invitations to participate were also sent to Heads of Midwifery to distribute to staff. FINDINGS: Three hundred and ninety-eight midwives completed the survey. Eighty-two percent of midwives did not use SWI in practice although 69% would consider learning the procedure. There was considerable variation in techniques amongst midwives that did provide SWI. The lack of available practice guidelines and the advice from the National Institute for Health and Care Excellence to not use SWI were cited as the main barriers. KEY CONCLUSIONS: SWI use is uncommon in the UK although midwives are interested in incorporating the procedure into practice. IMPLICATIONS FOR PRACTICE: National guidance on SWI and the lack of information and training is restricting the use of the procedure in practice, despite SWI being widely used in other countries and being effective in the treatment of pain in labour.

The clinical research into the application of multifunctional airbag abdominal pressure belt in midwifery and in the prevention of postpartum hemorrhage.

OBJECTIVE: Explore the effect of the multifunctional airbag abdominal pressure belt on midwifery and on the prevention of postpartum hemorrhage. METHODS: Select 363 natural delivery cases of hospitalized primiparae and divide them randomly into two groups. In the observation group, 182 primiparae used the multifunctional airbag abdominal pressure belt during the second and third stages of labor, whereas the control group of 181 did not use the belt. Delivery outcomes of the primiparae and their fetus were then observed. RESULTS: The average duration for the second stage of labor, from head emergence to delivery, placenta delivery and postpartum hemorrhage were all shorter in the observation group (p < 0.01). There was no statistical difference in episiotomy rate, maternal signs 2 h postpartum, neonatal Apgar score and neonatal cord blood gas analysis (p > 0.05). No statistical difference was found in primipara signs and no fetal heart rate change of the primiparae under different internal pressures of the belt during the second stage of labor in the observation group (p > 0.05). CONCLUSION: By closely monitoring and appropriately adjusting the internal pressure of the belt, the multifunctional airbag abdominal pressure belt can speed up the second and third stages of labor, prevent postpartum hemorrhage and promote natural delivery.

Displasia mesenquimal placentaria. Revisión placentaria / Placental mesenchymal dysplasia. Placental review

La displasia mesenquimal placentaria (DMP) es una anomalía cada vez más reconocible, que cursa con diversos signos, como placentomegalia, vasos tortuosos y vesículas quísticas en la placenta. Su repercusión sobre la madre y el recién nacido requiere una precisa valoración placentaria por parte de la matrona para el seguimiento de ambos. En el presente artículo se expone un caso clínico en el que la revisión pormenorizada de la placenta puso en marcha el correcto seguimiento de una madre y su recién nacido a partir del diagnóstico de DMP. La DMP es una entidad cuyo diagnóstico, aunque poco frecuente, no debe infraestimarse, dadas las repercusiones que pudiera tener tanto en la madre como en el desarrollo de su hijo. La revisión placentaria es una herramienta fundamental en el trabajo diario de la matrona. Esta práctica permite evitar sangrados e infecciones en el puerperio precoz e inmediato

Placental mesenchymal dysplasia (PMD) is an increasingly recognizable anomaly, with data such as placentomegaly, tortuous vessels and cystic vesicles in the placenta. Its repercussion on the mother and newborn makes the accurate placental assessment on the part of the matron is a necessary tool for the follow-up of both. This article presents a clinical case in which the detailed review of the placenta initiated the correct follow-up of a mother and her newborn due to the diagnosis of PMD. PMD is an entity that, although infrequent, should not be underestimated when it comes to diagnosing it, due to the repercussions it may have on both the mother and the development of her child. The placental revision is a fundamental tool in the daily work of the midwife. This practice allows bleeding and infection to be prevented in the early and immediate postpartum period

Status of and problems concerning neonatal resuscitation in Japan in 2015.

BACKGROUND: The International Liaison Committee on Resuscitation (ILCOR) published Consensus 2015 in October 2015. Thereafter, the Japanese version of neonatal cardiopulmonary resuscitation programs was revised. Prior to the revision, we re-conducted questionnaire surveys in three types of medical facilities in January 2015. METHODS: Targeted groups included (i) 277 training hospitals authorized by the Japanese Society of Perinatal/Neonatal Medicine for training of physicians specialized in perinatal care (neonatology) in January 2015 (training hospitals; response rate, 70.8%); (ii) 459 obstetric hospitals/clinics (response rate, 63.6%); and (iii) 453 midwife clinics (response rate, 60.9%). The survey included systems of neonatal resuscitation, medical equipment and practices, and education systems. The results were compared with that of similar surveys conducted in 2005, 2010 and 2013. RESULTS: Almost all results were generally improved compared with past surveys. In training hospitals, however, the use of oxygen blenders or manometers was not widespread. Only 35% of institutions used continuous positive airway pressure systems frequently, and expert neonatal resuscitation doctors attended all deliveries in only 6% of training centers. In addition, only 71% of training hospitals had brain therapeutic hypothermia facilities. Not all obstetric hospitals/clinics prepared pulse oximeters, and only a few used manometers frequently. Some midwife clinics did not keep warming equipment, and few midwife clinics were equipped with pulse oximeters. In addition, some midwife clinics did not prepare ventilation bags (masks). CONCLUSIONS: The equipment in Japanese delivery rooms is variable. Further efforts need to be made in the distribution of neonatal resuscitation devices and the dissemination of techniques.

Instrumental vaginal deliveries; are midwives safer practitioners? A retrospective cohort study.

OBJECTIVE: To compare obstetric morbidity of midwife-performed instrumental vaginal deliveries with those performed by doctors. DESIGN: Retrospective cohort study. SETTING: University Hospital, UK. POPULATION: Women undergoing an instrumental vaginal delivery of a singleton infant outside of the operating theater in Aberdeen Maternity Hospital, between June 2005 and June 2010. METHODS: Prospectively entered data were obtained from the hospital data management system. Obstetric outcomes of deliveries by midwives were compared with those performed by any doctor and, in a secondary analysis, with those by junior doctors (fewer than two years at 'registrar' level). Sociodemographic characteristics and clinical outcomes were compared using the chi-squared test, Mann-Whitney U-test and independent sample t-test. MAIN OUTCOME MEASURES: Third- or fourth-degree tears. RESULTS: Among 2540 women identified, 330 (13%) were delivered by midwives. Maternal and clinical characteristics were comparable in each group. Midwives were more likely to use ventouse as their instrument of choice. Women delivered by midwives were less likely to suffer a third- or fourth-degree tears than those delivered by doctors and junior doctors. This difference did not reach statistical significance once adjusted for instrument used: odds ratio 0.6 (95% confidence interval: 0.3-1.2) and odds ratio 0.6 (95% confidence interval: 0.3-1.1), respectively. CONCLUSIONS: Instrumental vaginal deliveries performed by trained midwives are associated with equivalent maternal morbidity to those performed by doctors once adjusted for midwives' preference for the ventouse. This study highlights the potential contribution of an advanced role for midwives in the labor ward.

Improved accessibility of emergency obstetrics and newborn care (EmONC) services for maternal and newborn health: a community based project.

BACKGROUND: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur. METHOD/DESIGN: This community based cluster randomized controlled trial will evaluate the impact of an Emergency Obstetric and Newborn Care (EmONC) package in the intervention arm compared to standard of care in control arm. Perinatal and neonatal mortality are primary outcome measure for this trial. The trial will be implemented in 20 clusters (Union councils) of District Rahimyar Khan, Pakistan. The EmONC package consists of provision of maternal and neonatal health pack (clean delivery kit, emollient, chlorhexidine) for safe motherhood and newborn wellbeing and training of community level and facility based health care providers with emphasis on referral of complicated cases to nearest public health facilities and community mobilization. DISCUSSION: Even though there is substantial evidence in support of effectiveness of various health interventions for improving maternal, neonatal and child health. Reduction in perinatal and neonatal mortality remains a big challenge in resource constrained and diverse countries like Pakistan and achieving MDG 4 and 5 appears to be a distant reality. A comprehensive package of community based low cost interventions along the continuum of care tailored according to the socio cultural environment coupled with existing health force capacity building may result in improving the maternal and neonatal outcomes. The findings of this proposed community based trial will provide sufficient evidence on feasibility, acceptability and effectiveness to the policy makers for replicating and scaling up the interventions within the health system.

Association between clean delivery kit use, clean delivery practices, and neonatal survival: pooled analysis of data from three sites in South Asia.

BACKGROUND: Sepsis accounts for up to 15% of an estimated 3.3 million annual neonatal deaths globally. We used data collected from the control arms of three previously conducted cluster-randomised controlled trials in rural Bangladesh, India, and Nepal to examine the association between clean delivery kit use or clean delivery practices and neonatal mortality among home births. METHODS AND FINDINGS: Hierarchical, logistic regression models were used to explore the association between neonatal mortality and clean delivery kit use or clean delivery practices in 19,754 home births, controlling for confounders common to all study sites. We tested the association between kit use and neonatal mortality using a pooled dataset from all three sites and separately for each site. We then examined the association between individual clean delivery practices addressed in the contents of the kit (boiled blade and thread, plastic sheet, gloves, hand washing, and appropriate cord care) and neonatal mortality. Finally, we examined the combined association between mortality and four specific clean delivery practices (boiled blade and thread, hand washing, and plastic sheet). Using the pooled dataset, we found that kit use was associated with a relative reduction in neonatal mortality (adjusted odds ratio 0.52, 95% CI 0.39-0.68). While use of a clean delivery kit was not always accompanied by clean delivery practices, using a plastic sheet during delivery, a boiled blade to cut the cord, a boiled thread to tie the cord, and antiseptic to clean the umbilicus were each significantly associated with relative reductions in mortality, independently of kit use. Each additional clean delivery practice used was associated with a 16% relative reduction in neonatal mortality (odds ratio 0.84, 95% CI 0.77-0.92). CONCLUSIONS: The appropriate use of a clean delivery kit or clean delivery practices is associated with relative reductions in neonatal mortality among home births in underserved, rural populations.

Does a novel prefilled injection device make postpartum oxytocin easier to administer? Results from midwives in Vietnam.

OBJECTIVE: to assess the acceptability of the Uniject prefilled injection device for delivery of oxytocin in the third stage of labour, and the effect of the device on overall willingness to perform active management of the third stage of labour (AMTSL). DESIGN: descriptive study that used baseline and post-intervention questionnaires. SETTING: three districts in northern Vietnam. The study population consisted of 52 midwives from two districts where AMTSL was already practiced, and 35 midwives from a district where AMTSL was introduced as part of the study. MEASUREMENTS AND FINDINGS: the majority of midwives reported that the Uniject device was easier to use and preferable compared with ampoules and standard syringes. They found the training materials easy to understand. KEY CONCLUSIONS: the use of a prefilled injection device overcame many of the barriers cited by midwives with regard to the use of oxytocin in ampoules, such as trying to break ampoules and fill syringes in a hurry. This device enabled midwives to deliver the correct dose of oxytocin in the third stage of labour in a safe and timely way, while attending to the other needs of the mother and her newborn baby. IMPLICATIONS FOR PRACTICE: use of a prefilled injection device for oxytocin may increase the acceptability and practice of AMTSL in primary level facilities, thus reducing maternal mortality due to postpartum haemorrhage.

Parents' experiences of using videoconferencing as a support in early discharge after childbirth.

OBJECTIVE: to describe parents' experiences of using videoconferencing (VC) when discharged early from a maternity unit. DESIGN: a combination of quantitative and qualitative methods was used to describe parents' experiences. Data were collected via questionnaires and interviews. SETTING: a pilot study involving a maternity department and new parents in their homes was conducted. Through VC, parents discharged early were able to maintain follow-up contact with the midwife via sound and picture at the department. PARTICIPANTS: nine couples/new parents participated. FINDINGS: the analysis revealed four categories of responses: 'feeling confident with the technology'; 'feeling confident of having control of their privacy'; 'feeling confident being face-to-face on the VC'; and 'feeling confident when worries and concerns were met and answers were received'. KEY CONCLUSIONS: using VC as a support in cases of early discharge after childbirth can facilitate a meeting that makes it possible for new parents to be guided by the midwife in their transition into parenthood. IMPLICATIONS FOR PRACTICE: the findings of this study indicate that VC equipment may be helpful for parents discharged from hospital early after childbirth. The findings can also be used as a foundation for further development of the application of VC within maternal health care and in health care in rural areas.

Use of the vacuum extractor by midwives--what has changed in the last decade?

This article provides an update on use of vacuum extraction by certified nurse-midwives (CNMs) and certified midwives (CMs). Research findings from the last decade relevant to the training and use of vacuum extractors are reviewed along with professional guidelines and legal implications.

Midwifery care measures in the second stage of labor and reduction of genital tract trauma at birth: a randomized trial.

Genital tract trauma after spontaneous vaginal childbirth is common, and evidence-based prevention measures have not been identified beyond minimizing the use of episiotomy. This study randomized 1211 healthy women in midwifery care at the University of New Mexico teaching hospital to 1 of 3 care measures late in the second stage of labor: 1) warm compresses to the perineal area, 2) massage with lubricant, or 3) no touching of the perineum until crowning of the infant's head. The purpose was to assess whether any of these measures was associated with lower levels of obstetric trauma. After each birth, the clinical midwife recorded demographic, clinical care, and outcome data, including the location and extent of any genital tract trauma. The frequency distribution of genital tract trauma was equal in all three groups. Individual women and their clinicians should decide whether to use these techniques on the basis of maternal comfort and other considerations.

Audit of an aromatherapy service in a maternity unit.

This paper reports the results of the audit of a maternity aromatherapy service at a small Midlands maternity unit. The service was introduced in May 2000 and the principal aims of the audit, conducted in October 2002 were to investigate clinical effectiveness, maternal satisfaction and staff training needs. The service has been shown to be effective in normalising childbirth and increasing satisfaction of mothers in respect of their labour experiences. A concurrent audit of staff demonstrated interest and enthusiasm of the service and identified areas for further development. The service was short listed for the Prince of Wales Foundation for Integrated Health Awards for Good Practice in 2003 and awarded a certificate of achievement.