Midwives' approach to the prevention and repair of obstetric perineal trauma in Spain.

AIM: Different clinical practice guidelines include recommendations on how to prevent and repair obstetric perineal trauma, as well as the use of episiotomy. To evaluate the variability in midwives' professional practices for preventing and repairing perineal trauma, as well as the professional factors that may be associated with the restrictive use of episiotomy. DESIGN: Observational cross-sectional study. METHODS: Three hundred five midwives completed an anonymous questionnaire developed by the authors and distributed across various midwifery scientific societies. The main outcomes measured were the frequencies of adopting specific practices related to perineal injury prevention and repair, episiotomy technique and restrictive episiotomy use (<10%). Odds ratios (OR) and adjusted odds ratios (aOR) with 95% confidence intervals were estimated. RESULTS: Intrapartum perineal massage was not normally used by 253 (83%) of midwives, and 186 (61%) applied compresses soaked in warm water to the perineum. Regarding episiotomy, there was a great deal of variability, noting that 129 (42.3%) adopted a restrictive use of this procedure, 125 (41%) performed it between 10% and 20%, while 51 midwives (16.7%) performed it in more than 20% of cases. In addition, 165 (54.1%) midwives followed an incision angle of 60º. Concerning tears, 155 (50.8%) usually sutured first-degree tears and 273 (89.5%) always sutured second-degree tears. Midwives attending home births (aOR = 6.5; 95% CI: 2.69-15.69), working at a teaching hospital (aOR = 3.69; 95% CI: 1.39-9.84), and the ones who recently completed their professional training (aOR = 3.58; 95% CI: 1.46-8.79) were significantly more likely to adopt a restrictive use of episiotomy. CONCLUSIONS: There is a significant variability in Spanish midwives' practices for preventing and repairing perineal tears. Moreover, the restrictive use of episiotomy is associated with midwives attending home births, working in teaching hospitals and having recent professional training. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution.

Nursing Support During Latent Phase Labor: A Scoping Review.

PURPOSE: The purpose of this scoping review was to synthesize the literature on nursing support during the latent phase of the first stage of labor. In 2014, the definition of the beginning of active labor changed from 4 centimeters (cm) to 6 cm cervical dilation. More women may have an induction of labor based on results of recent research showing no causal increase in risk of cesarean birth with elective induction of labor for low-risk nulliparous women. Therefore, in-hospital latent phase labor may be longer, increasing the need for nursing support. DESIGN: Scoping review of the literature from 2009 to present. METHODS: We conducted the review using key words in PubMed, CINAHL, and Scopus. Search terms included different combinations of "latent or early labor," "birth," "support," "nursing support," "obstetrics," and "onset of labor." Peer-reviewed research and quality improvement articles from 2009 to present were included if they had specific implications for nursing care during the latent phase of labor. Articles were excluded if they were not specific to nursing, focused exclusively on tool development, or were from the perspective of pregnant women or providers only. RESULTS: Ten articles were included. Results were synthesized into six categories; support of physiologic labor and birth, the nurse's own personal view of labor, birth environment, techniques and tools, decision-making, and importance of latent labor discussion during the prenatal period. CLINICAL IMPLICATIONS: Support for physiologic labor and birth is an important consideration for use of nonpharmacological methods during latent labor. The nurse's own personal view on labor support can influence the support that laboring women receive. Nurses may need additional education on labor support methods.

Intervención educacional para la mejora en la asistencia al trabajo de parto normal / Educational intervention to improve normal childbirth care / Intervenção educacional para melhoria na assistência ao trabalho de parto normal

INTRODUCCIÓN: El desempeño de la enfermería obstétrica en el escenario del parto y el parto, ha ido ganando protagonismo por ser una profesional considerada una figura indispensable para el logro de un parto humanizado, con el objetivo de rescatar la autonomía de las mujeres. MATERIALES Y MÉTODOS: Este es un estudio cuasi experimental, antes y después, que desarrolló una intervención educativa, realizada a través de un curso de capacitación aplicado al personal de enfermería. Celebrada del 01 al 03 de agosto de 2018 en la sala de partos de un hospital de maternidad en Teresina-PI. Se solicitó la autorización del comité de enseñanza e investigación de la institución, con una opinión favorable para llevar a cabo. RESULTADOS: Treinta y dos profesionales participaron en la intervención, con la mayoría del personal de enfermería del centro obstétrico, con 87.50% de técnicos de enfermería y 85.71% de enfermeras obstétricas. Se puede observar que en la prueba previa hubo un mayor número de errores en las preguntas, 5 con 46.87% de error y 10 con 32.50% de error en el tema de cuidados de enfermería en trabajo de parto y parto, con mejoría después de la aplicación de la intervención con 18.75 y 9.25 errores respectivamente en el examen posterior. DISCUSIÓN: Frente a varias opciones de estrategias de instrucción, la educación continua tiene un lugar destacado en enfermería, porque a partir de los resultados, podemos ver la mejora del conocimiento de profesionales después de aplicar la intervención educativa. CONCLUSIÓN: La intervención permitió a los profesionales ampliar sus conocimientos y proporcionar al binomio madre-RN una atención humanizada respaldada por evidencia científica

INTRODUCTION: The performance of obstetric nursing in the scenario of labor and childbirth has gained prominence because nursing professionals are considered indispensable actors for the achievement of humanized birth, to rescue the autonomy of women. MATERIALS AND METHODS: This is a quasi-experimental study of the before and after type, in which an educational intervention was developed, conducted through a training course applied to the nursing staff. The study was accomplished from August 01 to 03, 2018, in the childbirth room of a maternity hospital in Teresina-PI. Authorization from the teaching and research committee of the institution was requested, with a favorable Opinion for its realization. RESULTS: Thirty-two professionals participated in the intervention. The majority was from the obstetric center; 87.50% were nursing technicians and 85.71% obstetric nurses. There was a greater number of errors in questions 5 (46.87% of error) and 10 (32.50% of error) in the pre-test, in the theme nursing care in labor and childbirth, and an improvement of to 18.75 and 9.25 of error, respectively, in the post-test. DISCUSSION: Among the several options of instructional strategies, continuing education has a prominent place in nursing, as the results of this study showed an improvement in the knowledge of professionals after application of the educational intervention. CONCLUSION: The intervention allowed the professionals to broaden their knowledge and provide the mother-newborn binomial with a humanized care supported by scientific evidence

INTRODUÇÃO: A atuação da enfermagem obstétrica no cenário do trabalho de parto e parto vem ganhando destaque por esse ser um profissional considerado uma figura indispensável para o alcance de um parto humanizado, com intuito de resgatar a autonomia da mulher. MATERIAIS E MÉTODOS: Trata-se de um estudo quase experimental, do tipo antes e depois, o qual foi desenvolvido uma intervenção educacional, realizada por meio de curso de capacitação aplicado à equipe de enfermagem. Realizado no período de 01 a 03 de agosto de 2018 na sala de parto de uma maternidade em Teresina-PI. Solicitada autorização do comitê de ensino e pesquisa da instituição, com parecer favorável para realização. RESULTADOS: Participaram da intervenção 32 profissionais, havendo a presença majoritária da equipe de enfermagem do centro obstétrico, com a composição de 87,50% de técnicos de enfermagem e 85,71% de enfermeiros obstetras. Pode-se observar que no pré-teste houve maior número de erros nas questões 5 com 46,87% de erro e a 10 com 32,50% de erro da temática cuidados de enfermagem no trabalho de parto e parto, com melhoria após aplicação da intervenção com 18,75 e 9,25 de erros respectivamente no pós teste. DISCUSSÃO: Diante de diversas opções de estratégias instrutivas, a educação continuada possui um lugar de destaque na enfermagem, pois a partir dos resultados, podemos perceber a melhoria dos conhecimentos dos profissionais após aplicação da intervenção educativa. CONCLUSÃO: A intervenção possibilitou que os profissionais ampliassem seus conhecimentos e proporcionar ao binômio mãe-RN um cuidar humanizado e respaldado das evidências científicas

Preventing Cesarean Birth in Women with Obesity: Influence of Unit-Level Midwifery Presence on Use of Cesarean among Women in the Consortium on Safe Labor Data Set.

INTRODUCTION: Maternal obesity is associated with slow labor progression and unplanned cesarean birth. Midwives use fewer medical interventions during labor, and the women they care for have lower cesarean birth rates, compared with low-risk, matched groups of women cared for by physicians. The primary aim of this study was to examine associations between midwifery unit-level presence and unplanned cesarean birth in women with different body mass index (BMI) ranges. Unit-level presence of midwives was analyzed as a representation of a unique set of care practices that exist in settings where midwives work. METHODS: A retrospective cohort study was conducted using Consortium on Safe Labor data from low-risk, healthy women who labored and gave birth in medical centers with (n = 9795) or without (n = 13,398) the unit-level presence of midwives. Regression models were used to evaluate for associations between unit-level midwifery presence and 1) the incidence of unplanned cesarean birth and 2) in-hospital labor durations with stratification by maternal BMI and adjustment for maternal demographic and pregnancy factors. RESULTS: The odds of unplanned cesarean birth among women who gave birth in centers with midwives were 16% lower than the odds of cesarean birth among similar women at who gave birth at centers without midwives (adjusted odds ratio, 0.84; 95% CI, 0.77-0.93). However, women whose BMI was above 35.00 kg/m2 at labor admission had similar odds of cesarean birth, regardless of unit-level midwifery presence. In-hospital labor duration prior to unplanned cesarean was no different by unit-level midwifery presence in nulliparous women whose BMI was above 35.00 kg/m2 . DISCUSSION: Although integration of midwives into the caregiving environment of medical centers in the United States was associated with overall decrease in the incidence of cesarean birth, increased maternal BMI nevertheless remained positively associated with these outcomes.

Trauma perineal e seus fatores associados em partos assistidos por enfermeiros obstetras em um hospital SUS / Perineal trauma and its associated factors in births attended by obstetric nurses in a SUS hospital

Objetivou-se avaliar ocorrência e fatores associados ao trauma perineal em partos assistidos por enfermeiro obstetra em um hospital do SUS. Estudo de prevalência retrospectivo, realizado com 738 puérperas entre janeiro e dezembro de 2018. Procedeu-se estatística descritiva, realizadas análises univariadas e bivariadas, e calculados intervalos de confiança de 95%. As variáveis que se associaram à integridade perineal foram idade igual ou superior a 20 anos e maior paridade prévia, havendo tendência no grupo que não realizou analgesia durante o trabalho de parto, e inversamente proporcional ao peso do recém-nascido. As lacerações espontâneas associaram-se com idade precoce em relação ao grupo de 20-35 anos, havendo tendência nas acima de 35 anos. A episiotomia não associou-se à nenhuma variável. O emprego de tecnologias obstétricas não invasivas pode estar relacionado à proteção contra trauma perineal. A assistência ao parto liderada por enfermeiro obstetra colabora para a redução de intervenções desnecessárias, contribuindo para uma assistência humanizada

Using Scorecard Feedback to Improve Quantitative Blood Loss Measurement at Birth.

OBJECTIVE: To increase the percentage of cases in which quantitative blood loss (QBL) was documented by labor and delivery nurses for women giving birth. DESIGN: Quality improvement project. SETTING/LOCAL PROBLEM: Labor and delivery unit of a community hospital in which a previous implementation of QBL measurement was not sustained. PARTICIPANTS: Labor and delivery nurses were the focus of the intervention, but the entire multidisciplinary team became involved. INTERVENTION/MEASUREMENTS: Based on literature supporting the use of scorecard feedback to stimulate performance improvement, weekly blinded individual scorecards showing the percentage of births attended by each labor and delivery nurse with QBL documented and a run chart showing the percentage of all births with QBL documented were posted on the unit and discussed during huddles for 12 weeks. Data on blood product administration were collected, and charts comparing QBL and estimated blood loss (EBL) volumes documented were shared with nurses and physicians. RESULTS: Over 12 weeks, the percentage of births with QBL documented increased from 22.7% to 80.0%. Consistent with previous reports comparing QBL and EBL volumes at birth, there was a significant difference between the mean QBL volume (mean = 482.20 ml, standard deviation = 358.03) and the mean EBL volume (mean = 313.15 ml, standard deviation = 211.91; p < .001) for total births. The mean QBL volume was also greater than the mean EBL volume for vaginal and cesarean births, but those differences were not statistically significant. There was no increase in blood product administration associated with the increase in QBL documentation. CONCLUSION: Discussing weekly scorecards and a run chart of QBL measurement was associated with an increase in documentation of QBL by labor and delivery nurses. Planning this project and discussing the results engaged the entire multidisciplinary team in more consistent measurement of QBL. The increased level of QBL documentation has been sustained for longer than 1 year.

Implementation of the Fetal Monitor Safety Nurse Role: Lessons Learned.

BACKGROUND: The fetal monitor safety nurse role was created as a supplemental support for nurses assessing fetal heart rate tracings in response to an adverse event. An experienced labor and delivery nurse without a patient care assignment was designated to continuously assess all active fetal monitoring tracings, via an electronic display away from the main nurses' station, as an adjunct to the care and assessment of the nurse with primary responsibility for the patient. PURPOSE: The purpose of this project was to evaluate the views of nurses who served as fetal monitor safety nurses about various aspects of the role. METHODS: Nurses who served as fetal monitor safety nurses were invited to attend a small group session where they completed a survey about the role and then received information on the importance of fetal monitoring safety. Two weeks later, they were asked to take the survey again to evaluate potential changes in viewpoints. RESULTS: Thirty nurses attended small group sessions and completed the survey. Of those, 22 nurses completed the post survey 2 weeks later. There was minimal change in nurses' views of the fetal monitor safety nurse role after attending the small group sessions. Nurses expressed comfort in notifying peers about concerns related to the fetal heart rate tracing and perceived overall safety benefits; however, they felt that safe staffing measures were not in place to support the role. Concerns were expressed about a nurse being in a nondirect patient care position during times of high census and acuity. CLINICAL IMPLICATIONS: The fetal monitoring safety nurse may be an innovative potential solution to minimize risk of adverse events during labor that are related to accurate assessment of electronic fetal monitoring data and timely and appropriate interventions. More data are needed on improvements in fetal outcomes and adverse events potentially related to the fetal monitor safety nurse role. Budgetary support and adequate nurse staffing are required to make the role operationally feasible and safe. Valuing and seeking nurses' input as bedside experts about perinatal safety initiatives should be a part of implementing new practices.

Is Labor Induction at 39 Weeks Linked to Adverse Outcomes?

A new study says no, although concerns remain.

Cuidados de la matrona en la versión cefálica externa / Midwife care in external cephalic version

La versión cefálica externa (VCE) es una maniobra obstétrica que intenta convertir una presentación fetal podálica o transversa en cefálica, más favorable de cara al parto. La matrona, como parte del equipo multidisciplinar, está presente durante el proceso de su realización, aplicando los cuidados necesarios para una atención integral de la mujer gestante. El objetivo de este artículo es presentar el caso clínico de una mujer embarazada durante el procedimiento de VCE. Se elabora el plan de cuidados enfermeros basado en las necesidades básicas de Virginia Henderson y guiado por la taxonomía NANDA-NIC-NOC, donde se identifican tres diagnósticos de Enfermería, que serán la base de la realización de este proceso enfermero: temor, dolor agudo y riesgo de alteración de la díada materno/fetal. La aplicación de este plan de cuidados supuso una mejora en la atención a la mujer y en la organización del trabajo

External cephalic version (ECV) is an obstetric manoeuvre intended to change a breech or transversal fetal presentation into cephalic, more favourable in terms of delivery. The midwife, as a member of the multidisciplinary team, will be present during this procedure, implementing any necessary measures for a comprehensive care of the pregnant woman. The objective of this article is to present the clinical case of a pregnant woman during the ECV procedure. The nursing care plan is prepared on the basis of Virginia Henderson’s basic needs, and guided by the NANDA-NIC-NOC taxonomy, where three nursing diagnoses will be identified as the basis for conducting this nursing process: fear, acute pain and risk of alteration of the maternal/fetal dyad. The application of this healthcare plan represented an improvement in women care and work organization

Passive descent in the second stage: evaluation of variation in practice patterns.

OBJECTIVE: To compare the length of the second stage in nulliparous women with respect to a range of factors related to staffing and outcomes at a community hospital. METHODS: This was a retrospective cohort study of nulliparous women presenting for delivery over a 2-year period. The primary outcomes were the presence of passive descent and length of the second stage. Secondary outcomes were mode of delivery, chorioamnionitis, and postpartum hemorrhage. RESULTS: Passive descent was observed in 198 women in the second stage. When passive descent occurred, the differences in the median length of the second stage in relation to the nursing shift increments were statistically significant, with the longest times corresponding to the middle 4 h of the nursing shifts (p = .046). Physician patients were more likely than midwife patients to undergo passive descent on weekdays (36% vs. 26%, p = .034) but not on weekends (32% for both). Though the likelihood of a vaginal delivery remained high up to 6 h into the second stage, the rate of hemorrhage and chorioamnionitis increased significantly. CONCLUSIONS: When passive descent occurred, second stage length varied depending on the time of day. These findings suggest provider behaviors impact the length of the second stage.

PERINEAL WOUND CARE: EDUCATION AND TRAINING IN AUSTRALIA.

In Australia, approximately 75% of women who have a vaginal birth will sustain some form of perineal trauma (AIHW 2013); and over half of perineal injuries will require suturing.

A meta-ethnographic synthesis of midwives' and nurses' experiences of adverse labour and birth events.

INTRODUCTION: Health professionals are frequently exposed to traumatic events due to the nature of their work. While traumatic and adverse labour and birth events experienced by women are well researched, less attention has been given to midwives' and nurses' experiences of these events and the impact it has on their lives. AIMS AND OBJECTIVES: To undertake a meta-ethnographic study of midwives' and nurses' experiences of adverse labour and birth events. METHODS: Scopus, CINHAL PLUS, MEDLINE and PUBMED databases were searched using subject headings and keywords. The search was limited to papers published in peer-reviewed journals from 2004-October 2016. Quality appraisal was undertaken using the Critical Appraisal Skills Programme tool. INCLUSION CRITERIA: Papers had to be qualitative or have a substantial qualitative component. Studies were included if they primarily focused on midwives' or nurses' perspectives or experiences of complicated, traumatic or adverse labour and birth events. ANALYTIC STRATEGY: A meta-ethnographic approach was used incorporating methods of reciprocal translation guided by the work of Noblit and Hare (1988, Meta-Ethnography: Synthesizing qualitative studies (Vol. 11). Newbury Park: Sage publications). FINDINGS: Eleven qualitative studies were included in the final sample. Four major themes were (i) feeling the chaos; (ii) powerless, responsible and a failure; (iii) "It adds another scar to my soul"; and (iv) finding a way to deal with it. CONCLUSION: Midwives and nurses feel relatively unprepared when faced with a real-life labour and birth emergency event. While many of the midwives and nurses were traumatised by the experience, some were able to view their encounter as an opportunity to develop their emergency response skills. RELEVANCE TO CLINICAL PRACTICE: Witnessing and being involved in a complicated or adverse labour and birth event can be traumatic for nurses and midwives. Organisational and collegial support needs to be available to enable these health professionals to talk about their feelings and concerns.

Responses to birth trauma and prevalence of posttraumatic stress among Australian midwives.

BACKGROUND: Midwives frequently witness traumatic birth events. Little is known about responses to birth trauma and prevalence of posttraumatic stress among Australian midwives. AIM: To assess exposure to different types of birth trauma, peritraumatic reactions and prevalence of posttraumatic stress. METHODS: Members of the Australian College of Midwives completed an online survey. A standardised measure assessed posttraumatic stress symptoms. FINDINGS: More than two-thirds of midwives (67.2%) reported having witnessed a traumatic birth event that included interpersonal care-related trauma features. Midwives recalled strong emotions during or shortly after witnessing the traumatic birth event, such as feelings of horror (74.8%) and guilt (65.3%) about what happened to the woman. Midwives who witnessed birth trauma that included care-related features were significantly more likely to recall peritraumatic distress including feelings of horror (OR=3.89, 95% CI [2.71, 5.59]) and guilt (OR=1.90, 95% CI [1.36, 2.65]) than midwives who witnessed non-interpersonal birth trauma. 17% of midwives met criteria for probable posttraumatic stress disorder (95% CI [14.2, 20.0]). Witnessing abusive care was associated with more severe posttraumatic stress than other types of trauma. DISCUSSION: Witnessing care-related birth trauma was common. Midwives experience strong emotional reactions in response to witnessing birth trauma, in particular, care-related birth trauma. Almost one-fifth of midwives met criteria for probable posttraumatic stress disorder. CONCLUSION: Midwives carry a high psychological burden related to witnessing birth trauma. Posttraumatic stress should be acknowledged as an occupational stress for midwives. The incidence of traumatic birth events experienced by women and witnessed by midwives needs to be reduced.

Assessing nursing diagnoses and interventions in labour and high-risk pregnancies. / Avaliando diagnósticos e intervenções de enfermagem no trabalho de parto e na gestação de risco.

OBJECTIVE: To evaluate the use of nursing diagnoses and interventions proposed for women in labour and high-risk pregnancies. METHOD: This is a descriptive, retrospective study with documentary analysis of 1000 medical records and a checklist conducted from July to September 2014, at a maternity hospital in Paraiba, Brazil. It consisted of analysing descriptive measures and comparing the relationship between nursing diagnoses and interventions using NANDA - International and the Nursing Interventions Classification. RESULTS: The most common diagnoses in labour were acute pain (62%), fatigue (24.7%), and anxiety (22%). For high-risk pregnant women they were impaired sleep and rest (100%), risk of infection (81.8%), and anxiety (77.2%). The interventions were hand washing (80.8%) and identify and accommodate patient in the bed (78%). CONCLUSION: The diagnoses express needs during parturition and the psychobiological changes in high-risk pregnancy. The interventions are disconnected from the diagnoses and should therefore be reviewed and altered.