Arterial blood gases in newborn infants: Early extraction without prior clamping versus extraction after delayed clamping.

OBJECTIVES: To compare the postpartum arterial blood gas parameters recorded early before cord clamping and after delayed cord clamping (DCC). To explore adverse effects and complications of the cord blood gas collection technique without clamping. DESIGN: Randomised controlled trial. SETTING: Birthing room of La Ribera University Hospital (Valencia, Spain). PARTICIPANTS: 122 full-term infants born between February 2020 and January 2021. Two groups were established: the experimental group (early sampling prior to clamping and sampling again after DCC) and the non-experimental group (sampling only after DCC). MEASUREMENTS AND FINDINGS: The comparison of arterial blood gas parameters was made using the Student t-test, while the Fisher's exact test was used to compare the proportion of the adverse effects recorded. The pH and base excess values in the experimental group were significantly greater when the sampling was performed without prior clamping. No statistically significant differences were observed in relation to pCO2 or the appearance of adverse effects between the two groups. No complications were recorded. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: The pH and base excess values were higher when the arterial blood gas measurements were made prior to performing the umbilical cord clamping than when the sampling was performed after the DCC. Arterial blood gas sampling without prior clamping was found to be safe, since no complications or increased adverse effects were observed. The use of this technique is therefore advised in normal births of full-term infants.

Influence and use of information sources about childbearing among Spanish pregnant women.

BACKGROUND: Pregnant women create their childbirth expectations from their available information. Therefore, they should have access to reliable and quality medical information. However, the literature points a knowledge gap with respect to the sources of information used by them. OBJECTIVES: The primary objective was to analyse the most influential and widely used sources of information about childbearing in Spanish pregnant women. The secondary objectives were to assess the quality and usefulness of the information sources, to identify those regarded as deficient by pregnant women and to discover differences in information use related to parity. DESIGN AND METHODS: A cross-sectional descriptive study was undertaken involving the administration of questionnaires to 40 primiparous and 40 multiparous (taking into account their first and second pregnancy). Social Network Analysis was used, as well as descriptive and inferential statistics for secondary objectives. RESULTS: Midwives were the most widely used (degree 0.988) and influential source of information (degree 0.600). Although the Internet was very much used (degree 0.738), its influence was very limited (degree 0.050). Healthcare professionals provided the most useful and highest quality information. Statistically significant differences have been found between first and second pregnancy of multiparous women in relation to the utilisation of some sources of information. CONCLUSIONS: Midwives were identified as the key professionals for informing pregnant women. The most influential sources were always people (this underscoring the importance of the face-to-face contact in the search for information). Although new technologies offered support, were unable to replace the information provided by healthcare professionals.

Coordinación entre matronas del área de salud de La Ribera desde un enfoque fenomenológico / Coordination between midwives in La Ribera health area among a phenomenological based approach

Objetivo: Conocer, desde una perspectiva fenomenológica, la situación actual de coordinación entre niveles asistenciales y modelos de gestión de recursos humanos de las matronas del área de salud de La Ribera, así como sus propuestas para mejorar su coordinación. Metodología: Estudio cualitativo de perspectiva fenomenológica. Se realizaron entrevistas semiestructuradas a 28 matronas que trabajaban en el área de salud de La Ribera durante 2016. El análisis del contenido se realizó mediante la triangulación del investigador, usando el programa MAXQDA para la codificación y el análisis de los datos. Resultados: Las respuestas se clasificaron en 9 códigos: concepto de coordinación (dificultad para definirlo), recursos disponibles para la coordinación (Jefe de Servicio de Ginecología, teléfono y correo electrónico), elementos facilitadores (recursos materiales) y obstaculizadores (falta de contacto y existencia de compartimentos estancos), propuestas de mejora (coordinadora integral, rotatorios entre atención primaria y especializada, presencia de una matrona en planta de maternidad), persona de referencia para la coordinación (supervisora de paritorio), modelo de gestión de recursos humanos (diferencias en el trato según modelo), comunicación entre matronas (escasa y mejorable), déficit de conocimiento, y valoración de la coordinación (negativa entre matronas y positiva entre matronas y otros profesionales). Conclusiones: El presente estudio muestra una coordinación deficitaria entre matronas, con una comunicación escasa y diferencias en el trato según el modelo de gestión. Las matronas manifestaron su deseo de mejorar dicha coordinación mediante diversas propuestas

Objective: To know, from a phenomenological perspective, the current situation of coordination between different levels of care and human resource management models of midwives in La Ribera health area, as well as the strategies proposed by them to improve the coordination. Methodology: Qualitative study through a phenomenological perspective. Semi-structured interviews with 28 midwives who worked in La Ribera health area during 2016 were performed. The content analysis was performed by researcher triangulation, using the MAXQDA software for coding and data analysis. Results: The answers were classified into 9 codes: concept of coordination (difficulty to define it), available resources for coordination (Head of Gynecology, telephone and email), facilitating elements (material resources) and obstacles (lack of contact and existence of watertight compartments), proposals for improvement coordination (integral coordinator for both care levels, rotating between primary and specialized care, presence of a midwife in the maternity ward), reference person for coordination (supervisor of the delivery room), model of human resources management (differences in the treatment according to model), communication between midwives (scarce and improvable), knowledge deficit, and assessment of coordination (negative among midwives and positive among midwives and other professionals). Conclusions: The present study shows a poor coordination between midwives, with a scarce communication and differences in treatment according to the management model. Midwives expressed their desire to increase such coordination through its improvement proposals

Social Network Analysis Applied to a Historical Ethnographic Study Surrounding Home Birth.

Safety during birth has improved since hospital delivery became standard practice, but the process has also become increasingly medicalised. Hence, recent years have witnessed a growing interest in home births due to the advantages it offers to mothers and their newborn infants. The aims of the present study were to confirm the transition from a home birth model of care to a scenario in which deliveries began to occur almost exclusively in a hospital setting; to define the social networks surrounding home births; and to determine whether geography exerted any influence on the social networks surrounding home births. Adopting a qualitative approach, we recruited 19 women who had given birth at home in the mid 20th century in a rural area in Spain. We employed a social network analysis method. Our results revealed three essential aspects that remain relevant today: the importance of health professionals in home delivery care, the importance of the mother’s primary network, and the influence of the geographical location of the actors involved in childbirth. All of these factors must be taken into consideration when developing strategies for maternal health.

Expectativas de parto de las gestantes de La Ribera: una aproximación cualitativa / Childbirth expectations of La Ribera pregnant women: a qualitative approach

Objetivo: El cambio de modelo asistencial en la atención al parto normal, el interés por parte de las autoridades sanitarias en que se exploren las expectativas de parto de las gestantes, y su especificidad cultural y social, hacen que el estudio de tales expectativas sea pertinente en este momento. El objetivo del presente estudio es conocer cuáles son las expectativas de parto de una muestra de gestantes españolas y estudiar las diferencias entre las expectativas de las gestantes primíparas y multíparas. Metodología: Estudio cualitativo basado en una pregunta de respuesta libre sobre expectativas de parto. Se recogieron datos a gestantes de tercer trimestre del área de salud de La Ribera (Alzira, Valencia) durante 2014-2015. Se analizaron los datos mediante análisis del contenido. Resultados: Muestra de 213 gestantes cuyas principales expectativas de parto fueron tener un parto rápido, con buen resultado obstétrico, sin dolor y con apoyo de los profesionales. Las expectativas relacionadas con los protocolos de atención al parto normal supusieron un 5.2% del total de las respuestas. No se encontraron diferencias estadísticamente significativas entre gestantes primíparas y multíparas. Conclusiones: El conocimiento de las expectativas resulta importante, ya que las gestantes miden su satisfacción con el parto en base al cumplimiento de tales expectativas. Ayudarlas a desarrollar expectativas realistas aumentará su satisfacción. Las matronas tienen un importante papel a través de la formación que imparten (educación maternal) y del apoyo en el momento del parto (fundamental para que las gestantes se sientan protagonistas del mismo) (AU)

Objective: Change of healthcare model in normal childbirth, health authorities interest in exploring childbirth expectations of pregnant women, and their cultural and social specificity make relevant the study of these expectations at this moment. The aim is to know what are the childbirth expectations from a sample of Spanish pregnant women and to study the differences between primiparous and multiparous pregnant women expectations. Methodology: Qualitative study based on an open-ended question about childbirth expectations. Data were collected during 2014-2015 to third trimester pregnant women in La Ribera health area (Alzira, Valencia). Data were analyzed using content analysis. Results: Sample of 213 pregnant women whose main expectations were to have a fast delivery, with good obstetric outcome, painlessly and with professional support. Expectations regarding normal childbirth protocols accounted for 5.2% of total responses. No statistically significant differences between primiparous and multiparous pregnant women were found. Conclusions: Knowledge about childbirth expectations is highly relevant because pregnant women measure their satisfaction with childbirth through the fulfillment of these expectations. Helping them to develop realistic expectations will increase their satisfaction. Midwives play an important role through the training they give (maternal education) and through the support during delivery (this is essential for the pregnant women in order to feel themselves protagonist of their delivery) (AU)

Factores que influyen en la realización de una episiotomía en partos eutócicos / Factors affecting the performance of an episiotomy in spontaneous vaginal deliveries

Objetivo: Analizar los factores que condicionan la realización de episiotomía en partos eutócicos en el Hospital Universitario de La Ribera (HULR). Material y método: Estudio descriptivo, transversal y retrospectivo. Se recogieron datos de los partos eutócicos atendidos durante el año 2015. Se tabularon en una hoja de cálculo Excel y se analizaron con el paquete estadístico SPSS 17.0. Resultados: El número total de partos atendidos en el HULR durante 2015 fue de 1.814. De ellos, 1.116 fueron partos eutócicos (62%), de los cuales un 83% no precisó episiotomía. Por tanto, la tasa de episiotomías en partos eutócicos fue del 17%. Se encontró una relación estadísticamente significativa entre la realización de episiotomía y las variables primiparidad, uso de analgesia epidural, parto estimulado/inducido y posición de parto en litotomía. No se encontró relación estadísticamente significativa con la edad materna, el peso del recién nacido, el profesional que atendió el parto o la aparición de desgarros. Conclusiones: Conocer los factores que se asocian con la realización de episiotomías en el HULR puede ser determinante para restringir su uso a las situaciones estrictamente necesarias. Se proponen ciertas medidas al respecto, como el uso de posiciones alternativas durante el expulsivo, el inicio del parto espontáneo cuando sea posible, el respeto a los tiempos de expulsivo en los casos de analgesia epidural y la elaboración de un documento de consenso sobre las indicaciones de la episiotomía (AU)

Objective: To analyze the factors that condition the performance of an episiotomy in spontaneous vaginal deliveries at La Ribera University Hospital (HULR). Material and method: A descriptive, cross-sectional and retrospective study was carried out. Data about spontaneous vaginal deliveries attended during 2015 were collected. Data were tabulated in Excel spreadsheet and analyzed with SPSS 17.0 statistical package. Results: Data from 1,116 spontaneous vaginal deliveries were analyzed (62% of the total). In 83% of these cases no episiotomy was performed. A statistically significant relationship was found between the performance of episiotomy and the variables: primiparity, use of epidural analgesia, stimulated/induced labour and lithotomy position. There was no statistically significant relationship to maternal age, weight of the new-born, health care professional, or perineal trauma appearance. Conclusions: Knowing the factors that are associated with the performance of episiotomy in our delivery room is determinant to restrict its use to those situations strictly necessary. The following measures have been proposed: the use of alternative positions during the second stage of labour, spontaneous onset of labour when possible, to respect the duration of second stage of labour in cases of epidural analgesia, and the elaboration of a consensus document on episiotomy indications (AU)