Neonatal outcomes after water birth: A retrospective cohort study.

OBJECTIVE: To compare neonatal outcomes between water births, births with immersion only during labour, and births in which immersion was never used. METHODS: A retrospective cohort study was performed including mother-baby dyads attended between 2009 and 2019 at the Hospital do Salnés regional hospital (Pontevedra, Spain). These women were categorised into 3 groups: water birth; immersion only during dilation; and women who never used immersion. Several sociodemographic-obstetric variables were studied and the main outcome was the admission of the neonate to the intensive care unit (NICU). Permission was obtained from the responsible provincial ethics committee. Descriptive statistics were used and between-group comparisons were performed using variance for continuous variables and chi-square for categorical variables. Multivariate analysis was performed with backward stepwise logistic regression and incidence risk ratios with 95%CI were calculated for each independent variable. Data were analysed using IBM SPSS® statistical software. RESULTS: A total of 1191 cases were included. 404 births without immersions; 397 immersions only during the first stage of labor; and 390 waterbirths were included. No differences were found in the need to transfer new-borns to a NICU (p = .735). In the waterbirth cohort, neonatal resuscitation (p < .001, OR: 0,1), as well as respiratory distress (p = .005, OR: 0,2) or neonatal problems during admission (p < .001, OR: 0,2), were lower. In the immersion only during labor cohort, less neonatal resuscitation (p = .003; OR: 0,4) and respiratory distress (p = .019; OR: 0,4) were found. The probability of not breastfeeding upon discharge was higher for the land birth cohort (p < .001, OR: 0,4). CONCLUSIONS: The results of this study indicated that water birth did not influence the need for NICU admission, but was associated with fewer adverse neonatal outcomes, such as resuscitation, respiratory distress, or problems during admission.

Breastfeeding and Obstetric Violence during the SARS-CoV-2 Pandemic in Spain: Maternal Perceptions.

Catalan legislation, a pioneer in Europe, has defined obstetric violence (OV) as "preventing or hindering access to truthful information, necessary for autonomous and informed decision-making". The definition also states that OV can affect physical and mental health, as well as sexual and reproductive health. Some authors have expressed concern about an increase in OV during the SARS-CoV-2 pandemic. During the pandemic, recommendations were also openly offered on the non-establishment and/or early abandonment of breastfeeding without scientific evidence to support them. Experiencing a traumatic childbirth can influence breastfeeding outcomes. Here, we conducted a cross-sectional study using a self-administered online questionnaire. The sample consisted of women who gave birth in Spain between March 2020 and April 2021. The mean age was 34.41 (±4.23) years. Of the women, 73% were employed, 78.2% had a university education, and almost all were Caucasian. Among the subjects, 3.3% were diagnosed with SARS-CoV-2 during pregnancy and 1% were diagnosed during delivery. Some of the women (1.6%) were advised to stop breastfeeding in order to be vaccinated. Women diagnosed with SARS-CoV-2 during delivery (p = 0.048), belonging to a low social class (p = 0.031), with secondary education (p = 0.029), or who suffered obstetric violence (p < 0.001) perceived less support and that the health care providers were less inclined to resolve doubts and difficulties about breastfeeding. Breastfeeding has been significantly challenged during the pandemic. In addition to all the variables to be considered that make breastfeeding support difficult, we now probably need to add SARS-CoV-2 diagnosis and OV.

Obstetric Violence in Spain (Part III): Healthcare Professionals, Times, and Areas.

BACKGROUND: Obstetric violence is a worldwide public health problem, which seems greater in Spain. As no studies were found that identify the most representative healthcare professionals, times, and areas involved in obstetric violence, the objective of this work was to study at what time of maternity, with which professionals, and in what areas women identified obstetric violence. METHODS: This descriptive, retrospective, and cross-sectional study was performed from January 2018 to June 2019. The main variables were the area (hospital, primary care, both), the time (pregnancy, birth, puerperium), and the professionals attending to women. RESULTS: Our sample comprised 17,541 participants. The area identified with the most obstetric violence for the different studied variables was hospitals. Women identified more obstetric violence at time of birth. Findings such as lack of information and informed consent (74.2%), and criticism of infantile behavior and treatment (87.6%), stood out. The main identified healthcare professionals were midwives and gynecologists, and "other" professionals repeatedly appeared. CONCLUSIONS: Having identified the professionals, times, and areas of most obstetric violence in Spain, it seems necessary to reflect on not only the Spanish National Health System's structure and management but also on healthcare professionals' training.

Obstetric Violence in Spain (Part I): Women's Perception and Interterritorial Differences.

The decentralization of health systems can have direct repercussions on maternity care. Some inequalities can be noted in outcomes, like neonatal and child mortality in Spain. This study aimed to make the presence of obstetric violence in Spain visible as an interterritorial equity criterion. A descriptive, restrospective and cross-sectional study was conducted between January 2018 and June 2019. The sample comprised 17,541 questionnaires, which represented all Spanish Autonomous Communities. Of our sample, 38.3% perceived having suffered obstetric violence; 44.4% perceived that they had undergone unnecessary and/or painful procedures, of whom 83.4% were not requested to provide informed consent. The mean satisfaction with the attention women received obtained 6.94 points in the general sample and 4.85 points for those women who viewed themselves as victims of obstetric violence. Spain seems to have a serious problem with public health and respecting human rights in obstetric violence. Offering information to women and requesting their informed consent are barely practiced in the healthcare system, so it is necessary to profoundly reflect on obstetric practices with, and request informed consent from, women in Spain.

Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth.

BACKGROUND: obstetric violence can partially be represented by the high number of interventions and medicalization rates during the birthing process. The objective of the present study was to determine the interventionism and medicalization levels during childbirth in Spain. METHODS: a descriptive, retrospective, and cross-sectional study was conducted between January 2018 and June 2019. RESULTS: the intervention percentages were 34.2% for Kristeller maneuver and 39.3% for episiotomy. Differences appeared in public, private, and mixed healthcare settings (p < 0.001). The mean satisfaction, with healthcare in the different settings, was estimated at 6.88 points (SD ± 2.146) in public healthcare, 4.76 points (SD ± 3.968) in private healthcare, and 8.03 points (SD ± 1.930) in mixed healthcare (p < 0.001). No statistically significant differences were found in Spanish autonomous communities. CONCLUSIONS: births in Spain seem to be highly intervened. In this study, a certain equity criterion was found concerning interventionism during childbirth in Spain. Healthcare influenced female intervention, satisfaction, and perception levels for obstetric violence; this evidences that female empowerment plays an important role.

Influencia de las intervenciones realizadas durante el parto en la duración de la lactancia materna / Influence of the interventions during labour on breastfeeding duration

Objetivo: Analizar la influencia de diferentes intervenciones clínicas realizadas durante el parto sobre el inicio y mantenimiento de la lactancia materna (LM) a los 4, 6 y 12 meses. Método: Estudio observacional prospectivo. Se llevó a cabo en el Hospital do Salnés de Vilagarcía de Arousa (Pontevedra). La población de estudio fueron mujeres que dieron a luz entre marzo y diciembre de 2016 con intención de amamantar. Se realizó seguimiento de la muestra durante 12 meses o hasta abandonar la LM. La variable de resultado fue la duración total de la LM. Las variables independientes fueron una serie de intervenciones frecuentes en el proceso perinatal. También se analizó el efecto acumulativo negativo de dichas intervenciones sobre la LM. Resultados: Se obtuvo una muestra de 189 mujeres. El tiempo de LM mediano fue de 12 meses en el grupo sin intervenciones, de 10 meses en el grupo de 1-3 intervenciones y de 5 en el grupo de 4 o más intervenciones, siendo las diferencias estadísticamente significativas (p= 0,014). Los eventuales factores de confusión o ajuste se estudiaron mediante análisis multivariante. Cabe destacar el efecto positivo de no utilizar la epidural para conseguir una LM que se mantenga hasta los 12 meses ( odds ratio 2,1; p= 0,03). Conclusiones: Es necesario un mayor esfuerzo por parte de las instituciones para capacitar y sensibilizar al personal sanitario en cuanto a las normas y prácticas relacionadas con la atención amigable a la madre, así como dar a conocer el efecto acumulativo negativo de las intervenciones realizadas en el parto. Las mujeres que necesiten múltiples intervenciones durante el parto podrían precisar ayuda suplementaria para mejorar sus resultados en la LM

Objective: To evaluate the influence of different clinical procedures (operations) during labour on the beginning and maintenance of breastfeeding at 4, 6 and 12 months. Method: An observational-prospective study was carried out at the Salnés Hospital (Vilagarcía de Arousa, Pontevedra). The study population were women who had given birth between March and December 2016 and had the intention of breastfeeding their babies. The sample of 189 women were followed for 12 months or until breastfeeding was ceased. The result variable was the total length of breastfeeding. Independent variables were a series of frequent procedures during labour. The negative accumulative effect on breastfeeding was also analysed. Results: The average breastfeeding time was 12 months in the group undergoing no procedures, 10 months in the group undergoing 1-3 procedures and 5 months in the group undergoing 4 or more procedures. The statistical differences are significant (p= 0.014). The potential confusion or adjustment factors were analysed by means of multivariate analysis. It is worth highlighting the positive effect of not using the epidural to achieve an LM that is maintained until 12 months (odds ratio 2.1; p= 0.03). Conclusions: A greater effort is necessary on behalf of the institutions to not only train and sensitize their staff about the guidelines and practice related to offering kind care to the mother, but also making them aware of the negative accumulative effect of the procedures carried out during labour. Women who undergo several procedures during labour may need extra support in order to improve their breastfeeding results

[Sociocultural and healthcare factors influencing the choice and duration of breast feeding in a regional hospital]. / Lactancia materna en un hospital comarcal: factores socioculturales y sanitarios que pueden influir en su elección y mantenimiento.

OBJECTIVES: To determine the prevalence of breastfeeding in the health area of Salnés Hospital (Vilagarcía, Pontevedra, Spain) and the influence of social and healthcare factors on the initiation and duration of breastfeeding. To evaluate compliance with each of the BFHI (Baby Friendly Hospital Initiative) "Ten Steps to Successful Breastfeeding" defined by the WHO/UNICEF. METHOD: The study population included all the women who gave birth in Salnés Hospital between august 2004 and september 2005. All the women were administered a questionnaire before discharge. A prospective study was performed by telephone interviews at 4, 6 and 12 months postpartum. A database was created using SPSS 13.0 for Windows. Statistical analysis was performed using Student's t-test and the Mann-Whitney non-parametric test for quantitative variables, and the Chi-square test for categorical variables. RESULTS: At discharge, 66.3% (134) of newborns were exclusively breastfed. At 6 months postpartum, 23.7% (31) of the women continued exclusive breastfeeding, and 10.2% (13) continued at 12 months. Factors with a significant effect on breastfeeding initiation were the partner's educational level and women's attendance at prenatal classes. Factors with a positive effect on maintaining breastfeeding were maternal non-smoking, a partner with tertiary education and the recommendation of on-demand breastfeeding by the healthcare provider. CONCLUSIONS: Compliance with the BFHI "Ten Steps to Successful Breastfeeding" was fairly satisfactory, but the prevalence of breastfeeding should be higher. The father should be included in prenatal education.

Lactancia materna en un hospital comarcal: factores socioculturales y sanitarios que pueden influir en su elección y mantenimiento / Sociocultural and healthcare factors influencing the choice and duration of breast feeding in a regional hospital

Objetivos. Conocer la prevalencia de la lactancia materna (LM) en el área de salud del Hospital del Salnés (Vilagarcía, Pontevedra), así como factores sociosanitarios asociados a su inicio y duración. Conocer el grado de cumplimiento del decálogo de la Iniciativa de Hospital Amigo de los Niños (IHAN). Método. La población del estudio son mujeres que tuvieron un hijo en el Hospital del Salnés entre agosto de 2004 y septiembre de 2005, a las que se les pasó una encuesta al alta. Se realizó un estudio prospectivo mediante encuesta telefónica a los 4, 6 y 12 meses. Se utilizó SPSS para Windows 13.0. El estudio estadístico de las variables se realizó empleando la prueba de la t de Student, el test de Mann-Whitney, y la 2. Resultados. El 66,3 % (134) de los niños recibía LM exclusiva al alta. A los 6 meses seguía el 23,7% (31) y a los 12 el 10,2% (13). Influyen en el inicio de la LM el nivel de estudios de la pareja y que la mujer asista a clases de preparación maternal. En el mantenimiento influyen el tabaquismo de la mujer, el nivel de estudios de la pareja y que el niño lacte a demanda. Conclusiones. El grado de cumplimiento del decálogo de la IHAN es bastante satisfactorio, pero no la prevalencia de LM, que debería aumentar. El padre debe incorporarse a la labor educativa prenatal

Objectives. To determine the prevalence of breastfeeding in the health area of Salnés Hospital (Vilagarcía, Pontevedra, Spain) and the influence of social and healthcare factors on the initiation and duration of breastfeeding. To evaluate compliance with each of the BFHI (Baby Friendly Hospital Initiative) “Ten Steps to Successful Breastfeeding” defined by the WHO/UNICEF. Method. The study population included all the women who gave birth in Salnés Hospital between august 2004 and september 2005. All the women were administered a questionnaire before discharge. A prospective study was performed by telephone interviews at 4, 6 and 12 months postpartum. A database was created using SPSS 13.0 for Windows. Statistical analysis was performed using Student’s t-test and the Mann-Whitney non-parametric test for quantitative variables, and the Chi-square test for categorical variables. Results. At discharge, 66.3% (134) of newborns were exclusively breastfed. At 6 months postpartum, 23.7% (31) of the women continued exclusive breastfeeding, and 10.2% (13) continued at 12 months. Factors with a significant effect on breastfeeding initiation were the partner’s educational level and women’s attendance at prenatal classes. Factors with a positive effect on maintaining breastfeeding were maternal non-smoking, a partner with tertiary education and the recommendation of on-demand breastfeeding by the healthcare provider. Conclusions. Compliance with the BFHI “Ten Steps to Successful Breastfeeding” was fairly satisfactory, but the prevalence of breastfeeding should be higher. The father should be included in prenatal education