Impact of shared decision-making on women's childbirth preferences: A cluster randomised controlled trial.

BACKGROUND: Midwives provide counselling for birth plans (BPs) to women during prenatal care; however, the impact of individualised BP counselling interventions based on shared decision-making (SDM) regarding women's preferences is unknown. METHODS: This randomised cluster trial included four primary healthcare units. Midwives provided BP counselling based on SDM to women in the intervention group (IG) during prenatal care along with a handout about evidence-based recommendations. Women in the control group (CG) received standard BP counselling from midwives. The main outcome was preference changes concerning BPs. RESULTS: A total of 461 (95.5 %) pregnant women received BP counselling (IG, n = 247; CG, n = 214). Women in the IG changed their BP preferences for 13 items compared with those in the CG. These items were: using an unique space during birth (81.1 % vs 51.6 %; p < 0.001), option for light graduation (63 % vs 44.7 %; p < 0.001), listening to music (57.3 % vs 43.6 %; p = 0.006), drinking fluids during labour (84.6 % vs 93.6 %; p = 0.005), continuous monitoring (59 % vs 37.8 %; p < 0.001); desire for natural childbirth (36.6 % vs 25 %; p = 0.014), epidural analgesia (55.1 % vs 43.6 %; p = 0.023); breathing techniques (65.2 % vs 50.5 %; p = 0.003), massage (74.9 % vs 55.3 %; p < 0.001); birthing ball use (81.9 % vs 56.9 %; p < 0.001), spontaneous pushing (49.3 % vs 28.7 %; p < 0.001), choosing birth position (69.6 % vs 41.5 %) and delayed umbilical cord clamping (67.8 % vs 44.1 %; p = 0.001). CONCLUSION: SDM counselling, together with a handout about evidence-based recommendations on childbirth and newborn care, produced more changes in women's preferences expressed in the BP than standard counselling.

Effectiveness of birth plan counselling based on shared decision making: A cluster randomized controlled trial (APLANT).

BACKGROUND: A birth plan (BP) is a written document in which the pregnant woman explains her wishes and expectations about childbirth to the health professionals and aims to facilitate her decision-making. Midwives' support to women during the development of the BP is essential, but it's unknown if shared decision making (SDM) is effective in birth plan counselling. We hypothesized that women who receive counselling based on SDM during their pregnancy are more likely to present their BP to the hospital, more satisfied with the childbirth experience, and have better obstetric outcomes than women who receive standard counselling. We also aimed to identify if women who presented BP to the hospital have better obstetric outcomes and more satisfied with the childbirth experience. METHODS: This was a randomised cluster trial involving four Primary Care Units. Midwives provided BP counselling based on SDM to the women in the intervention group (IG) during their pregnancy, along with a leaflet with evidence-based recommendations. Women in the control group (CG) only received the standard birth plan counselling from midwives. The primary outcomes were birth plan presentation to the hospital, obstetrics outcomes and satisfaction with childbirth experience. The Mackey Satisfaction with Childbirth Scale (MCSRS) was used to measure childbirth satisfaction. RESULTS: A total of 461 (95.5%) pregnant women received BP counselling (IG n = 214 and CG n = 247). Fewer women in the intervention group presented their BP to the hospital compared to those in the control group (57.8% vs 75.1%; p <0.001). Mean satisfaction with childbirth experience was high in the IG as well as the CG: 150.2 (SD:22.6) vs. 153.4 (SD:21.8); p = 0.224). The information received about childbirth during pregnancy was high in both groups (95.1% vs 94.8%; p = 1.0). Fewer women in the IG used analgesia epidural compared to those in the CG (84.7% vs 91.7%; p = 0.034); women who combined non-pharmacological and pharmacological methods for pain relief were more in number in the IG (48.9% vs 29.5%; p = 0.001) and women who began breastfeeding in the delivery room were more in number in the IG (83.9% vs 66.3%; p = 0.001). Women who presented their BP had a greater probability of using combined non-pharmacological and pharmacological methods for pain relief aOR = 2.06 (95% CI: 1.30-4.30) and early skin-to-skin contact aOR = 2.08 (95% CI: 1.07-4.04). CONCLUSION: This counselling intervention was not effective to increase the presentation of the BP to the hospital and women's satisfaction with childbirth; however, it was related to a lower usage of analgesia epidural, a higher combination of pharmacological and non-pharmacological methods for pain relief and the initiation of breastfeeding in the delivery room. Presenting the BP to the hospital increased the likelihood of using pharmacological and non-pharmacological methods for pain relief, and early skin-to-skin contact.

Pre-pregnancy overweight and obesity prevalence and relation to maternal and perinatal outcomes.

OBJECTIVE: To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). METHOD: A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values <.05 (two-tailed) were considered significant. Logistic regression models were performed. RESULTS: The prevalence of pre-pregnancy obesity was 8.4% and 18.9% for overweight. Gestational diabetes was more frequent in pre-pregnancy overweight/obesity (OR 1.92: 95% CI 1.54-2.40 and OR 3.34: 95% CI 2.57-4.33), as were preeclampsia (OR 2.08: 95% CI 1.55-2.79 and OR 3.35: 95% CI 2.38-4.71), induction of labour (OR 1.19: 95% CI 1.02-1.38 and OR 1.94: 95% CI 1.57-2.10), caesarean section (OR 1.41: 95% CI 1.21-1.65 and OR 2.68: 95% CI 2.18-3.29), prematurity (OR 1.28: 95% CI 1-1.65 and OR 1.79: 95% CI 1.32-2.44) and macrosomia (OR 1.87: 95% CI 1.43-2.46 and OR 2.03: 95% CI 1.40-2.93). CONCLUSIONS: One in four pregnant women had pre-pregnancy overweight or obesity. This study shows the relationship between pre-pregnancy overweight or obesity with adverse maternal and perinatal outcomes.

Effectiveness of a Step Counter Smartband and Midwife Counseling Intervention on Gestational Weight Gain and Physical Activity in Pregnant Women With Obesity (Pas and Pes Study): Randomized Controlled Trial.

BACKGROUND: Women who are pregnant and have obesity and excessive gestational weight gain (GWG) present a higher risk of maternal and perinatal complications. The use of mobile apps and a wristband during pregnancy may contribute to promoting healthy lifestyles and, thus, improving maternal and neonatal health. OBJECTIVE: This study aims to evaluate the effectiveness of a complex digital health intervention, using a smartband and app with midwife counseling, on GWG and physical activity (PA) in women who are pregnant and have obesity and analyze its impact on maternal and perinatal outcomes. In addition, we aim to study the frequency of use, usability, and satisfaction with the mobile apps used by the women in the intervention group. METHODS: A parallel, 2-arm, randomized controlled trial was conducted. A total of 150 women who were pregnant and had obesity were included. The intervention group received a complex combined digital intervention. The intervention was delivered with a smartband (Mi Band 2) linked to the app Mi Fit to measure PA and the Hangouts app with the midwife to provide personal health information. The control group received usual care. The validated Spanish versions of the International Physical Activity Questionnaire-Short Form and the System Usability Scale were used. Satisfaction was measured on a 1- to 5-point Likert scale. RESULTS: We analyzed 120 women, of whom 30 (25%) were withdrawn because of the COVID-19 pandemic. The median GWG in the intervention group was 7.0 (IQR 4-11) kg versus 9.3 (IQR 5.9-13.3) kg in the control group (P=.04). The adjusted mean GWG per week was 0.5 (95% CI 0.4-0.6) kg per week in the control group and 0.3 (95% CI 0.3-0.4) kg per week in the intervention group (df=0.1, 95% CI -0.2 to 0.03; P=.008). During the 35 and 37 gestational weeks, women in the intervention group had higher mean PA than women in the control group (1980 metabolic equivalents of tasks-minutes per week vs 1386 metabolic equivalents of tasks-minutes per week, respectively; P=.01). No differences were observed between the study groups in the incidence of maternal and perinatal outcomes. In the intervention group, 61% (36/59) of the women who were pregnant used the smartband daily, and 75% (44/59) evaluated the usability of the Mi Fit app as excellent. All women in the intervention group used the Hangouts app at least once a week. The mean of the satisfaction scale with the health counseling app and midwife support was 4.8/5 (SD 0.6) points. CONCLUSIONS: The use of a complex mobile health intervention was associated with adequate GWG, which was lower in the intervention group than in the control group. In addition, we observed that the intervention group had increases in PA. No differences were observed in maternal perinatal complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03706872; https://www.clinicaltrials.gov/ct2/show/NCT03706872.

Efectividad de una intervención digital compleja en los hábitos alimentarios de gestantes con obesidad preconcepcional / Effectiveness of a complex digital intervention on eating habits in pregnant women with pre-pregnancy obesity

Objetivo: Evaluar la efectividad de una intervención digital compleja, en gestantes con obesidad, con la provisión de consejos sobre hábitos alimentarios y el soporte virtual de una matrona a través de una app, respecto a los hábitos alimentarios, así como analizar el grado de satisfacción global con la intervención digital. Métodos: Se realizó un ensayo clínico paralelo aleatorizado con dos brazos 1:1 con grupo intervención (GI) y grupo control (GC). Se incluyeron 150 gestantes con obesidad preconcepcional. Ambos grupos recibieron el control prenatal habitual. La intervención en el GI fue el uso de una pulsera de actividad y la recepción de consejos sobre hábitos alimentarios mediante una app, y el soporte virtual de una matrona. Se utilizó el «Cuestionario de hábitos alimentarios para pacientes con sobrepeso y obesidad» en una escala Likert de 1 a 5. Las pruebas estadísticas fueron bilaterales y se evaluaron a un nivel α de 0,05. Los análisis se realizaron con SPSS v. 25 y SAS v. 9.4.Resultados: Se analizaron 110 (73,3 % del total) mujeres. En el GI la puntuación media de los hábitos alimentarios fue mayor que en el GC (3,49 ± 0,36 vs. 3,35 ± 0,41; p= 0,056), pero no se observaron diferencias estadísticamente significativas. En el GI, la puntuación media del consumo del tipo de alimentos fue mayor que en el GC (3,49 ± 0,78 vs. 3,18 ± 0,71; p= 0,019). El grado de satisfacción global fue de 4,76 ± 0,6 puntos de media. Conclusiones: El uso de una intervención digital compleja fue efectivo en la mejora del consumo del tipo de alimentos respecto a las gestantes que solo recibieron el control prenatal habitual. (AU)

Objective: To assess the effectiveness of a complex digital health intervention, in pregnant women with obesity, by means of an app for advice eating habits and a virtual midwife’s support, regarding their eating habits, and also to analyze the global satisfaction with digital intervention.Methods: A parallel randomized clinical trial with two arms 1:1 with intervention group (IG) and control group (CG) was conducted. 150 pregnant women with pre-pregnancy obesity were included. Both groups received usual prenatal care. The intervention, in the IG, was delivered with smartband and an app providing advice about eating habits and with a virtual midwife to support women. The validated «Questionnaire of eating habits for patients with overweight and obesity» was administrated and measured using a 1-to-5-point Likert scale. Statistical tests were two-sided and evaluated at an α level of 0.05. Analyzes were performed with SPSS v. 25 and SAS v. 9.4.Results: 110 (73.3% of the total) women were analyzed. In the IG, the mean score for eating habits was higher than in the CG (3.49 ± 0.36 versus 3.35 ± 0.41; p=0.056), but no statistically significant differences were observed. In the IG, the mean score for the intake of the type of food was higher than in the CG (3.49 ± 0.78 versus 3.18 ± 0.71; p=0.019). The mean of global satisfaction was 4.76 ± 0.6 points. Conclusions: The use of a complex digital intervention was effective in improving the intake of the type of food compared to pregnant women who only received usual prenatal care. (AU)

Pre-pregnancy overweight and obesity prevalence and relation to maternal and perinatal outcomes.

OBJECTIVE: To identify the prevalence of pre-pregnancy overweight/obesity in pregnant women and its relationship with socio-demographic factors and to describe the maternal and perinatal outcomes in a Barcelona hospital (Spain). METHOD: A descriptive cross-association study, with retrospective data collection, was performed Barcelona Hospital. The data of 5447 pregnant women who delivered at >=23 weeks of gestation were included. Body Mass Index (BMI) data were categorised into World Health Organization classifications. p values <.05 (two-tailed) were considered significant. Logistic regression models were performed. RESULTS: The prevalence of pre-pregnancy obesity was 8.4% and 18.9% for overweight. Gestational diabetes was more frequent in pre-pregnancy overweight/obesity (OR 1.92: 95% CI 1.54-2.40 and OR 3.34: 95% CI 2.57-4.33), as were preeclampsia (OR 2.08: 95% CI 1.55-2.79 and OR 3.35: 95% CI 2.38-4.71), induction of labour (OR 1.19: 95% CI 1.02-1.38 and OR 1.94: 95% CI 1.57-2.10), caesarean section (OR 1.41: 95% CI 1.21-1.65 and OR 2.68: 95% CI 2.18-3.29), prematurity (OR 1.28: 95% CI 1-1.65 and OR 1.79: 95% CI 1.32-2.44) and macrosomia (OR 1.87: 95% CI 1.43-2.46 and OR 2.03: 95% CI 1.40-2.93). CONCLUSIONS: One in four pregnant women had pre-pregnancy overweight or obesity. This study shows the relationship between pre-pregnancy overweight or obesity with adverse maternal and perinatal outcomes.

Birth plan presentation to hospitals and its relation to obstetric outcomes and selected pain relief methods during childbirth.

BACKGROUND: The information on birth plan (BP) usage in Spanish hospitals is scant. AIM: To identify the percentage of pregnant women presenting a BP at five hospitals in Spain, the reasons why some women failed to do so and how BP presentation relates to obstetric outcomes and selected pain relief methods. METHODS: In this descriptive, multi-centre study, data were retrospectively collected. During the postpartum visits at primary healthcare centres in various health districts in Barcelona (Catalonia, Spain), a data collection sheet about obstetric outcomes and analgesia was administered to 432 mothers who had completed a BP during their pregnancies. The main outcome was the rate of BP presentation to the hospital. The sociodemographic and obstetric characteristics and pain relief measures were compared to identify any differences between mothers who presented a BP and those who did not. RESULTS: A total of 422 (99.7%) women were studied; 51.2% of women (95% confidence interval (CI): 46.4-55.9) had presented a BP. The main reason for not presenting a BP was because the hospital midwives did not request them (61.2%). No differences were observed in BP presentation according to age, the country of origin, education, employment or hospital. Mothers who presented a BP were more likely to start breastfeeding in the birthing room (82.4% vs. 73.3%; p = 0.024). Epidural analgesia was the most common method used for pain relief (88.9%), and women who presented a BP attempted to use concomitant non-pharmacological methods more often (50.5% vs. 38.8%; p = 0.012). CONCLUSION: Almost half of the mothers failed to present a BP, usually because midwives did not request it.

Perinatal contraceptive counselling: Effectiveness of a reinforcement intervention on top of standard clinical practice.

OBJECTIVE: To assess the effectiveness of supplemental perinatal contraceptive counselling in addition to standard Spanish postpartum contraceptive counselling with regard to contraceptive use and use of effective contraception up to 1 year postpartum. Women's satisfaction with counselling and the method chosen was also assessed. DESIGN: Community-randomized trial. SETTING: "Reproductive and Sexual Health Care" units of the National Health Care System at twenty public Primary Care facilities in Catalonia (Spain). PARTICIPANTS: 1,004 consecutive pregnant women (~week 30) receiving prenatal care between 1st October 2015 and 31st March 2016. Women were considered eligible for analysis if appropriate information was available. INTERVENTIONS: At half of the centres, midwives provided the standard Spanish postpartum contraceptive counselling (control group, CG). At the other half, supplemental perinatal contraceptive counselling was provided in addition to standard counselling (intervention group, IG) at different time points during pregnancy and postpartum. This consisted of a leaflet and a blog with practical information about all contraceptive options plus a short reminder message in the mobile phone during the third quarter of pregnancy and a face-to-face or a virtual meeting lasting 20 min in the first 15 days postpartum. Midwives used ad hoc questionnaires to collect information at week 30 of pregnancy (recruitment), and week 6, month 6 and month 12 postpartum. MEASUREMENTS AND FINDINGS: 975 women were eligible for analysis (482 in the CG and 493 in the IG). ~33% women had resumed sexual intercourse by week 6, and nearly all by months 6 and 12. Use and effectiveness of contraceptives was similar in both groups at week 6 and month 6. At month 12, more women in the IG used more effective contraception and less women used contraceptives considered somewhat effective vs. those of the CG (P = 0.006). When considering the place of origin, this was only true for Spanish women. Women of other origins had a much higher use of very effective contraceptives at month 12 also in the CG, with contraceptive counselling having scarce effect. On multivariate analysis, conducted only in Spanish women, the additional counselling resulted in a higher use of highly effective methods while having a university degree increased 3.6 times the OR for this behaviour. A bias towards fostering use of very effective contraceptives among women with low education was seen in standard clinical practice. Satisfaction with counselling and the type of contraception chosen was higher in the IG. KEY CONCLUSIONS: Our study has shown that the supplemental counselling tested has a moderate impact on contraceptive use and use of effective contraception in postpartum women. Results of this effort were seen after 6 months postpartum. A possible bias towards women who were more socially vulnerable was found in standard clinical practice, which reduced the effectiveness of the intervention in women who were otherwise the most needy. IMPLICATIONS FOR PRACTICE: Despite the benefits provided by supplemental support in perinatal contraceptive counselling, the existence of a possible bias affecting the effectiveness of these interventions should be investigated and addressed.

Efectividad de la acupuntura en la hipogalactia y en la inflamación mamaria. Revisión bibliográfica / Effectiveness of acupuncture in hypogalactia and breast inflammation. Bibliographic review

Objetivo: Determinar la efectividad de la acupuntura en el tratamiento de la hipogalactia y de la inflamación mamaria; mapear los puntos de aplicación y las técnicas utilizadas. Metodología: Revisión bibliográfica efectuada en las bases de datos PubMed, Cinahl, Cuiden, Scielo, Lilacs, Dialnet, Latindex, Cuidatge, WorldCat y Google Académico. Resultados: Se incluyeron 10 estudios; 7 observaron una mayor producción láctea o una prolongación en el tiempo de la lactancia; 2 evaluaron la efectividad de la acupuntura en la inflamación mamaria, y constataron un rápido alivio sintomático y un menor uso de antibióticos. No se ha encontrado unanimidad en la selección de la técnica y de los puntos para los diferentes tratamientos con acupuntura. Conclusión: La acupuntura parece ser efectiva para aumentar la producción láctea y mejorar los síntomas mamarios. Dada la falta de consenso en la selección de puntos y en las técnicas empleadas para los diferentes tratamientos con acupuntura, se requieren más estudios para poder generalizar estos tratamientos en la práctica clínica

Objective: To determine the effectiveness of acupuncture in the treatment of hypogalactia and breast inflammation; to map the application points and the techniques used. Methodology: A literature review was conducted by searching on PubMed, Cinahl, Cuiden, Scielo, Lilacs, Dialnet, Latindex, Cuidatge, WorldCat and Google Scholar. Results: A total of ten studies were included. A higher milk production or an extension in the time of lactation was observed in seven studies. The efficacy of acupuncture in the breast inflammation was evaluated in two studies and a quick relief of the symptoms and a lower use of antibiotics were observed. No agreement was found neither for the technique used nor for the acupuncture points used between the treatments. Conclusion: Acupuncture seems to be effective in increasing milk production and improving breast symptoms. The lack of consensus in the selection of points and in the techniques used for the different treatments with acupuncture means that more studies are required in order to generalize these treatments in clinical practice

La anticoncepción durante la cuarentena: situación actual y colectivos más vulnerables a embarazos no planificados durante este periodo / The contraception during the quarantine: current situation and groups more vulnerable to unplanned pregnancies during this period

OBJETIVOS: Conocer la prevalencia de reinicio de relaciones sexuales coitales (RSC) en mujeres puérperas, antes de las 6 semanas posparto, cuántas tienen cobertura anticonceptiva inadecuada y sus características. Sujetos, material y método: Estudio transversal de datos recogidos en mujeres participantes en el grupo control del estudio MAYA, llevado a cabo en 20 centros de Cataluña con el fin de analizar la efectividad a largo plazo de un programa de asesoramiento anticonceptivo posparto de refuerzo (grupo intervención, 10 centros) con respecto a la práctica clínica habitual (grupo control, 10 centros). Los datos analizados provienen de la información recogida a las 30 semanas de embarazo y a las 6 semanas posparto. No usar métodos anticonceptivos y el coito interrumpido se consideraron «cobertura anticonceptiva inadecuada». RESULTADOS: Se analizaron 428 mujeres de 32 ± 5,1 años. El 32,9% (n= 141) había reiniciado las RSC antes de las 6 semanas posparto, y el 20% (n= 28) tenía una cobertura anticonceptiva inadecuada. Las mujeres <30 años o usuarias de lactancia artificial frente a mixta/materna reiniciaron las RSC durante la cuarentena con más frecuencia. Las extranjeras frente a las españolas, con un menor nivel educativo o que daban lactancia mixta frente a artificial/materna presentaron más frecuentemente una cobertura anticonceptiva inadecuada. Las que no eran laboralmente activas o no habían planificado la gestación presentaban ambos comportamientos. CONCLUSIONES: Una de cada 3 mujeres inicia las relaciones sexuales antes de las 6 semanas, y de éstas, 1 de cada 5 no tiene una cobertura anticonceptiva adecuada. Este estudio ha identificado las características de mujeres que podrían ser especialmente vulnerables a embarazos no planificados

OBJECTIVES: To determine the prevalence of resumption of sexual intercourse (SI) among puerperal women before 6 weeks postpartum, how many do not use adequate contraception and their characteristics. Subjects, material and method: Cross-sectional study of data collected from women in the control group of the MAYA study that was conducted at 20 centres in Catalonia (Spain) in order to analyze the long-term effectiveness of an additional postpartum contraceptive counselling program (intervention group, 10 centres) vs. standard clinical practice (control group, 10 centres). The data was collected by midwives at week 30 of pregnancy and at week 6 postpartum. Not using any contraception or using the withdrawal method was considered «inadequate contraception». RESULTS: 428 women aged 32 ± 5.1 years were analyzed. 32.9% (n= 141) had resumed SI before 6 weeks postpartum, with 20% (n= 28) using inadequate contraception. Women aged <30 years and those who formula fed vs. those who mixed- or breastfed were most likely to resume SI during the 6-week postpartum period. Compared to Spanish women, foreigners, those with lower education levels or who mixed fed instead of formula feeding or breastfeeding were more likely to use inadequate contraception. Women who were unemployed or who had not planned pregnancy expressed both behaviours. CONCLUSIONS: One woman in three resumes sexual intercourse before the end of the 6-week postpartum period and of these, one in five uses inadequate contraception. This study identifies the characteristics of women who may be especially vulnerable to unintended pregnancy

Actividad educativa sobre el plan de nacimiento en el control prenatal: factores relacionados / Educational activity on birth plan in prenatal care: related factors

OBJETIVOS: Determinar la prevalencia de la actividad educativa (AE) sobre el Plan de Nacimiento (PN) que realizan las matronas en el control prenatal de las gestantes y averiguar las semanas de gestación (SG) en que se efectúa, e identificar los factores asociados a la realización de la AE sobre el PN. MATERIAL Y MÉTODOS: Estudio multicéntrico, descriptivo, transversal, de asociación cruzada. La población de estudio estuvo compuesta por 3.749 gestantes atendidas en 5 unidades de Atención a la Salud Sexual y Reproductiva (ASSIR) del Instituto Catalán de la Salud (ICS) entre 2015 y 2016 en Barcelona. Las principales variables fueron la AE sobre el PN, las SG en que se efectúa y si se realiza >24 SG, según el estándar de calidad del ICS. Los datos procedían de la historia clínica informatizada; se volcaron anonimizados en una hoja Excel, se analizaron con el programa SPSS 24.0 y se efectuó un análisis descriptivo e inferencial. RESULTADOS: Se excluyeron 812 (21,7%) gestantes y se evaluaron 2.937 (78,3%). La prevalencia de entrega del PN fue del 86,9% (n= 2.551; intervalo de confianza [IC] del 95%: 85,6-88,1). La media de SG fue de 24,7 (IC del 95%: 24,3-25,2) y se realizó AE a partir de las 24 SG en el 64,5% (n= 1.598) de las gestantes. Tener un menor número de partos es un factor independiente para recibir AE sobre el PN (odds ratio [OR]= 0,90); por el contrario, tener un nivel de riesgo obstétrico «muy alto» es un factor independiente para no recibirla (OR= 0,57). Las ASSIR con mayor prevalencia de AE sobre el PN tienen menor cumplimiento del estándar de calidad del ICS. CONCLUSIONES: La prevalencia de realización de la AE sobre el PN es elevada. Cerca de dos tercios de las gestantes reciben la AE a partir de las 24 SG, pero hay una gran variabilidad según la ASSIR

OBJECTIVES: To establish the prevalence of the educational activity (EA) of birth plan (BP), that midwives perform in the prenatal control of the pregnant women, to find out gestation week (GW) in what it is carried out, and to identify the associated factors to the accomplishment of the EA in the BP. MATERIAL AND METHODS: Multicenter, descriptive, cross-sectional of crossed association study. The analyzed population was the computerized clinical records of 3,749 pregnant women in 5 units of Sexual and Reproductive Health Care (ASSIR) of the Catalan Health Institute (ICS) between 2015 and 2016 in Barcelona. The main variables were the EA on the BP, the GW in which it was carried out and if it was performed before the 24 weeks, according to the ICS quality standard. The data come from computerized clinical records. Data were introduced anonymously in an excel sheet and analyzed with the statistical package SPSS 24.0. Descriptive and inferential analysis were performed. RESULTS: We excluded 812 (21.7%) pregnant women and we evaluated 2,937 (78.3%). The prevalence of BP delivery was 86.9% (n= 2,551; 95% CI: 85.6-88.1). The mean of GW was 24.7 (CI: 95% 24.3-25.2) and was performed from 24 GW in 64.5% (n= 1,598) pregnant women. Having a lower number of births is an independent factor to receive EA about the BP ( odds ratio [OR]= 0.90); on the contrary, having a "very high" level of obstetric risk is an independent factor to not receiving it (OR= 0.57). The ASSIRS that have a higher prevalence of EA over the BP had a lower compliance with the ICS quality standard. CONCLUSIONS: The prevalence of EA on BP is high. Nearly two thirds of pregnant women receive EA from 24 GW, although results according to ASSIR show a great variability

Adherencia y cumplimiento del método anticonceptivo hormonal oral / Adherence and compliance of oral contraceptive pill

OBJETIVO: Identificar los factores relacionados con la adherencia y el cumplimiento de las mujeres con los anticonceptivos hormonales orales (ACO). METODOLOGÍA: Revisión bibliográfica. Se realizó una búsqueda en las bases de datos PubMed, CINAHL, Cochrane Library, MEDES y ENFISPO en los últimos 10 años. RESULTADOS: Se seleccionaron un total de 35 artículos originales y una revisión bibliográfica. Los factores que mejoran el cumplimiento de los ACO son los conocimientos que tiene la mujer sobre la píldora, iniciar el método de forma inmediata y el apoyo de la pareja. Los factores que influyen en la adherencia son el coste de los ACO, la falta de conocimientos ante los olvidos y la práctica de descansos de la píldora. CONCLUSIONES: El consejo contraceptivo debe ser individualizado, teniendo en cuenta los factores que afectan a la adherencia y el cumplimiento

AIM: To identify the factors related with the adherence and compliance of women that use the oral contraceptives (OC). METHODOLOGY: Literature review. A search in PubMed, CINAHL, Cochrane Library, MEDES, and ENFISPO databases has been performed in the last 10 years. RESULTS: A total number of 35 original articles and a review were selected. The factors which improve the compliance of OC are the knowledge of women about the pill, "the quick start" contraceptive method and the partner support. The highlighted factors which concern the adherence are the OC cost, the shortage of knowledge facing oversights and the resting periods of pill. CONCLUSIONS: The contraceptive counselling must be personalized considering the factors which concern the compliance and adherence

Efficacy of a videoconferencing intervention compared with standard postnatal care at primary care health centres in Catalonia.

OBJECTIVE: to evaluate the efficacy of an intervention combining videoconferencing and telephone contact compared to standard post partum care of recent mothers attending health centres in Catalonia were recorded. DESIGN: multicentre, randomised parallel controlled clinical trial. PARTICIPANTS AND SETTING: 1598 post partum women with Internet access attending eight 'Attention to Sexual and Reproductive Health' (Catalan acronym ASSIR) units at Primary Health Care centres, in Catalonia (Spain). INTERVENTION: at each of the eight ASSIR units, 100 women were randomly assigned to the intervention group (IG) and 100 to the control group (CG). Women in the IG could consult midwives by videoconference or telephone and could also receive standard care. Women in the control group received standard care from midwives at their health centres or at home. MEASURES: number and type of visits, reasons for consultation, type of feeding at six weeks and women's satisfaction with the intervention on a scale of 1 to 5. FINDINGS: 1401 women were studied (80.9% of the initial sample), 683 in the IG and 718 in the CG. Two hundred and seventy-six women (40.4%) used videoconferencing or telephone in the IG. The mean total visits, virtual and face-to-face, was higher in IG women than in controls (2.74 versus 1.22). IG women made fewer visits to the health centre (mean=1) than CG women (mean=1.17). Both differences were statistically significant, with p<0.001 and p=0.002 respectively. The prevalence of breast feeding was similar in the two groups (IG 64.5%, and CG 65.4%). The mean overall satisfaction of women with midwife care was very high in both groups (IG 4.77, CG 4.76). CONCLUSIONS AND IMPLICATIONS FOR THE PRACTICE: virtual care via videoconferencing is effective for post partum women. It reduces the number of health centre visits and allows mothers to consult health staff immediately and from their own home.

Mecánica de la succión: comparación entrela lactancia artificial y la lactancia materna / Mechanics of sucking: comparison between bottle feeding and breastfeeding

Introducción: Hay poco conocimiento sobre la similitud de la mecánicaentre la lactancia materna y la artificial. Evaluamos la mecánica dela succión en neonatos con lactancia materna exclusiva, lactancia artificialexclusiva y lactancia mixta. Nuestra hipótesis fue que el patrón fisiológicode los movimientos de succión varía según el tipo de alimentación.Según esta hipótesis, los niños con lactancia materna exclusivarealizan unos movimientos al mamar distintos a los de la succión deuna tetina, realizados por niños con lactancia artificial. Los niños conlactancia mixta mezclan ambos tipos de movimientos de succión.Métodos: Estudio transversal de neonatos de 21-28 días de edad conlactancia materna o artificial exclusiva (124 parejas madre-hijo), y ensayode campo, abierto, cruzado y aleatorizado, realizado en neonatosde 21-28 días (110 parejas madre-hijo) y en lactantes de 3-5 meses deedad (125 parejas madre-hijo) con lactancia mixta. Las variables principalesfueron los movimientos de succión y las pausas.Resultados: Los neonatos de 21-28 días de edad alimentados conlactancia artificial exclusiva mostraron un menor número de movimientosde succión y el mismo número de pausas, pero de mayor duración,que los neonatos con lactancia materna exclusiva. Entre los niños querecibieron lactancia mixta, el número de movimientos de succión al recibiralimentación con biberón fue similar y las pausas menos numerosasy de menor duración respecto a lo observado al amamantar, tanto a (..) (AU)

Background: There is very little evidence of the similarity of the mechanicsof maternal and bottle feeding. We assessed the mechanics ofsucking in exclusive breastfeeding, exclusive bottle feeding, and mixedfeeding. The hypothesis established was that physiological pattern forsuckling movements differ depending on the type of feeding. Accordingto this hypothesis, babies with breastfeeding have suckling movementsat the breast that are different from the movements of suckling a teat ofbabies fed with bottle. Children with mixed feeding mix both types ofsuckling movements.Methods: Cross-sectional study of infants aged 21-28 days with onlymaternal feeding or bottle feeding (234 mother-infant pairs), and a randomizedopen cross-over field trial in newborns aged 21-28 days andbabies aged 3-5 months with mixed feeding (125 mother-infant pairs).Primary outcome measures were sucks and pauses.Results: Infants aged 21-28 days exclusively bottle-fed showed fewersucks and the same number of pauses but of longer duration comparedto breastfeeding. In mixed feeding, bottle feeding compared to breastfeedingshowed the same number of sucks but fewer and shorter pauses,both at 21-28 days and at 3-5 months. The mean number of breastfeedingsin a day (in the mixed feed group) was 5.83 ± 1.93 at 21-28 daysand 4.42 ± 1.67 at 3-5 months. In the equivalence analysis of the mixed (..) (AU)

Mechanics of sucking: comparison between bottle feeding and breastfeeding.

BACKGROUND: There is very little evidence of the similarity of the mechanics of maternal and bottle feeding. We assessed the mechanics of sucking in exclusive breastfeeding, exclusive bottle feeding, and mixed feeding. The hypothesis established was that physiological pattern for suckling movements differ depending on the type of feeding. According to this hypothesis, babies with breastfeeding have suckling movements at the breast that are different from the movements of suckling a teat of babies fed with bottle. Children with mixed feeding mix both types of suckling movements. METHODS: Cross-sectional study of infants aged 21-28 days with only maternal feeding or bottle feeding (234 mother-infant pairs), and a randomized open cross-over field trial in newborns aged 21-28 days and babies aged 3-5 months with mixed feeding (125 mother-infant pairs). Primary outcome measures were sucks and pauses. RESULTS: Infants aged 21-28 days exclusively bottle-fed showed fewer sucks and the same number of pauses but of longer duration compared to breastfeeding. In mixed feeding, bottle feeding compared to breastfeeding showed the same number of sucks but fewer and shorter pauses, both at 21-28 days and at 3-5 months. The mean number of breastfeedings in a day (in the mixed feed group) was 5.83 +/- 1.93 at 21-28 days and 4.42 +/- 1.67 at 3-5 months. In the equivalence analysis of the mixed feed group, the 95% confidence interval for bottle feeding/breastfeeding ratio laid outside the range of equivalence, indicating 5.9-8.7% fewer suction movements, and fewer pauses, and shorter duration of them in bottle feeding compared with breastfeeding. CONCLUSIONS: The mechanics of sucking in mixed feeding lay outside the range of equivalence comparing bottle feeding with breastfeeding, although differences were small. Children with mixed feeding would mix both types of sucking movements (breastfeeding and bottle feeding) during the learning stage and adopt their own pattern.

El programa de formación de matronas / No disponible

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Fin de curso / No disponible

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Manejo activo del alumbramiento y legislación / No disponible

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Inserción laboral de las matronas graduadas entre los años 2001 y 2005 / Integration into the workforce of midwives graduated between 2001 and 2005

Objetivo: Conocer las características de la inserción laboral de las matronas que se graduaron entre los años 2001 y 2005. Personas y método: Estudio observacional, descriptivo y transversal. Se estudiaron todas las matronas que se graduaron en España entre los años 2001 y 2005, en 18 Unidades Docentes de Matronas pertenecientes a 15 Comunidades Autónomas. Se utilizó un cuestionario elaborado por el equipo investigador que se envió por correo postal o electrónico. Resultados: Se recibieron 328 cuestionarios cumplimentados, un 44,14% de los enviados. Todas las matronas que respondieron habían trabajado como matrona, y el 89,3% (293) consiguió trabajo en menos de un mes. Tenía un contrato fijo el 12,2% (38), lo tenía interino el 43,9% (136), y el resto tenía un contrato eventual. El 84,8 (263) desarrollaba su actividad asistencial en el hospital. Un 24,2% (74) estaba en situación de pluriempleo. El 5,4% (18) no trabajaban como matronas. El número de matronas que estaba trabajando en la misma CC.AA. que se había formado era inferior al 50% de las matronas formadas en Canarias, Castilla-La Mancha, Cataluña, Galicia y País Vasco. Conclusiones: La inserción laboral se realiza rápidamente y la situación de pluriempleo es alta, lo que indica escasez de profesionales. La mayoría de las matronas desarrolla su actividad asistencial en hospitales. Hay unidades que forman a más matronas procedentes de otra comunidad que de la propia, como consecuencia de esto son menos las matronas que trabajan en estas comunidades que las que se formaron en ellas (AU)

Objective: To characterize the integration into the workforce of midwives graduated between 2001 and 2005. Participants and method: A descriptive, observational, cross-sectional study was performed. It included all the midwives who graduated from 18 Midwifery Teaching Units in 15 Spanish autonomous communities from 2001 to 2005. A questionnaire prepared by the research team and distributed by postal or electronic mail was employed. Results: We received 328 completed questionnaires, 44.14% of those sent out. All the responders had worked as a midwife and 89.3% (293) had found work within less than a month. Thirty-eight (12.2%) had found permanent jobs, while 136 (43.9%) had substitute positions and the remainder had temporary jobs. In all, 84.8% (n=263) were working in a hospital. Seventy-four (24.2%) held more than one job. Eighteen (5.4%) were not working as midwives. The number of midwives who were working in the same autonomous community in which they had received their training was less. Than 50% among those who had studied in the communities of Canary Islands, Castilla La Mancha, Catalonia, Galicia and the Basque Country. Conclusions: Midwives are integrated rapidly into the workforce and many work in more than one place, an indication of the shortage of these professionals. Most of the midwives work in hospitals. There are units that train more midwives from outside their community. Consequently, the number of midwives working in these communities is lower than the number who studied midwifery there (AU)

Centro de nacimientos / No disponible

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