Translating and Validating the Vietnamese Version of the Health Sciences Evidence-Based Practice Questionnaire.

No validated instrument is available for assessing the evidence-based practice capacity of Vietnamese health professionals. This study aimed to translate and validate the Health Sciences Evidence-Based Practice questionnaire (HS-EBP) from English to Vietnamese and ascertain its psychometric properties. Data were collected from two obstetric hospitals in Vietnam. Participants: A total of 343 midwives were randomly selected. The HS-EBP questionnaire was translated by a group of bilingual experts into Vietnamese (HS-EBP-V). Content validity was assessed by two experts. Internal consistency and test-retest reliabilities were assessed using Cronbach's α and intraclass correlation (ICC), respectively. Construct validity was assessed using the contrasted groups approach. As a result, the content validity index of the HS-EBP-V reached 1.0. For the individual subscales, Cronbach's α was 0.92-0.97 and ICC was between 0.45 and 0.66. The validity of the contrasted-groups approach showed discrimination by a significant difference in the subscale scores among diploma holders compared with bachelor's degree holders (p < 0.001). The validation of the HS-EBP questionnaire indicated satisfactory psychometric properties. The results indicate that the HS-EBP is a reliable and valid instrument which assesses the competencies of as well as facilitators of and barriers to the five steps of EBP among midwives. The HS-EBP-V was deemed a reliable and validated tool for assessing the competency and application of EBP among Vietnamese healthcare professionals.

'We felt like part of a production system': A qualitative study on women's experiences of mistreatment during childbirth in Switzerland.

INTRODUCTION: Mistreatment during childbirth is an issue of global magnitude that not only violates fundamental human rights but also seriously impacts women's well-being. The purpose of this study was to gain a better understanding of the phenomenon by exploring the individual experiences of women who reported mistreatment during childbirth in Switzerland. MATERIALS AND METHODS: This project used a mixed methods approach to investigate women's experiences of mistreatment during childbirth in general and informal coercion specifically: The present qualitative study expands on the findings from a nationwide online survey on childbirth experience. It combines inductive with theoretical thematic analysis to study the 7,753 comments women wrote in the survey and the subsequent interviews with 11 women who reported being mistreated during childbirth. RESULTS: The women described a wide range of experiences of mistreatment during childbirth in both the survey comments and the interviews. Out of all survey participants who wrote at least one comment (n = 3,547), 28% described one or more experiences of mistreatment. Six of the seven types of mistreatment listed in Bohren and colleagues' typology of mistreatment during childbirth were found, the most frequent of which were ineffective communication and lack of informed consent. Five additional themes were identified in the interviews: Informal coercion, risk factors for mistreatment, consequences of mistreatment, examples of good care, and what's needed to improve maternity care. CONCLUSION: The findings from this study show that experiences of mistreatment are a reality in Swiss maternity care and give insight into women's individual experiences as well as how these affect them during and after childbirth. This study emphasises the need to respect women's autonomy in order to prevent mistreatment and empower women to actively participate in decisions. Both individual and systemic efforts are required to prevent mistreatment and guarantee respectful, dignified, and high-quality maternity care for all.

Induction of labour: creation of a classification of Grenoble allowing an assessment of the evaluation of practices.

BACKGROUND: Induction of labour, a very common obstetric procedure, affects about one in five pregnant women in most developed countries. Induction of labour is medically indicated, is subject to risks and additional costs, and is often poorly experienced by patients. The practices concerning induction vary widely from centre to centre and therefore need to be evaluated. Our aim was to develop a tool for evaluating induction of labour which would facilitate geographical and temporal comparisons. METHODS: We have created a classification based on the principles of the internationally known Robson classification. It should be simple, robust, reproducible and require readily available data in each file. The groups are fully inclusive and mutually exclusive. This classification has been validated by a Delphi method. RESULTS: Our classification includes 8 clinically relevant groups according to 5 obstetrical criteria. In order to classify each patient into a group, a simple system based on a maximum of 7 successive questions (from 1 to 7 questions) is used. Our classification has been validated by 13 national experts with satisfactory overall approval. CONCLUSIONS: With a view to improving the quality of care, our Grenoble classification would allow a standardization of the evaluation of practices of the induction of labour over time in the same maternity hospital. It would also allow the comparison of practices within different maternity hospitals in a network, a country or even different countries.

Coexistence and prevalence of obstetric interventions: an analysis based on the grade of membership.

BACKGROUND: Obstetric interventions performed during delivery do not reflect improvements in obstetric care. Several practices routinely performed during childbirth, without any scientific evidence or basis - such as Kristeller maneuver, routine episiotomy, and movement or feeding restriction - reflect a disrespectful assistance reality that, unfortunately, remains in place in Brazil. The aims of the current study are to assess the coexistence and prevalence of obstetric interventions in maternity hospitals in Belo Horizonte City, based on the Grade of Membership (GoM) method, as well as to investigate sociodemographic and obstetric factors associated with coexistence profiles generated by it. METHODS: Observational study, based on a cross-sectional design, carried out with data deriving from the study "Nascer em Belo Horizonte: Inquérito sobre o Parto e Nascimento" (Born in Belo Horizonte: Survey on Childbirth and Birth). The herein investigated interventions comprised practices that are clearly useful and should be encouraged; practices that are clearly harmful or ineffective and should be eliminated; and practices that are inappropriately used, in contrast to the ones recommended by the World Health Organization. The analyzed interventions comprised: providing food to parturient women, allowing them to have freedom to move, use of partogram, adopting non-pharmacological methods for pain relief, enema, perineal shaving, lying patients down for delivery, Kristeller maneuver, amniotomy, oxytocin infusion, analgesia and episiotomy. The current study has used GoM to identify the coexistence of the adopted obstetric interventions. Variables such as age, schooling, skin color, primigravida, place-of-delivery financing, number of prenatal consultations, gestational age at delivery, presence of obstetric nurse at delivery time, paid work and presence of companion during delivery were taken into consideration at the time to build patients' profile. RESULTS: Results have highlighted two antagonistic obstetric profiles, namely: profile 1 comprised parturient women who were offered diet, freedom to move, use of partogram, using non-pharmacological methods for pain relief, giving birth in lying position, patients who were not subjected to Kristeller maneuver, episiotomy or amniotomy, women did not receive oxytocin infusion, and analgesia using. Profile 2, in its turn, comprised parturient women who were not offered diet, who were not allowed to have freedom to move, as well as who did not use the partograph or who were subjected to non-pharmacological methods for pain relief. They were subjected to enema, perineal shaving, Kristeller maneuver, amniotomy and oxytocin infusion. In addition, they underwent analgesia and episiotomy. This outcome emphasizes the persistence of an obstetric care model that is not based on scientific evidence. Based on the analysis of factors that influenced the coexistence of obstetric interventions, the presence of obstetric nurses in the healthcare practice has reduced the likelihood of parturient women to belong to profile 2. In addition, childbirth events that took place in public institutions have reduced the likelihood of parturient women to belong to profile 2. CONCLUSION(S): Based on the analysis of factors that influenced the coexistence of obstetric interventions, financing the hospital for childbirth has increased the likelihood of parturient women to belong to profile 2. However, the likelihood of parturient women to belong to profile 2 has decreased when hospitals had an active obstetric nurse at the delivery room. The current study has contributed to discussions about obstetric interventions, as well as to improve childbirth assistance models. In addition, it has emphasized the need of developing strategies focused on adherence to, and implementation of, assistance models based on scientific evidence.

5/8 - Palestra: Maternidade e COVID-19: o que dizem os protocolos nacionais?

Palestra que integra os eventos alusivos à Semana Mundial do Aleitamento Materno 2020. Eventos: XII SEMINÁRIO ESTADUAL DA SEMANA MUNDIAL DE AMAMENTAÇÃO VII SEMINÁRIO ESTADUAL DA ESTRATÉGIA AMAMENTA E ALIMENTA BRASIL Palestrante: Enfermeira, Dra. Virgínia Moretto

Evaluation of cytopathological screening results and risk factors of women who underwent Papanicolaou test in a maternity school in Fortaleza, Ceará, Brazil.

INTRODUCTION: Papanicolaou test (Pap smear) is the standard screening test of pre-neoplastic lesions and cervical cancer. This study aimed to investigate cervical cancer screening results and risk factors such as age, reason for the examination, the epithelia detected in the sample, microbiota and signs of sexually transmitted infection (STIs) of women in a maternity school in Fortaleza, Ceará, Brazil. METHODS: In this cross-sectional study, data were retrieved of 353 women who underwent Pap smear between April 2016 and January 2017 at the Federal University of Ceará. RESULTS: Of all Pap smear samples retrieved, 54.1% (191/353) had glandular epithelium and 40.2% (142/353) had metaplastic epithelium. After statistical analyses adjusted for the final model, age ≥51 years (odds ratio = 3.47) and signs of STIs (odds ratio = 4.95) remained as risk factors. CONCLUSIONS: The diagnosis of high-grade lesions and carcinomas in patients older than 50 years indicates a deficiency in cervical screening. Women with signs and symptoms of STIs and candidiasis sought medical services more frequently than asymptomatic women, and presence of these signs and symptoms contributes to the diagnosis of cervical cancer. We highlight the importance of obtaining a correct smear sampling to allow prompt detection of all preneoplastic lesions; moreover, the implementation of human papillomavirus vaccination and an efficient routine Pap screening are necessary in low-resource settings.

Pregnancy outcomes in facility deliveries in Kenya and Uganda: A large cross-sectional analysis of maternity registers illuminating opportunities for mortality prevention.

INTRODUCTION: As facility-based deliveries increase globally, maternity registers offer a promising way of documenting pregnancy outcomes and understanding opportunities for perinatal mortality prevention. This study aims to contribute to global quality improvement efforts by characterizing facility-based pregnancy outcomes in Kenya and Uganda including maternal, neonatal, and fetal outcomes at the time of delivery and neonatal discharge outcomes using strengthened maternity registers. METHODS: Cross sectional data were collected from strengthened maternity registers at 23 facilities over 18 months. Data strengthening efforts included provision of supplies, training on standard indicator definitions, and monthly feedback on completeness. Pregnancy outcomes were classified as live births, early stillbirths, late stillbirths, or spontaneous abortions according to birth weight or gestational age. Discharge outcomes were assessed for all live births. Outcomes were assessed by country and by infant, maternal, and facility characteristics. Maternal mortality was also examined. RESULTS: Among 50,981 deliveries, 91.3% were live born and, of those, 1.6% died before discharge. An additional 0.5% of deliveries were early stillbirths, 3.6% late stillbirths, and 4.7% spontaneous abortions. There were 64 documented maternal deaths (0.1%). Preterm and low birthweight infants represented a disproportionate number of stillbirths and pre-discharge deaths, yet very few were born at ≤1500g or <28w. More pre-discharge deaths and stillbirths occurred after maternal referral and with cesarean section. Half of maternal deaths occurred in women who had undergone cesarean section. CONCLUSION: Maternity registers are a valuable data source for understanding pregnancy outcomes including those mothers and infants at highest risk of perinatal mortality. Strengthened register data in Kenya and Uganda highlight the need for renewed focus on improving care of preterm and low birthweight infants and expanding access to emergency obstetric care. Registers also permit enumeration of pregnancy loss <28 weeks. Documenting these earlier losses is an important step towards further mortality reduction for the most vulnerable infants.

Birthing outside the system: the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia.

BACKGROUND: Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system - that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional. METHOD: This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time. RESULTS: The core category was 'wanting the best and safest,' which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was 'finding a better way'. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies. CONCLUSION: Shortfalls in the Australian maternity care system is the major contributing factor to women's choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk.

COVID-19 Obstetrics Task Force, Lombardy, Italy: Executive management summary and short report of outcome.

From February 24, 2020, a COVID-19 obstetric task force was structured to deliver management recommendations for obstetric care. From March 1, 2020, six COVID-19 hubs and their spokes were designated. An interim analysis of cases occurring in or transferred to these hubs was performed on March 20, 2020 and recommendations were released on March 24, 2020. The vision of this strict organization was to centralize patients in high-risk maternity centers in order to concentrate human resources and personal protective equipment (PPE), dedicate protected areas of these major hospitals, and centralize clinical multidisciplinary experience with this disease. All maternity hospitals were informed to provide a protected labor and delivery room for nontransferable patients in advanced labor. A pre-triage based on temperature and 14 other items was developed in order to screen suspected patients in all hospitals to be tested with nasopharyngeal swabs. Obstetric outpatient facilities were instructed to maintain scheduled pregnancy screening as per Italian guidelines, and to provide pre-triage screening and surgical masks for personnel and patients for pre-triage-negative patients. Forty-two cases were recorded in the first 20 days of hub and spoke organization. The clinical presentation was interstitial pneumonia in 20 women. Of these, seven required respiratory support and eventually recovered. Two premature labors occurred.

Structure and practices in hospitals of the Apice ON Project: a baseline study.

OBJECTIVE: To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON-Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS: The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC-Live Birth Information System). RESULTS: Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION: The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.

Interventions to improve wellbeing among obstetricians and midwives at Cork University Maternity Hospital.

BACKGROUND: There is an increasing body of research demonstrating stress, burnout, and compassion fatigue among those working in obstetrics and gynaecology. The literature is lacking with respect to targeted interventions aimed at improving staff wellbeing. AIMS: To investigate whether an intervention which increases support for staff is feasible to implement and effective at improving staff wellbeing. METHODS: This study was conducted in a tertiary university teaching maternity hospital. All doctors in training (DITs) (N = 28) and midwives (N = 69) working in the delivery suite were invited to participate. Wellbeing was assessed by measuring burnout, compassion fatigue, and perceived stress using validated questionnaires. These were distributed pre-intervention and 6 months after implementation of the interventions. The support interventions consisted of posters promoting self-care, team bonding sessions, and end of shift meetings. RESULTS: Eighteen (64%) DITs and 22 (31%) midwives returned pre-intervention questionnaires. Thirteen (18%) midwives retuned post-intervention questionnaires, of which five midwives (7%) returned both the pre-intervention questionnaire and the post-intervention questionnaire. Eighty-seven percent of participants were experiencing emotional exhaustion pre-intervention. There was a statistically significant decrease in the Professional Quality of Life burnout score from pre-intervention (M = 25.8) to post-intervention (M = 21.4), p = 0.02. End of shift meetings were discontinued after 5 weeks due to low attendance. End of shift meetings provided an opportunity for support and debriefing; however, the timing of these sessions impaired their long-term feasibility. CONCLUSION: DITs and midwives of this sample are experiencing high levels of burnout and compassion fatigue. End of shift meetings for midwives and team bonding sessions for DITs may positively impact on wellbeing, but in current format, they are not feasible for long-term implementation. The low level of participation highlights a challenge in implementing institution-wide support interventions.

Structure and practices in hospitals of the apice ON project: a baseline study / Estrutura e práticas de hospitais integrantes do projeto apice ON: estudo de linha de base

ABSTRACT OBJECTIVE To describe some characteristics of the 97 teaching hospitals participating in the Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON—Project for Improvement and Innovation in Care and Teaching in Obstetrics and Neonatology). METHODS The semester prior to the beginning of the program was adopted as the baseline to evaluate the subsequent structural and processes changes of this project. Secondary data from the first half of 2017 were extracted from the National Registry of Health Establishments (NRHE), the Hospital Information System and the Sistema de Informações sobre Nascidos Vivos (SINASC—Live Birth Information System). RESULTS Before the implementation of the project, only 66% of the hospitals had a Baby-friendly Hospital Initiative, only 3% offered special accommodations for high-risk pregnant women, mothers and their newborns, and 45.4% hospitals adopted the skin-to-skin contact; 97% hospitals had separate rooms for pre-labor and vaginal delivery (93%), not following the recommendations of the Ministry of Health; nine hospitals (9%) had no rooming-in; there were few obstetrics nurses (less than 1% of professionals enrolled in the NRHE), and in only six hospitals the proportion of births assisted by this professional was above 50% of vaginal deliveries, while in eight this percentage ranged between 15% and 50%; the average cesarean section rate was 42%, ranging between 37.6% (Southeast) and 49.1% (Northeast); ten hospitals did not charge for companions according to inpatient hospital authorization. CONCLUSION The study strengthens the relevance of the Apice ON project as an inducer of change of the care model in teaching hospitals and, therefore, as a strategy for the implementation of the national public policy represented by the Stork Network.

RESUMO OBJETIVO Este artigo descreve algumas características dos 97 hospitais de ensino participantes do Projeto de Aprimoramento e Inovação no Cuidado e Ensino em Obstetrícia e Neonatologia (Apice ON). MÉTODOS Foi adotado como linha de base o semestre anterior ao lançamento do programa, para permitir avaliar as mudanças estruturais e processuais decorrentes desse projeto. Utilizaram-se dados secundários referentes ao primeiro semestre de 2017 disponíveis no Cadastro Nacional de Estabelecimentos de Saúde (CNES), no Sistema de Informações Hospitalares e no Sistema de Informações sobre Nascidos Vivos. RESULTADOS Antes da implantação do projeto, apenas 66% dos hospitais apresentaram habilitação de Hospital Amigo da Criança, somente 3% estavam habilitados com Casa da gestante, Bebê e Puérpera e 45,4% adotavam o método canguru; 97% dispunham de sala de pré-parto e 93% de sala de parto normal separadas, sem seguir o preconizado pelo Ministério da Saúde; nove hospitais (9%) não tinham alojamento conjunto; havia poucos enfermeiros obstetras (menos de 1% dos profissionais cadastrados no CNES), e em apenas seis hospitais a proporção de partos assistidos por esse profissional foi superior a 50% dos partos vaginais, enquanto em oito hospitais esta proporção ficou entre 15 e 50%; a taxa média de cesáreas foi de 42%, variando entre 37,6% (Sudeste) e 49,1% (Nordeste); em dez dos hospitais não constava cobrança de diária de acompanhante na autorização de internação hospitalar. CONCLUSÃO O estudo fortalece a pertinência do projeto Apice ON como indutor de mudança do modelo nos hospitais de ensino e, portanto, como estratégico para a efetivação da política pública nacional representada pela Rede Cegonha.

A Systematic Evaluation of Hospital Performance of Childbirth Delivery Modes and Associated Factors in the Friuli Venezia Giulia Region (North-Eastern Italy), 2005-2015.

Cesarean sections (CS) have become increasingly common in both developed and developing countries, raising legitimate concerns regarding their appropriateness. Since improvement of obstetric care at the hospital level needs quantitative evidence, using routinely collected health data we contrasted the performance of the 11 maternity centres (coded with an alphabetic letter A to L) of an Italian region, Friuli Venezia Giulia (FVG), during 2005-15, after removing the effect of several factors associated with different delivery modes (DM): spontaneous vaginal delivery (SVD), instrumental vaginal delivery (IVD), overall CS (OCS) and urgent/emergency CS (UCS). A multivariable logistic regression model was fitted for each individual DM, using a dichotomous outcome (1 = each DM; 0 = rest of hospital births) and comparing the stratum specific estimates of every term with their respective reference categories. Results were expressed as odds ratios (OR) with 95% confidence intervals (95%CI). The Benjamini-Hochberg (BH) false discovery rates (FDR) approach was applied to control alpha error due to the large number of statistical tests performed. In the entire FVG region during 2005-2015, SVD were 75,497 (69.1% out of all births), IVD were 7,281 (6.7%), OCS were 26,467 (24.2%) and UCS were 14,106 (12.9% of all births and 53.3% out of all CS). SVD were more likely (in descending order of statistical significance) with: higher number of previous livebirths; clerk/employed occupational status of the mother; gestational age <29 weeks; placentas weighing <500 g; stillbirth; premature rupture of membranes (PROM). IVD were predominantly more likely (in descending order of statistical significance) with: obstructed labour, non-reassuring fetal status, history of CS, labour analgesia, maternal age ≥35 and gestation >40 weeks. The principal factors associated with OCS were (in descending order of statistical significance): CS history, breech presentation, non-reassuring fetal status, obstructed labour, multiple birth, placental weight ≥ 600 g, eclampsia/pre-eclampsia, maternal age ≥ 35 and oligohydramnios. The most important risk factors for UCS were (in descending order of statistical significance): placenta previa/abruptio placenta/ antepartum hemorrage; non-reassuring fetal status, obstructed labour; breech presentation; PROM, eclampsia/pre-eclampsia; gestation 33-36 weeks; gestation 41+ weeks; oligohydramnios; birthweight <2,500 g, maternal age ≥ 35 and cord prolapse. After removing the effects of all other factors, we found great variability of DM rates across hospitals. Adjusting for all risk factors, all hospitals had a OCS risk higher than the referent (hospital G). Out of these 10 hospitals with increased adjusted risk of OCS, 9 (A, B, C, D, E, F, I, J, K) performed less SVD and 5 (A, C, D, I, J) less IVD. In the above 5 centres CS was therefore probably overused. The present study shows that routinely collected administrative data provide useful information for health planning and monitoring. Although the overall CS rate in FVG during 2005-15 was 24.2%, well below the corresponding average Italian national figure (38.1%), the variability of DM rates across FVG maternity centres could be targeted by policy interventions aimed at reducing the recourse to unnecessary CS. In some clinical conditions such as obstructed labor, non-reassuring fetal status, breech presentation, history of CS, higher maternal age and multiple birth, consideration may be given to more conservative DM. The overuse of CS in nulliparas and repeat CS (RCS) should be carefully monitored and subject to audit.

[Evaluation of good practices about breastfeeding in a mother and child hospital.] / Evaluación de buenas prácticas en lactancia materna en un hospital materno infantil.

OBJECTIVE: Protection, promotion and support to the breastfeeding is considered as an area of priority in public health care and as a determining factor of child and maternal health. The use of good practice guides improves health outcomes and patients safety. The aim of study was to assess the impact on breastfeeding of a Guide of Good Clinic Practices about breastfeeding in the Mother and Child Center of the Virgen de las Nieves University Hospital in Granada. METHODS: Cross-sectional descriptive study. Mothers and newborns attended from 2015 to 2018 were studied. Process and outcome variables were considered to perform a descriptive and bivariate analysis for the comparison between years. RESULTS: The rate of exclusive breastfeeding at discharge went from 58.3% to 72.2%. Significant differences were found for the first intake of exclusive breastfeeding in eutocic births and in C-sections, from 90.8% to 93.2% in the first and from 21.7% to 60% in the second. Improvements were detected in the assessment of intake, postnatal education and onset and duration of skin-to-skin contact. CONCLUSIONS: Postnatal protocolized actions carried out by health professionals, such as the assessment of the intake of breastfeeding and postnatal education, were effective for the establishment of breastfeeding. The first moment of skin-to-skin contact and its duration are aspects to be reinforced for effective support.

OBJETIVO: La protección, promoción y apoyo a la lactancia materna (LM) está considerada como un área de atención prioritaria de salud pública, así como un factor determinante de la salud infantil y materna. La utilización de guías de buenas prácticas mejora los resultados de salud y la seguridad de los pacientes. El objetivo del estudio fue evaluar el impacto en la lactancia materna tras la implantación de la Guía de Buenas Prácticas Clínicas "Lactancia Materna" en el centro Materno Infantil del Hospital Universitario Virgen de las Nieves de Granada. METODOS: Se realizó un estudio descriptivo transversal. Se estudiaron madres y recién nacidos atendidos desde 2015 a 2018. Se examinaron variables de proceso y de resultados, realizando análisis descriptivo y bivariante para la comparativa entre años. RESULTADOS: La tasa de LM exclusiva al alta pasó del 58,3 % al 72,2 %. Se encontraron diferencias significativas para la primera toma de LM exclusiva en los partos eutócicos (del 90,8% al 93,2%) y en las cesáreas (del 21,7% al 60%). Se obtuvieron mejoras en la valoración de la toma, la educación postnatal y el inicio y duración del contacto piel con piel. CONCLUSIONES: Las acciones protocolizadas posnatales que realizan los profesionales de la salud, como la valoración de la toma de LM y la educación postnatal, resultan eficaces para instaurar la lactancia. El momento de inicio del contacto piel con piel y su duración son aspectos que deben ser reforzados para un apoyo efectivo.

Feasibility of Standardized Human Milk Collection in Neonatal Care Units.

Research in human lactation is a growing field. However, difficulties in studying human milk originate from the dynamicity of its composition. Using standardized collection protocols is mandatory to minimize variation and warrant comparability of findings across different studies. Yet, information on the feasibility of collecting human milk with standardized procedures, especially in neonatal units, are lacking. The present study aims to report on the feasibility and difficulties to collect human milk according to a standardized protocol, during early lactation from women who gave birth to preterm infants. Human milk was collected from 129 mothers of moderate- to late-preterm infants according to two variations of a standard protocol which differed for number of collection time-points. Collection rates and adherence to the sampling protocol were evaluated together with reason for missed collection. Collection of ≥1 sample was successful for 80% of the mothers. However adherence to the standard protocol was overall low (36% and 27%). Collection rates were different between the two protocol variations (73% against 92%, p ≤ 0.001). Amongst the reason for missed collection, low milk supply was the most recurrent (40%). Our findings show that while collecting human milk in neonatal units is achievable, obtaining standard and comparable samples results challenging.

Quality of the Clinical Maternal and Neonatal Healthcare Assessment in a Tertiary Public Maternity Hospital in R. Macedonia.

INTRODUCTION: Maternal and neonatal infections can be prevented, but they are still common in low and middle-developed countries. There is a connection between childbirth on one hand and postpartum and newborn care on the other. Globally, several efforts are being made to improve quality of childbirth by providing initial assessment of procedures, risk prevention and continuous monitoring of childbirth process and possible complications. The World Health Organization has developed Checklists for Safe Delivery with procedures to be implemented as routine care, in order to promptly detect and manage complications related to childbirth. MATERIAL AND METHODS: A retrospective study was conducted in the University Clinic of Gynecology and Obstetrics in Skopje, a maternity hospital in R. Macedonia from the tertiary level of the public health care system. In this study 300 obstetric and 307 neonatal histories from childbirths in February and March 2018 have been analyzed. The collected data refers to the care of the prepartum, intrapartum, early postpartum and early neonatal periods. RESULTS: An initial assessment at admission proved that 14.7% of pregnant women had existing infection, in 93% of them the body temperature was measured and in only 9.3% urine analysis was made, 10.3% of the women had arterial hypertension, and 66.5% of them with hypertension had a headache. In the continuous monitoring and prevention of potential risk, arterial tension was measured in 33% of all mothers. In all women the placenta quality was checked up, as well as vaginal bleeding, application of oxytocin and hemoglobin level before discharge. CONCLUSION: The quality and quantity of documented data in the maternity hospital medical histories is high. There were no standard protocols for assessment of pregnant women. Certain procedures are conducted in every woman during childbirth. Standardized procedures are needed to be applied during every childbirth.

Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care.

BACKGROUND: Healthcare providers are the vital link between evidence-based policies and women receiving high quality maternity care. Explanations for suboptimal care often include poor working conditions for staff and a lack of essential supplies. Other explanations suggest that doctors, midwives and care assistants might lack essential skills or be unaware of the rights of the women for whom they care. This ethnography examined the everyday lives of maternal healthcare providers working in a tertiary maternity hospital in Kabul, Afghanistan between 2010 and 2012. The aim was to understand their notions of care, varying levels of commitment, and the obstacles and dilemmas that affected standards. METHODS: The culture of care was explored through six weeks of observation, 41 background interviews, 23 semi-structured interviews with doctors, midwives and care assistants. Focus groups were held with two diverse groups of women in community settings to understand their experiences and desires regarding care in maternity hospitals. Data were analysed thematically. RESULTS: Women related many instances of neglect, verbal abuse and demands for bribes from staff. Doctors and midwives concurred that they did not provide care as they had been taught and blamed the workload, lack of a shift system, insufficient supplies and inadequate support from management. Closer inspection revealed a complex reality where care was impeded by low levels of supplies and medicines but theft reduced them further; where staff were unfairly blamed by management but others flouted rules with impunity; and where motivated staff tried hard to work well but, when overwhelmed with the workload, admitted that they lost patience and shouted at women in childbirth. In addition there were extreme examples of both abusive and vulnerable staff. CONCLUSIONS: Providing respectful quality maternity care for women in Afghanistan requires multifaceted initiatives because the factors leading to suboptimal care or mistreatment are complex and interrelated. Standards need enforcing and abusive practices confronting to provide a supportive, facilitating environment for both staff and childbearing women. Polarized perspectives such as 'villain' or 'victim' are unhelpful as they exclude the complex realities of human behaviour and consequently limit the scope of problem solving.

Psychometric properties of the hospital birth satisfaction scale: Birth in Brazil survey.

The objective of this study was to analyze the psychometric properties of the hospital birth satisfaction scale with data from the first follow-up interview of the Birth in Brazil survey. The 11 questions of the scale were asked by telephone up to six months after discharge in a stratified random sample of 16,109 women residing in all five regions of the country. The sample was randomly divided into two halves. Exploratory factor analysis (EFA) was applied to the first half in order to identify the scale's factorial structure. The scree plot suggested the scale to be one-dimensional. The EFA demonstrated a good fit of the one-dimensional model. Factor loadings were greater than 0.5 for all items, except for the mean time transpired between leaving the home and arriving at the maternity hospital, which was excluded from the next analysis. The confirmatory factor analysis applied to the sample's second half with the remaining ten items had a good fit and the factor loadings were > 0.50 with p-values < 0.001. The associations between birth satisfaction and the external variables, the mother's education level (standardized coefficient = 0.073; p = 0.035), private insurance (SC = 0.183; p < 0.001) and having a companion at some point during the hospitalization for labor (SC = 0.193; p = 0.001) were all as expected. There was evidence of configural and metric invariance according to type of hospital (private or public) and type of delivery (cesarean or vaginal). These results showed that the hospital birth satisfaction scale in Brazil is a one-dimensional instrument composed of ten items.

Accuracy of patient perceptions of maternity facility quality and the choice of providers in Nairobi, Kenya: a cohort study.

OBJECTIVES: This study aimed to assess the accuracy of pregnant women's perceptions of maternity facility quality and the association between perception accuracy and the quality of facility chosen for delivery. DESIGN: A cohort study. SETTING: Nairobi, Kenya. PARTICIPANTS: 180 women, surveyed during pregnancy and 2 to 4 weeks after delivery. PRIMARY OUTCOME MEASURES: Women were surveyed during pregnancy regarding their perceptions of the quality of all facilities they were considering during delivery and then, after delivery, about their ultimate facility choice. Perceptions of quality were based on perceived ability to handle emergencies and complications. Delivery facilities were assigned a quality index score based on a direct assessment of performance of emergency 'signal functions', skilled provider availability, medical equipment and drug stocks. 'Accurate perceptions' was a binary variable equal to one if a woman's ranking of facilities based on her quality perception equalled the index ranking. Ordinary least squares and logistic regressions were used to analyse associations between accurate perceptions and quality of the facility chosen for delivery. RESULTS: Assessed technical quality was modest, with an average index score of 0.65. 44% of women had accurate perceptions of quality ranking. Accurate perceptions were associated with a 0.069 higher delivery facility quality score (p=0.039; 95% CI: 0.004 to 0.135) and with a 14.5% point higher probability of delivering in a facility in the top quartile of the quality index (p=0.015; 95% CI: 0.029 to 0.260). CONCLUSIONS: Patient misperceptions of technical quality were associated with use of lower quality facilities. Larger studies could determine whether improving patient information about relative facility quality can encourage use of higher quality care.