Neonatal Outcomes After Delivery in Water.

OBJECTIVE: To assess neonatal intensive care unit (NICU) admissions and neonatal outcomes after water birth or land birth in an alternative birthing center. METHODS: We conducted a prospective observational study of preselected low-risk parturients separated into three groups depending on their location for labor and delivery: land-land, water-land, and water-water. Delivery outcomes, labor length, maternal pain assessment, need for newborn resuscitation, and NICU admission and diagnoses were collected. The primary outcome was admission to the NICU. RESULTS: There were 2,077 total deliveries from April 2015 to December 2019, consisting of 458 land-land deliveries, 730 water-land deliveries, and 889 water-water deliveries. The rate of NICU admission was 2.8% (95% CI 1.5-4.8%) for land-land deliveries, 4.1% (2.8-5.8%) for water-land deliveries, and 2.0% (1.2-3.2%) for water-water deliveries. A post hoc power analysis revealed a 70% power to detect a 2.1% difference in NICU admissions between the water-land and water-water groups. CONCLUSION: In this cohort of low-risk pregnant women, births in water and on land were associated with similar rates of admission to the NICU.

Birth Outcomes for Planned Home and Licensed Freestanding Birth Center Births in Washington State.

OBJECTIVE: To describe rates of maternal and perinatal birth outcomes for community births and to compare outcomes by planned place of birth (home vs state-licensed, freestanding birth center) in a Washington State birth cohort, where midwifery practice and integration mirrors international settings. METHODS: We conducted a retrospective cohort study including all births attended by members of a statewide midwifery professional association that were within professional association guidelines and met eligibility criteria for planned birth center birth (term gestation, singleton, vertex fetus with no known fluid abnormalities at term, no prior cesarean birth, no hypertensive disorders, no prepregnancy diabetes), from January 1, 2015 through June 30, 2020. Outcome rates were calculated for all planned community births in the cohort. Estimated relative risks were calculated comparing delivery and perinatal outcomes for planned births at home to state-licensed birth centers, adjusted for parity and other confounders. RESULTS: The study population included 10,609 births: 40.9% planned home and 59.1% planned birth center births. Intrapartum transfers to hospital were more frequent among nulliparous individuals (30.5%; 95% CI 29.2-31.9) than multiparous individuals (4.2%; 95% CI 3.6-4.6). The cesarean delivery rate was 11.4% (95% CI 10.2-12.3) in nulliparous individuals and 0.87% (95% CI 0.7-1.1) in multiparous individuals. The perinatal mortality rate after the onset of labor (intrapartum and neonatal deaths through 7 days) was 0.57 (95% CI 0.19-1.04) per 1,000 births. Rates for other adverse outcomes were also low. Compared with planned birth center births, planned home births had similar risks in crude and adjusted analyses. CONCLUSION: Rates of adverse outcomes for this cohort in a U.S. state with well-established and integrated community midwifery were low overall. Birth outcomes were similar for births planned at home or at a state-licensed, freestanding birth center.

The role of pandemic-related pregnancy stress in preference for community birth during the beginning of the COVID-19 pandemic in the United States.

BACKGROUND: The COVID-19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference. METHODS: This study included 3896 pregnant women from the COVID-19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic-related preparedness stress, and pandemic-related perinatal infection stress. RESULTS: Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID-19. In multivariate models, higher stress about perinatal COVID-19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high. DISCUSSION: Women's birth preferences during the COVID-19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in-hospital and out-of-hospital birth services should be encouraged.

The opportunity costs of birth in Australia: Hospital resource savings for a post-COVID-19 era.

BACKGROUND: COVID-19 caused significant disruptions to health systems globally; however, restricting the family presence during birth saw an increase in women considering community birth options. This study aimed to quantify the hospital resource savings that could occur if all low-risk women in Australia gave birth at home or in birth centers. METHODS: A whole-of-population linked administrative data set containing all women (n = 44 498) who gave birth in Queensland, Australia, between 01/07/2012 and 30/06/2015 was reweighted to represent all Australian women giving birth in 2017. A static microsimulation model of woman and infant health service resource use was created based on 2017 data. The model was comprised of a base model, representing "current" care, and a counterfactual model, representing hypothetical scenarios where all low-risk Australian women gave birth at home or in birth centers. RESULTS: If all low-risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. Similarly, there would have been 860 fewer inpatient bed days and 10.1 fewer hours of women's intensive care unit time per 1000 births. If all women gave birth in birth centers, cesarean rates would have reduced to 6.7%. In addition, over 760 inpatient bed days would have been saved along with 5.6 hours of women's intensive care unit time per 1000 births. CONCLUSIONS: Significant health resource savings could occur by shifting low-risk births from hospitals to home birth and birth center services. Greater examination of Australian women's preferences for home birth and birth center birth models of care is needed.

Satisfacción percibida por las mujeres durante el parto en el Hospital Universitario Materno-Infantil de Canarias a través del Childbirth Experience Questionnaire (CEQ-E) / Perceived satisfaction of women during labour at the Hospital Universitario Materno-Infantil of the Canary Islands through the Childbirth Experience Questionnaire (CEQ-E)

OBJETIVO: Conocer el grado de satisfacción de las mujeres tras el parto en el Hospital Universitario Materno-Infantil de Gran Canaria (HUMIC) y establecer posibles relaciones entre el grado de satisfacción y las variables estudiadas. MÉTODO: Estudio observacional descriptivo de corte transversal con componente analítico. La población a estudio fueron las mujeres cuyo parto tuvo lugar en el mes de noviembre del 2018 en el HUMIC reclutadas mediante muestreo no probabilístico de tipo consecutivo. Se utilizó el cuestionario Childbirth Experience Questionnaire en su versión española (CEQ-E) (cuestionario con 4 dominios: capacidad propia, apoyo profesional, seguridad percibida y participación/modelo de análisis 2). En una primera fase se realizó un análisis descriptivo y en una segunda, un análisis inferencial para explorar la asociación entre diferentes variables. RESULTADOS: La muestra total fue de 257 mujeres (n=257). La puntuación total con el CEQ-E fue de 3,24 (DE 0,37 puntos). No se encontraron diferencias estadísticamente significativas en la puntuación final del CEQ-E entre las mujeres con parto espontáneo frente a inducciones-estimulaciones (p = 0,563) ni entre mujeres primíparas frente a multíparas (p = 0,060).Las mujeres cuyo parto había sido menor o igual a 12 h (p = 0,024), sin traumatismo perineal (p = 0,021) y aquellas a las que no se les ha realizado episiotomía (p = 0,002) obtuvieron mejor puntuación final en el CEQ-E. El parto instrumental (fórceps) frente al parto eutócico se asocia a puntuaciones menores respecto a la puntuación final en el CEQ-E (p≤0,001). CONCLUSIONES: La satisfacción global de la gestante tras el parto en el HUMIC es alta. El parto instrumental parece asociarse a menor satisfacción percibida. Aspectos como el miedo y el cansancio en el parto pueden influir negativamente en la satisfacción. Estos aspectos son susceptibles de mejora mediante el establecimiento de estrategias que ayuden a mayor bienestar y minimicen el miedo de las gestantes en su parto

OBJECTIVE: To determine the degree of satisfaction of women after childbirth at the Hospital Universitario Materno-Infantil of Gran Canaria (HUMIC) and to establish possible relationships between the degree of satisfaction and the variables studied. METHOD: A cross-sectional, descriptive, observational study with an analytical component. The study population comprised women who gave birth at the HUMIC in November 2018, recruited through consecutive non-probabilistic sampling. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E) was used (questionnaire with 4 domains: own capacity', professional support, perceived safety and participation/analytical model 2). In a first phase a descriptive analysis was made, and in a second phase an inferential analysis to explore the association between different variables. RESULTS: The total sample comprised 257 women (n=257). The total score using the CEQ was 3.24 (SD .37 points). No statistically significant differences were found in the final CEQ score between the women who had a spontaneous delivery versus induction-stimulation (P=.563) or between primiparous versus multiparous women (P=.060). The women whose labour lasted 12hours or less (P=.024), without perineal trauma (P=.021) and those who had not undergone episiotomy (P=.002) achieved a better final CEQ score. Instrumental delivery (forceps) versus normal delivery is associated with lower scores with respect to the final CEQ-E score (P=≤.001). CONCLUSIONS: Women's overall satisfaction after delivery in HUMIC was high. Instrumental delivery seems to be associated with lower perceived satisfaction. Aspects such as fear and fatigue in labour could affect satisfaction negatively. These aspects can be improved by establishing strategies to increase comfort and minimise pregnant women's fear of labour

Exploring Why Birth Center Clients Choose Hospitalization for Labor and Birth.

OBJECTIVE: To identify demographic and clinical factors associated with birth center clients electing hospitalization for labor and birth and to explore the timing and rationale for elective hospitalization via health records. DESIGN: A secondary analysis of multiyear data from a quality assurance project at a single birth center. We compared two subsamples-birth center preference group and hospital preference group-and described the apparent rationale for transfers among clients in the latter group. SETTING: A single freestanding birth center where all midwives have admitting privileges at a local hospital and can accompany labor transfers. PARTICIPANTS: All cases included in the analytic sample represent women with low-risk pregnancies who were eligible for birth center birth. The birth center preference group represents clients planning to give birth at the center, and the hospital preference group consists of clients who elected for hospitalization. MEASUREMENTS: Relevant demographic and clinical information was provided for the entire analytic sample and was matched with available data collected systematically by birth center staff via chart review. The data set also included anonymous responses to an e-mailed questionnaire from clients identified by birth center staff. RESULTS: Approximately 56.1% (N = 1,155) of the cases in the data set were eligible for comparative analysis. The birth center preference and hospital preference groups included 899 (77.8%) and 256 (22.2%) individuals, respectively. In the hospital preference group, Black clients (n = 23), those who were publicly insured (n = 49), and primiparas (n = 101) were significantly overrepresented. Chart review data and questionnaire responses highlighted insurance restrictions, family preferences, pain relief options, and postpartum care as influential factors among members of the hospital preference subsample. CONCLUSION: The present analysis shows associations between certain individual characteristics and elective hospitalization during labor for birth center clients. Health record data and questionnaire responses indicated a variety of reasons for electing hospitalization, illustrating the complexity of clients' decision-making during pregnancy and birth.

Two decades of Birth Centre and midwifery-led care in South Australia, 1998-2016.

BACKGROUND: Birth Centres (BC) are underpinned by a philosophy of woman- centred care and were pivotal in growing models of midwifery-led care in South Australia (SA). AIM: To describe BC utilisation and the growth of midwifery-led care in SA over the past two decades. METHODS: The SA Perinatal Statistics Collection was used to describe women birthing from 1998 to 2016. Number of births through midwifery-led services from 2004 to 2016 were obtained from unit managers. Analyses are descriptive. FINDINGS: Women who birthed in BC in SA from 1998 to 2016 comprised approximately 6% of all births per year, and numbers have remained static. Three BC models operate in SA, all with different capacity. Proportionally, women not born in Australia are as likely to birth in BC as labour wards. The proportion of women who received midwifery-led care (whether affiliated with a BC or not), increased from 8.3% in 1998 to 19.2% of all births in 2016. Of the women who received midwifery-led care in 2016, 15.3% went on to birth in a midwifery-led model of care. CONCLUSION: Whilst the overall number of BC births has not increased, women seeking midwifery-led care has more than doubled over the past two decades. BC encompass the midwifery philosophy, quality of care, and a physical home-like environment. The BC models in SA are managed through the three tertiary maternity units enabling women to access publicly funded midwifery care and should be more widely available.

Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study.

UK legislation and government policy favour women's rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women's alternative physiological birthing choices-defined in this study as 'birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth'. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives' processes of facilitating women's alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women's needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.

Local guidelines for admission to UK midwifery units compared with national guidance: A national survey using the UK Midwifery Study System (UKMidSS).

OBJECTIVES: To describe the extent to which local guidelines for admission to UK midwifery units align with national guidance; to describe variation in individual admission criteria; and to describe the extent to which alongside midwifery units (AMUs) are the default option for eligible women. DESIGN: National cross-sectional survey. SETTING: All 122 UK maternity services with midwifery units, between October 2018 and February 2019. OUTCOME MEASURES: Alignment of local admission guidelines with national guidance (NICE CG190); frequency and nature of variation in individual admission criteria; percentage of services with AMU as default birth setting for eligible women. RESULTS: Admission guidelines were received from 87 maternity services (71%), representing 153 units, and we analysed 85 individual guideline documents. Overall, 92% of local admission guidelines varied from national guidance; 76% contained both some admission criteria that were 'more inclusive' and some that were 'more restrictive' than national guidance. The most common 'more inclusive' admission criteria, occurring in 40-80% of guidelines, were: explicit admission of women with parity ≥4; aged 35-40yrs; with a BMI 30-35kg/m2; selective admission of women with a BMI 35-40kg/m2; Group B Streptococcus carriers; and those undergoing induction of labour. The most common 'more restrictive' admission criteria, occurring in around 30% of guidelines, excluded women who: declined blood products; had experienced female genital cutting; were aged <16yrs; or had not attended for regular antenatal care. Over half of services (59%) reported the AMU as the default option for healthy women with straightforward pregnancies. CONCLUSIONS: The variation in local midwifery unit admission criteria found in this study represents a potentially confusing and inequitable basis for women making choices about planned place of birth. A review of national guidance may be indicated and where a lack of relevant evidence underlies variation in admission criteria, further research by planned place of birth is required.

The golden hour in Finnish birthing units - An ethnographic study.

OBJECTIVE: To explore midwives' and parents' perceptions and actions as well as the culture surrounding the first hour after the birth of a baby - the golden hour. DESIGN: Short-term ethnographic study, which included observations, informal interviews and focus group interviews. Thematic network analysis was used to analyse the data. SETTING: Two birthing hospitals in Finland. PARTICIPANTS: The first hour following 16 births was observed and informal interviews of attending midwives (n = 10) and parents (n = 3 couples and n = 6 mothers) were conducted to supplement the observations. The 16 cases included both primiparous (n = 8) and multiparous (n = 8) women, as well as vaginal (n = 12) and elective caesarean births (n = 4). Furthermore, two focus group interviews with midwives (n = 9) were conducted to deepen the understanding. FINDINGS: The over-arching theme Unchallenged hospital 'rules' comprised the two main themes of Safety-driven support by midwives and Silent voices of the parents. The hospital guidelines and practices guided the first hour, unchallenged by parents and midwives. Based on the guidelines, all the babies were given skin-to-skin contact early but not immediately. Midwives strictly followed the guidelines and performed many activities with the mothers during the first hour. Embedded power was present: midwives were in control but tended to listen to the parents. Although the mothers displayed a strong need to be close to their babies, their voices were silent in the units. The parents' compliance with midwives and parents' intense focus on the baby strengthened the midwives' embedded power. KEY CONCLUSION: Care culture in birthing units was 'rule-based' and the guidelines and practices sometimes inhibited uninterrupted skin-to-skin contact without questioning. The golden hour was mainly controlled by the maternity care staff. IMPLICATIONS FOR PRACTICE: Re-evaluation of hospital guidelines should enable more woman- and family-centred care. The golden hour is unique to families, and unnecessary separation and interventions should be avoided.

Evaluation of a health promotion intervention associated with birthing centres in rural Nepal.

INTRODUCTION: Birthing centres (BC) in Nepal are mostly situated in rural areas and provide care for women without complications. However, they are often bypassed by women and their role in providing good quality maternity services is overlooked. This study evaluated an intervention to increase access and utilisation of perinatal care facilities in community settings. METHODS: This longitudinal cross-sectional study was conducted over five years in four villages in Nepal and included two BCs. An intervention was conducted in 2014-2016 that involved supporting the BCs and conducting a health promotion programme with local women. Population-based multi-stage sampling of women of reproductive age with a child below 24 months of age was undertaken. Household surveys were conducted (2012 and 2017) employing trained enumerators and using a structured validated questionnaire. The collected data were entered into SPSS and analysed comparing pre- and post-intervention surveys. RESULTS: The intervention was associated with an increase in uptake in facility birth, with an increase in utilisation of perinatal services available from BCs. The post-intervention survey provided evidence that women were more likely to give birth at primary care facilities (OR 5.60, p-value <0.001) than prior to the intervention. Similarly, the likelihood of giving birth at a health facility increased if decision for birthplace was made jointly by women and family members for primary care facilities (OR 1.76, p-value 0.023) and hospitals/tertiary care facilities (OR 1.78, p-value 0.020. If women had less than four ANC visits, then they were less likely to give birth at primary care facilities (OR 0.39, p-value <0.001) or hospitals/tertiary care facilities (OR 0.63, p-value 0.014). Finally, women were less likely to give birth at primary care facilities if they had only primary level of education (OR 0.49, p-value 0.014). CONCLUSION: BCs have the potential to increase the births at health facilities and decrease home births if their services are promoted by the local health promoters. In addition, socio-economic factors including women's education, the level of women's autonomy and having four or more ANC visits affect the utilisation of perinatal services at the health facility.

A Collaborative Model of a Community Birth Center and a Tertiary Care Medical Center.

OBJECTIVE: To describe the development, implementation, and evaluation of a collaborative model between a freestanding birth center and a tertiary care medical center. METHODS: An interdisciplinary team developed a freestanding accredited birth center in collaboration with a tertiary care medical center in the southeast United States. We performed a retrospective cohort study of all women obtaining care at the birth center and assessed the rate (and 95% CIs) of cesarean delivery, patient transfers, and adverse maternal and neonatal events. RESULTS: Between January 2017 and December 2018, 1,394 women initiated prenatal care at the birth center. The study cohort consisted of 1,061 women who continued their prenatal care and planned to deliver at the birth center, of whom 358 (34%) were subsequently transferred before admission and 703 (66%) presented to the birth center in labor. Of those, 573 (82%) were subsequently delivered vaginally in the birth center, and 130 (18%) were transferred for hospital birth. Of those admitted to the birth center in labor, 41 ultimately underwent cesarean delivery for an overall cesarean delivery rate of 6% (95% CI 4-8%). Maternal transfers for postpartum hemorrhage occurred in eight patients (1%; 95% CI 1-2%). There were 39 neonatal intensive care admissions (6%; 95% CI 4-8%), eight cases (1%; 95% CI 0.5-2%) of 5-minute Apgar scores less than 7, and two previable neonatal deaths (0.3%; 95% CI 0-1%). CONCLUSION: We describe a collaborative model between a freestanding birth center and a tertiary care medical center, which provided women with access to a traditional birth center experience while maintaining access to the specialized care provided by a tertiary care medical center. We believe that the model may facilitate options for maternity care in regional perinatal systems.

Access and outcomes of general practitioner obstetrician (rural generalist)-supported birthing units in Queensland.

OBJECTIVE: To describe characteristics and outcomes of women birthing within GP-obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland. DESIGN: Retrospective descriptive study. SETTING: 21 GP-obstetrician supported birthing units in Queensland. PARTICIPANTS: Women (n = 3111) birthing from January 2017 to December 2017. MAIN OUTCOME MEASURES: Patient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data. RESULTS: Women birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001). CONCLUSION: GP-obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety.

Roots Community Birth Center: A culturally-centered care model for improving value and equity in childbirth.

Pernicious racial disparities in birth outcomes in the United States have their roots in structural racism-the systematic allocation of opportunities and resources based on race. These inequities, caused by systemic factors which contribute to lower quality of care, negatively impact the lives of Blacks/African Americans. The development of new maternity care models hold potential to reduce disparities and costs by focusing on the root cause of racism. Roots Community Birth Center is an African American-owned, midwife-led freestanding birth center in North Minneapolis. Roots provides a culturally-centered model of care during pregnancy, childbirth, and the postpartum period. The culturally-centered care model utilized by Roots Community Birth Center offers culturally-centered care that is community based, accepts Medicaid beneficiaries, and provides prenatal and postpartum visits that are customized to the needs of the birthing individual. Like other institutions, this birth center faces the financial challenges associated with maternity care payment models and inadequate Medicaid reimbursement, challenges that directly interfere with the center's culturally-centered care model which advocates for longer prenatal visits and close follow-up postpartum. The birth center model of care has proven effective; over the last four years Roots has had 284 families with zero preterm births. The culturally-centered care model used by Roots is not currently well-supported by maternity care payment models that were designed in large part to reflect typical care provided by obstetricians and hospitals.

The cost of vaginal birth at home, in a birth centre or in a hospital setting in New South Wales: A micro-costing study.

BACKGROUND: Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings. AIM: The aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales. METHODS: A micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy. FINDINGS: The median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings. CONCLUSION: In this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.

The Availability of Emergency Obstetric Care in Birthing Centres in Rural Nepal: A Cross-sectional Survey.

OBJECTIVE: The purpose of this health system's study is to assess the availability of Emergency Obstetric Care (EmOC) services in birthing centres in Taplejung District of eastern Nepal. METHODS: A cross-sectional survey was conducted in 2018 in all 16 public health facilities providing delivery services in the district. Data collection comprised: (1) quantitative data collected from health workers; (2) observation of key items; and (3) record data extracted from the health facility register. Descriptive statistics were used to calculate readiness scores using unweighted averages. RESULTS: Although key health personnel were available, EmOC services at the health facilities assessed were below the minimum coverage level recommended by the World Health Organisation. Only the district hospital provided the nine signal functions of Comprehensive EmOC. The other fifteen had only partially functioning Basic EmOC facilities, as they did not provide all of the seven signal functions. The essential equipment for performing certain EmOC functions was either missing or not functional in these health facilities. CONCLUSIONS FOR PRACTICE: The Ministry of Health and Population and the federal government need to ensure that the full range of signal functions are available for safe deliveries in partially functioning EmOC health facilities by addressing the issues related to training, equipment, medicine, commodities and policy.

The "Cocoon," first alongside midwifery-led unit within a Belgian hospital: Comparison of the maternal and neonatal outcomes with the standard obstetric unit over 2 years.

OBJECTIVES: Our aim was to compare maternal and neonatal outcomes of women with a low-risk pregnancy attending the "Cocoon," an alongside midwifery-led birth center and care pathway, with women with a low-risk pregnancy attending the traditional care pathway in a tertiary care hospital in Belgium. METHODS: We performed a retrospective cohort study of maternal and neonatal outcomes of women with a low-risk pregnancy who chose to adhere to the Cocoon pathway of care (n = 590) and women with a low-risk pregnancy who chose the traditional pathway of care (n = 394) from March 1, 2014, to February 29, 2016. We performed all analyses using an intention-to-treat approach. RESULTS: In this setting, the cesarean birth rate was 10.3% compared with 16.0% in the traditional care pathway (adjusted odds ratios [aOR] 0.42 [95% CI 0.25-0.69]), the induction rate was 16.3% compared with 30.5% (0.46 [0.30-0.69]), the epidural analgesia rate was 24.9% compared with 59.1% (0.15 [0.09-0.22]), and the episiotomy rate was 6.8% compared with 14.5% (0.31 [0.17-0.56]). There was no increase in adverse neonatal outcomes. Intrapartum and postpartum transfer rates to the traditional pathway of care were 21.1% and 7.1%, respectively. CONCLUSIONS: Women planning their births in the midwifery-led unit, the Cocoon, experienced fewer interventions with no increase in adverse neonatal outcomes. Our study gives initial support for the introduction of similar midwifery-led care pathways in other hospitals in Belgium.

Significado de la experiencia del embarazo, parto y puerperio en la mujer migrante en Chile / Meaning of the experience of pregnancy, birth and postpartum in immigrant women in Chile

OBJETIVO: Conocer el significado de la experiencia del proceso de embarazo, parto y puerperio en mujeres inmigrantes afiliadas a centros de salud familiar de una comuna de la zona sur de la ciudad de Santiago de Chile. METODOLOGÍA: Estudio con metodología cualitativa con muestreo por avalancha o bola de nieve. Se aplicaron entrevistas semiestructuradas a 8 mujeres inmigrantes, que fueron transcritas verbatim. Se realizó un análisis de contenido, detallándose aspectos del fenómeno de estudio y buscando las categorías de significado que dieran respuesta a los objetivos de la investigación. RESULTADOS: Emergieron 4 unidades de significado: 1) necesidades percibidas durante el proceso de embarazo, parto y puerperio en condición de inmigrante; 2) barreras o dificultades vividas durante este proceso; 3) facilitadores percibidos, y 4) percepción de red de apoyo en su condición de migrante. CONCLUSIONES: La mujer inmigrante presenta grandes desafíos durante el proceso de embarazo, parto y puerperio en el país receptor. Vivir esta etapa en un país desconocido produce importantes diferencias en las condiciones de vida y riesgo de vulnerabilidad, determinando la forma en que la mujer lo experimenta, planteando, por ende, nuevos desafíos para los profesionales de la salud

OBJECTIVE: To know the meaning of the experience of the pregnancy, childbirth and postpartum process in immigrant women affiliated to family health centers of a commune of the south zone of the city of Santiago (Chile). METHODOLOGY: Qualitative case study with sampling like snowball. Semistructured interview was applied to 8 immigrant women, which were transcribed verbatim. Content analysis was carried out, detailing aspects of the study phenomenon and looking for categories of meaning that would respond to the research objectives. RESULTS: Four units of meaning emerged to respond to the phenomenon under study, these were: 1) perceived needs during the pregnancy, childbirth and postpartum process in immigrant status; 2) barriers or difficulties experienced during the pregnancy, childbirth and postpartum in immigrant status; 3) facilitators perceived, and 4) perception of support network in their migrant status. CONCLUSIONS: The immigrant woman presents great challenges during the process of pregnancy, childbirth and puerperium in the receiving country. Living this stage in an unknown country produces important differences in the living conditions and risk of vulnerability, determining the way in which the woman experiences this stage of her life, and posing, therefore, new challenges for health professionals

Applying best practices to pregnant women in the obstetric center.

OBJECTIVE: To identify the meaning attributed by nursing technicians to good care practices based on scientific evidence used with the pregnant women during the dilation stage of labor. METHOD: A qualitative study, based on Grounded Theory principles. Twelve interviews with nursing technicians attending labor in the obstetric center of two public hospitals, in Florianópolis/SC, were performed, from August of 2016 to March of 2017. Data were analyzed using open, axial coding. RESULTS: The implementation of good practices, for nursing technicians, means adequately performing their activities, providing humanized care to the pregnant woman, respecting her autonomy, promoting pain relief, and a peaceful labor. FINAL CONSIDERATIONS: An adequate number of technicians must be determined to maintain quality of care, and to complete nursing records in a more detailed and systematized manner.