Effect of maternal birth positions on duration of second stage of labor: systematic review and meta-analysis.

BACKGROUND: It is believed that giving birth in an upright position is beneficial for both mother and the infant for several physiologic reasons. An upright positioning helps the uterus to contract more strongly and efficiently, the baby gets in a better position and thus can pass through the pelvis faster. Upright and lateral positions enables flexibility in the pelvis and facilitates the extension of the outlet. Before implementing a change in birthing positions in our clinics we need to review evidences available and context valid related to duration of second stage of labor and birthing positions. Therefore this review aimed to examine the effect of maternal flexible sacrum birth position on duration of second stage of labor. METHOD: The research searched articles using bibliographical Databases: Medline/PUBMED, SCOPUS, Google scholar and Google. All study designs were considered while investigating the impact of maternal flexible sacrum birthing positioning in relation duration of second stage of labor. Studies including laboring mothers with normal labor and delivery. A total of 1985 women were included in the reviewed studies. We included both qualitative and quantitative analysis. RESULTS: We identified 1680 potential citations, of which 8 articles assessed the effect of maternal upright birth positioning on the reduction during the duration of second stage of labor. Two studies were excluded because of incomplete reports for meta analysis. The result suggested a reduction in duration of second stage of labor among women in a flexible sacrum birthing position, with a mean duration from 3.2-34.8. The pooled weighted mean difference with random effect model was 21.118(CI: 11.839-30.396) minutes, with the same significant heterogeneity between the studies (I2 = 96.8%, p < 000). CONCLUSION: The second stage duration was reduced in cases of a flexible sacrum birthing position. Even though the reduction in duration varies across studies with considerable heterogeneity, laboring women should be encouraged to choose her comfortable birth position. Researchers who aim to compare different birthing positions should consider study designs which enable women to choose birthing position. PROSPERO REGISTRATION NUMBER: [CRD42019120618].

Half-time evaluation of a new 4-year Ph.D. program in nursing and midwifery at the University of Gondar, Ethiopia.

A new four-year Ph.D. programme in nursing and midwifery, the first of its kind in Ethiopia, was started in 2018/2019 at the University of Gondar when eight doctoral students in nursing and midwifery entered the program. We who have been involved see this as an appropriate time to evaluate what has been accomplished to date and to look toward future possibilities. Our aim in carrying out such an evaluation and presenting our findings is in part to determine if similar programs might be developed in other similar settings and in part to learn what modifications to the present program might be considered. The key elements of a questionnaire survey with closed and open response alternatives were based on the content, structure and learning outcomes of the home university Ph.D. programme as described in the curriculum. The questionnaire responses captured changes that would be needed to maintain a fully satisfactory programme that blends onsite instruction and online access to faculty resulting in a twenty-first century blended Ph.D. programme. Improved dialogue between the home university faculty and the external supervisors is needed. The programme can provide a career pathway that midwifery and nursing educators can follow in their own country rather than having to leave to study in another country. The findings provide insight into the feasibility of extending similar Ph.D. programmes to other parts of East Africa and with the SDG 5 in mind with an increased focus on women leadership. The justification for this initiative is to meet the need for more nursing and midwifery faculty who can provide quality midwifery and nursing education in East African countries. Retention of these professionals will help to deal with the shortage of healthcare personnel and will provide better care for the general population.

Utilization and Associated Factors of Modern Contraceptives During Extended Postpartum Period among Women Who Gave Birth in the Last 12 Months in Gondar Town, Northwest Ethiopia.

BACKGROUND: The postpartum period is a critical period for addressing widespread unmet needs in family planning and for reducing the risks of closely spaced pregnancies. However, many women do not realize that they are at risk for pregnancy during this period. Therefore, the aim of this study was to assess utilization and associated factors of modern contraceptives during extended post-partum period. METHODS: Institutional based cross-sectional study was conducted from March to April, 2015 in six health institutions among women who gave birth in the last 12 months prior to the study period in Gondar Town, Northwest Ethiopia. A systematic random sampling technique was used to select the study participants. Data were analyzed using SPSS version 20. Bivariate and multivariate logistic regression models were fitted to identify the determinants of postpartum modern contraceptive use. Adjusted odds ratios with 95% confidence intervals were calculated, and p-values <0.05 were considered to indicate statistical significance. RESULT: Of the total 404 participants, 45.8% mothers used modern contraceptives during postpartum period. Injectable contraceptive was the most frequently used method. Menstruating [AOR =3.84, 95% CI: (2.33, 6.35)], resumption of sex [AOR= 3.17, 95% CI: (1.80, 5.58)], 37-51 weeks of postpartum period [AOR= 2.48, 95% CI: (1.11, 5.55)], husband approval of contraceptive [AOR= 2.10, 95% CI: (1.16, 3.82)] and current knowledge on FP [AOR= 5.01, 95% CI: (2.23, 11.24)] were factors affecting contraceptive use in postpartum period. CONCLUSION: Utilization of modern contraceptive during the postpartum period was significantly decreased placing women at risk for a pregnancy in the extended postpartum period. Menstruating, resumption of sex, variation on postpartum period and husband approval of contraceptive were factors associated with contraceptive use. Strengthening FP counseling service at the ANC clinic and postnatal care would improve contraceptive use during the postpartum period.

Partograph utilization and associated factors among obstetric care providers in North Shoa Zone, Central Ethiopia: a cross sectional study.

BACKGROUND: Globally, prolonged and obstructed labor contributed to 8% of maternal deaths which can be reduced by proper utilization of partograph during labor. METHODS: An Institution based cross-sectional study was conducted in June, 2013 on 403 obstetric care providers. A pre-tested and structured questionnaire was used to collect data. Data was entered to EpiInfo version 3.5.1 statistical package and exported to SPSS version 20.0 for further analysis. Logistic regression analyses were used to see the association of different variables. RESULTS: Out of 403 obstetric care providers, 40.2% utilized partograph during labor.Those who were midwives by profession were about 8 times more likely to have a consistent utilization of the partograph than general practitioners (AOR=8. 13, 95% CI: 2.67, 24.78). Similarly, getting on job training (AOR=2. 86, 95% CI: 1.69, 4.86), being knowledgeable on partograph (AOR=3. 79, 95% CI: 2.05, 7.03) and having favorable attitude towards partograph (AOR=2. 35, 95% CI: 1.14, 4.87) were positively associated with partograph utilization. CONCLUSION: Partograph utilization in labor monitoring was found to be low. Being a midwife by profession, on job training, knowledge and attitude of obstetric care providers were factors affecting partograph utilization. Providing on job training for providers would improve partograph utilization.