Duration of skin-to-skin care and rectal temperatures in late preterm and term infants.

BACKGROUND: Hypothermia during the newborn period is widely regarded as a major contributory cause of significant morbidity and mortality of newborn infants. Thermoprotective behaviours such as skin-to-skin care (SSC) or the use of appropriate devices have been recommended as simple tools for the avoidance of neonatal hypothermia. We examined the relation between the duration of skin-to-skin care and infant temperature change after birth in suboptimal delivery room temperatures. METHODS: We reviewed the medical charts of all vaginally born infants of gestational age ≥ 35 weeks born January-July 2018 and admitted to the well-baby nursery. After SSC was discontinued, the infant's rectal temperature was measured to determine the frequency and severity of hypothermia. RESULTS: The charts of 688 vaginally born infants were examined. Our mean delivery room temperature was 21.7 (SD 2.2) °C, well below the WHO recommendation of 25 °C. After SSC 347 (50.4%) infants were normothermic (temperature 36.5-37.5 °C), 262 (38.0%) were mildly hypothermic (36.0-36.4 °C), and 79 (11.4%) were moderately hypothermic (32.0-35.9 °C). The mean skin-to-skin time in infants was 63.9 (SD 20.9) minutes. SSC duration was associated with increase in rectal temperature for patients of gestational ages ≥ 38 weeks and with decrease in rectal temperature in patients of gestational age < 38 weeks. CONCLUSION: SSC is effective, even at suboptimal delivery room temperatures, for promoting normothermia in infants of ≥ 38 weeks' gestation but may not provide adequate warmth for infants of < 38 weeks.

Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia.

BACKGROUND: Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. METHODS: A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed. RESULTS: Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% - 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). CONCLUSION: Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.

Exploring women's experiences of participation in shared decision-making during childbirth: a qualitative study at a reference hospital in Spain.

BACKGROUND: Women's engagement in healthcare decision-making during childbirth has been increasingly emphasised as a priority in maternity care, since it increases satisfaction with the childbirth experience and provides health benefits for women and newborns. The birth plan was developed as a tool to facilitate communication between health professionals and women in Spain, but their value in routine practice has been questioned. Besides, little is known about women's experiences of participation in decision-making in the Spanish context. Thus, this study aimed to explore women's experiences of participation in shared decision-making during hospital childbirth. METHODS: An exploratory qualitative study using focus groups was carried out in one maternity unit of a large reference hospital in Barcelona, Spain. Participants were first-time mothers aged 18 years or older who had had a live birth at the same hospital in the previous 12 months. Data collected were transcribed verbatim and analysed using a six-phase inductive thematic analysis process. RESULTS: Twenty-three women participated in three focus groups. Three major themes emerged from the data: "Women's low participation in shared decision-making", "Lack of information provision for shared decision-making", and "Suggestions to improve women's participation in shared decision-making". The women who were willing to take an active role in decision-making encountered barriers to achieving this and some women did not feel prepared to do so. The birth plan was experienced as a deficient method to promote women's participation, as health professionals did not use them. Participants described the information given as insufficient and not offered at a timely or useful point where it could aid their decision-making. Potential improvements identified that could promote women's participation were having a mutually respectful relationship with their providers, the support of partners and other members of the family and receiving continuity of a coordinated and personalised perinatal care. CONCLUSION: Enhancing women's involvement in shared decision-making requires the acquisition of skills by health professionals and women. The development and implementation of interventions that encompass a training programme for health professionals and women, accompanied by an effective tool to promote women's participation in shared decision-making during childbirth, is highly recommended.

[Basic hygiene measures in the delivery room-also during a pandemic]. / Basis-Hygienemaßnahmen im Kreißsaal ­ auch in Zeiten einer Pandemie.

BACKGROUND: The German Infection Protection Act calls for effective measures to be implemented in clinics to avoid nosocomial infections. The corona pandemic once again demonstrates the importance of adequate hygiene measures in avoiding infections. OBJECTIVES: Compilation of common basic hygiene measures for clinical obstetrics. METHODS: Discussion of relevant German guidelines relating to the work in the delivery room. Development of recommendations for hygienically correct childbirth care. RESULTS: Recommendations for surface disinfection refer to predefined risk-categories in the delivery unit. In cooperation with hospital hygiene, the frequency of cleaning and disinfection must be specified in the facility's internal hygiene plans. To avoid a selection of disinfectant-tolerant germs, it is essential to observe the spectrum of activity and exposure time of each disinfectant. Hand disinfection is the single most effective measure to prevent nosocomial infections. The challenge here is the consistent implementation of the generally known indications for hand disinfection in everyday life. For the hygienically correct management of water birth and maintenance of the bathtub, standards should be developed in every delivery room, the effectiveness of which must be regularly monitored. In a pandemic, there are additional hygiene rules, tailored to the particular pathogen. CONCLUSIONS: Although there is no lack of knowledge in the form of guidelines and recommendations, the implementation of basic hygiene measures in everyday life in the delivery room requires perseverance and commitment.

Defining and describing birth centres in the Netherlands - a component study of the Dutch Birth Centre Study.

BACKGROUND: During the last decade, a rapid increase of birth locations for low-risk births, other than conventional obstetric units, has been seen in the Netherlands. Internationally some of such locations are called birth centres. The varying international definitions for birth centres are not directly applicable for use within the Dutch obstetric system. A standard definition for a birth centre in the Netherlands is lacking. This study aimed to develop a definition of birth centres for use in the Netherlands, to identify these centres and to describe their characteristics. METHODS: International definitions of birth centres were analysed to find common descriptions. In July 2013 the Dutch Birth Centre Questionnaire was sent to 46 selected Dutch birth locations that might qualify as birth centre. Questions included: location, reason for establishment, women served, philosophies, facilities that support physiological birth, hotel-facilities, management, environment and transfer procedures in case of referral. Birth centres were visited to confirm the findings from the Dutch Birth Centre Questionnaire and to measure distance and time in case of referral to obstetric care. RESULTS: From all 46 birth locations the questionnaires were received. Based on this information a Dutch definition of a birth centre was constructed. This definition reads: "Birth centres are midwifery-managed locations that offer care to low risk women during labour and birth. They have a homelike environment and provide facilities to support physiological birth. Community midwives take primary professional responsibility for care. In case of referral the obstetric caregiver takes over the professional responsibility of care." Of the 46 selected birth locations 23 fulfilled this definition. Three types of birth centres were distinguished based on their location in relation to the nearest obstetric unit: freestanding (n = 3), alongside (n = 14) and on-site (n = 6). Transfer in case of referral was necessary for all freestanding and alongside birth centres. Birth centres varied in their reason for establishment and their characteristics. CONCLUSIONS: Twenty-three Dutch birth centres were identified and divided into three different types based on location according to the situation in September 2013. Birth centres differed in their reason for establishment, facilities, philosophies, staffing and service delivery.

Traumatic perinatal events and educational needs of labor and delivery room nurses in Korea: a cross-sectional survey.

PURPOSE: The present study investigated experiences of traumatic perinatal events, the provision of related education, and educational needs of nurses working in the labor and delivery room (LDR). METHODS: Nurses working in the LDRs of six institutions and two nurse portal sites were invited to participate in the survey, delivered on paper or online. The data were collected from October 1 to November 25, 2022. Data from 129 nurses were analyzed using frequency, the chi-square test, the Fisher exact test, the t-test, and analysis of variance. RESULTS: Virtually all participants (98.6%) reported having experienced at least one traumatic perinatal event (dystocia, postpartum hemorrhage, neonatal congenital anomalies, severe maternal or neonatal injury, stillbirth, and maternal or neonatal death) while working in the LDR. The most shocking traumatic perinatal event experienced was the maternal or neonatal death (40.3%), but 24.8% of participants did not recall ever receiving education on the topic. About 63% of participants experienced traumatic perinatal events within a year of working in the LDR. The average score for education needs regarding traumatic perinatal events was 3.67±0.37 out of 4, and participants preferred simulation education as the most effective educational method. CONCLUSION: Since most of the participants had experienced various traumatic perinatal events in the early stages of working in the LDR and expressed a high level of need for education on traumatic perinatal events, it is necessary to provide more effective stimulation education programs in the early period of work in the LDR.

Neonatal Resuscitation Practices in Portuguese Delivery Rooms: A Cross-Sectional Study.

INTRODUCTION: Data from previous studies have demonstrated inconsistency between current evidence and delivery room resuscitation practices in developed countries. The primary aim of this study was to assess the quality of newborn healthcare and resuscitation practices in Portuguese delivery rooms, comparing current practices with the 2021 European Resuscitation Council guidelines. The secondary aim was to compare the consistency of practices between tertiary and non-tertiary centers across Portugal. METHODS: An 87-question survey concerning neonatal care was sent to all physicians registered with the Portuguese Neonatal Society via email. In order to compare practices between centers, participants were divided into two groups: Group A (level III and level IIb centers) and Group B (level IIa and I centers). A descriptive analysis of variables was performed in order to compare the two groups. RESULTS: In total, 130 physicians responded to the survey. Group A included 91 (70%) and Group B 39 (30%) respondents. More than 80% of participants reported the presence of a healthcare professional with basic newborn resuscitation training in all deliveries, essential equipment in the delivery room, such as a resuscitator with a light and heat source, a pulse oximeter, and an O2 blender, and performing delayed cord clamping for all neonates born without complications. Less than 60% reported performing team briefing before deliveries, the presence of electrocardiogram sensors, end-tidal CO2 detector, and continuous positive airway pressure in the delivery room, and monitoring the neonate's temperature. Major differences between groups were found regarding staff attending deliveries, education, equipment, thermal control, umbilical cord management, vital signs monitoring, prophylactic surfactant administration, and the neonate's transportation out of the delivery room. CONCLUSION: Overall, adherence to neonatal resuscitation international guidelines was high among Portuguese physicians. However, differences between guidelines and current practices, as well as between centers with different levels of care, were identified. Areas for improvement include team briefing, ethics, education, available equipment in delivery rooms, temperature control, and airway management. The authors emphasize the importance of continuous education to ensure compliance with the most recent guidelines and ultimately improve neonatal health outcomes.

Impact of the implementation of a standardised interdisciplinary information transfer method in the delivery room and intermediate obstetric care unit.

AIM: This study aims to describe the implementation of the standard methodology for information transfer in the labour ward and Intermediate Obstetric Care Unit and to identify the impact of this implementation on the factors that act as facilitators and barriers in the procedure. METHOD: Quasi-experimental pretest-posttest study without a control group in an Intermediate Obstetric Care Unit and delivery room of the Maternal-Fetal Medicine Service of a tertiary hospital in Barcelona. Healthcare staff self-completed an ad hoc questionnaire before and after implementing the standardised IDEAS methodology in the service during 2019 and 2020. Personal self-perception in the information transfer procedure was assessed. The Wilcoxon pairwise test was used for comparison before and after. RESULTS: The use of a standardised methodology has shown an impact on improving the transmission of information. Significant differences were detected before and after the intervention in the following dimensions: location, people involved, time period of the procedure, structured, orderly and clear, and sufficient time for questions (p < 0.001); while no differences were observed in: transmission to the referring professional, well-defined actions, and completion of a summary. CONCLUSIONS: There are factors such as structural and organisational aspects and lack of time that hinder effective communication and therefore act as barriers to the transfer of information. The implementation of a methodology with the health professionals involved, the time and the appropriate space allows for the improvement of communication aspects in the multiprofessional team and, therefore, patient safety.

Impact of resuscitation training program on neonatal outcomes in a region of high socioeconomic vulnerability in Brazil: an interventional study.

OBJECTIVES: This pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. METHOD: This interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals' knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. RESULTS: Training was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. CONCLUSION: Following the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed.

Single Room Maternity Care Versus Traditional Maternity Care: A Cross-Sectional Study Examining Differences in Mothers' Perceptions of Readiness for Discharge and Satisfaction and Health Outcomes.

BACKGROUND: Single room maternity care (SRMC) includes all aspects of the birth process (labour, delivery, postpartum) in a single room with a consistent team of healthcare providers. Traditional maternity care (TMC) involves having mothers labouring and delivering their baby in one room and then transferring to a room on another unit, which also means a transition in providers. Although many hospitals have transitioned to SRMC, there has been limited evidence to support their development. METHODS: This study was conducted in two large hospitals (one offering SRMC, the other TMC) in Western Canada. A cross-sectional between-subjects design was used to compare differences between SRMC and TMC. New mothers were asked to complete validated questionnaires. Health information was collected from administrative and health databases. The main outcomes included readiness for hospital discharge, mothers' satisfaction, newborn length of stay, and mother length of stay. Several covariates were examined. RESULTS: In total, 506 (292 SRMC; 214 TMC) mothers participated. Readiness for discharge and maternal satisfaction were significantly higher in SRMC. Although newborn and mother length of stay were significantly reduced in SRMC compared to TMC for univariate tests, mother length of stay was not significantly different when adjusting for other variables. CONCLUSIONS: There are positive health and psychosocial outcomes for mothers and newborns in the SRMC model of care compared to TMC. Since readiness for discharge and satisfaction are associated with positive maternal-infant interactions and transitions to community, SRMC could be the better approach. Further research should examine healthcare provider outcomes and implementation costs.

Birth environments for women with complex pregnancies: A mixed-methods systematic review.

BACKGROUND: Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies. AIM: To investigate the impact of the birth environment for women with complex pregnancies. METHODS: This was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently. FINDINGS: 30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues. DISCUSSION: Women and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies. CONCLUSION: Further research is needed investigating different users' needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.

The Effects of Musculoskeletal Disorders on Professional Quality of Life Among Midwives Working in Delivery Rooms.

Background: This study was conducted to determine the effects of musculoskeletal disorders on professional quality of life among midwives working in delivery rooms. Aim: The aim of the study was to determine the effect of musculoskeletal disorders of midwives working in delivery rooms on the quality of professional life. Methods: This descriptive study was conducted with 88 midwives who worked in delivery rooms and delivered babies. The data were collected using the Nordic Musculoskeletal Questionnaire (NMQ) and the Professional Quality of Life Scale (ProQOL R-IV). Statistical Analysis Used: The data were analysed with IBM SPSS V23 using MANOVA and path analysis. Results: Of the midwives, 80.7% reported that they had pain in the waist in the last year. According to the result of path analysis for NMQ and ProQOL R-IV, only the path coefficient between the 12-month disability and burnout was found to be statistically significant (p = 0.012). The multivariate analysis showed that single midwives had higher job satisfaction than married ones (p = 0.030) and those who chose their profession willingly had higher job satisfaction than others (p = 0.043). Conclusion: It was observed that most of the midwives suffered from low back pain. Additionally, there may be a relationship between musculoskeletal problems experienced by midwives and their professional burnout levels. Relevant strategies to reduce occupational risks, especially musculoskeletal disorders, and to increase the professional quality of life of midwives should be implemented urgently.

Fetal Left Ventricular Apical Aneurysm Progressing to Dilated Cardiomyopathy Due to Glycogen Storage Disease.

Fetal dilated cardiomyopathy is a rare anomaly characterized by ventricular dilation and dysfunction. Its causes are diverse, and its outcomes are generally dismal. We describe a rare case of prenatally diagnosed left ventricular apical aneurysm that progressed rapidly to dilated cardiomyopathy. At age 2 months, the infant underwent heart transplantation. Pathologic examination of the explanted heart revealed that the cause of the dilated cardiomyopathy was glycogen storage disease. This case highlights the crucial roles of timely diagnosis, frequent close monitoring, and multidisciplinary care in achieving a successful postnatal outcome.

Single-room maternity care: Systematic review and narrative synthesis.

Aim: To describe the single-room maternity care model and evaluate its influence on patient, provider and system outcomes. Design: Mixed-method systematic review and narrative synthesis. Methods: We conducted searches of MEDLINE, CINAHL, Web of Science, Cochrane Database of Systematic Reviews, and the grey literature from January 1985-August 2018, yielding 151 records. Pairs of reviewers independently applied the inclusion criteria using a standardized screening tool to both titles/abstracts and full texts. Overall, 13 studies were retained. Results: Most studies of single-room care were from the United States and Canada, and assessed costs, patient satisfaction and/or provider satisfaction. Studies used cross-sectional and/or pre-post comparative, retrospective descriptive and qualitative designs. Methodological quality of quantitative studies was generally weak, and few studies conducted inferential statistics. Maternal satisfaction with the single-room maternity model was positive across the studies; however, healthcare provider satisfaction was mixed.

An exploratory cost-effectiveness analysis: Comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Belgium.

OBJECTIVE: The objective of this study was to compare midwife-led and consultant-led obstetrical care for women with uncomplicated low-risk pregnancies. We estimated costs and maternal outcomes in both units to achieve a cost-effectiveness ratio. DESIGN: The cost-analysis was made according to the "intention to treat" concept in order to minimize bias associated with the non-randomization of participants. At the obstetric-led unit, women received care from both midwives and medical staff while those in the alternative structure called 'Le Cocon' only received care from midwives. SETTING: The obstetric-led unit of the Erasme University-Hospital in Brussels and its alongside midwife-led unit. PARTICIPANTS: The study population included all low-risk pregnant women from 1 March 2014 until 31 October 2015 who were affiliated to the MLOZ (Mutualités Libres-Onafhankelijke Ziekenfondsen; third Belgian statutory health care insurer). INTERVENTIONS: The cost calculation involved a bottom-up approach. The health care consumption of each participant was obtained from MLOZ's data. The study included costs occurred the beginning of pregnancy until 3 months post-partum. Clinical data were extracted from the patient medical records. FINDINGS: Compared to the traditional obstetric-led unit, the alternative midwife-led unit was associated with a cost reduction for the national payer (∆ = -€397.39, p = 0.046) and for the patient (∆ = - €44.19, p = 0.016). There were no significant differences in rates of caesarean, instrumental birth and epidural analgesia between MLU and OLU. A sensitivity analysis was performed (Appendix C) but does not change the overall results and conclusions. KEY CONCLUSIONS: Due to the small size of the samples, no statistical differences were found. More analysis is needed to evaluate the cost-effectiveness regarding the use of epidural analgesia, caesarean and instrumental birth rates in the midwife-led unit. IMPLICATIONS FOR PRACTICE: Given the economical findings, this could contribute to reduce health expenditures for both women (out of pocket) and state (public payer via health care insurers).

Impacto de la arquitectura del hospital en la experiencia de parto: un estudio fenomenológico con madres expertas en su diseño / Impact of hospital architecture on the birthing experience: a phenomenological study with mothers-to-be who are design experts

Fundamento. El lugar donde paren las madres condiciona su proceso de parto y nivel de satisfacción. El objetivo de este estudio es identificar las experiencias y percepciones acerca de los elementos de diseño del entorno del parto hasta el alta hospitalaria, que influyen en la experiencia de las madres a largo plazo. Metodología. Investigación fenomenológica de tipo método biográfico, a través del análisis temático inductivo de veinticinco testimonios de parto en el hospital, escritos por madres arquitectas, ingenieras, paisajistas o diseñadoras de interiores. Resultados. Los resultados se organizaron en cuatro temas y siete subtemas. El primer tema es la “Impresión a primera vista y largo plazo” que se subdivide en los subtemas “Itinerario despersonalizado en accesos y pasillos” y “Búsqueda instintiva de conexión con la naturaleza”. El segundo tema trata sobre el “Acompañamiento y arropamiento durante el proceso de parto” y se subdivide en “Como en un hotel: espacio para el movimiento y adaptación personalizada” y “Desamparo, frío e incertidumbre: espacios donde estar contra su voluntad”. El tercer tema son los “Daños (en espacios) colaterales”, que engloba “La integración de los aseos en el proceso de parto”, los “Quirófanos inmutables ante el parto por cesárea” y las “Salas de neonatos que no integran a las familias”. El cuarto tema incluye “Propuestas de mejora para nuevos diseños”. Conclusiones. Esta investigación permite profundizar en aspectos de diseño identificados en literatura reciente y mostrar que son necesarios más estudios que incorporen la experiencia de la mujer en el proceso del parto para promocionar políticas de diseño basadas en evidencias. (AU)

Background. The birthplace has a crucial role in shaping the childbirth experience and mothers’ satisfaction levels. This study aimed to identify the experiences and perceptions that may have an impact in the long-term on mothers’ birthing experience, considering hospital design features in the birthing environment until discharge. Methods. Inductive thematic analysis of twenty-five hospital labor testimonies employing a phenomenological research approach and utilizing a biographical method. Participants were women with a professional background in architecture, landscape architecture, engineering, or interior design. Results. The results are organized into four themes and seven subthemes. The first theme is “First sight and long term impression” which is subdivided into the subthemes “Depersonalized itinerary in entrances and corridors” and “Instinctive search for connection with nature”. The second theme deals with “Accompaniment and tucking in during the birthing process”, subdivided into “Hotel-like: space for movement and personalized adaptation” and “Helplessness, cold and uncertainty: spaces to be against one’s will”. The third theme is “Damage in collateral rooms”, which includes “The integration of toilets in the birthing process”, “Operating rooms unchangeable in the face of cesarean delivery” and “Neonatal units that do not integrate families”. Finally, the fourth theme includes “Improvement proposals for new designs”. Conclusions. This study contributes to the existing literature by deepening the understanding of the design features identified in hospitals in recent studies. Further research incorporating the experiences of women in the birthing process is needed to facilitate evidence-based design policies. (AU)

Experiences Influencing upon the Significance of Obstetric Care in Mexican Nurses.

OBJECTIVES: This work sought to learn which and how are the professional experiences that influence upon significance processes of obstetric care in nurses working in toco-surgery rooms. METHODS: This was a qualitative study with grounded theory approach. Individual interviews were conducted with 16 nurses who work in two public hospitals in a border city in northern Mexico. Data analysis was performed according to that proposed by Strauss and Corbin. RESULTS: Four categories were identified that explain the relationship established among the professional experiences and the significance processes of obstetric care; these are: Dilution of borders and demand for interculturality, Modification in the scale of values associated to care, Institutional and public policy crises, and Violence endured within the work setting. Obstetric care is signified within an imaginary that recognizes the existence of a globalized context, which requests problematizing the worldview not of the "other" but of "many others", and not merely from those receiving care, but also from other professionals who participate in institutional care. CONCLUSIONS: Significance processes analyzed show how the socio-historical situation and current policy require new attitudinal skills and knowledge for nursing to participate efficiently in obstetric care.

Comprehensive promotion of perinatal collaboration for extremely preterm infants / 中华围产医学杂志

Extremely preterm infants (EPIs) are extremely immature in organ development, vulnerable to various comorbidities after birth, and may result in high mortality and disability rates. The short- and long-term prognosis of EPIs is closely related to early management. In-depth collaboration between obstetricians and pediatricians is the key to improving their quality of life. Compared to developed countries, there is much to improve in the Chinese mainland, especially in perinatal collaboration. The attitude towards EPI treatment, prenatal prophylaxis, intrauterine transport, delivery room warmth, respiratory management in the delivery room, breastfeeding, family integrated care, cord blood stem cell therapy, and other issues in the field of perinatal collaboration in China is discussed in this article, to promote the collaborative work in related fields further.

Impact of resuscitation training program on neonatal outcomes in a region of high socioeconomic vulnerability in Brazil: an interventional study

Abstract Objectives: This pre/post-intervention study aimed to evaluate neonatal outcomes after the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Method: This interventional study was conducted across five secondary healthcare regions that supported 62 cities in the southwestern mesoregion of Piauí. It included 431 healthcare professionals responsible for neonatal care in the study region. The participants were trained in neonatal resuscitation through the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics. Delivery room structuring, healthcare professionals' knowledge, and neonatal care outcomes were analyzed immediately before and after intervention and after 12 months between February 2018 and March 2019, and healthcare professionals were evaluated. Results: Training was conducted for over 106 courses. As a participant could take multiple courses, 700 training sessions were conducted. Regarding delivery room structuring, the acquisition of materials required for resuscitation increased from 28.4 to 80.6% immediately after the intervention and to 83.3% after 12 months. Knowledge retention was significant in the post-training period, with a 95.5% approval rate, and knowledge acquisition was satisfactory after 12 months. The number of newborns transferred during the study period increased significantly. A 72.6% reduction in mortality at birth was recorded, and 479 newborns were resuscitated. Conclusion: Following the implementation of the Neonatal Resuscitation Program of the Brazilian Society of Pediatrics, structural improvements in delivery rooms, adequate knowledge retention regarding neonatal resuscitation, and a consequent reduction in neonatal mortality were observed.