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Showing results for tags 'Labour'.
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Content ArticleIn this article for The Guardian, Dr Kara Thompson, an obstetrician and gynaecologist working in the public hospital system in Geelong and Melbourne, Australia, argues that women must be given clear and unbiased information in order to make informed decisions about their birth preferences. She highlights the case of an information brochure about caesarean birth published on the website of a hospital in New South Wales, which presented incorrect claims about the relative risks presented by vaginal and caesarean birth. She outlines how the leaflet indicates that the way women are informed about birth choices is still subject to fear-mongering and shaming, and highlights the need for healthcare workers to respect maternal choice and autonomy.
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Content ArticleIn Sierra Leone, 34% of pregnancies and 40% of maternal deaths are amongst teenagers and risks are known to be higher for younger teenagers. This qualitative study in Reproductive Health aimed to explore the causes of this high incidence of maternal death for younger teenagers, and to identify possible interventions to improve outcomes. Through focus groups and semi-structured interviews, the authors identified transactional sex - including sex for school fees, sex with teachers for grades and sex for food and clothes - as the main cause of high pregnancy rates for this group. They also identified gendered social norms for sexual behaviour, lack of access to contraception and the fact that abortion is illegal in Sierra Leone as factors meaning that teenage girls are more likely to become pregnant. Key factors affecting vulnerability to death once pregnant included abandonment, delayed care seeking and being cared for by a non-parental adult. Their findings challenge the idea that adolescent girls have the necessary agency to make straightforward choices about their sexual behaviour and contraceptives. They identify a mentoring scheme for the most vulnerable pregnant girls and a locally managed blood donation register as potential interventions to deal with the high rate of maternal death amongst teenage girls.
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Content ArticleThis guide is designed to support healthcare providers when talking to patients about the use of of oxytocin to start or advance labour.
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Content ArticleThe purpose of this investigation by the Healthcare Safety Investigation Branch (HSIB) was to consider the management and care of preterm labour and birth of twins. Preterm birth—defined as babies born alive before the completion of 37 weeks of pregnancy—is one of the main causes of death, long-term conditions and disability in under-fives worldwide, and 60% of twin pregnancies result in premature birth. The reference event for this investigation was the case of Sarah, who was pregnant with twins and was overseen by an obstetrician during her pregnancy. Sarah was assessed as having a higher-risk pregnancy as she had had previous medical intervention on her cervix and was pregnant with twins. Shortly after having been discharged from a hospital with a specialist neonatal unit following suspected early labour, she went to her local maternity unit at 29+2 weeks with further episodes of abdominal tightening. Her labour did not progress as expected and a caesarean section was required to deliver the babies at 29+6 weeks. The twin girls were born well, but 23 days after their birth a scan revealed brain injury in both babies. The investigation identified several findings to explain the experience of the mother in the reference event, including the lack of scientific evidence or specific guidelines and the uncertainty associated with the clinical decision making in this scenario. This highlighted the need for further research into preterm labour as a recognised risk factor for twin pregnancies. As part of the investigation, HSIB identified that since 2019 a large volume of national work and research in the area of twin pregnancy and preterm birth has been undertaken. The investigation report sets out the work currently in progress and seeks to understand if it will address gaps in knowledge.
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Content ArticleThe Birth Injury Help Center is a US-based online resource centre that provides information on birth injuries, as well pregnancy and childbirth. This article provides information for pregnant women about foods, drinks, medications and activities to avoid during pregnancy.
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Content ArticleWorldwide, most Caesarean sections (CS) are performed under neuraxial anaesthesia. However, neuraxial anaesthesia can fail and intraoperative breakthrough pain can occur. The aim of this study from Roofthooft et al. was to evaluate the incidence of breakthrough pain in consecutive CS and to describe the potential risk factors for breakthrough pain. In a two centre, prospective audit all CS performed under neuraxial anesthesia were included and the occurrence of breakthrough pain as well as all possible risk factors of breakthrough pain were recorded as well as the alternative anesthetic strategy.
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Content ArticleHarry Richford was born at the Queen Elizabeth the Queen Mother Hospital (QEQM), Margate, Kent on 2/11/17. He died on 9/11/17 at the William Harvey Hospital, Ashford to where he had been transferred. The cause of death was 1a Hypoxic Ischaemic Brain Encephalopathy. There was a narrative conclusion setting out some seven failures in the care of Harry Richford together with a conclusion that his death was contributed to by neglect.
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Content ArticleThis article tells the story of Baby E, who died two hours after delivery following issues with the management of her labour. The maternity unit was short-staffed on the night of Baby E's birth and there were delays in getting her mother to theatre for a caesarean section. Baby E's parents felt that the hospital withheld information from them, failing to inform them of internal investigations that had taken place following Baby E's death. At the inquest, the coroner concluded that errors had been made, including the fact that Baby E's low heart rate had been missed. She also criticised the decision-making process in the management of labour, but concluded that she was unable to say whether this had made a difference to whether or not Baby E lived.
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Content ArticleThis realist evaluation aimed to explore and explain the ways in which a programme initiated by the Scottish Government, Keeping Childbirth Natural and Dynamic (KCND), worked or did not work in different maternity care contexts. KCND was a maternity care programme that aimed to support normal birth by implementing multiprofessional care pathways and making midwife-led care for healthy pregnant women the national norm.
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Content ArticleIdentifying improvements in maternity care to help reduce the risk of delays in crucial interventions during labour when a baby is suspected to be unwell is the focus of this latest Healthcare Safety Investigation Branch (HSIB) report. The report was compiled after a review of 289 of our maternity investigations into intrapartum stillbirths, neonatal deaths and potential severe brain injuries. In 14.9% of the cases the delay was a contributory factor. The review identified issues such as inadequate staffing, poor infrastructure and high workload as contributory factors to the delays. Evidence from national reports confirms that such delays are a recognised patient safety risk.
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Content ArticleThe aim of this study from Jardine et al. was to determine the rate of complicated birth at term in women classified at low risk according to the National Institute for Health and Care Excellence guideline for intrapartum care (no pre-existing medical conditions, important obstetric history, or complications during pregnancy) and to assess if the risk classification can be improved by considering parity and the number of risk factors. The authors found nulliparous women without risk factors have substantially higher rates of complicated birth than multiparous women without a previous caesarean section even if the latter have multiple risk factors. Grouping women first according to parity and previous mode of birth, and then within these groups according to presence of specific risk factors would provide greater and more informed choice to women, better targeting of interventions, and fewer transfers during labour than according to the presence of risk factors alone.
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Content ArticlePatient Safety Movement Foundation is joined in this video by Kourtney Wilson, Clinical Practice Consultant, Regional Patient Care Services, Maternal Child Health-Obstetrical Concentration, Kaiser Permanente, to discuss the need for standardised massive transfusion protocols in the context of postpartum haemorrhage (PPH) and the common barriers hospitals face in effectively establishing these protocols.
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Content ArticleUK 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, published in PLOS ONE, 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.' Due to the wide range of women’s choices this study reported, the knowledge generated has applications as heuristic knowledge which can be used by midwives more broadly within their clinical care delivery. The benefits being that the findings can be applied to most ‘out of guidelines’ clinical situations by any maternity professional. Delivering such care can be achieved by meaningful engagement with women’; through mechanisms of trust and information sharing, care plans and safety measures can be implemented to support women’s autonomous decision-making.
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Content ArticleGeneral anaesthesia for obstetric surgery has distinct characteristics that may contribute towards a higher risk of accidental awareness during general anaesthesia. The primary aim of this study from Odor et al. was to investigate the incidence, experience and psychological implications of unintended conscious awareness during general anaesthesia in obstetric patients. Researchers discovered that one in 256 women going through pregnancy-related surgery are aware of what was going on — a far higher proportion than the one in every 19,000 identified in a previous national audit. If a patient is conscious at some point while under general anaesthetic, they may be able to recall events from the surgery such as pain or the sensation of being trapped, the researchers said.
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Content ArticleThe Early Notifcation scheme is a national programme for the early reporting of infants born with a potential severe brain injury following term labour to NHS Resolution. This leaflet has been produced as an overview to highlight the: key findings of the report six recommendations information on our collaborative partners and other resources available on our website including information on supporting staff and families.
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Content ArticleA framework has been developed by the Royal College of Obstetricians and Gynaecologists (RCOG), Royal College of Midwives and the Society and College of Radiographers, in partnership with NHS England and NHS Improvement, to support maternity services with the local reintroduction of hospital visitors and individuals accompanying women to appointments. This framework has been designed to assist NHS trusts to reintroduce access for partners, visitors and other supporters of pregnant women in English maternity services. It applies to inpatient and outpatient settings. Reintroducing visits is challenging during a pandemic, and the priority must be the safety of all service users (including pregnant women), staff and visitors.
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Content Article
National Learning Reports offer insight and learning about recurrent patient safety risks in NHS healthcare that have been identified through HSIB investigations. They present a digest of relevant, previously investigated events, highlight recurring themes and, where appropriate, make safety recommendations. National learning reports can be used by healthcare leaders, policymakers and the public to aid their knowledge of systemic patient safety risks and the underlying contributory factors, and to inform decision making to improve patient safety. The Healthcare Safety Investigation Branch (HSIB) Summary of themes arising from HSIB maternity investigation programme report (March 2020) describes eight themes arising from the maternity investigations. Sudden unexpected postnatal collapse (SUPC) was identified as a theme for further exploration in order to highlight areas of system-wide learning. SUPC is a rare but potentially fatal event in otherwise healthy appearing term (born after 37 completed weeks) newborn babies at birth. Between April 2018 and August 2019 HSIB completed 335 maternity investigations. Of the 12 identified SUPC cases, there were 6 cases where positioning of the baby to achieve skin-to-skin contact may have contributed to SUPC. While the number of incidents found was small compared to the number of term babies who had skin-to-skin contact at birth these incidents may in future be avoided and so learning is essential. -
Content Article
Midwifery during COVID-19: A personal account
Anonymous posted an article in Blogs
I am a case loading midwife, working during the coronavirus pandemic. This is my personal account of what we are doing in my area to keep our women and ourselves safe, and the barriers we are facing.- Posted
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