Considerations for labor, delivery and postnatal care

Active management of labor reduces the length of labor and rate of prolonged labor, but its effect on satisfaction with care, within a randomized controlled trial, has not previously been reported. The study objectives were to establish if a policy of active management of labor affected any aspect of maternal satisfaction, and to determine the independent explanatory variables for satisfaction with labor care in a low-risk nulliparous obstetric population. Nulliparous women at National Women's Hospital in Auckland, New Zealand, in spontaneous labor at term with singleton pregnancy, cephalic presentation, and without fetal distress were randomized after the onset of labor to active management (n = 320) or routine care (n = 331). Active management included early amniotomy, two-hourly vaginal assessments, and early use of high dose oxytocin for slow progress in labor. Routine care was not prespecified. Maternal satisfaction with labor care was assessed by postal questionnaire at 6 weeks postpartum. Sensitivity analyses were performed, and logistic regression models were developed to determine independent explanatory variables for satisfaction. Of the 651 women randomized in the trial, 482 (74%) returned the questionnaires. Satisfaction with labor care was high (77%) and did not significantly differ by treatment group. This finding was stable when sensitivity analysis was performed. The first logistic regression model found independent associations between satisfaction and adequate pain relief, one-to-one midwifery care, adequate information and explanations by staff, accurate expectation of length of labor, not having a postpartum hemorrhage, and fewer than three vaginal examinations during labor. The second model found fewer than three vaginal examinations and one-to-one midwifery care as significant explanatory variables for satisfaction with labor care. Active management did not adversely affect women's satisfaction with labor and delivery care in this trial. Future studies should concentrate on measurement of potential predictors before and during labor.

Swaziland government has implemented several programs aimed at improving maternal and child health. Despite wide spread messages to promote utilization of health facilities for maternity care, some women continue to engage in risky practices during pregnancy, child birth and postnatal period. A significant amount of mothers still give birth at home without assistance of a health professional; hence the need to determine women’s satisfaction with maternity services provided in public hospitals. Purpose The aim of the study was to assess women’s satisfaction with maternity care during labour and childbirth, and postnatal care at a regional public hospital. It also identified maternity care experiences and demographic characteristics that influence overall satisfaction with childbirth in hospital. Methods A cross sectional survey using structured interview questionnaire was used to obtain data from a sample of 198 women during their postnatal hospital stay. Descriptive statistics were computed for the demographic characteristics, intrapartum and postpartum care responses. Pearson correlations, one-way ANOVA and t-test were used to examine association between variables. Finally, multiple linear regression analysis using stepwise method was conducted to identify predictors of satisfaction using demographic variables, intrapartum care and postpartum care experiences. An alpha level of .05 was used to all statistical tests. Results Participants were generally more satisfied with postnatal care compared to labour and delivery care. Respecting women description of discomfort or pain and staff kindness during labour were the strongest predictors of satisfaction with maternity care. Other predictors were; level of education, gender of birth assistant and being left alone during labour and birth. Together these variables explained 44.6% of variation in maternity satisfaction, (F = 30.932, p <.001). Conclusion Intrapartum care experience is very important in women satisfaction with maternity care specifically patient/provider interaction during labour and childbirth. Maternity care providers should be sensitized on the findings that showing an uncaring attitude is associated with lower satisfaction. As a result maternal health programs should foster provider empathy and good communication skills in childbirth.

BackgroundA woman’s satisfaction with labour and delivery care service has a good effect on her health and subsequent utilization of the services. Thus knowledge about women’s satisfaction on labour and delivery care used to enhances the services utilization. The objective of this study was to assess the satisfaction of women’s towards labour and delivery care service and identify factors associated it at public health facilities in Arba Minch town and the surrounding district, Gamo Gofa zone, southern Ethiopia.MethodsFacility based cross sectional study was conducted among women who gave birth at public health facility. A total 256 women who gave birth during the study period were included in the study. Data was collected using a structured questionnaire. Satisfaction level was measured using a 5 point- likert scale questions. Data were entered using Epi data version 3.5.1 and analyzed using SPSS 20.0 statistical software. Factor analysis was employed for likert scale questions to extract factor represented each of the scale which facilitate treatment of variable as continuous for further analysis. Bi-variate and multivariable logistic regression analysis was employed to identify association between women’s satisfaction and predicator variables. Statistical significance was declared at P value <0.05 on final model. The strength of association was interpreted using the adjusted odds ratio and 95 % CI.ResultThis study revealed that 90.2 % of women who gave birth in public health facilities were satisfied with labour and delivery care. Factors associated with women’s satisfaction with labour and delivery care services include: not attending formal education [AOR = 8.00, 95 % CI = (1.52, 12.27)] attending antenatal care four times and more [AOR = 5.00, 95 % CI = (1.76, 14.20)] waiting below 15 minutes to be seen by health professional [AOR = 3.37, 95 % CI = (1.14, 9.97)] and not paying for drugs and supplies [AOR = 6.19, 95 % CI = (1.34, 18.59)].ConclusionAlthough majority of women were satisfied with the labour and delivery service they got, their level of satisfaction was influenced by educational status, number of ANC visits, waiting time, and payment for drug and supplies. Thus, public health intervention working on improving delivery care should consider these factors.

Moral diversity and abortion care in labor and delivery

Postnatal care is an integral part of maternity care and support, but NHS England's national data have consistently shown an unmet need in postnatal care. This article describes the outcomes of an improvement project that used design thinking methodology to understand the experiences, needs and challenges in an NHS postnatal ward in London, then used these insights to co-design a solution to support the delivery of joint-up mother and baby care. Challenges identified included difficulties coordinating care and reliance on standalone communication systems (such as paper-based ward handover sheets and wipe-down whiteboards for ward activity planning). The project aimed to improve communication and information sharing, ward discharge processes, time and resource management, and data capability. This involved a co-designed, bottom-up digital innovation that centralised all operational processes relevant to postnatal ward care, implemented at the trust in December 2018. The bespoke online portal integrates mother and baby care, and helps to ensure joined-up working among healthcare professionals, with real-time data and predictive analysis to inform integrated, dynamic and iterative responses to an individual maternity system's operational needs and challenges. Learning from this approach is shared in this article, with recommendations for future practice.

Understanding the developmental, cellular, and circuit processes across the postnatal period is crucial for elucidating the complexities of brain development and its impact on behavioral and social maturation. The transition from infant to adulthood involves significant neurobiological changes, including synaptic pruning and myelination, which are fundamental for cognitive abilities, emotional regulation, and social interactions. Studying brain development in prepubertal mice enables researchers to identify critical periods that support healthy brain growth and to establish timely interventions for neurodevelopmental disorders. To precisely dissect brain function, stereotaxic surgery has been a pivotal technique in neuroscience research, offering unparalleled precision in targeting brain regions of interest and allowing the delivery of viral agents. Even though stereotaxic surgeries in adult mice are widely implemented across neurobiology labs, there are very limited guidelines for performing stereotaxic surgeries in prepubertal mice, as well as crucial postoperative care to ensure the infant can be successfully reintroduced to its dam and littermates. Here, we describe a protocol for stereotaxic surgery and viral injection in infant (P11-P12) mice, highlighting anesthesia and analgesia delivery, considerations for postoperative care, and differences from stereotaxic surgery in adults. This protocol can be implemented in any brain region of interest by updating the desired target coordinates and can be modified for brain targeting at later stages in postnatal development, such as during the juvenile period (P15-P30). Overall, this protocol provides an entry point for the study of postnatal brain development and function.

BackgroundEthiopia has low skilled birth attendance rates coupled with low quality of care within health facilities contributing to one of the highest maternal mortality rates in Sub-Saharan Africa, at 412 deaths per 100,000 live births. There is lack of evidence on the readiness of health facilities to deliver quality labor and delivery (L&D) care. This paper describes the structural quality of routine L&D care in government hospitals of Ethiopia.MethodsA facility-based cross-sectional study design, involving census of all government hospitals in Southern Nations Nationalities and People’s Region (SNNPR) (N = 20) was conducted in November 2016 through facility audit using a structured checklist. Data collectors verified the availability and functioning of the required items through observation and interview with the heads of labor and delivery case team. An overall mean score of structural quality was calculated considering domain scores such as general infrastructure, human resource and essential drugs, supplies, equipment and laboratory services. Summary statistics such as proportion, mean and standard deviation were computed to describe the degree of adherence of the hospitals to the standards related to structural quality of routine labor and delivery care.ResultsOne third of hospitals had low readiness to provide quality routine L&D care, with only two approaching near fulfilment of all the standards. Hospitals had fulfilled 68.2% of the standards for the structural aspects of quality of L&D care. Of the facility audit criteria, the availability of essential equipment and supplies for infection prevention scored the highest (88.8%), followed by safety, comfort and woman friendliness of the environment (76.4%). Availability skilled health professionals and quality management practices scored 72.5% each, while availability of the required items of general infrastructure was 64.6%. The two critical domains with the lowest score were availability of essential drugs, supplies and equipment (52.2%); and laboratory services and safe blood supply (50%).ConclusionSubstantial capacity gaps were observed in the hospitals challenging the provision of quality routine L&D care services, with only two thirds of required resources available. The largest gaps were in laboratory services and safe blood, and essential drugs, supplies and equipment. The results suggest the need to ensure that all public hospitals in SNNPR meet the required structure to enable the provision of quality routine L&D care with emphases on the identified gaps.

Strengthening measurement of the quality of labor and delivery (L&D) care in low-resource countries requires an understanding of existing approaches. To identify quantitative indicators of L&D care quality and assess gaps in indicators. PubMed, CINAHL Plus, and Embase databases were searched for research published in English between January 1, 1990, and October 31, 2013, using structured terms. Studies describing indicators for L&D care quality assessment were included. Those whose abstracts contained inclusion criteria underwent full-text review. Study characteristics, including indicator selection and data sources, were extracted via a standard spreadsheet. The structured search identified 1224 studies. After abstract and full-text review, 477 were included in the analysis. Most studies selected indicators by using literature review, clinical guidelines, or expert panels. Few indicators were empirically validated; most studies relied on medical record review to measure indicators. Many quantitative indicators have been used to measure L&D care quality, but few have been validated beyond expert opinion. There has been limited use of clinical observation in quality assessment of care processes. The findings suggest the need for validated, efficient consensus indicators of the quality of L&D care processes, particularly in low-resource countries.

Postnatal care (PNC) plays a crucial role in averting newborn mortality, yet its use remains low, particularly in regions with the highest mortality. While demographic and social determinants of PNC use have been well studied and have informed current strategies focused on changing care-seeking behaviors, the stagnating decline in neonatal mortality highlights the need for upstream and system-wide approaches to increase PNC uptake. Limited evidence exists to guide system-level reforms; therefore, we investigated whether health systems that ensure high-quality perinatal care are associated with increased use of PNC. We performed a cross-sectional observational study using Demographic and Health Survey data from 38 countries that had not met SDG neonatal mortality targets by 2020. The study population comprised women aged 15-49 years whose most recent live birth occurred within five years preceding the survey. We employed logistic regression models with country fixed effects to examine associations between: (1) perinatal service utilization, (2) service quality; and their relationship with postnatal checkups for newborns within 28 days. We analyzed utilization-quality interactions to determine how the effects of service coverage on PNC use varied by care quality and conducted wealth-stratified analyses to assess how quality effects on PNC use differed across socioeconomic groups. High-quality perinatal care was associated with a 2-fold increase in the probability of postnatal checkups within 28 days (0.406 in the highest quality tertile versus 0.221 in the lowest quality tertile). For mothers who received the lowest tertile of service quality, full utilization of perinatal services yielded negligible changes in postnatal checkup probability (0.217 to 0.216). Conversely, for mothers who received the highest quality of antenatal and perinatal care, full access to perinatal care improved the probability of postnatal check-ups (0.392 to 0.428). Notably, women in the lowest wealth quintile experienced a substantial increase in postnatal checkup probability from 0.224 to 0.481 between low and high-quality care cohorts, while this differential was less pronounced in the highest wealth quintile (0.236 to 0.450). Key limitations include restricted quality indicators, potential recall bias from self-reported measures, limited information on follow-up care, and the cross-sectional nature of the data, which limits causal interpretation. Our interaction analysis reveals a critical insight: high-quality care substantially enhanced the magnitude of the association between expanded perinatal service use and PNC use, whereas increased utilization alone was not linked to higher PNC uptake. Notably, the impact of improved care quality was most pronounced among the lowest wealth groups, highlighting its potential as a mechanism for promoting equity. By demonstrating the central role of care quality in promoting PNC utilization, particularly among disadvantaged populations, our findings suggest that improving health system quality could be a more effective strategy for achieving universal maternal healthcare coverage than traditional access-focused approaches.

Introduction The postpartum period carries substantial risk for preventable morbidity, particularly among individuals with high-risk pregnancies complicated by chronic or pregnancy-associated conditions. Despite recommendations for early and ongoing postpartum follow-up, patterns of postpartum and acute care utilization across high-risk conditions remain poorly characterized. We evaluated postpartum and acute care utilization among individuals with high-risk pregnancies versus low-risk pregnancies in an urban safety-net health system. Methods We conducted a retrospective cohort study of individuals who delivered at two campuses of a tertiary academic medical center between 1 June 2018 and 31 May 2022. High-risk pregnancy status was defined using ICD-9/10 codes corresponding to chronic medical or pregnancy-associated conditions; low-risk was defined by the absence of these codes. The primary outcome was attendance of ≥1 postpartum visit (PPV) within 12 weeks of delivery. Secondary outcomes included emergency department (ED) visits and hospital readmissions within 12 weeks postpartum. Multivariable logistic regression was used to estimate adjusted odds ratios (aORs). Results Of 13,874 included individuals, 9435 (68.0%) had ≥1 high-risk diagnosis, and nearly half had multiple coexisting conditions. High-risk individuals were more likely than low-risk individuals to attend any PPV (59.2% vs. 45.4%) and an early PPV within 21 days (40.5% vs. 24.2%, both p < 0.001). ED visits (16.9% vs. 13.9%) and readmissions (5.4% vs. 2.7%) were also more frequent among high-risk individuals (p < 0.001). In adjusted analyses, hypertensive disorders of pregnancy (aOR 1.67), mental health conditions (aOR 1.49), cesarean delivery, and greater prenatal care utilization were associated with higher odds of PPV attendance, while gestational diabetes was associated with lower odds (aOR 0.79). High-risk conditions, particularly hypertensive disorders and pregestational diabetes, were associated with increased acute care utilization. Conclusions Although high-risk individuals were more likely to attend PPVs, overall engagement remained suboptimal and acute care utilization was high. These findings highlight the need for risk-tailored postpartum care and improved care coordination to reduce preventable morbidity.

The role of naturopathy in pregnancy, labour and post-natal care: Broadening the evidence-base

BackgroundThe maternal, newborn and child health care continuum require that mother/child pair should receive the full package of antenatal, intrapartum and postnatal care in order to derive maximum benefits. Continuity of care is a challenge in sub-Saharan Africa. In this study, we investigate the patterns and factors associated with dropout in the continuum of maternity (antenatal, delivery and postnatal) care in Nigeria.MethodUsing women recode file from the 2013 Nigeria Demographic and Health Survey, we analysed data on 20,467 women with an index birth within 5 years prior to data collection. Background characteristics and pattern of dropouts were summarised using descriptive statistics. The outcome variable was dropout which we explored in three stages: antenatal, antenatal-delivery, delivery-6 weeks postnatal visit. Multilevel logistic regression models were fitted to identify independent predictors of dropout at each stage. Measure of effect was expressed as Odds Ratio (OR) with 95 % confidence interval (CI).ResultsOverall, 12,392 (60.6 %) of all women received antenatal care among whom 38.1 % dropout and never got skilled delivery assistance. Of those who received skilled delivery care, 50.8 % did not attend postnatal visit. The predictors of dropout between antenatal care and delivery include problem with getting money for treatment (OR = 1.18, CI: 1.04–1.34), distance to health facility (OR = 1.31, CI: 1.13–1.52), lack of formal education, being in poor wealth quintile (OR = 2.22, CI: 1.85–2.67), residing in rural areas (OR = 1.98, CI: 1.63–2.41). Regional differences between North East, North West and South West were significant. Between delivery and postnatal visit, the same factors were also associated with dropout.ConclusionThe rate of dropout from maternity care continuum is high in Nigeria and driven by low or lack of formal education, poverty and healthcare access problems (distance to facility and difficulty with getting money for treatment). Unexpectedly, dropouts are high in South east and South south as well as in the Northern regions. Intervention programs focusing on community outreach about the benefits of continuum of maternal healthcare package should be introduced especially for women in rural areas and lower socio-economic strata.

Indigenous practices are performances that occur naturally in a region. Most women believe in Indigenous practices because of their cultures and social structure. In South Africa, regardless of the availability and accessibility of maternal and child health services, 50% of women still consult traditional birth attendants as their first choice during pregnancy, labour, delivery and postnatal care. A qualitative research approach was applied with an explorative and descriptive design to explore the Indigenous practices of women during pregnancy, labour and puerperium among cultural groupings. Non-probability purposive sampling was used to select 25 participants and data was collected through semi-structured interviews with a guide until data saturation was reached. Data was analysed using tech’s open coding method. The study showed most women use Indigenous practices for protection against witchcraft and a fear of caesarean section. This study will help pregnant women to be aware of the harmful Indigenous practices that can affect their own health and that of their baby. It will also help nurses provide holistic nursing care, taking into consideration pregnant women’s cultures and beliefs. The study recommends that nursing education include Indigenous practices in the curriculum so that healthcare practitioners know about them. This could reduce maternal and child morbidity and mortality.

Postnatal care (PNC) is essential for early identification and management of life-threatening obstetric complications. Despite efforts by the Ethiopian government to improve maternal and child health service use, PNC service has remained low, and disparity across geographic locations is a major public health problem. This study aimed to investigate the change and contributing factors in PNC service use across geographical locations (rural-urban) and over time (2016 to 2019) in Ethiopia. We analyzed data on women who gave birth from the 2016 and 2019 Ethiopian Demographic and Health Surveys. A total of 6,413 weighted samples (4,308 in 2016 and 2,105 in 2019) were included in the analysis. A multivariate decomposition analysis technique was used to determine the change and identify factors that contributed to the change across geographical locations and over time. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05. The prevalence of PNC use was higher among urban residents, and the urban-rural disparity reduced from 32.59% in 2016 to 19.08% in 2019. The difference in the composition of explanatory variables was the only statistically significant for the urban-rural disparity in PNC use in both surveys. Specifically, female household heads (4.51%), delivery at a health facility (83.45%), and birth order of two to three (5.53%) and four or more (-12.24%) in 2016 significantly contributed to the urban-rural gap. However, in 2019, middle wealth index (-14.66%), Muslim religion (3.84%), four or more antennal care contacts (18.29%), and delivery at a health facility (80.66%) significantly contributed to the urban-rural gap. PNC use increased from 16.61% in 2016 to 33.86% in 2019. About 60% of the explained change was due to the difference in the composition of explanatory variables. Particularly, urban residence (-5.79%), a rich wealth index (2.31%), Muslim (3.42%), and other (-2.76%) religions, having radio or television (1.49%), 1-3 (-1.13%), and 4 or more (11.09%) antenatal care contacts, and delivery at a health facility (47.98%) were statistically significant contributors to the observed change. The remaining 40% of the overall change was due to the difference in unknown behaviors (coefficient) of the population towards PNC. There was a significant change in PNC service use by residence location and over time in Ethiopia, with urban women in both surveys being more likely to use PNC service. The urban-rural disparity in PNC uptake was due to the difference in the composition of explanatory variables, whereas the change over time was due to the change in both the composition of explanatory variables and population behavior towards PNC. Increased antenatal care contacts and delivery at a health facility played a major role in explaining the gap in PNC services across residences and over time in Ethiopia, highlighting the importance of stepping up efforts to enhance their uptake in rural settings.

The annual Research and the Midwife conference was first held in the UK in 1978. Its purpose was to present to the profession research that was relevant to the practice of midwifery and the conference has allowed studies of varying sizes to be presented. Some of these studies are not extensive enough to warrant a single chapter each but the studies are of sufficient importance to merit wider dissemination than can be achieved in the conference proceedings. In Volume III of this series some studies of care in labour were presented (Thomson, 1994). In this chapter three studies of care in the postnatal period are described; the development of the FIRST score to assess mother—baby relationships in the early postnatal period (Salariya, 1983), early transfer home from hospital after birth (Whelton, 1992) and an assessment of the value of the six weeks’ postnatal examination (Bowers, 1985). Each study is described and the findings are discussed in the light of literature published since the research was undertaken. However, no attempt has been made to undertake a comprehensive review of the literature for each of the study subjects. In the final section lessons which can be learnt and implications for practice and further research are discussed.