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The Cochrane Database of Systematic... Apr 2016Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care.
OBJECTIVES
To compare midwife-led continuity models of care with other models of care for childbearing women and their infants.
SEARCH METHODS
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies.
SELECTION CRITERIA
All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth.
DATA COLLECTION AND ANALYSIS
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach.
MAIN RESULTS
We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence). Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.07; participants = 16,687; studies = 12; high quality). There were no differences between groups for caesarean births or intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (average RR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = four), episiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants = 17,674; studies = 14) and fetal loss less than 24 weeks and neonatal death (average RR 0.81, 95% CI 0.67 to 0.98; participants = 15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = seven), have a longer mean length of labour (hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = three) and more likely to be attended at birth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = seven). There were no differences between groups for fetal loss equal to/after 24 weeks and neonatal death, induction of labour, antenatal hospitalisation, antepartum haemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birthweight infant, five-minute Apgar score less than or equal to seven, neonatal convulsions, admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models.
AUTHORS' CONCLUSIONS
This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and all fetal loss/neonatal death associated with midwife-led continuity models of care.
Topics: Amnion; Analgesia, Obstetrical; Cesarean Section; Continuity of Patient Care; Episiotomy; Female; Humans; Infant; Infant Mortality; Infant, Newborn; Midwifery; Models, Organizational; Patient Satisfaction; Perinatal Care; Postnatal Care; Pregnancy; Prenatal Care; Randomized Controlled Trials as Topic
PubMed: 27121907
DOI: 10.1002/14651858.CD004667.pub5 -
Breastfeeding Medicine : the Official... May 2015This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority... (Review)
Review
This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.
Topics: Breast Feeding; Ethnicity; Female; Health Education; Health Knowledge, Attitudes, Practice; Healthcare Disparities; Humans; Infant; Infant, Newborn; Maternal Health Services; Minority Groups; Mothers; Postnatal Care; Social Support; United States
PubMed: 25831234
DOI: 10.1089/bfm.2014.0152 -
Ciencia & Saude Coletiva 2019Puerperium is a period of significant morbimortality for women, and Primary Health Care (PHC) is important in developing actions to meet women's health needs. This study... (Review)
Review
Puerperium is a period of significant morbimortality for women, and Primary Health Care (PHC) is important in developing actions to meet women's health needs. This study aimed to systematize the knowledge produced on postpartum care programs actions within PHC at both national and international levels. This is an integrative review of the literature in databases LILACS (Latin American and Caribbean Health Sciences Literature), BDENF (Nursing Database), SciELO (Scientific Electronic Library Online) and PubMed (US National Library of Medicine). Search was performed in the period April-May 2017. Forty-three papers met the selection criteria. Results indicate that PHC has the physical structure to provide puerperae with care, but has a shortage of human and material resources; there is low postpartum consultation coverage and home visits; there is a good evaluation of the incentive for breastfeeding, but focused on the child; international screening of Postpartum Depression through the Edinburgh Postnatal Depression Scale and care shortage for this condition in Brazil. Postpartum care still focuses on care for the newborn and is mostly restricted to the immediate and late puerperium.
Topics: Brazil; Child Health Services; Female; House Calls; Humans; Infant, Newborn; Maternal Health Services; Postnatal Care; Postpartum Period; Primary Health Care
PubMed: 31664395
DOI: 10.1590/1413-812320182411.28112017 -
American Family Physician Oct 2019The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient...
The postpartum period, defined as the 12 weeks after delivery, is an important time for a new mother and her family and can be considered a fourth trimester. Outpatient postpartum care should be initiated within three weeks after delivery in person or by phone, and may require multiple contacts with the patient to fully address needs and concerns. A full assessment is recommended within 12 weeks. Care should initially focus on acute needs and risks for morbidity and mortality and then transition to care for chronic conditions and health maintenance. Complications of pregnancy, such as hypertensive disorders and gestational diabetes mellitus, affect a woman's long-term health and require specific attention. Women diagnosed with gestational diabetes should receive a 75-g two-hour fasting oral glucose tolerance test between four and 12 weeks postpartum. Patients with hypertensive disorders of pregnancy should have a blood pressure check performed within seven days of delivery. All women should have a biopsychosocial assessment (e.g., depression, intimate partner violence) screening in the postpartum period, and preventive counseling should be offered to women at high risk. Additional patient concerns may include urinary incontinence, constipation, breastfeeding, sexuality, and contraception. Treating these issues during the postpartum period is important to the new mother's immediate and long-term health.
Topics: Breast Feeding; Curriculum; Education, Medical, Continuing; Female; Humans; Mothers; Postnatal Care; Postpartum Period; Practice Guidelines as Topic
PubMed: 31613576
DOI: No ID Found -
Journal of Advanced Nursing Oct 2019To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress. (Randomized Controlled Trial)
Randomized Controlled Trial
AIM
To determine if an electronic nursing intervention during the first 6 months postpartum was effective in improving mood and decreasing stress.
BACKGROUND
Unmet needs postpartum can have a negative impact on mood and parenting stress. Technology-assisted nursing care may provide needed support and reduce risk.
DESIGN
Randomized controlled trial (RCT) with three conditions.
METHODS
Enrollment began on 11 May 2017. Participants were randomized into one of three groups after completion of the baseline survey. Intervention I participants received standardized electronic messages four times/week for 6 months postpartum. Intervention II participants additionally received the option for nurse contact. Depression and parenting stress as measured using the Edinburgh Postnatal Depression Scale (EPDS) and Parenting Stress Index-Short form (PSI-SF) was obtained at 3 weeks, 3 months and 6 months postpartum and results compared with a usual care group. Patient satisfaction and nursing factors were measured.
RESULTS
Significantly higher satisfaction scores were found in both intervention groups as compared with control, but there were no significant changes in EPDS or PSI-SF.
CONCLUSION
The interventions were perceived as helpful and not burdensome. Better nurse-sensitive outcome measures are needed to adequately assess effectiveness.
IMPACT
Postpartum women report unmet needs for support and education. The interventions were perceived as being helpful but did not significantly reduce depressive symptoms or parenting stress. Nurses can use this research to inform development of innovative approaches to support postpartum women.
TRIAL REGISTRATION NUMBER
ClinicalTrials.gov NCT02843022.
Topics: Adult; Depression, Postpartum; Female; Humans; Inventions; Mothers; Postnatal Care; Pregnancy
PubMed: 31222789
DOI: 10.1111/jan.14114 -
BMC Pregnancy and Childbirth Feb 2016Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a... (Randomized Controlled Trial)
Randomized Controlled Trial
Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial.
BACKGROUND
Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.
METHODS
Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.
RESULTS
Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).
CONCLUSION
For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.
TRIAL REGISTRATION
Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).
Topics: Adult; Continuity of Patient Care; Female; Follow-Up Studies; Humans; Midwifery; Patient Satisfaction; Perinatal Care; Postnatal Care; Pregnancy; Prenatal Care; Surveys and Questionnaires; Victoria
PubMed: 26841782
DOI: 10.1186/s12884-016-0798-y -
Best Practice & Research. Clinical... Jul 2020Thyroid hormone (TH) is indispensable for normal embryonic and fetal development. Throughout gestation TH is provided by the mother via the placenta, later in pregnancy... (Review)
Review
Thyroid hormone (TH) is indispensable for normal embryonic and fetal development. Throughout gestation TH is provided by the mother via the placenta, later in pregnancy the fetal thyroid gland makes an increasing contribution. Maternal thyroid dysfunction, resulting in lower or higher than normal (maternal) TH levels and transfer to the embryo/fetus, can disturb normal early development. (Maternal) thyroid dysfunction is mostly caused by autoimmune hypo- or hyperthyroidism, i.e. Hashimoto and Graves disease. Autoimmune hyperthyroidism is caused by stimulating TSH receptor antibodies (TSHR Ab), patients with autoimmune hypothyroidism may have blocking TSHR Ab. Maternal TSHR Ab cross the placenta from mid gestation and may cause fetal and transient neonatal hyper- or hypothyroidism. Anti-thyroid drugs taken for autoimmune hyperthyroidism cross the placenta throughout gestation, and may cause fetal and transient neonatal hypothyroidism. This review focusses on the consequences of maternal hypo- and hyperthyroidism for fetus and neonate, and provides a practical approach to clinical management of neonates born to mothers with thyroid dysfunction.
Topics: Female; Humans; Infant Care; Infant, Newborn; Infant, Newborn, Diseases; Postnatal Care; Pregnancy; Pregnancy Complications; Prenatal Care; Prenatal Exposure Delayed Effects; Thyroid Diseases
PubMed: 32651060
DOI: 10.1016/j.beem.2020.101437 -
Australian Journal of General Practice Mar 2022The postnatal period is a rapidly changing and challenging time for new parents. General practitioners are well placed to provide support, advice, clinical care and...
BACKGROUND
The postnatal period is a rapidly changing and challenging time for new parents. General practitioners are well placed to provide support, advice, clinical care and intervention for common psychosocial and physical concerns in this critical period.
OBJECTIVE
The aim of this article is to outline a consistent approach to the content and structure of the postnatal visit in the general practice setting, along with key management strategies for common postnatal conditions and comorbidities.
DISCUSSION
Common physical and mental health postpartum concerns, follow-up management of antenatal comorbidities and contraceptive choices are outlined, along with management of early parenting issues.
Topics: Family Practice; Female; General Practice; General Practitioners; Humans; Parenting; Postnatal Care; Pregnancy
PubMed: 35224571
DOI: 10.31128/AJGP-02-21-5835 -
Bulletin of the World Health... Jan 2023
Topics: Pregnancy; Female; Humans; Postnatal Care; Delivery of Health Care; Health Expenditures; Policy
PubMed: 36593785
DOI: 10.2471/BLT.22.289440 -
Computational and Mathematical Methods... 2022The effect of skin-to-skin contact (SSC) on postpartum depression and physical rehabilitation of cesarean section women was explored. 280 parturients undergoing cesarean... (Randomized Controlled Trial)
Randomized Controlled Trial
The effect of skin-to-skin contact (SSC) on postpartum depression and physical rehabilitation of cesarean section women was explored. 280 parturients undergoing cesarean section were selected and were rolled into two groups randomly. The parturients in the control group (Con group, 140 cases) received routine care, and those in the experimental group (Exp group, 140 cases) received SSC on the basis of routine care. The postpartum depression and physical recovery of parturients in two groups were compared. It was found that, in the Exp group, the number of pregnant women with no or with very mild depression was much more 85% vs. 55%), the number of women with adequate lactation was more (53 cases vs. 27 cases), the first lactation time (FLT) was dramatically shorter (41.25 ± 4.81 h vs. 58.43 ± 5.43 h), the breastfeeding success rate (BFSR) and breastfeeding rate (BFR) were obvious higher, the days for uterine involution was much shorter (6.96 ± 1.13 days vs. 9.47 ± 1.75 days), the descent of uterine fundus 24 hours after delivery (24 h-DUF) was obviously larger (3.17 ± 0.26 mm vs. 1.56 ± 0.43 mm), the duration of lochia (DOL) was remarkably shorter (33.21 ± 5.32 days vs. 25.32 ± 3.54 days), and the (VAS) score was lower (4.88 ± 0.32 points vs. 3.41 ± 0.53 points), showing statistical differences for all above indicators ( < 0.05). It suggested that SSC could effectively relieve the postpartum depression of uterine parturients, promote the lactation, increase the BFR, facilitate uterine involution, and alleviate chronic uterine inflammation and postpartum pain, showing high clinical application and promotion value.
Topics: Adult; Breast Feeding; Cesarean Section; China; Computational Biology; Depression, Postpartum; Female; Humans; Infant Care; Infant, Newborn; Male; Mother-Child Relations; Obstetrics and Gynecology Department, Hospital; Postnatal Care; Postoperative Complications; Pregnancy; Young Adult
PubMed: 35103074
DOI: 10.1155/2022/9927805