In the News
Is your hospital safe?
US Hospital safety grades have been released providing hospitals with a rating from A to F. Patients treated at hospitals graded D and F were at 92% greater risk of dying from safety problems compared to those with an A grade. In total it was found that 160,000 lives are lost annually in the US due to avoidable errors.
Patients may often have an option of what hospital they are treated at and therefore knowledge of hospitals with higher safety grades can be important. Across all states 32% of hospital graded received an A. Shockingly there were no A rated hospital in Wyoming, Alaska, Washington, D.C., Delaware or North Dakota. The states with the highest % of A graded hospital were Oregon, Virginia, Maine, Massachusetts and Utah.
Faecal incontinence from tears while giving birth
Up to 10% of mothers who give birth vaginally will develop some form of anal incontinence. An Irish barrister is working to raise awareness of the problem that affects a large number of women. She highlights the devastating impact that these injuries can have on women including the ending of careers and relationship breakdown. Noting that ‘For me, the major thing is information so people can make an informed choice’.
Tools and Resources
Assisted Vaginal Birth – Clinical Guideline - Society of Obstetricians and Gynaecologists of Canada
The Society of Obstetricians and Gynaecologists of Canada (SOGC) has released a clinical practice guideline ‘No 318 Assisted Vaginal Birth’. It provides recommendations for safe and effective assisted vaginal birth including:
Antibiotics for operative vaginal delivery – Randomized Controlled Trial
Use of prophylactic antibiotic after operative vaginal birth can reduce the risk of women developing an infection. A randomized study of women across 27 UK obstetric units was conducted. Women were either allocated to receive a single dose of intravenous amoxicillin and clavulanic acid or placebo following operative vaginal birth at 36 weeks gestation or later.
In total 3427 women were randomly assigned treatment, 1719 to antibiotics and 1708 to placebo. The women who received antibiotics had a 56% reduction in confirmed infection compared to the placebo. The study also estimates that there is potential for a 17% reduction in overall antibiotic use when administered prophylactically.
Pregnancy is a wonderful time filled with many expectations and bodily changes. For some women pregnancy can be a relatively easy time but for others it can present some challenges. We are all different but what can help are the preparations you take before falling pregnant. This alone can make a major difference to your pregnancy and growing baby. It is normal to experience a few minor or major changes and issues throughout your different stages of pregnancy and this is why choosing a specialist who works in this field is imperative.
Whilst working with your GP, Midwives, Obstetrician or Doula is imperative during your pregnancy, there are many other specialised professionals who can support you. Look for pregnancy specialist in areas of; Yoga, Pilates, Acupuncture, Naturopathy, Chiropractic and Massage. These holistic therapists can help support you throughout your pregnancy, prepare you for your labour and guide you through post-natal self-care and baby support.
Remember Pregnancy is a time to Nurture and Embrace! Whilst you want to look after you and your growing baby know you can use this time to also embrace some amazing pregnancy exercises and techniques which in turn will assist your labour.
Every woman’s body is different; therefore, the ability of exercise options will also be different from one woman to the next.
Having a healthy balanced diet will assist in your baby’s development, your growing body and how much energy you have throughout the day. Meditation is another practice that you and your partner can do together to keep a balanced mental and emotional state during this life changing experience. Meditation or mindfulness practice will also help you prepare for labour.
It is important for women to acknowledge that pregnancy and birth does not need to be feared or scary. Know your body, communicate with your specialists, research and ask questions about your pregnancy and labour. Be informed and know your options and choices, without over-whelming yourself. As you become more connected and informed you will make the right choices for you, your baby and your family.
Most importantly take time to slow down and connect with your growing baby. The more connection you both have the smoother your transition in to mother-hood will be.
Written by: Tenille Samuelson
Tenille is a qualified Yoga and Pilates Instructor. Over the past 10 years Tenille has operated her own Pilates and Wellness studio with a passion for women’s health. Providing guidance to many women through fertility, pregnancy (pre and post-natal) and supporting women after traumatic birth experiences.
In the News
Keyhole surgery in the womb
Surgeons in the UK have performed keyhole surgery to repair a babies spine whilst in the womb. The baby was diagnosed with Spina bifida after a routine scan which showed the spine and spinal cord weren’t developing correctly. The mother underwent surgery at 27 weeks to correct the defect with doctors performing keyhole surgery to address the problems with the babies spine and spinal cord. Performing the surgery whilst the baby is still in the womb can reduce risk of complications for the baby later in life.
What happens to a baby during birth?
MRI showing the molding that occurs to a baby’s head during the second stage of labor has been examined in a recently published study. 7 women had an MRI before labor and during the second stage. All 7 showed fetal head molding in the MRI during the second stage of labor. Following delivery only 2 of the newborns showed deformed head contours.
The study highlights that the results suggest the fetus is subjected to greater stress than it was previously thought. It also highlights that a ‘normal birth’ where a mother gives birth by natural means with only a few maternal expulsive efforts may not lead to the optimal fetal outcome as it doesn’t take into consideration the amount of fetal head molding that may take place.
The study concludes that fetal head molding was observed in all 7 patients but was observed in only 2 following delivery. The ‘overlapping of the cranial sutures was most significant in the anterior-posterior direction, at the coronial and lambdoid suture’. The findings of the study are important for understanding the mechanism and risk of labor and birth.
Obesity status has no effect on VBAC
In this study 614 underwent trial of labor after cesarean section with 72.3% having a successful VBAC. The women were divided into 4 categories based on their pre-pregnancy and delivery weight. The study found that the success of VBAC was no different across the 4 groups and furthermore there were no difference in perinatal morbidity. The study highlights the importance in counselling women appropriately on TOLAC.
Model for likelihood of success of ECV
A study has looked into ECV with the aim to identify determinents of success. Women in the study underwent an ultrasound scan to provide a variety of information on the fetal position. An obstetrician attempted the ECV terminating the procedure if fetus was unsuccessfully turned, 30 minute of manipulation had elapsed, the woman asked to stop or the obstetrician determined there was no benefit of proceeding. Following the procedure another scan was performed.
A total of 250 women under the procedure during the study with a 64.8% success rate. Variables that impacted the success rate were determined to be BMI, size of fore-bag and parity. A large fore-bag, multiple parity and lower BMI were all found to be important determinants of ECV success.
Tools & Resources
A new website ‘Every week counts’ is highlighting the importance of the last few weeks of pregnancy. Research from the Clinical and Population Health Perinatal Research Centre of the Kolling Institute, based at Royal North Shore Hospital, Sydney Australia has shown the benefits for babies born close to their 40 weeks due date.
The website aimed at healthcare professionals highlights the short term and long term benefit of birth at 40 weeks including:
The website provides research papers and resource to support the conversations obstetrician are having with expectant mums.
WHO: Strengthening quality midwifery education
The WHO report in midwifery education has been published identifying 3 strategic priorities and a 7 step action plan.
The 3 strategic priorities:
The 7 step action plan to achieve this:
The full report goes into much greater detail on the importance of the strategic priorities and how they can be achieved.
In the News - Alabama passes law banning abortion
Legislation passed in Alabama is the most restrictive abortion bill in the US. It makes carrying out an abortion at any stage in pregnancy illegal even criminalizing abortion in cases of rape and incest. Doctors carrying out the procedure could face up to 99 years in jail.
Abortions would only be legal in cases where the mother’s life is in danger or if the fetus has a fatal condition. Many groups and organizations are planning to challenge the bill.
There are several countries around the world where there are also restrictions or bans on abortions including Northern Ireland, Malta, Philippines and Poland.
Safety culture can positively impact surgical outcomes
This study into the influence of hospital safety culture on surgical outcomes highlights the positive impact safety culture can have. Those hospitals that reported a positive safety culture were significantly associated with lower risk of postoperative morbidity. The study concludes:
‘Hospital safety culture can influence certain surgical patient outcomes. Improving the safety culture within a hospital can represent a previously unrecognized approach that can be leveraged to strengthen surgical quality improvement efforts at the hospital level.’
The study can be found here.
Translating Maternal Mortality Review into Quality Improvement Opportunities in Response to Pregnancy-Related Deaths in California
An article has been published looking at improvement opportunities from the maternal mortality review in California. The study looked at readiness, recognition and response allocating data from 203 pregnancy related deaths into one of the 3 categories. Opportunities for improvement relating to each category were identified:
Read the study here.
Pregnancy related deaths report
The Centers for Disease Control and Prevention has published a report into pregnancy related deaths. It highlights that around 700 women die each in the US from pregnancy related complications estimating that 3 in 5 of these could be prevented.
Figures in the study outline the statistics for the 2011 – 2015 period. The split is relatively even between deaths happening during pregnancy, at delivery or up to 1 week after and 1 week to 1 year postpartum. Heart disease and stroke were the cause of over 1/3 of the deaths and Black and American Indian/Alaska Native women were about 3 times as likely to die from a pregnancy-related cause.
Although heart disease was one of the main causes of death other causes differ depending on the stage of pregnancy or postpartum period. Most deaths during delivery are caused by obstetric emergencies for example excessive bleeding and in the week after delivery bleeding and infections are common. Some of the factors that play a part in deaths include women’s access to care, missed/delay diagnosis and failure to recognise warning signs.
The report provides some recommendations for what all stakeholders can do:
The full report and further resources are available here.
SMFM guidance - Immediate postpartum long-acting reversible contraception for women at high risk for medical complication
New guidance on Immediate postpartum long-acting reversible contraception (LARC) for women at high risk for medical complications has been published by the Society for Maternal Fetal Medicine. The document has been designed to educate all providers about the benefits of postpartum contraception, and to advocate for widespread implementation of immediate postpartum LARC placement programs.
Recommendations from SMFM are:
This Week in Maternity - Safer Care Victoria Report, Maternal Mental Health and International day of the Midwife
International Day of the Midwife
The 5th May marks the International Day of the Midwife, a day to recognise and celebrate the work done by midwives around the world. The theme this year is ‘Midwives: Defenders of Womens Rights'.
The Virtual International Day of the Midwife is an online conference celebrating the day. There are speakers from around the world discussing a range of topics and it is free to attend!
The full programme can be found here.
Safe Care Victoria – Mothers, Babies and children report 2017
Safer Care Victoria has published their latest report on data and trends in maternal and fetal mortality and morbidity. The report on data from 2017 provides recommendation for clinicians and health service providers.
The recommendations relating to pregnancy and childbirth are:
In 2017 there were 78226 women who gave birth in Victoria, the number of women giving birth by cesarean section increase to 34.9% and ¼ experienced a postpartum haemorrhage. Those women gave birth to 79407 babies, 8.5% of which were born preterm with 7% with a birth weight of under 2500g.
The report outlines that there were 7 maternal deaths with suicide being one of the main causes. The number of perinatal deaths across 2017 was 702 with the main causes of congenital abnormality, spontaneous preterm and other specific perinatal conditions. It is thought that sub-optimal factors likely contributed to 20 stillbirths and 12 neonatal death. The recommendation highlighted above are designed to address some of the factors found to be related to sub-optimal care.
The full report with all statistics and recommendations can be read here.
Maternal Mental Health Awareness
The 1st of May, World Maternal Mental Health Awareness day, marked the start of Maternal Mental Health Month. The initiative is aimed at highlighting and promoting the experiences of women and their families and providing information on the resources and support available.
To recognise and support the initiative we will be sharing information and resources across our social media platforms. You can follow along with the #MaternalMentalHealth.