Safer Care Victoria is launching a campaign to help women report decreased fetal movements and reduce the number of potentially preventable stillbirths. They have provided a number of resources including best practice guidance and online learning along with a webinar covering current best practice in identifying and managing decreased fetal movements.

The key messages are:
‘When a woman reports decreased fetal movements, please undertake an assessment of the woman and her baby as soon as possible, preferably within two hours.
Make sure you provide your pregnant women with information about baby movements at every clinic visit.’

​The resources can be accessed here.

A study published in the international journal of Obstetrics & Gynaecology has looked at gaining a better understanding into the natural progression of labour.

The study titled ‘Cervical dilatation patterns of ‘low‐risk’ women with spontaneous labour and normal perinatal outcomes: a systematic review’ aimed to look into the available data on the cervical dilation patterns during spontaneous labour of ‘low‐risk’ women with normal perinatal outcomes.

Included were 7 observational studies covering 99 971 women finding that the median time to advance by 1cm in nulliparous women was longer than 1 hour until a dilation of 5cm was reached with similar patterns in parous women.

The study concluded:

‘An expectation of a minimum cervical dilatation threshold of 1 cm/hour throughout the first stage of labour is unrealistic for most healthy nulliparous and parous women. Our findings call into question the universal application of clinical standards that are conceptually based on an expectation of linear labour progress in all women.’

The full study can be viewed here. 

ACOG have released a practice bulletin on the role of prophylactic antibiotics in labour and delivery. The OBG Project has provided a useful summary of the guidance providing key points and guidance including use in caesarean section and other obstetric procedures.
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Access the summary from OBG Project here. 

Research recently published by Birthrights has highlighted the differences in treatment of women who request a caesarean section.

A caesarean section is requested by women for a number of possible reasons. The report suggests the primary reason being previous traumatic birth followed by underlying medical conditions such as symphysis pubis dysfunction.

The research found that:

• 15% of Trusts have policies or processes that explicitly do not support maternal request caesarean
• 47% of Trusts have policies or processes that are problematic or inconsistent
• 26% of Trusts offer caesareans in line with NICE best-practice guidance

NICE guidance states:

‘'For women requesting a caesarean section, if after discussion and offer of support… a vaginal birth is still not an acceptable option (Trusts should) offer a planned cesarean section.’

Findings suggest that for women the process can often be lengthy, difficult or inconsistent adding anxiety and distress for the women.

The report highlights what a good maternal request caesarean guideline should look like and offers perspectives from healthcare professionals to support better support of maternal request caesarean.

​The full report can be read here.

A study has looked into the methods used to obtain women’s consent and women’s thoughts on these methods. The study interviewed women who did and did not give consent at their time of recruitment for the World Maternal Antifibrinolytic (WOMAN) Trial in the UK.

The WOMAN trial was researching treatment for heavy bleeding, consent was being sought in some cases at the time of the bleed. The study was the first in the UK to use the option of waiver of informed consent.
The result of the study suggests:

‘what is important is not so much the consent process used or a signature on a form, but the way in which consent is obtained. Clinicians who successfully negotiate consent to research during childbirth emergencies engage in a ‘humane choreography’ of words and actions.’

It seems that of most importance influence on the good or bad experiences of women is the use of actions and words by the birth attendants.
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Full study available here. 

An ABC radio show has examined if doctors have become too risk averse, the push for more midwifery led care and concerns that some midwives have deskilled because of the decline of natural births.

The show hears from a mother who had interventions during labour, an obstetrician and a midwife exploring the high rate of caesarean deliveries.

​Listen to the full discussion below.

A study has looked into caesarean rates to determine areas where it may be reduced without compromising safety. 19 hospital participated in the study with 228 562 deliveries between 2002 and 2008.

The study concluded:

‘women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births may be the potential targets for safely reducing prelabour CD rate, while nulliparas or multiparas with spontaneous or induced labour, women with repeat CD, term non-cephalic presentation, term twins or other multiple gestation and preterm births are potential targets for reducing intrapartum CD rate without compromising maternal and neonatal safety in the USA. On the other hand, CD may still be associated with better perinatal outcomes in women with singleton preterm breech presentation or preterm twins with the first twin in non-cephalic presentation.’

Read the full paper here. 

​Sands has produced this video that shares ways you can start a conversation about baby loss and help someone who has lost a baby. The video includes tips on:

• Talking about the baby
• Offering practical help
  
• Let them know you are thinking of them

A study has looked into the consequences of induction of labour at 39 weeks. The multicentre trial involved over 6000 women. They were randomly assigned to labour induction at 39 weeks or to expectant management. The study looked to measure primarily perinatal death or severe neonatal complications with caesarean delivery a secondary measure.

Results of the study show the primary outcome occurred in 4.3% of neonates in the induction group and in 5.4% in the expectant-management group. The frequency of caesarean delivery was significantly lower in the induction group than in the expectant-management group (18.6% vs. 22.2%).

The study concluded:
‘Induction of labor at 39 weeks in low-risk nulliparous women did not result in a significantly lower frequency of a composite adverse perinatal outcome, but it did result in a significantly lower frequency of cesarean delivery.’

​Full study available here.

A study has found that the prevalence of complete uterine rupture is higher in countries with low previous CS and high trial of labour after CS rates.

The international study merged individual data collected from 9 studies into ‘women with complete uterine rupture, defined as complete disruption of the uterine muscle and the uterine serosa, regardless of symptoms and rupture of fetal membranes.’

The study aimed to measure prevalence of complete uterine rupture, regional variation and correlation with rates of caesarean section and trial of labour after CS (TOLAC).

In 2,625,017 deliveries there were 864 complete uterine ruptures identified. The overall prevalence was 3.3 per 10,000 deliveries with 22 in women with and 0.6 in women without previous CS. Prevalence in women with previous Uterine rupture resulted in hysterectomy in 10% of women and in a perinatal death in 116 of 874 infants whose mother had uterine rupture.

The study concluded:
‘Higher prevalence of complete uterine ruptures per TOLAC was observed in countries with low previous CS and high TOLAC rates. Rates of hysterectomy and perinatal death are about 10% following complete uterine rupture, but in women undergoing TOLAC the rates are extremely low (only 2.2 and 3.2 per 10 000 TOLACs, respectively.)’

Full study available here.

A review of 34 studies involving 7785 obstetricians and 1197 midwives from 20 countries has identified several factors influencing the decision for caesarean sections. Factors included:

• Clinicians personal beliefs
• Influence of healthcare system
• Clinicians characteristics

A clinicians personal beliefs was identified as the key driver for decision making. Decision was influenced by their perception of risk and the belief that caesarean was a ‘safe option’. Beliefs relating to a women’s request for caesarean also influenced decision making.

Healthcare systems were also found to affect decision making. Fear of litigation was found to be a common influenced in the decision to perform caesarean. In addition to availability of resources, type of coverage and guidelines/management policy.

Finally, clinician characteristics were found to influence the decision making. Personal convenience was described as being an influencing factor with a scheduled caesarean being more convenient. Lack of confidence and skills in vaginal birth was also identified as a contributing factor.

The study suggests that with the increase in number of caesareans performed it is important to look into the factors that effect decision making.

​Full study can be viewed here.

NHS England has released a report into the impact of the Saving babies lives care bundle. The implementation of the guidance across 19 maternity units has helped to save more the 160 babies.

​It is estimated that if the guidance is rolled out across all units 600 stillbirths could be prevented.

Key successes identified in the report were:

• Increase in the detection of small babies attributed to better monitoring and scanning in pregnancy
• Better awareness of a baby’s movement in pregnancy with a high number of women attending hospital due to reduced movement.
• Carbon monoxide testing for smoking in pregnancy

 
Full report available here

The International Society of Ultrasound in Obstetrics and Gynecology (ISUOG) has published a new practice guideline on intrapartum ultrasound. The below video accompanies the guideline which can be access here.