Perinatal Mental Health
This video produced by the International Forum for Wellbeing in Pregnancy has been designed to help raise global awareness of mental health conditions during pregnancy and post-childbirth period. It highlights some of the experiences mums and dads may see and how that can affect the baby.
FIGO position paper: how to stop the caesarean section epidemic
FIGO has published a position paper with suggestions on how to reduce the worldwide caesarean section rate. To help reduce the caesarean section rates the paper asks stakeholders to consider:
NHS Digital report – Maternity Figures
NHS digital has published maternity data for 2017-18. The data is taken from Hospital Episodes Statistics (HES) and the Maternity Services Data Set (MSDS). Key outcomes from the data show:
The report and associate documents can be viewed here.
,This week much of the focus has been on the global rise in the number of caesarean births following The Lancet publication of a 3-part series ‘Optimising caesarean section use’. The series, available here, details the occurrence of caesarean births from data collected from 169 countries, reviews the short and long term effects of CS on the health of women and children and outlines interventions to reduce unnecessary CS in health women and babies.
Global epidemiology of use of and disparities in caesarean sections
The first part of the series titled ‘Global epidemiology of use of and disparities in caesarean sections’ reviews the trends in CS use globally estimating 29.7 millions births occurred through CS in 2015.
Figures suggest rates have almost doubled since 2000 from 12.1% to 21.1% of births however there was significant variation in rates across regions. Caesarean birth rates ranged from 58.15% of births in Dominican Republic to 0.6% in South Sudan. Those low-income countries have inadequate access to CS posing higher risk of mortality to those women. In comparison use of CS for higher income families was well above the rate expected based on obstetric indications.
The paper recommends:
‘Optimisation of CS use is needed, underpinned by a better understanding of demand and supply factors that drive the overuse of CS and by greater efforts to ensure universal access to CS for all women.’
Short-term and long-term effects of caesarean section on the health of women and children
The second part of the series titled ‘Short-term and long-term effects of caesarean section on the health of women and children’ highlights that the prevalence of maternal morbidity and mortality is higher after CS than vaginal birth.
It is suggested that the estimated risk of death from an emergency intrapartum CS is up to 4 time higher than vaginal birth with severe acute maternal morbidity (including haemorrhage, uterine rupture, anaesthetic complication and cardiac arrest) also higher. The paper highlights that almost everyone who has a CS increases risk of certain morbidities in future pregnancies.
Interventions to reduce unnecessary caesarean sections in healthy women and babies
The final part of the series titled ‘Interventions to reduce unnecessary caesarean sections in healthy women and babies’ investigates factors for CS use and the type and effects of interventions to reduce CS.
Clinical interventions including external cephalic version for breech delivery at term, vaginal breech delivery in appropriately selected women, and vaginal birth after CS could reduce CS rates. Additional approaches including labour companionship and midwife led care have been associated with safer outcomes and positive maternal experiences.
One of the key messages is:
‘…approaches that prioritise positive human relationships, promote respectful and collaborative multidisciplinary teamwork, and address clinicians’ beliefs and attitudes and women’s fear of labour pain and of poor quality of care, might be effective in reducing CS use or increasing physiological labour and birth.’
Schematic representation of factors related to women, society, health providers, and health-care organisations that affect the frequency of caesarean section use at the local level; these factors surround the obstetric and clinical factors that also affect the frequency of births by caesarean section, which are represented in the middle by the Robson 10-group classification
This week the UK has been raising awareness of baby loss through it baby loss awareness week and around the world babies who passed away from miscarriage, stillbirth or new born death will be remembered on October 15th - International Pregnancy & Infant Loss Remembrance Day.
Break the silence animation
Charities have come together to raise awareness of the issues that affect those who have experienced pregnancy loss or baby death in the UK. Watch their animation below:
Launch of movements matter campaign
Safer Care Victoria and the Centre of research excellence in stillbirth have worked to launch the movements matter campaign. The movements matters website provides information and resources for women and clinicians on babies movements. It includes fact sheets, videos & e-learning guides to help provide the best care when a woman reports a change in her babys movements.
Visit the website here.
BJOG Free access - Stillbirth: understand, standardise, educate – time to end preventable harm
BJOG has provided free access to its special issue on stillbirth published earlier this year. The issue covers a number of stillbirth topics including understanding stillbirth, reporting stillbirth and fetal death, interventions to reduce stillbirth and the global impact of stillbirth.
The issue highlights that the financial cost of stillbirth is about £700 million per year with much bigger implications of the emotional impact. It recognises the importance of improving the experience of parents and the necessity to involve them to educate and reduce stillbirths.
The issue can be viewed here.
Quiz: Hot to prevent postpartum haemorrhage
This quiz from contemporary OB/GYN tests your knowledge on postpartum haemorrhage (PPH). It is based on an article from Gary A. Dildy testing your ability to recognise signs of PPH in a patient. Have a go here and let us know how you did.
Video: Perinatal Mortality Reviews - Journey of Improvement
This video outlines the journey that one hospital has been on to improve their perinatal review process identifying challenges faced, engaging clinicians and their preparations.
Cochrane review - Non-clinical interventions for reducing unnecessary caesarean section
An updated review has been produced into ‘whether non-clinical interventions, which aim to reduce unnecessary caesarean sections, such as providing education to healthcare workers and mothers, are safe and effective’. The review will inform new WHO guidelines.
The key message from the review is that ‘Based on high-quality evidence, few interventions have been shown to reduce caesarean section rates without adverse effects on maternal or neonatal outcomes’.
There were 29 studies included in the review mainly representing high income countries. There were 8 interventions found to have a beneficial effect including:
Read the review in full here.