This Week in Maternity - Labour and Birth

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.
​
https://www.bbc.com/news/health-48253477

New studies

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.

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0215721

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.

https://www.nature.com/articles/s41372-019-0386-x

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.

https://journals.lww.com/greenjournal/Fulltext/2019/05000/Prediction_of_Success_in_External_Cephalic_Version.3.aspx

​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:

• Reduced neonatal morbidity
• Better brain development
• Reduced risk of NICU admission

The website provides research papers and resource to support the conversations obstetrician are having with expectant mums.

https://www.everyweekcounts.com.au/

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:

• Every woman and newborn to be cared for by a midwife, educated and trained to international standards and enabled to legally practise the full scope of midwifery. The title “midwife” should only be used for providers who are educated to international standards.
• Midwifery leadership to be positioned in high-level national policy, planning and budgeting processes to improve decision making about investments for midwifery education to help achieve UHC.
• Coordination and alignment between midwifery stakeholders at global, regional and country levels to align education and training processes, knowledge, research, evidence-based materials, indicators and investment.

The 7 step action plan to achieve this:

1. Strengthen leadership and policy
2. Gather data and evidence
3. Build public engagement and advocacy
4. Prepare educational institutions, practice settings and clinical mentors
5. Strengthen faculty, standards and curricula
6. Educate students
7. Monitor, evaluate, review and adjust

The full report goes into much greater detail on the importance of the strategic priorities and how they can be achieved.

https://www.who.int/maternal_child_adolescent/topics/quality-of-care/midwifery/strengthening-midwifery-education/en/