Antonella Nespoli

Intrapartum care quality indicators: a literature review

INTRODUCTION Quality of care is increasingly recognized as a critical aspect of the maternal and newborn health, mainly with respect to care around labor and delivery and in the immediate postnatal period. The aim of this review was to identify the recommended intrapartum care indicators in order to measure the quality of midwifery care. EVIDENCE ACQUISITION A structured literature search was conducted in August 2017 incorporating English and Italian language studies from 1993 and onwards to identify published articles on quality standards of intrapartum care. Research was performed into the area of enquiry in electronic database (Medline, Cochrane Library, CINAHL, Trip) and in relevant midwifery websites. EVIDENCE SYNTHESIS We identified 369 quality indicators to measure the intrapartum care. Following a systematic process that allows to classify all indicators in domains and categories, we analyzed 268 outcome and process indicators specifically designated to monitor the intrapartum care in a low risk population. Through the identification of further exclusion criteria and semantic analogies we obtained 80 final quality indicators (39 outcome indicators and 41 process indicators). CONCLUSIONS We identified 80 indicators that should be used to measure the quality of low risk intrapartum care. Although the majority of indicators we could monitor through hospital databases and the Italian Birth Register-CeDAP are outcome indicators, it is important to give attention also to process indicators that measure the activities performed and whether or not they are evidence-based. For a low risk population they could measure adherence with guidelines that promote and support the normality of the process.

Prenatal diagnosis tests and women’s risk perception: a cross-sectional study

Abstract Objective: To investigate women’s decision to undergo non-invasive and/or invasive tests for prenatal diagnosis depending on the procedure-related risk and the risk of carrying a foetus with Down syndrome (DS). Both risks are rated in terms of numerical relevance and acceptability. Method: A sample of 448 consecutive women with low-risk pregnancies were interviewed to collect social and clinical variables and to determine their perceptions of the risks of invasive procedure-related miscarriage and carrying a foetus with DS. The risks were scored numerically in terms of their relevance and acceptability using a 10-point rating scale. Results: The factors related to the use of non-invasive tests were age ≥35 years, not being treated at a public service, rating the risk of carrying a foetus with DS as having high numerical relevance and low acceptability, and rating the risk of miscarriage as having high acceptability. These relationships were still present when the use of invasive tests was considered, except in terms of the numerical relevance of the risk of carrying a foetus with DS. Conclusion: Perceived acceptability affects the interpretation of a given risk more than the numerical relevance of the risk.

Effect of Oral Hydration on External Cephalic Version at Term

Objective To evaluate the effect of oral hydration on the success rate of external cephalic version (ECV). Design Randomized controlled and single‐blind trial. Setting Academic tertiary hospital with approximately 3,000 births annually. Participants One hundred sixty‐four women at a gestational age of at least 37 weeks with breech‐presenting fetuses and normal amniotic fluid indexes (AFIs). Methods Participants were randomly assigned to drink 2000 ml or no more than 100 ml of water in the 2 hours before undergoing ECV. The AFIs were assessed before and after treatment by the same sonographer, who was blinded to the treatment group. Data were collected on relevant maternal and fetal characteristics and ECV success. Results The mean AFI after hydration was significantly greater than that in the control group (15.5 cm vs. 13.4 cm, p = .003). The ECV success rate was 53.7% in the hydration group and 46.3% in the control group (odds ratio: 1.34, 95% confidence interval [0.69, 2.59]; p = .349). Hydration was well tolerated and there were no serious adverse events. Conclusion Oral hydration significantly increased the AFIs but did not affect the success rate of ECVs.

Childbearing Women's Experiences of Early Pushing Urge

AIM: To explore childbearing women’s experiences of early pushing urge (EPU). STUDY DESIGN: A qualitative phenomenological study was undertaken in an Italian maternity hospital. The sample included 8 women that experienced EPU during labor. Data were collected through semistructured interviews. FINDINGS: The findings are presented as three main themes: (a) women’s perceptions of EPU, (b) bodily sensations versus midwives’ advice: struggling between conflicting messages, and (c) the “a posteriori” feeling of women about midwives’ guidance during EPU. The perception of EPU was characterized by sense of obstruction, bone pain, and different intensity of pushing efforts when compared with those of the expulsive phase. Women found it difficult to follow the midwife’s suggestion to stop pushing because this contradicted their bodily sensations. However, the women recognized a posteriori the importance of the midwife’s support while experiencing EPU. Women appreciated the midwives’ presence and emotional support most of all because they seemed to be more concerned with the personal relationship they formed in labor rather than the usefulness or appropriateness of their advice. CONCLUSION: Midwives should consider women’s physical perceptions to help them cope with EPU, acknowledging that women may struggle when caregivers’ suggestions are in contrast to their physical perceptions. The women’s overall positive experiences of birth suggest that EPU might be considered as a physiological event during labor, reinforcing the hypotheses of previous research. The optimal response to the EPU phenomenon remains unclear and should be studied, considering EPU at different dilatation ranges and related clinical outcomes.

Influência da rede social no processo de amamentação: um estudo fenomenológico

Objetivo: Compreender a influencia da rede social de mulheres durante o processo de amamentacao. Medodos: Pesquisa qualitativa embasada no referencial da fenomenologia sociologica de Alfred Schutz e na abordagem de rede social de Sanicola, realizada em uma unidade de atencao primaria a saude de Monza - Italia. Foram entrevistadas 11 mulheres por meio de entrevista semiestruturada. Resultados: Na analise compreensiva foram desveladas tres categorias: apoio familiar cotidiano, conselho de profissionais para vencer dificuldades e perspectiva de compreensao e apoio. Os membros da rede social que mais influenciaram na decisao e continuidade da amamentacao foram: marido, mae da participante, amigas e enfermeira. O relacionamento com estes significou auxilio, orientacao e expectativa de compreensao e apoio. Conclusao: O conhecimento da rede social constitui em um importante subsidio para que profissionais de saude possam buscar a interacao e o fortalecimento dessa rede, bem como propiciar acoes mais eficazes de promocao, protecao e apoio a amamentacao.

Influence of the social network on the breastfeeding process: a phenomenological study

Objetivo: Compreender a influencia da rede social de mulheres durante o processo de amamentacao. Medodos: Pesquisa qualitativa embasada no referencial da fenomenologia sociologica de Alfred Schutz e na abordagem de rede social de Sanicola, realizada em uma unidade de atencao primaria a saude de Monza - Italia. Foram entrevistadas 11 mulheres por meio de entrevista semiestruturada. Resultados: Na analise compreensiva foram desveladas tres categorias: apoio familiar cotidiano, conselho de profissionais para vencer dificuldades e perspectiva de compreensao e apoio. Os membros da rede social que mais influenciaram na decisao e continuidade da amamentacao foram: marido, mae da participante, amigas e enfermeira. O relacionamento com estes significou auxilio, orientacao e expectativa de compreensao e apoio. Conclusao: O conhecimento da rede social constitui em um importante subsidio para que profissionais de saude possam buscar a interacao e o fortalecimento dessa rede, bem como propiciar acoes mais eficazes de promocao, protecao e apoio a amamentacao.

Influencia de la red social en el proceso de la lactancia materna: un estudio fenomenológico

Objetivo: Compreender a influencia da rede social de mulheres durante o processo de amamentacao. Medodos: Pesquisa qualitativa embasada no referencial da fenomenologia sociologica de Alfred Schutz e na abordagem de rede social de Sanicola, realizada em uma unidade de atencao primaria a saude de Monza - Italia. Foram entrevistadas 11 mulheres por meio de entrevista semiestruturada. Resultados: Na analise compreensiva foram desveladas tres categorias: apoio familiar cotidiano, conselho de profissionais para vencer dificuldades e perspectiva de compreensao e apoio. Os membros da rede social que mais influenciaram na decisao e continuidade da amamentacao foram: marido, mae da participante, amigas e enfermeira. O relacionamento com estes significou auxilio, orientacao e expectativa de compreensao e apoio. Conclusao: O conhecimento da rede social constitui em um importante subsidio para que profissionais de saude possam buscar a interacao e o fortalecimento dessa rede, bem como propiciar acoes mais eficazes de promocao, protecao e apoio a amamentacao.