James Harris

The relationship between frequency of obstetric ultrasound scans and birthplace preference - A case control study

OBJECTIVE to investigate the relationship between frequency of ultrasounds and birthplace preference. STUDY DESIGN retrospective case-control study with the number of ultrasounds as the exposure and the pregnant womans preference to give birth in a low-technology setting (midwifery-led unit or home) or a high-technology setting (obstetric unit) as the primary outcome. SAMPLE AND SETTING low-risk primigravid women receiving antenatal care at a central London academic medical centre. MEASUREMENTS antenatal ultrasound frequency; birthplace preference at the initial pregnancy appointment (T1) and at the commencement of labour (T2); demographic data including ethnicity, index of multiple deprivation, age, and body mass index. FINDINGS 1100 cases were reviewed. Women received an average of 4.03 ultrasounds during their pregnancy (SD=1.96, range 2-14). The frequency of ultrasounds for women who had a low-technology T2 birthplace preference was significantly lower than for those who had a high-technology T2 birthplace preference (t=2.98, df=1098, p=0.003, r=0.1), and women who had a constant low-technology birthrate preference had significantly less ultrasounds than other women (F (3,644)=3.475, p=.02). However, within a logistic regression the frequency of ultrasound was not associated with T2 birthplace preference, after controlling for T1 birthplace preference. KEY CONCLUSIONS the findings of this investigation suggest that a preference made early in pregnancy is a greater predictor of birthplace preference than exposure to antenatal ultrasounds. IMPLICATIONS FOR PRACTICE further research is required to inform interventions that would encourage low-risk pregnant women to select a low-technology place of birth.

Employing the arts for knowledge production and translation: Visualizing new possibilities for women speaking up about safety concerns in maternity

This project used animated film to translate research findings into accessible health information aimed at enabling women to speak up and secure professional help for serious safety concerns during pregnancy and after birth. We tested as proof of concept our use of the arts both as product (knowledge production) and process (enabling involvement).

The four Ts of PPH experience: women and their birth partners' experiences of primary postpartum haemorrhage

Introduction Various risk factors have been identified in recent publications for obstetric anal sphincter injuries. There is conflicting information on ethnic distribution of obstetric anal sphincter injuries (OASI) rates. In order to design effective intervention to reduce OASI rates, it is essential to identify population specific OASI rates and risk factors. Our aim is to establish the rates of OASI in various ethnic populations, giving birth at a university teaching hospital. Methods Retrospective analysis of maternity data over 30 months was carried out. Data were obtained from the maternity database regarding all primiparous women with singleton, term pregnancies with cephalic presentation. OASI rates were compared for Caucasian, South-Asian, African and mixed ethnic populations. Results Of the 14 466 births during the study period, 6368 were primiparous women. The OASI rates in Caucasian and mixedethnicity groups were 4.4% (229/5194) and 4.1% (19/466) as compared to Asian 10.4% (28/267) and African women 10.7% (23/213). When compared to Caucasian group, there was a significant increase in OASI rate in Asian (P < 0.0001, 95% CI 0.26–0.59) and African groups (P < 0.0001, 95% CI 0.24–0.60). The operative vaginal delivery rates in women with OASI were comparable across all the groups (39–52%). The rate of neonatal birth-weight >4 kg was higher in Caucasian (21.8%) and mixed-ethnicity (21.1%) in comparison to Asian (0%) and African women (8.7%) who sustained an OASI. Conclusion The rate of OASI is significantly higher in Asian and African primiparous women, inspite of lower birthweights, as compared to Caucasian women. Further research is required to investigate this discrepancy. PL.2 Childhood learning disability and cerebral palsy following planned caesarean delivery: a population-based retrospective cohort study of Scottish data Black, M; McLernon, D; Norman, J; Bhattacharya, S University of Aberdeen, Aberdeen, United Kingdom; University of Edinburgh, Edinburgh, United Kingdom

‘Better safe than sorry’– better for whom?

Sir, I found Sulik, Leary-Moore and Riley’s commentary on the five alcohol-in-pregnancy papers interesting, and commend the authors on their excellent summation of the current evidence base within this field. I was somewhat saddened, however, by both the title of the commentary and their take-home message. Health care has surely moved away from a paternalistic model that selects what is best for our clients. Should we not be aiming to facilitate informed choice, rather than prescribing certain behaviours? The authors are correct to highlight the difficulties of advising a ‘safe’ drinking level. But we are professionals who are used to difficult discussions, especially on topics such as antenatal screening. Unfortunately, we do not always achieve unbiased, impartial discussions during these consultations, and some research has suggested that further support is needed to develop communication skills, but if the arguably less controversial positions such as diet and alcohol become dictatorial, what hope is there for the more emotionally charged topics? If we find it difficult to give information that is readily understood, perhaps we should look to improving our communication skills rather than to giving an inaccurate message to remove doubt. Many pregnant women will take a ‘better safe than sorry’ position and abstain from alcohol throughout their pregnancy, whereas others will not. It is not for us, as professionals in maternity care, to decide what information should be shared, or to filter that information into a recommendation of abstinence – our clients are able to interpret the information themselves. Our duty is to provide the information that women need to make a decision that is correct for her and her family. j