The relationship of early expressed milk quantity and later full breastmilk feeding after very preterm birth: A cohort study

Levene, I., O’Brien, F., Fewtrell, M., Quigley, M. A. (2024). The relationship of early expressed milk quality and later full breastmilk feeding after very preterm birth. Maternal and Child Nutrition, e13719, https://doi.org/10.1111/mcn.13719

Abstract

When infants cannot directly breastfeed after birth, mothers are advised to initiate lactation through mechanical expression. Families are recommended to target an expression volume of at least 500–750 mL by Day 14 after birth, as this is considered a ‘critical window’ to establish milk supply. This is challenging for many mothers after a very preterm birth. This article explores the relationship of early milk quantity and later full breastmilk feeding as a ‘gold standard’ outcome, using statistical techniques designed for diagnostic tests

Key messages

• Mothers of very preterm infants who expressed at least 250 g at day four after birth had a high probability of providing later full breastmilk: 88% (95% CI: 72%–97%). This was similar for those who expressed at least 650 g at Day 21: 91% (95% CI: 77%–98%).
• Mothers of very preterm infants who expressed less than 50 g at day four after birth had a low probability of providing later full breastmilk: 28% (95% CI: 10%–53%). This was similar for those who expressed less than 250 g at Day 21: 30% (95% CI: 12%–54%).
• These thresholds may be useful for families to understand their lactation trajectories and for clinicians to target support.

Full article available https://onlinelibrary.wiley.com/doi/10.1111/mcn.13719

Perineal techniques during the second stage of labour for reducing perineal trauma and postpartum complications.

Dwan, K., Fox, T., Lutje, V., Lavender, T., & Mills, T.A. (2024). Perineal techniques during the second stage of labour for reducing perineal trauma and postpartum complications. Cochrane Database of Systematic Reviews,10, Art. No.: CD016148. DOI: 10.1002/14651858.CD016148.

Objectives

To assess the effect of perineal techniques during the second stage of labour on the incidence of and morbidity associated with perineal trauma to prevent postpartum complications.

Conclusions

Overall, the evidence for the effectiveness of perineal techniques to reduce perineal trauma and postpartum haemorrhage is very uncertain.

Very few studies reported rates of postpartum haemorrhage, adverse events, women’s or health workers’ experience or other important outcomes that allow us to understand the effectiveness and acceptability of perineal techniques to reduce perineal trauma. Prior to any further large trials, research is needed to clarify the types of interventions, including a clear description of the process of development and involvement of relevant stakeholders. There is a need to clarify how the intervention is proposed to achieve its effects. Trials would benefit from process evaluation alongside, to explore context, mechanisms and effects.

Full review available https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD016148/full

A qualitative exploration of the barriers and enablers to accessing perinatal care for rural Australian women

Faulks, F., Shafiei, T., Mogren, I., & Edvardsson, K. (2024). “It’s just too far…”: A qualitative exploration of the barriers and enablers to accessing perinatal care for rural Australian women. Women and Birth, 37(6), https://doi.org/10.1016/j.wombi.2024.101809

Abstract

Purpose

Rural women and their babies experience poorer perinatal outcomes than their urban counterparts and this inequity has existed for decades. This study explored the barriers and enablers that exist for rural women in Australia in accessing perinatal care.

Methods

A qualitative descriptive design, using reflexive thematic analysis, was employed. Semi-structured interviews were conducted in 2023 with women who had recently given birth in rural Victoria, Australia (n=19).

Conclusion

Participants in this study articulated several key barriers influencing access to perinatal care in rural areas. These factors impede help-seeking behaviour and engagement with care providers, compounding the impact of rurality and isolation on perinatal outcomes and experience of care. Key enablers to accessing perinatal care in rural communities were also identified and included personal agency, health literacy, social capital, effective collaboration and communication between clinicians and services, technology enabled care and free perinatal care.

Full article available https://www.sciencedirect.com/science/article/pii/S1871519224002695?via%3Dihub

Breastfeeding in Emergencies

Bartick, M., Zimmerman, D. R., Sulaiman, Z., El Taweel, A., AlHreasy, F., Barska, L., Fadieieva, A., Massry, S., Dahlquist, N., Mansovsky, M., & Gribble, K. (2024). Academy of Breastfeeding Medicine Position Statement: Breastfeeding in Emergencies. Breastfeeding Medicine, 19(9), https://doi.org/10.1089/bfm.2024.84219.bess

Abstract

Background: During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies.

Key Information: Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support.

Recommendations: Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel

Full article available https://abm.memberclicks.net/assets/DOCUMENTS/bartick-et-al-2024-academy-of-breastfeeding-medicine-position-statement-breastfeeding-in-emergencies.pdf

Comment on studies on the prevention and treatment of postpartum haemorrhage

Mol, B. W. J., Flanagan, M., & Li, W. (2024). Prevention and treatment of postpartum haemorrhage: progress by learning what works and what does not work. The Lancet, 404(10463),1616-1618.

In The Lancet, The WOMAN-2 Trial Collaborators report the WOMAN-2 trial. This trial in 34 hospitals in Nigeria, Pakistan, Tanzania, and Zambia randomly assigned women (aged 14–50 years) with moderate and severe anaemia to receive 1 g of tranexamic acid (n=7580) or placebo (n=7488) by slow intravenous injection (over 10 min) within 15 min of umbilical-cord clamping. The primary endpoint of clinically diagnosed postpartum haemorrhage more than 500 mL occurred in 530 (7·0%) of 7579 in the tranexamic acid group and in 497 (6·6%) of 7487 in the placebo group (RR 1·05, 95% CI 0·94–1·19). There were no significant differences in secondary outcomes, including maternal death or adverse events.

Also in The Lancet, Katharine Ker and colleagues report a meta-analysis with original data on 54 404 women from five large randomised controlled trials (RCTs) evaluating tranexamic acid for postpartum haemorrhage, including the WOMAN and WOMAN-2 trials. Individual participant data were obtained for 43 409 women from four trials and aggregate data on 10 995 women from one trial. Pooling these five trials, tranexamic acid significantly reduced life-threatening bleeding with an odds ratio [OR] of 0·77 (95% CI 0·63–0·93; p=0·008). Among the studies that supplied data, the French TRAAP RCTs showed that administering 1 g tranexamic acid intravenously over 30–60 s, within 2–3 min after birth, significantly reduced postpartum haemorrhage after vaginal delivery (defined as >500 mL blood loss) and during caesarean section (defined as >1000 mL blood loss) by approximately 15% (vaginal delivery: RR 0·83, 95% CI 0·68–1·01 [p=0·07]; caesarean delivery: 0·84, 0·75–0·94 [p=0·003]). Another large RCT from the USA found that administering 1 g of tranexamic acid intravenously over 10 min immediately after umbilical-cord clamping during caesarean section resulted in a 10% reduction (RR 0·89, 95% CI 0·74–1·07 [p=0·19]) in the composite primary outcome of maternal death or blood transfusion, as well as most secondary outcomes. None of these large studies show side-effects of tranexamic acid, with specifically no indication for an increased risk of thromboembolic events.

Link to  the full Lancet comment – https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)02302-X/fulltext?dgcid=raven_jbs_etoc_email

Links to the Woman-2 Trial articles https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01749-5/fulltext#:~:text=We%20found%20that%20giving%20women,thromboembolic%20events%20in%20these%20women.

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(24)01749-5/fulltext#:~:text=We%20found%20that%20giving%20women,thromboembolic%20events%20in%20these%20women.

Switching from disposable to reusable PPE

BMJ, 384, e075778.

“What you need to know”

• Globally, demand for PPE is rising, despite a recent decrease relative to its peak in the covid pandemic
• In 2020, use of isolation gowns and surgical masks in the US alone contributed the carbon dioxide equivalent of 78 coal fired power plants running continuously
• Reusable PPE preserves safety, while offering less severe environmental consequences and reducing costs. Successful deployments of reusable gowns at large US medical centres have resulted in the diversion of hundreds of tons of landfill waste with cost savings of nearly 50% per gown with no impact on infection rates.

Link to full article – https://www.bmj.com/content/384/bmj-2023-075778

Breast milk odour and reduction of pain and stress in the newborn during suction procedures

Breastfeeding Medicine, doi: 10.1089/bfm.2023.0325.

Objective: The study aimed to determine the effect of the breast milk odor on the pain and stress levels of the newborn during the endotracheal suction procedure.

Results: We found that the intervention group’s pain and stress score averages were lower than the control group during and after the endotracheal suction procedure (p < 0.05).

Conclusion: We found that the breast milk odor reduced the pain, stress levels, and crying duration of newborns during the endotracheal suction process.

Link to full abstract – https://pubmed.ncbi.nlm.nih.gov/38526230/

Midwifery staffing and reported harmful incidents

BMC Health Serv Res, 24, 391. https://doi.org/10.1186/s12913-024-10812-8

Abstract: Independent inquiries have identified that appropriate staffing in maternity units is key to enabling quality care and minimising harm, but optimal staffing levels can be difficult to achieve when there is a shortage of midwives. The services provided and how they are staffed (total staffing, skill-mix and deployment) have been changing, and the effects of workforce changes on care quality and outcomes have not been assessed. This study aims to explore the association between daily midwifery staffing levels and the rate of reported harmful incidents affecting mothers and babies.

Conclusion: When there is understaffing by registered midwives, more harmful incidents are reported but understaffing by maternity assistants is not associated with higher risk of harms. Adequate registered midwife staffing levels are crucial for maintaining safety. Changes in the profile of maternity service workforces need to be carefully scrutinised to prevent mothers and babies being put at risk of avoidable harm.

Link to full article – https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-024-10812-8#Tab3

Experiences of whistleblowing in maternal and newborn healthcare

Women and Birth, 37(3),101593.

Problem

Whistleblowing, which involves raising concerns about wrongdoing, carries risks yet can be crucial to ensuring the safety of health service users in maternal and newborn healthcare settings. Understanding of the experiences of health care professionals that enact whistleblowing in this context is currently limited.

Background

Notable inquiries involving maternity services such as those reported upon by Ockenden and Kirkup and the Lucy Letby case in the United Kingdom have shone an international spotlight on whistleblowing failures.

Conclusion

Primary research on whistleblowing in maternal and newborn healthcare settings is limited. This study sheds light on power dynamics and factors that affect whistleblowing.

Link to full article – https://doi.org/10.1016/j.wombi.2024.101593

Breastfeeding or breast milk for procedural pain in newborn babies

Cochrane Database of Systematic Reviews, 8. Art. No.: CD004950. DOI: 10.1002/14651858.CD004950.pub4.

Review question

We investigated how well breastfeeding or supplemental breast milk (expressed breast milk given via feeding tube or by placing breast milk in baby’s mouth) works as a pain reliever in newborn babies while they undergo painful procedures (e.g. vaccination, heel prick, blood sampling for tests or eye examinations). The babies’ pain responses (e.g. changes in heart rate, oxygen level, blood pressure, percentages of crying time, duration of crying etc.) were assessed by health care professionals to measure the pain that babies are experiencing.

Key results

Newborn babies in the breastfeeding group experienced a lower heart rate, shorter duration of cry, lower percentage of cry time and lower scores on the Neonatal Infant Pain Scale than babies who received no intervention. Moderate concentrations of glucose/sucrose may have similar effectiveness to breastfeeding. Studies of supplemental breast milk showed variable results. Supplemental breast milk was found to have a lower increase in heart rate when compared to water, and a lower duration of crying when compared to placebo.

Conclusions

Moderate-/low-certainty evidence suggests that breastfeeding or supplemental breast milk may reduce pain in neonates undergoing painful procedures compared to no intervention/positioning/holding or placebo or non-pharmacological interventions. Low-certainty evidence suggests that moderate concentration (20% to 33%) glucose/sucrose may lead to little or no difference in reducing pain compared to breastfeeding. The effectiveness of breast milk for painful procedures should be studied in the preterm population, as there are currently a limited number of studies that have assessed its effectiveness in this population.

Full Cochrane Review available – https://www.cochrane.org/CD004950/NEONATAL_breastfeeding-or-breast-milk-procedural-pain-newborn-babies

Cranberries for preventing urinary tract infections

Cochrane Database of Systematic Reviews, 11. Art. No.: CD001321. DOI: 10.1002/14651858.CD001321.pub7

Background: Cranberries contain proanthocyanidins (PACs), which inhibit the adherence of p‐fimbriated Escherichia coli to the urothelial cells lining the bladder. Cranberry products have been used widely for several decades to prevent urinary tract infections (UTIs). This is the fifth update of a review first published in 1998 and updated in 2003, 2004, 2008, and 2012.

Objectives: To assess the effectiveness of cranberry products in preventing UTIs in susceptible populations.

Authors’ conclusions: This update adds a further 26 studies, taking the total number of studies to 50 with 8857 participants. These data support the use of cranberry products to reduce the risk of symptomatic, culture‐verified UTIs in women with recurrent UTIs, in children, and in people susceptible to UTIs following interventions. The evidence currently available does not support its use in the elderly, patients with bladder emptying problems, or pregnant women.

Implications for practice

The current body of evidence suggests that cranberry products (either in juice or as tablets or powder) compared to placebo or no treatment probably reduce the risk of symptomatic UTIs in women with recurrent UTIs, in children, and in people at risk of UTIs following an intervention.

The data did not support the use of cranberry products to reduce the risk of symptomatic UTIs in elderly men and women, in pregnant women or in adults with neuromuscular dysfunction of the bladder and incomplete bladder emptying. However, data in these latter groups are limited to small studies with considerable uncertainty around the results.

Full Cochrane Review available – https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001321.pub7/full

An exploratory study of women and midwives’ perceptions of environmental waste management – homebirth as climate action

Midwifery, 127,https://www.sciencedirect.com/science/article/abs/pii/S0266613823002474?via%3Dihub

Aims: The aim is to better understand how and why women and midwives from the homebirth community in Australia choose to manage waste generated during the birthing process. Babies across the globe are born without a carbon footprint and are united, no matter their location, by a future that will require an understanding of and action against climate change.

Conclusion: Birthing at home has a low environmental impact as clinical waste is negligible. This research demonstrates a need to incorporate sustainable waste management into midwifery education while respecting midwifery practices in the home setting.

Full abstract, introduction, and section snippets available https://www.sciencedirect.com/science/article/abs/pii/S0266613823002474?via%3Dihub

Telehealth use in maternity care during a pandemic

Women and Birth, https://doi.org/10.1016/j.wombi.2023.12.008

Background

To reduce transmission risk during the COVID-19 pandemic, ‘telehealth’ (health care delivered via telephone/videoconferencing) was implemented into Australian maternity services. Whilst some reports on telehealth implementation ensued, there was scant evidence on women and midwives’ perspectives regarding telehealth use.

Conclusion

During the COVID-19 pandemic, telehealth offered flexibility, convenience and cost efficiency whilst reducing COVID-19 transmission, yet benefits came at a cost. Telehealth may particularly suit women in rural and remote areas, however, it also has the potential to further reduce equitable, and appropriate care delivery for those at greatest risk of poor outcomes. Telehealth may play an adjunct role in post-pandemic maternity services but is not a suitable replacement to traditional face-to-face maternity care.

Full article available at https://www.sciencedirect.com/science/article/pii/S1871519223003190

Topical Use of Human Milk in the Neonatal Intensive Care Unit

Advances in Neonatal Care, 24(1),78-85.

Background: 

Research has shown that the bioactive components in human milk could demonstrate efficacy when applied topically. One common neonatal skin issue is diaper dermatitis (DD). DD treatment and prevention guidelines often lack the inclusion of topical human milk as a viable option.

Results: 

The search yielded 20 articles. The results of the review demonstrate that topical human milk application is a safe and effective topical treatment to skin integrity/inflammatory issues such as DD. It also identified that caregivers will likely show positive regard to the treatment, promoting its acceptance.

Implications for Practice and Research:

The results provide evidence to support methodologic development for human milk application for the prevention and treatment of DD. Further studies can use the results to develop protocols that investigate the effects of human milk application.

Full abstract available https://pubmed.ncbi.nlm.nih.gov/38181669/

An exploratory study of women and midwives’ perceptions of environmental waste management – homebirth as climate action

Midwifery, 127, https://www.sciencedirect.com/science/article/abs/pii/S0266613823002474?via%3Dihub

Aims

The aim is to better understand how and why women and midwives from the homebirth community in Australia choose to manage waste generated during the birthing process. Babies across the globe are born without a carbon footprint and are united, no matter their location, by a future that will require an understanding of and action against climate change.

Conclusion

Birthing at home has a low environmental impact as clinical waste is negligible. This research demonstrates a need to incorporate sustainable waste management into midwifery education while respecting midwifery practices in the home setting.

Full abstract, introduction, and section snippets available https://www.sciencedirect.com/science/article/abs/pii/S0266613823002474?via%3Dihub

Barriers and enablers to antenatal care attendance for women referred to social work services in a Victorian regional hospital: A qualitative descriptive study.

Women and Birth, 37, 2.

Aims

This study aimed to explore the barriers and enablers to antenatal care attendance by women referred to social work services from the perspectives of women, and clinicians who provide antenatal healthcare.

Conclusions

Continuity of care is essential for supporting women referred to social work services to attend antenatal appointments. Women are better equipped to overcome other barriers to antenatal service attendance when they have a strong partnership with clinicians involved in their care.

Full article available https://www.sciencedirect.com/science/article/pii/S1871519224000180

The role of breastfeeding in breast cancer prevention: a literature review

Frontiers in Oncology, 13  https://doi.org/10.3389/fonc.2023.1257804

Abstract

Breastfeeding constitutes a positive, health-promoting behavior, with breastfeeding duration reducing breast cancer risk. Building on multiple breastfeeding-breast cancer associations, we comprehensively outlined mechanisms through which breastfeeding averts breast cancer development. Numerous questions remain regarding breastfeeding’s role in reducing breast cancer risk. For instance, how much breastfeeding is required to mitigate risk? Is three months sufficient? Is the first or last pregnancy more pivotal, or is complete breastfeeding month duration key to risk reduction? Addressing these queries mandates extensive epidemiological studies providing detailed reproductive and breastfeeding histories, coupled with laboratory research illuminating these variables’ impact on breast cell populations. Future population-based inquiries must consider potential confounding effects of menarche age on breastfeeding associations, alongside possible interactions with other lifestyle factors such as oral contraceptive use, alcohol consumption, and body mass index. Enhanced understanding of breastfeeding’s impact on breast cancer mechanisms might uncover preventive pharmaceutical options for women unable or unwilling to breastfeed, curtailing cancer prevalence and its mortality, thereby setting our research’s future trajectory.

Open access article 

‘I might have cried in the changing room, but I still went to work’. Maternity staff balancing roles, responsibilities, and emotions of work and home during COVID-19: An appreciative inquiry

Problem: Knowing how to help staff thrive and remain in practice in maternity services.

Conclusion: Staff wellbeing initiatives, and research into wellbeing, would benefit from adopting a holistic approach that incorporates home and family with work. Research on emotion regulation strategies could provide insights into managing roles, responsibilities, and the emotional demands of working in maternity services. Emotion regulation strategies could be included in midwifery and obstetric training.

Open access article

Maternal oxygen administration during labor: A controversial practice

Children, 10(8), 1420. https://doi.org/10.3390/children10081420

Abstract

Oxygen administration to the mother is commonly performed during labor, especially in the case of a non-reassuring fetal heart rate, aiming to increase oxygen diffusion through the placenta to fetal tissues. The benefits and potential risks are controversial, especially when the mother is not hypoxemic. Its impact on placental gas exchange and the fetal acid–base equilibrium is not fully understood, and it probably affects the sensible placental oxygen equilibrium causing a time-dependent vasoconstriction of umbilical and placental vessels. Hyperoxia might also cause the generation of radical oxygen species, raising concerns for the developing fetal cells. Moreover, this practice affects the maternal cardiovascular system, causing alterations of the cardiac index, heart rate and vascular resistance, and unclear effects on uterine blood flow. In conclusion, there is no evidence that maternal oxygen administration can provide any benefit in the case of a non-reassuring fetal heart rate pattern, while possible collateral effects warn of its utilization. Oxygen administration during labor should be reserved for cases of maternal hypoxia.

Open access article 

A pre-post implementation study of a care bundle to reduce perineal trauma in unassisted births conducted by midwives

Women and Birth, DOI: https://doi.org/10.1016/j.wombi.2023.08.003

Abstract

Data from 20,155 births (pre-implementation) and 6273 (post-implementation) were analysed. After implementation, no significant difference in likelihood of severe perineal trauma was demonstrated (aOR 0.86, 95% CI 0.71–1.04, p = 0.124). Nulliparous women were more likely to receive an episiotomy (aOR 1.49 95% CI 1.31–1.70 p < 0.001) and multiparous women to suffer a second degree tear (aOR 1.18 95% CI 1.09–1.27 p < 0.001).

Aim

To measure the effect of perineal bundle implementation on perineal injury for women having unassisted births with midwives.

Discussion

This study adds to the growing body of literature which suggests a number of bundle components are ineffective, and some potentially harmful. Why, and how, the bundle was introduced at scale without a research framework to test efficacy and safety is a key concern.

Conclusion

Suitably designed trials should be undertaken on all proposed individual or grouped perineal protection strategies prior to broad adoption

Open access article

 Women’s experience of continuity of midwifery care in North-Eastern Italy: A qualitative study.

Eur J Midwifery, 7: DOI: https://doi.org/10.18332/ejm/159358

Abstract

Introduction: The establishment of a maternity path is often hampered by the fragmentation of care processes resulting in discontinuity of care. The interruption of continuity of care negatively affects the experience of maternity. The purpose of this research is to analyse the experience of women who get midwifery continuity of care from pregnancy till after childbirth.

Conclusions: From the perspective of prevention and protection of maternal and child health, in the short- and long-term, it becomes essential to focus on developing maternal competencies. This may be possible by implementing midwifery continuity of care pathways with an appropriate and flexible organizational system capable of responding to women’s needs throughout the maternity journey, even during periods of a health emergency.

Full abstract and open access article available here

Project20: maternity care mechanisms that improve access and engagement for women with social risk factors in the UK – a mixed-methods, realist evaluation.

BMJ Open, 13,e064291 doi:10.1136/bmjopen-2022-064291 

Abstract

Objectives: To evaluate how women access and engage with different models of maternity care, whether specialist models improve access and engagement for women with social risk factors, and if so, how?

Results: The number of social risk factors women were experiencing increased with deprivation score, with the most deprived more likely to receive a specialist model that provided continuity of care. Women attending hospital-based antenatal care were more likely to access maternity care late (risk ratio (RR) 2.51, 95% CI 1.33 to 4.70), less likely to have the recommended number of antenatal appointments (RR 0.61, 95% CI 0.38 to 0.99) and more likely to have over 15 appointments (RR 4.90, 95% CI 2.50 to 9.61) compared with community-based care. Women accessing standard care (RR 0.02, 95% CI 0.00 to 0.11) and black women (RR 0.02, 95% CI 0.00 to 0.11) were less likely to have appointments with a known healthcare professional compared with the specialist model. Qualitative data revealed mechanisms for improved access and engagement including self-referral, relational continuity with a small team of midwives, flexibility and situating services within deprived community settings.

Conclusion: Inequalities in access and engagement with maternity care appears to have been mitigated by the community-based specialist model that provided continuity of care. The findings enabled the refinement of a realist programme theory to inform those developing maternity services in line with current policy.

Full abstract and open access article available here

The impact of social media influencers on pregnancy, birth, and early parenting experiences: A systematic review.

Midwifery, 120: https://doi.org/10.1016/j.midw.2023.103623 

Abstract

Aim: To systematically review the literature to identify what is known about how following social media ‘influencers’ and ‘bloggers’ impacts pregnant and new parents’ experiences and decision-making.

Discussion: Social media influencers provide a network of peers amongst whom discussions, supportive behaviours, and information sharing take place. However, concern arises around the potential for combative interactions, the risk for transmission of misinformation, and the potential impacts of following influencers who are also qualified health professionals.

Conclusion: Existing research suggests that engaging with social media influencers can be both beneficial and harmful for pregnant and new parents. At the current time, it is unclear how exposure to the benefits or harm impacts personal experiences and decision-making.

Full abstract and open access paper available here

Consent during labour and birth as observed by midwifery students: A mixed methods study.

Women and Birth, S1871-5192. https://doi.org/10.1016/j.wombi.2023.02.005

Abstract

Background: While consent is an integral part of respectful maternity care, how this is obtained during labour and birth presents conflicting understandings between midwives’ and women’s experiences. Midwifery students are well placed to observe interactions between women and midwives during the consent process.

Aim: The purpose of this study was to explore the observations and experiences of final year midwifery students of how midwives obtain consent during labour and birth.

Discussion: The student’s accounts suggest that in many instances during labour and birth the principles of informed consent are not being applied consistently. Presenting interventions as routine care subverted choice for women in favour of the midwives’ preferences.

Conclusions: Consent during labour and birth is invalidated by a lack of disclosure of risks and alternatives. Health and education institutions should include information in guidelines, theoretical and practice training on minimum consent standards for specific procedures inclusive of risks and alternatives.

Full abstract and open access article available here

Support for healthy breastfeeding mothers with healthy term babies.

Cochrane Database of Systematic Reviews,10. DOI: 10.1002/14651858.CD001141.pub6

Background: There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant’s diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation.

Authors’ conclusions: When ‘breastfeeding only’ support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points.  For ‘breastfeeding plus’ interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face‐to‐face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.

Full Cochrane Review available here

Midwives and sexual violence: A cross-sectional analysis of personal exposure, education and attitudes in practice.

Women and Birth, 35(5):e487-e493.

Abstract

Background

Around one in three women experience sexual violence during their lifetime. They may need trauma-sensitive maternity care that takes sexual trauma triggers into account. Midwives are similarly likely to have experienced sexual violence in their lifetime. It is unknown whether midwives with a personal sexual violence history have a different professional approach to the topic than their colleagues without such history.

Aim

To explore whether midwives with a personal sexual violence history are more likely to have received or need education about sexual violence and whether they approach sexual violence differently in practice.

Conclusions

As fellow survivors, midwives with a personal sexual violence history have a unique standpoint towards sexual violence in maternity care practice that may make them more sensitive to the issue.

Full abstract and open access article available here 

Elective induction of labour and expectant management in late-term pregnancy: A prospective cohort study alongside the INDEX randomised controlled trial.

Eur J Obstet Gynecol Reprod Biol X. 16:100165.

Abstract

Objective

To assess adverse perinatal outcomes and caesarean section of low-risk women receiving elective induction of labour at 41 weeks or expectant management until 42 weeks according to their preferred and actual management strategy

Conclusion

In this cohort study among low-risk women receiving the policy of their preference in late-term pregnancy, a non-significant difference was found between induction of labour at 41 weeks and expectant management until 42 weeks in absolute risks of composite adverse (1.1% versus 1.9%) and severe adverse (0.3% versus 1.0%) perinatal outcome. The risks in this cohort study were lower than in the trial setting. There were no stillbirths among all 3,642 women. Caesarean section rates were comparable.

Full abstract and open access article available here

Experience of induction of labour: a cross-sectional postnatal survey of women at UK maternity units.

BMJ Yale medRxiv, doi: https://doi.org/10.1101/2022.11.30.22282928

Abstract

Background

Induction of Labour (IOL) is an increasingly common obstetric intervention, offered to 30-50% of pregnant women in the UK. IOL affects experience of childbirth: it is more painful than spontaneous labour and more likely to lead to additional interventions including operative birth. Experience of childbirth is important to women, and negative experience of childbirth has been linked to serious psychological harm. The high and rising rate of IOL has implications for provision of safe, effective, person-centred maternity services, yet there is little information about women’s experiences of induction.

Aim

To explore women’s views and experiences of key elements of the IOL process, including at home or in hospital cervical ripening (CR)

Conclusions

Women do not experience IOL as a benign and consequence free intervention. There is urgent need for research to better target IOL and optimise safety and experience for women and their babies. Relatively few women were offered CR at home and further research is needed on this experience.

Full abstract and open access article available here 

First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined.

Front Nutr, 9: https://doi.org/10.3389/fnut.2022.1049610

Background:

In March 2020, the World Health Organization (WHO) published clinical guidance for the care of newborns of mothers with COVID-19. Weighing the available evidence on SARS-CoV-2 infection against the well-established harms of maternal-infant separation, the WHO recommended maternal-infant proximity and breastfeeding even in the presence of maternal infection. Since then, the WHO’s approach has been validated by further research. However, early in the pandemic there was poor global alignment with the WHO recommendations.

Conclusion: Despite the WHO recommendations, many COVID-19 maternal and newborn care guidelines failed to recommend skin-to-skin contact, rooming-in, and breastfeeding as the standard of care. Irregular guidance updates and the discordant, but influential, guidance from the United States Centers for Disease Control may have been contributory. It appeared that once recommendations were made for separation or against breastfeeding they were difficult to reverse. In the absence of quality evidence on necessity, recommendations against breastfeeding should not be made in disease epidemics.

Full abstract and open access article available here 

Health and nutrition claims for infant formula: international cross sectional survey.

BMJ, 380:E071075.

Abstract

Objectives

To review available health and nutrition claims for infant formula products in multiple countries and to evaluate the validity of the evidence used for substantiation of claims.

Conclusions

Most infant formula products had at least one health and nutrition claim. Multiple ingredients were claimed to achieve similar health or nutrition effects, multiple claims were made for the same ingredient type, most products did not provide scientific references to support claims, and referenced claims were not supported by robust clinical trial evidence.

Full abstract and open access article available here

Midwifery continuity of care: A scoping review of where, how, by whom and for whom?

PLOS Global Public Health, 2(10): e0000935

Abstract

Systems of care that provide midwifery care and services through a continuity of care model have positive health outcomes for women and newborns. We conducted a scoping review to understand the global implementation of these models, asking the questions: where, how, by whom and for whom are midwifery continuity of care models implemented? Using a scoping review framework, we searched electronic and grey literature databases for reports in any language between January 2012 and January 2022, which described current and recent trials, implementation or scaling-up of midwifery continuity of care studies or initiatives in high-, middle- and low-income countries. After screening, 175 reports were included, the majority (157, 90%) from high-income countries (HICs) and fewer (18, 10%) from low- to middle-income countries (LMICs). There were 163 unique studies including eight (4.9%) randomised or quasi-randomised trials, 58 (38.5%) qualitative, 53 (32.7%) quantitative (cohort, cross sectional, descriptive, observational), 31 (19.0%) survey studies, and three (1.9%) health economics analyses. There were 10 practice-based accounts that did not include research. Midwives led almost all continuity of care models. In HICs, the most dominant model was where small groups of midwives provided care for designated women, across the antenatal, childbirth and postnatal care continuum. This was mostly known as caseload midwifery or midwifery group practice. There was more diversity of models in low- to middle-income countries. Of the 175 initiatives described, 31 (18%) were implemented for women, newborns and families from priority or vulnerable communities. With the exception of New Zealand, no countries have managed to scale-up continuity of midwifery care at a national level. Further implementation studies are needed to support countries planning to transition to midwifery continuity of care models in all countries to determine optimal model types and strategies to achieve sustainable scale-up at a national level.

Open access article link

Predictors and impact of women’s breastfeeding self-efficacy and postnatal care in the context of a pandemic in Australia and Aotearoa New Zealand

Midwifery, 114,103462

Abstract

Objective

To investigate predictors of breastfeeding self-efficacy, postnatal care experiences, and there subsequent impact on breastfeeding outcomes in Australia and Aotearoa New Zealand in the context of the COVID-19 pandemic.

Findings

There were 1001 complete responses. Visitor restrictions impacted the woman’s early parenting experience in both positive and negative ways. One third of participants stated their postnatal needs were not met with 82 stating that they had no postnatal care at all. During the first six weeks postnatal, 48.1% felt not very or not at all confident caring for their baby. Despite 94.3% of participants initiating breastfeeding, only 70% were exclusively breastfeeding at six weeks. The mean self-efficacy score was 49.98 suggesting the need for additional help, with first time mothers having a statistically significant lower score.

Discussion/conclusion

Sub-optimal postnatal care and support negatively influence breastfeeding self-efficacy. Women desired additional help during the COVID-19 pandemic inclusive of support and education to meet their postnatal needs and exclusively breastfeed.

Implications for practice

Women require appropriate and timely postnatal care and support to promote confidence in caring for baby and achieve their breastfeeding goals. Preferably this care should be provided face-to-face.

Open access abstract and extended introduction link

Antibodies in the breastmilk of COVID-19 recovered women

BMC Pregnancy and Childbirth 22, 635

Objective

Human milk contains antibodies against Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) which may serve as a protective factor through passive immunization in infants. The objective of this study was to measure the levels of anti-SARS-CoV-2 IgG and IgA in human milk and serum after a SARS-CoV-2 infection.

Study conclusion

Our results confirm the presence of SARS-CoV-2 IgA and IgG antibodies in the breastmilk of COVID-19 recovered women and the possibility of these antibodies in providing specific immunologic benefits to breastfeeding infants such as protection against the virus transmission and severity of the acquired COVID-19 disease.

Open access article link

Insider knowledge as a double-edged sword: an integrative review of midwives’ personal childbearing experience

 BMC Pregnancy and Childbirth, 22, 640

Abstract

The majority of maternity care is provided by female midwives who have either become mothers or are of childbearing age, but there is limited research exploring midwives’ own personal childbearing experiences. This integrative review aims to explore the published literature and research on midwives’ own experiences of pregnancy and childbirth.

Results

Twenty articles were included in the review and four overarching themes were identified. Insider knowledge plays a role in decision making encompassed the way midwives used their knowledge to choose; a preferred mode of birth, maternity care provider, model of care, and place of birth. Navigating the childbirth journey demonstrated how some midwives were able to use their insider knowledge to achieve agency, while others had difficulty achieving agency. This theme also revealed the ‘midwife brain’ that midwives need to manage during their childbearing journey. The theme impact of care on the birth experience described how the type of care the midwives received from maternity care providers affected their overall birth experience. The fourth theme from midwife to mother explains their preparedness for childbirth and their transition to motherhood.

Conclusion

For childbearing midwives, there is a potential conflict between their position as knowledgeable experts in maternity care, and their experience as mothers. Whilst they can use their insider knowledge to their advantage, they also experience heightened fear and anxiety through their pregnancy. It is important for maternity care providers to acknowledge and support them and provide balanced and tailored care that acknowledges the woman within the professional midwife and the professional midwife within the woman.

Click here to view open access article

Tighter or less tight glycaemic targets for women with gestational diabetes mellitus for reducing maternal and perinatal morbidity: A stepped-wedge, cluster-randomised trial.

PLoS Med 19(9): e1004087. https://doi.org/10.1371/journal.pmed.1004087

Abstract

Background

Treatment for gestational diabetes mellitus (GDM) aims to reduce maternal hyperglycaemia. The TARGET Trial assessed whether tighter compared with less tight glycaemic control reduced maternal and perinatal morbidity.

Conclusions

Tighter glycaemic targets in women with GDM compared to less tight targets did not reduce the risk of a large for gestational age infant, but did reduce serious infant morbidity, although serious maternal morbidity was increased. These findings can be used to aid decisions on the glycaemic targets women with GDM should use.

Link to open access article

How a perineal care bundle impacts midwifery practice in Australian maternity hospitals: A critical, reflexive thematic analysis

Women Birth, 35(1):e1-e9. doi:10.1016/j.wombi.2021.01.012

Abstract

A care bundle was introduced into 28 Australian hospitals in 2018 with the aim of reducing severe perineal tears. There has been limited research regarding the impact of this bundle on women’s birth experiences.

Findings

Three descriptive themes were generated: 1) Lack of information and consent to bundle elements, 2) Other non-consented and disrespectful treatment and 3) Recommendations for hospitals and clinicians. Two analytic themes were generated: 1) Default-position: Prioritising policies over women’s autonomy and 2) Counter-position: Women asserting their rights to autonomy and respect.

Discussion

None of the women interviewed could recall having received information about the perineal care bundle from clinicians during pregnancy. While many women accepted that its elements were in their or their baby’s best interests, this was not the case for all women. Some women reported coercive and non-consented application of bundle elements, which they found distressing.

Conclusion

Given the broader institutional context in which the perineal bundle was implemented, the impact on information provision, informed consent and the detrimental emotional consequences for some women arising from the bundle’s implementation were largely foreseeable. The potential for bundled care initiatives to impinge on women’s human rights to autonomy and respectful care should be given greater preventative attention prior to implementation.

Link to open access article

More home births during the COVID-19 pandemic in the Netherlands

Birth, https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12646

Background

The aim of this observational study was to examine whether the course of pregnancy and birth and accompanying outcomes among low-risk pregnant women changed in the COVID-19 pandemic compared to the prepandemic period.

Results

We included 5913 low-risk pregnant women of whom 2963 (50.1%) were pregnant during the first surge of the COVID-19 pandemic, and 2950 (49.9%) in the prepandemic period. During the COVID-19 pandemic, more women desired and had a home birth. More women used pain medication and fewer had an episiotomy in the COVID-19 period than prior. Multiparous women had a higher suspected rate of fetal growth restriction during COVID; however, the actual rate of small for gestational age infants was not significantly increased. We observed no differences for onset and augmentation of labor or for mode of birth, though the rate of vaginal births increased.

Conclusions

During the COVID-19 pandemic, there was a higher rate of planned and actual home birth, and suspected growth restriction and a lower rate of episiotomy among low-risk pregnant women in the Netherlands.

Link to open access article

Inducing labour in the United Kingdom: A feminist critical discourse analysis of policy and guidance.

SSM – Qualitative Research in Health, 2 – https://doi.org/10.1016/j.ssmqr.2022.100108

Conclusions

• This feminist critical discourse analysis explores professional writing about induction of labour (IOL) policy and practice from the United Kingdom.
• A double discourse was identified that operates at both explicit and implicit levels.
• There are differences between what is stated (explicit) and underlying messages (implicit).
• Women are afforded little agency within their own experience of IOL by many of the authors.
• Discourse often functions to preserve clinicians’ control over maternity care.

Abstract

Induction of labour (IOL), the process of starting labour artificially, is one of the most commonly performed procedures in maternity care in the United Kingdom (UK), yet there is debate whether inducing labour at ‘term’, in the absence of specific medical indication, is beneficial and reduces risk of stillbirth. Moreover, rates of routine IOL are rapidly rising in the UK, despite uncertainty about the evidence base and parents reporting receiving a lack of balanced information about the process. As a contested area of maternity care, the language used to debate, describe and discuss IOL takes on added significance and requires in-depth examination and analysis. To address this, we conducted a feminist critical discourse analysis on policy and professional writing about IOL in the UK, focusing on how these both reflect and construct social practices of pregnancy and birth. Our analysis identified a double discourse about IOL, which we term ‘explicit-implicit discourse of care’, revealing the differences between what is expected to be said and what is really said. Though most texts displayed an explicit discourse of care, which espoused women-centred care and informed choice, they also conveyed an implicit discourse of care, primarily composed of three key dimensions: women as absent actors, disembodiment, and evidence as a primary actor. We argue that this explicit-implicit discourse functions to preserve healthcare professionals’ control over maternity care and further alienate women from their own bodies while maintaining a discursive position of women-centred care and informed choice.

Open access article available

Cord clamping beyond 3 minutes: Neonatal short‐term outcomes and maternal postpartum hemorrhage.

Birth – https://doi.org/10.1111/birt.12645

Background

Delaying cord clamping (CC) for 3-5 minutes reduces iron deficiency and improves neurodevelopment. Data on the effects of CC beyond 3 minutes in relation to short-term neonatal outcomes and maternal risk of postpartum hemorrhage are scarce.

Conclusions

Umbilical CC times beyond 3 minutes in vaginal deliveries were not associated with negative short-term outcomes in newborns and were associated with a smaller maternal postpartum blood loss. Although CC time as long as 6 minutes could be considered as safe, further research is needed to decide the optimal timing.

Open access article available

Birth plans: A systematic, integrative review into their purpose, process, and impact.

Midwifery, 111:103388 – doi: 10.1016/j.midw.2022.103388

Background

The birth plan was introduced in the 1980s to facilitate communication between maternity care providers and women and increase agency for childbearing women in the face of medicalised birth. Forty years on, the birth plan is a heterogeneous document with uncertainty surrounding its purpose, process, and impact. The aim of this review was to synthesise the evidence and improve understanding of the purpose, process and impact of the birth plan on childbearing women’s experiences and outcomes.

Conclusions

Despite the heterogeneity of birth plans, birth plans were associated with positive outcomes for childbearing women when developed in collaboration with care providers. The act of collaboratively creating a birth plan may improve obstetric outcomes, aid realistic expectations, and improve satisfaction and the sense of control.

Expanded abstract available

Maternal and neonatal outcomes of women with gestational diabetes and without specific medical conditions: an Australian population-based study comparing induction of labor with expectant management.

Aust NZ J Obstet Gynaecol,1-11. https://doi.org/10.1111/ajo.13505

Background/aims

To evaluate maternal birth and neonatal outcomes among women with gestational diabetes mellitus (GDM), but without specific medical conditions and eligible for vaginal birth who underwent induction of labour (IOL) at term compared with those who were expectantly managed.

Conclusion

In women with GDM but without specific medical conditions and eligible for vaginal birth, IOL at 38, 39, 40 weeks gestation is associated with an increased risk of caesarean section.

Open access article available

“Never let a good crisis go to waste”: Positives from disrupted maternity care in Australia during COVID-19.

Midwifery, 110(103340): https://doi.org/10.1016/j.midw.2022.103340

Objective

Due to the COVID-19 pandemic, a number of changes to maternity care were rapidly introduced in all countries, including Australia, to reduce the risk of infection for pregnant women and their care providers. While many studies have reported on the negative effects of these changes, there is a paucity of evidence on factors which women and their providers perceived as positive and useful for future maternity care.

Key conclusions

Despite the negative effect of COVID-19-related restrictions on maternity care, a variety of changes were viewed as positive by both women and midwives, with strong agreement between the two groups.

Implications for practice

These findings provide evidence to support the inclusion of these positive elements of care and ensure that the lessons learned from the pandemic are utilised to improve maternity care in Australia going forward.

Open access article available 

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm.

Acta Paediatrica, 11(5): 1004-1014.

Aim

The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood.

Conclusion

Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Open access article available 

Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta‐Analysis Involving Data From 8 Studies and 1 192 700 Parous Women.

Journal of the American Heart Association, 11(2) – https://doi.org/10.1161/JAHA.121.022746

Background

Breastfeeding has been robustly linked to reduced maternal risk of breast cancer, ovarian cancer, and type 2 diabetes. We herein systematically reviewed the published evidence on the association of breastfeeding with maternal risk of cardiovascular disease (CVD) outcomes.

Conclusions

Breastfeeding was associated with reduced maternal risk of CVD outcomes.

Open access article available 

A comparison of the Woman-centred care: strategic directions for Australian maternity services (2019) national strategy with other international maternity plans.

Women and Birth, https://doi.org/10.1016/j.wombi.2022.04.003

Background

In 2019 the Australian government released a guiding document for maternity care: Woman-centred care strategic directions for Australian maternity services (WCC Strategy), with mixed responses from providers and consumers. The aims of this paper were to: examine reasons behind reported dissatisfaction, and compare the WCC Strategy against similar international strategies/plans. The four guiding values in the WCC strategy: safety, respect, choice, and access were used to facilitate comparisons and provide recommendations to governments/health services enacting the plan.

Conclusion

Maternity strategy/plans should be based on the best available evidence, with consistent and complementary recommendations. Within this framework, priority should be given to women’s preferences and choices, rather than the interests of organisations and individuals

Open access article available