Women want a personalised birth experience, but safety is paramount

NIHR | September 2018 | Women want a personalised birth experience, but safety is paramount

A review of studies that sought the views of 1800 women about what matters most to them about childbirth, found that having a health baby was the most important. This review considered what matters to women, rather than relying on surveys of women’s satisfaction after giving birth. 

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The high quality findings have already informed WHO recommendations on childbirth and so could be useful for commissioners of UK-based maternity services.

Read the full Signal at NIHR 

 

 

What matters to women during childbirth?

New systematic review finds that women want a personalised birth experience, but safety is paramount | PLoS One | via National Institute of Health Research

Most healthy women would like a natural birth if possible, but acknowledge the unpredictability and risks of childbirth. Women mainly want a supportive care environment where healthcare providers are competent, kind and respectful.

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In this large review of studies with over 1,800 women’s views on what matters in childbirth, having a healthy baby was the woman’s priority. Avoiding unnecessary medical intervention and retaining a sense of control whatever kind of birth is experienced is also important to many women. Basing the review on what matters to women, rather than surveys of patient satisfaction after the birth, ensured that their views were not limited by what was actually available to them.

 

Three broad summary themes were identified.

  • The first summary theme was on hopes and fears, looking towards a positive outcome but also being aware of the potential for pain and vulnerability. Key points included having a birth without medical intervention and wanting a healthy baby.
  • The second concerned the influence of social and cultural expectations. There was less evidence supporting this. The main point was expectations were influenced by family and friends.
  • The final theme explored how expectations can be met taking into account external factors. The main point was expecting staff to be sensitive, caring and kind

The high quality findings have already informed WHO recommendations on childbirth and so could be useful for commissioners of UK-based maternity services.

Read more at National Institute for Health Research

Full reference: Downe S, et al. | What matters to women during childbirth: a systematic qualitative review | PLoS One | 2018 Volume 13 (4)

Inducing labour at or after 41 weeks reduces risks to infants

This updated review of 30 trials with over 12,000 low-risk women compared outcomes of induction at or beyond term with spontaneous labour. Induction was associated with better infant outcomes and fewer caesarean births, with a small non-statistically significant increase in operative vaginal births.

The evidence from this review supports and strengthens NICE and WHO guidelines on induction of labour. This is likely to be the best available evidence, but we still do not know the best timing for induction. Women should be offered the option of labour induction at 41 to 42 weeks, together with information about these risks.

Read full National Institute of Health Research report here

Full reference: Middleton P, Shepherd E, Crowther CA. | Induction of labour for improving birth outcomes for women at or beyond term. | Cochrane Database of Systematic Reviews. 2018;(5):CD004945.

 

Maternal request caesarean research highlights postcode lottery

Birthrights | August 2018 | Maternal request caesarean research highlights postcode lottery

New figures published by Birthrights highlights concerns about  the treatment of women requesting a cesarean section. Their freedom of information request finds that the majority of Trusts in the UK make the process of requesting a caesarean lengthy, difficult or inconsistent adding anxiety and distress to women at a vulnerable time. Statistics show that 15% of Trusts have policies or processes that explicitly do not support maternal request caesarean, while 47% of Trusts have policies or processes that are problematic or inconsistent. Only 26% of Trusts offer caesareans in line with NICE best-practice guidance (via Birthrights). 

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Birthrights news story here 

In the news:

On Medica Some hospitals tell women requesting caesareans to go elsewhere

The Guardian One in six NHS trusts do not offer caesareans on request – charity

BBC News  Women ‘being denied Caesarean choice’

[Video] BBC News I had to fight for my C-section while in labour’

Maternity care guideline

Intrapartum care for a positive childbirth experience | The World Health Organization

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Image source: http://www.who.int

This guideline brings together new and existing WHO recommendations that, when delivered as a package, will ensure good-quality and evidence-based care irrespective of the setting or level of health care.

It highlights the importance of woman-centred care to optimize the experience of labour and childbirth for women and their babies.

Full document: Intrapartum care for a positive childbirth experience

 

Additional links: WHO press release | Royal College of Midwives press release

Humanising birth: Does the language used matter?

A new post on the the BMJ blog outlines how those providing maternity care need to consider their language carefully. This requires thoughtful use of language, reflection on their practice as caregivers, alongside listening and communicating to women appropriately  and respectfully to guide them through the complexities of maternity care.

The authors highlight how the latest version of the NICE Intrapartum Care Guideline emphasises the importance of good intrapartum communication.  During a three month period, they  analysed the language used in maternity settings using a multidisciplinary, collaborative Facebook group to identify how language could improve the experiences of women, babies and families.

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Within a week 121 comments were received offering further input regarding commonly used phrases and expressions used in maternity care, which should be challenged.
From these comments, six key categories were identified that required change:

  • paternalistic or patronising language
  • language which objectifies women
  • anxiety-provoking language
  • dictatorial language
  • discouraging language
  • exclusive or codified language.

Examples of poor language are shown alongside suggested alternatives, on the BMJ blog.

The researchers emphasise that good communication during the birthing process is critical to good maternity care; but achieving a shift in deeply ingrained language, and the thinking it reflects, is difficult.
They also recognise that  there is a fine line between changing terminology to use  language which is more respectful, and less intimidating for the mother, and substituting vague language which hinders the original message.

These newspaper articles may also be of interest:

Maternity services survey 2017

Maternity services survey 2017 |  The Care Quality Commission

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This survey looked at the experiences of women receiving maternity services. The results show that overall women are reporting a more positive experience of maternity care and treatment. The publication highlights improvements in areas such as choice of where to give birth, quality of information and access to help and support after giving birth, when compared to the results from previous years’ surveys.

Compared with the last survey in 2015 a greater proportion of women said that they:

  • were offered the choice of giving birth in a midwife-led unit or birth centre
  • saw the same midwife at every antenatal appointment
  • were ‘always’ treated with dignity and respect during labour and birth
  • were never left alone during the birth of their baby at a time when it worried them
  • could ‘always’ get help from a member of staff within a reasonable time while in hospital after the birth

For more information, please see the statistical release, which provides the results for all questions: Maternity services survey 2017: Statistical release