ABSTRACT Background Breastfeeding rates and duration have been linked to a variety of factors, including mode of birth and maternal psychopathology. Although the research on mode of birth has focused primarily on caesarean sections and produced conflicting results, the research on psychopathology has primarily been undertaken in postnatal women. Furthermore, no study has explored whether mode of birth may moderate the relationship between maternal psychopathology and breastfeeding rates and duration. Aims To evaluate the impact of mode of birth (caesarean section, spontaneous vaginal birth, instrumental birth) and antenatal maternal psychopathology (depression and anxiety symptoms) on breastfeeding in a sample of new mothers. Design A longitudinal study design was employed to collect data during pregnancy, at 10 weeks post‐partum, and at 10‐months post‐partum. Methods Participants were 488 women booked in to give birth at a Private Hospital in North Sydney, Australia. Participants completed self‐report questionnaires relating to maternal depression, anxiety, and breastfeeding during pregnancy and at 10‐weeks and 9‐months post‐partum. Details about mode of birth and breastfeeding during the immediate postnatal stay were extracted from hospital records. Results Older maternal age and primiparity were associated with lower breastfeeding rates and duration at hospital discharge, 10‐weeks and 9‐months post‐partum. No associations were observed between mode of delivery or antenatal depression/anxiety symptoms and breastfeeding. Conclusion For Australian women who give birth in the private system, risk factors for poorer breastfeeding outcomes include older age and primiparity. Women who present with these characteristics may benefit from targeted breastfeeding support.
ABSTRACT Objective To examine differences in low‐risk cesarean delivery rates based on socioeconomic factors and whether selected socioeconomic factors increased the odds of cesarean delivery among women within the United States and among U.S. census regions. Methods Data from CDC Wonder were used to identify all singleton live births in the cephalic presentation with gestation between 39 and 41 weeks resulting from primipara women with no prenatal risk factors from 2016 to 2022. Odd ratios and 95% confidence intervals were calculated to assess the association between race/ethnicity, insurance status, and dwelling with cesarean delivery odds. Results Out of 4,484,225 deliveries, 21.3% had a cesarean. African American/Black women had 1.54 (95% CI: 1.51, 1.57) times the odds of having a cesarean compared to non‐Hispanic white women. Women covered by Medicaid had 1.01 (95% CI: 1.00, 1.05) times the odds of having a cesarean compared to those with private insurance. Women residing in urban areas had 1.03 (1.01, 1.05) times the odds of those residing in rural areas. Discussion A national estimate of low‐risk cesarean deliveries using the SFMF definition and further restrictions reported a rate of 23.9% from 2016 to 2022. African American/Black women had higher odds of cesarean delivery on a national and regional level in the U.S.
ABSTRACT Background In Germany, potential risks are attributed to a high number of pregnant women. This and the fact that antenatal checkups are mainly performed by physicians and not by midwives might lead to more diagnostic measures and more interventions. Yet, guidelines usually demand an indication. Notably, previous studies have shown that in Germany, healthy women with normal pregnancies are overexposed to ultrasound and cardiotocographic traces (CTGs). Thus, our study aims to determine the correlation between the number of ultrasound scans/CTG traces and the cesarean section rate in Germany in a low‐risk pregnant population. Methods For the 166,992 women who gave birth between 2020 and 2022, we used billing data to analyze instances of CTGs and ultrasound scans and subsequent rates of cesarean sections. Results 85.2% fulfilled at least one criterion for increased need of monitoring. Pregnant women without increased need of monitoring received an average of 5.4 ultrasound scans and 4.9 CTGs, much more than stipulated by the German Maternity Directives. In healthy women who were overexposed to CTGs and ultrasound scans, the cesarean section rate was approximately sevenfold (CTGs) and threefold (ultrasound) higher than for women with appropriate exposures. Conclusion Pregnancy is a normal part of life. An excessive focus on risks can lead to an overuse of diagnostic measures and result in potentially harmful interventions. This must be seen as low‐quality care and a risk to patient safety. In Germany, quality assurance measures for antenatal care should be established to promote adherence to guidelines.
ABSTRACT Introduction Midwives are often among the first responders in unexpected emergency situations in the delivery room. Their preparedness for unanticipated complications during birth is crucial for patient safety. This survey assessed Austrian midwives' training schedules, self‐assessed preparedness for obstetric emergencies (OE) and neonatal resuscitation (NR), and their suggestions for improving education in these areas. Methods A structured online survey comprising 34 questions was distributed to all Austrian midwives through the registry of the Austrian Board of Midwives. The responses were analyzed, focusing on those actively involved in perinatal care. Results A total of 330 responses were analyzed. Most of the respondents ( n = 265) were actively engaged in perinatal care. Half of the active midwives did not feel well‐prepared (50% for OE; 43% for NR). Fewer than one‐third (31%) participated in OE training sessions at least once per year, and half (57%) attended NR training at least annually. Most respondents expressed a desire for more frequent and mandatory perinatal training. The training curricula aligned with the common emergencies encountered by the survey population, and two‐thirds of all training sessions were interdisciplinary. Discussion Only half of the midwives in the survey population felt well‐prepared for emergency situations. The data showed that emergency preparedness is associated with training frequency in the survey population. More than 90% of midwives found simulation training beneficial, and their preference for mandatory training likely reflects a need for better access to such programs. Apart from potential time and budget constraints, a lack of institutional support—particularly from higher hierarchical positions—was identified as a key barrier to more frequent training. Increasing access and institutional support for regular emergency training could significantly improve preparedness among midwives, who are often the first responders in perinatal emergencies.
ABSTRACT Introduction We implemented a safety bundle for operative vaginal birth, including routine intrapartum ultrasound to assess fetal position, a structured team time‐out and procedural checklist, a birth experience survey and postnatal debrief pathway. This study assesses maternity staff experience of implementing this bundle. Materials and Methods This mixed‐methods study involved four maternity hospitals in Australia. Surveys sent to maternity staff sought feedback on the bundle for 12‐months following implementation using Likert‐style and free‐text questions. Likert‐style responses were compared in the first and second 6 months, as well as between obstetric and midwifery, and senior and junior clinical roles. Results from quantitative and qualitative analysis of survey data guided further in‐depth qualitative enquiry using semi‐structured interviews in a sequential convergent design. Results There were 117 survey responses from obstetric ( n = 27) and midwifery ( n = 90) staff, including senior ( n = 55) and junior ( n = 62) roles. In the second 6 months, staff more often reported using the bundle “Always” or “Most of the time” (90% vs. 69%, p = 0.003), that the bundle improved accuracy of clinical assessment (85% vs. 69%, p = 0.018), communication with the woman (79% vs. 44%, p = 0.002), woman's birth experience (73% vs. 42%, p = 0.003), and 93% reported improved safety. Responses were similar between obstetric and midwifery staff, and junior and senior staff. Qualitative analysis identified improved safety culture with five underlying themes summarized by the acronym CALMER: clarity and transparency, agency and empowerment, learning and agility, mutuality and engagement, resourcing and feasibility. Conclusions Maternity staff perceived significant improvement in safety culture with the implementation of an operative vaginal birth safety bundle.
