INTRODUCTION:There has been increased use of both induction of labor (IOL) and cesarean section for women with term pregnancies in many high-income countries, and a trend toward birth at earlier gestational ages. Existing evidence regarding the association between IOL and cesarean section for term pregnancies is mixed and conflicting, and little evidence is available on the differential effect at each week of gestation, stratified by parity. MATERIAL AND METHODS:To explore the association between IOL and primary cesarean section for singleton cephalic pregnancies at term, compared with two definitions of expectant management (first: at or beyond the week of gestation at birth following IOL; and secondary: only beyond the week of gestation at birth following IOL), we performed analyses of population-based historical cohort data on women who gave birth in one Australian state (Queensland), between July 1, 2012 and June 30, 2018. Women who gave birth before 37+0 or after 41+6 weeks of gestation, had stillbirths, no-labor, multiple births (twins or triplets), non-cephalic presentation at birth, a previous cesarean section, or missing data on included variables were excluded. Four sub-datasets were created for each week at birth (37-40). Unadjusted relative risk, adjusted relative risk using modified Poisson regression, and their 95% confidence intervals were calculated in each sub-dataset. Analyses were stratified by parity (nulliparas vs. parous women with a previous vaginal birth). Sensitivity analyses were conducted by limiting to women with low-risk pregnancies. RESULTS:A total of 239 094 women were included in the analysis, 36.7% of whom gave birth following IOL. The likelihood of primary cesarean section following IOL in a Queensland population-based cohort was significantly higher at 38 and 39 weeks, compared with expectant management up to 41+6 weeks, for both nulliparas and paras with singleton cephalic pregnancies, regardless of risk status of pregnancy and definition of expectant management. No significant difference was found for nulliparas at 37 and 40 weeks; and for paras at 40 weeks. CONCLUSIONS:Future studies are suggested to investigate further the association between IOL and other maternal and neonatal outcomes at each week of gestation in different maternal populations, before making any recommendation.

PROBLEM:Gestational Diabetes Mellitus (GDM) is a complication of pregnancy which may exclude women from midwife-led models of care.BACKGROUND:There is a paucity of research evaluating the safety and feasibility of continuity of midwifery care (CoMC) for women with GDM.AIM:To investigate the impact of CoMC on maternal and neonatal outcomes, for otherwise low-risk women with GDM.METHODS:This exploratory cross-sectional study observed maternal and neonatal outcomes including onset of labour, augmentation, labour analgesia, mode of birth, perineal trauma, gestation at birth, shoulder dystocia, infant birth weight, neonatal feeding at discharge.FINDINGS:Participants were 287 otherwise low-risk pregnant women, who developed GDM, and either received CoMC (n=36) or standard hospital maternity care (non-CoMC) (n=251). Women with GDM who received CoMC were significantly more likely to experience an spontaneous onset of labour (OR 6.3; 95% CI 2.7-14.5; p<.001), labour without an epidural (OR 4.2; 95% CI 2.0 - 9.2,<0.001) and exclusively breastfeed (OR 4.3; 95% CI 1.26 - 14.32; p=0.02).DISCUSSION:Receiving CoMC may be a public health initiative which not only improves maternal and neonatal outcomes, but also long-term morbidity associated with GDM.CONCLUSION:Findings provide preliminary evidence suggesting CoMC improves maternal and neonatal outcomes and is likely a safe and viable option for otherwise low-risk women with GDM. Larger studies are recommended to confirm findings and explore the full impact of CoMC for women with GDM.

(Abstracted from Acta Obstet Gynecol Scand 2024;103:946–954) In high-income countries, there has been an increase in both induction of labor (IOL) and cesarean delivery (CD) in individuals with term pregnancies. On average, the rate of IOL has increased from 20% to 30% from 1990 to 2019, and the rate of CD has increased from 12% to 27% from 1990 to 2018.

BACKGROUND:Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications. OBJECTIVE:This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria. METHODS:We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model - representing standard public hospital care, and a counterfactual model - representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD. RESULTS:In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders). CONCLUSION:A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.

OBJECTIVE: Valid and reliable maternity patient-reported experience measures are critical to understanding women's experiences of care. They can support clinical practice, health service and system performance measurement, and research. The aim of this review is to identify and critically appraise the risk of bias, woman-centricity (content validity), and psychometric prop-erties of maternity patient-reported experience measures published in the scientific literature. DATA SOURCES: MEDLINE, CINAHL Plus, PsycINFO, and Embase were systematically searched for relevant records between January 1, 2010 and July 10, 2021. STUDY ELIGIBILITY CRITERIA: We searched for articles describing the instrument develop-ment of maternity patient-reported experience measures and measurement properties associ-ated with instrument validity and reliability testing. Articles that described patient-reported experience measures developed outside of the maternity context and articles that did not con-tribute to the instruments' development, content validation, and/or psychometric evaluation were excluded. METHODS: Included articles underwent risk of bias, content validity, and psychometric prop-erties assessments in line with the COSMIN (COnsensus-based Standards for the selection of health Measurement INstruments) guidance. Patient-reported experience measure results were summarized according to language subgroups. An overall recommendation for use was determined for each patient-reported experience measure language subgroup. RESULTS: A total of 54 studies reported on the development and psychometric evaluation of 25 maternity patient-reported experience measures, grouped into 45 language subgroups. The quality of evidence underpinning the instruments' development was generally poor. Only 2 (4.4%) patient-reported experience measures reported sufficient content validity, and only 1 (2.2%) received a level "A" recommendation, required for real-world use. CONCLUSION: Maternity patient-reported experience measures demonstrated poor-quality evidence for their measurement properties and insufficient detail about content validity. Future maternity patient-reported experience measure development needs to prioritize women's involvement in deciding what is relevant, comprehensive, and comprehensible to measure. Improving the content validity of maternity patient-reported experience measures will improve overall validity and reliability and facilitate real-world practice improvements. Standardized patient-reported experience measure implementation also needs to be prioritized to support advancements in clinical practice for women.

Background : There has been a trend toward birth at earlier gestational age and increased use of both induction of labour (IOL) and caesarean section (CS) for women with term pregnancies in many countries, particularly high-income countries. Unnecessary use of obstetric interventions during pregnancy and birth is associated with an increased risk of adverse health outcomes for women and babies, as well as adding financial costs to the health care systems. Existing evidence regarding the association between IOL at term and CS is mixed and conflicting, and little evidence has been known about the differential effect at each gestation between 37 – 41 weeks, separately among nulliparous and parous women. Objective : The aim of this study was to explore the association between IOL and primary CS for women with singleton term pregnancies, compared with expectant management (EM) of pregnancy. Methods : We performed an analysis of population-based retrospective cohort data on women who gave birth in one Australian state (Queensland), between 01/07/2012 and 30/06/2018. All no-labour births (i.e., prelabour CS), multiple births (e.g., twins or triplets), and women with a prior CS were excluded. Five sub-datasets were created based on the time of birth following IOL (37 - 37 ; 38 - 38 ; 39 - 39 ; 40 - 40 ; and 41 - 41 ). Unadjusted relative risk (RR) and adjusted relative risk (aRR) were calculated in each sub-dataset to explore the risk of primary CS following IOL, compared to EM. Analysis was stratified by parity (nulliparas versus paras). Sensitivity analyses were conducted by limiting to women with low-risk pregnancies. Results : The risk of primary CS following IOL was significantly higher for women with singleton pregnancies, compared with EM, before or after adjustment, at 38 - 38 (nulliparas: aRR = 1.14, 95% CI: 1.10 - 1.18; paras: aRR = 1.35, 95% CI: 1.25 - 1.46), at 39 - 39 (nulliparas: aRR = 1.18, 95% CI: 1.14 - 1.22; paras: aRR = 1.36, 95% CI: 1.24 - 1.49), at 40 - 40 (nulliparas: aRR = 1.25, 95% CI: 1.21 - 1.29; paras: aRR = 1.40, 95% CI: 1.26 - 1.56) and at 41 - 41 (nulliparas: aRR=1.42, 95% CI: 1.36 - 1.48; paras: aRR=1.61, 95% CI: 1.40 - 1.84). After adjusting for potential confounders, there was no significant difference in the risk of primary CS at 37 - 37 for nulliparas who had IOL and EM (aRR = 1.03, 95% CI: 0.95 - 1.12). Results remain stable in the sensitivity analyses. Conclusion : Our results demonstrated that the risk of primary CS following IOL was higher at each weeks’ gestation between 38 - 38 – 41 - 41 for both nulliparas and paras with singleton pregnancies, compared with EM, and the risk increased with gestational age. This has important implications to support shared decision making between women and health professionals regarding best clinical management and optimal timing of birth.

Introduction Variation in outcomes reported in maternity-related clinical trials and practice stifles data synthesis and contributes to ineffective or harmful treatments and interventions. Variation can be addressed using core outcome sets (COSs), minimum agreed sets of outcomes that should be measured and reported in all clinical trials in a specific area of health or health care. This scoping review identified studies that developed maternity-related COSs; evaluated the extent, scope, quality, and consistency of outcomes across similar COSs; and identified current gaps in evidence. Methods A multifaceted search of 2 COS registers (Core Outcome Measures in Effectiveness Trials, Core Outcomes in Women's and Newborn Health), the International Consortium for Health Outcomes Measurement website, electronic databases (MEDLINE, Embase, CINAHL), and hand search was conducted. Published, English-language studies describing maternal and neonatal COSs for any health condition and published from inception to January 2020 were included. COS development process was evaluated against recently published COS Standards for Development: scope, stakeholder involvement, and consensus process. Results Thirty-two articles relating to 26 COSs were included (maternal: 18 articles that addressed 17 COSs; neonatal: 14 articles that addressed 9 COSs) and covered a range of obstetric and neonatal conditions. COSs were published between 2006 and 2020, 58% since 2017. Maternal COSs included more outcomes (median, 17; range, 50) than neonatal COSs (median, 8; range, 20). Overlap in COSs was seen for maternity care and gestational diabetes. Overlap in outcomes was seen across similar COSs, which were mostly inconsistent or poorly defined. No included COS met all minimum standards for development. Two COSs extended recommendations for how and when to measure outcomes. Discussion Growth in COS development in the last 3 years signifies increasing commitment to address variation and improve data synthesis. Although the quality of the development process has improved in the last 3 years, there is a need for improvement. This article presents an urgent need to minimize overlap in outcomes and standardize outcome measurement, case definitions, and timing of measurement between COSs.

Background: Decision-makers need quantifiable data on costs and outcomes to determine the optimal mix of antenatal models of care to offer. This study aimed to examine the cost utility of a publicly funded Midwifery Group Practice (MGP) caseload model of care compared to other models of care and demonstrate the feasibility of conducting such an analysis to inform service decision-making. Objective: To provide a methodological framework to determine the value of public midwifery in different settings. Methods: Incremental costs and incremental utility (health gains measured in quality-adjusted life years (QALYs)) of public MGP caseload were compared to other models of care currently offered at a large tertiary hospital in Australia. Patient Reported Outcomes Measurement Information System Global Short Form scores were converted into utility values by mapping to the EuroQol 5 dimensions and then converting to QALYs. Costs were assessed from a health system funder's point of view. Results: There were 85 women in the public MGP caseload care group and 72 received other models of care. Unadjusted total mean cost for mothers' and babies' health service use from study entry to 12 months post-partum was $27 618 for MGP caseload care and $33 608 for other models of care. After adjusting for clinical and demographic differences between groups, total costs were 22% higher (cost ratio: 1.218, P = 0.04) for other models of maternity care. When considering costs to all funders, public MGP caseload care cost $5208 less than other models of care. There was no significant difference in QALY between the two groups (difference: 0.010, 95% CI: -0.038, 0.018). Conclusion: Public MGP caseload care costs 22% less than other models of care, after accounting for differences in baseline characteristics between groups. There were no significant differences in QALYs. Public MGP caseload care produced comparable health outcomes, with some indication that outcomes may be better for lower cost per woman.

Objective: To evaluate a framework to facilitate standardised reporting of perinatal incontinence. Design: An exploratory, prospective, observational cohort study. Setting: One Australian tertiary maternity referral centre. Participants: Data from 309 pregnant women collected between August 2017 and January 2019. Measurements and findings: A framework was developed using consensus-based terminology and definitions, measures and data-collection time-points. The ICIQ-UI SF and the Wexner Scale were administered during pregnancy (<27 and 36-weeks) and postpartum (6- and 26-weeks). Incidence, trajectory and group differences for urinary incontinence subcategories were evaluated. Stress urinary incontinence was the largest contributor of urinary incontinence during pregnancy (39.2%) followed by mixed (11.3%) and urgency incontinence (7.4%). Factors associated with incontinence subcategories during pregnancy were multiparity (stress: RR 1.74), co-existing anal incontinence (mixed: RR 3.51) and early pregnancy urinary incontinence (stress: RR 2.79; mixed: RR 2.85). Factors postpartum included primiparity (urgency), vaginal birth (stress), induction of labour (stress: RR 2.99; urgency: RR 0.2), waterbirth (urgency: RR 2.66), coexisting anal incontinence (urgency: RR 3.55) and late pregnancy urinary incontinence (mixed: RR 3.97). Low numbers of women with anal incontinence prohibited subcategory analysis. Key conclusions: Findings offer preliminary support for the effectiveness of the framework for the measurement and reporting of urinary incontinence in childbearing women. Future research is needed to evaluate the framework in larger and more diverse maternity populations. Implications for practice: A framework for standardised measurement and reporting of perinatal incontinence will facilitate improved synthesis of research findings with the potential to improve the quality of evidence-based clinical guidelines. (C) 2020 Elsevier Ltd. All rights reserved.

Background: Lack of social support during pregnancy is associated with psychosocial vulnerability. The Single Item Measure of Social Supports (SIMSS) is included in a core outcome set to facilitate case-adjustment based on social support. Validity of the SIMSS has not been evaluated in childbearing women. We aimed to evaluate the construct validity of the SIMSS during pregnancy. Secondary aim was to evaluate an alternative short-measure of social support. Methods: Recruited women (n = 309) attending antenatal care were invited to complete the SIMSS, Multidimensional Scale of Perceived Social Support (MSPSS), Antenatal Risk Questionnaire (ANRQ), and Edinburgh Postnatal Depression Scale (EPDS). Convergent validity of SIMSS with MSPSS and hypothesis testing for psychosocial risk and depressive symptoms were conducted. Results: Correlations were moderate between the SIMSS and MSPSS (r(s) = .35), but weak between the SIMSS and EPDS (r(s) = -.18); and SIMSS and ANRQ (r(s) = -.22). In contrast, correlations were moderate between the MSPSS and EPDS (r(s) = -.39) and ANRQ (r(s) = -.45). A shortened 3-item version of the MSPSS showed good psychometric properties and internal consistency reliability (a = .86). Limitations: Findings relate to one Australian birthing sample during pregnancy. Replication of this study in larger, diverse maternity populations, including postpartum is recommended. Conclusions: The SIMSS is a poor measure of social support during pregnancy with poor predictive ability to detect maternal vulnerability including depression and psychosocial risk. A revised 3-item version of the MSPSS was found to be a valid and reliable measure of social support.

Abstract Background Variation exists regarding perinatal depression screening. A two-step screening method has been recommended. According to a maternity-focused core outcome set developed by the International Consortium for Health Outcomes Measurement, women who score 3 or more on the PHQ-2 then complete the Edinburgh Postnatal Depression Scale (EPDS). Limited evidence exists regarding the screening accuracy of the PHQ-2 in childbearing women. An alternative case-identification method may be more sensitive for perinatal women. We aimed to [1] evaluate the screening accuracy of the PHQ-2 during the perinatal period using two case-identification methods, and [2] measure the variability of accuracy over four time-points during pregnancy and postpartum. Methods A prospective, longitudinal cohort study was conducted with 309 consecutive women who completed the PHQ-2 and EPDS during pregnancy (booking, 36-weeks) and postpartum (6-, 26-weeks). EPDS was the reference standard using cut-off scores for ‘at least probable minor depression’ during pregnancy (≥ 13) and postpartum (≥ 10) and for ‘probable major depression’ during pregnancy (≥ 15) and postpartum (≥ 13). PHQ-2 was analysed using two methods: [1] scored (cut-points ≥ 2 and ≥ 3), [2] dichotomous yes/no (positive response to either question) against EPDS cut-points for at least probable minor and probable major depression. Receiver operating characteristic analyses determined accuracy. Results Probable major depression: Over four timepoints PHQ-2 ≥ 3 revealed lowest sensitivity (36–79%) but highest specificity (94–98%). An alternative case-identification method revealed high sensitivity (93–100%), but lowest specificity (58–71%). Minor depression: PHQ-2 ≥ 3 revealed the lowest sensitivity (19–50%) but highest specificity (95–98%). An alternative case-identification method revealed the highest sensitivity (81–100%) and moderate specificity (60–74%). Conclusions Recommended method of case-identification (PHQ-2 ≥ 3) missed an unacceptable number of women at-risk of depression. As a clinical decision-making tool, an alternative, dichotomous method maximized case-identification and is recommended. Further, the literature identified inconsistent reporting of the PHQ-2 and the alternative case-identification method hindering the ability to synthesise data. The future use and reporting of consistent question wording and response format will improve outcome reporting and synthesis. Further research in larger and diverse maternity populations is recommended.

Background: Methods used to develop existing core outcome sets relevant to maternal and neonatal health have not been fully evaluated. Objectives: To systematically review core outcome sets relevant to maternal and neonatal health; evaluate against minimum standards for development; and evaluate overlap between core outcome sets. Search strategy: Multi-faceted search of two core outcome set registers (COMET, CROWN) the ICHOM database of standard sets, and three electronic databases (MEDLINE, EMBASE, CINAHL) was conducted from inception to January 2020. Selection criteria: Published papers reporting completed core outcome sets relevant to maternal or neonatal health, for research or clinical use, were evaluated against COS-STAD minimum standards for development. Data collection and analysis: Descriptive statistics describe characteristics and results. Main results: Thirty-two papers relating to 26 core outcome sets were included (maternal: 18 papers: 17 COS; neonatal: 14 papers: 9 COS). Fifteen (58%) were published since 2017. No included COS met all minimum standards for development. All COS met the minimum standard for scope. Eighteen (69%) met all three minimum standards for stakeholder involvement. No included COS met all five minimum standards for consensus process. COS included between 6 and 56 outcomes. Two COS (8%) provided recommendations for how and when to measure outcomes. Conclusions: This is the first application of COS-STAD minimum standards relevant to maternal and neonatal health. Findings offer a baseline evaluation. There is an urgent need to address outcomes, measurement and timing in core outcomes to support harmonization between core outcome sets.

AIM:The International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-UI SF) and the Wexner Scale have been included in the International Consortium for Health Outcomes Measurement core outcome set during pregnancy and childbirth, to measure urinary and anal incontinence. The reliability and validity of these instruments have not been fully evaluated in maternity populations. The aim of this study was to conduct a psychometric evaluation of the ICIQ-UI SF and Wexner Scale. METHODS:Consecutive pregnant women (n = 309) who booked for care at one Australian birth facility between August 2017 and April 2018 completed the online surveys. Women who screened positive for urinary and/or anal incontinence were administered the ICIQ-UI SF and/or Wexner Scale during pregnancy ( <27 and 36-weeks) and postpartum (6 and 26-weeks). Scale internal consistency, construct validity, and responsiveness were evaluated. FINDINGS:In women with urinary incontinence, the ICIQ-UI SF demonstrated good internal consistency during pregnancy (baseline and 36 weeks) and 6-weeks postpartum (mean inter-item correlation: 0.47, 0.39, and 0.46, respectively), recorded significant change across three time-points, and was sensitive to group differences in age and obesity during pregnancy. Wexner Scale was unsuitable for psychometric analysis due to insufficient numbers of women with anal incontinence. CONCLUSION:The ICIQ-UI SF is a valid and reliable instrument to measure urinary incontinence during pregnancy and postpartum. The findings support the inclusion of the ICIQ-UI SF in the International Consortium for Health Outcomes Measurement core outcome set for use during the perinatal period. Psychometric analysis of the Wexner Scale in larger maternity populations is recommended.

Background Health related quality of life is a critical concept during the perinatal period but remains under-researched. The International Consortium for Health Outcomes Measurement have included the Patient Reported Outcomes Measurement Information System (PROMIS®) Global Short Form (GSF) in their core outcome set for pregnancy and childbirth to measure health related quality of life. The PROMIS GSF has not been fully evaluated as a valid and reliable instrument in this population. This study assessed the psychometric properties of the PROMIS GSF during pregnancy and postpartum period. Methods PROMIS GSF was administered to a sample of 309 pregnant women at four time-points during pregnancy (≤ 27 and 36-weeks) and postpartum (6- and 26-weeks). The structural validity, internal consistency reliability, construct validity, and responsiveness of the PROMIS GSF were evaluated. The internal structure of the PROMIS GSF was explored using Rasch Measurement Theory. Response format, item fit, differential item functioning (item bias), dimensionality of the scale and its targeting were assessed. Results Two revised subscales (Mental Health: four items; and Physical Health: five items) showed good fit to the Rasch model. The revised mental health subscale demonstrated good internal consistency reliability during pregnancy and postpartum period (α = .88 and .87, respectively). The internal consistency reliability of the physical health subscale was adequate (α = .76 and .75, respectively). The revised mental health subscale was sensitive to group differences according to a history of mental health disorder, income, smoking status, drug use, stress levels and planned versus unplanned pregnancy. Differences in scores on the revised physical subscale were detected for groups based on obesity, income, drug use, smoking status, stress, and history of mental health disorders. Scores on both subscales recorded significant changes across the four time-points, spanning pregnancy and postpartum period. Conclusions The revised version of the PROMIS GSF was better able to measure mental and physical health during pregnancy and postpartum period compared to the original version. Findings support the clinical and research application of the PROMIS GSF within the International Consortium for Health Outcomes Measurement Standard Set of Outcome Measures for Pregnancy and Childbirth. Ongoing psychometric analysis of the PROMIS GSF is recommended in other maternity populations.

Measles cases have occurred in individuals with histories of vaccination against the disease in Zhejiang Province, China. The purposes of this study were to determine the seroprevalence of immunoglobulin G (IgG) measles antibodies in vaccinated individuals, to explore the waning kinetics of measles antibody among children after receipt of a measles-containing vaccine, and to define high-risk groups in the population. A seroprevalence survey of measles antibody was conducted with 1900 randomly selected and age-stratified participants aged 6–14 years in Zhejiang province. In our study, seronegative persons accounted for 7.17% of study participants. A case-control study of participants who had received at least one dose of measles-containing vaccine was conducted, with 123 cases of immune failure and 1593 controls with immune success. Multivariate logistic regression analysis showed that age, and number of doses were the influencing factors for measles immunization failure. The older a participant (odds ratio [OR] = 1.164), the more likely that measles vaccine immunity failed. In addition, immune failure was more likely to occur after one dose of MCV than two doses (OR = 0.008) or three doses and more (OR = 0.047). In a univariate logistic regression analysis, we found that immune failure was more likely to occur with MCV vaccination beginning at 8 months than at 9–11 months (OR = 0.562) and the subjects whose registration residence was in other cities in Zhejiang province (OR = 3.527). However, these differences in seropositivity were not significant in the multivariate logistic regression analysis. The exponential regression equation of the attenuation model after measles immunization was y = 884.64e−0.057x (R2 = 0.0521, p < 0.001), and results showed that the measles geometric mean concentration of IgG antibodies was approximately 884.64 mIU/ml after the last MCV vaccination and decreased with time since last vaccination.

A knowledge gap exists around midwives' and obstetricians' mode of delivery in comparison to the general population, and if their personal experience influences their attitudes towards different modes of delivery.The aim of the present study was to investigate midwives' and obstetricians' mode of delivery compared to the population at large. The second aim was to see if their mode of delivery had been influenced by the expanded indications for caesarean section as described in medical literature. Thirdly, the differences between obstetricians' and midwifes' attitudes to caesarean section on maternal request was investigated.Textbooks from midwifery education and medical schools were reviewed using a structured protocol. A questionnaire for midwives and obstetricians containing questions on mode of delivery, attitudes towards patients' autonomy and performing caesarean sections on maternal request was sent to 380 midwives and 97 obstetricians born in 1935, 1955 or 1975 with an invitation to participate in the study. Two hundred and sixty three midwives and 55 obstetricians provided completed responses.The review of textbooks identified that the number of indications for caesarean section has increased. Indications for caesarean section increased in medical textbooks from seven in the oldest books, from year 1955, to 11 in the textbook from 1993. The focus has shifted in more recently published textbooks to prevention of fatal deliveries. In earlier obstetric care they tend to learn to solve the catastrophe when it had occurred.No significant relationship between midwives' and obstetricians; own mode of delivery and their attitudes towards performing a caesarean section on maternal request (p = 0.191) was found. Thirty percent of the obstetricians reported that they would perform a caesarean section if the pregnant woman requested one. The study found a significant difference between the professions in the statement “the proportion of caesarean section is too high” where midwives to a greater extent agreed with the statement (p = 0.033).There were no significant differences between caesarean section as the mode of delivery for midwives and obstetricians as compared to the general population. Midwives born in 1975 had significantly lower rate of instrumental births compared to the population at large (p < 0.05).Over the years, the indications for caesarean section have increased. The increase is shown in both the textbooks read during the different time periods as well as among the Swedish midwives and obstetricians born in 1955 and 1975.

BACKGROUND:Around 20% of women report high levels of childbirth fear. An evidence-based psychoeducation intervention delivered by midwives reduced maternal childbirth fear and increased confidence for birth. Implementation of the intervention into practice is now required. Translating evidence into practice, however, remains challenging.AIM:This study aimed to explore organizational factors, including barriers and possible solutions that may impact on the successful application of the midwife psychoeducation intervention in practice.METHODS:Mixed methods data collection included a self-administered survey (n= 62), clinician-led focus groups (n= 28), and interviews with key stakeholders (n= 5). Simple descriptive statistics were used to analyze the quantitative data. Latent content analysis was used to analyze the qualitative data.RESULTS:Midwives were perceived to be best placed to deliver psychoeducation to women fearful of birth. Support for normal birth was high. There was, however, disparity between positive attitudes toward evidence-based practice in theory and its clinical application. Similarly, although the workplace learning culture was generally assessed as positive, many participants believed changing practice was difficult and reported a low sense of agency for challenging or facilitating change. Participants reported that barriers to implementing the evidence included time constraints and heavy workloads. There was a lack of awareness and confidence to implement evidence-based practice (EBP) with participants identifying that resistance to change was often the result of clinician fear and self-interest. The way services were routinely structured was considered problematic as fragmentation actively worked against midwives forming meaningful relationships with women. Enablers included organizational support, education, local champions, and continuity of midwifery care.CONCLUSION:The study identified the clinicians’ readiness, barriers, and possible solutions to the widespread implementation of an evidence-based psychoeducation intervention delivered by midwives for women fearful of birth at one maternity facility in South East Queensland, Australia. Many of the identified barriers were commensurate with the international literature on translating evidence into practice.

BACKGROUND:Psychoeducation counselling delivered by midwives has been demonstrated to reduce maternal fear and improve women's confidence for birth. Translating the evidence in practice presents challenges. A systematic approach to the implementation of evidence and evaluation of this process can improve knowledge translation. AIM:To implement and evaluate the translation of psychoeducation counselling on (1) midwives' knowledge, skills and confidence to provide the counselling; (2) perceived barriers and enablers to embedding the psychoeducation counselling in practice; and (3) pregnant women's levels of fear. METHODS:Using a mixed methods approach, data were collected using a pre (n=22) and post (n=21) training survey, recorded interviews (n=17), diaries (n=6), and retrospective audit of fear of birth scores. Data were analysed using descriptive statistics, independent sample t-tests, and chi-square tests. Latent content analysis was used to analyse the qualitative data. RESULTS:Training in the counselling framework significantly improved midwives' knowledge, skills and confidence to counsel women on psychosocial issues and reduce fear scores for women reporting high childbirth fear. The main barriers to midwives introducing counselling into routine care related to the fragmentation of care delivery during pregnancy. Conversely continuity of care by a known midwife was considered an enabler. CONCLUSION:Psychoeducation provided by midwives is of benefit to women experiencing high levels of birth fear. While psychoeducation training was successful in enhancing midwives' knowledge, skills and confidence; embedding the counselling framework in everyday practice was challenging. Counselling is more easily implemented within midwifery caseload models which enable midwives to build relationships with women across their pregnancy.

BACKGROUND: Obesity in childbearing women is associated with poorer pregnancy and birth outcomes, particularly caesarean section, compared with normal-weight women. The high caesarean section rate may reflect care and outcomes which occur at the time surrounding the first birth.AIM: To describe the birth outcomes of extremely obese pregnant women (body mass index [BMI] of 40 or more) experiencing their first birth.METHODS: Clinical audit was used to systematically review the care and birth outcomes of all extremely obese pregnant women experiencing their birth at one study site during a 2-year period in 2009 and 2010. Fifty participants birthed during the study period. Data were collected from booking to discharge from the maternity service and included variables such as model of care, number of appointments, and obstetric and neonatal outcomes. Descriptive statistics were used to describe and synthesize the data. Inferential statistics were used to draw inferences about the population.RESULTS: Obese women rarely had contact with a midwife, except at booking, receiving a standard model of care provided by numerous caregivers, most often inexperienced medical staff. More than half of the obese women experienced a caesarean section (56%), 2.3 times that of normal-weight primiparous women who birthed at the study site during the same period (24.2%). This was despite 64% experiencing normal pregnancy free from any complication. For women who planned to labor, birth intervention including induction of labor, augmentation for slow labor, epidural, and continuous cardiotocography was high. Caesarean occurred most often for “failure to progress” and “failed induction.”CONCLUSION: Clinical audit was useful in determining information, which suggests current maternity care provision is not meeting the needs of extremely obese women experiencing their first birth.IMPLICATIONS FOR PRACTICE: The development of effective, targeted antenatal care designed to meet the needs of extremely obese women is recommended as are strategies to keep birth normal.