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OBJECTIVE: The aim of the study was to investigate the effect of induction of labor on maternal and fetal outcomes. PATIENTS AND METHODS: This retrospective case-control study included 4386 pregnant women with low-risk singleton pregnancies who underwent regular prenatal examination and successful vaginal delivery at =41 weeks and 0 days of gestation in Fujian Maternal and Child Health Hospital between January 2014 and December 2018. Clinical data of women were retrospectively divided into the induction of labor group (2007 cases) and spontaneous onset of labor group (2361 cases) based on the mode of labor initiation. Two-sample independent t-test and X2 tests were used to analyze the differences in clinical characteristics, such as maternal age and parity between the two groups. RESULTS: The induction of the labor group had a significantly longer total duration of labor (9.37±5.37 vs. 8.82±5.13 h; p<0.001), more postpartum blood loss (219.18±188.32 vs. 199.95±124.69 mL; p=0.01) and a significantly higher incidence of severe postpartum hemorrhage (PPH) comparing to the spontaneous onset of labor group [0.8% (16/2007) vs. 0.33% (8/2361); p=0.041]. However, no significant difference was found in the neonatal outcomes. After adjusting for age, induction of labor in nulliparous women was more likely to lead to PPH than the spontaneous onset of labor [2.74% (55/2007) vs. 1.65% (39/2361); odds ratio=1.557; 95% confidence interval: 1.039-2.332; p<0.05]. CONCLUSIONS: Induction of labor increases the duration of labor and postpartum blood loss, especially in primary parturient, leading to an increased risk of PPH. This increase may be related to the overall higher duration of labor, associated with IOL. Therefore, low-risk nulliparous women should try to avoid induction of labor without medical indications. [ABSTRACT FROM AUTHOR]

Assess the outcome of induction of labour (IOL) with a Foley catheter in pregnancies at 41 weeks in midwifery-led care setting compared to consultant-led care setting. Mixed-methods cohort study at a midwifery – hospital partnership in Amsterdam, the Netherlands. Prospectively, women undergoing IOL in midwifery-led care were recruited at a secondary hospital. This group was compared to a retrospective cohort, in which IOL was exclusively performed under consultant-led care. We compared 320 women whose induction started in midwifery-led care to a historical cohort of 320 women induced for the same reason under consultant-led care. Both groups exhibited similar rates of spontaneous vaginal births (64.2 %vs62.5 %). Caesarean section and assisted vaginal birth rates did not significantly differ. Maternal adverse outcomes were comparable, while neonatal adverse outcomes were significantly higher in the midwifery-led care group (8.1 %vs3.8 %; OR 2.27, 95 % CI 1.12–4.58). The use of pain relief was significantly lower in midwife-led care (65.3 %vs75.3 %; OR 0.62, 95 % CI 0.44–0.87). 20.6 % of births occurred in midwife-led care. In this single-centre study, spontaneous vaginal birth rates following IOL with a Foley catheter were similar between midwife- and consultant-led care. However, the midwife-led group showed a higher risk of adverse neonatal outcomes, mainly early onset neonatal sepsis, with a minority eventually delivering under midwife-led care. Implications highlight the need for broader research, validation across diverse settings and exploration of patient and healthcare worker perspectives to refine the evolving midwifery-led care model. [ABSTRACT FROM AUTHOR]

Midwifery led units are rare in Spain. Midwife-Led Care (MLC) is a widely extended model of care and, within this, the alongside midwifery-led units (AMLU) are those hospital-based and located in close connection with obstetric units. In Spain, CL is the first center belonging to the National Health System of these characteristics. To evaluate the first year of activity of this pioneering unit. An observational cross-sectional study was carried out to assess maternal and neonatal outcomes of births facilitated at CL by comparing with those births that fulfilled the criteria to be admitted at the AMLU but were assisted at the standard obstetric care unit of the hospital. 174 (20,3%) women and birthing people decided to give birth at CL, whereas 684 (79,7%) gave birth at the Obstetric Unit of the Hospital. Women assisted at the AMLU had lower intervention rates (episiotomy, epidural analgesia) and a higher rate of breastfeeding practice. There were no statistical differences in maternal outcomes (postpartum hemorrhage, third-or-four-degree laceration) or neonatal outcomes (Apgar< 7 at 5 min; birth weight < 2500 gr; macrosomia; shoulder dystocia, neonatal care transfer). There were differences in transfers from MLU to OU between nulliparous and multiparous; the main reason for transfer is the request for analgesia. Epidural analgesia should be considered when analyzing maternal outcomes. An alongside midwifery-led unit is a safe option with a low incidence of complications. This model of care can be positively implemented at the Public Healthcare System. [ABSTRACT FROM AUTHOR]

Abstract Problem It is unknown if client experiences with perinatal healthcare differ between low-risk and high-risk women. Background In the Netherlands, risk selection divides pregnant women into low- and high-risk groups. Receiving news that a pregnancy or childbirth has an increased likelihood of complications can cause elevated levels of emotional distress. Aim The purpose of this study is to describe client experiences with perinatal healthcare and to determine which, if any, background characteristics, pregnancy circumstances, childbirth or follow-up care characteristics are explaining variables of differences in client experiences between high-risk and low-risk women. Methods Client experiences were measured with a validated questionnaire completed by 1388 women within 12 weeks after childbirth. Findings Women rated their experiences with perinatal healthcare with a mean score of 3.78 on a scale of 1–4; 5.5% of the women rated their experiences as "notably bad". Client experiences with perinatal healthcare show small variations, with a lower mean score for women who were at high risk (3.75) compared to low-risk women (3.84). This difference is partially due to more unplanned medical interventions and pain relief during childbirth in the high-risk group. Also, single mothers and non-Dutch women were more susceptible to less positive experiences. Conclusion Given the potential negative impact of adverse client experiences, this study highlights the need for healthcare professionals to be aware of what women are susceptible for having had negative experiences. It is advised that healthcare provision be altered to tailor to the needs of these women. [ABSTRACT FROM AUTHOR]

Evidence-based and sustainable intrapartum care policies are essential for safer, effective, and positive birth experiences. This scoping review aimed to map intrapartum care policies for pregnant women at low-risk of complications, in high-income countries with a universal health system. The study followed Joanna Briggs Institute methodology for scoping reviews and PRISMA-ScR. Search was conducted on CINAHL-EBSCO, Scopus, MEDLINE-Pubmed, Cochrane Central Register of Controlled Trials-EBSCO, and, Academic Search Complete-EBSCO. Grey literature was searched, references screened and experts contacted for additional studies/policies. Data were extracted/analysed by two independent reviewers and results were presented in tabular and narrative format. The concept was governmental intrapartum care policies, the context were OECD high-income countries with a health-financing system founded on the Beveridge Model and the participants were low-risk pregnant women From the 561 records screened, 22 were selected, concerning intrapartum care policies from Australia, Denmark, Spain, Finland, Portugal, and the United Kingdom. All the included records were retrieved in the grey literature. No intrapartum care governmental policies were found for Greece, Iceland, Italy, New Zealand, Norway, and Sweden. Some countries do not refer to all the analysed care aspects and there are differences in detail, depth, range, and scientific. The policies show general similarities but differ in the timing and the content of the recommended intrapartum care. Not all of the analysed countries have intrapartum care policies and those who have shown differences between recommendations. These results can be used to create/revise intrapartum care policies. [ABSTRACT FROM AUTHOR]

• Knowledge of severe acute maternal morbidity (SAMM) is constantly growing. • Its prevalence and risk factors remain undocumented in low-risk women. • Peripartum SAMM in low-risk women is rare (0.5%) but still exists. • Primiparity, IVF pregnancy and migration are associated with increased risk of SAMM. • Gestational anaemia is the only identified modifiable risk factor of SAMM. Knowledge of severe acute maternal morbidity (SAMM) and its risk factors is constantly growing, but studies have rarely focused on the specific population of low-risk women. To estimate the prevalence and to identify subgroups at risk of peripartum SAMM in low-risk women From a population-based cohort-nested case-control study conducted in six French regions, i.e., 182 309 women who gave birth at ≥22 weeks in 119 maternity units, we selected women considered at low risk up to the end of pregnancy before labour according to the NICE guidelines and compared those experiencing peripartum SAMM (during birth and up to 7 days postpartum; n = 489) to a 2% random sample of women without peripartum SAMM from the same units (n = 1800). Risk factors for peripartum SAMM were identified by multivariable logistic regression. amongst low-risk women, the estimated rate of SAMM was 0.548/100 deliveries (95%CI 0.501–0.599). Severe obstetric haemorrhage was the main cause (83.6% of SAMM cases). Main risk factors for peripartum SAMM were primiparity (aOR 2.4, 95%CI 1.9–3.0), IVF pregnancy (aOR 1.8, 1.0–3.4), third-trimester anaemia (aOR 1.7, 1.3–2.3), being born out of Europe or Africa (aOR 1.9, 1.2–3.0). amongst women considered at low risk up to the end of pregnancy before labour, peripartum SAMM is rare but still exists. Knowledge of risk factors of SAMM in this population will inform the discussion on peripartum risks and the most appropriate place of birth for each woman. [ABSTRACT FROM AUTHOR]

Purpose: To analyze the change of childbirth expectations over the course of pregnancy as well as their relation to socio-demographic and clinical variables. Background: The study of expectations in pregnant women is gaining more interest from a biopsychosocial approach because of its consequences on pregnant women's wellbeing. To our knowledge there are no previous studies analyzing the evolution of childbirth expectations over the course of pregnancy. Methods: Longitudinal study (first trimester and third trimester). Women were evaluated for childbirth expectations in their first trimester (n = 285) and third trimester (n = 122) of pregnancy. They also completed questionnaires collecting socio-demographic information. Results: Childbirth expectations appear to remain more or less stable over the course of pregnancy, although they tend to become slightly negative at the end of gestation, specifically referring to personal control and delivery circumstances. Multiparity and planned pregnancy are associated with higher positive expectations. Conclusion: It seems essential to explore and to try to adjust childbirth expectations to more realistic ones, in order for them to be fulfilled. Midwives and other maternity healthcare providers play a key role in this regard. [ABSTRACT FROM AUTHOR]

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

Abstract: Objective: to describe the incidence and characteristics of patient safety incidents in midwifery-led care for low-risk pregnant women. Design: multi-method study. Setting: 20 midwifery practices in the Netherlands; 1,000 patient records. Population: low-risk pregnant women. Methods: prospective incident reporting by midwives during 2 weeks; questionnaire on safety culture and retrospective content analysis of 1,000 patient records in 2009. Main outcome measures: incidence, type, impact and causes of safety incidents. Results: in the 1,000 patient records involving 14,888 contacts, 86 safety incidents were found with 25 of these having a noticeable effect on the patient. Low-risk pregnant women in midwifery care had a probability of 8.6% for a safety incident (95% CI 4.8–14.4). In 9 safety incidents, temporary monitoring of the mother and/or child was necessary. In another 6 safety incidents, reviewers reported psychological distress for the patient. Hospital admission followed from 1 incident. No safety incidents were associated with mortality or permanent harm. The majority of incidents found in the patient records concerned treatment and organisational factors. Conclusions: a low prevalence of patient safety incidents was found in midwifery care for low-risk pregnant women. This first systematic study of patient safety in midwifery adds to the base of evidence regarding the safety of midwifery-led care for low-risk women. Nevertheless, some areas for improvement were found. Improvement of patient safety should address the better adherence to practice guidelines for patient risk assessment, better implementation of interventions for known lifestyle risk factors and better availability of midwives during birthing care. [Copyright &y& Elsevier]

Abstract: Objective: a national study of midwives’ perceptions of women''s decision-making in the technical interventions in the birth process. Design: questionnaire survey of women and their midwives. Midwives completed a maternity record for each woman in the study after the birth, and the women completed a demographic questionnaire at to 20–24 weeks gestation. Setting: a stratified sample of 25 Dutch midwifery practices based on rural or urban location. Each of these 25 independent practices agreed to approach 25 eligible consecutive pregnant women on a randomly assigned day. Participants: in total 637 women were invited and 625 participated (response rate 98%). Findings and key conclusions: midwives reported that they had a large influence in the decision to refer a woman to an obstetrician, but far and far less so when it comes to decisions around taking pharmaceutical pain relief. Midwives felt women had least say in the decision around augmentation of labour and most in the decision to sweep the membranes, whilst obstetricians had most input in the decision around primary induction of labour and least in the decision to refer from primary to secondary care. Our analysis indicated that midwives saw younger women (29 and younger) as having more influence in the decision-making process than old ones. Our analysis suggests there might be a tension between midwives own professional ideology and their non-interventionist focus and women''s choice, which leads to an increase in medicalisation of childbirth. [Copyright &y& Elsevier]

• Induction of labour in low-risk women exceeds recommended rate of <10% established as a quality indicator in Spain. • There is a positive association between induced labour and caesarean section rates. • There is a positive association between induced labour and operative vaginal births. • Induction of labour has a negative association in early initiation of breastfeeding and early skin-to-skin maternal contact. To compare birth and neonatal outcomes in low-risk women undergoing induced labour with those undergoing spontaneous onset. This retrospective multicentre study included 30 public maternity hospitals in Catalonia between 2016 and 2017. The study population consisted of 5,717 women. Of the 5,717 births, 75.8% had spontaneous onset and 24.2% had an induction. Induced labour was more likely at week 41 of gestation and in nulliparous women. Induced labour increased the likelihood of undergoing caesarean section (adjusted OR [ORa], 2.59; 95% confidence interval [CI], 2.11–3.16), assisted vaginal birth (ORa, 1.70; 95% CI, 1.46–1.98), epidural analgesia (ORa, 2.64; CI, 2.14–3.27), postpartum haemorrhage (ORa, 1.56; 95% CI, 1.14–2.15) and episiotomy (ORa, 1.26; 95% CI, 1.08–1.47). Induced labour was also associated with not performing skin-to-skin contact with the mother (ORa, 0.47; 95% CI, 0.39–0.58) and with not performing early breastfeeding (ORa, 0.49; 95% CI, 0.39–0.61). The frequency of labour inductions among low-risk women exceeds the level recommended by scientific organisations in Catalonia and Spain, and is associated with adverse birth outcomes such as increased caesarean section rates, assisted vaginal births, and episiotomy rates. It is also associated with the failure to perform early skin-to-skin contact with the mother and failure to initiate early breastfeeding. [ABSTRACT FROM AUTHOR]

to compare neurodevelopment differences between babies born from low-risk pregnancies and babies born from high-risk pregnancies. Longitudinal design Spain A total of 91 women participated in the study, divided into two groups: 49 women in the low-risk pregnancy group and 42 women in the high-risk group. The average amount of cortisol in pregnant mothers' hair was determined in both groups. Following their birth, the babies' neurodevelopment was evaluated using the Bayley-III instrument at 6 months of age and a new sample of cortisol was obtained from both the baby and the mother. The results showed that pregnancy risk group could predict cognitive, fine motor, gross motor and general motor neurodevelopment. These results seem to show that an appropriate treatment tailored to the needs of individualised pregnancies may favor babies' neurodevelopment, including that of babies born from high-risk pregnancies. It is essential to take special care of pregnant women no matter their medical condition and offer them the best medical care available. [ABSTRACT FROM AUTHOR]