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Term newborn infants without significant medical problems usually transition from fetal to newborn life without medical assistance. Infants requiring therapy often need care in a neonatal intensive care unit as opposed to a well-baby unit. Infants with unclear physiologic status or disease that may require therapies in the immediate newborn period may benefit from a period of observation with close monitoring before admission to a well-baby unit. Whenever possible, providing care for a newborn infant in an area that provides care for the newborn and mother together in the same room facilitates adaptation to normal breastfeeding and family bonding.

Background Several methods have been developed to improve the episiotomy skills of midwifery students. This study was conducted to determine the effect of episiotomy simulation training on the episiotomy skills of midwifery students and their state anxiety levels. Methods This study is a quasi-experimental randomized controlled trial. Its sample consisted of 68 third-year students in the midwifery department of a university in Turkey. The students were randomly divided into experimental (34) and control (34) groups. The study data were collected using a sociodemographic information form, the State Anxiety Inventory (STAI) and the Episiotomy Skill Assessment Form. All the data collection tools were administered during the fall semester of 2018-2019. Results After the delivery room practice, the simulation group had significantly higher Episiotomy Skill Assessment Form scores (p Conclusion The episiotomy skill performance of the students in the episiotomy suture simulation group was significantly higher than that of the control group, but the use of simulation did not reduce the students’ state anxiety.

Background National audit data showed our hospital had one of the highest numbers of term admissions in the region during the period January until June 2017. Methods Authors conducted a quality improvement project aimed at reducing the number of term admissions in our neonatal unit. With retrospective audit during the pre-intervention phase (January until June 2017), we identified hypothermia and hypoglycemia as the two modifiable risk factors for term admissions. During the “intervention phase” from July 2017 until Dec 2017, authors introduced interventions in the delivery room and postnatal ward. Real-time data were collected during the post-intervention phase from January until December 2018. Results We had reduced the number of admissions with a diagnosis of hypoglycemia or hypothermia by 49% during the intervention phase and by 44% during the post-intervention phase. Conclusion This QI project reduced the number of term admissions with a diagnosis of hypoglycemia or hypothermia.

Establishing effective respiration is vital in the transition from fetal to neonatal life. Respiratory support mainly facilitates and creates functional residual capacity and maintains adequate gas exchange. Sustained inflation (SI) delivers prolonged inflation and rapidly creates and establishes the functional residual capacity. The use of SI in preterm infants in the delivery room is still controversial. The optimum settings of SI remain unknown. Animal studies and clinical reports have demonstrated the advantages and disadvantages of SI. In this article, the current literature was reviewed to examine the efficacy of SI in infants.

AIM: Flow Disruptions (FDs) are deviations from the progression of care that compromise safety and efficiency of a specific process. The study aim was to identify the impact of FDs during neonatal resuscitation and determine their association with key process and outcome measures. METHODS: Prospective observational study of video recorded delivery room resuscitations of neonates

Objective This study aims to determine estradiol levels in mothers who experience postpartum blues. Methods It was a crossectional study conducted in Pertiwi Maternal and Child Hospital Makassar. The population was all mothers who had normal postpartum births on the third day from January to March 2018, and samples were 31 selected accidentally selected. Postpartum blues data was obtained with the Edinburgh Postnatal Depression Scale (EPDS) questionnaire and secondary data obtained from maternal medical records in the delivery room and nursing staff at the hospital. Estradiol levels examined using the enzyme-linked immunosorbent assay (ELISA) technique. Analysis of the data in this study Mann Whitney and data were performed using frequency and mean. Results Estradiol levels between mothers who experienced and those who did not experience postpartum blues were different significantly (p = 0.024, p Conclusion Levels of hormone estradiol are lower in mothers who have postpartum blues. It is needed individual attention to postpartum mothers so that those detected with very low estradiol levels can get treatment and prevention as soon as possible.

Brugada Syndrome (BrS) is a rare and high risk condition, seldom encountered in the delivery room. Pregnant patients with BrS benefit from the lowest possible doses of arrhythmogenic drugs such as local anesthetics. Based on this premise, the following case report exposes how a subarachnoid approach might be a desirable technique in C-section procedures for BrS patients. Pain and anxiety management are priorities in this specific population. Peri-partum planning, with a previous anesthesiology appointment and mutidisciplinary care in tertiary hospital facilities are crucial to avoid complications.

Aim: This definitive and cross-sectional study was conducted to determine the relation between mothers’ types of labor, birth interventions, birth experiences and postpartum depression. Methods: A total of 1010 mothers who gave birth in four different provinces of Turkey were chosen to participate in the study via purposive sampling method Results: The Edinburgh Postpartum Depression Scale score was determined to be 13 and over in 36.4% of the women. In this study, it was determined that the Edinburgh Postpartum Depression Scale scores for women in the 18–24 age group who had a vaginal birth, did not have health insurance, experienced health problems during pregnancy and were not trained about type of labor during pregnancy were statistically higher. There was no significant correlation between the birth experiences and postpartum depression. The linear regression model showed that there was a statistically significant correlation between enema and amniotomy interventions practised during the birth and the Edinburgh Postpartum Depression Scale scores. Conclusion: In conclusion, it is thought that preparing the mothers for birth with birth preparation training in the antenatal period and imposing the necessary regulations in the delivery room for the mothers to have a positive birth experience are important in reducing postpartum depression risk. © 2018

Background Almost 20% of neonates experience pain during delivery or the period following birth. Aim To describe the practices of pain assessment in the maternity wards in the greater Paris area, France. Methods An e-mail questionnaire was sent to each practitioner in the 96 maternity units in Ile de France between December 2013 and February 2014. Results In all, 63 (65%) questionnaires were completed. Pain was assessed in 43 (68%) maternity units, mostly using the French scale “echelle de douleur et d’inconfort du nouveau-ne” (EDIN). In total, 20 maternity units (32%) reported no pain assessment, mainly because they considered it to be too time-consuming, or because they argued that no pain scale was adequate; they relied on clinical signs or on the obstetric history for assessing and treating pain. About 40% of the maternity units using the EDIN scale judged it unsuitable for evaluating pain in term neonates in maternity units. Conclusion This first regional study on pain assessment in the maternity ward showed that nearly two thirds of centers assessed pain. This rate may be overestimated because of the reporting method used. The EDIN scale is the most widely used tool but seems unsuitable especially for the delivery room setting. Studies should be conducted to test other tools for assessing neonatal pain in the delivery room.

Resuscitation algorithms and guidelines highlight the importance of heart rate (HR) in determining interventions and assessing their effect. However, the actual HR values used are historical based upon normal physiology, and HR at birth may be affected by mode of delivery and timing of cord clamping as well as respiratory status and condition at delivery. Furthermore, the most accurate and effective ways to assess and monitor HR in the newborn infant are only now becoming established. This article examines the importance of HR values and the most widely used methods of estimation as well as some newer modalities which are being developed.

A majority of babies initiate spontaneous respirations shortly after birth. Up to 10%, however, require resuscitative measures to make the transition from fetus to newborn. Ideally, the need for resuscitation at birth would be predicted before delivery, and a skilled neonatal resuscitation team would be available and ready. This is not always possible. Therefore, neonatal resuscitation teams must be prepared to provide lifesaving resuscitation at every delivery. In this report, we examine risk factors for resuscitation at birth, discuss the importance of communication between obstetric and newborn teams, review key questions to ask before delivery, and investigate antenatal counseling methods. We also investigate ways to prepare for newborn deliveries, including personnel and equipment preparation, and pre-delivery team briefing. Finally, we explore ways in which neonatal resuscitation teams can improve their preparedness through the use of simulation and post-resuscitation debriefing. This report will help neonatal resuscitation teams to anticipate and prepare for every delivery room resuscitation.

OBJECTIVES Mortality rates of very preterm infants may vary considerably between healthcare facilities depending on the neonates' place of inclusion in the cohort study. The objective of this study was to compare the mortality rates of live-born extremely preterm neonates observed in two French tertiary referral hospitals, taking into account the occurrence of neonatal death both in the delivery room and in the neonatal intensive care unit (NICU). METHODS Retrospective observational study including all pregnancy terminations, stillbirths and live-born infants within a 22- to 26-week 0/6 gestational age range was registered by two French level 3 university centers between 2009 and 2013. The mortality rates were compared between the two centers according to two places of inclusion: either the delivery room or the NICU. RESULTS A total of 344 infants were born at center A and 160 infants were born at center B. Among the live-born neonates, the rates of neonatal death were similar in center A (54/125, 43.2%) and center B (33/69, 47.8%; P=0.54). However, neonatal death occurred significantly more often in the delivery room at center A (31/54, 57.4%) than at center B (6/33, 18.2%; P

Introduction The first exchanges between a newborn baby and its mother are essential. Any separation can have negative effects on the establishment of the first connections as well as breastfeeding. Objective To establish the current state of management of healthy newborn babies in the delivery room and assess the reasons for possible separation and the feelings of mothers facing this separation. Materials and methods Observational descriptive single-center study, made up of two parts: 1/a questionnaire given to the mothers, postpartum; 2/the collection of data concerning the transfer of healthy newborn babies to the nursery. Results The study took place over a period of 8 weeks. Eighty-five mothers were interviewed. Seventy-two percent of the newborn babies left the delivery room during the first 2 h of life. For 67 %, the duration of skin-to-skin contact was less than 1 h. For 49 %, the main reason was the performance of routine care. The mothers were satisfied with the care provided in the delivery room. Conclusion Too many healthy newborn babies are separated from their mothers during the first 2 h of life, mainly for routine care. Skin-to-skin contact must be part of the physiological reception of newborn babies in the delivery room. The medical staff and parents must be informed of this aspect and its beneficial effects. It is necessary to reconsider the organization of practices to propose a management system that promotes the establishment of a strong mother–child bond.

Aim To determine whether heart rate (HR) could be detected earlier than by pulse oximeter (POX), using a novel method of application of electrocardiogram (ECG) electrodes during neonatal resuscitation in the delivery room. Methods ECG electrodes were set before delivery to be applied to the back of infants’ thorax. Time to detect HR was recorded as soon as a numerical HR along with a recognizable and persistent QRS complex was observed on ECG monitor (HRECG) and a plethysmographic waveform was seen on POX monitor (HRPOX). Results Out of 334 infants, 49 were Conclusion In the delivery room, electrodes applied by the study method are more effective than pulse oximetry in providing the neonatal team with timely HR information that is necessary for proper resuscitative actions.

Objective Although ketamine analgesia is effective in reducing pain and facilitating the tracheal intubation of newborns in the delivery room, no data on the neurological effects of this treatment are available. This study compared the neurodevelopmental outcomes at 2 years of age in a cohort of preterm newborns having received ketamine prior to tracheal intubation at birth (the ketamine group) and in a control group. Methods We included newborns delivered at less than 33 weeks gestational age (WGA) having undergone tracheal intubation at birth. The Ages and Stages Questionnaire (ASQ) was completed at 1 and 2 years of age. The development quotient (DQ) was calculated from the revised Brunet-Lezine score assessed at a corrected age of 2 years. Results There were no statistically significant differences between the ketamine group (n = 54 at 1 year and n = 51 at 2 years) and the control group (n = 16 at 1 and 2 years) in terms of the mean ± standard deviation DQ at the age of 2 (98 ± 12 vs. 103 ± 9, respectively; P = 0.17) and the ASQ score at the age of 2 (221 ± 44 vs. 230 ± 39, respectively; P = 0.55). Discussion This prospective cohort of 51 preterm newborns having received ketamine at birth did not reveal any differences in terms of neurological development at the age of 2 (relative to a control group and the literature data). These preliminary results must be confirmed in a randomized trial with longer follow-up.

Some newborns require the presence of a paediatrician in the delivery room, for emergency care. This generally leads to hospitalisation in neonatal intensive care or neonatology. Prematurity and respiratory distress are the main causes. These unexpected situations are a source of anxiety for the parents. It is essential that the multidisciplinary team draws on both its technical and relational expertise, in order to provide optimal treatment to the infant while supporting the parents with the necessary empathy.

To determine whether the use of heated-humidified gases for respiratory support during the stabilization of infants30 weeks of gestational age (GA) in the delivery room reduces rates of hypothermia on admission to the neonatal intensive care unit (NICU).A multicenter, unblinded, randomized trial was conducted in Melbourne, Australia, between February 2013 and June 2015. Infants30 weeks of GA were randomly assigned to receive either heated-humidified gases or unconditioned gases during stabilization in the delivery room and during transport to NICU. Infants born to mothers with pyrexia38°C were excluded. Primary outcome was rate of hypothermia on NICU admission (rectal temperature36.5°C).A total of 273 infants were enrolled. Fewer infants in the heated-humidified group were hypothermic on admission to NICU (36/132 [27%]) compared with controls (61/141 [43%], P .01). There was no difference in rates of hyperthermia (37.5°C); 20% (27/132) in the heated-humidified group compared with 16% (22/141) in the controls (P = .30). There were no differences in mortality or respiratory outcomes.The use of heated-humidified gases in the delivery room significantly reduces hypothermia on admission to NICU in preterm infants, without increased risk of hyperthermia.Australian and New Zealand Clinical Trials Register (www.anzctr.org.au) ACTRN12613000093785.

Inadequate staff training was identified as the most common cause of adverse events in obstetric (OB) emergencies. There is a plethora of evidence supporting the use of simulation-based training (SBT) specifically in the management of OB emergencies. A review of the evidence evaluating the effectiveness of SBT in the management of OB emergencies indicates that SBT is associated with improvement in staff skills, patient safety, and quality of care. Life-threatening OB emergencies are not frequent but require skill and prompt action. SBT of delivery room teams in the management of OB emergencies could improve clinical performance and reduce incidence of medical negligence.

The aim of this study was to explore mothers' experiences with skin-to-skin contact (SSC) during hospitalization following a hospital's change in delivery routine for moderately premature infants—from immediate separation of mother and infant to immediate SSC. Three focus group interviews were conducted at the study hospital 7–12 months after delivery. Altogether, nine mothers participated in one interview each, and the interviews were analyzed using qualitative content analysis. All mothers responded positively to immediate SSC in the delivery room and claimed that this practice had normalized the premature birth experience. However, several mothers were not satisfied with how SSC was adapted later during hospitalization. Barriers to SSC and factors supporting it were identified, and three main themes emerged during the analyzing process: importance of staff competence and support, the mothers' desire for an overall focus on health despite the prematurity, and physical/organizational barriers to SSC.

Implementation of standardized practices in the delivery room fosters a safe environment to ensure that newborn infants are cared for optimally, whether or not they require extensive resuscitation. Quality improvement (QI) is an excellent methodology for implementation of standardized practices due to the multidisciplinary nature of the delivery room, the complexity of the tasks involved, and opportunities to track measurable processes and outcomes. In this article, we discuss the various ways that the delivery room is a unique environment and present specific examples on how to approach delivery room QI. Key areas of potential focus for teams pursuing delivery QI include thermal regulation, optimizing respiratory support, and facilitating team communication.

Extremely low birth weight (ELBW) infants are particularly vulnerable at birth, and stabilization in the delivery room (DR) remains challenging. After birth, ELBW infants are at high risk for the development of thermal dysregulation, respiratory insufficiency, and hemodynamic instability due to their immature physiology and anatomy. Although successful stabilization facilitates the transition and reduces acute morbidity, suboptimal care in the DR could cause long-term sequelae. This review addresses the challenges in stabilization in the DR and current neonatal resuscitation guidelines and recommendations.

Emphasis has been placed on engaging parents in processes of shared decision making for delivery room management decisions of critically ill neonates whose outcomes are uncertain and unpredictable. The goal of antenatal consultation should rather be to adapt to parental needs and empower them through a personalized decision-making process. This can be done by acknowledging individuality and diversity while respecting the best interests of neonates. The goal is for parents to feel like they have agency and ability and are good parents, before birth, at birth, and after, either in the NICU or until the death of their child.

Objectives A recent meta-analysis found a 30% mortality decrease in extremely preterm singletons randomized to receive deferred cord clamping (DCC). Data on DCC in twins are scant. Our primary objective was to determine whether DCC was associated with a decrease in death before discharge and/or severe neurological injury in survivors (SNI) in twins ≤29+6 weeks. Methods We conducted a retrospective study using the Canadian Neonatal/Preterm Birth Network database, comparing twins ≤29+6 weeks who received DCC ≥30 seconds and immediate cord clamping (ICC) Results We included 1597 infants from twin pairs; 624 received DCC (39.1%), and 973 (60.9%) received ICC. Death/SNI occurred in 17.8% (N=111) twins who received DCC and in 21.7% (N=211) who received ICC. Between twins who received DCC versus ICC, we did not find a significant difference in death/SNI (aOR 1.07, 95% CI 0.78–1.47). DCC was associated with decreased need for mechanical ventilation (aOR 0.51, 95% CI 0.39–0.67), delivery room intubations (aOR 0.53, 95% CI 0.42–0.68), transfusions (coefficient -0.49, 95% CI -0.86, -0.12) and NICU length of stay (coefficient -4.17, 95% CI -8.15, -0.19). Conclusions DCC was not associated with decreased death/SNI in twins ≤29+6 weeks but was associated with some other positive outcomes.

The arrival of a newborn in the delivery room is a precious and unique moment which caregivers support by seeing to the comfort and wellbeing of the baby and his or her parents. Developmental care is introduced early, skin-to-skin contact is favoured and invasive treatment is only performed if strictly necessary. At the same time, the teams are ready to intervene in the event of a complication.

Modern neonatal intensive care arose from, and will forever depend upon, technology. There are increasing pressures to leverage new technologies to make care safer, more efficient and cost-effective. Changes in the delivery room will bring better monitoring and data display for the resuscitation team. Sensing and monitoring advances will be used in the NICU, measuring a wider range of physiologic parameters. Better integration of technologies with the EMR will be the basis for decision support and predictive analytics. Communication will be improved between the EMR, NICU staff and parents of newborns. Advances in conventional, CT, MRI and ultrasound imaging of neonates will aid in our diagnostic efforts. Ventilators are getting smarter, with wider ranges of support options and monitoring, in parallel with improvements in non-invasive respiratory support. New technologies can be used to evaluate and support neurodevelopment and to optimize nutrition. Laboratory testing can be done more rapidly, with smaller sample size and reduced costs, bringing more testing to the bedside. All these new technologies should optimize the NICU physical environment, improving the experience for patients, their families and hospital staff.

The Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network (NRN) has examined the effects of various obstetrical perinatal interventions and neonatal delivery room practices on the newborn with particular focus on those born preterm. Studies exploring the effects and safety of various antepartum maternal medications and the effects of the route and timing of delivery are examined. The NRN has contributed key studies to the evidence base for the International Liaison Committee on Resuscitation neonatal resuscitation guidelines. These studies are reviewed including research on timing of cord clamping, the importance of maintaining euthermia immediately after birth, delivery room ventilation strategies, outcomes following delivery room cardiopulmonary resuscitation, and the effects of prolonged resuscitation efforts. In addition, the NRN's detailed outcome data at the lowest gestational ages have greatly influenced on how providers counsel families regarding the appropriateness of resuscitation efforts at the lowest gestational ages.

Resume Objectif Identifier les pratiques d’accompagnement de fin de vie et de soins palliatifs dans les salles de naissance. Methode Etude nationale multicentrique et retrospective realisee en 2015 aupres des 549 maternites francaises. Resultats Deux cent dix-neuf maternites ont repondu a l’enquete (taux de reponse : 40 %). Parmi elles, 35 % etaient des maternites de type I, 26 % de type IIA, 22 % de type IIB et 18 % de type III. La majorite de ces services etait confrontee annuellement a au moins une prise en charge palliative en salle de naissance (83 %). D’apres 90 % des maternites, ces situations releveraient des missions des equipes des salles de naissances. Concernant la formation, 44 % des maternites disposaient d’au moins un professionnel forme aux soins palliatifs et/ou a la fin de vie et 65 % avaient identifie un besoin de formation. Un document d’aide a la prise en charge palliative existait dans 31 % des maternites, 81 % avaient moins de 5 ans. En moyenne, plus de quatre professionnels s’etaient mobilises autour de son elaboration. Certaines pratiques d’accompagnement de fin de vie etaient communes a toutes les maternites (peau a peau, traces memorielles), celles disposant d’un protocole se distinguaient sur l’evaluation de la douleur et la consideration de l’environnement du nouveau-ne notamment. Conclusion Les services de maternites bien que rarement confrontes a l’accompagnement de fin de vie des nouveau-nes n’y sont pas pour autant moins sensibilises. La culture palliative tend a se developper dans ces services qui voient dans ces accompagnements une vraie mission et en identifient clairement les besoins de formation.

• Pre-hospital COVID-19 screening should be implemented for all pregnant patients. • Limit the number of staff in a delivery room or operating room when feasible • Encourage the use of video messaging with other members of the patient's support system • An experienced provider should perform neuraxial procedures and intubations, whenever possible.

Purpose Centers that care for newborns with congenital diaphragmatic hernia (CDH) may impose selection criteria for offering or limiting aggressive support in those patients most severely affected. The purpose of this study was to analyze outcomes in newborns with highly severe CDH uniformly treated for survival. Methods We reviewed 172 consecutive inborn patients without associated lethal anomalies treated at a single institution with a dedicated CDH program. Survival, respiratory outcome, and time to discharge in the most severe 10% (or fewer) of patients based on the physiologic measures of 5-minute Apgar, CDH Study Group (CDHSG) predicted survival, need for ECMO in the first 6 hours, and need for ECMO in the first 3 hours of life were studied. We also identified patients with best PaCO 2 greater than 100 and best pH less than 7.0. A multivariate model (AUC-0.92) predicting mortality was also used to define the most severe 10%. Results Of 172 consecutive inborn patients, 18 had a 5-minute Apgar of 3 or less, and 11 survived (61%), 10 had a 5-minute Apgar of 2 or less, and 6 survived (60%), and 6 had a 5-minute Apgar of 1 or less, and 4 survived (67%). Seventeen had a CDHSG predicted survival less than 25%, and 9 survived (53%). Thirteen of 172 required ECMO for rescue in the first 6 hours of life, and 9 survived (69%), including 7 in the first 3 hours, and 5 survived (71%). Despite focused resuscitation in the delivery room and high levels of ventilatory support, 22 patients had a best PCO 2 greater than 100 and best pH less than 7.0 for 1 hour or longer. Twelve of these 22 survived to discharge (55%). Of 17 defined by multivariate predictive modeling as the most severe, 8 survived (47%) with zero of the 3 ECMO ineligible prematures surviving. Of the 16 (10%) most severe ECMO-eligible patients, 10 of 16 survived (63%). All survivors were discharged home on no ventilatory support greater than nasal cannula oxygen. Conclusion In newborn CDH patients without lethal associated anomalies, accepted measures of physiologic severity failed to predict mortality. Survival met or exceeded 50% even in the most severe 10% as defined by these measures. These data support the practice of treating each patient for survival regardless of the physiologic severity in the first hours of life, and selection criteria for not offering ECMO should be reevaluated where practiced.

Premature infants often experience difficulties adapting to postnatal life. The most relevant ones are related to establishing an adult type cardiorespiratory circulation and acquiring hemodynamic stability, aerating the lung and attaining a functional residual capacity, performing an adequate gas exchange and switching to an oxygen enriched metabolism, and keeping an adequate body temperature. In recent years a body of evidence supports a trend towards gentle management in the delivery room aiming to reduce damage especially to the lungs in the so-called first golden minutes. Herewith, we describe and update four of the most relevant interventions performed in the delivery room: delayed cord clamping, non-invasive ventilation, individualized oxygen supplementation, and maintaining an adequate body temperature so as to avoid hyperthermia and/or hypothermia.

Objectives Metabolomics is defined as the comprehensive study of all low molecular weight biochemicals, (metabolites) present in an organism. Using a systems biology approach, metabolomics in umbilical cord blood (UCB) may offer insight into many perinatal disease processes by uniquely detecting rapid biochemical pathway alterations. In vitro haemolysis is a common technical problem affecting UCB sampling in the delivery room, and can hamper metabolomic analysis. The extent of metabolomic alteration which occurs in haemolysed samples is unknown. Design and methods Visual haemolysis was designated by the laboratory technician using a standardised haemolysis index colour chart. The metabolomic profile of haemolysed and non-haemolysed UCB serum samples from 69 healthy term infants was compared using both 1 H-NMR and targeted DI and LC–MS/MS approach. Results We identified 43 metabolites that are significantly altered in visually haemolysed UCB samples, acylcarnitines (n = 2), glycerophospholipids (n = 23), sphingolipids (n = 7), sugars (n = 3), amino acids (n = 4) and Krebs cycle intermediates (n = 4). Conclusion This information will be useful for researchers in the field of neonatal metabolomics to avoid false findings in the presence of haemolysis, to ensure reproducible and credible results.

Background: Women’s negative experiences in the delivery room can have significance for later fear of childbirth. Therefore, it is important to critically evaluate the care during childbirth. The aim was to gain a deeper understanding of women’s negative experiences in the delivery room. Methods: This study is based on original data from three qualitative studies on Swedish women’s experiences of fear of childbirth. Data were collected from interviews with 21 women; 15 pregnant women (6 + 9) with intense fear of childbirth, and six women who had experienced intense fear of childbirth 7–11 years prior to the interview. The analysis had a hermeneutic approach, with focus on the women’s descriptions of their previous negative birth experiences. Findings: The interpretation showed that in the delivery room the women were objects of surveillance, and they endured suffering related to the care during childbirth. This involves experiences of midwives as uncaring, feelings of being suppressed, unprotected and lacking safety, of feeling disconnected and of the body as incompetent in giving birth. The birth environments are understood as power structures, containing views of women’s birthing bodies as machines, and delivery rooms as surveillance environments, involving interventions such as foetal heart monitoring, induction and augmentation of labour. Conclusions: The delivery room was, for these women, a place creating fear of childbirth. To avoid negative birth experiences and future fear, women must be offered not only medical, but also emotional and existential safety in the delivery room.

A study was carried out by Brest regional teaching hospital to analyse practices in relation to non procedural pain in newborns in the delivery room and in a maternity hospital. It highlighted the fact that written transmissions are limited to recording newborns' clinical pain. The newborn pain and discomfort assessment scale is rarely used either because it is not known about, or because it is unavailable or too time-consuming. Pain management can be improved through the use of drugs, traceability and the implementation of other techniques.

Evidence-based thermal care recommendations designed to minimize heat loss immediately at birth are readily available however, hypothermia still persists as a global challenge especially when caring for the most immature and smallest preterm infants. In this narrative overview we aim to provide the reader with a succinct summary of the causes and consequences of hypothermia, the extent of the problem (rates of hypothermia), principles of good thermal care, delivery room preventative measures, the research evidence underpinning existing interventions, current issues in practice, and the way forward. Due to the plethora of research literature available in this subject area, our article will focus primarily on evidence derived from systematic reviews and randomized or quasi-randomized controlled trials assessing the effectiveness of interventions to prevent hypothermia in the most vulnerable (preterm/low birth weight) infants where the intervention or combination of interventions is applied immediately at birth.

There is a paucity of data to support recommendations for stabilization and resuscitation of the periviable neonate in the delivery room. The importance of delivery at a tertiary center with adequate experience, resuscitation team composition, and training for a periviable birth is reviewed. Evidence for delayed cord clamping, delivery room temperature stabilization, strategies to establish functional residual capacity, and adequate ventilation as well as oxygen use in the delivery room is generally based on expert consensus, physiologic plausibility, as well as data from slightly more mature extremely low gestational-age neonates. Little is known about optimal care in the delivery room of these most fragile infants, and thus the need for research remains critical.

Introduction According to the World Health Organization (WHO), every year millions of people are exposed to adverse events (AEs) resulting from medical devices. A growing body of evidence supports their rate is associated with healthcare professionals’ attitudes toward safety. The purpose of the study was to evaluate the impact of training on patient safety culture of midwives in obstetrical unit. Material and methods We have proceeded to a prospective interventional study in 2016 with one group, which included midwives practicing in the delivery room in the department of obstetrics-gynecology, in university hospital Farhat Hached, Sousse, Tunisia. A French version of “Hospital Survey on Patient Safety Culture” (HSOPSC) was used for measuring safety culture. The training program consisted of two workshops with scenario's analysis. The questionnaire was used before and after the two training sessions. Results Sixteen volunteer midwives were included. The comparison of the total scores’ section (mean of the percentage of positive responses to sections’ items), at pre- and post-training, showed a significantly increased score regarding the section D from 7 ± 0.8 to 9 ± 1 (P = 0.017). However, the score of section F decreased significantly from 34 ± 11.5 to 26.5 ± 12 (P = 0.03). In addition, the level of the Dimension 2 “Frequency of event reporting” enhanced significantly from 0.3/3 to 1/3 (P = 0.025) and only item C5 “In the department, we discussed errors’ prevention methods” had a significant increase in the number of positive responses, from 2 to 9 (P = 0.016). Conclusion Our study has shown that training can improve the culture of safety. However, the magnitude of impact varies among different safety culture sections and dimensions. In other hand, we observed poorly developed dimensions of safety culture.

There is very little law-either case law or statutory law - that regulates delivery room decisions about resuscitation of critically ill newborns. Most of the case law that exists is decades old. Thus, physicians cannot look to the law for much guidance about what is permissible or prohibited. Local hospital policies and professional society statements provide some guidance, but they cannot be all-inclusive and encompass all potentially encountered scenarios. Ultimately, the physician, the medical team, and the parents must try to reach a shared decision about the best course of action for each individual infant and each unique family. In this paper, we review some of the case law that may be applicable to such decisions and make recommendations about how decisions should be made.

The transition from fetal to neonatal life is a dramatic and complex process involving extensive physiologic changes, which are most obvious at the time of birth. Individuals who care for newly born infants must monitor the progress of the transition and be prepared to intervene when necessary. In the majority of births, this transition occurs without a requirement for any significant assistance. If newborns require assistance, the majority of the time respiratory support is all that is required. In some instances, however, there are circulatory emergencies that need to be rapidly identified or there may be dire consequences including death in the delivery room. This chapter will review various pathologies that are circulatory emergencies, and discuss how to assess them. We will also review new technologies which may help providers better understand the circulatory status or hemodynamic changes in the delivery room including heart rate, cardiac output, cerebral oxygenation and echocardiography.

Delivery room emergencies due to birth injuries are serious, usually unexpected, and can be distressing situations that necessitate immediate action to reduce neonatal morbidity and prevent neonatal mortality. Birth injuries requiring immediate, urgent care in the delivery room are uncommon, hence knowledge of obstetric risk factors and prenatal conditions linked to birth injury is an important first step in the management of affected neonates. Furthermore, immediate recognition of injury and quick action upon delivery is essential in order to achieve the best possible outcomes. This chapter briefly reviews the known risk factors associated with birth injury, and then discusses the identification and management of specific injuries that may require immediate treatment in the delivery room, or hasty management within hours after birth.

The need for cardiopulmonary resuscitation in newborns is quite rare, as most non-vigorous infants respond well to effective ventilation. For the minority of babies who do not respond to adequate ventilation, chest compressions are necessary using the preferred two thumb technique. Since effective ventilation remains a key component to successful resuscitation, chest compressions are coordinated with ventilations in a 3:1 ratio. If despite adequate ventilation and compressions, the heart rate remains below 60 beats per minute, epinephrine is indicated. The intravenous route is preferred over the endotracheal route and the recommended dose of epinephrine is 0.01-0.03mg/kg. This can be repeated every 3-5 minutes until return of spontaneous circulation is achieved. In rare instances, when there is no response to these above measures and in infants who show evidence of significant hypovolemia, volume replacement should be considered.

We report an outbreak Bacillus cereus causing postpartum bacteraemia in the maternity ward and delivery room. Spores transferred by the hands and gloves of the staff in the maternity ward contaminated equipment in these two areas. Keywords: Bacillus cereus, bacteremia, maternity ward, sterilization

Although seldom needed, the short list of medications used for delivery room resuscitation of the newborn includes epinephrine and volume expanders. Naloxone, sodium bicarbonate and the use of other vasopressors are no longer considered helpful during acute resuscitation and are more often administered in the post-resuscitative period under special circumstances. This review examines the existing literature for the two commonly used medications in neonatal resuscitation and identifies the many knowledge gaps requiring further research.

Objective To evaluate the heart rate (HR) and oxygen saturation (SpO 2 ) at 15-second intervals within 60 seconds after incremental increases of fractional inspired oxygen (FiO 2 ) during resuscitation of infants younger than 29 weeks requiring two different forms of ventilatory support. Study design Retrospective observational study. Methods Forty-three infants were stabilized, 14 by continuous positive airway pressure exclusively (CPAP group), and 29 by positive pressure ventilation (PPV group). Both groups received ventilatory support in a special bed with two cameras enabling the evaluation of all interventions including HR, SpO 2 , FiO 2 , positive inflation pressure, and positive end-expiratory pressure values. FiO 2 was commenced at 0.30 and titrated in 0.1–0.2 increments every 30–60 seconds. The relationships between the incremental increases of FiO 2 and related SpO 2 and HR changes were evaluated. Results Although there was an inverse correlation between initial FiO 2 and SpO 2 in both groups, a significant positive correlation between the incremental increase of FiO 2 and SpO 2 changes after 30 seconds was found only in the CPAP group. Only higher initial levels of FiO 2 had a positive effect on the improvement in SpO 2 in the PPV group. Conclusion The efficacy of FiO 2 titration in 0.1–0.2 increments may be attenuated and delayed in extremely preterm infants required PPV during the first 6 minutes of life.