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Objectives To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. Design Prospective cohort study. Setting Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study. Participants 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births. Main outcome measurements The Optimality IndexNL-2015, a tool to measure ‘maximum outcome with minimal intervention’, was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth. Results There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women. Conclusion The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.

Objectives To compare the Optimality Index of planned birth in a birth centre with planned birth in a hospital and planned home birth for low-risk term pregnant women who start labour under the responsibility of a community midwife. Design Prospective cohort study. Setting Low-risk pregnant women under care of a community midwife and living in a region with one of the 21 participating Dutch birth centres or in a region with the possibility for midwife-led hospital birth. Home birth was commonly available in all regions included in the study. Participants 3455 low-risk term pregnant women (1686 nulliparous and 1769 multiparous) who gave birth between 1 July 2013 and 31 December 2013: 1668 planned birth centre births, 701 planned midwife-led hospital births and 1086 planned home births. Main outcome measurements The Optimality IndexNL-2015, a tool to measure ‘maximum outcome with minimal intervention’, was assessed by planned place of birth being a birth centre, a hospital setting or at home. Also, a composite maternal and perinatal adverse outcome score was calculated for the different planned places of birth. Results There were no differences in Optimality Index NL-2015 for pregnant women who planned to give birth in a birth centre compared with women who planned to give birth in a hospital. Although effect sizes were small, women who planned to give birth at home had a higher Optimality Index NL-2015 than women who planned to give birth in a birth centre. The differences were larger for multiparous than for nulliparous women. Conclusion The Optimality Index NL-2015 for women with planned birth centre births was comparable with planned midwife-led hospital births. Women with planned home births had a higher Optimality Index NL-2015, that is, a higher sum score of evidence-based items with an optimal value than women with planned birth centre births.

Background: Swaziland has one of the highest HIV prevalence rates in sub-Saharan Africa, 26 % of the adult population is infected with HIV. The prevalence is highest among pregnant women, at 41.1 %. According to Swaziland’s prevention of mother-to-child transmission (PMTCT) guidelines, approximately 50 % of pregnant women are eligible for antiretroviral therapy (ART) by CD4 criteria (

Background: Blood transfusions are an essential element of obstetric care and may have a role in reducing maternal mortality, if used appropriately. Monitoring of transfusion practices provides information on current and future needs of blood. It may also lead to rational use of blood transfusions. Identifying common obstetric complications requiring transfusions is also critical for informing the development of appropriate operational maternal health programmes necessary for preventing their recurrence. Aim: To describe the demographic characteristics of blood transfusion recipients, and diagnoses associated with the use of blood and blood components in obstetric care in Zimbabwe. Study design and methods: Data on the characteristics of the blood transfusion recipients (age, sex, blood group), blood components received (type, quantity), discharge diagnoses and outcomes following transfusion (discharge status, length of stay in hospital), were retrospectively collected from Mbuya Nehanda Maternity Hospital, a tertiary referral hospital, during the period January 1, 2014 through December 31, 2014. Diagnoses were grouped into categories according to the block codes under Chapter 15 of the International Classification of Diseases, (ICD-10). Results: The total number of admissions in the maternity wards of the hospital was 12450. Of these, 416 (3.3%) received blood transfusion as part of obstetric care. The median age of the recipients was 30 years (range; 15 - 55 years). Most of the recipients (n = 301; 84.3%) were in the age group 20-39 years. The majority of these recipients (n = 412; 99.0%) received a red blood cell transfusion. The median number of red blood cell units transfused per recipient was 2 units (range; 1-11 units). The majority of the transfusion recipients were diagnosed with complications of labour and delivery (n = 147; 35.3%), and pregnancy with abortive outcome (n = 141; 33.9%). The majority of the recipients required blood for the management of postpartum haemorrhage (130; 31.3%). The median length of stay in hospital was 4 days (range, 1-59) and in-hospital mortality was 4.0%. [TABLE PRESENTED] Conclusions: The rate of blood transfusion is comparable to rates reported elsewhere in sub-Saharan Africa. With most of the patients requiring blood for postpartum haemorrhage, further research is required to identify factors associated with excessive blood loss and the need for transfusions. The treatment of underlying anaemia, as a preventative measure, may also aid in reducing postpartum haemorrhage.

Background: Blood transfusions are an essential element of obstetric care and may have a role in reducing maternal mortality, if used appropriately. Monitoring of transfusion practices provides information on current and future needs of blood. It may also lead to rational use of blood transfusions. Identifying common obstetric complications requiring transfusions is also critical for informing the development of appropriate operational maternal health programmes necessary for preventing their recurrence. Aim: To describe the demographic characteristics of blood transfusion recipients, and diagnoses associated with the use of blood and blood components in obstetric care in Zimbabwe. Study design and methods: Data on the characteristics of the blood transfusion recipients (age, sex, blood group), blood components received (type, quantity), discharge diagnoses and outcomes following transfusion (discharge status, length of stay in hospital), were retrospectively collected from Mbuya Nehanda Maternity Hospital, a tertiary referral hospital, during the period January 1, 2014 through December 31, 2014. Diagnoses were grouped into categories according to the block codes under Chapter 15 of the International Classification of Diseases, (ICD-10). Results: The total number of admissions in the maternity wards of the hospital was 12450. Of these, 416 (3.3%) received blood transfusion as part of obstetric care. The median age of the recipients was 30 years (range; 15 - 55 years). Most of the recipients (n = 301; 84.3%) were in the age group 20-39 years. The majority of these recipients (n = 412; 99.0%) received a red blood cell transfusion. The median number of red blood cell units transfused per recipient was 2 units (range; 1-11 units). The majority of the transfusion recipients were diagnosed with complications of labour and delivery (n = 147; 35.3%), and pregnancy with abortive outcome (n = 141; 33.9%). The majority of the recipients required blood for the management of postpartum haemorrhage (130; 31.3%). The median length of stay in hospital was 4 days (range, 1-59) and in-hospital mortality was 4.0%. [TABLE PRESENTED] Conclusions: The rate of blood transfusion is comparable to rates reported elsewhere in sub-Saharan Africa. With most of the patients requiring blood for postpartum haemorrhage, further research is required to identify factors associated with excessive blood loss and the need for transfusions. The treatment of underlying anaemia, as a preventative measure, may also aid in reducing postpartum haemorrhage.

Background: Blood transfusions are an essential element of obstetric care and may have a role in reducing maternal mortality, if used appropriately. Monitoring of transfusion practices provides information on current and future needs of blood. It may also lead to rational use of blood transfusions. Identifying common obstetric complications requiring transfusions is also critical for informing the development of appropriate operational maternal health programmes necessary for preventing their recurrence. Aim: To describe the demographic characteristics of blood transfusion recipients, and diagnoses associated with the use of blood and blood components in obstetric care in Zimbabwe. Study design and methods: Data on the characteristics of the blood transfusion recipients (age, sex, blood group), blood components received (type, quantity), discharge diagnoses and outcomes following transfusion (discharge status, length of stay in hospital), were retrospectively collected from Mbuya Nehanda Maternity Hospital, a tertiary referral hospital, during the period January 1, 2014 through December 31, 2014. Diagnoses were grouped into categories according to the block codes under Chapter 15 of the International Classification of Diseases, (ICD-10). Results: The total number of admissions in the maternity wards of the hospital was 12450. Of these, 416 (3.3%) received blood transfusion as part of obstetric care. The median age of the recipients was 30 years (range; 15 - 55 years). Most of the recipients (n = 301; 84.3%) were in the age group 20-39 years. The majority of these recipients (n = 412; 99.0%) received a red blood cell transfusion. The median number of red blood cell units transfused per recipient was 2 units (range; 1-11 units). The majority of the transfusion recipients were diagnosed with complications of labour and delivery (n = 147; 35.3%), and pregnancy with abortive outcome (n = 141; 33.9%). The majority of the recipients required blood for the management of postpartum haemorrhage (130; 31.3%). The median length of stay in hospital was 4 days (range, 1-59) and in-hospital mortality was 4.0%. [TABLE PRESENTED] Conclusions: The rate of blood transfusion is comparable to rates reported elsewhere in sub-Saharan Africa. With most of the patients requiring blood for postpartum haemorrhage, further research is required to identify factors associated with excessive blood loss and the need for transfusions. The treatment of underlying anaemia, as a preventative measure, may also aid in reducing postpartum haemorrhage.

Background For mothers who have just given birth, the postpartum hospital stay is meant to promote an environment where resting, healing and bonding can take place. New mothers, however, face many interruptions throughout the day including multiple visitors and noise caused by medical equipment, corridor conversations and intercom announcements. This paper argues that disruptions and noise on a maternity ward are detrimental to the healing process for new mothers and their newborns and healthcare decision-makers need to act to improve the environment for these patients. This paper also provides recommendations on how to reduce the noise levels, or at least control the noise on a maternity ward, through the implementation of a daily quiet time. Discussion Hospital disruptions and its negative health effects in particular for new mothers and their children are illustrated in this paper. Hospital noise and interruptions act as a stressor for both new mothers and staff, and can lead to sleep deprivation and detrimental cardiovascular health effects. Sleep deprivation is associated with a number of negative mental and physical health consequences such as decreased immune function, vascular dysfunction and increased sympathetic cardiovascular modulation. Sleep deprivation can also increase the risk of postpartum mental health disorders in new mothers. Some efforts have been made to reduce the disruptions experienced by these patients within a hospital setting. For example, the introduction of a daily quiet time is one way of controlling noise levels and interruptions, however, these have mostly been implemented in intensive care units. Summary Noise and disruptions are a significant problem during postpartum hospital stay. Healthcare institutions are responsible for patient-centered care; a quiet time intervention promises to contribute to a safe, healing environment in hospitals.