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Qualitative research about women and birthing people's experiences of fetal monitoring during labour and birth is scant. Labour and birth is often impacted by wearable or invasive monitoring devices, however, most published research about fetal monitoring is focused on the wellbeing of the fetus. This manuscript is derived from a larger mixed methods study, 'WOmen's Experiences of Monitoring Baby (The WOMB Study)', aiming to increase understanding of the experiences of women and birthing people in Australia, of being monitored; and about the information they received about fetal monitoring devices during pregnancy. We constructed a national cross-sectional survey that was distributed via social media in May and June, 2022. Responses were received from 861 participants. As far as we are aware, this is the first survey of the experiences of women and birthing people of intrapartum fetal monitoring conducted in Australia. This paper comprises the analysis of the free text survey responses, using qualitative and inductive content analysis. Two categories were constructed, Tending to the machine, which explores participants' perceptions of the way in which clinicians interacted with fetal monitoring technologies; and Impressions of the machine, which explores the direct impact of fetal monitoring devices upon the labour and birth experience of women and birthing people. The findings suggest that some clinicians need to reflect upon the information they provide to women and birthing people about monitoring. For example, freedom of movement is an important aspect of supporting the physiology of labour and managing pain. If freedom of movement is important, the physical restriction created by a wired cardiotocograph is inappropriate. Many participants noticed that clinicians focused their attention primarily on the technology. Prioritising the individual needs of the woman or birthing person is key to providing high quality woman-centred intrapartum care. Women should be provided with adequate information regarding the risks and benefits of different forms of fetal monitoring including how the form of monitoring might impact her labour experience. [ABSTRACT FROM AUTHOR]

This paper examines the links between place attachment and older persons' preferences to age in place, and factors that disrupt these preferences. We use data from the 2001–2021 Household, Income and Labour Dynamics in Australia Survey and panel-data modelling to confirm strong associations between several place attachment dimensions and aging-in-place preferences. Strong ties to children, strong social capital, residence in social housing, homeownership status, housing wealth, and home and neighborhood satisfaction are all positively linked to a stronger preference to age in place. Our findings reveal important differences between older homeowners and older non-owners. For owners, closeness to children is a strong predictor of aging-in-place preferences, although mortgage debt can trigger involuntary moves. For non-owners, tenure security achieved through longer durations at one's address of residence is linked to stronger aging-in-place preferences. However, private renters are more often exposed to involuntary moves. We discuss the policy implications of these disruptions. [ABSTRACT FROM AUTHOR]

Since early 2020, the world has been dealing with the COVID-19 pandemic. The rapid changing situation led to unforeseeable challenges and questions for many people, including pregnant women. Through a textual analysis of personal narratives told via pregnancy and/or laboring vlogs during COVID-19, this present study aims to understand how women from China who live in another country during pregnancy have utilized YouTube vlogs to share their experiences. Through this analysis, we identify various challenges that these women experienced during their pregnancy. The COVID-19 pandemic exaggerated the normal difficulties of these issues and also created additional problems for these women, including regular pregnancy tests, choice of birthing locations, and the support and caring that were normal during this time period. [ABSTRACT FROM AUTHOR]

Background: Neonatal hypoxic ischaemic encephalopathy (HIE) is the most common cause of encephalopathy in the neonatal period and carries a high risk of mortality and long‐term morbidity. Aim: The aim of this study was to investigate key antecedents of moderate and severe HIE in a large contemporary birth cohort. Methods: A retrospective cohort study of births meeting criteria was conducted between 2016 and 2020 at the Mater Mothers' Hospital, Brisbane, Australia. This is a quaternary perinatal centre and Australia's largest maternity hospital. Univariate and multivariate Firth logistic regression were used to account for imbalanced frequency classes between non‐HIE and HIE groups. Maternal variables and intrapartum factors were investigated for associations with neonatal moderate and severe HIE. Results: Overall, 133 of 46 041 (0.29%) infants were diagnosed with HIE: 77 (0.17%) with mild HIE and 56 (0.12%) with moderate/severe HIE. Nulliparity, type 1 diabetes mellitus and maternal intensive care unit admission were associated with increased odds of moderate/severe HIE. Intrapartum risk factors included emergency caesarean birth, emergency caesarean for non‐reassuring fetal status or failure to process, intrapartum haemorrhage and an intrapartum sentinel event (shoulder dystocia, cord prolapse, uterine rupture and placental abruption). Neonatal risk factors included male sex, late preterm gestation (35+0–36+6 weeks), Apgar score less than four at 5 min, severe respiratory distress requiring ventilatory support and severe acidosis at birth. Conclusions: This cohort study identified a series of potentially modifiable maternal and obstetric risk factors for HIE. Risk factors for HIE do not appear to have changed significantly with evolution in modern obstetric care. [ABSTRACT FROM AUTHOR]

Objective: To investigate the Australian general public's perception of appropriate medical scenarios that warrants a call to an emergency ambulance. Methods: An online survey asked participants to identify the likely medical treatment pathway they would take for 17 hypothetical medical scenarios. The number and type of nonemergency scenarios (n = 8) participants incorrectly suggested were appropriate to place a call for an emergency ambulance were calculated. Participants included Australian residents (aged >18 years) who had never worked as an Australian registered medical doctor, nurse or paramedic. Results: From a sample of 5264 participants, 40% suggested calling an emergency ambulance for a woman in routine labour was appropriate. Other medical scenarios which were most suggested by participants to warrant an emergency ambulance call was 'Lego in ear canal' (11%), 'Older person bruising' (8%) and 'Flu' (7%). Women, people aged 56+ years, those without a university qualification, with lower household income and with lower emotional wellbeing were more likely to suggest calling an emergency ambulance was appropriate for nonemergency scenarios. Conclusions: Although emergency healthcare system (EHS) capacity not increasing at the same rate as demand is the biggest contributor to EHS burden, non-urgent medical situations for which other low-acuity healthcare pathways may be appropriate does play a small role in adding to the overburdening of the EHS. This present study outlines a series of complaints and demographic characteristics that would benefit from targeted educational interventions that may aid in alleviating ambulance service attendances to low-acuity callouts. [ABSTRACT FROM AUTHOR]

Aim: To describe current practice, examine the influences and explore barriers and facilitators to accurate documentation, for the administration of intravenous fluids during labour. Design: A descriptive qualitative study was performed. Methods: Qualitative semi‐structured interviews were conducted with Registered Midwives working across Australia. Midwives were recruited via email and social media advertisements. A maximum variation sampling strategy was used to identify potential participants. Interview questions explored four main areas: (i) understanding of indications for IV fluids in labour; (ii) identification of current practice; (iii) barriers to documentation and (iv) benefits and complications of IV fluid administration. Reflexive thematic analysis of recorded‐transcribed interviews was conducted. Results: Eleven midwives were interviewed. Clinical practice variation across Australia was recognized. Midwives reported a potential risk of harm for women and babies and a current lack of evidence, education and clinical guidance contributing to uncertainty around the use of IV fluids in labour. Overall, eight major themes were identified: (i) A variable clinical practice; (ii) Triggers and habits; (iii) Workplace and professional culture; (iv) Foundational knowledge; (v) Perception of risk; (vi) Professional standards and regulations; (vii) The importance of monitoring maternal fluid balance and (viii) barriers and facilitators to fluid balance documentation. Conclusion: There was widespread clinical variation identified and midwives reported a potential risk of harm. The major themes identified will inform future quantitative research examining the impact of IV fluids in labour. Impact The implications of this research are important and potentially far‐reaching. The administration of IV fluids to women in labour is a common clinical intervention. However, there is limited evidence available to guide practice. This study highlights the need for greater education and evidence examining maternal and neonatal outcomes to provide improved clinical guidance. [ABSTRACT FROM AUTHOR]

Background: The COVID pandemic has highlighted the stresses experienced by our medical workforce, with worldwide publications attesting to high rates of depression, anxiety and burnout, particularly in junior doctors. Many studies focus on reporting on the prevalence of mental health issues, but not many report on interventional strategies. One of the most stressful interactions in the day of a junior doctor is the medical handover. The incorporation of kindness into clinical handover has coined the term 'KISBAR' to underline the importance of delivering handover in a kind manner. Aim: The aim is to analyse the efficacy of a novel intervention by introducing an emotional support representative to participate in the morning labour ward handover. Methods: We undertook an ethnographic constructivist qualitative research project in a tertiary hospital in Perth, Western Australia, using focus groups to explore the views of junior medical staff on the KISBAR handover tool in the specific context of labour ward handover. Fifty per cent of the total junior doctors from the hospital participated in this study. Results: Four dominant themes arose from analysis of the focus group discussions: (i) inherent stress experienced by junior doctors during the labour ward handover process, (ii) support strategies for junior doctors during labour ward handover; (iii) role modelling and the hidden curriculum aspects of communication from senior doctors at labour ward handover; and (iv) benefit of having an emotional support person present for labour ward handover. Conclusion: Our study confirmed the benefit of having an emotional support person present at labour ward handover: improved perception of safety and an environment that junior doctors found to be supportive. This is a novel and reproducible interventional strategy which is applicable to various obstetric units around Australia. [ABSTRACT FROM AUTHOR]

Nitrous oxide is commonly used in Australia for labour analgesia. Its use in labour is potentially associated with aerosol generation. During the first wave of the COVID‐19 pandemic of 2020, nitrous oxide was suspended on many birthing units to reduce the risk of transmission. We aimed to determine the impact of withholding nitrous oxide for labour analgesia, during the COVID‐19 pandemic, on epidural rates, opioid analgesia use, and maternal and neonatal outcomes. Withholding nitrous oxide for labour analgesia did not alter epidural rates but did significantly increase opioid analgesia use. Caesarean section rates, post‐partum blood loss and neonatal APGAR scores did not change. [ABSTRACT FROM AUTHOR]

Aims: This study aimed to understand midwifery care during labour, particularly decision‐making processes, within Australian health systems. Background: Midwifery, founded on a wellness model of motherhood, is at risk of being medicalized. Whilst medical intervention is lifesaving, it requires judicious use. Governance provides oversight to care. Exploring decision‐making contributes to understanding governance of practices. Method: Straussian grounded theory using semi‐structured interviews. Eighteen Australian registered midwives were interviewed about their practice when caring for women during labour. Results: Midwives were caught between divergent positions; birth as natural versus birth as risk. Experienced midwives discussed focussing on the woman, yet less experienced were preoccupied with mandatory protocols like early warning tools. Practice was governed by midwives approach within context of labour. The final theory: The Coalescence of Perceptions, Practice and Power, comprising three categories: perceptions and behaviour, shifting practice and power within practice, emerged. Conclusions: Coalescence Theory elucidates how professional decision making by midwives during care provision is subject to power within practice, thereby governed by tensions, competing priorities and organizational mandates. Implications for Midwifery Managers: Midwifery managers are well positioned to negotiate the nuanced space that envelopes birthing processes, namely, expert knowledge, policy mandates and staffing capability and resources, for effective collaborative governance. In this way, managers sustain good governance. [ABSTRACT FROM AUTHOR]

Background: Consensus‐based recommendations guiding oral intake during labour are lacking. Aims: We surveyed women at a tertiary women's hospital about preferences for and experiences of oral intake during labour, gastrointestinal symptoms during labour and recalled advice about oral intake. Materials and methods: Women who experienced labour completed a postpartum survey with responses as free text, yes‐no questions and five‐point Likert scales. We identified demographic data and risk factors for surgical or anaesthetic intervention at delivery from medical records. We summarised free text comments using conventional content analysis. Results: One hundred and forty‐nine women completed the survey (47% response rate). Their mean (SD) age was 31 (four) years, birthing at median gestation of 39 weeks (interquartile range: 38‐40). One hundred and twenty‐two (83%) and 44 (30%) women strongly agreed or agreed they felt like drinking and eating respectively during labour. Ninety women (61%) reported nausea and 47 women (32%) reported vomiting in labour. Forty‐one women (28%) did not receive advice on oral intake during labour. Maternal risk factors for surgical intervention were identified in 72 (48%) women and fetal risk factors in 27 (18%) women. Thirty‐one women (21%) delivered by emergency caesarean section. Conclusion: Pregnant women received variable advice regarding oral intake during labour, from variable sources. Most women felt like drinking but not eating during labour. Guidelines on oral intake in labour may be beneficial to women, balancing the preferences of women with risks of surgical intervention. [ABSTRACT FROM AUTHOR]

Background: Many women living in rural and remote Australia are required to travel large distances to birth in a hospital with maternity facilities, incurring considerable financial, social and emotional burden for them and their families. No studies to date have investigated the use of quantitative fetal fibronectin (qfFN) to predict term labour in asymptomatic pregnant women. A tool which is able to more accurately predict term labour has the potential to guide informed travel decision‐making for women and healthcare professionals in rural and remote Australia. Aim: The aim of this study is to determine if qfFN can reliably predict term labour in asymptomatic women from rural and remote areas. Materials and Methods: Thirty‐nine women from rural Australia provided 71 fFN samples between June 2016 and October 2018, from 37 weeks' gestation, with at least one week between samples for those providing multiple samples. Days from fFN sampling until spontaneous onset of labour were recorded. Using generalised estimating equation modelling we examined the utility of fFN as a predictor for onset of labour at term after adjusting for confounders. Results: There was a small‐to‐moderate negative correlation (rs −0.27, P < 0.05) between time until labour and fFN. Quantitative fFN was observed to be a significant predictor of time until labour after adjusting for confounding variables (P < 0.001). Conclusion: fFN levels may play a role in predicting term labour in rural women; however, future studies with a larger sample size are required to validate the findings of our pilot study. [ABSTRACT FROM AUTHOR]

Background: This study follows the 2017 UK INFANT Collaborative Group RCT, which compared neonatal outcomes with and without the use of the INFANT cardiotocograph decision support system for over 46 000 patients in labour. The original trial failed to demonstrate a significant improvement to neonatal outcomes; however, the study design was subject to methodological critique. Aims: This Australian retrospective cohort study aimed to report perinatal outcomes before and after the introduction of INFANT decision support software for cardiotocograph use in labour. Materials and Methods: The study cohort was divided into two equivalent 18‐month epochs, before and after the introduction of INFANT‐Guardian® CTG decision support system. Propensity score matching analysis was undertaken to balance pre‐ and post‐implementation groups by baseline covariates. The matched cohort included 11 154 public‐funded women between November 2016 and 2019, with a singleton live fetus ≥34 + 0 weeks, being induced or in spontaneous labour. The main outcome measures were: a composite measure of serious adverse neonatal outcome comprising of one or more of: admission to intensive care nursery >48 h, Apgar <4 at 5 min, cord arterial pH <7.0, hypoxic ischaemic encephalopathy grade 2 or 3, therapeutic hypothermia, neonatal death. Results: The incidence of the composite primary outcome was significantly lower following implementation of INFANT (0.57% vs. 1.00%; OR 0.57, 95%CI 0.37–0.88; P = 0.01). A significant reduction in nursery admission >48 h was also observed (0.05% vs. 0.30%; OR 0.18, 95%CI 0.05–0.60; P = 0.002). Conclusions: INFANT software is associated with a reduction in serious adverse neonatal outcomes, without increasing the rate of operative delivery. [ABSTRACT FROM AUTHOR]

Background: Post-term gestation beyond 41+6 completed weeks of gestation is known to be associated with a sharp increase in the risk of stillbirth and perinatal mortality. However, the risk of common adverse outcomes related to labour, such as shoulder dystocia and post-partum haemorrhage for those delivering at this advanced gestation, remains poorly characterised. The objective of this study was to examine the risk of adverse, labour-related outcomes for women progressing to 42 weeks gestation or beyond, compared with those giving birth at 39 completed weeks.Methods: We performed a state-wide cohort study using routinely collected perinatal data in Australia. Comparing the two gestation cohorts, we examined the adjusted relative risk of clinically significant labour-related adverse outcomes, including macrosomia (≥ 4500 at birth), post-partum haemorrhage (≥1000 ml), shoulder dystocia, 3rd or 4th degree perineal tear and unplanned caesarean section. Parity, maternal age and mode of birth were adjusted for using logistic regression.Results: The study cohort included 91,314 women who birthed at 39 completed weeks and 4317 at ≥42 completed weeks. Compared to 39 weeks gestation, those giving birth ≥42 weeks gestation had an adjusted relative risk (aRR) of 1.85 (95% CI 1.55-2.20) for post-partum haemorrhage following vaginal birth, 2.29 (95% CI 1.89-2.78) following instrumental birth and 1.44 (95% CI 1.17-1.78) following emergency caesarean section; 1.43 (95% CI 1.16-1.77) for shoulder dystocia (for non-macrosomic babies); and 1.22 (95% CI 1.03-1.45) for 3rd or 4th degree perineal tear (all women). The adjusted relative risk of giving birth to a macrosomic baby was 10.19 (95% CI 8.26-12.57) among nulliparous women and 4.71 (95% CI 3.90-5.68) among multiparous women. The risk of unplanned caesarean section was 1.96 (95% CI 1.86-2.06) following any labour and 1.47 (95% CI 1.38-1.56) following induction of labour.Conclusions: Giving birth at ≥42 weeks gestation may be an under-recognised risk factor for several important, labour-related adverse outcomes. Clinicians should be aware that labour at this advanced gestation incurs a higher risk of adverse outcomes. In addition to known perinatal risks, the risk of obstetric complications should be considered in the counselling of women labouring at post-term gestation. [ABSTRACT FROM AUTHOR]

Objective: The aim of this work was to assess the cost-effectiveness of induction of labor with outpatient balloon catheter cervical priming versus inpatient prostaglandin vaginal gel or tape.Study Design: Economic evaluation alongside a multi-centre, randomized controlled trial at eight Australian maternity hospitals. The trial reported on 448 women with live singleton term pregnancies, undergoing induction of labor for low-risk indications between September 2015 and October 2018. An economic decision tree model was designed from a health services perspective from time of induction of labor to hospital discharge. Sensitivity and subgroup analyses were performed to test the robustness of model outcomes. We estimated resource use, collected data on health outcomes (using EQ-5D-3 L questionnaire) and reported cost (Australian Dollars) per quality-adjusted life year gained, incremental cost-effect ratio and net monetary benefit.Results: Deterministic analysis showed lower mean costs ($7294 versus $7585) in the outpatient-balloon (n = 205) compared to the inpatient-prostaglandin group (n = 243), with similar health outcomes (0.75 vs 0.74 quality-adjusted life years gained) and overall higher net monetary benefit ($30,054 vs $29,338). In probabilistic analyses outpatient-balloon induction of labor was cost-effective in 55.3 % of all simulations and 59.1 % for women with favourable cervix (modified Bishop score >3) and 64.5 % for nulliparous women.Conclusions: Outpatient-balloon induction of labor may be cost-saving compared to inpatient induction of labor with prostaglandin and is most likely to be cost-effective for nulliparous women, but more research is warranted in other settings to explore the generalisability of results. [ABSTRACT FROM AUTHOR]

Objectives: The importance of shared decision-making (SDM) in relation to induction of labour (IOL) is recognised, little is known about women's experiences of and satisfaction with decision-making and how this can be improved. The aim of this study was to 1) gain insight into women's experiences of SDM in relation to IOL, 2) understand the factors associated with satisfaction versus dissatisfaction during SDM, and 3) identify recommendations for service improvement.Methods: Qualitative semi-structured telephone interviews were conducted with 32 women who had a recent IOL at one of eight public hospitals in Sydney, Australia. An inductive approach to coding and categorisation of themes was used.Results: While women reported varied experiences with SDM, many reported not feeling that they had a choice about IOL, not being presented with the risks and benefits of different birth options, and receiving insufficient information about the IOL process and methods. Satisfaction versus dissatisfaction with SDM appeared more closely related to a woman's willingness to have an IOL and their willingness to defer decision-making, rather than the process of SDM. Recommendations for improvement included improved SDM practices, access to guidelines and continuity of care.Conclusion: There is a need to improve SDM processes around IOL.Practice Implications: Particular areas for improvement include more comprehensive discussions surrounding the pros and cons of different birth methods and the IOL process. Decision aids and clinician training may assist with SDM. [ABSTRACT FROM AUTHOR]

Background: Despite being an efficacious means of pain relief, there is a broad range of usage rates of epidural analgesia among countries worldwide. Australia sits between common usage in North America and more conservative usage in the UK. The reason for this is unclear, raising the question of whether there is a difference between Australia and other Western countries in pregnant women's attitudes toward epidural use, or the hospital context. Aim: To explore predictors for epidural analgesia request among pregnant women in Townsville, Australia. Materials and Methods: A three‐phase mixed methods exploratory study design, with Phase One involving 12 one‐on‐one interviews with pregnant and post‐partum women regarding attitudes toward labour analgesia decision‐making and epidural preferences. Interview data were analysed thematically to develop a survey distributed to 265 third‐trimester women in Phase Two. Phase Three involved a chart review of survey participants to record delivery mode, epidural request and indication. Bivariate and logistic regression analysis of Phases Two and Three data were used to develop predictive models for epidural decision‐making. Results: Interviews revealed several themes influencing analgesia preferences in Townsville women: concerns regarding personal safety, trust in health professionals, and previous experiences with labour. The logistic regression identified epidural request in labour to be predicted by: primiparity, epidural experience, induction or augmentation of labour, and perceived sense of control associated with epidural use. Conclusions: This study suggests that the most significant influencers on Townsville women's epidural decision‐making were parity, induction or augmentation of labour, previous experience of epidurals and attitude toward epidurals. [ABSTRACT FROM AUTHOR]

Higher stocking rates of lambing ewes have been associated with poorer ewe-lamb behaviour and lamb survival. This study tested the hypothesis that increasing the mob size and stocking rate of lambing ewes on commercial farms will reduce the survival of their lambs. Data were collected from 66 producers in Australia for Experiment one and 22 producers in New Zealand for Experiment two. Survival of single- and twin-born lambs decreased by 1.4% and 3.5% per extra 100 ewes in the mob, regardless of breed, in Experiment one. The survival of Merino lambs in Experiment two decreased by 0.9% per extra 100 ewes in the mob, regardless of birth type. Increasing stocking rate by 1 ewe/ha also decreased lamb survival by 0.7% in Experiment one. However, this was not evident in Experiment two. These findings highlight the scope to optimise ewe mob size and stocking rate at lambing to improve lamb survival. [ABSTRACT FROM AUTHOR]

Background: Expediting delivery in the second stage of labour often involves a choice between a caesarean section at full dilatation or mid‐cavity instrumental delivery. Accumulating evidence suggests that the mode of delivery may influence the risk of preterm birth in the subsequent pregnancy. Aims: To directly compare first birth caesarean section at full dilatation with mid‐cavity instrumental delivery for the risk of preterm birth in the subsequent pregnancy (second birth). A further aim was to identify predictive factors associated with these index modes of delivery. Materials and Methods: This is a retrospective cohort study involving three maternity hospitals in western Sydney over the period of 2006–2017. Inclusion criteria were nulliparous women with a singleton term cephalic first birth delivered by caesarean section at full dilatation or mid‐cavity instrumental delivery, and whose second birth also occurred under our care. Data were analysed separately for first and second births. Results: There were 425 caesarean section at full dilatation and 874 mid‐cavity instrumental cases which met inclusion criteria. The risk of preterm birth in the second birth was 5.7% compared to 3.2%, respectively (risk ratio 1.76; 95% CI 1.04–3.00; P = 0.035). After excluding causes of preterm birth not related to previous mode of delivery, the risk of spontaneous preterm birth was 4.3% compared to 2.0%, respectively (risk ratio 2.18; 1.14–4.19; P = 0.019). Conclusion: Caesarean section at full dilatation is associated with a significantly higher rate of preterm birth in the subsequent pregnancy compared to a mid‐cavity instrumental delivery. This should be considered in second‐stage mid‐cavity decision‐making. [ABSTRACT FROM AUTHOR]

Objective: Induction of labor (IOL) typically involves cervical priming in an inpatient setting. Outpatient cervical priming may be a safe and cost-effective alternative. However, little is known about women's preference and the impact of outpatient cervical priming on their healthcare experience. The objective was to compare women's healthcare experiences following IOL using a balloon catheter and going home, versus prostaglandin (PG) and remaining an inpatient.Study Design: A randomized controlled trial was undertaken across eight Australian maternity hospitals. Between September 2015 and October 2018, 695 women with uncomplicated term singleton pregnancies were randomized. Of these, 215 and 233 women in the balloon-outpatient and PG-inpatient groups, respectively, received the allocated intervention. The PG group received Dinoprostone gel or controlled-release tape. The balloon group had a double-balloon catheter inserted and went home. Experiential and quality-of-life outcomes were measured via written questionnaire after birth. The primary outcome was a composite neonatal measure. Women's healthcare experience, health-state (EQ-5D-3 L) and pain scores are reported here.Results: Questionnaire data were available for 366 (81.7 %) women enrolled who received their treatment allocation. More women in the balloon-outpatient group reported they would choose IOL next pregnancy (49.2 % vs 38.4 %; p = 0.037) and desire the same method (72.4 % vs 61.1 %; p = 0.022). The balloon-outpatient group experienced higher pain scores at the start of IOL (median (IQR) 3(2-5) vs 2(1-4); p = 0.002) but lower scores at time of rupture of membranes (3(1-5) vs 4(2-6); p = 0.007). The EQ-5D-3 L health-utility index did not differ significantly between the groups (0.77 vs 0.78; p = 0.899).Conclusions: Women report similar healthcare experiences following balloon-outpatient compared to PG-impatient IOL, but are more likely to desire the same method next pregnancy if IOL is required. If both options are available, then differences in experience should be shared with women, alongside differences in clinical outcomes as part of their decision-making process. [ABSTRACT FROM AUTHOR]

Background: Third‐ and fourth‐degree tears are associated with significant pain, discomfort and impact on quality of life and intimate relationships. Australian women experience comparatively higher rates of third‐ and fourth‐degree tears relative to countries of similar economic development. Aims: We aimed to conduct a comprehensive review of the literature, published over the past five years, to identify the best ways to prevent and manage third‐ and fourth‐degree perineal tears in Australian maternity centres. Materials and Methods: We searched the literature using the Cochrane Database of Systematic Reviews, EMBASE, MEDLINE, Maternity and Infant Care Database and Google Scholar for articles published since 2013 using key search terms. A review of reviews was undertaken given the extensive amount of literature on this topic. Results: Twenty‐six systematic reviews were identified. The most common risk factors reported in the literature for third‐ and fourth‐degree tears included primiparity, mother's ethnicity, large for gestational age infants and certain interventions used in labour and birth, such as instrumental deliveries. Preventive practices with varying degrees of effectiveness and often dependant on parity included: antenatal perineal massage, different maternal birthing positions, water births, warm compresses, protection of the perineum and episiotomy for instrumental births. Conclusions: Third‐ and fourth‐degree perineal tears are associated with immediate and long‐term implications for women and health systems. Evidence‐based approaches can reduce the number of women who sustain a severe perineal tear and alleviate the associated disease burden for those who do. [ABSTRACT FROM AUTHOR]

Objective: To compare clinical outcomes following induction of labour (IOL) using a balloon catheter and going home, versus prostaglandin (PG) as an inpatient.Design: Randomised controlled trial.Setting: Eight Australian maternity hospitals.Population: Women with uncomplicated term singleton pregnancies undergoing IOL for low-risk indications including post-term, advanced maternal age and 'social' reasons.Methods: Between September 2015 and October 2018, 347 women were randomised to a balloon outpatient group and 348 to a PG inpatient group. The PG group received Dinoprostone, either 2 mg gel or 10 mg controlled-release tape. The balloon group had a double-balloon catheter inserted and went home.Main Outcome Measures: The primary outcome was a composite neonatal measure comprising nursery admission, intubation/cardiac compressions, acidaemia, hypoxic ischaemic encephalopathy, seizure, infection, pulmonary hypertension, stillbirth or death. Clinical and process outcomes are reported.Results: There were no statistically significant differences in the primary outcome comparing balloon with PG (18.6% versus 25.8%; relative risk = 0.77, 95% CI 0.51-1.02; P = 0.070), cord arterial pH <7.10 (3.5% versus 9.2%; P = 0.072), nursery admissions (12.6% versus 15.5%; P = 0.379), neonatal antibiotic use (12.1% versus 17.6%; P = 0.103), or mode of birth. Nulliparous women in the balloon group had lower rates of the primary outcome (20.4% versus 31.0%;P = 0.032); Parous women were less likely to have an unassisted vaginal birth (77.6% versus 92.3%; P = 0.045).Conclusions: Balloon catheters may be a superior method of cervical priming for nulliparous women, whereas this may not be the case for parous women. It is feasible that nulliparous women go home after commencing balloon catheter IOL, and the likelihood of adverse outcomes is low.Tweetable Abstract: Multicentre trial shows outpatient induction using balloon catheter is safe and feasible for nulliparous women. [ABSTRACT FROM AUTHOR]

Understanding the mechanisms and psychosocial pathways potentially underlying the association between maternal childhood abuse exposure and poor child health and wellbeing is important to inform opportunities for support and intervention early in the period of becoming a parent. The aim of the study was to investigate whether adverse birth outcomes and psychosocial health issues (maternal depressive symptoms, exposure to intimate partner violence in the first postnatal year) are potential mechanisms underlying the association between maternal childhood abuse and children's emotional-behavioral functioning at 10 years. Data were drawn from 1,507 first-time mothers and their 10-year-old children participating in the Maternal Health Study, a prospective study of women's health during pregnancy and after birth. One in four women reported that they had experienced physical or sexual abuse in childhood. Children whose mothers had experienced either of these types of childhood abuse had significantly higher emotional-behavioral difficulties than children whose mothers had not. Psychosocial health pathways via maternal depressive symptoms and exposure of mothers to intimate partner violence in the first 12 months postpartum, but not adverse birth outcomes, mediated the association between maternal childhood abuse and children's emotional-behavioral difficulties. These findings underscore the need to support mothers who have experienced childhood abuse and psychosocial health issues, both as a means of promoting maternal health and mitigating the potential intergenerational risks for children's emotional and behavioral health. (PsycINFO Database Record (c) 2020 APA, all rights reserved). [ABSTRACT FROM AUTHOR]

Preeclampsia (PE) can suddenly disrupt a normal pregnancy experience. This project aimed to see how PE was experienced close to the time of birth, in a group of hospital patients. Women with PE who gave birth at The Royal Women's Hospital, Melbourne, Australia, from October 2010 to May 2012 were asked to complete a survey designed with consumer input. There was a 74% response rate. Regarding diagnosis, 90% experienced PE, 2.5% experienced eclampsia and 7.5% experienced HELLP. For 60% of women, their baby was born earlier than expected. Although 67.5% of women knew little about PE prior to pregnancy and diagnosis, 67.5% believed PE was serious or life threatening. Fifty-five percent were afraid that their baby might die. The women in the study identified the need to obtain more information about PE (97.5%), and 60% indicated that their PE experience would either delay or contribute to the decision to not undertake a future pregnancy. This project details that PE can have a substantial psychological effect on patients around the time of birth. Maternity caregivers can direct counselling to address the specific vulnerabilities raised in PE and thus improve the care of women with PE.Impact StatementWhat is already known on this subject? Qualitative research from New Zealand showed that women experiencing preeclampsia (PE) can have a number of psychological issues with their pregnancy experience, including feeling no longer in control of their pregnancy, dealing with an unexpected medicalised preterm birth, and feeling fear for themselves and their baby's life, even if no formal psychiatric issues are identified. A PE support group surveyed their own members and found that these psychological issues are present in most of their members who had PE.Whatthe results of this study add? This study was a survey of 40 women experiencing PE around the time of birth in a tertiary hospital in Melbourne, Australia, to see if these themes could be applied to a general hospital group. There was a 74% response rate. For 60% of women, the baby was born earlier than expected. Although most women knew little about PE prior to diagnosis, 67.5% believed PE was serious or life threatening at diagnosis. More than half (55%) were afraid their baby might die and 47.5% of women identified that separation from their baby impaired their ability to bond. Most women planned to obtain more information about PE (97.5%) and 50% indicated that their PE experience meant they would either delay or not undertake future pregnancy.Whatthe implicationsareof these findings for clinical practice and/or further clinical research? This study demonstrates the significance of psychological factors in the care of women with pre-eclampsia or eclampsia and offers a range of issues that the health care provider can use in discussions with women in the early postnatal period, in the inter-pregnancy interval and in subsequent pregnancies. Further research would ideally involve a large sample in a range of hospital settings (primary through tertiary) to further consider the prevalence and enduring nature of themes identified in the present study. [ABSTRACT FROM AUTHOR]

Australian School Age Care programmes are little researched childhood settings that are commonly understood as sites of leisure and play in between school and home. This article draws on recent research to consider the status of a seemingly non-playful activity, that of children's waiting in School Age Care. The poststructural framing in this article conceptualizes waiting as an activity that incorporates acts of emotional labour, play and identity construction. It prompts consideration of whether waiting is a site of play and should therefore be incorporated in programming practices in School Age Care and other play-based settings. [ABSTRACT FROM AUTHOR]

Background: Prolonged second stage of labour is known to be associated with higher caesarean section rates. However, the association between prolonged second stage of labour (PSSL) and adverse neonatal outcomes remains contradictory. The aim of this study was to assess the association between prolonged second stage of labour and obstetric and neonatal outcomes. Methods: This was a retrospective cohort study of women with term, singleton pregnancies at the Mater Mother's Hospital, Brisbane. Intrapartum, maternal and neonatal outcomes were assessed and stratified according to prolonged second stage of labour. Results: Of 48 352 women, 9.7% had PSSL. Women with PSSL were more likely to be nulliparous and have received oxytocin for augmentation of their labour (P < 0.001), less likely to have an epidural or have undergone induction of labour (P < 0.001). Women with PSSL were less likely to achieve a spontaneous vaginal delivery (adjusted odds ratio (aOR) 0.13, 95%CI 0.12–0.14, P < 0.001), more likely to undergo an instrumental delivery (aOR 3.93, 95%CI 3.62–4.25, P < 0.001) or emergency caesarean section (aOR 9.08, 95%CI 8.00–10.29, P < 0.001). PSSL was associated with shoulder dystocia (aOR 1.61, 95%CI 1.42–1.81, P < 0.001), and postpartum haemorrhage (aOR 1.37, 95%CI 1.16–1.60, P < 0.001). Univariate analysis demonstrated prolonged second stage of labour was associated with low five‐minute Apgar score, acidosis and neonatal intensive care admission. However, after adjusting for potential confounders only five‐minute Apgar scores ≤3 remained significantly increased (aOR 2.36, 95% CI 1.36–4.09, P = 0.002). Conclusion: PSSL is associated with increased operative birth and maternal morbidity. [ABSTRACT FROM AUTHOR]

Background: There is a paucity of information regarding perineal injuries in women who achieve vaginal birth after caesarean section (VBAC). Aims: To ascertain the rate of severe perineal injuries in women achieving VBAC at a major tertiary obstetric hospital, and to determine if vaginal birth is more likely to be associated with perineal injuries in women with one previous caesarean section compared with nulliparous women. Materials and Methods: A retrospective cohort study was undertaken of women with singleton pregnancies at term who delivered vaginally between 2013 and 2016. We compared nulliparous women with women who had undergone one previous caesarean section. The primary outcome analysed was the rate of third and fourth degree tears in each group. Secondary outcomes were major post‐partum haemorrhage and instrumental delivery. Results: Totals of 10 663 nulliparous women and 629 VBAC women achieved vaginal birth. Of the VBAC women, 418 achieved their first vaginal birth (first VBAC group). Overall, there was no significant difference in the rate of third and fourth degree tears in the VBAC group compared with the nulliparous group (6.0% vs 5.6%; P = 0.73). There was no significant increase in anal sphincter injuries in the first VBAC group compared with the nulliparous group (6.0% vs 7.4%; P = 0.25). Conclusion: No overall difference in the rate of severe perineal injuries between VBAC women and nulliparous women who achieve vaginal birth was observed in this study. [ABSTRACT FROM AUTHOR]

Background: Research supports water immersion for labour if women are healthy, with no obstetric or medical risk factors. Aims: To evaluate the obstetric and neonatal outcomes of women intending to use immersion in water for labour or birth. Methods: Retrospective audit of clinical outcomes for women intending to labour or birth in water conducted between July 2015 and June 2016, at a tertiary maternity hospital in Western Australia. Obstetric and neonatal data were collected from medical records. Multivariable logistic regression was utilised to investigate women who laboured in water stratified by those who birthed in water. Results: A total of 502 women intended to labour or birth in water; 199 (40%) did not and 303 (60%) did. The majority of women using water immersion (179 of 303; 59%) birthed in water. Multiparous women were more likely than primparous to birth in water (73% vs 46%; P < 0.001). Women who birthed in water were at increased odds of: a first stage labour ≤240 min (odds ratio (OR) 2.56, 95% CI 1.34–4.87, P = 0.004); a second stage ≤60 min (OR 3.53, 95% CI 1.82–6.84, P < 0.000); a third stage labour of 11–30 min (OR 2.15, 95% CI 1.23–3.78, P = 0.008); and having an intact perineum (OR 3.10, 95% CI 1.70–5.64, P < 0.000). Conclusion: Not all women who set out to labour and birth in water achieve their aim. There is a need for high‐quality collaborative research into this option of labour and birth, so women can make an informed choice around this birth option. [ABSTRACT FROM AUTHOR]

Background Clinicians hand position and advised pushing techniques may impact on rates of perineal injury. Objective To assess the association of four techniques used in management of second stage with risk of moderate and severe perineal injury. Design Retrospective cross-sectional study. Setting A metropolitan maternity hospital and a private maternity hospital in Brisbane, Australia. Participants Term women with singleton, cephalic presentation experiencing a non-operative vaginal birth from January 2011 to December 2016. Methods The research sites perinatal database recorded data on clinicians approach to instructing women during second stage and hand position at birth. Women were identified from matching the inclusion criteria (n = 26,393) then grouped based on combinations of hands-on, hand- poised, directed and undirected pushing. The associations with perineal injury were estimated using odds ratios obtained by multivariate analysis. Primary outcomes were the risk of moderate and severe perineal injury. The significance was set at 0.001. Results In Nulliparous women there was no difference in the risk of moderate or severe perineal injury between the different techniques. In multiparous women the use of a hands-on/directed approach was associated with a significant increase in the risk of moderate (AOR 1.18, 95% CI 1.10–1.27, p < 0.001) and severe perineal injury (AOR 1.50, 95% CI 1.20–1.88, p < 0.001) compared to hands-poised/undirected. Conclusions A hands poised/undirected approach could be utilised in strategies for the prevention of moderate and severe perineal injury. [ABSTRACT FROM AUTHOR]

Background: There is emerging evidence that caesarean section at full dilatation is associated with an increased risk of subsequent spontaneous preterm birth. Aim: To investigate the association between caesarean section at full dilatation and spontaneous preterm birth in subsequent pregnancies. Materials and methods: This was a retrospective cohort study of women who had two consecutive births at Royal Prince Alfred Hospital, 1989–2015. Our main comparison group was women who had emergency caesarean sections during the first stage of labour. Secondary comparison groups were women who had elective caesarean sections, instrumental deliveries and unassisted vaginal deliveries. The primary outcome was spontaneous preterm birth (<37 weeks gestation) in a subsequent pregnancy. Results: There were 2672 women who had an emergency caesarean section, with 2142 (80%) performed during the first stage of labour and 533 (20%) at full dilatation. The rates of spontaneous preterm birth in a subsequent pregnancy were 1.7% and 3.8%, respectively (odds ratio 2.2 (95%CI 1.3–3.8), P = 0.003). The hazard ratio for spontaneous onset of labour at any given gestation from 20 weeks until full term was 1.4 (95%CI 1.2–1.6) and did not change after adjusting for maternal age and body mass index. Conclusion: There is a significantly higher rate of subsequent spontaneous preterm birth in women who had a caesarean section at full dilatation compared with women who had a caesarean section during the first stage of labour. Awareness of this as a risk factor may warrant referral to a high‐risk obstetric or preterm birth clinic. [ABSTRACT FROM AUTHOR]

Backgound Partographs are used in many labour settings to provide a pictorial overview of a woman’s cervical dilation pattern in the first stage of labor and to alert clinicians to slow progress possibly requiring intervention. Recent reviews called for large trials to establish the efficacy of partographs to improve birth outcomes whilst highlighting issues of clinician compliance with use. Previous studies have also reported issues with participant recruitment related to concerns regarding the possibility of a longer labour. Objectives We sought to compare a standard partograph with an action line, to a newly designed partograph with a stepped line, to determine the feasibility of recruitment to a larger clinical trial. Methods A pragmatic, single-blind randomised trial wherein low-risk, nulliparous women in spontaneous labour at term were randomized to an action-line or stepped-line partograph. First stage labour management was guided by the allocated partograph. Primary outcomes included the proportion of eligible women recruited, reasons for failed recruitment and compliance with partograph use. Secondary outcomes included rates of intervention, mode of birth, maternal and neonatal outcomes. Results Of the 384 potentially eligible participants, 38% (149/384) were approached. Of these 77% (116/149) consented, with 85% (99/116) randomized, only nine women approached (6%) declined to participate. A further 9% (14/149) who were consented antenatally were not eligible at onset of labor and 7% (10/149) of women approached in the birth suite but did not meet the inclusion criteria. Compliance with partograph completion was 65% (action) versus 84% (dystocia line). Conclusions for Practice Participant recruitment to a larger randomized controlled trial comparing new labour management guidelines to standard care is feasible. Effective strategies to improve partograph completion compliance would be required to maintain trial fidelity. [ABSTRACT FROM AUTHOR]

Introduction: Many of the risk factors for perineal trauma are modifiable, and midwives are in an ideal position to mitigate such risks. To date, no investigation using a midwifery-specific decision-making tool has sought to determine how midwives make decisions within a midwifery philosophy/context or identify the factors that may contribute to that decision making about perineal management. We sought to apply such a tool to midwives’ narratives and explore their clinical reasoning and midwifery practice when managing a woman’s perineum in labor. Methods: A qualitative interview-based study with practicing midwives in one regional Australian maternity unit was conducted. The decision-making matrix specified by a psychometrically robust and validated measure of clinical decision making and midwifery practice-guided analysis. Results: Effective clinical decision making in response to perineal trauma is contingent on a heuristic and individualized “working hypothesis” that combines distinct elements of an optimal clinical decision-making process. Midwives’ narratives highlighted their ability to engage in some form of clinical reasoning. Some elements of midwifery practice was lacking within several midwives’ narratives, thus resulting in them abdicating their professional role. Conclusion: The manner and processes by which midwives engage effectively with perineal management are complex. However, a significant influence on this process appears to be recollections from original training in perineal management, which appears to be largely rote and taught by example. We recommend balance between practical experience and synthesis with current evidence within a midwifery philosophy to optimize perineal care and risk modification. [ABSTRACT FROM AUTHOR]

Objective: To determine the impact of a multidisciplinary fetal surveillance education program (FSEP) on term neonatal outcomes.Methods: A retrospective cohort study of term neonatal outcomes before (1998-2004) and after (2005-2010) introduction of a FSEP. Clinical data was collected for all term infants admitted to a neonatal intensive care unit (NICU) in Australia between 1998 and 2010. Infants with congenital abnormalities were excluded. Neonatal mortality and severe neonatal morbidity (admission to a NICU, respiratory support, hypoxic encephalopathy) were compared before and after the FSEP was introduced. The rates of operative delivery during this time were assessed.Results: There were 3 512 596 live term births between 1998 and 2010. The intrapartum hypoxic death rate at term decreased from 2.02 to 1.07 per 10 000 total births. More neonates were admitted to NICU after 2005 (10.6 versus 14.6 per 10 000 live births), however fewer babies admitted to the neonatal unit had Apgar scores < 5 at five minutes (55.1-45.5%, RR 0.82, 95% CI 0.7-0.87); and rates of hypoxic ischemic encephalopathy fell from 36% to 30% (RR 0.83, 95% CI 0.76-0.90). There was no increase in rates of emergency in labour caesarean sections (11.7% pre versus 11.1% post, RR 0.95, 95% CI 0.95-0.96).Conclusions: Introduction of a national FSEP was associated with increased neonatal admissions but a reduction in intrapartum hypoxia, without increasing emergency caesarean section rates. [ABSTRACT FROM AUTHOR]

Background Postpartum haemorrhage ( PPH) rates are increasing worldwide. The rate is particularly high in women undergoing an induced or augmented labour. In response to this, we altered our hospital's protocol for the management of the third stage of labour to recommend Syntometrine, in preference to oxytocin alone, for women being induced or augmented. We set out to assess the impact of the protocol change on the PPH rate. Materials and methods A random sample of 1200 women who had a singleton, term vaginal birth before and after the protocol change was taken. Exclusion criteria were then applied to match PPH risk status. Using a quasi-experimental study design, PPH rates were compared between women who had received oxytocin or Syntometrine for third stage management. Results Five hundred and forty-nine women received oxytocin prior to the protocol change and were compared with 333 women who received Syntometrine after protocol change. There was no difference in the PPH rate with respect to uterotonic used ( P = 0.9). There was no evidence of an interaction between labour type, third stage uterotonic and PPH ( P = 0.4). PPH rates were lowest for women who laboured spontaneously and received Syntometrine (19% oxytocin, 14% Syntometrine). The PPH rate was unchanged by uterotonic in women whose labour was augmented (34% for both). PPH was more common in women being induced who received Syntometrine (22% oxytocin, 27% Syntometrine). None of these differences were statistically significant. Conclusion Compared to oxytocin, Syntometrine did not reduce the rate of PPH in women with augmented or induced labour. Other approaches to reducing PPH rates are required. [ABSTRACT FROM AUTHOR]

Aims To report on the opinions and reported practices of Australian obstetricians and general practice ( GP) obstetricians, in the definition and management of spontaneous first stage of labour, in low-risk nulliparous women. Materials and methods Cross-sectional survey sent electronically to all Australian Specialist obstetricians ( FRANZCOG) and Diplomates. Respondents answered questions regarding care of nulliparous women in spontaneous labour at term across three domains: (i) practitioners' characteristics; (ii) current practice; (iii) opinion regarding joint statement by ACOG/ SMFM (Society of Maternal Fetal Medicine) 'Safe prevention of primary caesarean section'. Results The dataset included responses from 664 participants, representing 29% of Specialists and 11% of Diplomates. Responses varied in the criteria used to define normal labour, and the diagnosis and management of prolonged labour. Clinicians with more post-qualification experience considered the minimal acceptable progress to be faster than those with fewer years of experience ( P = 0.02). Clinicians working in higher acuity hospitals were more likely to augment labour for longer prior to recommending a caesarean section for active phase arrest, compared to those in lower acuity hospitals ( P = 0.025). The majority of respondents (58.2%) already based their practice on the ACOG/ SMFM 'Safe prevention of primary caesarean section' statement, or would now consider changing their practice. Conclusion There is a lack of consensus among Australian obstetricians and GP obstetricians regarding definition of normal progress in first stage of labour and how to manage abnormal progress; however, many are open to new recommendations for practice. [ABSTRACT FROM AUTHOR]

Background: The majority of women experience pain during labour and childbirth, however not all women experience it in the same way. In order to develop a more complete understanding of labour pain, this study aimed to examine women's experiences within the perspective of modern pain science. A more complete understanding of this phenomenon can then guide the development of interventions to enhance women's experiences and potentially reduce their need for pharmacological intervention.Methods: A qualitative study was conducted using phenomenology as the theoretical framework. Data were collected from 21 nulliparous women, birthing at one of two large maternity services, through face-to-face interviews and written questionnaires. Data were analysed using an Interpretative Phenomenological Analysis approach.Results: The data from this study suggest that a determining factor of a woman's experience of pain during labour is the meaning she ascribes to it. When women interpret the pain as productive and purposeful, it is associated with positive cognitions and emotions, and they are more likely to feel they can cope. Alternatively, when women interpret the pain as threatening, it is associated with negative cognitions and emotions and they tend to feel they need help from external methods of pain control. The social environment seems particularly important in shaping a woman's pain experience by influencing her interpretation of the context of the pain, and in doing so can change its meaning. The context and social environment are dynamic and can also change throughout labour.Conclusion: A determining factor in a woman's experience of pain during labour is its perceived meaning which can then influence how the woman responds to the pain. The meaning of the pain is shaped by the social environment and other contextual factors within which it is experienced. Focussed promotion of labour pain as a productive and purposeful pain and efforts to empower women to utilise their inner capacity to cope, as well as careful attention to women's cognitions and the social environment around them may improve women's experiences of labour pain and decrease their need for pain interventions. [ABSTRACT FROM AUTHOR]

Background: Maternal ethnicity is a recognized risk factor for stillbirth, such that South Asian women have higher rates than their Caucasian counterparts. However, whether maternal ethnicity is a risk factor for intrapartum outcomes is less clear. The aim of this study is to explore associations between maternal country of birth, operative vaginal delivery and emergency cesarean section, and to identify possible mechanisms underlying any such associations.Methods: We performed a retrospective cohort study of singleton term births among South Asian, South East/East Asian and Australian/New Zealand born women at an Australian tertiary hospital in 2009-2013. The association between maternal country of birth, operative vaginal birth and emergency cesarean was assessed using multivariate logistic regression.Results: Of the 31,932 births, 54% (17,149) were to Australian/New Zealand-born women, 25% (7874) to South Asian, and 22% (6879) to South East/East Asian born women. Compared to Australian/New Zealand women, South Asian and South East/East Asian women had an increased rate of both operative vaginal birth (OR 1.43 [1.30-1.57] and 1.22 [1.11-1.35] respectively, p < 0.001 for both) and emergency cesarean section (OR 1.67 [1.53-1.82] and 1.16 [1.04-1.26] respectively, p < 0.001 and p = 0.007 respectively). While prolonged labor was the predominant reason for cesarean section among Australian/New Zealand and South East/East Asian women, fetal compromise accounted for the majority of operative births in South Asian women.Conclusion: South Asian and South East/East Asian women experience higher rates of both operative vaginal birth and cesarean section in comparison to Australian/New Zealand women, independent of other risk factors for intrapartum interventions. [ABSTRACT FROM AUTHOR]

Objective: To describe the outcomes of a public hospital maternity unit in rural New South Wales (NSW) following the adaptation of the service from an obstetrician and general practitioner-obstetrician (GPO)-led birthing service to a low-risk midwifery group practice (MGP) model of care with a planned caesarean section service (PCS). Design: A retrospective descriptive study using quantitative methodology. Setting: Maternity unit in a small public hospital in rural New South Wales, Australia. Participants: Data were extracted from the wardbased birth register for 1172 births at the service between July 2007 and June 2012. Main outcome measures: Birth numbers, maternal characteristics, labour, birthing and neonatal outcomes. Results: There were 750 births over 29 months in GPO and 277 and 145 births over 31 months in MGP and PCS, respectively, totalling 422 births following the change in model of care. The GPO had 553 (73.7%) vaginal births and 197 (26.3%) caesarean section (CS) births (139 planned and 58 unplanned). There were almost universal normal vaginal births in MGP (>99% or 276). For normal vaginal births, more women in MGP had no analgesia (45.3% versus 25.1%) or non-invasive analgesia (47.9% versus 38.6%) and episiotomy was less common in MGP than GPO (1.9% versus 3.4%). Neonatal outcomes were similar for both groups with no difference between Apgar scores at 5 min, neonatal resuscitations or transfer to high-level special care nurseries. Conclusion: This study demonstrates how a rural maternity service maintained quality care outcomes for low-risk women following the adaptation from a GPO to an MGP service. [ABSTRACT FROM AUTHOR]

PURPOSE: This study aimed to describe and compare the attitudes and practices of midwives and obstetric doctors in a tertiary setting regarding water immersion for labor and birth and to identify strategies for improving bath usage in the facility. DESIGN: A questionnaire consisting of 47 multiple choice and 2 open-ended questions was distributed to midwives and obstetric doctors providing labor care in the facility. FINDINGS: Obstetric doctors were unsupportive. Birth suite midwives, despite assigning value to it, rarely facilitated water immersion. Only continuity midwives routinely facilitated water immersion. The main identified strategies for increasing bath usage in labor were staff training and support, antenatal education, and increased access to continuity of care. CONCLUSION: Providing bath access and supporting guidelines is not sufficient to increase water immersion for labor and birth in a tertiary setting. Additional strategies are needed to incorporate this practice into standard care in the birth suite. [ABSTRACT FROM AUTHOR]

The article presents abstracts on medical topics involving adenomyosis, urinary incontinence and post-menopausal bleeding treatment.

Study Question: What are the psychosocial determinants of women's intentions to delay childbearing until after 35 years?Summary Answer: Attitudes, pressure from important others, perceived self-confidence and anticipated regret all influence the decision-making process of women aged 18-30 years to defer their attempts to conceive their first child until 35+ years.What Is Known Already: Research has consistently demonstrated that, for many women, the decision to delay childbearing can lead to 'unintentional childlessness' due to a failure to consider the impact of age-related fertility decline. A large body of literature has also found strong links between age-related involuntary infertility and negative psychological impacts, including an increased prevalence of anxiety, depression, guilt, stigma and poor mental health.Study Design, Size, Duration: The study initially conducted focus groups designed to ascertain important beliefs informing participants' intentions to delay childbearing. A subsequent larger-scale quantitative questionnaire followed.Participants/materials, Setting, Methods: Participants (n = 358) were female, aged between 18 and 30 years, lived in Australia, identified as being open to the idea of having children, were heterosexual, had not already had children, were not already pregnant, and had not received a diagnosis of medical infertility prior to participating.Main Results and the Role Of Chance: Hierarchical multiple regression analyses showed strong support for psychosocial predictors of attitude, pressure from others and perceived self-confidence as predictors of women's intentions to delay childbearing, accounting for 59% of total variance. The extended model that included anticipated regret, accounted for a significant additional 4.4% variance in intention to delay childbearing past the age of 35 years.Limitations, Reasons For Caution: Proportionally more participants were younger, Caucasian, and were university students, thus limiting the generalizability of results to the wider Australian community. Future research in this domain is recommended to adopt a prospective design and incorporate a measure of behaviour to investigate the link between intentions to delay childbearing and future fertility behaviour.Wider Implications Of the Findings: This research augments our understanding of the decision-making process and key beliefs underlying the decision to delay childbearing. Further efforts are needed to advise young women to investigate their fertility options during the peak of their reproductive years in order to prevent negative psychological consequences associated with unintentional childlessness.Study Funding/competing Interests: None. [ABSTRACT FROM AUTHOR]