Use of Routine Interventions in Vaginal Labor and Birth: Findings from the Maternity Experiences Survey

Ottawa Hospital Research Institute at the University of Ottawa, Ontario, Canada.
Birth (Impact Factor: 1.26). 04/2009; 36(1):13-25. DOI: 10.1111/j.1523-536X.2008.00291.x
Source: PubMed


Intervention rates in maternity practices vary considerably across Canadian provinces and territories. The objective of this study was to describe the use of routine interventions and practices in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Rates of interventions and practices are considered in the light of current evidence and both Canadian and international recommendations.
A sample of 8,244 estimated eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer-assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old (9-14 mo in the territories). Completed responses were obtained from 6,421 women (78%).
Women frequently reported electronic fetal monitoring, a health care practitioner starting or speeding up their labor (or trying to do so), epidural anesthesia, episiotomy, and a supine position for birth. Some women also reported pubic or perineal shaves, enemas, and pushing on the top of their abdomen.
Several practices and interventions were commonly reported in labor and birth in Canada, although evidence and Canadian and international guidelines recommend against their routine use. Practices not recommended for use at all, such as shaving, were also reported.

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    • "Reviews, Pubmed and Google Scholar. Some studies found had examined the routine policies and practices of normal birth worldwide (Maimbolwa et al., 1997; Festin et al., 2003; Turan et al., 2006; Harris et al., 2007; Danichevski et al., 2008; The SEA-ORCHID study group, 2008; Chalmers et al., 2009). In the Arab world, studies of hospital policies and practices for normal childbirth have begun to assess whether they are within EBP (Khayat and Campbell, 2000; Abdulsalam et al., 2004; Khalil et al., 2005; Wick et al., 2005; Hassan-Bitar and Wick, 2007; Sweidan et al., 2008; Khresheh et al., 2009). "
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    ABSTRACT: Objectives To explore reported hospital policies and practices during normal childbirth in maternity wards in Jeddah, Saudi Arabia, to assess and verify whether these practices are evidence-based. Design Quantitative design, in the form of a descriptive questionnaire, based on a tool extracted from the literature. Setting Nine government hospitals in Jeddah, Saudi Arabia. These hospitals have varied ownership, including Ministry of Health (MOH), military, teaching and other government hospitals. Participants Key individuals responsible for the day-to-day running of the maternity ward. Measurements Nine interviews using descriptive structured questionnaire were conducted. Data were analysed using SPSS for Windows (version 16.0). Findings The surveyed hospitals were found to be well equipped to deal with obstetric emergencies, and many follow evidence-based procedures. On average, the Caesarean section rate was found to be 22.4%, but with considerable variances between hospitals. Some unnecessary procedures that are known to be ineffective or harmful and that are not recommended for routine use, including pubic shaving, enemas, episiotomy, electronic foetal monitoring (EFM) and intravenous (IV) infusion, were found to be frequently practiced. Only 22% of the hospitals sampled reported allowing a companion to attend labour and delivery. Key Conclusions Many aspects of recommended EBP were used in the hospitals studied. However, the results of this study clearly indicate that there is wide variation between hospitals in Jeddah, Saudi Arabia in some obstetric practices. Furthermore, the findings suggest that some practices at these hospitals are not supported by evidence as being beneficial for mothers or babies and are positively discouraged under international guidelines. Implications for practice This study has specific implications for obstetricians, midwives and nurses working in maternity Units. It gives an overview of current hospital policies and practices during normal childbirth. It is likely to contribute to improving the health and well-being of women, and have implications for service provision. It could also help in the development of technical information for policy-makers, and health care professionals for normal childbirth care.
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    • "We found considerable variation in rates of obstetric intervention for induction of labour, operative vaginal delivery and epidural anaesthesia use across regions in the Republic of Ireland. Regional differences in obstetrical intervention have been reported within several large countries, including the United Kingdom [18], France [19], Canada [20] and the United States [21]. With approximately four million residents, the Republic of Ireland is considerably smaller than these countries; yet, clear patterns in regional variation persisted within this small, relatively homogenous population. "
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    ABSTRACT: Background Obstetrical interventions during childbirth vary widely across European and North American countries. Regional differences in intrapartum care may reflect an inpatient-based, clinician-oriented, interventional practice style. Methods Using nationally representative hospital discharge data, a retrospective cohort study was conducted to explore regional variation in obstetric intervention across four major regions (Dublin Mid Leinster; Dublin Northeast; South; West) within the Republic of Ireland. Specific focus was given to rates of induction of labour, caesarean delivery, epidural anaesthesia, blood transfusion, hysterectomy and episiotomy. Logistic regression analyses were performed to assess the association between geographical region and interventions while adjusting for patient case-mix. Results 323,588 deliveries were examined. The incidence of interventions varied significantly across regions; the greatest disparities were observed for rates of induction of labour and caesarean delivery. Women in the South had nearly two-fold odds of having prostaglandins (adjusted OR: 1.75, 95% CI 1.68-1.82), whereas women in the West had 1.85 odds (95% CI 1.77-1.93) of artificial rupture of membrane. Women delivering in the Dublin Northeast, South and West regions had more than two-fold increased odds of elective caesarean delivery relative to women delivering in the Dublin Mid Leinster region. The Dublin Northeast region had the highest odds of emergency caesarean delivery (adjusted OR: 1.36; 95% CI: 1.31-1.40). Conclusions Substantial regional variation in intrapartum care was observed within this small, relatively homogeneous population. The association of intervention use with region illustrates the need to encourage uptake of scientific based practice guidelines to better inform clinical judgment.
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