Strategies for reducing maternal mortality: getting on with what works

Advances in medical, biomedical and health services research have reduced the level of uncertainty in clinical practice. Clinical practice guidelines (CPGs) complement this progress by establishing standards of care backed by strong scientific evidence. CPGs are statements that include recommendations intended to optimize patient care. These statements are informed by a systematic review of evidence and an assessment of the benefits and costs of alternative care options. Clinical Practice Guidelines We Can Trust examines the current state of clinical practice guidelines and how they can be improved to enhance healthcare quality and patient outcomes. Clinical practice guidelines now are ubiquitous in our healthcare system. The Guidelines International Network (GIN) database currently lists more than 3,700 guidelines from 39 countries. Developing guidelines presents a number of challenges including lack of transparent methodological practices, difficulty reconciling conflicting guidelines, and conflicts of interest. Clinical Practice Guidelines We Can Trust explores questions surrounding the quality of CPG development processes and the establishment of standards. It proposes eight standards for developing trustworthy clinical practice guidelines emphasizing transparency; management of conflict of interest; systematic review--guideline development intersection; establishing evidence foundations for and rating strength of guideline recommendations; articulation of recommendations; external review; and updating. Clinical Practice Guidelines We Can Trust shows how clinical practice guidelines can enhance clinician and patient decision-making by translating complex scientific research findings into recommendations for clinical practice that are relevant to the individual patient encounter, instead of implementing a one size fits all approach to patient care. This book contains information directly related to the work of the Agency for Healthcare Research and Quality (AHRQ), as well as various Congressional staff and policymakers. It is a vital resource for medical specialty societies, disease advocacy groups, health professionals, private and international organizations that develop or use clinical practice guidelines, consumers, clinicians, and payers.

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Clinical Practice Guidelines We Can Trust

Historically women have been attended and supported by other women during labour and birth However in many countries, as more women are giving birth in hospital rather than at home, continuous support during labour has become the exception rather than the norm This may contribute to the dehumanisation of women's childbirth experiences Modern obstetric care frequently subjects women to institutional routines, which may have adverse effects on the progress of labour Supportive care during labour may involve emotional support, comfort measures, information and advocacy These may enhance physiologic labour processes as well as women's feelings of control and competence, and thus reduce the need for obstetric intervention The review of studies included 23 trials (22 providing data), from 16 countries, involving more than 15,000 women in a wide range of settings and circumstances The continuous support was provided either by hospital staff (such as nurses or midwives), women who were not hospital employees and had no personal relationship to the labouring woman (such as doulas or women who were provided with a modest amount of guidance), or by companions of the woman's choice from her social network (such as her husband, partner, mother, or friend) Women who received continuous labour support were more likely to give birth 'spontaneously', ie give birth with neither caesarean nor vacuum nor forceps In addition, women were less likely to use pain medications, were more likely to be satisfied, and had slightly shorter labours Their babies were less likely to have low five-minute Apgar scores No adverse effects were identified We conclude that all women should have continuous support during labour Continuous support from a person who is present solely to provide support, is not a member of the woman's social network, is experienced in providing labour support, and has at least a modest amount of training, appears to be most beneficial In comparison with having no companion during labour, support from a chosen family member or friend appears to increase women's satisfaction with their childbearing experience

Continuous support for women during childbirth.

Safe prevention of the primary cesarean delivery

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(14)60792-3.pdf

Can available interventions end preventable deaths in mothers, newborn babies, and stillbirths, and at what cost?

Background: Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour.



Objectives:  Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour.



Search strategy:  We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003).



Selection criteria:  All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.



Data collection and analysis:  Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.



Main results:  Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available.



Reviewers’ conclusions:  All women should have support throughout labour and birth.



Citation:  Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. •••The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X). The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons, Ltd.

Continuous Support for Women During Childbirth

With permission from Childbirth Connection, the concise version of the Listening to Mothers II “Survey Methodology” is reprinted here. Harris Interactive® conducted Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences on behalf of Childbirth Connection. The survey consisted of 1,373 online interviews and 200 telephone interviews with women who had given birth in U.S. hospitals in 2005, with weighting of data to reflect the target population. Interviews were conducted from January 20 through February 21, 2006. The methods used to conduct the survey and analyze the data collected are described.

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Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.

Continuous support for women during childbirth (Review)

To understand the experiences and views of childbearing women in the United States and trends over time, Childbirth Connection carried out the third national Listening to Mothers survey among 2,400 women who gave birth in U.S. hospitals to a single baby from mid-2011 to mid-2012 and could participate in English. Harris Interactive conducted the survey using a validated methodology that includes data weighting to ensure that results closely reflect the target population. Results of the initial survey describe experiences from before pregnancy through the early postpartum period, and were reported in Listening to Mothers III: Pregnancy and Birth. A follow-up survey directed to the same participants explored postpartum experiences, attitudes about maternity care, and some additional pregnancy and birth items.

Major Survey Findings of Listening to Mothers(SM) III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women's Childbearing Experiences.

Carol Sakala

Papers

Continuous support for women during childbirth.

Continuous Support for Women During Childbirth

Listening to Mothers II: Report of the Second National U.S. Survey of Women's Childbearing Experiences: Conducted January-February 2006 for Childbirth Connection by Harris Interactive(R) in partnership with Lamaze International.

Continuous support for women during childbirth (Review)

Major Survey Findings of Listening to Mothers(SM) III: Pregnancy and Birth: Report of the Third National U.S. Survey of Women's Childbearing Experiences.