Objective: Postpartum haemorrhage (PPH) complicates approximately 5% of births worldwide and is a leading direct cause of maternal death. Rates of PPH are increasing in many developed countries, particularly PPH related to uterine atony. There is a lack of published up-to-date information about healthcare resource use associated with management of PPH following vaginal birth. The objective of this study was to describe healthcare resource use for the management of minor PPH (blood loss 500-1,000 ml) and major PPH (blood loss > 1,000 ml) compared to uncomplicated birth (no PPH) following hospital vaginal birth in France, Italy, the Netherlands, and the UK. Study design: In-depth interviews with two midwives from each participating country were conducted to establish differences in resource use for the management of minor PPH, major PPH, and uncomplicated birth. A web-survey was then developed and one obstetrician per participating country reviewed the survey. In total, 100 midwives (25 per country) completed the survey. Results were discussed at a multiprofessional consensus meeting of midwives and obstetricians/gynaecologists (n = 6). Results and conclusions: Midwives participating in the survey estimated that 80% of women receive Active Management of the Third Stage of Labour (AMTSL) and 93% of participants specified that uterotonics would routinely be used during AMTSL. Most participants (84%) reported that blood loss is routinely measured in their hospital, using a combination of methods. PPH is associated with increased healthcare resource use, including administration of additional uterotonics and use of additional medical interventions, such as urinary catheter, intravenous fluids, and possible requirement for surgery. The number of nurses, obstetricians/gynaecologists, and anaesthetists involved in the management of PPH increases with the occurrence and severity of PPH, as well as the proportion of healthcare personnel providing continuous care. Women may spend an additional 24 h in hospital following major PPH compared to uncomplicated birth. The results of this study highlight the burden of PPH management on healthcare resources. To reduce costs associated with PPH, prevention is the most effective strategy and can be enhanced with the use of an effective uterotonic as part of the active management of the third stage of labour.
In Australia a vibrant tradition of participatory and often politically motivated performance work developed under the term ‘community arts and cultural development’ across the 1980s, 1990s and early 2000s. In this body of practice, considerations of ethics are articulated through process, practices and representation rather than content. Though effective, community arts as it developed in Australia is often time, resource and emotionally intensive for artists, community participants and audiences. In recent years, retraction of funding, as well as shifts in practice towards live art, performance art and relational aesthetics have reduced the resources available for these once prominent practices. Practitioners are confronting challenges and needing to develop new ways of working in an operating environment where long-term consultation is not necessarily possible or preferred by stakeholders. In this article, we reflect on the current state of play for practitioners seeking to develop ethical dramaturgy in performance works that collaborate with communities to tell life stories or represent participants’ lived experiences in Australia. Through examples from our own practice, as practice-led researchers, we consider how work in this sector is under strain and experiencing scarcity, precarity and an increasing lack of access to institutional resources that have historically enabled ethically rigorous dramaturgical practices. We aim, through this process, to rediscover and rearticulate an ethical dramaturgy for deployment in the Australian environment as it exists today.
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