Hydrotherapy, is also called as aquatic or water therapy, and its benefits include improved muscle strength and endurance, increased joint range of motion and enhanced cardio respiratory functioning and reduced cardio metabolic risk profile. Utilization of hydrotherapy during labor and child birth is increasing globally among the educated public. Despite its exclusive benefits, data on its safety and outcomes are still lacking especially in India. Hence it is the need of the hour for the clinicians to discuss the potential benefits and safety of water birth and utilize it particularly for women with uncomplicated pregnancy who prefer physiological childbirth and wish to avoid the use of pharmacological pain relief methods. To assess and validate about the maternal and neonatal outcomes of hydrobirthing from a series of parturients who volunteered for the utilization of hydrotherapy during labor and childbirth.This case series consist of 26 out of 33 pregnant women who opted for hydrobirthing between 1 December 2015 and 31 April 2019 at a tertiary care hospital with NABH accreditation. Booked cases with uncomplicated pregnancy and who were on regular antenatal check up, with gestational age >37 <42 weeks and were included in the study after obtaining the informed consent. The dataset was limited to vaginal delivery following spontaneous labor and included pre-specified outcomes such as labor pain, perineal tear , episiotomy, post partum hemorrhage (PPH), temperature after delivery and apgar scores of the new born to evaluate the maternal and fetal outcomes following hydrotherapy and the results were discussed. The present case series onhydro birthing has demonstrated that it is one among the safe natural mode of labor without any serious maternal and neonatal complications. Further study on a large scale with evaluation of long-term outcomes would help to generalise the observed outcomes of the present study.
Objective: Assessment of the cost-effectiveness of strategies to scale
up cesarean sections (CS) Design: Cost-effectiveness analysis to
evaluate three different strategies to scale up CS Setting: Rural and
urban areas of India with varying rates of CS and access to
comprehensive emergency obstetric care (CEmOC) Population: Women of
reproductive age in India Methods: Three strategies with different
access to CEmOC and CS rates were evaluated: (A) India’s national
average (50.2% access, 17.2% CS rate), (B) rural areas (47.2% access,
12.8% CS rate) and (C) urban areas (55.7% access, 28.2% CS rate). We
performed a first-order Monte Carlo simulation using a 1-year cycle time
and 35-year time horizon. All inputs were derived from literature. A
societal perspective was utilized with a willingness-to-pay threshold of
$1,940. Main outcome measures: Costs and quality-adjusted life years
were used to calculate the incremental cost-effectiveness ratio (ICER).
Maternal and neonatal outcomes were calculated. Results: Strategy C with
the highest access to CEmOC despite the highest CS rate was
cost-effective, with an ICER of 354.90. Two-way sensitivity analysis
demonstrated this was driven by increased access to CEmOC. The highest
CS rate strategy had the highest number of previa, accreta and ICU
admissions. The strategy with the lowest access to CEmOC had the highest
number of fistulae, uterine rupture, and stillbirths. Conclusions:
Morbidity and mortality result from lack of access to CEmOC and overuse
of CS. While interventions are needed to address both, increasing access
to surgical obstetric care drives cost-effectiveness and is paramount to
optimize outcomes.
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