The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden

Edqvist, Malin; Dahlen, Hannah; Häggsgård, Cecilia; Tern, Helena; Ängeby, Karin; Teleman, Pia; Ajne, Gunilla; Rubertsson, Christine

doi:10.1016/s0140-6736(22)00188-x

Cited by 16 publications

(23 citation statements)

References 22 publications

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“…When a staffing model has already taken these components of care into account there is greater resilience should an emergency occur. Very recently, a formal trial has provided evidence that the presence of a second midwife in the delivery room can result in a clinically important reduction in perineal and sphincter injury during childbirth ( 11 ).…”

Section: Introductionmentioning

confidence: 99%

Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator

Stones

Nair²

2023

Front. Glob. Womens Health

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BackgroundThe lack of usable indicators and benchmarks for staffing of maternity units in health facilities has constrained planning and effective program implementation for emergency obstetric and newborn care (EmONC) globally.ObjectivesTo identify potential indicator(s) and benchmarks for EmONC facility staffing that might be applicable in low resource settings, we undertook a scoping review before proceeding to develop a proposed set of indicators.Eligibility criteriaPopulation: women attending health facilities for care around the time of delivery and their newborns. Concept: reports of mandated norms or actual staffing levels in health facilities.Contextstudies conducted in healthcare facilities of any type that undertake delivery and newborn care and those from any geographic setting in both public and private sector facilities.Sources of evidence and chartingSearches were limited to material published since 2000 in English or French, using Pubmed and a purposive search of national Ministry of Health, non-governmental organization and UN agency websites for relevant documents. A template for data extraction was designed.ResultsData extraction was undertaken from 59 papers and reports including 29 descriptive journal articles, 17 national Ministry of Health documents, 5 Health Care Professional Association (HCPA) documents, two each of journal policy recommendation and comparative studies, one UN Agency document and 3 systematic reviews. Calculation or modelling of staffing ratios was based on delivery, admission or inpatient numbers in 34 reports, with 15 using facility designation as the basis for staffing norms. Other ratios were based on bed numbers or population metrics.ConclusionsTaken together, the findings point to a need for staffing norms for delivery and newborn care that reflect numbers and competencies of staff physically present on each shift. A Core indicator is proposed, “Monthly mean delivery unit staffing ratio” calculated as number of annual births/365/monthly average shift staff census.

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Section: Introductionmentioning

confidence: 99%

Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator

Stones

Nair²

2023

Front. Glob. Womens Health

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“…Five labor wards had accepted to participate in a M-RCT, four University teaching hospitals and one County hospital. The study is described elsewhere 19 . All midwives and nurse assistants on these labor wards who attend births were scheduled to participate in a training session before the start of the M-RCT.…”

Section: Methodsmentioning

confidence: 99%

“…This procedure involves two midwives attending the woman during the second stage of labor in spontaneous vaginal births. This practice can be viewed as a complex health intervention and are evaluated in a multicenter randomized controlled trial (M-RCT) 19 . Professions involved in the trial are midwives assisting women giving birth spontaneously, together with nurse assistants who support the midwives and the women.…”

Section: Introductionmentioning

confidence: 99%

Self-compassion and professional quality of life among midwives and nurse assistants: A cross-sectional study

Ängeby¹,

Rubertsson²,

Hildingsson³

et al. 2022

Eur J Midwifery

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INTRODUCTION Self-compassion and satisfaction derived from helping others is part of healthcare providers’ professional quality of life. The aim of this study was to explore and psychometrically test two instruments measuring self-compassion and professional quality of life among midwives and nurse assistants. METHODS This was a cross-sectional study with midwives and nurse assistants working with intrapartum care at five different labor wards in Sweden. The Self-Compassion Scale (SCS) and the modified Professional Quality of Life Measurement (ProQOL) were validated and correlation analyses were calculated between the different subscales. Descriptive statistics, t-test, were calculated to analyze associations between the subscales of the SCS, the ProQOL and the background variables. RESULTS Midwives were more self-critical than nurse assistants, and the midwives who were negative towards the new clinical practice scored higher for compassion fatigue. The principal component analysis showed a two-factor solution for both the SCS and the modified ProQOL. The two SCS subscales were named ‘self-criticism’ (α=0.85) and ‘self-kindness’ (α=0.87). The two ProQOL subscales were named ‘compassion satisfaction’ (α=0.83) and ‘compassion fatigue’ (α=0.78). A negative correlation was found between self-kindness and compassion fatigue subscales, between compassion satisfaction and compassion fatigue, and between self-kindness and self-criticism. CONCLUSIONS The SCS and modified ProQOL are considered as valid questionnaires for use in a Swedish maternity setting and a correlation between the scales was found. Midwives are more self-critical than nurse assistants. Understanding and identifying compassion fatigue among midwives is important to managers responsible for quality improvement and practice changes.

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“…Severe perineal trauma (SPT) can have long‐term detrimental effects on women's physical and psychological health and new care practices that aim to reduce its occurrence have been suggested, such as the use of warm compresses and massage of the perineum 5,6 . In Sweden, collegial midwifery assistance during the active second stage of labor has been implemented to reduce the risk of SPT 7 . This clinical practice involves an additional midwife assisting the primary midwife and supporting the birthing woman during the active second stage of labor 7 .…”

Section: Introductionmentioning

confidence: 99%

Primary midwives' experiences of collegial midwifery assistance during the active second stage of labor: Data from the Oneplus trial

Tern

Edqvist

Ekelin

et al. 2023

Birth

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BackgroundCollegial midwifery assistance during the active second stage of labor that involves a second midwife being present has been shown to reduce severe perineal trauma (SPT) by 30%. The aim of this study was to investigate primary midwives' experiences of collegial midwifery assistance with the purpose of preventing SPT during the active second stage of labor.MethodsThis study uses an observational design with data from a multicenter randomized controlled trial (Oneplus). Data consist of clinical registration forms completed by the midwives after birth. Descriptive statistics as well as univariable and multivariable logistic regression were used to analyze the data.ResultsThe majority of the primary midwives felt confident (61%) and were positive (56%) toward the practice. Midwives with less than 2 years' work experience were more likely to completely agree they felt confident (aOR 9.18, 95% CI: 6.28–13.41) and experience the intervention as positive (aOR 4.04, 95% CI: 2.83–5.78) than those with over 20 years' work experience. Factors such as duration of time spent in the birthing room by the second midwife, opportunity for planning and if the second midwife provided support were further associated with the primary midwife's experience of the practice as being positive.ConclusionsOur findings indicate that having a second midwife present during the active second stage of labor was an accepted practice, with the majority of primary midwives feeling confident and positive toward the intervention. This was especially pronounced among midwives with less than 2 years' work experience.

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The effect of two midwives during the second stage of labour to reduce severe perineal trauma (Oneplus): a multicentre, randomised controlled trial in Sweden

Cited by 16 publications

References 22 publications

Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator

Metrics for maternity unit staffing in low resource settings: Scoping review and proposed core indicator

Self-compassion and professional quality of life among midwives and nurse assistants: A cross-sectional study

Primary midwives' experiences of collegial midwifery assistance during the active second stage of labor: Data from the Oneplus trial

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