The impact of obesity on outcomes of midwife‐led pregnancy and childbirth in a primary care population: a prospective cohort study

Daemers, Darie; Wijnen, Hennie; Limbeek, Evelien B.M. van; Budé, Luc; Nieuwenhuijze, Marianne; Spaanderman, M.E.A.; Vries, Raymond De

doi:10.1111/1471-0528.12684

Cited by 11 publications

(6 citation statements)

References 40 publications

(93 reference statements)

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“…For example, recent research suggests that otherwise healthy parous women with a BMI of 35–40 kg/m 2 may have relatively low intrapartum risks, 21 and a Dutch study found that extremely obese women achieved good outcomes in midwifery-led care. 22 …”

Section: Discussionmentioning

confidence: 99%

“…Further research is required into whether some groups of ‘higher risk’ women might be safely looked after in other midwifery‐led settings. For example, recent research suggests that otherwise healthy parous women with a BMI of 35–40 kg/m 2 may have relatively low intrapartum risks, and a Dutch study found that extremely obese women achieved good outcomes in midwifery‐led care …”

Section: Discussionmentioning

confidence: 99%

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Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

Townend

Rowe

et al. 2015

BJOG: Int J Obstet Gy

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ObjectiveTo explore and compare perinatal and maternal outcomes in women at ‘higher risk’ of complications planning home versus obstetric unit (OU) birth.DesignProspective cohort study.SettingOUs and planned home births in England.Population8180 ‘higher risk’ women in the Birthplace cohort.MethodsWe used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures.Main outcome measuresComposite perinatal outcome measure encompassing ‘intrapartum related mortality and morbidity’ (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth.ResultsThe risk of ‘intrapartum related mortality and morbidity’ or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31–0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure ‘intrapartum related mortality and morbidity’ (RR adjusted for parity 1.92, 95% CI 0.97–3.80). Maternal interventions were lower in planned home births.ConclusionsThe babies of ‘higher risk’ women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

Townend

Rowe

et al. 2015

BJOG: Int J Obstet Gy

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“…Obesity was introduced in the vignettes because this characteristic challenges midwives’ clinical decision-making on medical and psychosocial levels. Obese women experience stigma, which may threaten the bond of trust between midwife and woman [ 19 ] and in the Netherlands, there is scant evidence on the best care for obese women in midwife-led care, clear national guidelines are lacking, and local protocols are ambiguous [ 20 ]. Based on discussions with practising midwives (other than the ones interviewed), we identified typical clinical dilemmas associated with supporting obese women and incorporated these in the vignettes.…”

Section: Methodsmentioning

confidence: 99%

Factors influencing the clinical decision-making of midwives: a qualitative study

Daemers

Limbeek

Wijnen

et al. 2017

BMC Pregnancy Childbirth

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BackgroundAlthough midwives make clinical decisions that have an impact on the health and well-being of mothers and babies, little is known about how they make those decisions. Wide variation in intrapartum decisions to refer women to obstetrician-led care suggests that midwives’ decisions are based on more than the evidence based medicine (EBM) model – i.e. clinical evidence, midwife’s expertise, and woman’s values - alone. With this study we aimed to explore the factors that influence clinical decision-making of midwives who work independently.MethodsWe used a qualitative approach, conducting in-depth interviews with a purposive sample of 11 Dutch primary care midwives. Data collection took place between May and September 2015. The interviews were semi-structured, using written vignettes to solicit midwives’ clinical decision-making processes (Think Aloud method). We performed thematic analysis on the transcripts.ResultsWe identified five themes that influenced clinical decision-making: the pregnant woman as a whole person, sources of knowledge, the midwife as a whole person, the collaboration between maternity care professionals, and the organisation of care. Regarding the midwife, her decisions were shaped not only by her experience, intuition, and personal circumstances, but also by her attitudes about physiology, woman-centredness, shared decision-making, and collaboration with other professionals. The nature of the local collaboration between maternity care professionals and locally-developed protocols dominated midwives’ clinical decision-making. When midwives and obstetricians had different philosophies of care and different practice styles, their collaborative efforts were challenged.ConclusionMidwives’ clinical decision-making is a more varied and complex process than the EBM framework suggests. If midwives are to succeed in their role as promoters and protectors of physiological pregnancy and birth, they need to understand how clinical decisions in a multidisciplinary context are actually made.

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“…[4][5][6][7] The progression of the birth process and concomitant interventions are associated with maternal characteristics such as age, parity, body mass index (BMI), ethnicity, illness and infant birth weight, as well as with organisational factors such as existing guidelines, the availability of 24 hours pain relief, the profession of the obstetric care provider (midwife vs physician) and the level of care (primary/secondary). [8][9][10][11][12] Moreover, maternal anxiety might play a role in the birth process. Although one review found no overall association between anxiety and obstetric complications, specific types of anxiety (such as fear of childbirth) may be Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study Johanna Maria Koelewijn, 1,2 Anne Marie Sluijs, 3 Open Access associated with specific complications and interventions, such as prolonged labour and caesarean section.…”

Section: Introductionmentioning

confidence: 99%

Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study

2017

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ObjectivesThe rate of interventions during childbirth has increased dramatically during the last decades. Maternal anxiety might play a role in the progress of the labour process and interventions during labour. This study aimed to identify associations between anxiety in the first half of pregnancy and the birth process, including any interventions required during labour. In addition, differences in the associations by parity and ethnicity were explored.DesignProspective cohort study.SettingPrimary care midwifery practices and secondary/tertiary care obstetric practices in Amsterdam, participating in the multiethnic ABCD (Amsterdam Born Children and their Development) study (participation rate 96%; response 8266/12 373 (67%)).ParticipantsIncluded were women with singletons, alive at labour start, with a gestational age ≥24 weeks (n=6443).Independent variableGeneral anxiety (State-Trait Anxiety Inventory state) and pregnancy-related anxiety (Pregnancy-Related Anxieties Questionnaire (PRAQ)) were self-reported in the first half of pregnancy.OutcomesAssociations between both forms of anxiety and several indicators of the birth process were analysed. Subgroup analyses were performed for parity and ethnicity.ResultsThe prevalence of high general anxiety (State-Trait Anxiety Inventory score ≥43) and pregnancy-related anxiety (PRAQ score ≥P90) were 30.9% and 11.0%, respectively. After adjustment, in nulliparae, both general anxiety and pregnancy-related anxiety were associated with pain relief and/or sedation (OR for general anxiety 1.23; 95% CI 1.02 to 1.48; OR for pregnancy-related anxiety 1.45; 95% CI 1.14 to 1.85). In multiparae, general anxiety was associated with induction of labour (OR 1.53; 95% CI 1.16 to 2.03) and pregnancy-related anxiety was associated with primary caesarean section (OR 1.66; 95% CI 1.02 to 2.70). Associations were largely similar for all ethnicities.ConclusionsHigh levels of general and pregnancy-related anxiety in early pregnancy contribute modestly to more interventions during the birth process with similar associations between ethnic groups, but with some differences between nulliparae and multiparae.

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The impact of obesity on outcomes of midwife‐led pregnancy and childbirth in a primary care population: a prospective cohort study

Cited by 11 publications

References 40 publications

Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

Perinatal and maternal outcomes in planned home and obstetric unit births in women at ‘higher risk’ of complications: secondary analysis of the Birthplace national prospective cohort study

Factors influencing the clinical decision-making of midwives: a qualitative study

Possible relationship between general and pregnancy-related anxiety during the first half of pregnancy and the birth process: a prospective cohort study

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