Five things we learned in Winter 2013…

small_4050290960 Just in case you missed some of these as we slowed down for the holidays, I am offering a quick trip through five papers from towards the end of 2013 whose contents, for one reason or another, might be worthy of coffee room discussion…  I’ve even added a few questions to ponder for anyone who might be feeling reflective! 😀

1. Environments that get oxytocin flowing might facilitate better care…

Athena Hammond and colleagues (2013) explored the relationship between the birth environment, neurobiology and midwifery practice; an important area considering the fact that we already know that the same midwives practice differently in different places.  They paid particular attention to oxytocin, which is known to be linked with stress reduction, trust and other positive behaviours, and suggested that the environment of birth may play a key part in the provision of quality midwifery care by facilitating the release of oxytocin.

Feeling reflective?! Does the environment in which you work facilitate or inhibit the release of oxytocin?

2. The near-extinction of early fetal heart rate decelerations might be leading to more false positive traces…

small_4227411105Sholapurkar (2013) anonymously surveyed 56 midwives from a variety of NHS trusts and discovered that, since the implementation of the 2007 NICE intrapartum care guidelines, the categories of ‘early’ and ‘late’ decelerations are now almost completely unused, with 99-100% of decelerations being categorised as ‘variable’.  Midwives who had practised both before and after the implementation of this particular NICE guideline noted that 50-70% of decelerations would previously have been classed as ‘early’.  The author proposes that this ‘is not just a theoretical matter but leads to increasing numbers of false positive pathological traces‘ and argues that ‘midwives may be increasingly disenfranchised by having to rigidly adhere to the NICE categorisation of FHR decelerations‘.

3. More evidence supports delayed cord clamping…

Duley and Batey’s (2013) review added to the evidence about the value of late cord clamping, and they summarise the research showing that even in a more medicalised birth where a managed third stage is planned it is best to wait before clamping the cord, as delayed cord clamping conveys significant physiological advantages to babies.  I found their comment about cord milking particularly welcome in view of the way in which some people seem to be seeing this as a viable alternative to delayed cord clamping:

‘Cord milking has been suggested for preterm births as a means to increase placental transfusion without deferring cord clamping.  Cord milking over-rides the infant’s physiological control of its own blood volume and blood pressure, however, and disrupts umbilical blood flow.’ (Duley and Batey 2013: 906).

4. Women like having normal births in the company of loved ones and nice caregivers…

small_4407971477A study by Aguilar Cordero et al (2013) of 60 women who gave birth in Grenada, Spain found that women who had a vaginal birth without epidural anesthesia and women who were accompanied by a family member during their birth were happier than women who did not experience these things.  Other factors that increased the women’s satisfaction included the attitude of healthcare personnel and starting early breast-feeding.

5. Women need to see normal genitalia…

In their efforts to find out what women see as ‘normal’ and ‘desirable’ in female genital appearance, Moran and Lee (2013) carried out another small but interesting study in which women were randomly assigned to look at different images of vulvas; some were normal and natural, and some were surgically modified.  No prizes for guessing that their results showed that exposure to images of surgically modified vulvas tended to change women’s perceptions of what is normal and/or desirable, which Moran and Lee note may explain why some healthy women are seeking labiaplasty.

Feeling reflective?! This is great to know, but how on earth could such a finding be implemented?!

References

Aguilar Cordero MJ, Sáez Martín, Menor Rodríguez MJ et al (2013). Valoración del nivel de satisfacción en un grupo de mujeres de Granada sobre atención al parto, acompañamiento y duración de la lactancia. Nutr Hosp. 28(3):920-926.

Duley L and Batey N (2013). Optimal timing of umbilical cord clamping for term and preterm babies, Early Human Development, Volume 89, Issue 11, November 2013, Pages 905-908, ISSN 0378-3782, http://dx.doi.org/10.1016/j.earlhumdev.2013.09.002.

Hammond A, Foureur M, Homer CSA and Davis D (2013).  Space, place and the midwife: Exploring the relationship between the birth environment, neurobiology and midwifery practice. Women and Birth 26(4):277-81. doi: 10.1016/j.wombi.2013.09.001.

Moran C, Lee C (2013). What’s normal? Influencing women’s perceptions of normal genitalia: an experiment involving exposure to modified and nonmodified images. BJOG DOI: 10.1111/1471-0528.12578.

Sholapurkar SL (2013).  Are ‘early’ and ‘late’ fetal heart rate decelerations extinct? A survey of British midwives and analysis of controversies, facts and fiction.  British Journal of Midwifery 21(12): 860-66.

 

photo credits: coffee by Guwashi999 cc, mountain peaks by Martin Sojka cc and waterbirth by rabble cc, all from photopin

2 comments for “Five things we learned in Winter 2013…

  1. January 9, 2014 at 6:59 pm

    Thank you for an interesting smorgasbord,
    as a non UK/ NHS, homebirth midwife I do know when the oxytocin ramps up stress seems to leave the birth room, and I also feel fortunate that after more than 30 years practice I am yet to see a labiaplasty nor do I know these CTG categories.

  2. BabyMW
    January 18, 2014 at 10:47 am

    All things we have discussed in varying degrees in midwifery 2nd year last year. I love the research on CTGs lead me on a meandering path of the authors other research and made me glad were not taught the North American interpretation. We get far too much practice on clinical interpreting CTGs!!! I find much resistance to the delayed cord clamping but ill keep banging on about it in my antenatal classes too.

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