Midwifery
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Randomized Controlled Trial
Influence of timing of admission in labour and management of labour on method of birth: results from a randomised controlled trial of caseload midwifery (COSMOS trial).
to explore the relationship between the degree to which labour is established on admission to hospital and method of birth. ⋯ these findings that women allocated to caseload care were admitted to hospital later in labour, and that earlier admission was strongly associated with birth by caesarean section, suggest that remaining at home somewhat longer in labour may be one of the mechanisms by which caseload care was effective in reducing caesarean section in the COSMOS trial.
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the rates of primary, repeat, and elective caesarean deliveries have risen dramatically over the past several decades. The reasons for the rise are complex and likely reflect a cultural shift to a greater acceptance of surgical birth as a reasonable option, which may favour infant over maternal outcomes. The purpose of this interpretive qualitative study was to explore the complexities of women's and clinicians' choices around elective caesarean delivery. ⋯ counselling about elective caesarean and vaginal birth after a prior caesarean is complex and reflects an intersection of culture and science. Women and clinicians enter the discussion with different backgrounds and concerns, but ultimately want the best outcome possible. Future exploration should address shared decision-making, evidence-based clinical guidelines, and the social context of care.
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to describe the non-invasive care technologies most frequently used by nurse midwives to relieve childbirth pain, and provide a synthesis of studies published by Brazilian nurse midwives on the use of such technologies. ⋯ the study presented ideas towards improved theoretical foundations and strategies for establishing practice consonant with humanised care.
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Randomized Controlled Trial Multicenter Study
Are all skilled birth attendants created equal? A cluster randomised controlled study of non-physician based obstetric care in primary health care clinics in Mexico.
the great majority of births in Mexico are attended by physicians. Non-physician health professionals have never been evaluated or compared to the medical model of obstetric care. This study evaluates the relative strengths of adding an obstetric nurse or professional midwife to the physician based team in rural clinics. ⋯ Mexican National Institute for Women, Mexican National Center for Gender Equity and Reproductive Health, MacArthur Foundation, Bill and Melinda Gates Foundation.
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the professional midwife is a key person for promoting maternal and family health. Not all countries have yet reached the professional standard for midwives set by the International Confederation of Midwives (ICM) and Nepal is one of these countries. This study explores the feasibility to establish a professional midwifery cadre in Nepal that meets the global standards of competencies, and to define a strategy to reach this. ⋯ the study has delivered a proposed strategy for the Government of Nepal for effective management of the midwifery workforce in order to enhance midwives' contribution in maternity care and thus promoting improved maternal and new-born health. The developed analytical framework could be used as an assessment tool also in other countries to establish professional midwifery cadres that meets the global standards of competencies.