Midwifery
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childbearing is a significant transition, especially for first-time mothers. The objectives of this study were to explore the maternal transition from womens' perspectives and to identify any unmet needs for support. ⋯ providing more information about early pregnancy before conception may enable women to form more accurate expectations of this period. Facilitating contact between pregnant mothers would help them to establish a more appropriate support network prior to the birth.
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to develop a pragmatic service for pregnant smokers. ⋯ this service development provides a pragmatic approach to identify nearly all pregnant smokers at maternity booking, and an opt-out model to refer them to specialist smoking cessation services. Further research is required to establish if extra auxiliary staff in maternity booking clinics can optimise the identification and referral of pregnant smokers to specialist smoking cessation services. This telephone- and clinic-based specialist service engaged 20% of referred pregnant smokers to attend a face-to-face appointment with a specialist smoking cessation midwife. Further research is required to assess if home-based support would engage a greater proportion of pregnant smokers, or if an incentive scheme would achieve the same aim. In total, 117 of 370 (32%) women who set a quit date had quit smoking 4 weeks later, which compares fairly well with a figure of 40% for pregnant smokers in the English smoking treatment services.
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Randomized Controlled Trial
Comparison of active and expectant management on the duration of the third stage of labour and the amount of blood loss during the third and fourth stages of labour: a randomised controlled trial.
Postpartum haemorrhage is one of the most important causes of maternal death. ⋯ Active management did not decrease blood loss during the third stage of labour, but did decrease the duration of this stage. Active management was associated with increased blood loss during the fourth stage of labour. Due to conflicting results between studies, further research should be undertaken to determine the optimal method by which to manage the third stage of labour.
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Comparative Study
Does counsellor's attitude influence change in a request for a caesarean in women with fear of birth?
the attitudes of two counsellors towards women requesting a caesarean section due to fear of birth were identified. One emphasised the ability to overcome any emotional obstacle to vaginal birth ('coping attitude'), and the other emphasised that the ultimate choice of mode of birth was the womans' ('autonomy attitude'). Two research questions were asked: (1) What are the predictors of change in a wish for a caesarean and of vaginal birth in women with fear of birth? (2) Does a change from an 'autonomy attitude' to a 'coping attitude' increase the number of women who change their request for a caesarean and who give birth vaginally? ⋯ a coping attitude was strongly associated with change in the desire for a caesarean and giving birth vaginally. A coping attitude can be learned through critical reflection and awareness of the counsellor's attitude, with measurable clinical results.