Midwifery
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Randomized Controlled Trial Clinical Trial
A randomised controlled trial in the north of England examining the effects of skin-to-skin care on breast feeding.
to examine the effect of early skin-to-skin contact between mothers and their healthy full-term babies on initiation and duration of breast feeding. ⋯ the difference between the groups in the success rate for the first breast feed and rates at 4 months was not statistically significant. However, mothers who had skin-to-skin contact enjoyed the experience, and most reported that they would choose to have skin-to skin care in the future. In this, the largest trial to date, previous concerns about baby-body temperature after skin-to-skin care were dispelled.
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to determine whether intrapartum fetal monitoring guidelines used by midwives in one region of England for women at low risk of obstetric complications were evidence-based. ⋯ a small number of guidelines were assessed as high quality, but the majority were poorly appraised by the reviewer group in most areas. This has implications for the delivery of evidence-based midwifery care since those midwives practising according to the guidelines surveyed would not have been supported in implementing research into practice.
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Randomized Controlled Trial Clinical Trial
A prospective randomised trial on the effect of position in the passive second stage of labour on birth outcome in nulliparous women using epidural analgesia.
To determine whether the rate of instrumental birth in nulliparous women using epidural analgesia is affected by maternal position in the passive second stage of labour. ⋯ Women randomised to the lateral position had a better chance of a spontaneous vaginal birth than those randomised to the supported sitting position. Position of the babies head at full dilation had an additional effect on mode of birth. These effects are not conclusively generalizable. RECOMMENDATIONS FOR PRACTICE: The lateral position is likely to be at best beneficial, and at the worst no less harmful than the sitting position for most women and their babies who meet the criteria set for this study. Conclusive evidence for or against the technique should be established using larger trials.
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Comparative Study
An intrapartum intervention scoring system for the comparison of maternity units' intrapartum care of nulliparous women suitable for midwifery-led care.
To develop an intrapartum intervention scoring tool which could be used to define maternity units as either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. This scoring tool was designed to form the basis of a comparison of the perception of risk by midwives working in either 'lower intrapartum intervention' or 'higher intrapartum intervention' units. ⋯ Routinely collected computerised data can be used to identify the outcomes of intrapartum care. This study suggests that the analysis of computerised data could provide a suitable basis for the audit and the comparison of intrapartum interventions for the care of women suitable for midwifery-led care.
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To review the reporting of randomised controlled trials for intrapartum interventions. ⋯ The importance of accurate documentation of numbers at all stages in the research process is highlighted, in particular the number of eligible people not recruited, to allow the reader to assess the generalisability of the study.