OBJECTIVE: This study describes staffing, caseloads and reported routine practices for normal childbirth in Palestinian West Bank (WB) governmental maternity facilities and compares these practices with evidence-based care. METHODS: Data on routine childbirth practices in all eight governmental hospitals were obtained through interviews with head obstetricians and midwives. Data on staffing and monthly number of births were collected by phone or personal interview from all 37 WB hospitals. RESULTS: Forty-eight percent of WB deliveries took place in crowded and understaffed governmental hospitals. Reported practices were not consistently in line with evidence-based care. Lack of knowledge and structural barriers were reasons for this gap. CONCLUSION: The implications of limiting unnecessary interventions in the normal birth process are particularly important in a context of limited access and scarce resources. More skilled birth attendants and a universal commitment to effective care are needed. (+info)
Magnitude of the problem of retinopathy of prematurity. experience in a large maternity unit with a medium size level-3 nursery.
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This report describes the extent and severity of retinopathy of prematurity (ROP) in a large maternity unit. The screening of 79 preterm babies showed that ophthalmic examinations should become an important part of neonatal care. (+info)
Routines in facility-based maternity care: evidence from the Arab World.
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OBJECTIVES: To document facility-based practices for normal labour and delivery in Egypt, Lebanon, the West Bank (part of the Occupied Palestinian Territory) and Syria and to categorise common findings according to evidence-based obstetrics. DESIGN: Three studies (Lebanon, West Bank and Syria) interviewed a key informant (providers) in maternity facilities. The study in Egypt directly observed individual labouring women. SETTING: Maternity wards. SAMPLE: Nationally representative sample of hospitals drawn in Lebanon and Syria. In the West Bank, a convenience sample of hospitals was used. In Egypt, the largest teaching hospital's maternity ward was observed. METHODS: Shared practices were categorised by adapting the World Health Organization's (WHO) 2004 classification of practices for normal birth into the following: practices known to be beneficial, practices likely to be beneficial, practices unlikely to be beneficial and practices likely to be ineffective or harmful. MAIN OUTCOME MEASURES: Routine hospital practices for normal labor and delivery. RESULTS: There was infrequent use of beneficial practices that should be encouraged and an unexpectedly high level of harmful practices that should be eliminated. Some beneficial practices were applied inappropriately and practices of unproven benefit were also documented. Some documented childbirth practices are potentially harmful to mothers and their babies. CONCLUSION: Facility practices for normal labour were largely not in accordance with the WHO evidence-based classification of practices for normal birth. The findings are worrying given the increasing proportion of facility-based births in the region and the improved but relatively high maternal and neonatal mortality ratios in these countries. Obstacles to following evidence-based protocols for normal labour require examination. (+info)
Liveborn and stillborn very low birthweight infants in Switzerland: comparison between hospital based birth registers and the national birth register.
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BACKGROUND AND AIM: Perinatal and infant mortality rates are considered key indicators of medical care. The aim of this investigation was to examine how representative and reliable the official national figures of Switzerland are by comparing them with the data in local birth registers. METHODS: 124 of 156 maternity hospitals in Switzerland, catering for about 80% of all newborn infants, participated in the study. The hospital based birth registers were screened for the years 1996 and 2000 for live and stillborn infants weighing less than 1500 g. These data were matched with the data in the official register (federal office for statistics). RESULTS: in 1996 a total of 753 newborn infants and in 2000 820 infants weighing between 300 and 1499 g were officially registered. In the hospital based registers in 1996 101 additional infants and in 2000 94 infants were identified that had not been officially registered; 31 of these were stillborn before 24 completed weeks. Infants registered only locally had lower birth weight and lower gestational age than those recorded in both registers. CONCLUSION: In Switzerland a significant number of very low birth weight infants who died soon after birth are not officially registered. If these infants are included, the national perinatal mortality rate would increase from 6.9 per thousand to 8.0 per thousand. Reasons for underreporting are unclear but may be due to varying definitions of stillbirth and different lower limits for reporting in various cantons. We suggest adopting the WHO-rules for reporting all births and to include gestational age, head circumference, Apgar scores and umbilical artery pH in the national birth register. (+info)
Longitudinal patterns of breastfeeding initiation.
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Breastfeeding, in spite of proven benefits and energetic promotion, lags behind national goals, is less prevalent in disadvantaged populations, and declines across successive children in a family. Using longitudinally linked data from the New Jersey Electronic Birth Certificate (EBC) from 1996 to 2001, we found considerable fluidity in breastfeeding status at hospital discharge for births to the same mother. Among mothers who breastfed exclusively after the first birth, only 69% did so after the second (we refer to this as recurrence). Among mothers who exclusively formula fed after the first birth, 16% initiated exclusive breastfeeding after the second birth (referred to as recruitment). Combination feeding the first born, i.e., breastfeeding supplemented by formula, was followed by exclusive breastfeeding for 38% of second births. Rates of recurrence and recruitment differed in distinct ways by race/ethnicity and immigrant status. We conclude that breastfeeding initiation is not necessarily or exclusively a matter of fixed preferences, and that opportunities exist to expand breastfeeding to realize national goals by enhancing both recurrence and recruitment. (+info)
Delivering babies in a time of transition in Tula, Russia.
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OBJECTIVE: To investigate the provision of maternal services in the Tula region of Russia, with an emphasis on variations in practice. METHOD: The study was set in Tula Oblast. Data sources included an obstetric information database detailing all Tula deliveries in 2000 (n = 11,123) and structured interviews with the heads of maternity facilities and hospital maternity departments. RESULTS: Caesarean-section rates varied from 3.3-37%; episiotomy from 9-80%; and amniocentesis from 0-51%. As fertility rates fell since the 1980s, increasing numbers of women were hospitalized for 'pathological pregnancy' in an attempt to preserve infrastructure. CONCLUSION: Over-medicalization arises in a system typified by excess capacity and large numbers of specialists. Some practice variations were correlated with characteristics of mothers, but others derive from systems structures such as equipment availability. Improvements in practice will require addressing these structural elements and steering the clinical culture towards evidence-based medicine, rather than simply writing new decrees. (+info)
Implementing the new BCG vaccination guidelines--a maternity hospital-based clinic approach.
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BACKGROUND: With the recent changes to the UK BCG vaccination programme, the emphasis on childhood immunisation changes to identification and immunisation of at risk neonates. We report our experience of improving the system for provision of early BCG immunisation to high-risk infants born in the east of Glasgow. METHODS: A maternity hospital-based BCG clinic was established, together with a programme designed to increase awareness among midwifery and junior medical staff. RESULTS: Neonatal identification of at risk infants increased by 300% and was associated with high rates of clinic attendance and a 93% uptake of BCG immunisation in early infancy. Almost all infants were immunised within the first three months of life. CONCLUSION: Targeting parents prior to discharge from the maternity unit is an effective means of implementing BCG immunisation guidelines. The clinic model described is a successful and easily implemented example of co-operation between acute and community services. (+info)
Audit of birth defects in 34,109 deliveries in a tertiary referral center.
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The objective of the study is to determine the proportion and different types of birth defects among the children born in Hospital Kuala Lumpur. A cross-sectional study was conducted for a period of 18 months where all consecutively born infants, dead or alive were included. There were total of 34,109 births recorded during this period. The proportion of birth defects in Hospital Kuala Lumpur was 3.1% (n = 1056). The commonest involved were the hematology system, (157.7 per 10,000 births), the central nervous system, genitourinary system and chromosomal anomalies. The proportion was significantly higher in males and in the Chinese (p < 0.001). The commonest abnormalities are Glucose 6 Phosphate Deficiency (157.7/10000), Down's syndrome (12.6/10000), thalassaemia (8.8/10000), cleft lip and/or palate (7.6/10000) and anencephaly (7.3/10000). Neural tube defect is common and ranked second after G6PD deficiency. There is a need for a birth defect registry to assess the extent of the problem in Malaysia. (+info)