Learning from 40 births using the Odon Device for assisted vaginal birth - using case study methodology to explore optimum use

Objective To explore optimum use of the Odon Device by establishing the optimal device design, describing the ‘usual’ steps for use and setting clinical parameters for device use. Design Qualitative case study methodology was embedded in the ASSIST Study – a feasibility study of the Odon Device. Setting Central Delivery Suite, North Bristol NHS Trust, UK. Population Women who required a clinically indicated assisted vaginal birth. Methods Each case was determined by the single use of the Odon Device and could contain data from one or more of the following: formal observation of the Odon assisted birth, an interview with obstetricians, midwives or women involved in an Odon assisted birth. Data collection and analysis ran iteratively and in parallel enabling rapid dissemination of findings. Main outcome measures Determining the optimal steps for device use, recommendations for optimal device design and defining clinical parameters for device use. Results Optimal steps included applying the device during rather than between contractions, having a flexible approach to the application angle and deflating the air cuff sooner than originally proposed. Three design modifications were proposed. The device can be used under local or regional anaesthetic and is successful with all vertex presentations. It is not successful at assisting birth when the vertex is at station spines. Conclusions Case study methodology facilitated rapid insight into optimum device design, device use and key clinical parameter for successful use. This methodology should be considered whenever innovative devices are introduced to clinical trials and settings.

Factors related to the practice of vacuum-assisted birth: findings from provider interviews in Kigoma, Tanzania

Background Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and training experiences with the procedure affect practice. This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors. Methods A cross-sectional knowledge, attitudes and practice survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provided comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. Results Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); nurse officers, assistant nurse officers, registered nurses (32%); and enrolled nurses (44%). Eighty percent reported either pre-service, in-service vacuum extraction training or both, but only 31% reported conducting a vacuum-assisted birth in the last 3 months. Based on 11 training and enabling factors, a positive association with recent practice was observed; the single most promising factor was hands-on solo practice during in-service training (66% of providers with this experience had conducted vacuum extraction in the last 3 months). The logistic regression model showed that providers exposed to 7–9 training modalities were 7.8 times more likely to have performed vacuum extraction than those exposed to fewer training opportunities (AOR = 7.78, 95% CI: 4.169–14.524). Providers who worked in administrative councils other than Kigoma Municipality were 2.7 times more likely to have conducted vacuum extraction than their colleagues in Kigoma Municipality (AOR = 2.67, 95% CI: 1.023–6.976). Similarly, providers posted in a health center compared to those in a hospital were twice as likely to have conducted a recent vacuum extraction (AOR = 2.11, 95% CI: 1.153–3.850), and finally, male providers were twice as likely as their female colleagues to have performed this procedure recently (AOR = 1.95, 95% CI: 1.072–3.55). Conclusions Training and location of posting were associated with recent practice of vacuum extraction. Multiple training modalities appear to predict recent practice but hands-on experience during training may be the most critical component. We recommend a low-dose high frequency strategy to skills building with simulation and e-learning. A gender integrated approach to training may help ensure female trainees are exposed to critical training components.

Assisted Birth Delivery In Ghana: Evidence From Ghana Demographic And Health Survey 1988 - 2014

Background: Assistance during birth delivery is an essential reproductive care given to women during pregnancy. Even with the best possible antenatal care, any delivery can become a complicated one; therefore, skilled assistance is essential to safe delivery care. Proven health care interventions such as skilled assistance during childbirth can prevent or manage these complications. Methods: The study used secondary data from all the six rounds of the Ghana Demographic and Health Survey (GDHS). Bivariate, multivariate and binary logistic regression models were applied to examine the association between some background characteristics and assisted birth delivery. Results: The results showed that birth delivery is generally assisted by Nurses/Midwives over the period under review. The proportion of women who were not assisted during delivery declined over the period. Similarly, there was a decline in the percentage of women who were assisted by traditional birth attendants. In addition, it was observed that older women were more likely to be assisted by doctors during delivery as compared with younger women. Women with secondary education were more likely to utilize the services of nurses/midwives during delivery compared with those with no education. Women from the rural areas were more likely to receive delivery assistance from Traditional Birth Attendants compared with those from urban areas. Conclusion: These findings heighten that future successful interventions for skilled birth attendants should prioritise the identified groups who were more likely to utilize the services of TBAs.

Factors Related to the Practice of Vacuum-Assisted Birth: Findings from Provider Interviews in Kigoma, Tanzania

Background: Vacuum-assisted birth is not widely practiced in Tanzania but efforts to re-introduce the procedure suggest some success. Few studies have targeted childbirth attendants to learn how their perceptions of and experiences with the procedure affect practice.This study explores a largely rural cohort of health providers to determine associations between recent practice of the procedure and training, individual and contextual factors.Methods: A knowledge, attitudes and practice cross-sectional survey of 297 providers was conducted in 2019 at 3 hospitals and 12 health centers that provide comprehensive emergency obstetric care. We used descriptive statistics and binary logistic regression to model the probability of having performed a vacuum extraction in the last 3 months. Results: Providers were roughly split between working in maternity units in hospitals and health centers. They included: medical doctors, assistant medical officers (14%); clinical officers (10%); nurse officers, assistant nurse officers, registered nurses (32%); and enrolled nurses (44%). Eighty percent reported either pre-service, in-service vacuum extraction training or both, and 31% reported conducting a vacuum-assisted birth in the last 3 months. Based on 11 training and enabling factors, a positive linear association with recent practice was observed; the single most predictive factor was hands-on solo practice during in-service training (66%). The logistic model showed that for each additional training factor the likelihood of recent performance increased by 52% (OR 1.52, CI 1.327-1.740). A knowledge score based on indications and contra-indications for vacuum extraction showed an 11% increased probability for each item mentioned (OR 1.11, CI 1.033-1.196). Providers who worked in a health center compared to those in a hospital were 2.5 times more likely to have conducted a recent vacuum extraction (OR 2.46, CI 1.325-4.579), and male providers were twice as likely as females (OR 2.0, CI 1.088-3.733).Conclusions: Knowledge and training were positively associated with recent practice of vacuum extraction. Multiple training modalities appear to predict recent practice but hands-on experience during training may be the most critical component. We recommend a low-dose high frequency strategy to skills building with simulation and e-learning. A gender integrated approach to training may help ensure female trainees are exposed to critical training components.

Prevalence of and characteristics associated with operative vaginal birth at Mizan-Tepi University Teaching Hospital

Background To observe prevalence, characteristics and outcomes associated with operative vaginal birth (OVB). Methods We compared spontaneous vaginal birth with OVB. Results Of 993 women, 759 (76.4%) experienced vaginal birth; 716 were spontaneous (94.3%), 14 (1.8%) underwent forceps-assisted birth and 29 (3.8%) had vacuum assistance. In a multivariable model of OVB (forceps and vacuum), compared with a midwife, general practitioners (OR 5.6, p = 0.04) and integrated emergency surgical officers (OR 42.8, p = 0.001) were more likely to attend. Women experiencing OVB were more likely to receive local anesthesia (OR 3.0, p = 0.009). Conclusion OVB is used sparingly but safely at Mizan-Tepi University Teaching Hospital.

Midwives, medicine and natural births

This article examines how the often juxtaposed concepts ‘natural birth’ and ‘medically assisted birth’ figure in Jordemødrene, Barnmorskorna and En unge i minuten: three Scandinavian documentary programmes depicting midwifery and childbirth. Through comparisons between US and UK birthing shows, the study considers the socio-historically specific construction of birthing practices and the figure of the midwife. Non-invasive approaches to labour are celebrated as symbols of an essential ‘women’s culture’ that asserts female agency, but medical technology and pain medication also figure as potential tools for female empowerment, thus rendering the midwife a malleable figurehead for multiple strands of feminism.