BackgroundPostpartum haemorrhage (PPH) is the leading cause of maternal mortality in low-income countries and severe maternal morbidity in many high-income countries. Poor outcomes following PPH are often attributed to delays in the recognition and treatment of PPH. Experts have suggested that improving the accuracy and reliability of blood loss estimation is the crucial step in preventing death and morbidity from PPH. However, there is little guidance on how this can be achieved. The aim of this integrative review was to evaluate the various methods of assessing maternal blood loss during childbirth.MethodsA systematic, integrative review of published research studies was conducted. All types of studies were included if they developed, tested, or aimed to improve methods and skills in quantifying blood loss during childbirth, or explored experiences of those involved in the process.ResultsThirty-six studies were included that evaluated the accuracy of visual estimation; tested methods to improve skills in measurement; examined their effect on PPH diagnosis and treatment, and / or explored additional factors associated with blood loss evaluation. The review found that health professionals were highly inaccurate at estimating blood loss as a volume. Training resulted in short term improvements in skills but these were not retained and did not improve clinical outcomes. Multi-faceted interventions changed some clinical practices but did not reduce the incidence of severe PPH or the timing of responses to excessive bleeding. Blood collection bags improved the accuracy of estimation but did not prevent delays or progression to severe PPH. Practitioners commonly used the nature and speed of blood flow, and the condition of the woman to indicate that the blood loss was abnormal.ConclusionsEarly diagnosis of PPH should improve maternal outcomes, but there is little evidence that this can be achieved through improving the accuracy of blood loss volume measurements. The diagnosis may rely on factors other than volume, such as speed of blood flow and nature of loss. A change in direction of future research is required to explore these in more detail.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-015-0653-6) contains supplementary material, which is available to authorized users.

BackgroundThe partograph (or partogram) is recommended by the World Health Organisation (WHO), for monitoring labour wellbeing and progress. Concerns about limitations in the way the partograph is used in the clinical context and the potential impact on its effectiveness have led to this realist systematic review of partograph use.MethodsThis review aimed to answer two key questions, 1) What is it about the partograph that works (or does not work); for whom does it work; and in what circumstances? 2) What are the essential inputs required for the partograph to work? A comprehensive search strategy encompassed key databases; including papers of varying methodologies. Papers were selected for inclusion if the focus of the paper was the partograph and related to context, mechanism or outcome. Ninety five papers were included for data synthesis. Two authors completed data extraction and synthesis.ResultsThe evidence synthesis relates the evidence to identified theories of health worker acceptability, health system support, effective referral systems, human resources and health worker competence, highlighting barriers and facilitators.ConclusionsThis first comprehensive realist synthesis of the partograph, provides the international community of maternity clinicians with a picture of potential issues and solutions related to successful labour recording and management, which is also translatable to other monitoring approaches.

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Globally, breastfeeding remains the primary method of infant feeding. Despite the indisputable benefits of breastfeeding, studies have identified both positive and negative aspects of women’s experiences. This article aims to enhance our understanding of these breastfeeding experiences. Methods: Using a narrative review approach, 26 papers using different qualitative approaches were synthesized in order to consider the findings of real-life experiences of breastfeeding women. Selected qualitative studies described women’s experiences of breastfeeding across international regions. This was intended to provide a critical review of the existing evidence and contribute to improving the knowledge of breastfeeding practice. Results: The inclusive studies yielded five main themes. The essence of breastfeeding was described in relation to a symbol of motherhood, feeling connected between the mother and baby, the dilemma of mother’s expectations versus reality of breastfeeding, and mothers’ need for consistent reassurance and support, and lastly social-cultural construct of breastfeeding. Conclusion: The findings identify the wider importance of breastfeeding experience that goes beyond simply providing the baby with nutrition.

Background Guidelines from the National Institute for Health and Care Excellence recommend that telemetry is offered to any woman who needs continuous cardiotocography in labour. Methods An online survey of 168 maternity units in the UK was undertaken between November 2013 and February 2014 to determine how many units in the UK offered telemetry to women in labour and in what circumstances it was used. Findings The response rate was 62% (n=104). Some 63% (n=65) of responding units had at least one cardiotocography machine that could monitor the fetal heart via telemetry. Telemetry was used most often for women who had experienced a previous caesarean section and respondents felt that mobility and satisfaction with labour experience were most likely to be positively influenced by telemetry. Conclusion The survey gives an indication of how often and for whom telemetry is being used in the UK and describes the benefits that maternity units see for women using telemetry, such as increased choice and control.