Objectivesthe objectives of this review were (1) to assess whether interventions to support effective communication between maternity care staff and healthy women in labour with a term pregnancy could improve birth outcomes and experiences of care; and (2) to synthesize information related to the feasibility of implementation and resources required.Designa mixed-methods systematic review.Setting and participantsstudies which reported on interventions aimed at improving communication between maternity care staff and healthy women during normal labour and birth, with no apparent medical or obstetric complications, and their family members were included. ‘Maternity care staff’ included medical doctors (e.g. obstetricians, anaesthetists, physicians, family doctors, paediatricians), midwives, nurses and other skilled birth attendants providing labour, birth and immediate postnatal care. Studies from all birth settings (any country, any facility including home birth, any resource level) were included.Findingstwo papers met the inclusion criteria. One was a step wedge randomised controlled trial conducted in Syria, and the other a sub-analysis of a randomised controlled trial from the United Kingdom. Both studies aimed to assess effects of communication training for maternity care staff on women's experiences of labour care. The study from Syria reported that a communication skills training intervention for resident doctors was not associated with higher satisfaction reported by women. In the UK study, patient-actors’ (experienced midwives) perceptions of safety and communication significantly improved for postpartum haemorrhage scenarios after training with patient-actors in local hospitals, compared with training using manikins in simulation centres, but no differences were identified for other scenarios. Both studies had methodological limitations.Key conclusions and implications for practicethe review identified a lack of evidence on impact of interventions to support effective communication between maternity care staff and healthy women during labour and birth. Very low quality evidence was found on effectiveness of communication training of maternity care staff. Robust studies which are able to identify characteristics of interventions to support effective communication in maternity care are urgently needed. Consideration also needs to be given to how organisations prepare, monitor and sustain interventions to support effective communication, which reflect outcomes of priority for women, local culture and context of labour and birth care.

women, labour companions and health professionals find early labour difficult to manage well, with women unsure of how decisions about admission to their planned place of birth are taken. It is unclear why women are effectively left to manage this aspect of their labour with minimal guidance or support. Tailoring management to meet individual needs, with provision of effective communication could reassure women and facilitate timely admission from perspectives of women, their companions, midwives and other health professionals. Information on labour onset and progress, and approaches to pain management, should be shared with women's labour companions to enable them to feel more confident to better support women. Further research is needed of the impact of different models of care and increasing use of web-based information on women's approaches to self-management when labour commences. PROSPERO 2014 CRD 42014009745.

Rates of breastfeeding uptake are lower after a caesarean birth than vaginal birth, despite caesarean rates increasing globally over the past 30 years, and many high-income countries reporting overall caesarean rates of above 25%. A number of factors are likely to be associated with women's infant feeding decisions following a caesarean birth such as limited postoperative mobility, postoperative pain, and ongoing management of medical complications that may have triggered the need for a caesarean birth. The aim of this systematic review was to evaluate evidence of interventions on the initiation and duration of any and exclusive breastfeeding among women who had a planned or unplanned caesarean birth. Seven studies, presenting quantitative and qualitative evidence, published in the English language from January 1994 to February 2016 were included. A limited number of interventions were identified relevant to women who had had a caesarean birth. These included immediate or early skin-to-skin contact, parent education, the provision of sidecar bassinets when rooming-in, and use of breast pumps. Only one study, an intervention that included parent education and targeted breastfeeding support, increased initiation and continuation of breastfeeding, but due to methodological limitations, findings should be considered with caution. There is a need to better understand the impact of caesarean birth on maternal physiological, psychological, and physical recovery, the physiology of lactation and breastfeeding and infant feeding behaviors if effective interventions are to be implemented.

Background Due to the limited number of studies in low- and middle-income countries (LMICs), this study aimed to identify the prevalence and determinants of postpartum poor maternal sleep and depression. Methods This cross-sectional study was conducted with 380 women who were 2–12 months postpartum in March and April 2017 in Ramechhap district, Nepal. Multiple logistic regression was used to identify the associated factors. Results The prevalence of poor sleep quality and depression was 28.2% and 18.7%, respectively. Poor sleep quality was associated with having an occupation (in government or business, odds ratio [OR] 6.69; in agriculture/labour, OR 15.5), a male infant (OR 2.37), home delivery (OR 2.17), mental illness during pregnancy (OR 5.87), complications after delivery (OR 5.58) and postpartum depression (OR 2.86). Meanwhile, postpartum depression was associated with having no post-natal care (OR 98.7), living in a nuclear family (OR 48.5), living in a rural area (OR 26.6), having a male infant (OR 4.61), having complications after delivery (OR 21.9), introducing complementary foods before 6 months of age (OR 4.71) and having poor sleep quality (OR 3.20). Conclusions A relatively high prevalence of depression and poor sleep quality were found. The close positive association between poor sleep quality and depression suggests the need for early identification and support for women at risk of poor sleep quality and depression in Nepal.