Failure to perform assisted deliveries is resulting in an increased neonatal and maternal morbidity and mortality: An expert opinion

Pattinson, Robert Clive; Vannevel, Valerie; Barnard, Dalene; Baloyi, S.; Gebhardt, Stefan; Roux, Karl le; Moran, Neil F.; Moodley, J

doi:10.7196/samj.2018.v108i2.12786

Cited by 15 publications

(25 citation statements)

References 13 publications

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“…Increased use of vacuum extraction or other modes of assisted vaginal birth could potentially prevent many maternal deaths caused by complications of prolonged labour or unsafe caesarean section and a large proportion of stillbirths and neonatal deaths in sub‐Saharan Africa .…”

Section: Introductionmentioning

confidence: 99%

Birthing experience and quality of life after vacuum delivery and second‐stage caesarean section: a prospective cohort study in Uganda

Nolens

Akker

Lule

et al. 2018

Tropical Med Int Health

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Section: Introductionmentioning

confidence: 99%

Birthing experience and quality of life after vacuum delivery and second‐stage caesarean section: a prospective cohort study in Uganda

Nolens

Akker

Lule

et al. 2018

Tropical Med Int Health

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“…Results from other studies, including the ones performed in the context of the implementation programme in Mulago Hospital, revealed that frequent periodic training sessions and supply of equipment can reverse the trend of low vacuum extraction use with improvement of neonatal and maternal outcomes. (2,3,12,17,18) As a matter of fact, before the start of the programme, trainings were limited and vacuum extractors scarce.…”

Section: Discussionmentioning

confidence: 99%

“…(2, 3) It also has signi cant advantages over caesarean section (CS), including the reduction of complications associated with surgery, reduced delay between decision for intervention and birth, faster recovery, lower health care costs and avoiding complications related to uterine scars in subsequent pregnancies -an important aspect, particularly in low resource areas with high fertility rates. (2,4,5) Despite these advantages, vacuum extraction has been under-utilized in low-and-middle-income countries (LMIC) in recent years, as compared to many high-income countries. (6,7) Furthermore, rising CS rates and increasing proportions of CS unsupported by medical indications are also present in LMIC.…”

Section: Introductionmentioning

confidence: 99%

Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda

Capelle

Nolens

Lule

et al. 2020

Preprint

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Background: The objective of this manuscript is toexplore perceptions of health workersregardingthe use of vacuum extraction, two years after the implementation of training programme, in Mulago Hospital, Uganda. Methods: A cross-sectional survey among midwives, residents and consultant obstetricians,was performed. It was composed of questions pertaining to vacuum extraction, addressing reasons for low use, recommendations to increase use, preferred mode of birth, views aboutwho is suited to perform the procedure and contraindications.Results: Eighty-threeof 134(61.9%) participants returned the survey. The most frequent reasons for low use of vacuum extraction were lack of training (60/83, 72.3%) andequipment (59/83, 71.1%). Skills training and improved supply of equipment were recommended. Most participants (57/83, 68.8%) chose vacuum extraction over caesarean section as hypothetical mode of birth forthemselves or a relative. There was a tendency to cite contraindications not identified as such in international guidelines (big baby, caput succedaneum, moulding). Midwives and doctors with appropriate training were generally allconsideredsuited to perform vacuum extraction. Conclusion: Health workers generally conveyed a positive attitude towards vacuum extraction, despite some perceived barriers, often unsupported by evidence.Organisation of skills training, supply of equipment and focus on knowledge of indications are essential to increase its use.

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“…AVD has the potential to improve maternal and newborn health and outcomes in any setting where the maternal and fetal condition require the rapid birth of the baby, and where it can be done safely. This may be particularly valuable in settings where caesarean section is not available, and where, even if available, surgical safety or safe management of complications cannot be guaranteed [1][2][3]. This is a particular issue when the woman is late in labour and the fetal head is very low in the pelvis.…”

Section: Introductionmentioning

confidence: 99%

“…Although forceps and vacuum are not inherently dangerous, inappropriate decision making about when to use them, or sub-standard level of technical skills or training can cause iatrogenic harm, and this could disincentivize their use in favour of a caesarean section (if this is possible and a safe option locally) or even be a barrier to their use where they are the only technical solution available [2,3]. The practice of AVD is more prevalent in high-income countries than in low-and middle-income settings [12].…”

Section: Introductionmentioning

confidence: 99%

Women’s, partners’ and healthcare providers’ views and experiences of assisted vaginal birth: a systematic mixed methods review

et al. 2020

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Background: When certain complications arise during the second stage of labour, assisted vaginal delivery (AVD), a vaginal birth with forceps or vacuum extractor, can effectively improve outcomes by ending prolonged labour or by ensuring rapid birth in response to maternal or fetal compromise. In recent decades, the use of AVD has decreased in many settings in favour of caesarean section (CS). This review aimed to improve understanding of experiences, barriers and facilitators for AVD use. Methods: Systematic searches of eight databases using predefined search terms to identify studies reporting views and experiences of maternity service users, their partners, health care providers, policymakers, and funders in relation to AVD. Relevant studies were assessed for methodological quality. Qualitative findings were synthesised using a meta-ethnographic approach. Confidence in review findings was assessed using GRADE CERQual. Findings from quantitative studies were synthesised narratively and assessed using an adaptation of CERQual. Qualitative and quantitative review findings were triangulated using a convergence coding matrix. Results: Forty-two studies (published 1985-2019) were included: six qualitative, one mixed-method and 35 quantitative. Thirty-five were from high-income countries, and seven from LMIC settings. Confidence in the findings was moderate or low. Spontaneous vaginal birth was most likely to be associated with positive short and long-term outcomes, and emergency CS least likely. Views and experiences of AVD tended to fall somewhere between these two extremes. Where indicated, AVD can be an effective, acceptable alternative to caesarean section. There was agreement or partial agreement across qualitative studies and surveys that the experience of AVD is impacted by the unexpected nature of events and, particularly in high-income settings, unmet expectations. Positive relationships, good communication, involvement in decision-making, and (believing in) the reason for intervention were important mediators of birth experience. Professional attitudes and skills (development) were simultaneously barriers and facilitators of AVD in quantitative studies.

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Failure to perform assisted deliveries is resulting in an increased neonatal and maternal morbidity and mortality: An expert opinion

Cited by 15 publications

References 13 publications

Birthing experience and quality of life after vacuum delivery and second‐stage caesarean section: a prospective cohort study in Uganda

Birthing experience and quality of life after vacuum delivery and second‐stage caesarean section: a prospective cohort study in Uganda

Health Workers’perspectives on Vacuum Extraction in Mulago Hospital, Uganda

Women’s, partners’ and healthcare providers’ views and experiences of assisted vaginal birth: a systematic mixed methods review

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