Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study

Abstract

Background: In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. This study examines the relationships between the intrapartum transfer of care (TOC) from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. Methods: A prospective, multicentre, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Spain and Ireland between 2016–2019. The primary outcome was TOC. The secondary outcomes included type of onset of labour, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum haemorrhage, early initiation of breastfeeding and early skin-to-skin contact. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a TOC; Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1772) were selected. There were statistically significant differences between TOC and OUS (S1 = 29.0%, S2 = 44.0%, S3 = 52.9%, S4 = 30.2%, p < 0.001). Statistically differences between OUS and onset of labour, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p = 0.009, p < 0.001, p < 0.001, p < 0.001 respectively); Conclusions: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum TOC and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system.

Validação de escala para mensurar a carga de trabalho das parteiras

“…Resultados compatíveis com a literatura indicam como a estrutura organizacional, o tamanho das unidades de parto e o aumento da tecnificação do processo de nascimento variam a frequência e o número de intervenções realizadas pelas parteiras. (22) Ao explorar o turno de trabalho e o tipo de paciente que atende, constatamos que, durante o turno diurno, a carga de trabalho aumenta significativamente em relação ao turno noturno. Essa situação se deve a dois fatores.…”

“…É o tempo gasto na coordenação e comunicação entre as diferentes unidades envolvidas no processo de parto. (22)(23)(24)(25) As parteiras estão na linha de frente dos serviços obstétricos e devem ser percebidas como tal pelos Departamentos e Direções de Enfermagem dos hospitais. Os turnos padrão de 12 horas estabelecidos para as parteiras condensam os cuidados que devem ser realizados, entre uma média de 2 horas e mais 6,5 horas, fora desse turno.…”

Obstetricians’ Attitude towards Childbirth

“…The promotion of women's awareness about the effects of pregnancy on a mental disorder and an examination of their preferences and attitudes for care may reduce the sense of loneliness and mitigate anxiety or depressive symptoms [6]. Women's feelings of being in control of the childbirth process depend largely on the physical and emotional support that professionals provide, especially when women have a history of obstetric psychological trauma [7]. Accordingly, health professionals should revise what specific aspects of their delivery-room practices could improve their interaction with women at childbirth, and promote a positive and humanized experience for women [8].…”