BACKGROUND: The Alternative Birth Centre (ABC) is a midwife-led unit which offers low-risk women integrated, individualised antenatal, intrapartum and postpartum care. MATERIAL AND METHODS: The study included 432 women who received their care at the ABC from November 1997 until July 2000. Demographic information and details about antenatal care were recorded for all women. Information about labour, delivery and the postnatal period were recorded for the 341 women who started their labour at the ABC. RESULTS: Of the 432 women who started their care at the ABC, 265 (61.3 %) gave birth there, 100 (38 %) were primiparous while 165 (62.3 %) were multiparous. 84 (19.4 %) women were not suitable for birth at the ABC for reasons such as preterm birth, postterm pregnancies, breech presentation and preeclampsia, and were referred back to their own hospital during pregnancy. Among the 341 women that started labour at the ABC, 76 (22 %) were transferred to the obstetrical department during labour. Three reasons accounted for 88 % off all transfers during labour: failure to progress (n = 34, 44.7 %), need for continuous fetal monitoring (n = 20, 26.3 %), and the need for pharmacological pain relief (n = 13, 17.1 %). Of the 76 women transferred in labour, 42 had a spontaneous vaginal birth while 36 (44.7 %) women had an operative delivery, 14 caesarean section, 16 vacuum extraction and 1 of them forceps delivery. One baby born at the ABC had an Apgar score below 7 at 5 min. ABC is a safe alternative to standard care for low-risk women.
We aimed to determine how serious adverse events in obstetrics were assessed by supervision authorities.
We selected cases investigated by supervision authorities during 2009-2013. We analyzed information about who reported the event, the outcomes of the mother and infant, and whether events resulted from errors at the individual or system level. We also assessed whether the injuries could have been avoided.
During the study period, there were 303 034 births in Norway, and supervision authorities investigated 338 adverse events in obstetric care. Of these, we studied 207 cases that involved a serious outcome for mother or infant. Five mothers (2.4%) and 88 infants (42.5%) died. Of the 207 events reported to the supervision authorities, patients or relatives reported 65.2%, hospitals reported 39.1%, and others reported 4.3%. In 8.7% of cases, events were reported by more than 1 source. The supervision authority assessments showed that 48.3% of the reported cases involved serious errors in the provision of health care, and a system error was the most common cause. We found that supervision authorities investigated significantly more events in small and medium-sized maternity units than in large units. Eighteen health personnel received reactions; 15 were given a warning, and 3 had their authority limited. We determined that 45.9% of the events were avoidable.
The supervision authorities investigated 1 in 1000 births, mainly in response to complaints issued from patients or relatives. System errors were the most common cause of deficiencies in maternity care.
The Directorate of Health’s national guide Et trygt fødetilbud – kvalitetskrav til fødselsomsorgen [A safe maternity service – requirements regarding the quality of maternity care] was published in December 2010 and was intended to provide a basis for an improved and more predictable maternity service. This article presents data from the maternity institutions on compliance with the quality requirements, including information on selection, fetal monitoring, organisation, staffing and competencies.
The information was acquired with the aid of an electronic questionnaire in the period January–May 2015. The form was sent by e-mail to the medical officer in charge at all maternity units in Norway as at 1 January 2015 (n=47).
There was a 100?% response to the questionnaire. The criteria for selecting where pregnant women should give birth were stated to be in conformity with the quality requirements. Some maternity institutions failed to describe the areas of responsibilities of doctors and midwives (38.5?% and 15.4?%, respectively). Few institutions recorded whether the midwife was present with the patient during the active phase. Half of the maternity departments (level 2 birth units) reported unfilled doctors’ posts, and a third of the university hospitals/central hospitals (level 1 birth units) reported a severe shortage of locum midwives. Half of the level 2 birth units believed that the quality requirements had resulted in improved training, but reported only a limited degree of interdisciplinary or mandatory instruction.
The study reveals that there are several areas in which the health enterprises have procedures that conform to national quality requirements, but where it is still unclear whether they are observed in practice. Areas for improvement relate to routines describing areas of responsibility, availability of personnel resources and staff training.
Fødestuene utgjør en del av en differensiert og desentralisert fødselsomsorg i Norge. Hensikten med studien var å undersøke forekomst og karakteristika ved planlagte og ikke-planlagte fødestuefødsler og årsaker til overflytting samt resultater for mor og barn.
I perioden 2008-10 ble et tilleggsskjema til rutinemeldingen til Medisinsk fødselsregister fortløpende utfylt av jordmor for 2 514 av i alt 2 556 (98,4 %) fødestuefødsler og for 220 fødsler som var planlagt i fødestue, men der fødselen foregikk andre steder. Data fra tilleggsskjema ble så koblet med rutinedata i Medisinsk fødselsregister og resultater fra fødestuefødsler sammenlignet med resultater fra en lavrisikofødepopulasjon i sykehus.
Av de 2 514 fødestuefødslene var 2 320 (92,3 %) planlagt å foregå der, mens 194 (7,7 %) ikke var det. Ved planlagt fødestuefødsel ble totalt 6,9 % overflyttet til sykehus under fødsel, hvorav 19,5 % blant førstegangsfødende. Det var 0,4 % operative vaginale fødsler ved vanlige fødestuer, 3,5 % ved forsterkede fødestuer og 12,7 % ved fødsler overflyttet fra fødestue til sykehus. Blant barn født i fødestue hadde 0,6 % apgarskår
CommentIn: Tidsskr Nor Laegeforen. 2018 Jun 12;138(10): PMID 29893095
The objective of the study was to assess risk factors for moderate and severe blood loss after cesarean delivery (CD).
All planned (n = 32,716) and emergency (n = 47,942) cesareans, as reported over a 10-year period to the Medical Birth Registry of Norway, were analyzed separately in a case-control design. Women with moderate (500 to =1500 mL) or severe (>1500 mL) blood loss were analyzed with women with blood loss less than 500 mL as controls in SPSS (version 17.0) with ?(2) test and logistic regression.
The prevalence of severe blood loss was consistently higher in emergency (3.2%) than planned CD (1.9%). Planned and emergency CDs share common risk factors for both moderate and severe blood loss, whereas emergency CD carries in addition delivery-related risk factors.
When revising management schemes for CD, anesthetic procedures should be reconsidered as surgical competence in cases with placenta previa, placental abruption, and low hemoglobin.
To investigate whether inter-professional simulation training influenced the rate of red blood cell (RBC) transfusions after birth.
Two cohorts were compared retrospectively using a pre-post design.
Norwegian university hospital with 4800 deliveries annually.
Women with estimated blood loss >500 mL within 24 h after birth in 2009 and 2011.
In 2010, all maternity staff attended a 6-h, scenario-based training on emergency obstetrics including postpartum hemorrhage, using a birthing simulator. The simulation focused on prevention, identification, and treatment of postpartum hemorrhage and on communication and leadership. Debrief immediately after the scenarios involved reflection and self-assessment.
The frequency of women receiving RBC transfusions as a marker for blood loss. Secondary outcome was the frequency of surgical procedures in the management of postpartum hemorrhage.
In 2009, 111/534 (20.8%) women with estimated blood loss >500 mL after birth received RBC transfusions vs. 67/546 (12.3%) in 2011 (p
This study aimed to observe risk status on admission to hospital and change in risk status during labor.
A prospective observational study allocating all women into low-risk and high-risk groups on admittance to hospital and during labor based on prespecified risk criteria.
Department of Obstetrics and Gynecology in a district hospital.
All 6406 deliveries from 2 May 2004 to 30 September 2006.
A special form was filled out for all women admitted to the department in labor classifying them as either low or high risk. A change in risk status during labor was also recorded.
Risk status (low and high risk) on admittance to hospital and change in risk status during first stage of labor.
On admittance, 67% of women with an intended vaginal delivery were low risk. During the first stage of labor, 41% of the low-risk women changed risk status. Use of epidural anesthesia gave rise to 73% of the risk changes during the first stage of labor and use of oxytocin caused 12%.
Two-thirds of the women were low risk before labor, and 39% of these remained low-risk at the end of the first stage of labor. The main reason for a change of risk status in the obstetric department was the use of epidural anesthesia.
Childhood abuse affects adult health. The objective of this study was to examine the association between a self-reported history of childhood abuse and fear of childbirth.
A population-based, cross-sectional study was conducted of 2,365 pregnant women at five obstetrical departments in Norway. We measured childhood abuse using the Norvold Abuse Questionnaire and fear of childbirth using the Wijma Delivery Expectancy Questionnaire. Severe fear of childbirth was defined as a Wijma Delivery Expectancy Questionnaire score of = 85.
Of all women, 566 (23.9%) had experienced any childhood abuse, 257 (10.9%) had experienced emotional abuse, 260 (11%) physical abuse, and 290 (12.3%) sexual abuse. Women with a history of childhood abuse reported severe fear of childbirth significantly more often than those without a history of childhood abuse, 18 percent versus 10 percent (p = 0.001). The association between a history of childhood abuse and severe fear of childbirth remained significant after adjustment for confounding factors for primiparas (adjusted OR: 2.00; 95% CI: 1.30-3.08) but lost its significance for multiparas (adjusted OR: 1.17; 95% CI: 0.76-1.80). The factor with the strongest association with severe fear of childbirth among multiparas was a negative birth experience (adjusted OR: 5.50; 95% CI: 3.77-8.01).
A history of childhood abuse significantly increased the risk of experiencing severe fear of childbirth among primiparas. Fear of childbirth among multiparas was most strongly associated with a negative birth experience.
Bone loss during advancing age in women and men is partly the result of sex steroid deficiency. As the contribution of circulating sex steroids and sex hormone-binding globulin (SHBG) to bone loss remains uncertain, we sought to determine whether levels of sex steroids or SHBG predict change in bone mineral density (BMD) in women and men. A population-based study in the city of Tromsø of 6.5 years' duration (range 5.4-7.4) included 927 postmenopausal women aged 37-80 years and 894 men aged 25-80 years. Total estradiol and testosterone, calculated free levels, and SHBG were measured at baseline, and BMD change at the distal forearm was determined using BMD measurements in 1994-1995 and 2001. Bone loss was detected in postmenopausal women and men. Free estradiol and SHBG predicted age-adjusted bone loss in postmenopausal women, but only free estradiol was associated after further adjustment for body mass index and smoking in mixed models (P