This article describes the development of a database to facilitate quality assurance review of obstetric and neonatal care. The neonatal component of the database was developed as an alternative classification system to that of Wigglesworth's. The architecture of the new database follows that of the Winnipeg model, developed in part for the Pediatric Cardiac Surgery Inquest in Winnipeg, Manitoba. Use of the Winnipeg model allows reviewers to determine not only what happened and how, but more importantly, why. The new database provides a starting point for educational endeavors for all those involved in the care of patients, with the aim of preventing future deaths and other adverse outcomes.
For a better understanding of how women's satisfaction with maternity care is affected, a representative sample of 1790 women from the Montreal area who had delivered four to seven months earlier were mailed a postal questionnaire; 938 (52.4%) completed and returned it. With factor analysis, we determined five dimensions to women's satisfaction: (a) the delivery itself, (b) medical care, (c) nursing care, (d) information received and participation in the decision-making process, and (e) physical aspects of the labor and delivery rooms. Multiple regression analysis was used to determine explicative factors for each of these dimensions of satisfaction. Items relative to the delivery process such as pain intensity, complications, and length of labor were the most important for the delivery experience itself. Participation in the decision-making process was the first component of satisfaction with medical care. Information received appeared to be the major component of their satisfaction with nursing care. The physical environment did not affect women's satisfaction with obstetric care.
This paper describes the development and psychometric assessment of a scale to measure satisfaction with intrapartum and postpartum care in hospital: The Care in Obstetrics: A Measure For Testing Satisfaction (COMFORTS) scale. A sample of 415 participants completed the 40-item scale. Cronbach's alpha for the scale was .95. Evaluation of construct validity through principal components factor analysis with varimax rotation yielded six subscales: confidence in newborn care, postpartum nursing care, provision of choice, the physical environment, respect for privacy, and labor/delivery nursing care. The COMFORTS scale was able to discriminate between multiparous versus primiparous women, and between women cared for in single room maternity care versus in separate labor/delivery and postpartum rooms. Pending further validation, the COMFORTS scale has potential to measure women's satisfaction with childbirth care and contribute to an assessment of the quality of care provided.
To determine if unrestricted oral carbohydrate intake during labor reduced the incidence of dystocia in low-risk nulliparous women.
A randomized clinical trial at a university-affiliated hospital in southeastern Ontario. Low-risk nulliparous women were randomized between 30 and 40 weeks gestation to either an intervention or usual care group.
Women in the intervention group received, prenatally, guidelines about food and fluid intake during labor and were encouraged to eat and drink as they pleased during labor. Women in the usual care group received no prelabor information and were restricted to ice chips and water during labor in the hospital.
The incidence of dystocia, defined as a cervical dilatation rate of less than 0.5 cm/hr for a period of 4 hrs after a cervical dilatation of 3 cm.
Three hundred twenty-eight women were randomized to the intervention (n = 163) or usual care (n = 165) groups. Women in the intervention group reported a significantly different pattern of oral intake during early labor in the hospital (chi(2) = 40.7, p
To measure the extent to which documented Swedish midwifery care for low-risk labour and birth followed the World Health Organization's (WHO) recommendations for care in normal birth, and to compare midwifery care given to women who's labours were classified as low and high risk.
A retrospective examination of midwifery and medical records, 144 from women with low-risk births and 54 from women with high-risk births, for aspects of pregnancy, labour and birth using a validated instrument based on WHO's recommendations.
Care given in accordance with WHO's four categories of practice and changes in risk group during the birth process.
Care interventions not recommended by WHO, such as routine establishment of an intravenous route, routine amniotomy during the first stage, continuous electronic fetal monitoring and pharmacological methods of pain relief, were widespread in the records. Documented care differed little between the labours of women at low risk and high risk. The midwives at the unit under study did not routinely carry out risk assessment.
The mode of care was one of readiness for medical intervention. The act of carrying out risk assessments at the time of the woman's admission may affect awareness of the level of care offered to birthing women, and thus help to reduce the number and variety of practices not recommended by WHO.
The aim of the study was to develop an instrument to measure midwifery care in relation to World Health Organization's classification of care in normal birth and to test the instrument for content validity and inter-rater reliability.
The Delphi method was used for development of the instrument and to elicit evidence of content validity. Six experts from three different geographical regions in Sweden, representing clinically working midwives, lecturers in midwifery and obstetricians, participated in the first part of the study. The instrument was tested for inter-rater reliability in an exploratory study by two midwives and one of the authors. Data were analysed using percentage of agreement level and the Kappa coefficient.
Five expert rounds were needed to reach consensus for content validity. The inter-rater reliability test showed high agreement levels (95.9, 94.2 and 95.7%) and good to very good Kappa coefficients (0.74-1.0). The final instrument consisted of 78 items divided into five sections: background (five items); practices which are demonstrably useful and should be encouraged (55 items); practices which are clearly harmful or ineffective and should be eliminated (five items); practices for which insufficient evidence exists to support a clear recommendation and which should be used with caution while further research clarifies the issue (four items); and finally practices which are frequently used inappropriately (nine items).
The instrument can be used at a labour ward to measure documented care and quality of midwifery care. The results can be used to identify areas for improvements, to develop guidelines towards evidence-based care and to improve documentation. However, the present study should be regarded as an exploratory study and the feasibility of the instrument remains to be tested in empirical studies.
This study examined the subjective needs of labouring patients. A convenience sample of 80 postpartum patients was interviewed. They described the nursing care they had received, indicated the most helpful nursing measure received, and rated their satisfaction with their nursing care. These answers were categorized into types of nursing care. These were supportive care nursing, physical care nursing, medications and combinations of these three. X2 calculations done between these categories and satisfaction scores indicated a significant relationship between the type of care a patient received and her satisfaction scores. Patients found combined care very satisfying, but supportive care was the decisive factor in the way patients viewed their nursing care. The most frequently mentioned element in supportive care was the ability of the nurse to be a sustaining presence. The nurse's ability to assess and to meet the patient's need or non-need for her presence was major factor in patient satisfaction with nursing care in this sample. The relationship between congruency (agreement between time wanted and time spent by the nurse at the bedside) and satisfaction scores was highly significant. Thus the ability to recognize and respond to the patient's need or non-need for her presence was a crucial factor in patient satisfaction and in the way in which a nurse allocated her time. The relationships between numbers of nurses caring for a patient, parity, length of labour, presence of visitors, worries about the baby and patient satisfaction scores were examined. All were non-significant. However numbers of nurses caring for a patient was defined as a contributing factor to the delivery of supportive care nursing. More nurses contributed to more supportive care nursing being given, but was not the major factor in the delivery of supportive care nursing. Finally it was shown that the administration of syntocinon to patients in this sample decreased patient satisfaction with nursing care. Implications and possible reasons for these results are discussed.