EBP-Forum Promoting Primary Vaginal Birth in Hospital Settings



EBP-Forum Promoting Primary Vaginal Birth in Hospital Settings
Promoting Primary Vaginal Birth in Hospital Settings
Maternal Obesity and Excessive Weight Gain During Pregnancy
Mittwoch, 2. Juli 2014, 16.00 – 18.00 Uhr, Frauenklinik, Kursraum D 102
Holly Powell Kennedy: Executive Deputy Dean & Helen Varney Professor of Midwifery, CNM, PhD,
Cecilia M. Jevitt: Associate Professor of Nursing & Midwifery Speciality Coordinator, CNM, PhD,
Prof. Dr. habil. Eva Cignacco Müller, Leiterin Forschung und Dienstleistung Geburtshilfe, Berner Fachhochschule, Fachbereich Gesundheit
Promoting Primary Vaginal Birth in Hospital Settings
One in three U.S. mothers will have a surgical birth. Most U.S. births occur in hospitals where policies
for childbearing care reflect far more than just the translation of what we learn from research studies
into actual care of women. Attitudes and values of clinicians, medical and malpractice insurers, administrative initiatives, and economics influence the development and interpretation of those policies. To
effectively improve childbearing care and outcomes in hospitals, all those involved in birth, including
women must work together to consider what changes are necessary to improve care and enhance first
time mothers’ success at vaginal birth. We conducted a study on hospital birth culture to identify facilitators and barriers in the achievement of a vaginal birth for first time mothers in a hospital setting and
identify strategies to foster primary vaginal birth. Using participatory action research, we interviewed
100 clinicians, nurses, administrators, childbirth educators, doulas, and women from a tertiary regional
center. A representative group of birth care stakeholders and women worked with the researchers to
confirm the research findings. Early admission before establishment of labor and women’s preparation
for the realities of childbirth emerged as strong contenders for change. Individual clinicians’ practices
were also considered important, as well as inconsistent interpretation and application of evidence into
practice. There was a cascade effect on staff when vaginal birth rates dropped and cesarean rates
rose. The second phase of the research will work with stakeholders and women in the setting to collaboratively develop, implement, and evaluate changes in birth care to support primary vaginal birth. This
presentation will focus on how to implement change through an engaged process within a complex
hospital setting.
Maternal Obesity and Excessive Weight Gain during Pregnancy
Obesity (body mass index (BMI)≥30) is associated with adverse outcomes during pregnancy and birth
including increased risk of caesarean section, induction of labour, instrumental birth, gestational diabetes, preeclampsia, placental abruption, excessively large newborns, postpartum haemorrhage, urinary
and genital tract infection, wound infection and venous thromboembolism. Excessive weight gain and
pre-pregnancy obesity can lead to retention of central fat and further development of obesity perpetuating the global obesity epidemic.
Prenatal care, where mothers are a captive audience, is an opportunity to influence the health of mothers and families. Women are motivated to adopt new activities, therefore information and support to
address the nutritional needs of mothers can improve maternal health. Because information and education alone are insufficient to produce health behaviour change, the use of a range of evidence-based
techniques which go beyond motivating change is essential. A recent review reported that a combination of self-monitoring (e.g. keeping a diary) along with goal setting and action planning were the most
effective techniques for promoting change in dietary and physical activity behaviours. This session will
review evidence based techniques that can be used by midwives to assist women in planning a prenatal weight gain that is optimal for mother and newborn.
Kunst auf der Straße in Dresden, Münzgasse,
Bild von Will.Hillmer
Wir freuen uns, Sie am 2. Juli 2014 begrüssen zu dürfen.
Inselspital, Direktion Pflege/MTT, CH-3010
Bereich Fachentwicklung
[email protected]

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