- Email: [email protected]
optimal cord clamping
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Abstracts / Women and Birth 30(S1) (2017) 1–47
their own culture are highly recommended to aid in the development of cultural awareness. http://dx.doi.org/10.1016/j.wombi.2017.08.016 O5 Whose blood is it anyway? A presentation about delayed/optimal cord clamping Amanda Burleigh Presented by Annie Barnes Aim or rationale: To present the rationale and the evidence for practising evidence based care with regards to timing of umbilical cord clamping. Innovation: Implementation of delayed cord clamping as recommended by WHO and many international guidelines. What, Why and How to implement DCC into practice. This presentation will also discuss the Lifestart trolley an award winning mini resuscitaire developed by a team of obstetricians and one midwife (myself) in the UK. This trolley enables premature and compromised babies to receive resuscitation whilst the cord remains intact and is being used by midwifery/obstetric units around the world. Discussion: Immediate cord clamping (ICC) is a very routine procedure that has no evidence base and deprives the baby of approximately 30% of their intended blood volume. Research is showing that babies that have ICC are more likely to have anemia and this impact on neurological development, in particular males aged 4 years who were shown to have decreased fine motor and social skills. Large studies are underway and at 12 months of age babies who have ICC are shown to be anaemic. Follow up studies are planned. This presentation gives the history, latest guidelines around the world (which advocate delayed cord clamping). The researchers and the evidence will be introduced. The way to implement delayed cord clamping in everyday practice and quell the many myths around obstacles that are placed to prevent change will be addressed. This presentation will discuss active management, physiological management, taking cord blood with an intact cord, resuscitation with the cord intact and will ask providers to consider cord blood donation carefully and reflect on whether the baby’s blood is better in the baby or in a laboratory. Conclusions and implications for practice: The presentation will also discuss change management and culture in midwifery. As a proponent of a change in practice it has been a struggle over the past 12 years to turn the tide of immediate cord clamping into delayed cord clamping in the UK. The battle to change a practice that you are passionate about is worth it in the end if you keep going and that as the evidence is there we have an obligation to provide the safest possible care. http://dx.doi.org/10.1016/j.wombi.2017.08.017 O6 The journey from pain to power: A meta-ethnography on women’s experiences of vaginal birth after caesarean Hazel Keedle ∗ , Virginia Schmied, Elaine Burns, Hannah Dahlen School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia Background: Vaginal birth after caesarean (VBAC) can be a safe and satisfying option for many women who have had a
previous caesarean, yet rates of VBAC remain low in the majority of countries. Exploring women’s experiences of VBAC can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a VBAC. Aim: The aim of the meta-ethnography was to explore women’s experiences of VBAC across a variety of birth locations. Methods: This paper reports on a meta-ethnographic review of 20 research papers exploring women’s experience of VBAC. Meta-ethnography utilises a seven-stage process to synthesise qualitative research. Included studies had achieved ethics approval. Results: The overarching theme was ‘the journey from pain to power’. The theme ‘the hurt me’ describes the previous caesarean experience and resulting feelings. Women experience a journey of ‘peaks and troughs’ moving from their previous caesarean to their VBAC. Achieving a VBAC was seen in the theme ‘the powerful me,’ and the resultant benefits are described in the theme ‘the ongoing journey’. Conclusion and implications: Positive support from a health care professional is more common in confident practitioners and continuity of care (COC) with a midwife. Midwifery models that support COC should be supported and encouraged to enhance women’s experience of VBAC. The ‘journey from pain to power’ is strongly influenced by both negative and positive support provided by health care practitioners; this presentation hopes to increase interest and confidence in audience members to translate this evidence into ways to support women planning a VBAC. http://dx.doi.org/10.1016/j.wombi.2017.08.018 O7 Midwives knowledge and understanding of vasa praevia: A qualitative descriptive study Nasrin Javid 1,∗ , Jon Hyett 2 , Caroline S.E. Homer 1 1 Centre for Midwifery, Child and Family Health, University of Technology Sydney, New South Wales, Australia 2 University of Sydney, Sydney, Australia
Introduction: Vasa praevia is a pregnancy complication that can cause stillbirth and early neonatal death if it is not recognised antenatally. Several studies have demonstrated improved perinatal outcomes in women who have an antenatal diagnosis of vasa praevia typically through hospitalisation in the third trimester and late preterm caesarean section. Aim: This study aimed to document the current knowledge and understanding of Australian midwives of vasa praevia. Methods: A qualitative descriptive study involving registered midwives across Australia who had cared for at least one woman with vasa praevia during 2010–2016. Recruitment was achieved mainly through Australian College of Midwives. Semi-structured interviews were conducted over the phone, digitally recorded and transcribed. Interviews lasted 37-144 minutes. Data were analysed using thematic analysis. Ethical approval was provided by the University’s Human Research Ethics Committee. Results: Twenty midwives (19 registered and 1 student midwife) were interviewed from public and private hospitals across Australia. Preliminary findings show significant variation in midwives’ understanding of vasa praevia. This included gaps in an appreciation of the definition and categorisation of vasa praevia and the importance of multi-disciplinary care during pregnancy. There was also limited understand about the potential consequences of various antenatal management strategies.
Abstracts / Women and Birth 30(S1) (2017) 1–47
their own culture are highly recommended to aid in the development of cultural awareness. http://dx.doi.org/10.1016/j.wombi.2017.08.016 O5 Whose blood is it anyway? A presentation about delayed/optimal cord clamping Amanda Burleigh Presented by Annie Barnes Aim or rationale: To present the rationale and the evidence for practising evidence based care with regards to timing of umbilical cord clamping. Innovation: Implementation of delayed cord clamping as recommended by WHO and many international guidelines. What, Why and How to implement DCC into practice. This presentation will also discuss the Lifestart trolley an award winning mini resuscitaire developed by a team of obstetricians and one midwife (myself) in the UK. This trolley enables premature and compromised babies to receive resuscitation whilst the cord remains intact and is being used by midwifery/obstetric units around the world. Discussion: Immediate cord clamping (ICC) is a very routine procedure that has no evidence base and deprives the baby of approximately 30% of their intended blood volume. Research is showing that babies that have ICC are more likely to have anemia and this impact on neurological development, in particular males aged 4 years who were shown to have decreased fine motor and social skills. Large studies are underway and at 12 months of age babies who have ICC are shown to be anaemic. Follow up studies are planned. This presentation gives the history, latest guidelines around the world (which advocate delayed cord clamping). The researchers and the evidence will be introduced. The way to implement delayed cord clamping in everyday practice and quell the many myths around obstacles that are placed to prevent change will be addressed. This presentation will discuss active management, physiological management, taking cord blood with an intact cord, resuscitation with the cord intact and will ask providers to consider cord blood donation carefully and reflect on whether the baby’s blood is better in the baby or in a laboratory. Conclusions and implications for practice: The presentation will also discuss change management and culture in midwifery. As a proponent of a change in practice it has been a struggle over the past 12 years to turn the tide of immediate cord clamping into delayed cord clamping in the UK. The battle to change a practice that you are passionate about is worth it in the end if you keep going and that as the evidence is there we have an obligation to provide the safest possible care. http://dx.doi.org/10.1016/j.wombi.2017.08.017 O6 The journey from pain to power: A meta-ethnography on women’s experiences of vaginal birth after caesarean Hazel Keedle ∗ , Virginia Schmied, Elaine Burns, Hannah Dahlen School of Nursing and Midwifery, Western Sydney University, Sydney, New South Wales, Australia Background: Vaginal birth after caesarean (VBAC) can be a safe and satisfying option for many women who have had a
previous caesarean, yet rates of VBAC remain low in the majority of countries. Exploring women’s experiences of VBAC can improve health practitioners’ understanding of the factors that facilitate or hinder women in the journey to have a VBAC. Aim: The aim of the meta-ethnography was to explore women’s experiences of VBAC across a variety of birth locations. Methods: This paper reports on a meta-ethnographic review of 20 research papers exploring women’s experience of VBAC. Meta-ethnography utilises a seven-stage process to synthesise qualitative research. Included studies had achieved ethics approval. Results: The overarching theme was ‘the journey from pain to power’. The theme ‘the hurt me’ describes the previous caesarean experience and resulting feelings. Women experience a journey of ‘peaks and troughs’ moving from their previous caesarean to their VBAC. Achieving a VBAC was seen in the theme ‘the powerful me,’ and the resultant benefits are described in the theme ‘the ongoing journey’. Conclusion and implications: Positive support from a health care professional is more common in confident practitioners and continuity of care (COC) with a midwife. Midwifery models that support COC should be supported and encouraged to enhance women’s experience of VBAC. The ‘journey from pain to power’ is strongly influenced by both negative and positive support provided by health care practitioners; this presentation hopes to increase interest and confidence in audience members to translate this evidence into ways to support women planning a VBAC. http://dx.doi.org/10.1016/j.wombi.2017.08.018 O7 Midwives knowledge and understanding of vasa praevia: A qualitative descriptive study Nasrin Javid 1,∗ , Jon Hyett 2 , Caroline S.E. Homer 1 1 Centre for Midwifery, Child and Family Health, University of Technology Sydney, New South Wales, Australia 2 University of Sydney, Sydney, Australia
Introduction: Vasa praevia is a pregnancy complication that can cause stillbirth and early neonatal death if it is not recognised antenatally. Several studies have demonstrated improved perinatal outcomes in women who have an antenatal diagnosis of vasa praevia typically through hospitalisation in the third trimester and late preterm caesarean section. Aim: This study aimed to document the current knowledge and understanding of Australian midwives of vasa praevia. Methods: A qualitative descriptive study involving registered midwives across Australia who had cared for at least one woman with vasa praevia during 2010–2016. Recruitment was achieved mainly through Australian College of Midwives. Semi-structured interviews were conducted over the phone, digitally recorded and transcribed. Interviews lasted 37-144 minutes. Data were analysed using thematic analysis. Ethical approval was provided by the University’s Human Research Ethics Committee. Results: Twenty midwives (19 registered and 1 student midwife) were interviewed from public and private hospitals across Australia. Preliminary findings show significant variation in midwives’ understanding of vasa praevia. This included gaps in an appreciation of the definition and categorisation of vasa praevia and the importance of multi-disciplinary care during pregnancy. There was also limited understand about the potential consequences of various antenatal management strategies.