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Biomedical subjects

M Renfrew

Publications and source records attributed to M Renfrew.

12 recordsLinked to original sources
PubMed1999

Distribution of genital tract trauma in childbirth and related postnatal pain.

BACKGROUND: The full extent of genital tract trauma in spontaneous births is not well documented. The purpose of this study was to describe the range and extent of childbirth trauma and related postnatal pain using data from a large randomized clinical trial of perineal management techniques (n = 5471). METHODS: Descriptive analysis was conducted on trial participants who delivered spontaneously at term and were examined by their midwife after birth (n = 5404). Data are reported for sites of trauma, and the relation to episiotomy, suturing, and maternal reports of pain at 2 days, 10 days, and 3 months after birth. RESULTS: Eighty-five percent of all women experienced some form of trauma, with first- or second-degree perineal lacerations occurring in two-thirds of women and outer vaginal tears occurring in one-half. Tears to the rectum and vaginal vault were more common with episiotomy. Nearly all unsutured trauma was restricted to perineal first- or second-degree, outer vaginal, and labial sites. Pain declined over time, and a gradient in pain was observed according to the site and complexity of trauma. CONCLUSIONS: Genital tract trauma is extremely common with spontaneous vaginal birth. Effective measures to prevent or reduce its occurrence would benefit many new mothers.

Adult↗
PubMed1998

A randomised controlled trial of care of the perineum during second stage of normal labour.

OBJECTIVE: To compare the effect of two methods of perineal management used during spontaneous vaginal delivery on the prevalence of perineal pain reported at 10 days after birth. DESIGN: Randomised controlled trial. SETTING: Two English maternity care units. SAMPLE: 5471 women who gave birth between December 1994 and December 1996. METHODS: At the end of the second stage of labour women were allocated to either the 'hands on' method, in which the midwife's hands put pressure on the baby's head and support ('guard') the perineum; lateral flexion is then used to facilitate delivery of the shoulders, or the 'hands poised' method, in which the midwife keeps her hands poised, not touching the head or perineum, allowing spontaneous delivery of the shoulders. MAIN OUTCOME MEASURE: Perineal pain in the previous 24 hours reported by women in self-administered questionnaire 10 days after birth. RESULTS: Questionnaires were completed by 97% of women at 10 days after birth. 910 (34.1%) women in the 'hands poised' group reported pain in the previous 24 hours compared with 823 (31.1%) in the 'hands on' group (RR 1.10, 95% CI 1.01 to 1.18: absolute difference 3%, 0.5% to 5%, P = 0.02). The rate of episiotomy was significantly lower in the 'hands poised' group (RR 0.79, 99% CI 0.65 to 0.96, P = 0.008) but the rate of manual removal of placenta was significantly higher (RR 1.69, 99% CI 1.02 to 2.78; P = 0.008). There were no other statistically significant differences detected between the two methods. CONCLUSION: The reduction in pain observed in the 'hands on' group was statistically significant and the difference detected potentially affects a substantial number of women. These results provide evidence to enable individual women and health professionals to decide which perineal management is preferable.

Adult↗
PubMed1994

Postnatal home visiting by midwives.

Information about postnatal home visiting is presented from a postal survey of all directors of midwifery in English NHS districts, carried out in April and May 1991. The main finding was that almost all districts had changed from the traditional policy of daily home visits up to the tenth postnatal day to selective home visits by midwives. What was meant by 'selective' varied greatly, however, and the study highlighted the need to carry out audits of postnatal midwifery visiting.

Female↗
PubMed1993

Immersion in water during labor and birth: the need for evaluation.

Despite widespread and increasing use of immersion in water during labor, birth, or both in many different countries, no reliable information is available about its advantages, hazards, and resource implications. We describe the development of immersion in water during labor and birth, the current use of this form of care in the United Kingdom, the research that has been conducted to date, and possible strategies for future research. Three approaches to research are suggested: a survey of existing practice, a randomized controlled trial, and a confidential register of serious adverse events.

Delivery, Obstetric↗
PubMed1991

Teaching and support: nursing input in the postpartum period.

The findings from two studies, surveys of hospitals and community health units in Alberta, Canada, to determine the policies, procedures and content related to postpartum teaching are presented in this paper. While content covered was extensive the limited time available for teaching suggested that material would have to be presented at a superficial level, with little time for reinforcement. The average time for a home visit by the nurse was 7-12 days post-discharge and in some instances staff shortages precluded a second visit. The most frequent reason for follow-up visits in the community was problems with newborn feeding. Volunteer services in the community, such as the La Lêche League, were frequently not recommended to mothers by hospital nurses, so breastfeeding mothers were left without support at a critical time. While the study did not support the mother's contention in an earlier study that they did not receive information, the lack of opportunity for expansion and reinforcement of provided information would mitigate against adequate maternal education.

Alberta↗