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Biomedical subjects

Tina Lavender

Publications and source records attributed to Tina Lavender.

14 recordsLinked to original sources
PubMed2006

Effect of different partogram action lines on birth outcomes: a randomized controlled trial.

OBJECTIVE: The World Health Organization recommends partograms with a 4-hour action line, denoting the timing of intervention for prolonged labor; others recommend earlier intervention. We assessed the effect of different action line positioning on birth outcomes. METHODS: A randomized trial of primigravid women with uncomplicated pregnancies, in spontaneous labor at term, was conducted in the northwest of England. Women were assigned to have their labors recorded on a partogram with an action line 2 or 4 hours to the right of the alert line. If progress crossed the action line, diagnosis of prolonged labor was made and managed according to standard protocol. Primary outcomes were rate of cesarean delivery and maternal satisfaction. RESULTS: A total of 3,000 women were randomly assigned to groups; 2,975 (99.2%) were available for analysis. Questionnaires were completed by 1,929 (65%) women. There were no differences in cesarean delivery rate (136/1,490 compared with 135/1,485; relative risk [RR] 1, 95% confidence interval [CI] 0.80-1.26) or women dissatisfied with labor experience (72/962 compared with 81/967; RR 0.89, 95% CI 0.66-1.21). More women assigned to the 2-hour arm had labors that crossed the action line (854/1,490 compared with 673/1,485; RR 1.27, 95% CI 1.18-1.37); received more intervention (772/1,490 compared with 624/1,485; RR 1.23, 95% CI 1.14-1.33); and, if admitted to the midwife-led unit, were transferred for consultant-led care (366/674 compared with 285/666; RR 1.26, 95% CI 1.13-1.42). CONCLUSION: In this birth setting, for primigravid women selecting low intervention care, the 2-hour partogram increases the need for intervention without improving maternal or neonatal outcomes, compared with the 4-hour partogram, advocated by the World Health Organization. CLINICAL TRIAL REGISTRATION: Current Controlled Trials, http://www.controlled-trials.com/isrctn/trial/|/0/78346801.html, ISRCTN78346801.

Adult↗
PubMed2006

Systematic review of nulliparous women's views of planned cesarean birth: the missing component in the debate about a term cephalic trial.

BACKGROUND: The suggestion that planned cesarean birth is gaining acceptance among women has led some physicians to advocate the need for a trial of primary planned cesarean section versus planned vaginal birth in healthy women with singleton cephalic pregnancies at term. This paper reviews published studies of nulliparous women's views of mode of birth collected in the antenatal period, examining why women may express a preference for cesarean birth and exploring implications for the debate about the need for a trial. METHODS: A systematic literature review was undertaken of Cochrane, CINAHL, EMBASE, MEDLINE, and PsycINFO using the MeSH heading "cesarean section" and four free text spellings of "cesarean," or "birth" or "delivery," near truncated synonyms of 17 words meaning expressed preference. Studies of nulliparous women with a medical indication for cesarean birth, studies where a woman's preference for mode of birth was reported in the postpartum period, surveys of midwives or obstetricians, and opinion and non-English language papers were all excluded. RESULTS: Nine papers were included in the review, which reported rates of women expressing a preference for cesarean birth that ranged from 0 to 100 percent at recruitment. However, the papers raised specific methodological, conceptual, and cultural issues that may have influenced women's preferences for mode of birth in the populations studied. These issues included the timing and frequency of data collection, complexity of factors determining individual women's decision making, and influence of societal norms. CONCLUSIONS: Little evidence is available that an increasing cultural acceptance of cesarean delivery will bring about support for a trial among pregnant nulliparous women. Further qualitative research investigating the influence of both obstetric and psychosocial factors on women's views of vaginal and cesarean birth is required.

Adult↗
PubMed2006

Breastfeeding and family life.

The problems faced by breastfeeding mothers are well documented. However, the influence of social networks has mainly received attention solely through the eyes of the women. Therefore, we explored the views of the family as a whole. This exploratory study utilizes semi-structured interviews, diaries and questionnaires. A purposive sample of 24 women and their families, from a hospital in the north-west of England were invited to participate. Questionnaire data were analysed descriptively. Diaries and interviews were analysed using an open coding mechanism to identify emergent themes. Twenty-three women and 27 of their family members participated. Questionnaire data showed that the majority of women (n = 17) expected to breastfeed for more than 3 months; 12 actually did this. Women anticipated that family members would provide the main source of breastfeeding support. Three main themes emerged from the interviews and diaries: "moving with the times", "marketable commodity" and "disparate communications". The authors conclude that multi-layered approach to breastfeeding promotion and support should be considered. Society needs to proactively encourage a positive breastfeeding culture, family members need direction on how to support a woman to breastfeed and women need to be able to articulate their individual requirements. Midwives could be instrumental in supporting such needs and facilitating change.

Adolescent↗
PubMed2005

Factors that influence women's decisions about whether to participate in research: an exploratory study.

BACKGROUND: Women are increasingly being asked to consider participating in medical research. We sought to investigate views of women who participated in and declined to participate in a study that was part of a program of maternity care research. METHODS: An exploratory study using focus group interviews and semistructured interviews was conducted. A purposive sample of 17 postnatal women who had participated in research, from a hospital in the North West of England, were interviewed. An open coding mechanism to identify emergent themes was used for the analysis of data. RESULTS: Of women who had not declined to participate in any research, the following themes were identified: altruism versus self-protection, enhanced versus inferior care, professional guidance versus self-direction, and welcome versus unacceptable methodology. Of women who had participated in some research but declined to participate in other research, the following themes were identified: feeling disempowered by the process, inability to believe equipoise existed, and practical inconvenience. CONCLUSIONS: These findings suggest that although health care researchers adopt an individualistic approach to care, they may fail to adopt a similar approach within research. What is important and acceptable to women needs to be ascertained to develop appropriate research strategies. This plan will ensure that research is carried out to the highest ethical standard, which may increase recruitment rates.

Clinical Trials as Topic↗
PubMed2005

Women's experiences after a third-degree obstetric anal sphincter tear: a qualitative study.

BACKGROUND: Little qualitative data are available that address the experiences of women who sustain a third-degree obstetric anal sphincter tear during childbirth. The objective of this study was to explore the views and experiences of women in the postpartum period after sustaining a third-degree obstetric anal sphincter tear. METHODS: A qualitative study was conducted using focus groups in a large maternity hospital in the United Kingdom. Two focus groups used a purposive sample of women who had suffered a third-degree tear. One group (n = 6) had a tear in the index pregnancy and the second group (n = 4) had a subsequent pregnancy after the tear. RESULTS: The main themes identified included apprehension about consequences of the injury in terms of continence; body image and sexual functioning; anxiety about and lack of involvement in planning for future pregnancies; poor information exchange and communication (including both content and timing of discussions); poor emotional support from professionals and family members; physical and emotional impact; and unresolved anxieties in partners. Similarities occurred across both groups. CONCLUSIONS: A third-degree tear causes a significant emotional and psychological impact on women's physical and emotional well-being. We recommend that all staff receive adequate training to deal with the issues that may be raised. The provision of a dedicated, multidisciplinary team involved at an early stage to coordinate the repair and follow-up is recommended to allow a sensitive, consistent, evidence-based approach, particularly in terms of decision-making for subsequent births. The experiences and needs of partners require further study.

Adult↗
PubMed2005

Breastfeeding expectations versus reality: a cluster randomised controlled trial.

OBJECTIVE: To evaluate the affect of an antenatal educational breastfeeding intervention on women's breastfeeding duration. DESIGN: Cluster randomised controlled trial. Unit of randomisation: electoral ward. The primary outcome was the proportion that fulfilled their antenatal breastfeeding expectation. Secondary outcomes were the number of women breastfeeding on discharge and at four months. Data were collected using a series of questionnaires and diaries. SETTING: Teaching hospital in North West of England. PARTICIPANTS: Women who expressed a desire to breast-feed at the start of their pregnancy. METHODS: Women were allocated to either routine antenatal education or an additional single educational group session supervised by a lactation specialist and attended by midwives from their locality. MAIN OUTCOME MEASURE: The proportion of women who fulfilled their expectation of breastfeeding. RESULT: One thousand three hundred and twelve women were randomised, with 1249 (95%) women available for analysis. There was no difference between the groups in the proportion of women who attained their expected duration of breastfeeding (OR 1.2; 95% CI 0.89-1.6; chi(2)= 1.4, df= 1, P= 0.2; mean cluster size 156, design effect 1.6). There were no differences between the groups in the uptake of breastfeeding on discharge (OR = 1.2; 95% CI 0.8-1.7; chi(2)= 1.1, df= 1, P= 0.3; mean cluster size 163, design effect = 2.0) or exclusively at four months (OR = 1.1; 95% CI 0.6-1.8; chi(2)= 0.07, df= 1, P= 0.8; mean cluster size 156, design effect 1.6). CONCLUSION: The provision of a single educational group session supervised by a lactation specialist, and attended by midwives and women, failed to promote the uptake of breastfeeding. Public health interventions, which encourage positive attitudes to breastfeeding within the family and wider community, should be developed and evaluated.

Adult↗
PubMed2005

Personal accounts of 'near-miss' maternal mortalities in Kampala, Uganda.

OBJECTIVE: To explore the socio-economic determinants of maternal mortality in Uganda through interviews with women who had 'near-misses'. DESIGN: Observational study using qualitative research methods. SETTING: The postnatal and gynaecology wards of a large government hospital in Kampala, Uganda. SAMPLE: Thirty women who had narrowly avoided maternal deaths with diagnoses of obstructed labour (7), severe pre-eclampsia/eclampsia (3), post caesarean infection (6), haemorrhage (5), ectopic pregnancy (5) and septic abortion (4). METHODS: The semi-structured interviews were conducted in the local language by a woman unconnected to the hospital, and were recorded before being translated and transcribed. Analysis was conducted in duplicate using commercial software. RESULTS: The predominant theme was powerlessness, which occurred both within and outside the hospital. It was evident in the women's attempts to get both practical and financial help from those around them as well as in their failure to gain rapid access to care. Financial barriers and problems with transport primarily governed health-seeking behaviour. Medical mistakes and delays in referral were evident in many interviews, especially in rural health centres. Women were appreciative of the care they received from the central government hospital, although there were reports of overcrowding, long delays, shortages and inhumane care. There were no reports of bribery. CONCLUSIONS: Women with near-miss maternal mortalities experience institutional and social powerlessness: these factors may be a major contributor to maternal mortality.

Adolescent↗
PubMed2005

Progress of first stage of labour for multiparous women: an observational study.

As there is no universal definition of 'normal' labour, diagnosing prolonged labour is inherently difficult. Simple charts (partograms) are used to aid this process; however, there are little empirical data on which to base such charts. Therefore, we monitored 403 multiparous women, in the first stage of labour with uncomplicated term pregnancies, in a midwife-led unit. They had vaginal examinations every 2 hours, and we modelled rates of cervical dilatation for all women, either to the end of the first stage of labour or to the point of transfer for intervention. Overall, the median rate of dilatation was 1.9 cm/hour and the 5th percentile was 0.5 cm/hour. There was a weak positive correlation between initial dilatation and rate of dilatation (r= 0.2). Individualised computer-based partograms incorporating some of the factors that affect progress might prove useful in the future.

Adult↗
PubMed2004

An exploration of midwives' views of the current system of maternity care in England.

OBJECTIVE: to explore, in-depth, the views of midwives working in maternity services about birth setting, models of care and philosophy of care. DESIGN: an Appreciative Inquiry approach was adopted utilising focus group interviews as the method of data collection. SETTING: 15 focus group interviews were conducted at 14 sites in England. PARTICIPANTS: a purposive sample of 120 midwives and six student midwives who were serving women in different birth settings (home, free-standing maternity units, midwife-led units, and traditional obstetric units) participated, in 2001/2002. FINDINGS: the main themes generated by the midwives were: cultural changes; midwifery leadership; appropriate role models; training in normality; appropriate responsibility of care divisions; choice for women; equity of care provision between women considered to be at high or low risk; and staff morale. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: this study highlighted the consistency of views amongst midwives working in different settings. Midwives wanted support to practice autonomously in an environment that facilitated equity of care for women and job satisfaction for midwives. Suggestions were put forward by midwives on how to improve maternity services. A unified approach is required to develop these suggestions into strategies, that will remove the identified barriers and promote normality.

Clinical Competence↗
PubMed2002

Parenteral opioids for labor pain relief: a systematic review.

Parenteral opioids are commonly used for labor pain relief and have been the subject of research for many years. The objectives of this review were to determine the safety and effectiveness of parenteral opioids in this context. Of 85 trials systematically reviewed, 48 comprising more than 9800 were included, but the number of trials contributing data to individual outcome measures is very limited. Epidural provides better pain relief. However, if women opt for systemic analgesia, no strong preference for any of the opioids can be recommended. Pethidine is the most commonly used opioid worldwide, and although there are considerable doubts about its analgesic effectiveness and concerns about its potential maternal, fetal, and neonatal side effects, it has the virtue of familiarity and low cost. There is as yet no convincing research evidence to show that alternative opioids are better. In view of the large number of women who receive opioids in labor and the paucity of research evidence about the relative effectiveness and side effects of different opioids and opioids compared with other methods (apart from epidural), well-designed and suitably sized trials of pethidine versus the main alternatives that address substantive outcomes for mothers and babies are strongly recommended.

Analgesia, Epidural↗