Research Instruments

The HCAV scale is a reliable and valid instrument for assessing positive attitudes of clinical staff toward VBAC (vaginal birth after caesarean) and consists of a total of 15 items. The questions are designed to systematically capture the opinions and attitudes of clinical staff (doctors and midwives) regarding various aspects of vaginal birth after a caesarean section (VBAC).

Each item is answered on a Likert scale ranging from agreement to disagreement (e.g., 1 = "strongly disagree" to 5 = "strongly agree"). The scale can be used to examine how clinicians' attitudes might contribute to institutional differences in VBAC rates.

The HCAV scale holds significant practical relevance as it can help improve the quality of care for women undergoing VBAC and foster interprofessional understanding.

Publication: Portz S, Stoll K, Lundgren I, Gross MM. Midwives and obstetricians' attitudes towards VBAC: Development and validation of the HCAV-scale. Sex Reprod Healthc. 2021 Feb;27:100589. doi: 10.1016/j.srhc.2020.100589. Epub 2020 Dec 24. PMID: 33388540 can be found here.

Both the CBSEI, with 62 questions, and the CBSEI-C32, with 32 questions, are internationally established and repeatedly validated instruments. The Childbirth Self-Efficacy Inventory measures confidence in the ability to cope with childbirth and is based on Albert Bandura's theory. The concept of self-efficacy refers to the individual belief in one's abilities to handle a specific situation. The questionnaire is divided into the areas of self-efficacy expectation and outcome expectation. The questionnaire measures confidence in coping with childbirth and may improve advice and counselling during prenatal care in Germany.

Publication: Schmidt G, Stoll K, Jäger B, Gross MM. Deutsche Version des Childbirth Self-Efficacy Inventory und dessen Kurzform - ein Fragebogen zur Selbstwirksamkeit [German Version of the Childbirth Self-Efficacy Inventory and its Short Form]. Z Geburtshilfe Neonatol. 2016 Feb;220(1):28-34. German. doi: 10.1055/s-0035-1547296. Epub 2015 Sep 17. PMID: 26378776 can be found here.

Two validated instruments (Zinsser et al., 2016; Limmer et al., 2021) were adapted to the perspective of midwifery students to measure their observations of respect (or lack thereof), autonomy, discrimination, and violence against women during childbirth, as well as their attitudes toward supporting normal birth. The adaptation process included an expert review and a pilot study. The questionnaire consists of 32 items that cover various dimensions of observed violence during childbirth, including: forms of violence (verbal, physical, psychological), frequency and context in which violence was observed, emotional impact on midwifery students, possible interventions and ways of dealing with observed situations.

Publication: Schoene BEF, Oblasser C, Stoll K, Gross MM. Midwifery students witnessing violence during labour and birth and their attitudes towards supporting normal labour: A cross-sectional survey. Midwifery. 2023 Apr;119:103626. doi: 10.1016/j.midw.2023.103626. Epub 2023 Feb 11. PMID: 36842428 can be found here. 

This research project developed and validated a German-language instrument to measure disrespect and abuse during childbirth perceived by childbearing women. The questionnaire incorporates adapted scales such as the Mothers on Respect Index, the Mothers' Autonomy in Decision Making Scale, and indices to assess mistreatment and discrimination. The scales demonstrated high reliability and significant correlations with post-traumatic symptoms, which may be associated with long-term psychological consequences.

Publication: Limmer CM, Stoll K, Vedam S, Leinweber J, Gross MM. Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool. Midwifery. 2023 Nov;126:103809. doi: 10.1016/j.midw.2023.103809. Epub 2023 Sep 2. PMID: 37689053 can be found here.

A new measurement instrument was developed to assess midwives' attitudes toward supporting normal births. In this context, "normal birth" was defined as a spontaneous birth without medical interventions such as cesarean section or pain medication. The 38 questions are based on scientific evidence regarding natural childbirth and proven midwifery practices. The midwives rated the statements on a six-point Likert scale.

The study has shown that, compared to work setting, the general self-efficacy of German midwives, years providing intrapartum care and sources of knowledge about normal birth had comparatively little impact on their attitude towards supporting normal physiologic birth. Increasing exposure to out-of-hospital birth among German midwives throughout education and practise and fostering the skills and confidence necessary to support normal birth in hospital settings are important strategies to decrease unnecessary obstetric interventions.

 

Publication: Zinsser LA, Stoll K, Gross MM. Midwives' attitudes towards supporting normal labour and birth - A cross-sectional study in South Germany. Midwifery. 2016 Aug;39:98-102. doi: 10.1016/j.midw.2016.05.006. Epub 2016 May 10. PMID: 27321726 can be found here.

Funded by the Lower Saxony Ministry of Science and Culture (MWK) for a period from 04/2024 to 03/2029

The aim of the project is to examine and evaluate the still young midwifery study degree programs in Lower Saxony in a competence and profession-oriented manner and thus contribute to an innovative and evidence-based quality development and establishment of the study programs. New insights into the curricular and didactic design of the dual degree program in midwifery science are to be gained through cross-locational analyses. KoHeb pursues a multicenter research approach that is carried out at universities in Germany. The project comprises five studies that focus on various key areas of midwifery education:

1. Analysis of success-critical conditions in the introductory phase of the midwifery degree program
2. Development of the professional identity and the self-concept of professionally relevant competencies in the course of midwifery studies
3. Analysis of links between theory and practice in midwifery studies, taking into account didactic and learning psychology aspects
4. Modeling of selected competencies in studies of midwifery science and investigation
5. promotion of the competence orientation of midwifery state examinations

Parallel to the research project, a monitoring of the midwifery degree programs in Lower Saxony is to be established in order to record basic structural parameters of the degree programs and to serve as a basis for comparative and cross-locational analyses as well as for quality development.

The project is being carried out in cooperation with the following universities: Paderborn University and Hochschule Bochum. 

(H2020 2020-2025)

KAROLINSKA INSTITUTET (SWEDEN), INSTITUTE OF TROPICAL MEDICINE (BELGIUM), MEDIZINISCHE HOCHSCHULE HANNOVER (GERMANY), MAKERERE UNIVERSITY (UGANDA), UNIVERSITY OF MALAWI, COLLEGE OF MEDICINE, THE CENTRE FOR REPRODUCTIVE HEALTH (MALAWI), MUHIMBILI UNIVERSITY OF HEALTH AND ALLIED SCIENCES, (TANZANIA), AGA KHAN UNIVERSITY, MEDICAL COLLEGE (EAST AFRICA),  CENTRE DE RECHERCHE EN REPRODUCTION HUMAINE ET EN DÉMOGRAPHIE (CERRHUD) (BENIN)

 

The objective

To develop and evaluate a multifaceted intervention to i) strengthen the implementation of evidence-based interventions and responsive care and ii) reduce in-facility perinatal mortality and morbidity through a multidisciplinary approach in Benin, Malawi, Tanzania and Uganda.

 

The background

• Intrapartum care needs more attention: every day more than 7,000 women and their offspring could be saved if known evidence-based intervention were consistently implemented during the few hours surrounding birth.
• Hospitals care for about 40-50% of all births in Sub-Saharan Africa including complicated births.

 

Our strategy

• End-user participation using narratives of women, families and midwifery providers for co-designed competency-based training and quality improvement empowered by data from a perinatal e-registry
• Empowerment and leadership mentoring of hospital maternity unit leaders
• District-based bi-annual coordination and accountability meetings

 

Our evaluation

• A stepped-wedge design to evaluate the effect of intervention on in-facility perinatal mortality
• A nested realist process evaluation to understand what works, for whom, and under which conditions, complemented by an economic evaluation
• Evaluation of scalability including costs in four different countries of Sub-Saharan Africa  

 

Our expected results

• 25% reduction of in-facility early perinatal mortality (stillbirths and early neonatal deaths)
• A gendered approach to describe and tackle the constraints on provision of high quality intrapartum care in view of the multi-disciplinary teams providing maternity care
• Evidence of scalability, costs and effects of simultaneously implementing our multifaceted ALERT intervention focused on intrapartum care
• Inform programming for the Sustainable Development Goals and Every Women Every Child Agendas of the United Nations to support Universal Health Coverage

 

Our team

A multi-disciplinary team of clinicians (obstetrics and midwifery), public health physicians, social scientists, health systems specialists, medical anthropologists, economists, and management scientists from leading universities and research institutions.

COST Action "Perinatal Mental Health and Birth-Related Trauma: Maximising best practice and optimal outcomes" (DEVoTION) CA18211
Website: https://www.ca18211.eu/

 

Birthing Better

Birth trauma affects mothers, fathers and children. The impact of a negative or traumatic birth experience can last for years and even a lifetime.

The main goal of COST Action DEVOTION CA18211 is to connect a pan-European multidisciplinary network of birth trauma researchers. By connecting researchers across the world, CA18211 aims to accelerate what can be learned and shared amongst researchers.

Ultimately, CA18211 is working towards an ideal universal standard of care to prevent and minimise birth trauma and optimise birth experiences.

Source: https://www.ca18211.eu/

 

About CA18211

The main goal of DEVOTION CA118211 is to establish a multidisciplinary pan-European Research Network dedicated to minimising birth trauma and optimising birth experiences.

Part of this objective is to focus on the prevalence of birth trauma and work towards universal standards of measuring, assessing and preventing birth trauma.

Unlike other sources of trauma, perinatal or birth-related trauma is relatively unrecognised. Evidence suggests up to 30% of women describe their birth experience as traumatic and experience some symptoms of intrusion, avoidance or hyper-arousal.

Meta-analyses show post-traumatic stress disorder (PTSD) affects 4% of women after birth and up to 18% of women in high risk groups. Rectification of this situation is essential.

In 2016, 5.11 million babies were born in Europe. This means that up to 1.5 million mothers may have had sub-optimal birth experiences. Further, this suggests that over 200,000 mothers and up to 200,000 fathers may have developed PTSD as a result of a traumatic birth.

Developmental research has firmly established that the quality of infant-parent relationships is a critical factor in early and later childhood development, consequently, a family-centred approach to any investigation of birth-related trauma is critical, as trauma can be transmitted within the family system.

Given the enormous economic burden it places on women, health systems, and particularly children, relatively small improvements in services to prevent, detect and treat this problem can benefit society significantly.

This COST Action will establish an international multidisciplinary network of researchers, clinicians, NGOs and SMEs to consolidate and disseminate current evidence and coordinate a joint effort to seek ways to prevent, minimise and resolve birth-related trauma, and to optimise emotional and psychological outcomes for parents and families and CA18211 will work to accelerate the translation of that knowledge into best practices that can be shared across Europe to reduce the societal and economic burden arising from birth-related negative/traumatic experiences.

To learn more about the research, please click here and if you would like to join the Network, please click here.

COST ACTION CA18211, DEVOTION also published an online course with the title "Epigenetics as a Lifelong Record of the Early-Life Environment", including a lecture of Prof. Dr. Mechthild Groß about Epigenetic Programming Events Around Birth

Source: https://www.ca18211.eu/about/

Global Research Study

https://www.stillbirthcre.org.au/our-research/global-research-study-maternity-care-during-covid-19/

The Stillbirth Centre of Research Excellence is coordinating a global research study to understand the challenges and concerns of parents who are pregnant or have recently given birth during the COVID-19 pandemic outbreak.

We also want to understand the experiences of parents who have lost their baby to stillbirth or neonatal death. We extend our condolences to you and your family during this difficult time.

We hope that our research can help improve future care for all families around the world.

The global research study involves participants from Australia, Italy, Spain, UK, Canada, USA and many others.

Here you can find the research protocol.

 

Evaluation of the Methodology to Address Missing Outcome Data in Network Meta-analysis of Healthcare Interventions: a combination of a systematic review, empirical and simulation study

Missing outcome data in evidence synthesis has preoccupied many researchers who have contributed to a rather abundant published literature on that special topic mainly in the meta-analysis framework. While the methodology already developed in meta-analysis can be elaborated further to operate in a network of interventions, addressing missing outcome data in the context of network meta-analysis (NMA) holds an additional degree of complexity. The publication agenda pertaining to missing outcome data in the NMA framework is particularly inadequate. For instance, there is no evidence on the prevalence, reporting and handling of missing outcome data in systematic reviews with NMA. Evidence on the performance of different methods to handle missing outcome data when conducting NMA is missing as well.

This 3-year project proposal aims to provide empirical evidence on the reporting and handling of missing outcome data in networks of interventions as well as a thorough empirical and simulative evaluation of the performance of different missing binary outcome data methods in the context of NMA.

Ultimate goals are to lay the foundations in order to develop guidelines to address missing outcome data in systematic reviews that include NMA and to direct the attention of the researchers to this special topic in order to intensify further research.

 

Grant of the German Research Council DFG

This study investigated the effects of intrapartum interventions on the course of labour and on maternal wellbeing during labour in low-risk women. With an instrument that was designed especially for this purpose complemented with data from the women themselves the aim was to examine the hypothesis that the dynamics of labour are determined more by intrapartum variables than by pre-existent factors, such as parity, place of birth, or infant birthweight. For that purpose data was collected in differently sized obstetric departments, in birthing homes, and during home births within Lower Saxony. Owing to the time-related collection of data it was possible to review how attendance of midwives and medical staff as well as intrapartum interventions and events did have an impact on the process of labour as well as on the outcome. With that analysis of investment of resources during the process of labour was enabled. Just as well, optimal moments of intervention and sequences could be investigated.

 

 Publications:

• Petersen A Köhler LM Schwarz C Vaske B Gross MM. [Outcomes of Planned Out-of-Hospital and Low-Risk Hospital Births in Lower Saxony]. Z Geburtshilfe Neonatol. 2017 Aug;221(4):187-197. doi: 10.1055/s-0043-101528. Epub 2017 Aug 11. German. IF: 0.246
• Zondag DC Gross MM Grylka-Baeschlin S Poat A Petersen A. The dynamics of epidural and opioid analgesia during labour. Arch.Gynecol.Obstet. 2016 Nov; 294(5):967-977. Epub 2016 May 19. IF: 2.09
• Grylka-Baeschlin S Petersen A Karch A Gross MM. Labour duration and timing of interventions in women planning vaginal birth after caesarean section. Midwifery 2016; 34: 221-9; doi: 10.1016/j.midw.2015.11.004. IF: 1.948
• Gross MM Frömke C Hecker H. The timing of amniotomy, oxytocin and neuraxial analgesia and its association with labour duration and mode of birth. Arch. Gynecol. Obstet. 2014; 289 (1): 41-8; doi: 10.1007/s00404-013-2916-7. IF: 1.364
• Petersen A Poetter U Michelsen C Gross MM. The sequence of intrapartum interventions: a descriptive approach to the cascade of interventions. Arch. Gynecol. Obstet. 2013 Aug; 288(2):245-54; doi: 10.1007/s00404-013-2737-8. IF: 1.279
• Petersen A Penz SM Gross MM. Women’s perception of the onset of labour and epidural analgesia: A prospective study. Midwifery 2013; 29:284-93; doi: 10.1016/j.midw.2012.08.006. IF: 1.707 
• Petersen A Ayerle GM Frömke C Hecker H Gross MM. The timing of interventions during labour: descriptive results of a longitudinal study. Midwifery 2011; 27: e267-e273; doi: 10.1016/j.midw.2010.10.017. IF: 1.777
• Gross MM Petersen A Hille U Hillemanns P. Association between women’s self-diagnosis of labour on labour duration after admission. J Perinat. Med. 2010; 38: 33-38; doi: 10.1515/JPM.2010.005. IF: 1.871
• Köhler LM Groß MM. Außerklinische Geburt – eine gefährliche Sache? HebammenForum 2010; (10): 830-835 (nicht peer reviewed)
• Gross MM Burian RA Froemke C Hecker H Schippert C Hillemanns P. Onset of labour: Women’s experiences and midwives’ assessment in relation to first stage duration. Arch. Gynecol. Obstet. 2009; 280: 899-905; doi: 10.1007/s00404-009-0990-7. IF: 0.912
• Ayerle GM Hecker H Frömke C Hillemanns P Groß MM. Zusammenhänge zwischen Anwesenheit der Hebamme, Interventionen und dem Outcome der Geburt. Z Geburtshilfe Neonatol. 2008; 212: 176-182; doi: 10.1055/s-2008-1076979.
• Gross MM Schwarz C Burian RA Keirse MJNC Hecker H. Midwifery teams differ in their opinions regarding study participation. Birth Issues 2007; 15: 77- 82.

 

Published posters:

• Köhler LM Petersen A Vaske B Gross MM. Vergleich von klinischer und außerklinischer Geburtshilfe in Niedersachsen. Z Geburtshilfe Neonatol 2011; 215 (S1): E10
• Petersen A Penz SM Brendel K Gross MM. Erleben des Geburtsbeginns und Regionalanalgesie. Z Geburtshilfe Neonatol 2011; 215 (S1): E11
• Petersen A Poetter U Hillemanns P Gross MM. Modelling the cascade of interventions. J Perinat Med. 2009; 37 (S1): 655–721. ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPME.2009.655, /October/2009
• Petersen A Poetter U Hillemanns P Gross MM. Are there any factors predicting amniotomy as the first intervention during labor? J Perinat Med. 2009; 37 (S1): 655–721. ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPME.2009.655, /October/2009
• Petersen A Poetter U Hillemanns P Gross MM. Predisposing factors for oxytocin augmentation as the first intervention during labor. J Perinat Med. 2009; 37 (S1): 655–721. ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPME.2009.655, /October/2009
• Petersen A Poetter U Hillemanns P Gross MM. Epidural analgesia as the first intervention during labor is associated with a risk profile in pregnant women. J Perinat Med. 2009; 37 (S1): 655–721. ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: 10.1515/JPME.2009.655, /October/2009
• Petersen A Drobnič Hillemanns P Gross MM. Der Interventionskaskade auf der Spur - Wie lange dauern die Intervalle zwischen Geburtsbeginn, intrapartalen Interventionen und der Geburt? Z Geburtshilfe Neonatol 2009; 213: S9
• Gross MM Hecker H Frömke C Hillemanns P. The timing of amniotomy, oxytocin and epidural and its association to labor duration and mode of birth. Am J Obstet Gynecol 2007; 197: 101
• Gross MM Hecker H Frömke C Ayerle G Hillemanns P. Dynamische Zusammenhänge zwischen präexistenten und intrapartalen Faktoren und dem Geburtsverlauf in Eröffnungs- und Austreibung bei Erstgebärenden – Ergebnisse der niedersächsischen ProGeb-Studie. Z Geburtshilfe Neonatol 2007; 211: 118
• Nowotzek A Hecker H Hillemanns P Groß MM. Vergleich zwischen geburtshilflich-anästhesiologischen Klinikprofilen in Niedersachsen und anästhesiologischen Angaben in der ProGeb-Studie. Geburtsh Frauenheilkd 2007; 68: 906
• Ayerle G Hecker H Frömke C Gross MM. Associations between midwife presence during labour, intrapartum interventions, and outcomes. 4th World Congress on Developmental Origins of Health & Disease (DOHaD) 2006, Utrecht, 13.-16.09.2006 Early Human Development 2006; 82: 532
• Burian RA Frömke C Schippert C Groß MM (für das ProGeb-Team). Welche präexistierenden Faktoren bestimmen die Dauer der Eröffnungsphase? 56. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, Berlin 19.-22.09.2006 Geburtsh Frauenheilkd 2006; 66: 107
• Frömke C Groß MM Hecker H. Darstellung von zeitkonstanten und zeitabhängigen Interventionen auf den Geburtsverlauf in Übergangsmodellen. 51. Jahrestagung der Deutschen Gesellschaft für Medizinische Informatik, Biometrie und Epidemiologie (GMDS), Leipzig, 10.-14.09.2006. Löffler M, Winter A (Hrsg.). GMDS e.V., Programm- und Abstractband, Leipzig: Jütte-Messedruck Leipzig GmbH, 2006, S. 357
• Groß MM Frömke C Schippert C Wenzlaff P Hecker H Hillemanns P (für das ProGeb-Team). Intrapartale Einflussfaktoren des Gebärens in einer niedersächsischen Kohortenstudie (ProGeb-Studie). 56. Kongress der Deutschen Gesellschaft für Gynäkologie und Geburtshilfe, Berlin 19.-22.09.2006 Geburtsh Frauenheilkd 2006; 66: 187
• Gross MM Schwarz CH Hecker H. Recruiting midwives for a multicentre cohort study. XX. European Congress of Perinatal and Neonatal Medicine, Prag, 24.-27.05.2006. J Matern Fetal Neonatal Med 2006; 19: 143
• Groß MM Wenzlaff P Haeseler G Hecker H Schneider M. Geburtshilflich-anästhesiologische Klinikprofile in Niedersachsen. 22. Deutscher Kongress für Perinatale Medizin, Berlin 01.-03.12.2005 Z Geburtshilfe Neonatol 2005; 209: S104
• Groß MM Stahl K Wenzlaff P Rätz S Hecker H. Wie lange dauern Geburtsverläufe? 22. Deutscher Kongress für Perinatale Medizin, Berlin 01.-03.12.2005  Z Geburtshilfe Neonatol 2005; 209: S87

Around 4.7 million European women experience childbirth annually. Optimal maternal and infant health is critical to societal well-being. Survival rates have improved, but there are now concerns about iatrogenic morbidity. There are significant cross-EU differences in maternity care cultures, philosophies, organisation, uptake, and outcomes. This Action will advance scientific knowledge about ways of improving maternity care provision and outcomes by examining what works, for who, in what circumstances , and by identifying and learning from the best. It will share, synthesize and extend the work of experts from a range of disciplines, using a common framework of salutogenesis and complexity theory. The work will include an examination of first trimester prenatal diagnosis, routine intrapartum interventions for low risk women, and care for migrant women. It will focus on rapid dissemination of new knowledge, to improve European competitiveness in this area. Meetings, Short-Term Scientific Missions, Workshops, Training Schools and Conferences will catalyse effective collaborations, particularly for early stage and women researchers. Bringing all maternity care in Europe up to the standard of the best is the ultimate aim of the European Research Network that will be a result of the Action in the longer term.

More information can be found on the COST Action website and www.cost.eu/COST_Actions/isch/IS0907

 

Around the globe, the improvement of maternity care is one of the pending issues to increase the wellbeing of women, families and whole communities. To inform a lasting and meaningful progress, it is essential to collect and compare data about service design, health indicators and outcomes on a local, regional and international level. With this aim, a number of national and multinational organisations already collect predominantly quantifiable information (for example Destatis and QUAG in Germany, ONS and HSCIC in the UK, Euro Peristat in Europe and the WHO worldwide). Based on this data, a strong regional variance in the design of care, levels of intervention and clinical outcomes can be observed. It has been suggested that this variance stemmed from differences in political, legal, economic and cultural differences. However, this does not justify the magnitude of variance, particularly of intervention rates and clinical outcomes. Visibly, the translation of evidence to practice encounters severe barriers, which renders these differences even less acceptable. Yet, without further investigation, it is difficult to interpret the large amount of quantitative data, which is currently being collected in the European Union and elsewhere.
 

In the attempt to approximate maternity services in different regions in a mutual pursuit of quality and equity in healthcare, it is vital to gain a deeper understanding of the care experience of women and families. A number of governments and international agencies already embraced a patient-centred orientation and added client satisfaction to the core indicators of quality care. Today, care satisfaction has advanced to the most frequently used salutogenically oriented outcome measure. However, opposed to quantitative data collection, the investigation of user views is often limited to a local or regional level. Few organisations investigate the quality of the care experience on a national level (for example the Gesundheitsmonitor in Germany and the CQC and NPEU in the UK). A multinational and multifaceted investigation of experiences of maternity care was not attempted before.

The Babies Born Better (B3) Project aims to fill this gap. The project aims to explore, which topics are particularly important to women, their families and carers in different cultural and regional contexts, what works well and how excellent service strategies can be transferred to other settings. Thereby the B3 Project aims to supplement quantitative data and provide guidance for the improvement of maternity services in Europe, and worldwide.

The B3 user survey was designed to explore women’s experiences of maternity care. It is currently live in more than 20 languages, and represented in more than 30 countries.

 

Abbreviations and full names:

Destatis = Statistisches Bundesamt (Germany)

QUAG = Gesellschaft für Qualität in der außerklinischen Geburtshilfe e.V. (Germany)

ONS = Office for National Statistics (UK)

HSCIC = Health and Social Care Information Centre (UK)

WHO = World Health Organization

CQC = Care Quality Commission (UK)

NPEU = National Perinatal Epidemiology Unit (UK)

 

www.babiesbornbetter.org

eubirthresearch.wordpress.com/babies-born-better-b3/  

Publications and Conference Presentations

• Weckend MJ Downe S Balaam M-C Lengler L Gross MM. Das Babies Born Better Project: Europäische Umfrage zur Erfahrung mit der Gesundheitsversorgung in der Schwangerschaft, während des Gebärens und im Wochenbett. Deutscher Hebammenkongress, 03.05.2016, Hamburg, Germany.
• Weckend MJ Downe S Balaam MC Lengler L deWall S Gehling H Grylka-Baeschlin S Gross MM. Gesundheitsversorgung und Geburtshilfe im Umbruch: Was berichten Frauen über Defizite und Potenziale in Deutschland? - Die Babies Born Better User Survey [Health and maternity care in transition: What do women report about deficiencies and potential in Germany? - the Babies Born Better User Survey]. Z Hebammenwiss [J Midwifery Sci]. 2016;04(Suppl.1):34-35; doi:10.3205/16dghwi18
• Weckend MJ Gross MM Update on the Babies Born Better Project. Conference of the COST Action IS0709, 05.10.2015, Lancaster, UK.
• Weckend MJ Gross MM. Preliminary cross-country analysis and country specific analysis. Contribution to symposium: The Babies Born Better Survey. 10th Normal Labour and Birth Conference, 15.-17.06.2015, Grange over Sands, UK.
• Weckend MJ Gross MM. The Babies Born Better Project. Conference of the COST Action IS0709, 05.05.2015, Barcelona, Spain.
• Weckend M. Women's experiences of maternity care in Germany and Austria: The Babies Born Better User Survey. MSc Thesis. 2015. University of Central Lancashire, Preston, UK.

Building Intrapartum Research Through Health (BIRTH) - An interdisciplinary whole system approach to understanding and contextualising physiological labour and birth  

The COST-Action IS1405 ("BIRTH") is a consortium of researchers from 28 countries, predominantly in the European Union. Through multidisciplinary research, the aim of the Action is to improve the care for women and their families, particularly during the antenatal and postnatal period and during birth. In this process, the European Cooperation in Science and Technology (COST) supports the collaboration of researchers across borders. The Action commenced in October 2014 and partly continues the work of the previous Action IS0907 ("iresearch4birth").

Optimal maternal and infant health is critical to societal well-being. Reducing childbirth mortality and severe morbidity is a primary concern for most governments. However, this focus on pathology has been associated with an over-extension of clinical interventions to low risk women, with unexpected adverse clinical consequences, and rising health care costs. Part of the problem has been a scientific focus on understanding pathologies of pregnancy and childbirth from simple, clinical, linear perspectives, with a consequent lack of understanding of the range and limits of normal childbirth physiology in different populations, individuals, and contexts. The proposed Action will advance scientific knowledge in this area from a whole-systems perspective, using the realist research framework of what works, for whom, in what circumstances and following the principles of salutogenesis.

The Action is divided into five interlocking work groups with different emphases:

1. Biomedicine (Effect of the birth mode and interventions on the epigenome, microbiome and the immune system)
2. Biomechanics (Development of new methods to visualize fetal and maternal movements prior to and during birth; influence of thermography on the fetus)
3. Socio-cultural perspectives (Experiences and satisfaction with maternity care with particular focus on marginalized and migrant populations)
4. Organizational perspectives (variation in intervention rates and outcomes; education and training of health professionals; violence and human rights in maternity care)
5. Neuro-psycho-social perspectives (Influence of inter-personal actions and behaviours on physiological processes, for instance on natural oxytocin release)

For further information, please visit the COST website:

http://www.cost.eu/COST_Actions/isch/Actions/IS1405

https://eubirthresearch.wordpress.com

In Europe

The OptiBIRTH team comprised of 12 partner institutions from eight countries and included service users, midwives, obstetricians, neonatologists, epidemiologists, sociologists, psychologists, bioethicists, health economists and a 'high-tech' small industry.

The study examined the rising rates of Caesarean section throughout Europe, focusing in particular on routine Caesarean section following a previous Caesarean birth, despite calls for increased vaginal births after Caesareans. In comparison to Caesarean sections, vaginal births are associated with lower maternal mortality, less overall morbidity for mothers and babies, and are the preferred option to give birth for the majority of women. The rates for vaginal births in Ireland, Germany, and Italy are significantly lower (29-36%) than those in the Netherlands, Norway, and Sweden (45-55%). The aim of the OptiBIRTH project was a 15% increase in vaginal birth rates in Ireland, Germany and Italy through a complex intervention designed to increase women-centred care and women's involvement in their care. The project used a cluster randomised trial in each of the target countries, with 15 clusters of 120 women in each.

The partner institutions included Trinity College Dublin; Association for Improvements in Maternity Services, UK; University of Gothenburg, Sweden; Zuyd University, The Netherlands; University of Eastern Finland, Finland; University of Ulster, UK; Entando, UK; Queen's University of Belfast, UK; Medizinische Hochschule Hannover, Germany; National University Ireland, Galway, Ireland; Universita Degli Studi Di Genova, Italy; and Vrije Universiteit Brussel, Belgium.

Please note the first periodic report summary:

http://cordis.europa.eu/result/rcn/157755_en.html?WT.mc_id=Twitter_myCORDIS 

For further information please follow the link: www.optibirth.eu

 

In Germany

Five hospitals (Bürgerhospital Frankfurt, Henriettenstiftung Hannover, Hannover Medical School, Dritter Orden München and Helios Klinikum Wuppertal) in four federal states (Bavaria, Hesse, Lower Saxony, North Rhine-Westphalia) were participating in the German part of the OptiBIRTH study, led by Prof. Dr. Mechthild Gross. A retrospective study of data taken from the perinatal database of the medical associations of the participating federal states was conducted to ascertain the latest rates of caesarean sections, women with caesarean section in history, planned vaginal birth after caesarean section (VBAC) vs. primary elective repeat caesarean (ERCS), secondary repeat caesarean sections, and actually experienced VBACs (Gross et al., 2015). Furthermore a systematic review of the literature was undertaken. Focus group interviews with clinicians and women with their partners were conducted in the intervention sites. Based on these results the intervention was developed to increase the rate of VBACs. The pilot phase of the study started in January 2014 and between May 2014 and October 2015, recruitment for the main phase of the study took place. The last OptiBIRTH babies were born in December 2015 and data collection was completed in spring 2016. The control sites got the offer to implement the Intervention.

  

Releases

•  Newspaper report from the Perinatal Congress 2015 in Berlin: http://www.tagesspiegel.de/wissen/perinatalkongress-2015-operation-leben/12690958.html

• Publication about the VBAC rates in the study sites, Gross et al. 2015: Interinstitutional variations in mode of birth after a previous caesarean section. a cross-sectional study in six German hospitals

• Publication of the OptiBIRTH study protocol, Clarke et al. 2015: Improving the organisation of maternal health service delivery and optimising childbirth by increasing vaginal birth after caesarean section through enhanced women-centred care (OptiBIRTH Trial): study protocol for a randomised controlled Trial (ISRCTN10612254)

 

Publication:

Clarke M, Devane D, Gross MM, Morano S, Lundgren I, Sinclair M, Putman K, Beech B, Vehviläinen-Julkunen K, Nieuwenhuijze M, Wiseman H, Smith V, Daly D, Savage G, Newell J, Simpkin A, Grylka-Baeschlin S, Healy P, Nicoletti J, Lalor J, Carroll M, van Limbeek E, Nilsson C, Stockdale J, Fobelets M, Begley C. OptiBIRTH: a cluster randomised trial of a complex intervention to increase vaginal birth after caesarean section. BMC Pregnancy Childbirth. 2020 Mar 6;20(1):143. doi: 10.1186/s12884-020-2829-y.

Midwifery Literature Service

The Midwifery-Literature-Service (HeLiDi) was an abstract-based supplement in the field of midwifery and obstetric research. Aiming to decrease misunderstandings based on language barriers, English abstracts were translated into German to reduce language barriers on current international obstetric literature. The data base contains approximately several hundreds translated articles. The supplement has been published in four midwifery magazines in Germany, Austria and Switzerland twice a year from 1992 until 2018.

For the 15th anniversary of the Midwifery-Literature-Service, the Unit provided an index of contexts of all on our homepage.

Development of Standards for Further Midwifery Education

Changes within the health care systems, increased demands on professional training of midwives, opening up for tertiary education structures following European examples, as well as the changing expectations and demands of pregnant women caused the Ministries for Health, Social Welfare, Women and Family in North Rhine-Westphalia (MGSFF) to reform the regulations for midwifery training regarding §7 HebBO (NRW) by means of a guideline.

The midwifery research unit at the Medical School Hanover has been authorised by the Ministries of Health, Social Welfare, Women and Family of North Rhine-Westphalia to develop a new concept for the years 2005-2008 by analysing the offered training systems for midwives over the period from 2002-2005 together with the schemes currently applied.

https://www.mags.nrw/sites/default/files/asset/document/pflege_fortbildungspflicht-hebammen.pdf

 

Dosage of oxytocin at German university hospitals

Oxytocin is a natural occurring hormone, which is produced within the hypothalamus and released by the pituitary gland during pregnancy and increasingly during labour. It increases contractions of the uterus during labour and is therefore used to induce and support labour. The aim of this intervention is to accelerate labour and prevent operative delivery due to obstructed labour.

Internationally oxytocin is seen as a drug with high risk for side effects, as administration can result in hyperstimulation of the uterus in the form of excessively strong and long contractions, as well as an intolerance of the foetus. Hyperstimulation is defined by the Irish guideline as more than seven contractions within 15 minutes in primipara and more than five in multipara.

Diverse guidelines on application of oxytocin exist, differing between the federal states of Germany. In several Cochrane reviews, different schemes on dosage of oxytocin have been investigated. Clear advantage of one certain scheme has not been detected to date, even if a Cochrane Review including 644 participants did detect shortened labour and lesser rates of cesarean sections in high-dose schemes.

While it is to be assumed that several hospitals have firm standards, no national guideline on application of oxytocin does exist in Germany. For this reason, the study investigated about how many hospitals did devise standards, including the variability within the dosage, the schemes on augmentation, and criteria for abandonment.

 

Publication:

• Helbig S, Petersen A, Sitter E, Daly D, Gross MM. Inter-institutional variations in oxytocin augmentation during labour in German university hospitals:a national survey. BMC Pregnancy Childbirth. 2019 Jul 9;19(1):238. doi: 10.1186/s12884-019-2348-x.

 

The prevention of preterm birth (PTB) poses a global challenge, as 14.9 million infants (11%) are estimated to be born before 37 completed weeks of gestation each year. In Europe, PTB rates range between 5.2% in Iceland and 10.4% in Cyprus.

Up to 40% of PTBs are associated with genital tract infections. The vaginal pH can reflect changes in the vaginal milieu and may therefore serve as an indicator of a local infection at an early stage. Furthermore, an increased vaginal pH ≥ 5.0 in pregnancy is associated with more caesarean sections, poorer neonatal outcome and increased admission rates to a neonatal intensive care unit. In numerous studies, bacterial vaginosis (BV) has been discussed as a cause for PTB. However, a Cochrane review showed that an effective eradication of BV during pregnancy did not decrease PTB rates. It was suggested, that a routine measurement of the antenatal vaginal pH could reduce the overall PTB rate through a more rapid identification, and subsequent treatment, of abnormal vaginal flora.

In 2000, promising results  prompted an implementation of a self-assessment programme in five German federal states, which meanwhile became established nationwide albeit a lack of rigorous evidence for its benefits. Observational study findings remain heterogeneous. It is therefore questionable, whether a routine assessment of the vaginal pH can contribute to reduce PTB. It was decided to conduct a systematic review and meta-analysis investigating, whether an increased antenatal vaginal pH >4.5 is associated with an increased preterm birth rate.

 

Publication:

• Weckend MJ, Spineli LM, Grylka-Baeschlin S, Gross MM. Association between increased antenatal vaginal pH and preterm birth rate: a systematic review. J Perinat Med. 2019 Feb 25;47(2):142-151. doi: 10.1515/jpm-2018-0097

The doctoral student Laura Zinßer engages in the topic of empowerment during antenatal classes and motivation for birth

During pregnancy many women set increased value on a healthy way of life and are very motivated to change their every-day habits (Lindqvist et al., 2017). Currently different approaches are implemented within antenatal care to maintain and promote women’s and newborn’s health. A constructive approach is the salutogenic concept, which shifts focus from pathology towards health. An important factor to maintain and promote health is ‘empowerment’ (WHO, 1997). Empowerment indicates methods and strategies which increases self-determination and autonomy.

Additionally, self-efficacy (confidence) is an established psychological construct which applies in many different areas of the health sector (Bandura, 1977). Focusing on well-being and salutogenesis can contribute not to overrate the construct of risk. This allows to look at pregnancy and birth less as pathological but rather as normal physiological events. The main focus is to strengthen the pregnant woman’s competency.

During the study “motivation for birth” an autonomous self-motivation-strategy shall be used, with which women can prepare for birth. Information on the women’s confidence will be collected as well. The study aims to find whether the self-motivation-strategy supports women to enter birth more self-assured and confident.

 

Literature

• Bandura A. Self-efficacy: Toward a unifying theory of behavioral change. Psychological Review, 1977; 84(2):191-21.
• Lindqvist M, Lindkvist M, Eurenius E, Persson M, Mogren I. Change of lifestyle habits - Motivation and ability reported by pregnant women in northern Sweden. Sex. Reprod. Healthc. Off. J. Swed. Assoc. Midwives. 2017;13:83–90.
• WHO. Jakarta Declaration on Leading Health Promotion into the 21st Century [Internet]. WHO. 1997 [cited 2017 Oct 16]. Available from: http://www.who.int/healthpromotion/conferences/previous/jakarta/declaration/en/

Stillbirth is a devastating event for parents, families and health care staff. Despite significant advances in medical science, there has been little reduction in stillbirth rates in high-income countries for over two decades. The Lancet’s Stillbirth Series, which was published in April 2011, aimed to bring attention to stillbirth and create the change needed to reduce stillbirths. However, there is still a lot of work to do. In this study parents, care providers and community members from different countries surveyed. This knowledge will help to identify areas where actions can be taken to prevent stillbirths, and to improve care for families who have had a stillborn baby.

Purpose of this study was to learn more about practices, knowledge and views of

• stillbirth from parents who have a stillborn baby;
• to ask care providers about their experiences, views and  practice in caring for women and families around the time of stillbirth and in subsequent pregnancies, and about priority areas for continued research and practice in stillbirth prevention;
• to learn more about practices, knowledge and views of stillbirth from community members.

This knowledge will help to identify areas where actions can be taken to prevent stillbirths, and to improve care for families who have had a stillborn baby.

 

Publications & Conference Proceedings:

• Intrauterine Mortalität - die Lancet-Serie zur Totgeburt (Intrauterine death - The Lancet’s Stillbirths Series). 27. Kongress für Perinatale Medizin, 01.-03.12.2015, Berlin.

• Wojcieszek AM, Boyle FM, Belizán JM, Cassidy J, Cassidy P, Erwich J, FarralesL, Gross M, Heazell A, Leisher SH, Mills T, Murphy M, Pettersson K, Ravaldi C,Ruidiaz J, Siassakos D, Silver RM, Storey C, Vannacci A, Middleton P, Ellwood D, Flenady V. Care in subsequent pregnancies following stillbirth: an international survey of parents. BJOG. 2018 an;125(2):193-201. doi: 10.1111/1471-0528.14424.Epub 2016 Nov 30. IF 2017: 4.876

• Flenady V Wojcieszek AM Middleton P Ellwood D Erwich JJ Coory M Khong TY Silver RM Smith GC Boyle FM Lawn JE Blencowe H Leisher SH Gross MM Horey D Farrales L Bloomfield F McCowan L Brown SJ Joseph KS Zeitlin J Reinebrant HE Ravaldi C Vannacci A Cassidy J Cassidy P Farquhar C Wallace E Siassakos D Heazell AE Storey C Sadler L Petersen S Frøen JF Goldenberg  RL. Lancet Ending Preventable Stillbirths study group; Lancet Stillbirths In High-Income Countries Investigator Group Stillbirths: recall to action in high-income countries. Lancet 2016 Feb 13; 387(10019): 691-702; doi: 10.1016/S0140-6736(15)01020-X. Epub 2016 Jan 19. Review. IF: 47.831

• deWall S Gross MM Gehling H Grylka-Baeschlin S Schwarz C Weckend MJ. Totgeburten in Deutschland - was Eltern brauchen und was Gesundheitsfachpersonen geben können (Stillbirth in Germany - what parents need and what care providers are able to give). Z Hebammenwiss  2016: 04(Suppl.1): 32-34; doi:10.3205/16dghwi17.