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Biomedical subjects

H Spiby

Publications and source records attributed to H Spiby.

15 recordsLinked to original sources
PubMed2000

Costs and effectiveness of community postnatal support workers: randomised controlled trial.

OBJECTIVES: To establish the relative cost effectiveness of postnatal support in the community in addition to the usual care provided by community midwives. DESIGN: Randomised controlled trial with six month follow up. SETTING: Recruitment in a university teaching hospital and care provided in women's homes. PARTICIPANTS: 623 postnatal women allocated at random to intervention (311) or control (312) group. INTERVENTION: Up to 10 home visits in the first postnatal month of up to three hours duration by a community postnatal support worker. MAIN OUTCOME MEASURE: General health status as measured by the SF-36 and risk of postnatal depression. Breast feeding rates, satisfaction with care, use of services, and personal costs. RESULTS: At six weeks there was no significant improvement in health status among the women in the intervention group. At six weeks the mean total NHS costs were pound 635 for the intervention group and pound 456 for the control group (P=0.001). At six months figures were pound 815 and pound 639 (P=0.001). There were no differences between the groups in use of social services or personal costs. The women in the intervention group were very satisfied with the support worker visits. CONCLUSIONS: There was no health benefit of additional home visits by community postnatal support workers compared with traditional community midwifery visiting as measured by the SF-36. There were no savings to the NHS over six months after the introduction of the community postnatal support worker service.

Adolescent↗
PubMed2000

Fathers' coping style, antenatal preparation, and experiences of labor and the postpartum.

BACKGROUND: In recent years the trend for fathers in Western postindustrial countries to attend childbirth has increased. This study examined the interaction between fathers' information-seeking coping predispositions and their level of attendance at antenatal classes with respect to their experiences of attending childbirth. Associations between fathers' childbirth experiences, their relationship with their baby, and level of depressive symptomatology at 6 weeks postpartum were also examined. METHODS: A quantitative methodology was employed in which 78 fathers completed several questionnaires, some within 6 days of childbirth and others at 6 weeks postpartum. RESULTS: Fathers who were characterized as high blunters (avoiders) of threat information, from antenatal classes reported that experiencing childbirth was less fulfilling than fathers with similar coping styles who did not attend classes. Fathers' reports of fulfillment and delight while attending childbirth were negatively related to their level of depressive symptomatology at 6 weeks postpartum. Levels of distress were associated with subsequent depressive symptoms, but their effect was removed when preexisting depressive symptoms were partialled out. Fathers whose children were born by cesarean delivery used significantly more negative adjectives to describe their baby at 6 weeks postpartum compared with those born by vaginal delivery. More married fathers attended antenatal classes and reported lower levels of depressive symptomatology than unmarried fathers. CONCLUSIONS: Although fathers' attendance at antenatal classes may have positive consequences for them and their partner, for some fathers, attendance at classes may be associated with less positive reports of experiencing childbirth. The way in which men experience childbirth may have some influence on their subsequent emotional well-being.

Adaptation, Psychological↗
PubMed2000

Costs and benefits of community postnatal support workers: a randomised controlled trial.

OBJECTIVES: This study aimed to measure the effect and the total cost per woman of providing postnatal support at home, based on a Dutch model. The research hypothesis was furnished by some existing evidence that postnatal support could reduce the risk of postnatal depression and encourage breastfeeding. DESIGN: The randomised controlled trial aimed to measure differences in health status in a group of women who were offered postnatal support from a community midwifery support worker (SW) compared with a control group of women who were not offered this support. Women were followed-up by postal questionnaire at 6 weeks and 6 months postnatally. SETTING AND SUBJECTS: All women who delivered a baby at the recruiting hospital were eligible to take part in the trial if they lived within the study area, were aged 17 years or over, and could understand English. INTERVENTION: The intervention consisted of the SW offering practical and emotional support and to help women rest and recover after childbirth. The SW offered ten visits in the first 28 days postnatally, for up to 3 hours per day. The SW's activities included housework, talking with the mother, and care for the baby or other siblings. The service was provided in addition to routine visits by the community midwife. MAIN OUTCOME MEASURES: The primary outcome was the general health perception domain of the Short Form-36 at 6 weeks. Secondary outcomes were mean Edinburgh Postnatal Depression Scale (EPDS), Duke Functional Social Support (DUFSS) scores and breastfeeding rates. RESULTS: The 623 randomised women were well-matched by group with a good response to follow-up. At 6 weeks there was no evidence of a significant difference between the two groups for the primary outcome. There was a non-significant trend for the control group to have better mean DUFSS and EPDS scores at 6 weeks. Breastfeeding rates were not significantly different at follow-up. At 6 months, both groups had similar health status. Satisfaction with the service was higher than for all other services received. The incremental cost of introducing the service comprised setting up and running the service. There were no differences between the groups in other resource use (general practitioner contacts, hospital services, prescriptions or medicines bought for mothers and babies) to 6-month follow-up. The total mean NHS cost to 6-month follow-up for the intervention group was pound180 per woman greater than for the control group (confidence interval, pound79.60, pound272.40). CONCLUSIONS: Although women valued the service, there was no evidence of any health benefit at the 6-week or 6-month follow-up, no difference in use of NHS services, and the additional cost of the service provision would be around pound 180 per woman.

Adolescent↗
PubMed1999

Strategies for coping with labour: does antenatal education translate into practice?

There is little evidence to associate attendance at antenatal classes with a reduction in psychological distress or increased satisfaction with the experience of labour. There may be several reasons for this, including failure to implement coping strategies. A within-subjects research design explored the use in labour of coping strategies taught in antenatal classes and the role of practice. Women's views about using these strategies and their expectations of their midwives and birth companions were also identified. Following Ethics Committee approval and providing informed consent, 121 nulliparous women completed a questionnaire at their final antenatal class. This included questions on confidence and the amount of effort required to use coping strategies, the involvement hoped for from birth companions and midwives in using coping strategies in labour and satisfaction with the amount of practice of coping strategies. Within 72 hours of delivery, women were interviewed to obtain a narrative of the events of labour and their use of the coping strategies (sighing-out-slowly breathing, Laura Mitchell relaxation and postural change). A questionnaire obtained information on the involvement of the midwife and birth companion. Women used the three coping strategies to different extents. Midwives were not involved to the extent that women had hoped for antenatally. Birth companions achieved a level of involvement closer to women's hopes than that achieved by midwives. A significant proportion of women expressed dissatisfaction with the amount of practice of coping strategies during antenatal classes. The findings of this study of a group of well-prepared women raise questions about the correct components of antenatal classes and how midwives and birth companions can be involved optimally in this aspect of a woman's labour. Further research is required to determine how women can best be helped to cope with the experience of labour.

Adaptation, Psychological↗
PubMed1995

A study exploring midwives' education in, knowledge of and attitudes to nutrition in pregnancy.

OBJECTIVE: to explore midwives' education in, knowledge of and attitudes to nutrition in pregnancy. DESIGN: survey using questionnaire and interview schedule. PARTICIPANTS: a randomly selected sample of 77 Registered Midwives. SETTING: one English regional health authority. MEASUREMENTS AND FINDINGS: qualitative and quantitative data collection methods. Midwife teachers were responsible for 95% of teaching in nutrition. 86% of midwives had received no education in nutrition following qualification. 46% of midwives achieved a poor score in nutrition knowledge. Considerable numbers of midwives felt unprepared to offer dietary advice to women from ethnic minority groups (36%), vegetarians (66%) and to women with pre-existing medical conditions (41%). KEY CONCLUSION: midwives require more education in nutrition both during basic education and following qualification. IMPLICATIONS FOR EDUCATION PRACTICE: nutritional issues should be included in continuing education programmes available to qualified midwives.

Female↗
PubMed1990

Maternal haematocrit in labour is related to fetal cord pH at delivery.

OBJECTIVE: To determine whether a correlation exists between maternal haematocrit in labour and umbilical cord pH values at delivery. DESIGN: An observational study. SETTING: The delivery suite. SUBJECTS: 200 pregnant women in labour. MAIN OUTCOME MEASURES: Umbilical artery and vein blood pH values. RESULTS: A statistically significant inverse correlation was observed between maternal haematocrit levels during labour and umbilical vein pH (r = -0.22; P = 0.001) and umbilical artery pH (r = -0.18; P = 0.008) at delivery. CONCLUSIONS: Although an inverse correlation does appear to exist between maternal haematocrit and cord pH values, it is unlikely that this weak association will prove to be of clinical value in the management of labour.

Female↗
PubMed1989

Oxytocin infusion during second stage of labour in primiparous women using epidural analgesia: a randomised double blind placebo controlled trial.

OBJECTIVE: To determine whether the high rate of forceps delivery associated with the use of epidural analgesia could be reduced through giving an intravenous infusion of oxytocin during the second stage of labour. DESIGN: A randomised, double blind, placebo controlled trial. SETTING: Delivery suites in three hospitals. SUBJECTS: 226 Primiparous women with adequate epidural analgesia in whom full dilatation of the cervix had been achieved without prior stimulation with oxytocin. INTERVENTION: An infusion of oxytocin or placebo starting at the diagnosis of full cervical dilatation at an initial dose rate of 2 mU/min increasing to a maximum of 16 mU/min. MAIN OUTCOME MEASURES: The outcome of labour was assessed in terms of the duration of the second stage, mode of delivery, fetal condition at birth, postpartum blood loss, and the incidence of perineal trauma. RESULTS: Treatment with oxytocin was associated with a shorter second stage (p = 0.01), a reduction in the number of non-rotational forceps deliveries (p = 0.03), and less perineal trauma (p = 0.03) but was not associated with any reduction in the number of rotational forceps deliveries performed for malposition of the occiput. No adverse effects on fetal condition at birth or in the early puerperium were seen in association with the use of oxytocin. CONCLUSIONS: The use of an oxytocin infusion may reduce the high rate of operative delivery associated with epidural analgesia provided that the fetal occiput is in an anterior position at the onset of the second stage of labour but within the dose range studied does not seem to correct malposition of the fetal occiput.

Adolescent↗
PubMed1989

A randomized study of the sitting position for delivery using a newly designed obstetric chair.

A new obstetric chair has been designed to overcome some of the problems of those currently available commercially. The chair has been used to assess the effects of the sitting position in the second stage of labour on the outcome of delivery in 304 women randomly allocated to be delivered either in the chair or in the conventional dorsal position. Delivery in the chair conferred no benefits to mother or baby and resulted in greater mean blood loss and a higher rate of postpartum haemorrhage.

Delivery, Obstetric↗