inderjeet kaur
Barts Health NHS Trust/Fernandez Hospital. Hyderabad, India
Passionate about reducing health inequalities and worked closely with vulnerable groups in East London. Currently based in Hyderabad, India working with vulnerable groups with Fernandez Hospital in embedding the professional midwifery models and helping introduce the concepts of professional midwifery impacting and influencing the natural birth agenda.
Background: According to the MCWP Consensus statement, normal birth is a birth without induction of labour (with prostaglandins, oxytocics or ARM), epidural or spinal or general anaesthetic, forceps or ventouse, caesarean... [ view full abstract ]
Background: According to the MCWP Consensus statement, normal birth is a birth without induction of labour (with prostaglandins, oxytocics or ARM), epidural or spinal or general anaesthetic, forceps or ventouse, caesarean section, or episiotomy. This has not been well-studied in the Indian subcontinent and the study aimed to address this gap.
Method: This retrospective study comprised women delivered in 2016 at Fernandez hospital, a tertiary care perinatal centre with midwifery support (midwives: parturients = 1:2 to 1:3). The incidence of normal births was determined and characteristics of those who experienced normal births compared with those who did not.
Results: Of the 8397 deliveries occurring at or beyond 24 weeks of gestation, 4148 (49.4%) were vaginal births. Excluding pre-labour Caesarean sections (n=2086), the rates of labour induction and epidural analgesia were 41.9% and 48.9% respectively. Episiotomy was performed in 46.1% of vaginal deliveries. Normal births constituted 11.1% of all deliveries and 27.9% of births in women belonging to Robson groups 1 and 3; 31.9% in the unit with more midwifery involvement compared to 19.6% in the high-risk unit. Multiparity (OR 12.1; 95% CI: 9.97-14.81; p<0.0001) and advanced maternal age (OR 2.2; 95% CI: 1.35-3.49; p=0.001) were significantly associated with normal births.
Discussion: The high Caesarean rate is attributable to the hospital being a tertiary referral centre for high risk pregnancies and neonates. All women in Robson groups 1 and 3 had one or more maternal or fetal risk factors; so, potentially modifiable factors in them include analgesics, episiotomy and operative deliveries. Further, labour induction policies and Caesarean section indications need to be closely monitored.
Conclusion: There is an urgent need for reducing interventions in labour. Training of professional midwives and development of a midwifery-led care model is paramount. Even among high-risk pregnancies, a stringent implementation of intrapartum care protocols coupled with periodic audits can promote normal births.
The identification and examination of relevant outcomes relating to labour and birth
