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Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial.

ABSTRACT: OBJECTIVE:To examine the effect of an antenatal education programme in small classes versus standard auditorium-based lectures. DESIGN:Randomised trial using random-generated web-based 1:1 allocation. SETTING:The largest birth site in the Capital Region of Denmark, from August 2012 to May 2014. PARTICIPANTS:1766 pregnant women. Inclusion criteria ?18?years, pregnant with a single child, and able to speak and understand Danish. Women were enrolled in the trial from 10+0 to 20+0?weeks of gestation. INTERVENTIONS:The intervention programme consisted of three times 2.5?hours of antenatal education in small classes (n=6-8 women), and focused on improving information and problem-solving skills for expectant parents in order to ease birth and the transition to parenthood. The control group received standard auditorium-based lectures consisting of two times 2?hours in an auditorium with participation of ?250 people. MAIN OUTCOME MEASURES:The primary trial outcome was use of epidural analgesia. Other types of pain relief and obstetric interventions were analysed as explorative outcomes. RESULTS:There was no statistically significant difference in use of epidural analgesia between participants in the intervention group (30.9%) versus the control group (29.1%), adjusted OR 1.10 (95% CI 0.87 to 1.34). Also, the two groups did not differ regarding other types of pain relief or obstetric interventions. Concomitant birth preparation was common in both groups and highest in the control group, but did not seem to influence our results noticeably. CONCLUSIONS:Antenatal education in small groups versus standard auditorium-based lectures did not differ regarding use of epidural analgesia, other pain relief, or obstetric interventions. TRIAL REGISTRATION NUMBER:NCT01672437; Results.

SUBMITTER: Brixval CS

PROVIDER: S-EPMC4908902 | biostudies-literature | 2016 Jun

REPOSITORIES: biostudies-literature

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Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial.

Brixval Carina Sjöberg CS Thygesen Lau Caspar LC Axelsen Solveig Forberg SF Gluud Christian C Winkel Per P Lindschou Jane J Weber Tom T Due Pernille P Koushede Vibeke V

BMJ open 20160610 6

<h4>Objective</h4>To examine the effect of an antenatal education programme in small classes versus standard auditorium-based lectures.<h4>Design</h4>Randomised trial using random-generated web-based 1:1 allocation.<h4>Setting</h4>The largest birth site in the Capital Region of Denmark, from August 2012 to May 2014.<h4>Participants</h4>1766 pregnant women. Inclusion criteria ≥18 years, pregnant with a single child, and able to speak and understand Danish. Women were enrolled in the trial from 10 ...[more]

PMID: 27288375

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Project description:BackgroundSince 2002, Tanzania has been implementing the focused Antenatal Care (ANC) model that recommended four antenatal care visits. In 2016, the World Health Organization (WHO) reintroduced the standard ANC model with more interventions including a minimum of eight contacts. However, cost-implications of these changes to the health system are unknown, particularly in countries like Tanzania, that failed to optimally implement the simpler focused ANC model. We compared the health system cost of providing ANC under the focused and the standard models at primary health facilities in Tanzania.MethodsWe used a micro-costing approach to identify and quantify resources used to implement the focused ANC model at six primary health facilities in Tanzania from July 2018 to June 2019. We also used the standard ANC implementation manual to identify and quantify additional resources required. We used basic salary and allowances to value personnel time while the Medical Store Department price catalogue and local market prices were used for other resources. Costs were collected in Tanzanian shillings and converted to 2018 US$.ResultsThe health system cost of providing ANC services at six facilities (2 health centres and 4 dispensaries) was US$185,282 under the focused model. We estimated that the cost would increase by about 90% at health centres and 97% at dispensaries to US$358,290 by introducing the standard model. Personnel cost accounted for more than one third of the total cost, and more than two additional nurses are required per facility for the standard model. The costs per pregnancy increased from about US$33 to US$63 at health centres and from about US$37 to US$72 at dispensaries.ConclusionIntroduction of a standard ANC model at primary health facilities in Tanzania may double resources requirement compared to current practice. Resources availability has been one of the challenges to effective implementation of the current focused ANC model. More research is required, to consider whether the additional costs are reasonable compared to the additional value for maternal and child health.

Project description:Australia experiences frequent heat waves and generally high average temperatures throughout the continent with substantial impacts on human health and the economy. People adapt to heat by adopting various relief measures in their daily lives including changing their behaviour. Many labour intensive outdoor industries implement standards for heat stress management for their workforce. However, little is known about how people cope with heat at their workplaces apart from studies targeting some specific industries where labourers are exposed to extreme heat. Here, we analysed responses from 1719 people in the Australian labour force to self-reported heat stress and associated coping mechanisms. Three quarters of respondents experienced heat stress at their workplace with fatigue and headache being the two most frequently stated symptoms. Almost all of those who were affected by heat would hydrate (88%), 67% would cool, and 44% would rest as a strategy for coping with heat. About 10% intended to change their jobs because of heat stress in the workplace. We found differences in heat relief measures across gender, education, health, level of physical intensity of job, and time spent working outside. People working in jobs that were not very demanding physically were more likely to choose cooling down as a relief measure, while those in labour intensive jobs and jobs that required considerable time outside were more likely to rest. This has potential consequences for their productivity and work schedules. Heat affects work in Australia in many types of industry with impact dependent on workforce acclimatisation, yet public awareness and work relief plans are often limited to outdoor and labour intensive industries. Industries and various levels of government in all sectors need to implement standards for heat management specific to climate zones to help people cope better with high temperatures as well as plan strategies in anticipation of projected temperature increases.

Project description:BackgroundApproximately one million stillbirths occur annually during labour; most of these stillbirths occur in low and middle-income countries and are associated with absent, inadequate, or delayed obstetric care. The low proportion of intrapartum stillbirths in high-income countries suggests that intrapartum stillbirths are largely preventable with quality intrapartum care, including prompt recognition and management of intrapartum complications. The evidence for impact of intrapartum interventions on stillbirth and perinatal mortality outcomes has not yet been systematically examined.MethodsWe undertook a systematic review of the published literature, searching PubMed and the Cochrane Library, of trials and reviews (N = 230) that reported stillbirth or perinatal mortality outcomes for eight interventions delivered during labour. Where eligible randomised controlled trials had been published after the most recent Cochrane review on any given intervention, we incorporated these new trial findings into a new meta-analysis with the Cochrane included studies.ResultsWe found a paucity of studies reporting statistically significant evidence of impact on perinatal mortality, especially on stillbirths. Available evidence suggests that operative delivery, especially Caesarean section, contributes to decreased stillbirth rates. Induction of labour rather than expectant management in post-term pregnancies showed strong evidence of impact, though there was not enough evidence to suggest superior safety for the fetus of any given drug or drugs for induction of labour. Planned Caesarean section for term breech presentation has been shown in a large randomised trial to reduce stillbirths, but the feasibility and consequences of implementing this intervention routinely in low-/middle-income countries add caveats to recommending its use. Magnesium sulphate for pre-eclampsia and eclampsia is effective in preventing eclamptic seizures, but studies have not demonstrated impact on perinatal mortality. There was limited evidence of impact for maternal hyperoxygenation, and concerns remain about maternal safety. Transcervical amnioinfusion for meconium staining appears promising for low/middle income-country application according to the findings of many small studies, but a large randomised trial of the intervention had no significant impact on perinatal mortality, suggesting that further studies are needed.ConclusionAlthough the global appeal to prioritise access to emergency obstetric care, especially vacuum extraction and Caesarean section, rests largely on observational and population-based data, these interventions are clearly life-saving in many cases of fetal compromise. Safe, comprehensive essential and emergency obstetric care is particularly needed, and can make the greatest impact on stillbirth rates, in low-resource settings. Other advanced interventions such as amnioinfusion and hyperoxygenation may reduce perinatal mortality, but concerns about safety and effectiveness require further study before they can be routinely included in programs.

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Dataset Information

Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial.

Publications

Effect of antenatal education in small classes versus standard auditorium-based lectures on use of pain relief during labour and of obstetric interventions: results from the randomised NEWBORN trial.

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