Authors

1Mª Cecilia Ruiz Ferrón, 2Estefanía Jurado García, 2Francisca Baena Antequera, 3Mª Del Socorro Arnedillo Sánchez, 3Manuel Jorge Romero Martínez, 3Nuria Barberá Rubini

Position

¹Matrona. Hospital de la Mujer, Hospital Universitario Virgen del Rocío. Profesora asociada Facultad de Enfermería, Fisioterapia y Podología. Universidad de Sevilla. ²Matrona y profesor del Grado de Enfermería de la Escuela Universitaria Francisco Maldonado de Osuna. ³Matrona.

Contact email: nicienfer12@hotmail.com

Abstract

Purpose: We aimed at assessing whether changes in the paradigm of delivery and perinatal care that were implemented in Women's Hospital from 2007 to 2011 (individually-tailored birth care by the same midwife; admission of low risk pregnant women being in active phase and discharge of those in latent phase, based on midwife's decision) resulted in changes in delivery methods and post-partum bleeding (PPB) rate.
Methods: A descriptive, longitudinal, observational study was conducted in pregnant women at the Women's Hospital Virgen del Rocío, Seville, Spain, from 2007 to 2011.
Results: No statistically significant differences were found in post-partum bleeding rates for all births and for eutocic births. A significant difference was found, however, in the rate of post-partum bleeding-free births over the years (N= 15,751, χ2 [degrees of freedom 6] = 3.041, p < 0.001) with the post-partum bleeding-free rate among overall eutocic births and among forceps-assisted or vacuum extractor-assisted instrumental deliveries being lower in 2007 than in 2011. A reduced rate of eutocic births was observed in 2011. Among instrumental deliveries, a reduced rate of those using forceps and vacuum extraction was found, at the expense of an increased rate of spatula-assisted vaginal deliveries and Cesarean section deliveries.
Discussion: Some previous studies showing a relationship between severe obstetric bleeding risk and maternal age should be highlighted. Thus, pregnant women older than 30 show an increased bleeding risk. However, in our study no statistically significant differences were found in overall post-partum bleeding rate for instrumental deliveries in 2011 compared to 2007, in spite of a reduced number of births in 2011 along with increased maternal age (older than 35 years), a higher number of comorbid diseases and an increased number of Cesarean section deliveries. Regarding the final method of delivery, a reduced vaginal delivery rate and an increased (about 2%) Cesarean section rate was observed. This is a remarkable finding as the results have been the opposite in previous studies; this is due to the fact of the studies being based on models in which midwives are fully autonomous.
Conclusions: In order to achieve more noticeable results in obstetric outcomes, midwives should have a leading role in promoting a change to the new paradigm in birth care.

Keywords:

midwife competences; postpartum bleedingbirth

Versión en Español

Título:

Influencia del cambio en las competencias de la matrona en algunos resultados obstétricos

Bibliography