Home Midwives Research Research abstracts

Research abstracts

Submissions 2
Research abstracts and items of interest selected
for their relevance to midwifery in New Zealand

July to September 2022

Verhoeven, C. J. M., Boer, J., Kok, M., Nieuwenhuijze, M., de Jonge, A., Peters, L. L. (2022)

More home births during the COVID-19 pandemic in the Netherlands

Birth, https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12646


The aim of this observational study was to examine whether the course of pregnancy and birth and accompanying outcomes among low-risk pregnant women changed in the COVID-19 pandemic compared to the prepandemic period.


We included 5913 low-risk pregnant women of whom 2963 (50.1%) were pregnant during the first surge of the COVID-19 pandemic, and 2950 (49.9%) in the prepandemic period. During the COVID-19 pandemic, more women desired and had a home birth. More women used pain medication and fewer had an episiotomy in the COVID-19 period than prior. Multiparous women had a higher suspected rate of fetal growth restriction during COVID; however, the actual rate of small for gestational age infants was not significantly increased. We observed no differences for onset and augmentation of labor or for mode of birth, though the rate of vaginal births increased.


During the COVID-19 pandemic, there was a higher rate of planned and actual home birth, and suspected growth restriction and a lower rate of episiotomy among low-risk pregnant women in the Netherlands.

Link to open access article


Yuill, C., Harkness, M., Wallace, C., McCourt, C., Cheyne, H., & Litosseliti, L. (2022)

Inducing labour in the United Kingdom: A feminist critical discourse analysis of policy and guidance.

SSM – Qualitative Research in Health, 2 – https://doi.org/10.1016/j.ssmqr.2022.100108


  • This feminist critical discourse analysis explores professional writing about induction of labour (IOL) policy and practice from the United Kingdom.
  • A double discourse was identified that operates at both explicit and implicit levels.
  • There are differences between what is stated (explicit) and underlying messages (implicit).
  • Women are afforded little agency within their own experience of IOL by many of the authors.
  • Discourse often functions to preserve clinicians’ control over maternity care.


Induction of labour (IOL), the process of starting labour artificially, is one of the most commonly performed procedures in maternity care in the United Kingdom (UK), yet there is debate whether inducing labour at ‘term’, in the absence of specific medical indication, is beneficial and reduces risk of stillbirth. Moreover, rates of routine IOL are rapidly rising in the UK, despite uncertainty about the evidence base and parents reporting receiving a lack of balanced information about the process. As a contested area of maternity care, the language used to debate, describe and discuss IOL takes on added significance and requires in-depth examination and analysis. To address this, we conducted a feminist critical discourse analysis on policy and professional writing about IOL in the UK, focusing on how these both reflect and construct social practices of pregnancy and birth. Our analysis identified a double discourse about IOL, which we term ‘explicit-implicit discourse of care’, revealing the differences between what is expected to be said and what is really said. Though most texts displayed an explicit discourse of care, which espoused women-centred care and informed choice, they also conveyed an implicit discourse of care, primarily composed of three key dimensions: women as absent actors, disembodiment, and evidence as a primary actor. We argue that this explicit-implicit discourse functions to preserve healthcare professionals’ control over maternity care and further alienate women from their own bodies while maintaining a discursive position of women-centred care and informed choice.

Open access article available

Winkler, A., Isacson, M., Gustafsson, A., Svedenkrans, J., & Andersson, O. (2022)

Cord clamping beyond 3 minutes: Neonatal short‐term outcomes and maternal postpartum hemorrhage.

Birth – https://doi.org/10.1111/birt.12645


Delaying cord clamping (CC) for 3-5 minutes reduces iron deficiency and improves neurodevelopment. Data on the effects of CC beyond 3 minutes in relation to short-term neonatal outcomes and maternal risk of postpartum hemorrhage are scarce.


Umbilical CC times beyond 3 minutes in vaginal deliveries were not associated with negative short-term outcomes in newborns and were associated with a smaller maternal postpartum blood loss. Although CC time as long as 6 minutes could be considered as safe, further research is needed to decide the optimal timing.

Open access article available

Bell, C.H., Muggleton, S., Davis, D. L. (2022)

Birth plans: A systematic, integrative review into their purpose, process, and impact.

Midwifery, 111:103388 – doi: 10.1016/j.midw.2022.103388


The birth plan was introduced in the 1980s to facilitate communication between maternity care providers and women and increase agency for childbearing women in the face of medicalised birth. Forty years on, the birth plan is a heterogeneous document with uncertainty surrounding its purpose, process, and impact. The aim of this review was to synthesise the evidence and improve understanding of the purpose, process and impact of the birth plan on childbearing women’s experiences and outcomes.


Despite the heterogeneity of birth plans, birth plans were associated with positive outcomes for childbearing women when developed in collaboration with care providers. The act of collaboratively creating a birth plan may improve obstetric outcomes, aid realistic expectations, and improve satisfaction and the sense of control.

Expanded abstract available

June to August 2022

Seimon, R. V., Natasha, N., Schneuer, F. J., Pereira, G., Mackie, A., Ross, G. P., Sweeting, A. N., Seeho, S. K. M., & Hocking, S. L. (2022)

Maternal and neonatal outcomes of women with gestational diabetes and without specific medical conditions: an Australian population-based study comparing induction of labor with expectant management.

Aust NZ J Obstet Gynaecol,1-11. https://doi.org/10.1111/ajo.13505


To evaluate maternal birth and neonatal outcomes among women with gestational diabetes mellitus (GDM), but without specific medical conditions and eligible for vaginal birth who underwent induction of labour (IOL) at term compared with those who were expectantly managed.


In women with GDM but without specific medical conditions and eligible for vaginal birth, IOL at 38, 39, 40 weeks gestation is associated with an increased risk of caesarean section.

Open access article available

Kluwgant, D., Homer, C., & Dahlen, H. (2022)

“Never let a good crisis go to waste”: Positives from disrupted maternity care in Australia during COVID-19.

Midwifery, 110(103340): https://doi.org/10.1016/j.midw.2022.103340


Due to the COVID-19 pandemic, a number of changes to maternity care were rapidly introduced in all countries, including Australia, to reduce the risk of infection for pregnant women and their care providers. While many studies have reported on the negative effects of these changes, there is a paucity of evidence on factors which women and their providers perceived as positive and useful for future maternity care.

Key conclusions

Despite the negative effect of COVID-19-related restrictions on maternity care, a variety of changes were viewed as positive by both women and midwives, with strong agreement between the two groups.

Implications for practice

These findings provide evidence to support the inclusion of these positive elements of care and ensure that the lessons learned from the pandemic are utilised to improve maternity care in Australia going forward.

Open access article available 

Charpak, N., Tessier, R., Ruiz, J. G., Uriza, F., Hernandez, J. T., Cortes, D., Montealegre-Pomar, A. (2022)

Kangaroo mother care had a protective effect on the volume of brain structures in young adults born preterm.

Acta Paediatrica, 11(5): 1004-1014.


The protective effects of Kangaroo mother care (KMC) on the neurodevelopment of preterm infants are well established, but we do not know whether the benefits persist beyond infancy. Our aim was to determine whether providing KMC in infancy affected brain volumes in young adulthood.


Our findings suggest that the neuroprotective effects of KMC for preterm infants persisted beyond childhood and improved their lifetime functionality and quality of life.

Open access article available 

Tschider, L., Seekircher, L., Kunutsor, S. K., Peters, S. A., O’Keefe, L. M., & Willeit, P. (2022)

Breastfeeding Is Associated With a Reduced Maternal Cardiovascular Risk: Systematic Review and Meta‐Analysis Involving Data From 8 Studies and 1 192 700 Parous Women.

Journal of the American Heart Association, 11(2) – https://doi.org/10.1161/JAHA.121.022746


Breastfeeding has been robustly linked to reduced maternal risk of breast cancer, ovarian cancer, and type 2 diabetes. We herein systematically reviewed the published evidence on the association of breastfeeding with maternal risk of cardiovascular disease (CVD) outcomes.


Breastfeeding was associated with reduced maternal risk of CVD outcomes.

Open access article available 

Dahlen, H. G., Ormsby, S., Staines, A., Kirk, M., Johnson, L., Small, K., Hazard, B., & Schmied, V. (2022)

A comparison of the Woman-centred care: strategic directions for Australian maternity services (2019) national strategy with other international maternity plans.

Women and Birth, https://doi.org/10.1016/j.wombi.2022.04.003


In 2019 the Australian government released a guiding document for maternity care: Woman-centred care strategic directions for Australian maternity services (WCC Strategy), with mixed responses from providers and consumers. The aims of this paper were to: examine reasons behind reported dissatisfaction, and compare the WCC Strategy against similar international strategies/plans. The four guiding values in the WCC strategy: safety, respect, choice, and access were used to facilitate comparisons and provide recommendations to governments/health services enacting the plan.


Maternity strategy/plans should be based on the best available evidence, with consistent and complementary recommendations. Within this framework, priority should be given to women’s preferences and choices, rather than the interests of organisations and individuals

Open access article available  


January to March 2022

Feeley, C., Downe, S., & Thomson, G. (2021)

Stories of distress versus fulfilment’: A narrative inquiry of midwives’ experiences supporting alternative birth choices in the UK National Health Service

Women and Birth, https://doi.org/10.1016/j.wombi.2021.11.003 

Abstract conclusion

The midwives’ experiences were mediated by their socio-cultural working contexts. Negative experiences were characterised by a misalignment between the midwives’ philosophy and organisational cultures, with significant consequences for the midwives. Conversely, examples of good organisational culture and practice reveal that it is possible for organisations to fulfil their obligations for safe and positive maternity care for both childbearing women who make alternative birthing choices, and for attending staff. This highlights what is feasible and achievable within maternity organisations and offers transferable insights for organisational support of out-of-guideline care that can be adapted across the UK and beyond.

Full abstract available here

Zhang, H., Liu, H., Luo, S., & Weirong, G. (2021)

Oxytocin use in trial of labor after cesarean and its relationship with risk of uterine rupture in women with one previous cesarean section

BMC Pregnancy Childbirth 21, 11. https://doi.org/10.1186/s12884-020-03440-7

Abstract conclusion

Women with induced labor had a higher risk of uterine rupture compared to women with spontaneous labor following TOLAC. Oxytocin use may increase this risk, which could be influenced by the process of induction or individual cervix condition. Consequently, simplified and standardized intrapartum management, precise protocol, and cautious monitoring of oxytocin use in TOLAC are necessary.

Link to open access article

Karlmark, K. R., El Haddad, M., Donato, X-C., Martin, G. V., et al. (2021)

Grandmaternal cells in cord blood

The Lancet, 74(103721). https://doi.org/10.1016/j.ebiom.2021.103721


During pregnancy a feto-maternal exchange of cells through the placenta conducts to maternal microchimerism (Mc) in the child and fetal Mc in the mother. Because of this bidirectional traffic of cells, pregnant women have also acquired maternal cells in utero from their mother and could transfer grandmaternal (GdM) cells to their child through the maternal bloodstream during pregnancy. Thus, cord blood (CB) samples could theoretically carry GdMMc. Nevertheless this has never been demonstrated.


Transgenerational transfer of cells could have implications in immunology and evolution. Further analyses will be necessary to evaluate whether GdMMc in CB is a passive or immunologically active transfer and whether invasive prenatal procedures could trigger GdMMc.

Link to open access article 

Conti, M. G., Terreri, S., Piano Mortari, E., et al. (2021)

Immune Response of Neonates Born to Mothers Infected With SARS-CoV-2

JAMA Netw Open, 4(11):e2132563. doi:10.1001/jamanetworkopen.2021.32563


Importance: Although several studies have provided information on short-term clinical outcomes in children with perinatal exposure to SARS-CoV-2, data on the immune response in the first months of life among newborns exposed to the virus in utero are lacking.

Conclusions and Relevance: In this cohort study, SARS-CoV-2 spike–specific IgA antibodies were detected in infant saliva, which may partly explain why newborns are resistant to SARS-CoV-2 infection. Mothers infected in the peripartum period appear to not only passively protect the newborn via breastmilk secretory IgA but also actively stimulate and train the neonatal immune system via breastmilk immune complexes.

Link to open access article


Robledo, K. P., Tarnow-Mordi, W. O., Rieger, I., Suresh, P., et al. (2021)

Effects of delayed versus immediate umbilical cord clamping in reducing death or major disability at 2 years corrected age among very preterm infants (APTS): a multicentre, randomised clinical trial

The Lancet Child and Adolescent Health, https://doi.org/10.1016/S2352-4642(21)00373-4


Very preterm infants are at increased risk of adverse outcomes in early childhood. We assessed whether delayed clamping of the umbilical cord reduces mortality or major disability at 2 years in the APTS Childhood Follow Up Study.


Clamping the umbilical cord at least 60s after birth reduced the risk of death or major disability at 2 years by 17%, reflecting a 30% reduction in relative mortality with no difference in major disability.

Link to full abstract 

Murray, C. J. L., Shunji Ikuta, K., Sharara, F., Swetchinski, L et al., (Antimicrobial Resistance Collaborators). (2022)

Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis

 The Lancet, DOI: https://doi.org/10.1016/S0140-6736(21)02724-0


Antimicrobial resistance (AMR) poses a major threat to human health around the world. Previous publications have estimated the effect of AMR on incidence, deaths, hospital length of stay, and health-care costs for specific pathogen–drug combinations in select locations. To our knowledge, this study presents the most comprehensive estimates of AMR burden to date.


To our knowledge, this study provides the first comprehensive assessment of the global burden of AMR, as well as an evaluation of the availability of data. AMR is a leading cause of death around the world, with the highest burdens in low-resource settings. Understanding the burden of AMR and the leading pathogen–drug combinations contributing to it is crucial to making informed and location-specific policy decisions, particularly about infection prevention and control programmes, access to essential antibiotics, and research and development of new vaccines and antibiotics. There are serious data gaps in many low-income settings, emphasising the need to expand microbiology laboratory capacity and data collection systems to improve our understanding of this important human health threat.

Link to open access article

October - December 2021

Stulz, V. M.,  Bradfield, Z., Cummins, A., Catling, C., Sweet, L., McInnes, R., McLaughlin, K., Taylor, J., Hartz, D., Sheehan, A. (2021).

Midwives providing woman-centred care during the Covid-19 pandemic in Australia: A national qualitative study

Women and Birth, https://doi.org/10.1016/j.wombi.2021.10.006

Findings of this study offer important evidence regarding the impact of the pandemic on the provision of woman-centred care which is key to midwifery philosophy. Recommendations are made for ways to preserve and further enhance woman-centred care during periods of uncertainty such as during a pandemic or other health crises.

Full abstract

Oommen, H., Oddbjørn Tveit, T., Eskedal, L. T., Myr, R., Swanson, D. M., Vistad, I. (2021).

The association between intrapartum opioid fentanyl and early breastfeeding: A prospective observational study.

AOGS, DOI: 10.1111/aogs.14268

Fentanyl in labor is associated with breastfeeding difficulties. However, IV fentanyl in low doses (≤200 µg) seems to affect breastfeeding less than EDA fentanyl and is therefore a viable alternative when labor analgesia is needed. This could be most relevant for multiparous women, where a shorter labor is expected. More research is needed to determine the optimal dose and route of administration of fentanyl for labor analgesia.

Full article

Thompson, J.M.D., Wilson, J., Bradford, B.F., Li, M., Cronin, R. S., Gordon, A., et al. (2021).

A better understanding of the association between maternal perception of foetal movements and late stillbirth—findings from an individual participant data meta-analysis.

BMC Med 19(267) https://doi.org/10.1186/s12916-021-02140-z

Reduced foetal movements are associated with late stillbirth, with the association strongest at preterm gestations. Foetal hiccups and multiple episodes of vigorous movements are reassuring at all gestations after 28 weeks’ gestation, whereas a single episode of vigorous movement is associated with stillbirth at term.

Full article

Hadebe, R., Seed, P.T., Essien, D., et al. (2001)

Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population. A retrospective cohort study, London, UK.

BMJ Open, 11:e049991. doi: 10.1136/bmjopen-2021-049991

This study shows that a model of caseload midwifery care implemented in an inner city deprived community improves outcome by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. This data trend suggests that when applied to targeted groups (women in higher IMD quintile and women of diverse ethnicity) that the impact of intervention is greater.

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July - September 2021

Crowther, S., Maude, R., Bradford, B., Austin, D., Gilkison, A., McAra-Couper, J., & Krisjanous, J. (2021)

When Maintaining Relationships and Social Connectivity Matter: The Case of New Zealand Midwives and COVID-19.

Front Social, 6:614017. doi:10.3389/fsoc.2021.614017

Midwives kept women, their families and communities central to the conversation throughout lockdown whilst juggling their concerns about keeping themselves and their own families safe. Insights gained from the media analysis suggest that despite the significant stress and upheaval experienced by midwives and wāhine/women, relational continuity facilitates quality and consistent care that honours women’s choices and cultural needs even during situations of national crisis.

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Marín Gabriel, M. Á., Malalana Martínez, A.M., Marín Martínez, M. E., & Anel Pedroche, J. (2020)

Negative Transmission of SARS-CoV-2 to Hand-Expressed Colostrum from SARS-CoV-2-Positive Mothers.

Breastfeed Med,15(8):492-494

Breast milk was not a source of SARS-CoV-2 transmission. Hand expression (assuring that a mask is used and that appropriate hygienic measures are used for the hands and the breast), when direct breastfeeding is not possible, appears to be a safe way of feeding newborns of mothers with COVID-19.

Full abstract

Mharapara, T. L., Staniland, N., Stadler, M., Clemons, J. H., & Dixon, L. (2021)

Drivers of job satisfaction in midwifery — a work design approach.

Women and Birth, https://doi.org/10.1016/j.wombi.2021.07.004

Given that job satisfaction contributes to recruitment, retention, and sustainability, our findings show that drivers of job satisfaction differ by midwifery work context. We present evidence to support tailored efforts to bolster midwives job satisfaction, especially where resources are limited.

Full abstract

Scarf, V. L., Yu, S., Viney, R., Cheah, S. L., Dahlen, H., Sibbritti, D., Thornton, C., Tracy, S., & Homer, C. (2021)

Modelling the cost of place of birth: a pathway analysis.

BMC Health Services Research, 816: https://doi.org/10.1186/s12913-021-06810-9

The findings from this study provide some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.

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Espada-Trespalacios, X., Ojeda, F., Rodrigo, N. N., Rodriguez-Biosca, A., Coll, P. R., Martin-Arribas, A., & Escuriet, R. (2021)

Induction of labour as compared with spontaneous labour in low-risk women: A multicenter study in Catalonia.

Sexual and Reproductive Healthcare, 29: https://doi.org/10.1016/j.srhc.2021.100648.


  • Induction of labour in low-risk women exceeds recommended rate of <10% established as a quality indicator in Spain.
  • There is a positive association between induced labour and caesarean section
  • There is a positive association between induced labour and operative vaginal births.
  • Induction of labour has a negative association in early initiation of breastfeeding and early skin-to-skin maternal contact.

Full abstract

April - June 2021

Al Wattar, B. H., Honess, E., Bunnewell, S., Welton, N. J., Quenby, S., Khan, K. S., Zamora, J., & Thangaratinam, S. (2021)

Effectiveness of intrapartum fetal surveillance to improve maternal and neonatal outcomes: a systematic review and network meta-analysis

 CMAJ, 193(14):E468-E477


Background: Cesarean delivery is the most common surgical procedure worldwide. Intrapartum fetal surveillance is routinely offered to improve neonatal outcomes, but the effects of different methods on the risk of emergency cesarean deliveries remains uncertain. We conducted a systematic review and network meta-analysis to evaluate the effectiveness of different types of fetal surveillance.

Results: We included 33 trials (118 863 patients) evaluating intermittent auscultation with Pinard stethoscope/handheld Doppler (IA), cardiotocography (CTG), computerized cardiotocography (cCTG), CTG with fetal scalp lactate (CTG-lactate), CTG with fetal scalp pH analysis (CTG-FBS), CTG with fetal pulse oximetry (FPO-CTG), CTG with fetal heart electrocardiogram (CTG-STAN) and their combinations. Intermittent auscultation reduced the risk of emergency cesarean deliveries compared with other types of surveillance (IA v. CTG: RR 0.83, 95% CI 0.72-0.97; IA v. CTG-FBS: RR 0.71, 95% CI 0.63-0.80; IA v.CTG-lactate: RR 0.77, 95% CI 0.64-0.92; IA v. FPO-CTG: RR 0.75, 95% CI 0.65-0.87; IA v.FPO-CTG-FBS: RR 0.81, 95% CI 0.67-0.99; cCTG-FBS v. IA: RR 1.21, 95% CI 1.04-1.42), except STAN-CTG-FBS (RR 1.17, 95% CI 0.98-1.40). There was a similar reduction observed for emergency cesarean deliveries for fetal distress. None of the evaluated methods was associated with a reduced risk of neonatal acidemia, neonatal unit admissions, Apgar scores or perinatal death.

Interpretation: Compared with other types of fetal surveillance, intermittent auscultation seems to reduce emergency cesarean deliveries in labour without increasing adverse neonatal and maternal outcomes.

Full abstract and open access article   


Fernandez Turienzo C., Silverio, S. A., Coxon, K., Brigante, L., Seed, P. T., Shennan, A. H., Sandall, J., On behalf of the POPPIE Collaborative Group. (2021)

Experiences of maternity care among women at increased risk of preterm birth receiving midwifery continuity of care compared to women receiving standard care: Results from the POPPIE pilot trial

PLOS ONE, 16(4): e0248588


Midwifery continuity of care models for women at low and mixed risk of complications have been shown to improve women’s experiences of care. However, there is limited research on care experiences among women at increased risk of preterm birth. We aimed to explore the experiences of care among women with risk factors for preterm birth participating in a pilot trial (POPPIE) of a midwifery continuity of care model which included a specialist obstetric clinic.


Compared with standard maternity care, women at increased risk of PTB who received midwifery continuity of care were more likely to report increased perceptions of trust, safety and quality of care.

Full abstract and open access article

Villar, J., Ariff, S., Gunier, R. B., et al. (2021)

Maternal and Neonatal Morbidity and Mortality Among Pregnant Women With and Without COVID-19 Infection The INTERCOVID Multinational Cohort Study

JAMA Pediatrics, doi:10.1001/jamapediatrics.2021.1050


Objective: To evaluate the risks associated with COVID-19 in pregnancy on maternal and neonatal outcomes compared with not-infected, concomitant pregnant individuals.

Design, Setting, and Participants:  In this cohort study that took place from March to October 2020, involving 43 institutions in 18 countries, 2 unmatched, consecutive, not-infected women were concomitantly enrolled immediately after each infected woman was identified, at any stage of pregnancy or delivery, and at the same level of care to minimize bias. Women and neonates were followed up until hospital discharge.

Main Outcomes and Measures: The primary outcome measures were indices of (maternal and severe neonatal/perinatal) morbidity and mortality; the individual components of these indices were secondary outcomes. Models for these outcomes were adjusted for country, month entering study, maternal age, and history of morbidity.

Results: A total of 706 pregnant women with COVID-19 diagnosis and 1424 pregnant women without COVID-19 diagnosis were enrolled, all with broadly similar demographic characteristics (mean [SD] age, 30.2 [6.1] years

Conclusions and Relevance: In this multinational cohort study, COVID-19 in pregnancy was associated with consistent and substantial increases in severe maternal morbidity and mortality and neonatal complications when pregnant women with and without COVID-19 diagnosis were compared. The findings should alert pregnant individuals and clinicians to implement strictly all the recommended COVID-19 preventive measures.

Full abstract and open access article


Olonan-Jusi, E., Zambrano, P.G., Duong, V.H. et al. (2021).

Human milk banks in the response to COVID-19: a statement of the regional human milk bank network for Southeast Asia and beyond


This statement reflects the expert opinion of the Regional Human Milk Bank Network for Southeast Asia and Beyond on the need to revisit national guidelines based on the best evidence for breastfeeding during the COVID-19 pandemic, to incorporate human milk bank services in national obstetric and newborn care guidelines for COVID-19 where possible, and to ensure that operations of human milk banks are adapted to meet the needs of the current pandemic and to sustain donor human milk supply in the long-term. The Network also recommends sustained engagement with the global human milk bank community.

Full abstract and open access article


January to March 2021

Barry, P. L., McMahon, L. E., Banks, R. AM., Fergus, A. M. & Murphy, D. J. (2020)

Prospective cohort study of water immersion for labour and birth compared with standard care in an Irish maternity setting

BMJ Open, 10(12): e038080 doi: 10.1136/bmjopen-2020-038080 https://bmjopen.bmj.com/content/10/12/e038080


To examine the birth outcomes for women and babies following water immersion for labour only, or for labour and birth.


A cohort of 190 low-risk women who used water immersion; 100 gave birth in water and 90 laboured only in water. A control group of 190 low-risk women who received standard care.


Women choosing water immersion for labour or birth were no more likely to experience adverse birth outcomes than women receiving standard care and rated their birth experiences more highly.

Full paper available here


Hussain, N., Lagnese, C. M., Hayes, B., Kumar, N., Weaver, T., Essandoh, M. K., Reno, J., Small, R. H., Abdallah, F. W. (2020)

Comparative analgesic efficacy and safety of intermittent local anaesthetic epidural bolus for labour: a systematic review and meta-analysis

Obstetric Anaesthesia, 125(4):560-579


Continuous epidural infusion (CEI) is commonly used for labour analgesia, but concerns over potential motor block, second-stage labour complications, and ineffective analgesia in late labour have prompted examining intermittent epidural bolus (IEB) as an alternative. However, evidence comparing these modalities is conflicting. The meta-analysis evaluates the analgesic efficacy of CEI vs IEB.

Editor’s key points

  • The authors performed a meta-analysis of 27 studies (3133 patients), examining the pain control provided by intermittent epidural bolus and continuous epidural infusion.
  • The data suggest that intermittent epidural bolus provides superior pain control during the first 4 h of epidural placement during labour and reduces the risk of developing breakthrough pain.
  • Intermittent epidural bolus also appears to reduce the risk of motor weakness, but no difference was found with other side-effects such as hypotension, nausea, and pruritus.

Full paper available here

Betts, R. C., Johnson, H. M., Eglash, A., Mitchell, K. B. (2020)

It’s Not Yeast: Retrospective Cohort Study of Lactating Women with Persistent Nipple and Breast Pain

Breastfeeding Medicine. doi: 10.1089/bfm.2020.0160


Health care providers treating lactating women for nipple and breast pain often attribute symptoms to Candida albicans infection. However, multiple other conditions may present with pain, erythema, and pruritis. We explored the experience of a breastfeeding medicine practice that received referrals for patients failing antifungal therapy and who desired further evaluation for alternative diagnoses.


While persistent nipple and breast pain in breastfeeding is often attributed to Candida, this cohort demonstrates that providers should consider multiple other conditions in their differential diagnosis. Accurate, timely diagnosis is crucial, as pain is a risk factor for premature cessation of breastfeeding. Symptomatic resolution occurs on appropriate therapy.

Full paper available here

Ota, E., da Silva Lopes, K., Middleton, P., Flenady, V., Wariki, W.M.V., Rahman, M. O., Tobe-Gai, R., Mori. R. (2020)

Antenatal interventions for preventing stillbirth, fetal loss and perinatal death: an overview of Cochrane systematic reviews

Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD009599. DOI: 10.1002/14651858.CD009599.pub2

Authors’ conclusions

While most interventions were unable to demonstrate a clear effect in reducing stillbirth or perinatal death, several interventions suggested a clear benefit, such as balanced energy/protein supplements, midwife‐led models of care, training versus not training traditional birth attendants, and antenatal cardiotocography. Possible benefits were also observed for insecticide‐treated anti‐malarial nets and community‐based intervention packages, whereas a reduced number of antenatal care visits were shown to be harmful. However, there was variation in the effectiveness of interventions across different settings, indicating the need to carefully understand the context in which these interventions were tested.

Prevention, detection and management of other healthcare problems

  • Where midwives were the primary healthcare provider, particularly for low‐risk pregnant women, loss of the fetus or infant deaths fell by 16%.
  • Having a trained traditional birth attendant versus having an untrained traditional birth attendant probably reduces stillbirth in rural populations of low‐ and middle‐income countries by 31% and infant death by 30%.
  • A reduced number of antenatal care visits probably results in an increase in infant death around the time of birth.
  • Community‐based intervention packages (including community‐support groups/women’s groups, community mobilisation and home visits, or training traditional birth attendants who made home visits) may reduce stillbirth by 19%.

Full paper available here

Tasci, B., & Ayyildiz, T. K. (2020)

The Calming Effect of Maternal Breast Milk Odor on Term Infant: A Randomized Controlled Trial

Breastfeeding Medicine, 15(11): 724-730.http://doi.org/10.1089/bfm.2020.0116



This study was carried out to assess the effect of the odor of breast milk and formula milk on reducing the acute pain of newborn infants during the heel-prick blood sampling.


The pain threshold and heart rates of the newborn in the breast milk group were significantly lower than those in the formula milk group (p < 0.001). Salivary cortisol in the formula milk group increased and oxygen saturation levels in these infants decreased significantly more as compared to the breast milk group (p < 0.05).


The odor of breast milk may be helpful in reducing the pain of newborn during heel-prick blood sampling.

Full paper available here

Luo, L., Zhou, K., Zhang, J., Xu, L., Yin, W. (2020)

Cochrane Library Interventions for leg cramps in pregnancy (Review)

Cochrane Database of Systematic Reviews, Issue 12. Art. No.: CD010655. DOI: 10.1002/14651858.CD010655.pub3

We searched for evidence in September 2019 and identified eight randomised controlled studies, with a total of 576 women who were 14 to 36 weeks pregnant, comparing either magnesium, calcium, calcium-vitamin D or vitamin B with placebo or no treatment, and comparing vitamin C with calcium. All treatments were given as tablets to be chewed or swallowed.

It is not clear from the evidence reviewed whether any of the oral interventions (magnesium, calcium, calcium-vitamin D, vitamin B vitamin D or vitamin C) provide an effective and safe treatment for leg cramps in pregnancy. Supplements may have different effects depending on women’s usual intake of these substances. No trials considered therapies such as muscle stretching, massage, relaxation or heat therapy.

Full review available here

October to December 2020

Yu, S., Fiebig, D. G., Scarf, V., Viney, R., Dahlen, H. G., & Homer, C. (2020)

Birth models of care and intervention rates: The impact of birth centres.

Health Policy, in press https://doi.org/10.1016/j.healthpol.2020.10.001


  • Improving maternal autonomy and intervention rates are policy priorities in birth care.
  • Birth centres offer a non-medicalised approach to childbirth led by midwives.
  • However, women choosing birth centres differ considerably from those in hospitals.
  • Accounting for selection effects, birth centres lower birth intervention rates substantially.
  • Importantly, the effects are increasing over time.

Full abstract

Darling, F., McCourt, C., & Cartwright, M. (2021)

Facilitators and barriers to the implementation of a physiological approach during labour and birth: A systematic review and thematic synthesis

Midwifery, 92,102861


To explore facilitators and barriers to the implementation of a physiological approach to care during labour and birth in obstetric settings.

To explore how facilitators and barriers located at three levels: organisation, professional groups (midwives and obstetricians) and women, interact to influence the implementation of a physiological approach

Key conclusions

Contrary to evidence-based guidelines that recommend a physiological approach, a risk-based approach informs practices in obstetric units. Primary research has mainly identified barriers to implementing a physiological approach at a professional level, and this has been studied largely from a midwifery perspective. To aid comprehensive investigations of facilitators and barriers and their interactive influences, this review identifies important research gaps for study across all levels: organisation, professionals (midwives and obstetricians) and women.

Full abstract and open access paper


Sugimura, T., Tomoko, S., Terasaki, N., Ozaki, Y., Rikitake, N., Okabe., & Matsushita, M. (2020)

Efficacy and safety of breast milk eye drops in infants with eye discharge

Acta Paediatricia, in Press


Breast milk (BM) contains various protective components, such as immunoglobulins, lactoferrin, lysozyme, oligosaccharides, and immune cell subsets. We evaluated the effectiveness of BM eye drops in infants with eye discharge in a randomised controlled study.


This study demonstrated that BM is no less effective than ophthalmic solution in infants with eye discharge aged ≤ 6 months. The results suggested that the use of breast milk as eye drops could be considered as a first‐line treatment for infants aged ≤ 6 months with eye discharge.


Full abstract

Karavadra, B., Stockl, A., Prosser-Snelling, E., Simpson, P., & Morris, E. (2020)

Women’s perceptions of COVID-19 and their healthcare experiences: a qualitative thematic analysis of a national survey of pregnant women in the United Kingdom

BMC Pregnancy Childbirth, 20600: https://doi.org/10.1186/s12884-020-03283-2


The aim of this national survey was to explore pregnant women’s perceptions of COVID-19 and their healthcare experiences.


One thousand four hundred fifty-one participants replied to the online questionnaire. Participants provided significant insight into the perceived barriers to seeking healthcare during this pandemic. These include ‘not wanting to bother anyone’, ‘lack of wider support from allied healthcare workers’ and the influence of the media. Other concerns included the use of virtual clinics antenatally and their acceptability to patients, the presence of birthing partners, and the way in which information is communicated about rapidly changing and evolving services.

Full abstract and open access paper 

July to September 2020

Adler, L., Rahkonen, L., & Kruit, H. (2020)

Maternal childbirth experience in induced and spontaneous labour measured in a visual analog scale and the factors influencing it; a two year cohort study.

BMC Pregnancy and Childbirth, 20:415: https://doi.org/10.1186/s12884-020-03106-4


Poor maternal childbirth experience plays a role in family planning and subsequent pregnancies. The aim of this study was to compare childbirth experiences in induced and spontaneous labor and to investigate the factors influencing the childbirth experience.


Poor childbirth experience was associated with labor induction, primiparity, operative delivery, and labor complications, such as post-partum hemorrhage and maternal infections. These results highlight the aspects of care for which patient experience may be improved by additional support and counselling.

Full abstract and paper available here 

Daly, D., Minnie, K. C. S., Blignaut, A., Blix, E., Vika, Nilsen., A. B., Dencker, A., et al. (2020)

How much synthetic oxytocin is infused during labour? A review and analysis of regimens used in 12 countries.

PLoS ONE, 15(7): e0227941. https://doi.org/10.1371/journal.pone.0227941


To compare synthetic oxytocin infusion regimens used during labour, calculate the International Units (IU) escalation rate and total amount of IU infused over eight hours.


Current variations in oxytocin regimens for induction and augmentation of labour are inexplicable. It is crucial that the appropriate minimum infusion regimen is administered because synthetic oxytocin is a potentially harmful medication with serious consequences for women and babies when inappropriately used. Estimating the total amount of oxytocin IU received by labouring women, alongside the institution’s mode of birth and neonatal outcomes, may deepen our understanding and be the way forward to identifying the optimal infusion regimen.

Full paper available here  

Olza, I., Uvnas-Moberg, K., Ekström-Bergström, A., Leahy-Warren, P., Karlsdottir, S. I., Nieuwenhuijze, M., et al. (2020)

Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth.

PLoS ONE, 15(7): e0230992. https://doi.org/10.1371/journal.pone.0230992


Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth.


By listening to women’s experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers’ wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.

Full abstract and paper available here


Small, K. A., Sidebotham, M., Fenwick, J., & Gamble, J. (2020)

Intrapartum cardiotocograph monitoring and perinatal outcomes for women at risk: Literature review.

Women and Birth, 33(5):411-418


Caesarean section rates have risen in high-income countries. One of the potential drivers for this is the widespread use of CTG monitoring.


Nine randomised controlled trials and 26 non-experimental studies were included. Meta-analysis of pooled data from RCTs in mixed- and high-risk populations found no statistically significant differences in perinatal mortality rates. The majority of non-experimental research was at critical risk of bias and should not be relied on to inform practice. Cardiotocograph monitoring during preterm labour was associated with a higher incidence of cerebral palsy.


Research evidence failed to demonstrate perinatal benefits from intrapartum cardiotocograph monitoring for women at risk for poor perinatal outcome.


There is an urgent need for well-designed research to consider whether intrapartum cardiotocograph monitoring provides benefits.

Full abstract and paper available here 

Association of Anaesthetists

Guideline on anaesthesia and sedation in breastfeeding women 2020


Breastfeeding has many health benefits for the mother and infant. Women who are breastfeeding may require anaesthesia or sedation. Concerns regarding the passage of drugs into breast milk may lead to inconsistent advice from professionals. This can sometimes result in the interruption of feeding for 24 hours or longer after anaesthesia, or expressing and discarding (‘pumping and dumping’) breast milk; this may contribute to early cessation of breastfeeding. However, there are data regarding the transfer of most anaesthetic drugs into breast milk. We advise that breastfeeding is acceptable to continue after anaesthesia and should be supported as soon as the woman is alert and able to feed, without the need to discard breast milk. We provide evidence-based information on the pharmacokinetics of drugs commonly used during anaesthesia so that professionals can undertake a risk-benefit discussion with the woman. We advise the development of local policies that aid logistical planning and guide staff to facilitate breastfeeding during the woman’s hospital stay.

Full guidelines available here