Academic Journal
A research agenda to improve incidence and outcomes of assisted vaginal birth.
| Title: | A research agenda to improve incidence and outcomes of assisted vaginal birth. |
|---|---|
| Authors: | Betrán AP; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland., Torloni MR; EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil., Althabe F; Buenos Aires, Argentina., Altieri E; Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland., Arulkumaran S; St George's University of London, London, United Kingdom of Great Britain and Northern Ireland., Ashraf F; Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh., Bailey P; Reproductive, Maternal, Newborn and Child Health, FHI 360, Durham, North Carolina, United States of America., Bonet M; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland., Bucagu M; Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland., Clark E; Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States., Changizi N; Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran., Churchill R; Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States., Dominico S; Thamini Uhai (Value Life), United Republic of Tanzania., Downe S; Department of Midwifery, University of Central Lancashire, Preston, United Kingdom., Draycott T; The Chilterns, Southmead Hospital, Bristol, United Kingdom., Faye A; Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia., Feeley C; School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom., Geelhoed D; Tete, Mozambique., Gherissi A; High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia., Gholbzouri K; WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt., Grupta G; United Nations Children's Fund, New York, United States., Hailegebriel TD; United Nations Children's Fund, New York, United States., Hanson C; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden., Hartmann K; Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany., Hassan L; Women's Health Intervention and Development Initiative, Islamabad, Pakistan., Hofmeyr GJ; Department of Obstetrics and Gyneacology, University of Botswana, Gaborone, Botswana., Jayathilaka AC; WHO Regional Office for South-East Asia, New Delhi, India., Kabore C; Institut de Recherche en Sciences de la Sante, Ouagadougou, Burkina Faso., Kidula N; WHO Regional Office for Africa, Brazzaville, Congo., Kingdon C; Research in Childbirth and Health Unit, University of Central Lancashire, Preston, United Kingdom., Kuzmenko O; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; EBH Postgraduate Programme, Department of Medicine, Sao Paulo Federal University-UNIFESP, Sao Paulo, Brazil., Lumbiganon P; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Buenos Aires, Argentina., Mola GD; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Behavioural Insights Unit, Department of Communications, World Health Organization, Geneva, Switzerland., Moran A; Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland., de Muncio B; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; St George's University of London, London, United Kingdom of Great Britain and Northern Ireland., Nolens B; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Department of Obstetrics & Gynaecology, Shaheed Suhrawardy Medical College Hospital, Dhaka, Bangladesh., Opiyo N; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland., Pattinson RC; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Reproductive, Maternal, Newborn and Child Health, FHI 360, Durham, North Carolina, United States of America., Romero M; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Department of Maternal, Newborn, Child and Adolescent Health and Ageing, World Health Organization, Geneva, Switzerland., van Roosmalen J; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Maternal Child Health and Nutrition, USAID Bureau for Global Health, Arlington, United States., Siaulys MM; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Maternal, Fetal and Neonatal Research Center, Tehran University of Medical Sciences, Tehran, Iran., Camelo JS; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Thamini Uhai (Value Life), United Republic of Tanzania., Smith J; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Department of Midwifery, University of Central Lancashire, Preston, United Kingdom., Sobel HL; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; The Chilterns, Southmead Hospital, Bristol, United Kingdom., Sobhy S; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Reproductive, Maternal, Newborn, Child and Adolescent Health Unit, Ministry of Health, Gambia., Sosa C; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom., Souza JP; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Tete, Mozambique., Ten Hoope-Bender P; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; High School for Health Science and Techniques, University of Tunis El Manar, Tunis, Tunisia., Thangaratinam S; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; WHO Regional Office for the Eastern Mediterranean, Cairo, Egypt., Varallo J; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; United Nations Children's Fund, New York, United States., Wright A; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Department of Global Public Health, Karolinska Institute, Stockholm, Sweden., Yates A; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland.; Mother Hood e.V. - Federal Parents' Initiative for the Protection of Mother and Child during Pregnancy, Bonn, Germany., Oladapo OO; Department of Sexual and Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1202Geneva, Switzerland. |
| Source: | Bulletin of the World Health Organization [Bull World Health Organ] 2023 Nov 01; Vol. 101 (11), pp. 723-729. Date of Electronic Publication: 2023 Oct 04. |
| Abstract: | Access to emergency obstetric care, including assisted vaginal birth and caesarean birth, is crucial for improving maternal and childbirth outcomes. However, although the proportion of births by caesarean section has increased during the last few decades, the use of assisted vaginal birth has declined. This is particularly the case in low- and middle-income countries, despite an assisted vaginal birth often being less risky than caesarean birth. We therefore conducted a three-step process to identify a research agenda necessary to increase the use of, or reintroduce, assisted vaginal birth: after conducting an evidence synthesis, which informed a consultation with technical experts who proposed an initial research agenda, we sought and incorporated the views of women's representatives of this agenda. This process has allowed us to identify a comprehensive research agenda, with topics categorized as: (i) the need to understand women's perceptions of assisted vaginal birth, and provide appropriate and reliable information; (ii) the importance of training health-care providers in clinical skills but also in respectful care, effective communication, shared decision-making and informed consent; and (iii) the barriers to and facilitators of implementation and sustainability. From women's feedback, we learned of the urgent need to recognize labour, childbirth and postpartum experiences as inherently physiological and dignified human processes, in which interventions should only be implemented if necessary. The promotion and/or reintroduction of assisted vaginal birth in low-resource settings requires governments, policy-makers and hospital administrators to support skilled health-care providers who can, in turn, respectfully support women in labour and childbirth. ((c) 2023 The authors; licensee World Health Organization.) |
| Publication Type: | Journal Article |
| Language: | English |
| Journal Info: | Publisher: World Health Organization Country of Publication: Switzerland NLM ID: 7507052 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1564-0604 (Electronic) Linking ISSN: 00429686 NLM ISO Abbreviation: Bull World Health Organ Subsets: MEDLINE |
| Imprint Name(s): | Original Publication: Geneva : World Health Organization, |
| MeSH Terms: | Cesarean Section* , Labor, Obstetric*, Pregnancy ; Female ; Humans ; Incidence ; Delivery, Obstetric ; Postpartum Period |
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| Grant Information: | 001 International WHO_ World Health Organization |
| Contributed Indexing: | Local Abstract: [Publisher, French] L'accès aux soins obstétriques d'urgence, y compris l'accouchement vaginal assisté et la césarienne, est essentiel pour améliorer les effets de la maternité et de l'accouchement. Toutefois, bien que la proportion de césariennes ait augmenté ces dernières décennies, le recours à l'accouchement vaginal assisté a diminué. C'est particulièrement le cas dans les pays à revenu faible ou intermédiaire, bien que l'accouchement vaginal assisté soit souvent moins risqué qu'une césarienne. Nous avons donc mené un processus en trois étapes afin d'imaginer un programme de recherche qui permettrait d'augmenter le recours à l'accouchement vaginal assisté ou de le réintroduire. Après avoir réalisé une synthèse des données probantes, qui a servi de base à une consultation avec des experts techniques qui ont proposé un programme de recherche initial, nous avons sollicité et incorporé les avis des représentantes des femmes pour ce programme. Ce processus nous a permis d'imaginer un programme de recherche complet, avec des sujets classés comme suit: (i) la nécessité de comprendre la perception qu'ont les femmes de l'accouchement vaginal assisté et de fournir des informations appropriées et fiables; (ii) l'importance de la formation des prestataires de soins de santé en matière de compétences cliniques, mais aussi de respect dans les soins de santé, de communication efficace, de prise de décision partagée et de consentement éclairé; ou (iii) les obstacles à la mise en œuvre et à la durabilité et les facteurs qui les facilitent. Les réactions de femmes nous ont appris qu'il était urgent de reconnaître que l'accouchement, la naissance et le post-partum sont des processus humains intrinsèquement physiologiques et dignes au cours desquels les interventions ne devraient être mises en œuvre qu'en cas de nécessité. La promotion et/ou la réintroduction de l'accouchement vaginal assisté dans les régions à faibles ressources nécessitent que les pouvoirs publics, les décideurs politiques et les administrations d'hôpitaux soutiennent les prestataires de soins de santé qualifiés, qui pourront à leur tour soutenir respectueusement les femmes pendant l'accouchement. [Publisher, Spanish; Castilian] El acceso a la atención obstétrica de emergencia, incluido el parto vaginal asistido y el parto por cesárea, es crucial para mejorar los resultados de la maternidad y el parto. No obstante, aunque el porcentaje de partos por cesárea ha aumentado en las últimas décadas, el uso del parto vaginal asistido ha disminuido. Esto ocurre especialmente en los países de ingresos bajos y medios, a pesar de que un parto vaginal asistido suele ser menos arriesgado que un parto por cesárea. Por lo tanto, llevamos a cabo un proceso de tres pasos para identificar un programa de investigación necesario para aumentar el uso del parto vaginal asistido o volver a incorporarlo: tras realizar una síntesis de la evidencia, que sirvió de base para una consulta con expertos técnicos que propusieron un programa de investigación inicial, buscamos e integramos las opiniones de las representantes de las mujeres sobre este programa. Este proceso nos ha permitido identificar un programa de investigación exhaustivo, con temas categorizados como: (i) la necesidad de comprender las percepciones de las mujeres sobre el parto vaginal asistido, y proporcionar información adecuada y fiable; (ii) la importancia de formar a los profesionales sanitarios en habilidades clínicas, pero también en atención respetuosa, comunicación efectiva, toma de decisiones compartida y consentimiento informado; o (iii) las barreras y los facilitadores de la implementación y la sostenibilidad. A partir de las opiniones de las mujeres, nos enteramos de la urgente necesidad de reconocer las experiencias del parto, el alumbramiento y el posparto como procesos humanos inherentemente fisiológicos y dignos, en los que las intervenciones solo deben aplicarse si son necesarias. La promoción o la reincoporación del parto vaginal asistido en regiones de escasos recursos exige que los gobiernos, los responsables de formular políticas y los administradores de hospitales apoyen a los profesionales sanitarios capacitados que, a su vez, pueden ayudar a las mujeres en el trabajo de parto y el alumbramiento de manera respetuosa. [Publisher, Arabic] إن الوصول إلى رعاية التوليد الطارئة، بما في ذلك الولادة الطبيعية المدعومة والولادة القيصرية، هو أمر بالغ الأهمية لتحسين نتائج رعاية الأمومة والولادة. ومع ذلك، فعلى الرغم من زيادة نسبة الولادة القيصرية خلال العقود القليلة الماضية، فقد انخفض اللجوء إلى الولادة الطبيعية المدعومة. وهذا هو الحال بشكل خاص في الدول ذات الدخل المنخفض، والدول ذات الدخل المتوسط، على الرغم من أن الولادة الطبيعية المدعومة غالبًا ما تكون أقل خطورة من الولادة القيصرية. وعلى ذلك، فقد قمنا بإجراء عملية من ثلاث خطوات لتحديد أجندة البحث الضرورية لزيادة اللجوء إلى، أو إعادة طرح، الولادة الطبيعية المدعومة: بعد إجراء تجميع للأدلة، والذي كان بمثابة مشورة للخبراء الفنيين الذين اقترحوا أجندة بحث أولية، فقد سعينا وراء آراء ممثلي النشاء في هذه الأجندة، وقمنا بتضمين هذه الآراء فيها. وقد أتاحت لنا هذه العملية تحديد أجندة بحثية شاملة، مع تصنيف المواضيع كما يلي: (1) الحاجة إلى فهم تصورات النساء للولادة الطبيعية المدعومة، وتوفير معلومات مناسبة وموثوقة؛ أو (2) أهمية تدريب مقدمي الرعاية الصحية على المهارات الإكلينيكية، وكذلك على الرعاية المحترمة، والتواصل الفعال، وصنع القرار المشترك، والموافقة المستنيرة؛ أو (3) العوائق التي تواجه التنفيذ والاستدامة والعوامل المساعدة لهما. ومن خلال تعليقات النساء، تعلمنا الحاجة الملحة للاعتراف بتجارب المخاض، والولادة، وما بعد الولادة، باعتبارها عمليات إنسانية فسيولوجية وراقية بالفطرة، والتي لا ينبغي التدخل فيها، إلا إذا لزم الأمر. إن الترويج للولادة الطبيعية المدعومة، أو إعادة طرحها، في البيئات ذات الموارد المنخفضة، يتطلب من الحكومات، وواضعي السياسات، ومديري المستشفيات، دعم مقدمي الرعاية الصحية من ذوي المهارة، والذين يمكنهم بدورهم دعم النساء في المخاض والولادة بشكل محترم. [Publisher, Chinese] 能够获得产科急诊护理（包括阴道助产分娩和剖腹产）对于改善孕产妇分娩结果至关重要。然而，尽管在过去几十年，剖腹产的比例有所增长，但使用阴道助产分娩的比例却有所下降。在低收入和中等收入国家尤其如此，尽管阴道助产分娩的风险往往低于剖腹产。因此，我们通过一个三步流程，确定了增加使用或重新引入阴道助产分娩所需的研究议程：我们在综合证据之后，咨询了提出初步研究议程的技术专家，并寻求和纳入了该议程中妇女代表的意见。这一过程使我们能够确定一个全面的研究议程，其主题分为：(i) 需要了解妇女对阴道助产分娩的看法，并提供适当和可靠的信息；(ii) 对医疗保健提供者进行临床技能培训的重要性，但也包括在尊重护理、有效沟通、共同决策和知情同意方面的培训；或 (iii) 在实施和可持续性方面的障碍和促进因素。从妇女的反馈中，我们了解到，现在迫切需要认识到分娩、生产和产后经历是与生俱来的生理过程和有尊严的人类过程，只有在必要时才应实施干预措施。在资源匮乏的环境中促进和/或重新引入阴道助产分娩需要政府、决策者和医院管理人员支持熟练的医疗保健提供者，这些提供者因此会尊重和支持分娩妇女。. [Publisher, Russian] Доступ к неотложной акушерской помощи, включая ассистированные вагинальные роды и кесарево сечение, имеет решающее значение для улучшения показателей исходов родов для матери и плода. Однако, несмотря на то что доля родов путем кесарева сечения за последние несколько десятилетий увеличилась, использование ассистированных вагинальных родов снизилось. Это особенно актуально для стран с низким и средним уровнем дохода, несмотря на то что ассистированные вагинальные роды часто менее рискованны по сравнению с кесаревым сечением. В связи с этим был проведен трехэтапный процесс определения программы исследований, необходимых для расширения использования или возобновления практики ассистированных вагинальных родов: после проведения синтеза доказательств, на основе которого проводились консультации с техническими специалистами, предложившими первоначальную программу исследований, были запрошены и учтены мнения представителей женщин относительно этой программы. Благодаря данному процессу была разработана комплексная программа исследований, в которую вошли такие темы, как: (i) необходимость понимания того, как женщины воспринимают ассистированные вагинальные роды, и предоставления соответствующей и достоверной информации; (ii) важность обучения медицинских работников не только клиническим навыкам, но и уважительному подходу в лечении, эффективному общению, совместному принятию решений и информированному согласию; (iii) барьеры и факторы, способствующие внедрению и устойчивому развитию. На основании отзывов женщин была выявлена острая необходимость признания родов, родовой деятельности и послеродового периода как физиологических и достойных уважения процессов жизнедеятельности человека, вмешательство в которые должно осуществляться только в случае необходимости. Продвижение и (или) повторное внедрение ассистированных вагинальных родов в странах с низкими ресурсами требуют от государств, ответственных лиц и администраторов больниц поддержки квалифицированных медицинских работников, которые в свою очередь могут с уважением относиться к женщинам во время схваток и родов. |
| Entry Date(s): | Date Created: 20231114 Date Completed: 20231115 Latest Revision: 20231214 |
| Update Code: | 20240513 |
| PubMed Central ID: | PMC10630731 |
| DOI: | 10.2471/BLT.23.290140 |
| PMID: | 37961052 |
| ISSN: | 1564-0604 |
| DOI: | 10.2471/BLT.23.290140 |
| Database: | MEDLINE |
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