Bio: Colm OBoyle is an academic researcher from Trinity College, Dublin. The author has contributed to research in topics: Home birth & Health care. The author has an hindex of 8, co-authored 22 publications receiving 272 citations.
TL;DR: It is hoped that use of the data set will increase the potential for national and international comparisons of models for maternity care and make it easier to assess the care of women and their babies during pregnancy and childbirth.
Abstract: Background: Comparing the relative effectiveness of interventions on specific outcomes across trials can be problematic due to differences in the choice and definitions of outcome measures used by researchers. We sought to identify a minimum set of outcome measures for evaluating models of maternity care from the perspective of key stakeholders. Methods: A 3-round, electronic Delphi survey design was used. Setting was multinational, comprising a range of key stakeholders. Participants consisted of a single heterogeneous panel of maternity service users, midwives, obstetricians, pediatricians/neonatologists, family physicians/general practitioners, policy-makers, service practitioners, and researchers of maternity care. Members of the panel self-assessed their expertise in evaluating models of maternity care. Results: A total of 320 people from 28 countries expressed willingness to take part in this survey. Round 1 was completed by 218 (68.1%) participants, of whom 173 (79.4%) completed round 2 and 152 (87.9%) of these completed round 3. Fifty outcomes were identified, with both a mean value greater than the overall group mean for all outcomes combined (x = 4.18) and rated 4 or more on a 5-point Likert-type scale for importance of inclusion in a minimum data set of outcome measures by at least 70 percent of respondents. Three outcomes were collapsed into a single outcome so that the final minimum set includes 48 outcomes. Conclusions: Given the inconsistencies in the choice of outcome measures routinely collected and reported in randomized evaluations of maternity care, it is hoped that use of the data set will increase the potential for national and international comparisons of models for maternity care. Although not intended to be prescriptive or to inhibit the collection of other outcomes, we hope that the core set will make it easier to assess the care of women and their babies during pregnancy and childbirth. © 2007, Blackwell Publishing, Inc.
TL;DR: The authors recommend the utility of the CBSEI in midwifery practice as a tool for the identification of women who will require extra support in labour and pregnancy.
Abstract: The Childbirth Self-Efficacy Inventory: a replication study In 1993 Lowe developed the Childbirth Self-Efficacy Inventory (CBSEI). This is a self-administered, 62-item, Likert tool which measures women’s confidence in their ability to cope with labour. The tool is valid and reliable for use in American culture but had not been tested in Northern Ireland, therefore a replication study was deemed necessary. The research study set out to replicate Lowe’s study and to test the potential application of this tool in clinical midwifery practice. A convenience sample comprising a cohort of 126 women attending an urban maternity unit in Northern Ireland formed the study population and a response rate of 64% was achieved. The tool was administered antenatally, intranatally and postnatally. The predictive validity of the instrument was tested to determine actual coping behaviours in labour (Pearson’s r=0·3963, P < 0·00 for active labour; r=0·5149, P < 0·00 for second stage labour). This work confirms the CBSEI as a measurement of confidence in women’s ability to cope in labour. The authors recommend the utility of the CBSEI in midwifery practice as a tool for the identification of women who will require extra support in labour and pregnancy.
01 Jan 2009
TL;DR: Evaluation of facilitated reflection sessions for pre and post-registration midwifery students in two large Dublin maternity teaching hospitals suggests that reflective practice can contribute to the development of skilled, self-aware and engaged practitioners.
Abstract: Midwifery students undertaking the undergraduate midwifery education programme in Ireland participate in facilitated reflective sessions that aim to develop their skills of reflecting on and in clinical practice. This paper presents a qualitative evaluation of the appropriateness and effectiveness of the facilitated reflection sessions for pre and post-registration midwifery students in two large Dublin maternity teaching hospitals. The aim was to evaluate structured reflective practice sessions which sought to assist midwifery students to become competent reflective practitioners. Group reflection sessions were conducted weekly in a clinical practice area at the same time each week over one academic year. After the series of structured reflective sessions, midwifery students and facilitating staff were invited to evaluate the reflective process. This evaluation consisted of a self-completion survey to identify the factors that facilitated and impeded student participation in the sessions. Respondents answered a series of questions about the reflective practice sessions and were also invited to enter qualitative data regarding their subjective experiences of the process in free text boxes. The data were then collated into themes by an independent reviewer. The results of the evaluation clearly indicate that midwifery students and facilitators welcomed the opportunity to engage in group reflection sessions as a form of peer support and as a catalyst for learning from clinical practice. Findings suggest that reflective practice can contribute to the development of skilled, self-aware and engaged practitioners.
TL;DR: This ethnography describes a particularly volatile period in Irish home birth midwifery practice, which is professionally isolated which, given wider cultural antagonism to home birth, perfuses their practice with an element of defensiveness.
Abstract: Objective to describe the context of Irish home birth midwives' practise experience Design ethnography derived from participant observation, unstructured interview and documentary analysis Setting women and midwives' homes and meeting places in Ireland Participants 21 self-employed community midwives Measurements and findings choice of place of birth is extremely limited in Ireland Structural and professional supports for home birth and midwifery are lacking Home birth midwives highly value midwifery professionalism but are professionally isolated They promote women's birthing autonomy and choice of place of birth However, they experience and anticipate negative, even punitive, responses from their own and other professions This ethnography describes a particularly volatile period in Irish home birth midwifery practice Key conclusions Irish home birth midwives are professionally isolated which, given wider cultural antagonism to home birth, perfuses their practice with an element of defensiveness Strong midwifery association is a key pillar of professionalism globally In Ireland, the lack of a strong professional body undermines autonomous midwifery practice in all settings but particularly in the home The midwifery philosophy of ‘being with woman' appears to run contrary to professionalising discourses where the professional ‘knows best' Contemporary cultural expectations of professionalism such as clinical indemnification and risk averse practice protocols, bring challenges to autonomous midwifery practice Implications for practice place and context of birth effects not only the woman's birth experience but the midwife's professional autonomy Without supports for autonomous midwifery, autonomous birthing is under threat Place of birth effects birth experience and birth quality, not least because it is that context which also influences, for good or ill, midwifery autonomy
TL;DR: The need for general guidance on the development of core outcome sets, which should be measured and reported, as a minimum, in all trials for a specific clinical area, is identified.
Abstract: The selection of appropriate outcomes or domains is crucial when designing clinical trials in order to compare directly the effects of different interventions in ways that minimize bias. If the findings are to influence policy and practice then the chosen outcomes need to be relevant and important to key stakeholders including patients and the public, health care professionals and others making decisions about health care. There is a growing recognition that insufficient attention has been paid to the outcomes measured in clinical trials. These issues could be addressed through the development and use of an agreed standardized collection of outcomes, known as a core outcome set, which should be measured and reported, as a minimum, in all trials for a specific clinical area. Accumulating work in this area has identified the need for general guidance on the development of core outcome sets. Key issues to consider in the development of a core outcome set include its scope, the stakeholder groups to involve, choice of consensus method and the achievement of a consensus.
TL;DR: A four-step process to develop a core outcome set is recommended, an agreed standardised collection of outcomes which should be measured and reported, as a minimum, in all trials for a specific clinical area.
Abstract: The selection of appropriate outcomes is crucial when designing clinical trials in order to compare the effects of different interventions directly. For the findings to influence policy and practice, the outcomes need to be relevant and important to key stakeholders including patients and the public, health care professionals and others making decisions about health care. It is now widely acknowledged that insufficient attention has been paid to the choice of outcomes measured in clinical trials. Researchers are increasingly addressing this issue through the development and use of a core outcome set, an agreed standardised collection of outcomes which should be measured and reported, as a minimum, in all trials for a specific clinical area. Accumulating work in this area has identified the need for guidance on the development, implementation, evaluation and updating of core outcome sets. This Handbook, developed by the COMET Initiative, brings together current thinking and methodological research regarding those issues. We recommend a four-step process to develop a core outcome set. The aim is to update the contents of the Handbook as further research is identified.
TL;DR: Women who had midwife-led continuity models of care were less likely to experience regional analgesia and spontaneous vaginal birth and more likely to be attended at birth by a known midwife, according to the quality of the trial evidence.
Abstract: Background Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between midwife-led continuity models and other models of care. Objectives To compare midwife-led continuity models of care with other models of care for childbearing women and their infants. Search methods We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (25 January 2016) and reference lists of retrieved studies. Selection criteria All published and unpublished trials in which pregnant women are randomly allocated to midwife-led continuity models of care or other models of care during pregnancy and birth. Data collection and analysis Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. Main results We included 15 trials involving 17,674 women. We assessed the quality of the trial evidence for all primary outcomes (i.e. regional analgesia (epidural/spinal), caesarean birth, instrumental vaginal birth (forceps/vacuum), spontaneous vaginal birth, intact perineum, preterm birth (less than 37 weeks) and all fetal loss before and after 24 weeks plus neonatal death using the GRADE methodology: all primary outcomes were graded as of high quality.For the primary outcomes, women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.85, 95% confidence interval (CI) 0.78 to 0.92; participants = 17,674; studies = 14; high quality), instrumental vaginal birth (average RR 0.90, 95% CI 0.83 to 0.97; participants = 17,501; studies = 13; high quality), preterm birth less than 37 weeks (average RR 0.76, 95% CI 0.64 to 0.91; participants = 13,238; studies = eight; high quality) and less all fetal loss before and after 24 weeks plus neonatal death (average RR 0.84, 95% CI 0.71 to 0.99; participants = 17,561; studies = 13; high quality evidence). Women who had midwife-led continuity models of care were more likely to experience spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.07; participants = 16,687; studies = 12; high quality). There were no differences between groups for caesarean births or intact perineum.For the secondary outcomes, women who had midwife-led continuity models of care were less likely to experience amniotomy (average RR 0.80, 95% CI 0.66 to 0.98; participants = 3253; studies = four), episiotomy (average RR 0.84, 95% CI 0.77 to 0.92; participants = 17,674; studies = 14) and fetal loss less than 24 weeks and neonatal death (average RR 0.81, 95% CI 0.67 to 0.98; participants = 15,645; studies = 11). Women who had midwife-led continuity models of care were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.21, 95% CI 1.06 to 1.37; participants = 10,499; studies = seven), have a longer mean length of labour (hours) (mean difference (MD) 0.50, 95% CI 0.27 to 0.74; participants = 3328; studies = three) and more likely to be attended at birth by a known midwife (average RR 7.04, 95% CI 4.48 to 11.08; participants = 6917; studies = seven). There were no differences between groups for fetal loss equal to/after 24 weeks and neonatal death, induction of labour, antenatal hospitalisation, antepartum haemorrhage, augmentation/artificial oxytocin during labour, opiate analgesia, perineal laceration requiring suturing, postpartum haemorrhage, breastfeeding initiation, low birthweight infant, five-minute Apgar score less than or equal to seven, neonatal convulsions, admission of infant to special care or neonatal intensive care unit(s) or in mean length of neonatal hospital stay (days).Due to a lack of consistency in measuring women's satisfaction and assessing the cost of various maternity models, these outcomes were reported narratively. The majority of included studies reported a higher rate of maternal satisfaction in midwife-led continuity models of care. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models. Authors' conclusions This review suggests that women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care.Further research is needed to explore findings of fewer preterm births and fewer fetal deaths less than 24 weeks, and all fetal loss/neonatal death associated with midwife-led continuity models of care.
TL;DR: The aim of this bi-monthly column is to highlight Cochrane Systematic Reviews of relevance to pregnancy and childbirth and to stimulate discussion on the relevance and implications of the review for practice.
Abstract: The aim of this bi-monthly column is to highlight Cochrane Systematic Reviews of relevance to pregnancy and childbirth and to stimulate discussion on the relevance and implications of the review for practice. The Cochrane Collaboration is an international organisation that prepares and maintains high quality systematic reviews to help people make well-informed decisions about healthcare and health policy. A systematic review tries to search for, appraise and bring together existing research to answer a specific research quesiton. The Cochrane Database of Systematic Reviews (CDSR) is published monthly online. Residents in countries with a national licence to the Cochrane Libray, including the U.K. and Ireland, can access the Cochrane Library online, free of charge through www.thecochranelibrary.com.
TL;DR: Ian Sinha and colleagues advise that when using the Delphi process to develop core outcome sets for clinical trials, patients and clinicians be involved, researchers and facilitators avoid imposing their views on participants, and attrition of participants be minimized.
Abstract: Summary Points N Studies that use the Delphi process for gainingconsensus around a core outcome set for clinical trialsshould be of sufficiently high quality in order for theirrecommendations to be considered valid. N We report a systematic review of 15 studies that usedthe Delphi technique for this purpose, in which weidentified variability in methodology and reporting. N To improve the quality of studies that use the Delphiprocess for developing core outcome sets, we recom-mend that patients and clinicians be involved, research-ers and facilitators avoid imposing their views onparticipants, and attrition of participants be minimised. N Methodological decisions should be clearly described inthe main publication in order to enable appraisal of thestudy.Table 1. Reporting quality of the 15 included studies. Broad Aspect of ReportingSpecific Items for Which the ReportingQuality Was AssessedStudies in WhichClearly ReportedStudies in Which NotClearly Reported N/ASize and composition of the panel Number of participants 15 0 0Types of participants (e.g., clinicians, patients) 15 0 0Proportion of each type of participant 15 0 0How participants were identified/sampled 14 1 0Methodology of the Delphi process Administration of questionnaires (e.g., postal) 15 0 0How items were generated for first questionnaire 14 1 0What was asked in each round 15 0 0Information provided to participants beforethe first round69 0How the overall group response was fedback to participants87 0Level of anonymity (total or quasi-anonymity) 4 11 0A priori definition of ‘‘consensus’’ aboutwhether an outcome should be measured)71 7