This poster presentation aims to evaluate the effectiveness of a new cooling device (gel pad) with a standard regimen (ice pack) and compare these with no localised treatment regimen (control). 450 women partipcated in this study at St James's University Hospital and their own homes. The trial confirmed earlier findings to support the use of a specially designed cooling gel pad (Feme pad)to alleviate perineal trauma.
Background: Breech presentation, where a baby is buttocks or feet first rather than head occurs in about 3 to 4% of singleton pregnancies at term. Worldwide, the vast majority of babies identified as breech are now delivered by planned caesarean section. Aim: to identify relevant published research evidence relating to vaginal and caesarean breech birth and then to discuss the evidence, subsequent controversy and clinical implications that have influence an ongoing obstetrical debate. Method: A structured literature review was undertaken using the Cochrane Library, CINAHL, EMBASE and MEDLINE databases. Different permutations of 'breech' ('frank' or 'complete' or 'extended' or 'flexed') and 'vaginal' or 'caesarean' ('cesarean' or 'cesarian' or 'caesarean') and 'term' and 'singleton' in the title, key words or abstracts were the terms used. Results: Over the last 50 years, there has been an increasing trend toward the routine use of caesarean section as a preventive way of reducing the poor outcomes associated with breech presentation. Research evidence has also played a pivotal role in influencing the routine use of caesarean breech birth and, in particular, a single research trial, the Term Breech Trial (TBT) has substantially influenced current policy and practice. There is no other area of research that has such an impact upon clinical practice in such a short period of time. Conclusions: The speed and extent to which the recommendations of the TBT were implemented has given rise to new controversy surrounding the safety of breech birth, while raising important questions about how the findings of research are used in practice.
Women perceive, describe and react to pain differently; it cannot be easily quantified. Pain is a private and personal experience to the individual. It is, therefore, impossible for another person to know exactly what someone else’s pain feels like. When measuring pain there is a need to assess both the intensity and the quality of the pain to gain an insight into a person’s experience of pain. Therefore during a PhD Study which involved the investigation of the effectiveness of localised cooling treatments to alleviate perineal pain, women were asked to describe the pain as well as the intensity (Steen & Marchant, 2007). The quality of pain was measured by asking the woman to describe the pain in her own words. These words were analysed as pain descriptors under the themes of sensory, affective, evaluative and miscellaneous as described by the McGill Pain Scale. In addition, intensity, discomfort, physical symptoms, metaphors used and links to the expectations of the woman were considered. (Melzack & Wall, 1996). This article will give an overview of the pain syndrome, discuss measurement of pain methods and the use of word descriptors to assess the quality of pain. The assessment of perineal pain and women’s descriptions will be further explored. This insight will give an understanding of the pain experience of women who have perineal trauma following childbirth and this may lead to further research and the development of a specific evaluating tool.
Steen, Mary; Macdonald, Susan(Royal College of Midwives, 2008-08)
This article describes and discusses the findings from a structured review of baby skin care and guidelines based on the best available evidence which was undertaken on behalf of the Royal College of Midwives. Health professionals and parents can download the full article from the RCM URL:
Background: Trauma to the perineum is extremely common during childbirth and the intensity of perineal pain has been reported to vary from being mild to very severe in nature. Aim: To evaluate the effectiveness of two localised cooling treatments (ice pack and cooling gel pad) compared with a no localised treatment group at relieving perineal pain. Method: A randomised controlled trial conducted in a large maternity unit in the north of England and followed up in women's own homes in which 450 women who had either undergone a normal or instrumental delivery that required suturing of an episiotomy or second-degree tear were randomly assigned to three treatment groups. Results: The response rate was 316 out of 450(71%). Perineal pain was most severe when sitting compared to lying down or walking and there was a significant difference between the three groups in estimates of overall pain when sitting on day four (Kruskal-Wallis test,df=2 p=0.01). Estimates of overall pain were lower in the gel pad group, and the difference between the three groups was significant at days five and day ten (Kruskal-Wallis test,df=2 p=0.02, p=0.01). On days two, three and five, significance was measured when making a binary comparison of reported 'moderate' or 'severe' pain with 'none' or 'mild' (chi-square test, p=0.04,p=0.04, p=0.02). Using a summary pain measurement, mothers experienced fewer painful days in the gel pad group but this did not reach statistical significance (Kruskal-Wallis test, df=2 p=0.26). The use of analgesia was reported to be similar in all three groups. Maternal satisfaction with their overall care was rated more highly in the gel pad group when compared to the two other groups (Kruskal-Wallis test, df=2 p>0.001). Conclusions: Cooling treatments can alleviate pain when compared to no localised treatment. Women appeared to find the cooling gel pad to be a more acceptable treatment.
This article gives an insight into how to encourage a woman to remain active in labour. There is substantial evidence that demonstrates being active during labour is beneficial and a range of different positions can be adopted. Good preparation during pregnancy is essential as this will assist women to become confident and believe in their ability to be active during labour. Ideally, upright positions in first and second stage should be encouraged and the use of props such as a chair, bean bag or birth ball. The impact of water immersion during labour should also be highlighted as an effective birthing option.
This book provides a visual guide to looking after your baby in the first year. In-depth, daily advice on baby's growth, care and developments are covered. This resource has been writtten by an exceptional team including a paediatrician, child psychologist, nutritionist, midwife and experienced parents.
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