The Prediction And Prevention Of Caesarean Section For Slow Progress In Labour
Funder
National Health and Medical Research Council
Funding Amount
$227,261.00
Summary
8% of all births are by caesarean section (CS) for slow labour. Bringing on labour just before the due date reduces the chance of CS but we can’t do this for all women. We have a way to predict high risk of CS for slow labour to select women who may benefit from bringing on the labour. We will perform a study where the women at high risk have can have the labour brought on slightly early. The project could result in 6,000 fewer CSs in Australia alone and prevent many complications of CS.
Born A Bit Early: Long-term Child Educational And Health Outcomes
Funder
National Health and Medical Research Council
Funding Amount
$597,170.00
Summary
This will be a population level study covering all children born in New South Wales between 1994 and 2010. The size of the study population will be approximately 1.5 million children. The ratio of males to females will be approximately 1:1.
Fetal Lactate Measurement To Reduce Caesarean Sections During Labour: A Randomised Trial
Funder
National Health and Medical Research Council
Funding Amount
$386,600.00
Summary
Caesarean section rates in Australia are well above the World Health Organization’s recommended level. Many babies appear unhealthy in labour, so they are born by caesarean. They are usually healthy at birth, meaning that the operation could have been avoided. In this study, half the babies who seem distressed will have a blood test for lactate and the other half will not. We will then determine whether having a lactate test makes a difference in the number women having caesarean births.
A Double Blind Randomised Placebo Controlled Trial Of Melatonin As An Adjuvant Agent In Induction Of Labour
Funder
National Health and Medical Research Council
Funding Amount
$384,566.00
Summary
Induction of labour, a common obstetric intervention fails in almost 40% of first time mothers. There is evidence to suggest that the endogenous hormone melatonin has important roles in the progress of labour. We will undertake a double-blind randomised placebo controlled trial of melatonin supplementation to improve the success of induction of labour in first time mothers. We will also assess the economic impact of melatonin supplementation at induction of labour.
The aim of this project is to determine whether or not turning a baby from the posterior position to the more common anterior position increases the chances of a normal birth. This involves performing an internal examination during labour and gently turning the baby as the mother pushes. At present, if the baby is in the posterior position (facing towards the front of the mother’s body) there is a higher risk of a caesarean, forceps or vacuum delivery.
DOES CONTINUITY OF MIDWIFERY CARE INCREASE VAGINAL BIRTH AFTER CAESAREAN (VBAC): A RANDOMISED CONTROLLED TRIAL
Funder
National Health and Medical Research Council
Funding Amount
$271,960.00
Summary
Pregnancy and birth directly affect almost 300,000 families in Australia each year. A key concern is that the caesarean section rate in Australia is higher than similar countries with a lack of support for women to have a vaginal birth after caesarean section. We plan to undertake a trial to determine whether midwifery continuity of care increases the rate of vaginal birth in women who have had a previous caesarean section. This trial could significantly alter the way maternity care is provided.
Impact On Caesarean Rates Following Injections Of Sterile Water (ICARIS) – A Randomised Controlled Trial.
Funder
National Health and Medical Research Council
Funding Amount
$472,692.00
Summary
The rising number of caesarean section births is causing concern across the country. Injections of small amounts of sterile water into the lower back provide relief to women who have back pain in labour. A review of the research found that administration of these injections may be associated with a reduction in caesarean section rates. Four Queensland hospitals, will conduct the largest study to date to determine if sterile water injections can decrease caesarean section rates without increasing ....The rising number of caesarean section births is causing concern across the country. Injections of small amounts of sterile water into the lower back provide relief to women who have back pain in labour. A review of the research found that administration of these injections may be associated with a reduction in caesarean section rates. Four Queensland hospitals, will conduct the largest study to date to determine if sterile water injections can decrease caesarean section rates without increasing morbidity for the woman or her baby.Read moreRead less
A significant proportion of mothers give birth assisted by forceps or vacuum extraction (Ventouse) when problems occur during labour. A number of problems such as incontinence, haemorrhoids, persistent perineal pain, incontinence and sexual problems seem to be commoner after birth in mothers who have had an operative vaginal birth. It has been suggested that to avoid these problems more women should have an elective caesarean without going through labour at all. Although caesarean births would p ....A significant proportion of mothers give birth assisted by forceps or vacuum extraction (Ventouse) when problems occur during labour. A number of problems such as incontinence, haemorrhoids, persistent perineal pain, incontinence and sexual problems seem to be commoner after birth in mothers who have had an operative vaginal birth. It has been suggested that to avoid these problems more women should have an elective caesarean without going through labour at all. Although caesarean births would probably avoid the problems listed above caesarean births are not necessarily better for women's health in all ways - and they are much more costly. This study will follow-up 990 women who had an operative birth (vaginal or caesarean) in 1996-8, 'debriefing' after birth and assessment of health status and health problems 6 months after birth. It will assess their subsequent recovery and fertility, review the events of pregnancy, labour and birth in their medical records to identify factors associated with incontinence, perineal pain, haemorrhoids and sexual problems, and review the outcome of any pregnancies since the original study. The study will provide: * better long term information about health problems, recovery, and fertility after caesarean birth and after operative vaginal birth; * stronger evidence on factors during labour associated with incontinence and related problems; * documentation of the reasons why women with incontinence and related problems rarely seek help or treatment from GPs or specialists; * evidence of any long-term effects of 'debriefing' after birth.Read moreRead less
Caseload Midwifery For Women At Low Risk Of Medical Complications: A Randomised Controlled Trial
Funder
National Health and Medical Research Council
Funding Amount
$604,527.00
Summary
In June 2004, the Victorian Department of Human Services released a policy document Future directions for Victoria's maternity services. The document endorsed the expansion of public models of maternity care that offer 'one on one' midwifery care (caseload). This model has had limited evaluation with safety and efficacy largely unknown. Research conducted in the UK and in Australia has largely measured the effect of teams of care providers (commonly 6-12 midwives) with only two in the UK testing ....In June 2004, the Victorian Department of Human Services released a policy document Future directions for Victoria's maternity services. The document endorsed the expansion of public models of maternity care that offer 'one on one' midwifery care (caseload). This model has had limited evaluation with safety and efficacy largely unknown. Research conducted in the UK and in Australia has largely measured the effect of teams of care providers (commonly 6-12 midwives) with only two in the UK testing caseload care. Studies of continuity of midwifery teams have reported reduced caesareans and other interventions in labour. They have also found increased satisfaction, with no statistically significant differences in health outcomes for babies. Women who are identified at low medical risk will be recruited from the antenatal clinic of a large, tertiary, public maternity hospital. Women will be randomly allocated to caseload midwifery or standard low risk care. Those allocated to caseload will receive pregnancy, birth and postnatal care from a primary midwife with one or two pregnancy visits to be conducted by a 'back-up' midwife. The midwife will collaborate with obstetricians and other health professionals as necessary. This will be the first RCT of caseload midwifery care in Australia and only the third one conducted anywhere. It is a unique opportunity to provide a rigorous evaluation of a model that is beginning to be implemented widely in Australia. The trial will provide much needed information regarding the outcomes of caseload midwifery including interventions in childbirth, safety, costs, women's satisfaction with care and impact on the midwifery workforce. The study will provide data that will inform clinical practice and guide service providers involved in the organisation of maternity services.Read moreRead less