Health Care and Health Policy

Weekend working: A Retrospective Cohort Study of Maternal and Neonatal Outcomes in a Large NHS Delivery Unit

Article, Refereed Journal
Aiken, C.E.M., Aiken, A.R.A., Scott, J.G., Brockelsby, J., Trussell, J. (2016). Weekend working: A Retrospective Cohort Study of Maternal and Neonatal Outcomes in a Large NHS Delivery Unit. European Journal of Obstetrics Gynaecology, 199: 5-10. PMC4799734

pOBJECTIVES:nbsp;br /
Mandatory weekend working for NHS consultants is currently the subject of intense political debate. The Secretary of State for Health#39;s proposed 7-day contract policy is based on the claim that such working patterns will improve patient outcomes. We evaluate this claim by taking advantage of as-if-at-random presentation of women for non-elective deliveries throughout the week. We examine (i) whether consultants currently perform fewer deliveries during weekends versus weekdays, and (ii) whether adverse outcomes increase during weekends.br /
STUDY DESIGN:br /
We conducted a retrospective cohort study using data on all non-elective deliveries from January 2008 to December 2013 in a large UK obstetrics centre (n=27,466). We used Pearson#39;s chi-squared tests to make direct comparisons of adverse outcome rates during weekdays versus weekends. Outcomes included: estimated maternal blood loss ge;1.5l; severe perineal trauma; delayed neonatal respiration; umbilical arterial pH 7.1; and critical incidents at delivery.br /
RESULTS:br /
Consultants currently perform the same proportion of non-elective deliveries on weekends and weekdays (2.3% versus 2.6%, p=0.25). We found no increase in any adverse maternal or neonatal outcomes during weekends versus weekdays, despite high statistical power to detect such differences. Moreover, adverse outcomes are no higher during periods of the weekend when consultants are not routinely present compared to equivalent periods during weekdays.br /
CONCLUSIONS:br /
Under current working arrangements, women who would benefit from consultant-led delivery are equally likely to receive one on weekends compared to weekdays. Weekend delivery has no effect on maternal or neonatal morbidity. Adopting mandatory 7-day contracts is unlikely to make any difference to either consultant-led delivery during weekends or to patient outcomes./p

Research Topic
Health Care and Health Policy

Barriers to Postpartum Contraception in Texas and Pregnancy within Two Years of Delivery

Article, Refereed Journal
Potter, J.E., Hubert, C., Stevenson, A., Hopkins, K., Aiken, A.R.A., White, K., Grossman, D. (2016). Barriers to Postpartum Contraception in Texas and Pregnancy within Two Years of Delivery. Obstetrics Gynecology, 127(2): 289-96. PMC4780343
Research Topic
Health Care and Health Policy

Happiness About Unintended Pregnancy and its Relationship to Contraceptive Desires Among a Predominantly Latina Cohort

Article, Refereed Journal
Aiken, A.R.A. (2015). Happiness About Unintended Pregnancy and its Relationship to Contraceptive Desires Among a Predominantly Latina Cohort Perspectives on Sexual and Reproductive Health, 47(2): 99-106. PMC4487420

pCONTEXTbr /
Women frequently profess happiness about unintended pregnancies; such incongruence is associated with use of less effective contraceptive methods and inconsistent or incorrect method use. Yet, the methods women use may differ from those they desire.br /
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METHODSbr /
Data on 578 women were drawn from a prospective survey of postpartum women aged 18ndash;44 recruited from three hospitals in Texas between 2012 and 2014. Jonckheere-Terpstra tests were used to compare women#39;s feelings about a future pregnancy with their childbearing intentions. Fisher-Freeman-Halton tests compared distributions of contraceptive methods currently used and desired by women who professed happiness about a future unintended pregnancy, as well as distributions of desired methods by women#39;s reported feelings.br /
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RESULTSbr /
The proportion of women who reported happiness about a future pregnancy was 59% among those intending to wait two or three years for another child, 46% among those intending to wait four or more years, and 36% among those intending to have no more children. Among women who professed happiness, a greater proportion desired to use a highly effective contraceptive method than were currently using one (72% vs. 15% among those intending no more children; 55% vs. 23% among those intending to wait at least four years; and 36% vs. 10% among those intending to wait two or three years). Across intention categories, the types of methods desired did not differ by whether women professed happiness or unhappiness.br /
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CONCLUSIONSbr /
Women who profess happiness about a future unintended pregnancy may nonetheless desire highly effective contraceptive methods./p

Research Topic
Health Care and Health Policy

A Blessing I Can’t Afford: Factors Underlying the Paradox of Happiness About Unintended Pregnancy

Article, Refereed Journal
Aiken, A.R.A., Dillaway, C., Mevs-Korff, N. (2015). A Blessing I Can’t Afford: Factors Underlying the Paradox of Happiness About Unintended Pregnancy Social Science and Medicine, 132: 149-155. PMC4400251

pAn unresolved paradox in the measurement and interpretation of unintended pregnancy is that women frequently report feeling happy about pregnancies they also classify as unintended (i.e. they have incongruent intentions and feelings). This study explores the underlying reasons why women profess such happiness and how these relate to their motivations to avoid pregnancy. Between September 2013 and February 2014, semi-structured in-depth interviews were conducted with 27 women (8 white, 19 Latina) selected from a longitudinal study measuring prospective pregnancy intentions and feelings among 403 women in Austin, Texas. Women were selected for interview on the basis of wanting no more children and consistently professing either happiness (n = 17) or unhappiness (n = 10) at the prospect of pregnancy. Interviews were coded and analyzed following the principles of grounded theory. We found that it is possible for women to express happiness at the idea of pregnancy while simultaneously earnestly trying to prevent conception. Happiness at the idea of an unintended pregnancy was explained as the result of deep and heartfelt feelings about children taking precedence over practical considerations, the perception that the psychosocial stress resulting from another child would be low, and the ability to rationalize an unintended pregnancy as the result of fate or God#39;s plan. The major exception to the sincerity of professed happiness was that conveyed as a result of social pressure despite truly negative feelings, predominantly expressed by foreign-born Latina women. Overall, equating incongruence with ambivalence about avoiding conception may undermine the sincerity of women#39;s intentions and their desires for highly-effective contraception. At the same time, unintended pregnancies that are greeted with happiness may have different implications for maternal and child health outcomes compared to pregnancies that are greeted with unhappiness. Identifying which unintended pregnancies are most likely to result in adverse outcomes is a target for future research./p

Research Topic
Health Care and Health Policy

Maternal and Fetal Outcomes Following Unplanned Conversion to General Anesthetic at Elective Cesarean Section

Article, Refereed Journal
Aiken, C.E.M., Aiken, A.R.A., Cole, J.C., Brockelsby, J.C., Bamber, J.H. (2015). Maternal and Fetal Outcomes Following Unplanned Conversion to General Anesthetic at Elective Cesarean Section. Journal of Perinatology, 35(9): 695-9 PMC4552585.
Research Topic
Health Care and Health Policy

Factors Associated with Adverse Clinical Outcomes Among Obstetrics Trainees

Article, Refereed Journal
Aiken, C.E.M., Aiken, A.R.A., Park, H., Brockelsby, J.C., Prentice, A. (2015). Factors Associated with Adverse Clinical Outcomes Among Obstetrics Trainees. Medical Education, 49(7): 674-83. PMC4731334

pOBJECTIVES:nbsp;br /
This study was conducted to determine whether UK obstetrics trainees transitioning from directly to indirectly supervised practice have a higher likelihood of recording adverse patient outcomes in operative deliveries compared with other indirectly supervised trainees, and to examine whether performing more procedures under direct supervision is associated with fewer adverse outcomes in initial practice under indirect supervision.br /
METHODS:br /
We examined all deliveries (13 856) conducted by obstetricians at a single centre over 6 years (2008-2013). Mixed-effects logistic regression models were used to compare estimated blood loss (EBL), maternal trauma, umbilical arterial pH, delayed neonatal respiration, failed instrumental delivery, and critical incidents for trainees in their first indirectly supervised year with those for trainees in all other years of indirect supervision. Outcomes for trainees in their first indirectly supervised 3 months were compared with their outcomes for the remainder of the year. Linear regression was used to examine the relationship between number of procedures performed under direct supervision and initial outcomes under indirect supervision.br /
RESULTS:br /
Trainees in their first indirectly supervised year had a higher likelihood of recording EBL of 2 L at any delivery (odds ratio [OR] 1.32, 95% confidence interval [CI] 1.01-1.64; p 0.05) and of failed instrumental delivery (OR 2.33, 95% CI 1.37-3.29; p 0.05) compared with other indirectly supervised trainees. Other measured outcomes showed no significant differences. In the first 3 months of indirect supervision, the likelihood of operative vaginal deliveries with EBL of 1 L (OR 2.54, 95% CI 1.88-3.20; p 0.05) was higher than in the remainder of the first year. Performing more deliveries under direct supervision prior to beginning indirectly supervised training was associated with decreased risk for recording EBL of 1 L (p 0.05).br /
CONCLUSIONS:br /
Obstetrics trainees in their first year of indirectly supervised practice have a higher likelihood of recording immediate adverse delivery outcomes, which are primarily maternal rather than neonatal. Undertaking more directly supervised procedures prior to transitioning to indirectly supervised practice may reduce adverse outcomes, which suggests that experience is a key consideration in obstetrics training programme design./p

Research Topic
Health Care and Health Policy
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