Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda
Abstract Background Globally, the quality of maternal and newborn care remains inadequate, as seen through indicators like perineal injuries and low Apgar scores. While midwifery practices have the potential to improve care quality and health outcomes, there is a lack of evidence on how midwife-led...
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2025-01-01
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| Online Access: | https://doi.org/10.1186/s12889-024-21137-w |
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| author | Johanna Blomgren Michael B. Wells Dinah Amongin Kerstin Erlandsson John Wanyama Diana A. Afrifa Helena Lindgren |
| author_facet | Johanna Blomgren Michael B. Wells Dinah Amongin Kerstin Erlandsson John Wanyama Diana A. Afrifa Helena Lindgren |
| author_sort | Johanna Blomgren |
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| description | Abstract Background Globally, the quality of maternal and newborn care remains inadequate, as seen through indicators like perineal injuries and low Apgar scores. While midwifery practices have the potential to improve care quality and health outcomes, there is a lack of evidence on how midwife-led initiatives, particularly those aimed at improving the use of dynamic birth positions, intrapartum support, and perineal protection, affect these outcomes. Objective To explore how the use of dynamic birth positions, intrapartum support, and perineal protection impact the incidence of perineal injuries and the 5-min Apgar score within the context of a midwife-led quality improvement intervention. Methods A cohort of 630 women with uncomplicated full-term pregnancies was recruited from a hospital in Uganda. Observations and questionnaires assessed birth positions, intrapartum support, perineal protection, health outcomes and maternal characteristics. Primary outcomes included perineal injuries and the 5-min Apgar scores. The primary outcomes were analysed using descriptive data, with trends visualised through a run chart to assess changes during the midwife-led Quality Improvement intervention. Secondary outcomes included postpartum haemorrhage, admission to neonatal intensive care, newborn resuscitation, skin-to-skin care, and breastfeeding initiation. Result A statistically significant association was found between women having intact perineum (i.e., no perineal injuries) and giving birth in a dynamic birth position [AOR; 0.6 (95% CI 0.4 – 0.90)], receiving intrapartum support [AOR; 0.9 (95% CI 0.9 – 1.0)], and using perineal protection measures [AOR; 0.3 (95% CI 0.2 – 0.5)]. Newborns with an Apgar score below seven at five minutes were significantly associated with intrapartum support [AOR; 0.8 (95% CI 0.7 – 1.0)] and perineal protection [AOR; 0.3 (95% CI 0.1 – 0.8)]. However, after adjustment, no significant association was found between Apgar score and birth positions [AOR; 0.5 (95% CI 0.2 – 1.5)]. Perineal injuries and low Apgar scores significantly decreased (p < 0.001) during the Midwife-led Quality Improvement intervention period. Conclusion This study demonstrates that low 5-min Apgar scores and perineal injuries decreased during a midwife-led Quality Improvement intervention focusing on dynamic birth positions, intrapartum support, and perineal protection strategies. Clinical trial This study is registered on ClinicalTrials.gov as of 14th February 2022, under registration number NCT05237375. |
| format | Article |
| id | doaj-art-95b896fc64bb41e48899cf227fad3d32 |
| institution | Kabale University |
| issn | 1471-2458 |
| language | English |
| publishDate | 2025-01-01 |
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| spelling | doaj-art-95b896fc64bb41e48899cf227fad3d322025-01-05T12:49:01ZengBMCBMC Public Health1471-24582025-01-0125111310.1186/s12889-024-21137-wImproving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in UgandaJohanna Blomgren0Michael B. Wells1Dinah Amongin2Kerstin Erlandsson3John Wanyama4Diana A. Afrifa5Helena Lindgren6Department of Women’s and Children’s Health, Karolinska InstitutetDepartment of Women’s and Children’s Health, Karolinska InstitutetDepartment of Health Policy Planning and Management, School of Public Health, College of Health Sciences, Makerere UniversityInstitution of Health and Welfare, Dalarna UniversityChina Uganda Friendship Hospital NaguruDepartment of Learning, Informatics, Management and Ethics, Karolinska InstitutetDepartment of Women’s and Children’s Health, Karolinska InstitutetAbstract Background Globally, the quality of maternal and newborn care remains inadequate, as seen through indicators like perineal injuries and low Apgar scores. While midwifery practices have the potential to improve care quality and health outcomes, there is a lack of evidence on how midwife-led initiatives, particularly those aimed at improving the use of dynamic birth positions, intrapartum support, and perineal protection, affect these outcomes. Objective To explore how the use of dynamic birth positions, intrapartum support, and perineal protection impact the incidence of perineal injuries and the 5-min Apgar score within the context of a midwife-led quality improvement intervention. Methods A cohort of 630 women with uncomplicated full-term pregnancies was recruited from a hospital in Uganda. Observations and questionnaires assessed birth positions, intrapartum support, perineal protection, health outcomes and maternal characteristics. Primary outcomes included perineal injuries and the 5-min Apgar scores. The primary outcomes were analysed using descriptive data, with trends visualised through a run chart to assess changes during the midwife-led Quality Improvement intervention. Secondary outcomes included postpartum haemorrhage, admission to neonatal intensive care, newborn resuscitation, skin-to-skin care, and breastfeeding initiation. Result A statistically significant association was found between women having intact perineum (i.e., no perineal injuries) and giving birth in a dynamic birth position [AOR; 0.6 (95% CI 0.4 – 0.90)], receiving intrapartum support [AOR; 0.9 (95% CI 0.9 – 1.0)], and using perineal protection measures [AOR; 0.3 (95% CI 0.2 – 0.5)]. Newborns with an Apgar score below seven at five minutes were significantly associated with intrapartum support [AOR; 0.8 (95% CI 0.7 – 1.0)] and perineal protection [AOR; 0.3 (95% CI 0.1 – 0.8)]. However, after adjustment, no significant association was found between Apgar score and birth positions [AOR; 0.5 (95% CI 0.2 – 1.5)]. Perineal injuries and low Apgar scores significantly decreased (p < 0.001) during the Midwife-led Quality Improvement intervention period. Conclusion This study demonstrates that low 5-min Apgar scores and perineal injuries decreased during a midwife-led Quality Improvement intervention focusing on dynamic birth positions, intrapartum support, and perineal protection strategies. Clinical trial This study is registered on ClinicalTrials.gov as of 14th February 2022, under registration number NCT05237375.https://doi.org/10.1186/s12889-024-21137-wMidwiferyQuality of careMaternal healthNeonatal healthPregnancy outcomeApgar score |
| spellingShingle | Johanna Blomgren Michael B. Wells Dinah Amongin Kerstin Erlandsson John Wanyama Diana A. Afrifa Helena Lindgren Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda BMC Public Health Midwifery Quality of care Maternal health Neonatal health Pregnancy outcome Apgar score |
| title | Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda |
| title_full | Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda |
| title_fullStr | Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda |
| title_full_unstemmed | Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda |
| title_short | Improving apgar scores and reducing perineal injuries through midwife-led quality improvements: an observational study in Uganda |
| title_sort | improving apgar scores and reducing perineal injuries through midwife led quality improvements an observational study in uganda |
| topic | Midwifery Quality of care Maternal health Neonatal health Pregnancy outcome Apgar score |
| url | https://doi.org/10.1186/s12889-024-21137-w |
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