Papers by Louise Silverton
International Urogynecology Journal, Jan 21, 2021
Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a severe form of perineal t... more Introduction and hypothesis Obstetric anal sphincter injury (OASI) is a severe form of perineal trauma that can occur during vaginal birth. Long-term morbidities include anal incontinence and psychosocial disorders. To reduce these injuries within England, Scotland and Wales, the OASI Care Bundle was introduced to 16 maternity units (January 2017-March 2018). The OASI Care Bundle comprises four elements: (1) antenatal information, (2) manual perineal protection, (3) medio-lateral episiotomy (when indicated) and 4) recognition and diagnosis of tears. As part of the project evaluation, a qualitative study was conducted to explore women's experiences of the OASI Care Bundle. Methods Semi-structured interviews were conducted with women (n = 19) who received the OASI Care Bundle as part of their maternity care. This was to explore their experience of each element. A thematic analysis of the interview data was performed. Results Three themes were identified: (1) memories of touch, whereby women reported that a 'hands-on' approach to perineal protection was a positive experience; (2) midwife as a supportive guide, where women reported that good communication facilitated a calm birth and post-birth diagnosis; (3) education: women need more information about perineal trauma. Conclusion This study contributes to the literature through its exploration of women's experiences of perineal protection techniques and diagnosis of perineal trauma. Interviewed women indicated that they did not experience any of the care bundle elements as an intrusion of their physical integrity. Additionally, an urgent need was identified for more information about perineal trauma in terms of risk, prevention and recovery.
BMJ Open, Sep 1, 2020
This study explores the implementation of the Obstetric Anal Sphincter Injury (OASI) Care Bundle ... more This study explores the implementation of the Obstetric Anal Sphincter Injury (OASI) Care Bundle and highlights the importance of how interpersonal and cognitive factors affected adoption. ► Focus groups were conducted in 16 UK maternity units that implemented the OASI Care Bundle-the wide coverage and qualitative methodology provide deep insights into the barriers and enablers of improvement. ► Study generalisability may be limited due to participant's self-selection to attend. ► The findings of this study provide a useful blueprint for the implementation of improvement interventions throughout maternity services.
British journal of midwifery, Jan 2, 2019
Service audits are an essential way of identifying areas for development and putting changes into... more Service audits are an essential way of identifying areas for development and putting changes into practice. Louise Silverton identifies the essential factors for service improvement
British journal of midwifery, Jul 2, 2018
Midwifery, Sep 1, 1985
This article reviews the factors responsible for the previous decline and recent slight rise in t... more This article reviews the factors responsible for the previous decline and recent slight rise in the popularity of breast feeding, from a historical standpoint, it considers the economic and social changes which have produced a rapid alteration in the role of women leading to possible conflict with their biological position as mothers. Comparisons are made between the situation current in the West and that which is now developing in the Third World.
The term ‘elderly primigravida was first used in 1958 by the International Council of Obstetricia... more The term ‘elderly primigravida was first used in 1958 by the International Council of Obstetricians and Gynecologists to refer to women aged over 35 years who were embarking upon their first pregnancy (Tuck et al 1988). Such a rigid cut off point has been criticised by Kane (1967) who demonstrated that risk increases (and outcomes worsen) from a maternal age of 25 years onwards. A review of the literature, however, indicates that a wider range of definition is used. Some authors are interested in primiparous women aged over 30 (Vessey et al 1986; Barkan & Bracken 1987), whilst others have only followed up those women aged over 40 (Berryman & Windridge 1991a, 1991b). For this reason, this chapter has not adopted a rigid definition but states the range of ages examined in each particular circumstance.
British journal of midwifery, Mar 2, 2015
This article reviews the various discourse communities that can be found throughout the field of ... more This article reviews the various discourse communities that can be found throughout the field of supervision. Over the last several decades, the field has largely struggled with its identity. The struggle to define supervision, as well as supervision scholarship being forced to travel incognito to survive (Glanz & Hazi, 2019), has largely been due to a lack of an academic journal to serve as a publishing venue dedicated solely to issues of educational supervision. As the Journal of Educational Supervision continues to evolve from inception to fruition (Mette & Zepeda, 2019), it is important to keep supervision discourse communities vibrant and growing, as well as to help the field move forward. Additionally, supervision scholars must acknowledge the realities of policies facing practitioners in order to better bridge the research-practice-policy gap. The continual development of these five discourse communitiesas well as any cross-pollination among them and preparation for emergent discourse communitiesis paramount to the future of supervision.
This is a text for use on undergraduate and student diploma courses in midwifery. It prepares the... more This is a text for use on undergraduate and student diploma courses in midwifery. It prepares the midwife for utilizing research findings to determine practice. Where research findings indicate a preferred management approach this is suggested, in less clear cut situations a range of options are offered, with their advantages and disadvantages. Reference lists and selected bibliographies allow students to undertake further study.
British Journal of Midwifery
New Year is traditionally associated with the month of January, but as Louise Silverton writes, t... more New Year is traditionally associated with the month of January, but as Louise Silverton writes, the autumn is also a good time to reflect on months past and make plans for the future
The practising midwife, 1999
Bjog: An International Journal Of Obstetrics And Gynaecology, Jan 21, 2015
Objective To explore and compare perinatal and maternal outcomes in women at 'higher risk' of com... more Objective To explore and compare perinatal and maternal outcomes in women at 'higher risk' of complications planning home versus obstetric unit (OU) birth. Design Prospective cohort study. Setting OUs and planned home births in England. Population 8180 'higher risk' women in the Birthplace cohort. Methods We used Poisson regression to calculate relative risks adjusted for maternal characteristics. Sensitivity analyses explored possible effects of differences in risk between groups and alternative outcome measures. Main outcome measures Composite perinatal outcome measure encompassing 'intrapartum related mortality and morbidity' (intrapartum stillbirth, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus or clavicle) and neonatal admission within 48 hours for more than 48 hours. Two composite maternal outcome measures capturing intrapartum interventions/adverse maternal outcomes and straightforward birth. Results The risk of 'intrapartum related mortality and morbidity' or neonatal admission for more than 48 hours was lower in planned home births than planned OU births [adjusted relative risks (RR) 0.50, 95% CI 0.31-0.81]. Adjustment for clinical risk factors did not materially affect this finding. The direction of effect was reversed for the more restricted outcome measure 'intrapartum related mortality and morbidity' (RR adjusted for parity 1.92, 95% CI 0.97-3.80). Maternal interventions were lower in planned home births. Conclusions The babies of 'higher risk' women who plan birth in an OU appear more likely to be admitted to neonatal care than those whose mothers plan birth at home, but it is unclear if this reflects a real difference in morbidity. Rates of intrapartum related morbidity and mortality did not differ statistically significantly between settings at the 5% level but a larger study would be required to rule out a clinically important difference between the groups.
International Urogynecology Journal, May 14, 2021
BMC Pregnancy and Childbirth, Aug 13, 2018
Background: Third and fourth degree perineal tears, or obstetric anal sphincter injuries (OASI), ... more Background: Third and fourth degree perineal tears, or obstetric anal sphincter injuries (OASI), sustained during childbirth can result in anal incontinence and psychosocial problems which require ongoing treatment. Within the English National Health System (NHS) reported rates of OASI have gradually increased. In response, a care bundle was developed incorporating four elements: 1) antenatal information to women, 2) manual perineal protection during all vaginal births, 3) episiotomy to be performed with a 60°mediolateral angle at crowning (when clinically indicated) and 4) perineal examination (including per rectum) after childbirth. Implementation of the OASI Care Bundle is aided by a skills development module and an awareness campaign. The project is a collaboration between two national professional bodies, an NHS hospital trust and an academic institution. Methods: Implementation of the OASI Care Bundle will be evaluated using a stepped-wedge design. From January 2017 sixteen maternity units across England, Wales and Scotland will participate in the study over a 15-month period, with sequential roll-out of the intervention in four blocks (regions) of four units. The primary clinical outcome is OASI rate. Regression analysis will adjust for differences in organisational characteristics and obstetric risk factors in women who gave birth before and after implementation of the care bundle. Focus group discussions and in-depth interviews with clinicians will evaluate the feasibility of integrating the care bundle into routine practice. Interviews with women will explore the acceptability of the intervention. Discussion: This protocol outlines the evaluation of our quality improvement project which aims to prevent OASI using a bundle of evidence-based interventions that are each widely used in practice. The OASI project aims to 1) standardise practice to prevent OASI in a way that is acceptable to clinicians and women and 2) identify the barriers and enablers associated with upscaling interventions within maternity units. If found to be effective, feasible and acceptable, the OASI Care Bundle will be shared with a range of audiences using the communication channels available to the professional bodies. Trial registration: The OASI Project was retrospectively registered on the ISCTRN12143325 database date assigned 03/10/2017.
Bjog: An International Journal Of Obstetrics And Gynaecology, Sep 29, 2021
‘hands off’ to protect against episiotomy. Even more unsettling is the statement ‘MPP should be u... more ‘hands off’ to protect against episiotomy. Even more unsettling is the statement ‘MPP should be used unless the woman objects’, implying little consideration for autonomy and informed consent. For these reasons we are not only disappointed with the BJOG article but also with the professional stakeholder investment in the intervention, which seems to have been widely and uncritically supported, with some support even being somewhat evangelical, despite the limited evidence in favour.
Uploads
Papers by Louise Silverton