Eileen Hutton | McMaster University (original) (raw)

Papers by Eileen Hutton

Evaluation of primary care midwifery in the Netherlands: design and rationale of a dynamic cohort... more Evaluation of primary care midwifery in the Netherlands: design and rationale of a dynamic cohort study (DELIVER)

Nutrients

The introduction of solid foods is an important dietary event during infancy that causes profound... more The introduction of solid foods is an important dietary event during infancy that causes profound shifts in the gut microbial composition towards a more adult-like state. Infant gut bacterial dynamics, especially in relation to nutritional intake remain understudied. Over 2 weeks surrounding the time of solid food introduction, the day-to-day dynamics in the gut microbiomes of 24 healthy, full-term infants from the Baby, Food & Mi and LucKi-Gut cohort studies were investigated in relation to their dietary intake. Microbial richness (observed species) and diversity (Shannon index) increased over time and were positively associated with dietary diversity. Microbial community structure (Bray–Curtis dissimilarity) was determined predominantly by individual and age (days). The extent of change in community structure in the introductory period was negatively associated with daily dietary diversity. High daily dietary diversity stabilized the gut microbiome. Bifidobacterial taxa were posit...

EClinicalMedicine

Background: We previously concluded that risk of stillbirth, neonatal mortality or morbidity is n... more Background: We previously concluded that risk of stillbirth, neonatal mortality or morbidity is not different whether birth is intended at home or hospital. Here, we compare the occurrence of birth interventions and maternal outcomes among low-risk women who begin labour intending to birth at home compared to women intending to birth in hospital. Methods: We used our registered protocol (PROSPERO, http://www.crd.york.ac.uk, No.CRD42013004046) and searched five databases from 1990À2018. Using R, we obtained pooled estimates of effect (accounting for study design, study setting and parity). Findings: 16 studies provided data from~500,000 intended home births for the meta-analyses. There were no reported maternal deaths. When controlling for parity in well-integrated settings we found women intending to give birth at home compared to hospital were less likely to experience: caesarean section OR 0.58 (0.44,0.77); operative vaginal birth OR 0.42(0.23,0.76); epidural analgesia OR 0.30(0.24,0.38); episiotomy OR 0.45(0.28,0.73); 3rd or 4th degree tear OR 0.57(0.43,0.75); oxytocin augmentation OR 0.37(0.26,0.51) and maternal infection OR 0.23(0.15,0.35). Pooled results for postpartum haemorrhage showed women intending home births were either less likely or did not differ from those intending hospital birth [OR 0.66(0.54,0.80) and RR 1.30(0.79,2.13) from 2 studies that could not be pooled with the others]. Similar results were found when data were stratified by parity and by degree of integration into health systems. Interpretation: Among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes. These findings along with earlier work reporting neonatal outcomes inform families, health care providers and policy makers around the safety of intended home births. Funding: Partial funding: Association of Ontario Midwives open peer reviewed grant.

Pregnancy Hypertension

If citing, it is advised that you check and use the publisher's definitive version for pagination... more If citing, it is advised that you check and use the publisher's definitive version for pagination, volume/issue, and date of publication details. And where the final published version is provided on the Research Portal, if citing you are again advised to check the publisher's website for any subsequent corrections.

BJOG : an international journal of obstetrics and gynaecology, Jan 14, 2018

Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary ... more Does planned caesarean compared with planned vaginal birth lower the risk of problematic urinary stress, fecal or flatal incontinence?. Women between 32 0/7 and 38 6/7 weeks gestation with twin pregnancy were randomised to planned caesarean or planned vaginal birth. 106 centers in 25 countries. 2305 /2804 enrolled in the study completed questionnaires at two years (82.2%follow up): 1155 in the planned caesarean group, 1150 in the planned vaginal birth group. A structured self-administered questionnaire two years postpartum. The primary maternal outcome and a secondary outcome of the Twin Birth Study was problematic urinary stress incontinence, or fecal, or flatal incontinence at two years. Women in the planned caesarean group had lower problematic urinary stress incontinence rates compared with women in the planned vaginal birth group (93/1147 [8.11%] vs 140/1143 [12.25%], odds ratio, 0.63; 95% confidence interval, 0.47 to 0.83; p=0.001). Among those with problematic urinary stress ...

Women and birth : journal of the Australian College of Midwives, Jan 11, 2017

About 30% of women in labour suffer from lower back pain. Studies of sterile water injections for... more About 30% of women in labour suffer from lower back pain. Studies of sterile water injections for management of low back pain have consistently shown this approach to be effective. The objective of this evidence-based guide is to facilitate the clinical use of sterile water injections to relieve lower back pain in labouring women. To identify relevant publications our search strategy was based on computerised literature searches in scientific databases. The methodological quality of each study was assessed using the modified version of the Jadad scale, 12 studies were included. Recommendations regarding the clinical use of sterile water injections for pain relief in labour are reported in terms of the location of injection administration, various injection techniques, number of injections used, amount of sterile water in each injection and adverse effects. Both injection techniques provide good pain relief for lower back pain during labour. The subcutaneous injection technique is po...

Hypertension (Dallas, Tex. : 1979), Jan 23, 2018

For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether... more For hypertensive women in CHIPS (Control of Hypertension in Pregnancy Study), we assessed whether the maternal benefits of tight control could be achieved, while minimizing any potentially negative effect on fetal growth, by delaying initiation of antihypertensive therapy until later in pregnancy. For the 981 women with nonsevere, chronic or gestational hypertension randomized to less-tight (target diastolic blood pressure, 100 mm Hg), or tight (target, 85 mm Hg) control, we used mixed-effects logistic regression to examine whether the effect of less-tight (versus tight) control on major outcomes was dependent on gestational age at randomization, adjusting for baseline factors as in the primary analysis and including an interaction term between gestational age at randomization and treatment allocation. Gestational age was considered categorically (quartiles) and continuously (linear or quadratic form), and the optimal functional form selected to provide the best fit to the data base...

Midwifery

Background: Inter-professional collaboration is considered essential in effective maternity care.... more Background: Inter-professional collaboration is considered essential in effective maternity care. National projects are being undertaken to enhance interprofessional relationships and improve communication between all maternity care providers in order to improve the quality of maternity care in the Netherlands. However, little is known about primary care midwives' satisfaction with collaboration with other maternity care providers, such as general practitioners, maternity care assistance organisations (MCAO), maternity care assistants (MCA), obstetricians, clinical midwives and paediatricians. More insight is needed into the professional working relations of primary care midwives in the Netherlands before major changes are made Objective: To assess how satisfied primary care midwives are with collaboration with other maternity care providers and to assess the relationship between their 'satisfaction with collaboration' and personal and work-related characteristics of the midwives, their attitudes towards their work and collaboration characteristics (accessibility). The aim of this study was to provide insight into the professional working relations of primary care midwives in the Netherlands. Methods: Our descriptive cross-sectional study is part of the DELIVER study. Ninety nine midwives completed a written questionnaire in May 2010. A Friedman ANOVA test assessed differences in satisfaction with collaboration with six groups of maternity care providers. Bivariate analyses were carried out to assess the relationship between satisfaction with collaboration and personal

The Lancet

but such trials will be costly. Second, the use of clinical trial simulators can provide powerful... more but such trials will be costly. Second, the use of clinical trial simulators can provide powerful insights into the likelihood that a given trial design and endpoint choice are appropriate before an expensive clinical trial is initiated. Clinical trial simulators are not frequently used by the pharmaceutical industry. 17 This should change, especially when evaluating therapies for diseases with long incubation or development durations that require many years of patient follow-up.

Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC, Jan 2, 2017

This study sought to compare obstetrical outcomes for women with a cephalic presentation at birth... more This study sought to compare obstetrical outcomes for women with a cephalic presentation at birth resulting from successful external cephalic version (ECV) compared to those resulting from spontaneous cephalic version (SCV). Secondary analysis was performed on Early External Cephalic Version Trial data. A total of 931 study participants had breech presentations between 34 and 36 weeks' gestation and cephalic presentations at birth. The incidence of intrapartum interventions was compared between patients with successful ECV (557) and those with SCV (374). A generalized linear mixed model was used to determine ORs for our primary outcomes. Parity, maternal BMI, previous CS, and enrolment centre were controlled for in the analysis. No differences were found after ECV compared with SCV in the incidence of CS (96 of 557 and 76 of 374, respectively; adjusted OR [aOR] 0.89; 95% CI 0.63-1.26), instrumental birth (68 of 557 and 29 of 373, respectively; aOR 1.55; 95% CI 0.96-2.50), or nor...

Midwifery, Jan 10, 2017

to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are disc... more to quantify to what extent evidence-based health behaviour topics relevant for pregnancy are discussed with clients during midwife-led prenatal booking visits and to assess the association of client characteristics with the extent of information provided. quantitative video analyses. 173 video recordings of prenatal booking visits with primary care midwives and clients in the Netherlands taking place between August 2010 and April 2011. thirteen topics regarding toxic substances, nutrition, maternal weight, supplements, and health promoting activities were categorized as either 'never mentioned', 'briefly mentioned', 'basically explained' or 'extensively explained'. Rates on the extent of information provided were calculated for each topic and relationships between client characteristics and dichotomous outcomes of the extent of information provided were assessed using Generalized Linear Mixed Modelling. our findings showed that women who did not take ...

International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, Jan 13, 2017

To assess the cesarean delivery (CD) rate among low-risk pregnancies before and after implementat... more To assess the cesarean delivery (CD) rate among low-risk pregnancies before and after implementation of a hospital-based program in Canada. A prospective before-and-after study was conducted to assess the effects of the CARE (CAesarean REduction) strategy, which was developed and implemented at Markham Stouffville Hospital, Toronto, ON, Canada, in 2010 to reduce CD among low-risk women. Hospital records were reviewed to identify changes in the proportions of CD performed during 12 months (April 2009-March 2010) before implementation of the CARE strategy versus 12 months after implementation (April 2012-March 2013) at Markham Stouffville Hospital and 36 hospitals of the same level in the same province. At the intervention hospital, 30.3% (964/3181) of women underwent CD in 2009-2010, compared with 26.4% (803/3045) in 2012-2013 (difference -3.9%, P<0.001). By contrast, no significant difference was recorded in control hospitals (28.1% [23 694/84 361] vs 28.2% [23 683/83 895]; diffe...

Acta obstetricia et gynecologica Scandinavica, Jan 17, 2017

While evidence suggests that beginning an external cephalic version (ECV) before term (34(0/7) to... more While evidence suggests that beginning an external cephalic version (ECV) before term (34(0/7) to 36(6/7) weeks) compared with after term may be associated with an increase in late preterm birth (34(0/7) to 36(6/7) weeks), it remains unknown what might account for this risk. The objective of the present study is to further investigate the association between ECV before term and late preterm birth. Secondary analysis of data collected from the international, multicenter Early ECV trials. We evaluated the relation between ECV exposure and late preterm birth (34(0/7) to 36(6/7) weeks), as well as whether additional risk factors for preterm birth (e.g. maternal age, height, body mass index, parity, placental location, and perinatal mortality rate) moderated this relation. Generalized linear mixed methods were used to account for center effect and adjust for covariates. Among 1765 women with breech pregnancies and without a prior preterm birth, 749 (42.4%) received at least one ECV befor...

Midwifery, Jan 21, 2017

to explore the experiences, wishes and needs of pregnant women with respect to health education i... more to explore the experiences, wishes and needs of pregnant women with respect to health education in primary care with midwives. qualitative semi-structured interview study, using thematic analysis and constant comparison. twenty-two pregnant women in midwife-led primary care, varying in socio-demographic characteristics, weeks of pregnancy and region of residence in the Netherlands, were interviewed between April and December 2013. women considered midwives to be the designated health caregivers for providing antenatal health education, and generally appreciated the information they had received from their midwives. Some women, however, believed the amount of verbal health information was insufficient; others that there was too much written information. Many women still had questions and expressed uncertainties regarding various health issues, such as weight gain, alcohol, and physical activity. They perceived their health education to be individualised according to their midwives&#3...

BMC pregnancy and childbirth, Jan 11, 2017

A major change in the organisation of maternity care in the Netherlands is under consideration, g... more A major change in the organisation of maternity care in the Netherlands is under consideration, going from an echelon system where midwives provide primary care in the community and refer to obstetricians for secondary and tertiary care, to a more integrated maternity care system involving midwives and obstetricians at all care levels. Student midwives are the future maternity care providers and they may be entering into a changing maternity care system, so inclusion of their views in the discussion is relevant. This study aimed to explore student midwives' perceptions on the current organisation of maternity care and alternative maternity care models, including integrated care. This qualitative study was based on the interpretivist/constructivist paradigm, using a grounded theory design. Interviews and focus groups with 18 female final year student midwives of the Midwifery Academy Amsterdam Groningen (AVAG) were held on the basis of a topic list, then later transcribed, coded ...

Birth (Berkeley, Calif.), 2016

A "less than good" experience during childbirth can affect a mother's early interac... more A "less than good" experience during childbirth can affect a mother's early interaction with her child and may significantly influence a woman's emotional well-being. In this study, we focus on clients who experienced midwifery care provided during childbirth as "less than good" care. The aim of this study was to understand the relationship between client-related factors and the experience of midwifery care during childbirth to improve this care. This study was part of the "DELIVER study" where mothers report on the care they received. We used generalized estimation equations to control for correlations within midwife practices. Forward multivariate logistic regression analyses were conducted to model the client-related factors associated with the experienced midwifery care during childbirth. We included the responses of 2,377 women. In the multivariable logistic regression model, odds of reporting "less than good care" were significan...

BMC Pediatrics, 2016

Background: The intestinal microbiota influences metabolic, nutritional, and immunologic processe... more Background: The intestinal microbiota influences metabolic, nutritional, and immunologic processes and has been associated with a broad range of adverse health outcomes including asthma, obesity and Type 2 diabetes. Early life exposures may alter the course of gut microbial colonization leading to differences in metabolic and immune regulation throughout life. Although approximately 50 % of low-risk full-term infants born in Canada are exposed to intrapartum antibiotics, little is known about the influence of this common prophylactic treatment on the developing neonatal intestinal microbiota. The purpose of this study is to describe the intestinal microbiome over the first 3 years of life among healthy, breastfed infants born to women with low-risk pregnancies at full term gestation and to determine if at 1 year of age, the intestinal microbiome of infants exposed to intrapartum antibiotics differs in type and quantity from the infants that are not exposed. Methods: A prospectively followed cohort of 240 mother-infant pairs will be formed by enrolling eligible pregnant women from midwifery practices in the City of Hamilton and surrounding area in Ontario, Canada. Participants will be followed until the age of 3 years. Women are eligible to participate in the study if they are considered to be low-risk, planning a vaginal birth and able to communicate in English. Women are excluded if they have a multiple pregnancy or a preterm birth. Study questionnaires are completed, anthropometric measures are taken and biological samples are acquired including eight infant stool samples between 3 days and 3 years of age. Discussion: Our experience to date indicates that midwifery practices and clients are keen to participate in this research. The midwifery client population is likely to have high rates of breastfeeding and low rates of intervention, allowing us to examine the comparative development of the microbiome in a relatively healthy and homogenous population. Results from this study will make an important contribution to the growing understanding of the patterns of intestinal microbiome colonization in the early years of life and may have implications for best practices to support the establishment of the microbiome at birth.

Journal of Obstetrics and Gynaecology Canada, 2016

Each team member will: Ensure that safe care is always a top priority Practice in compliance with... more Each team member will: Ensure that safe care is always a top priority Practice in compliance with and support of local/institutional protocols and policies Practice within her/his scope of practice and privileges Accept responsibility for all of her/his actions in health care Maintain comprehensive and sufficient liability protection for her/his actions Practice according to current standards of care, acknowledging the preferences of the woman Express her/his opinion as required for the betterment of care