Women's expectations and experiences with labour pain in medical and midwifery models of birth in the United States

BackgroundThis research focuses on how women understand and experience labour as related to two competing views of childbirth pain. The biomedical view is that labour pain is abnormal and anaesthesia/analgesia use is encouraged to relieve the pain. The midwifery view is that pain is a normal part of labour that should be worked with instead of against.AimsTo determine differences in the preparation for and experiences with labour pain by women choosing midwives versus obstetricians.MethodsPrenatal and postpartum in-depth semi-structured interviews were conducted with a convenience sample of 80 women in Florida (United States): 40 who had chosen an obstetrician and 40 who had chosen a licensed midwife as their birth practitioner.FindingsWomen in both groups were concerned with the pain of childbirth before and after their labour experiences. Women choosing midwives discussed preparing for pain through various non-pharmaceutical coping methods, while women choosing physicians discussed pharmaceutical and non-pharmaceutical pain relief.ConclusionsEqual numbers of women expressed concerns with childbirth pain during the prenatal interviews, while more women choosing doctors spoke about pain after their births. Women had negative experiences when their planned pain relief method, either natural or medical, did not occur. The quandary facing women when it comes to labour pain relief is not choosing what they desire, but rather preparing themselves for the possibility that they may have to accept alternatives to their original preferences.     

Women’s experience of midwife-led counselling and its influence on childbirth fear: A qualitative study

Background

Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women’s views about counselling for childbirth fear.

A qualitative study of how caseload midwifery is experienced by couples in Denmark

Background

Caseload midwifery is expanding in Denmark. There is a need for elaborating in-depth, how caseload midwifery influences the partner and the woman during childbirth and how this model of care influences the early phases of labour.

Impact of acupressure on onset of labour and labour duration: A systematic review

BackgroundThere is worldwide concern with increasing rates of pharmacologically induced labour and operative birth. Many women would like to avoid medical or surgical interventions in childbirth; a desire that may contribute towards the popularity of complementary and alternative medicine/therapies.MethodThis systematic review examines the effects of acupressure on labour onset and duration of labour. We searched MEDLINE, CINAHL, AMED, Cochrane Collaboration, and Science Direct from 1999 to 2013 for published randomised controlled trials and controlled trials comparing acupressure with placebo and no treatment. Studies recruited primiparous and/or multiparous women with either spontaneous or induced onset of labour. The outcome measures were labour onset and duration of all stages of labour.FindingsSeven trials with data reporting on 748 women using different acupressure points and methods of administration were included in the review. One study examined the initiation of labour and six studies examined labour duration and/or pain levels. The two most studied acupoints were Sanyinjiao/Spleen 6 and Hegu/Large Intestine 4. Results suggest acupressure may reduce the length of labour particularly in the first stage.ConclusionFurther research is required on whether acupressure can shorten labour duration, augment prolonged labour or initiate onset of labour by stimulating uterine contractions. Clinical trials should report the basis for acupressure treatment described in the STRICTA (minus needling) and CONSORT non-pharmaceutical guidelines.     

Needs of fathers during labour and childbirth: A cross-sectional study

Fathers play an important role in the childbearing process, but are sometimes sidelined by midwives. The objectives were: identify fathers’ needs during the labor and childbirth process; determine if their needs were met by midwives; and identify variables influencing these needs.The questionnaire was designed based on a systematic literature search and validated by a multistage consensus method. Data were collected during a cross-sectional study in two maternity wards in Belgium, where a medical-led model is used. Fathers present during natural childbirth were recruited via consecutive sampling.Based on multivariate analyses, fathers with a higher education level and multiparous fathers needed less information about the process of birth compared to less educated fathers (p < 0.05; OR = 4.08; 95% CI = 1.02–16.31) or first-time fathers (p < 0.001; OR = 0.04; 95% CI = 0.01–0.18). For multiparous fathers, a tour of the delivery room was less important than for primiparous fathers (p = 0.005; OR = 0.14; 95% CI = 0.03–0.54). Married fathers needed less information on how to support their partners physically (p < 0.005; OR = 0.18; 95% CI = 0.06–0.59) and emotionally (p = 0.01; OR = 0.24; 95% CI = 0.08–0.72) compared to cohabiting fathers. Information needs are more important to fathers compared to needs focusing on the birth experience or their involvement. Socio-demographic variables like educational level, parity, and marital status were associated with fathers’ needs. Midwives need to be aware of fathers’ needs during the birth process and to fulfill these needs appropriately.     

Analysis of the social acceptability of a humanized childbirth intervention in Senegal: A qualitative study

BackgroundIn efforts to improve the quality of women’s care and enhance related experiences in Senegal, the Senegalese government implemented an intervention named “humanized childbirth” in their health facilities.AimTo analyze the social acceptability of humanized childbirth as well as its relevance given the social values in Senegal.MethodsA multiple-case study was conducted within four health facilities in Dakar. Breastfeeding mothers (n = 20), pregnant women (n = 4), midwives (n = 8), Bajenu Gox (n = 4), members of the Health Development Committee (n = 4), and men from the community (n = 4) were interviewed individually, and a documentary analysis was done. The thematic analysis was performed using the acceptability theoretical framework.FindingsThe results show that most participants agreed with the idea of humanized childbirth. However, participants display varying viewpoints as to the social acceptability of various components of the intervention. While there is an overall agreement concerning the benefits of motivated and attentive health professionals focused on prevention, restoring dignity for the parturient woman, freedom to eat and drink, massages and relaxation, the same cannot be said about the freedom of choice for birth positions and companionship.DiscussionThe contrasting viewpoints as to the acceptability of humanized childbirth can be explained by the perception of risk and lack of experience with free birthing positions, as well as structural and cultural barriers surrounding the notion of companionship.ConclusionEducation and awareness of the benefits of free birthing positions and companionship would be required among Senegalese women to enable a cultural shift in maternity wards in Senegal.     

The nutrition-related information seeking behaviours and attitudes of pregnant women with a high BMI: A qualitative study

BackgroundThe prevalence of high body mass index is increasing amongst women of child bearing age. High maternal body mass index has ramifications for both mother and baby including increased health risks from gestational diabetes mellitus, caesarean section and stillbirth. Despite the increasing prevalence of high maternal body mass index little is known of the experiences of these women regarding nutrition information access and use during the antenatal period.MethodsA qualitative study using individual interviews was undertaken at a tertiary hospital in south-eastern Australia. Twenty-Eight women with a body mass index ≥30 kg/m² participated. Interviews were audio recorded, transcribed, cross-checked for consistency and entered into a word processing document for further scrutiny. Data was analysed using interpretative phenomenological analysis (IPA). In any phenomenological study the researcher’s objective is to elicit the participant’s views on their lived experiences.FindingsThree major themes emerged: (1) Nutrition-related information attainment; (2) Nutrition-related information management; (3) Nutrition-related information needs and wants.ConclusionThe findings from this study may assist the future development and dissemination of nutrition-related information for pregnant women with a high body mass index. Women want more individualised support regarding nutritional requirements during pregnancy.     

Reasons for substance use continuation and discontinuation during pregnancy: A qualitative study

Background

Substance use during pregnancy is a major public health concern, stemming from potential physical and psychosocial harms to both the mother and child.

Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study

ObjectiveTo compare labour and birth outcomes between nulliparous women who used versus did not use intrapartum epidural analgesia.DesignProspective cohort study.SettingTwo maternity hospitals in Ireland.PopulationA total of 1221 nulliparous women who gave birth vaginally or by emergency caesarean section.MethodsMultinomial logistic regression was used to analyse categorical outcomes, with results presented as ratios of relative risks (RRR). For dichotomous outcomes we used logistic regression, with results presented as odds ratios (OR).Main outcome measuresMode of birth, IV syntocinon use, pyrexia (≥38 °C), antibiotic treatment, first stage labour ≥10 h, second stage labour ≥2 h, blood loss (≥500 mls, ≥1000 mls), perineal trauma. Neonatal outcomes included Apgar score ≥7 at 1 min and 5 min, admission to neonatal intensive care unit, and infant feeding method.ResultsWomen using EA were more likely to require a vacuum-assisted birth (RRR 3.35, p < 0.01) or forceps-assisted birth (RRR 11.69, p < 0.01). Exposure to EA was associated with significantly greater risk of ≥10 h first (OR 6.72, p = 0.01) and ≥2 h second (OR 2.25, p < 0.01) stage labour, increased likelihood of receiving IV syntocinon (OR 9.38, p < 0.01), antibiotics (OR 2.97, p < 0.01) and a greater probability of pyrexia (OR 10.26, p < 0.01). Women who used EA were half as likely to be breastfeeding at three months postpartum (OR 0.53, p < 0.01). No differences were observed between groups in neonatal outcomes.ConclusionsOur data shows significant associations between EA use and several intrapartum outcomes.     

The effect of antenatal pelvic floor muscle exercise on sexual function and labour and birth outcomes: A randomised controlled trial

BackgroundPelvic floor muscle exercises (PFME) are recommended for treatment of urinary incontinence with less evidence available about the effect on female sexual function (FSF) and childbirth.AimTo investigate the effect of antenatal PFME on FSF during pregnancy and the first three months following birth as a primary outcome, and on labour and birth outcomes as a secondary outcome.Method200 nulliparous women were randomised to control (n = 100) and intervention (n = 100) groups. The women in the intervention group (IG) undertook PFME from 20 weeks gestation until birth and had routine antenatal care, while those in the control group (CG) received routine antenatal care only. The Female Sexual Function Index (FSFI) was used to measure FSF at 36 weeks gestation and three months postnatal. Baseline characteristics and childbirth data were also collected and analysed using SPSS.ResultsThere were no statistically significant differences between the two groups in terms of FSF scores during pregnancy and on childbirth outcomes. Sexual satisfaction was slightly higher in the CG [Mean ± SD, CG: 4.35 ± 1.45 vs. IG: 3.70 ± 1.50, (P = 0.03)] at three months after birth. However, 50% of women adhered to the PFME, and 40% of women did not resume sex by three months after the birth.ConclusionThough some trends were observed, the results showed no effect of PFME on sexual function or labour and birth outcomes. This needs to be interpreted considering the 50% adherence to PFME. More research is recommended.     

Admitting women in active labour: A randomised controlled trial about the effects of protocol use on childbirth method and interventions

AimTo determine the effects of protocol of admitting women in active labour on childbirth method and interventions during labour and childbirth.MethodsThis single-blind randomised clinical trial was conducted in a public hospital in Mazandaran province (Iran) in 2017. Two hundred nulliparous low-risk women were randomly assigned into intervention and control groups. The participant women were admitted in the intervention group using the admission protocol and to the group control by staff midwives and doctors. The admission criteria of the protocol were: the presence of regular, painful contractions, the cervix at least four cm dilated and at least one of the following cues: cervix effaced, and spontaneous rupture of membranes, or “show”. The primary outcome measure was childbirth method. Data were analyzed in SPSS-22 using Mann–Whitney and Chi–square tests. The level of statistical significance was set as p < 0.05.FindingThere were significant differences between the intervention and control groups in the number of caesarian section (CS) (p < 0.001). Two groups had a statistically significant difference in amniotomy (p = 0.003), augmentation by oxytocin (p < 0.001), number of vaginal examinations (p < 0.001) and fundal pressure (p < 0.001).ConclusionsUsing a protocol for admission of low risk nulliparous women in active labour contributed to reduction of the primary caesarean section rate and interventions during childbirth. A risk assessment and using evidence informed guidelines in admission can contribute to reduce unsafe and harmful practices and support normalisation of birth. This is essential for demedicalisation and a useful strategy for reducing primary CS.     

Fear of childbirth in nulliparous women: A cross-sectional multicentre study in China

ObjectiveFew studies have focused on the fear of childbirth (FOC) in China. This study aimed to explore the status of FOC and its associated factors among nulliparous women in China.MethodsUsing a cross-sectional study design, 1039 nulliparous women with singleton pregnancies were recruited from four public hospitals in four cities of China. FOC was evaluated using the Chinese version of the Childbirth Attitude Questionnaire scale. Associations of demographic, obstetric and social–psychological factors with the levels of FOC among nulliparous women were investigated.ResultsThe average score on the Childbirth Attitude Questionnaire scale was 31.30 (standard deviation = 8.43). Generalized linear regression analysis revealed that low self-rated health status (β = 2.26, P = 0.003), higher educational levels (β = 2.06, P = 0.010), lower levels of self-efficacy (β = −0.79, P < 0.001), and use of pregnancy-related smartphone applications (β = 2.42, P < 0.001) were associated with higher levels of FOC.ConclusionThe Childbirth Attitude Questionnaire scale is an appropriate tool to measure FOC. Education levels, self-rated health status, self-efficacy levels, and use of pregnancy-related smartphone applications were predictors of FOC among pregnant women in China. Healthcare professionals should identify the Chinese pregnant women with FOC and implement targeted interventions focused on the above factors.     

Influencing factors in midwives’ decision-making during childbirth: A qualitative study in the Netherlands

Background

Dutch maternity care is based on the principle that pregnancy and childbirth are physiological processes. However, the last decade an increase of intra-partum referrals to obstetric-led care has been observed. Most of these referrals are among nulliparous women, non-urgent and occur during the first stage of labour. The increase in referrals seems not associated with better perinatal outcomes.

The influence of the birthplace and models of care on midwifery practice for the management of women in labour

This paper will examine how the settings in which midwives practice (the birthplace) and models of care affect midwives’ decision making during the management of labour. One-hundred-and-four independent, team and hospital based midwives and 100 low obstetric risk nulliparous women to whom labour care was provided were surveyed. These midwives and women resided in the Auckland metropolitan area of New Zealand. The majority of midwives who participated worked in models of care which provided women with continuity of carer and care, however, this was not found to influence the way the midwives provided labour care. Instead, practice was found to be relatively homogenous regardless of whether the midwives worked in independent, team, or hospital-based practice. The birthplace setting in which the labour care took place did influence midwifery practice. The majority of midwives provided labour care in large obstetric hospitals and identified practices dominated by the medical model of care. Practice was described as being influenced by intervention and the need for technology, however, this did not prevent the majority of women from perceiving they were actively involved in the decision making process and that they worked in partnership with their midwives. Closer examination of the midwives’ decision making processes whilst providing the labour care revealed that the midwives’ individual decisions were influenced by the needs of the women rather than the hospital protocols. What became evident was that the midwives in this study had adopted a humanistic approach to care whereby technology was used alongside relationship-centred care.