Ice pack induced perineal analgesia after spontaneous vaginal birth: Randomized controlled trial

Background

Ice-pack is widely used for alleviating postpartum perineal pain sustained after birth related perineal trauma. However, it lacks robust evidence on timing and frequency of applications, to ensure the effective and safe use of this therapy.

Risk factors for severe perineal trauma during vaginal childbirth: A Western Australian retrospective cohort study

AimTo determine rates and risk factors for third and fourth degree perineal tears (severe perineal trauma) in a Western Australian context.Design and settingA retrospective hospital-based cohort study was performed using computerised data for 10,408 singleton vaginal deliveries from 28 weeks gestation.MethodsWomen with severe perineal trauma were compared to those without. Logistic regression analysis, stratified by parity, was used to assess demographic and obstetric factors associated with perineal trauma.ResultsSevere perineal trauma incidence was 3% (338/10408), 5.4% (239/4405) for primiparas and 1.7% (99/5990) for multiparas (p < 0.001). Adjusted risk factors associated with trauma and common across parity included Asian or Indian ethnicity, shoulder dystocia and assisted delivery. Epidural analgesia (OR 0.72, 95% CI 0.54–0.96), preterm birth (OR 0.40, 95% CI 0.23–0.72) and episiotomy (OR 0.54, 95% CI 0.39–0.74) were protective in primiparas, while episiotomy was associated with increased risk in multiparas (OR 2.01, 95% CI 1.18–3.45). Additional factors among primiparas were occipito posterior (OP) delivery (OR 3.35, 95% CI 1.75–6.41) and prolonged second stage (OR 1.98, 95% CI 1.46–2.68), and among multiparas included gestational diabetes (OR 1.78, 95% CI 1.04–3.03) and birth weight >4000 g (OR 1.86, 95% CI 1.10–3.15).ConclusionParity differences in risk factors such as episiotomy, infant weight, OP delivery, gestational diabetes and prolonged second stage warrant investigation into clinical management. Although rates differ internationally, and replication evidence has confirmed consistency for certain demographic and obstetric factors, the development of internationally endorsed clinical guidelines and further research around interventions to protect the perineum are recommended.     

Midwifery management of second-degree perineal tears in New Zealand: A cross-sectional survey of practice

Background

Second-degree tears are the most common form of perineal trauma occurring after vaginal birth managed by New Zealand midwives, although little is known about midwives’ perineal practice.

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.     

A phenomenological exploration of parenting after birth trauma: Mothers perceptions of the first year

ProblemWhile perinatal mental health issues are considered to have an impact on a mother’s parenting capacity, there is limited research exploring mothers’ perceptions of their relationship with their child following traumatic birth experiences and how these might affect their parenting capacity.BackgroundBirth trauma is a well-recognised phenomenon which may result in ongoing physical and perinatal mental health difficulties for women. This may impact on their attachment to their children, their parenting capabilities, and their self-identity as mothers.AimsTo explore maternal self-perceptions of bonding with their infants and parenting experiences following birth trauma.MethodsIn-depth interviews with ten mothers were undertaken using an Interpretative Phenomenological Analysis methodology.FindingsWomen who experienced birth trauma often described disconnection to their infants and lacking confidence in their parental decision making. Many perceived themselves as being ‘not good enough’ mothers. For some women the trauma resulted in memory gaps of the immediate post-partum period which they found distressing, or physical recovery was so overwhelming that it impacted their capabilities to parent the way they had imagined they would. Some women developed health anxiety which resulted in an isolating experience of early parenthood.ConclusionsWomen who have suffered birth trauma may be at risk of increased fear and anxiety around their child’s health and their parenting abilities. Some women may experience this as feeling a lower emotional attachment to their infant. Women who experience birth trauma should be offered support during early parenting. Mother-Infant relationships often improve after the first year.     

The Perfect Storm of Trauma: The experiences of women who have experienced birth trauma and subsequently accessed residential parenting services in Australia

Background

There appears to be a chasm between idealised motherhood and reality, and for women who experience birth trauma this can be more extreme and impact on mental health. Australia is unique in providing residential parenting services to support women with parenting needs such as sleep or feeding difficulties. Women who attend residential parenting services have experienced higher rates of intervention in birth and poor perinatal mental health but it is unknown how birth trauma may impact on early parenting.

The cost of vaginal birth at home,in a birth centre or in a hospital setting in New South Wales: A micro-costing study

BackgroundWomen want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings.AimThe aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales.MethodsA micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy.FindingsThe median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings.ConclusionIn this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.     

Intergenerational transmission of age at first birth in the Netherlands for birth cohorts born between 1935 and 1984: evidence from municipal registers

Whereas most research on the intergenerational transmission of fertility behaviour has focused on transmission of the number of children, this paper studies the transmission of the timing of first births. Specific attention is paid to changes in the strength of transmission across cohorts. Theoretically, it is unclear whether the strength of intergenerational transmission of entry into parenthood can be expected to increase or to decrease across cohorts. Event history analyses of data in Dutch registers show a substantial degree of intergenerational transmission in the age at which people have their first child. The degree of transmission from mothers to children increases for successive cohorts. Intergenerational transmission becomes weaker the longer children postpone entry into parenthood. At young ages transmission from mothers to children is stronger than from fathers to children.     

A cross-cultural examination of the relationship between ages at menarche,marriage, and first birth

Recent work with samples of black and white urban American women showed a clear behavioral sequence relating age at menarche to age at first intercourse to age at first birth. This paper shows that the linking of ages at menarche, intercourse, marriage, and first birth is a pattern which occurs in very diverse cultures. We present confirmatory data from the United States, Belgium, and Pakistan, and from Malay and Chinese women in Malaysia. We interpret our findings as indicating a biological process leading to (a) social interpretations of readiness for reproduction, and (b) persisting biological differences between early and late maturing women.     

Study on the Relationship between Parity Structure and Imbalance of Sex Ratio at Birth in China

In China, the increase of the sex ratio at birth(SRB)associates with the decline of the fertility level. The change of the parity structure,one of the main reasons of the low fertility level,may also play an important part in the change of the SRB. We fi nd that the decrease of the proportion of the second and higher parity deters the imbalance of the SRB in China. The increase of the SRB in China is mainly caused by the increase of the second and higher parity's correspondent level of SRB before 2000,and the fi rst parity's SRB also Plays more and more important role after 2000.     

Demographic change and response: Social context and the practice of birth control in six countries

This paper expands on Kingsley Davis’s demographic thesis of change and response. Specifically, we consider the social context that accounts for the primacy of particular birth control methods that bring about fertility change during specific time periods. We examine the relevance of state policy (including national family planning programs), the international population establishment, the medical profession, organized religion, and women’s groups using case studies from Japan, Russia, Puerto Rico, China, India, and Cameroon. Some of these countries are undergoing the second demographic transition, others the first. Despite variations in context, heavy reliance on sterilization and/or, abortion as a means of birth control is a major response in most of these countries. The key roles of the medical profession and state policy are discussed, along with the general lack of influence of religion and of women’s groups in these countries.     

孩次结构与中国出生性别比失衡关系研究

中国出生性别比的升高与生育水平的下降存在着时间上的紧密关联。生育水平下降所导致的孩次结构变化与出生性别比失衡的关系,是本研究关注的主要问题。研究发现,第二孩尤其是多孩生育的减少对我国出生性别比的失衡起到了明显抑制作用,且作用幅度从1981年至1999年逐年加强,2000年至2010年又有所减弱。2000年以前,中国出生性别比的失衡主要由二孩及多孩出生性别比水平的大幅升高所导致,2000年以后第一孩出生性别比水平升高的影响也日益显著。     

Fear of birth: Prevalence,counselling and method of birth at five obstetrical units in Norway

BackgroundThere is increasing evidence that fear of birth can have long-term effects on the childbearing woman and the method of birth.AimTo examine differences between five hospitals in Norway in the occurrence of fear of birth, counselling received and method of birth.MethodSource data was from the Norwegian cohort of the Bidens study and retrieved through a questionnaire and electronic patient records from five different hospitals in Oslo, Drammen, Tromsø, Ålesund and Trondheim, which included 2145 women. The Wijma Delivery Expectancy Questionnaire measured fear of birth, and a cut-off of ≥85 was used to define fear of birth.ResultsIn total, 12% of the women reported fear of birth, with no significant differences between the different units. A total of 8.7% received counselling according to hospital obstetrical records, varying significantly from 5.7% in Drammen to 12.7% in Oslo. Only 24.9% of the women with fear of birth had counselling at their hospital. All the units provided counselling for women with fear, but the content varied. Overarching aims included helping women develop coping strategies like writing a birth plan and clearing up issues regarding prior births. A secondary objective was to prevent unnecessary caesarean section. Both primi- and multiparous women who reported fear of birth had a twofold increased risk of a planned caesarean section.ConclusionThere were no differences between five Norwegian hospitals regarding the occurrence of fear of birth. Counselling methods, resources, level of commitment and the number of women who received counselling varied; thus, hospital practices differed.     

The age at first birth and timing of the second in Costa Rica and Guatemala

This paper explores the relationship between the age at first birth and the timing of subsequent fertility in Costa Rica and in four rural villages and two urban areas of Guatemala. The results indicate that, for Costa Rica, the age at first birth is significantly related to the tempo of subsequent births, and that this association, at least for the interval to second birth, remains significant when socio-economic factors and marital status at the time of first birth are held constant. While the results suggest that the age at first birth is related to timing of the second in the Guatemalan sample as well, the association is weaker and less consistent than in Costa Rica.     

An ethnographic study of the interaction between philosophy of childbirth and place of birth

BackgroundOrganisational culture and place of birth have an impact on the variation in birth outcomes seen in different settings.AimTo explore how childbirth is constructed and influenced by context in three birth settings in Australia.MethodThis ethnographic study included observations of 25 healthy women giving birth in three settings: home (9), two birth centres (10), two obstetric units (9). Individual interviews were undertaken with these women at 6–8 weeks after birth and focus groups were conducted with 37 midwives working in the three settings: homebirth (11), birth centres (10) and obstetric units (16).ResultsAll home birth participants adopted a forward leaning position for birth and no vaginal examinations occurred. In contrast, all women in the obstetric unit gave birth on a bed with at least one vaginal examination. One summary concept emerged, Philosophy of childbirth and place of birth as synergistic mechanisms of effect. This was enacted in practice through ‘running the gauntlet’, based on the following synthesis: For women and midwives, depending on their childbirth philosophy, place of birth is a stimulus for, or a protection from, running the gauntlet of the technocratic approach to birth. The birth centres provided an intermediate space where the complex interplay of factors influencing acceptance of, or resistance to the gauntlet were most evident.ConclusionsA complex interaction exists between prevailing childbirth philosophies of women and midwives and the birth environment. Behaviours that optimise physiological birth were associated with increasing philosophical, and physical, distance from technocratic childbirth norms.