Women’s views about the timing of birth

Background

Estimated date of birth (EDB) is used to guide the care provided to women during pregnancy and birth, although its imprecision is recognised. Alternatives to the EDB have been suggested for use with women however their attitudes to timing of birth information have not been examined.

What are the facilitators,inhibitors, and implications of birth positioning? A review of the literature

BackgroundFrom the historical literature it is apparent that birthing in an upright position was once common practice while today it appears that the majority of women within Western cultures give birth in a semi-recumbent position.AimTo undertake a review of the literature reporting the impact of birth positions on maternal and perinatal wellbeing, and the factors that facilitate or inhibit women adopting various birth positions throughout the first and second stages of labour.MethodsA search strategy was designed to identify the relevant literature, and the following databases were searched: CINAHL, CIAP, the Cochrane Database of Systematic Reviews, Medline, Biomed Central, OVID and Google Scholar. The search was limited to the last 15 years as current literature was sought. Over 40 papers were identified as relevant and included in this literature review.ResultsThe literature reports both the physical and psychological benefits for women when they are able to adopt physiological positions in labour, and birth in an upright position of their choice. Women who utilise upright positions during labour, have a shorter duration of the first and second stage of labour, experience less intervention, and report less severe pain and increased satisfaction with their childbirth experience than women in a semi recumbent or supine/lithotomy position. Increased blood loss during third stage is the only disadvantage identified but this may be due to increased perineal oedema associated with upright positions. There is a lack of research into factors and/or practices within the current health system that facilitate or inhibit women to adopt various positions during labour and birth. Upright birth positioning appears to occur more often within certain models of care, and birth settings, compared to others. The preferences for positions, and the philosophies of health professionals, are also reported to impact upon the position that women adopt during birth.ConclusionUnderstanding the facilitators and inhibitors of physiological birth positioning, the impact of birth settings and how midwives and women perceive physiological birth positions, and how beliefs are translated into practice needs to be researched.     

How valid are the common concerns raised against water birth? A focused review of the literature

BackgroundWomen have birthed in water for many years, with researchers finding a number of benefits for mother and baby. Despite these benefits, many health institutions and clinicians are hesitant to support women's access to water immersion in birth for a number of reasons. As such, this paper aimed to (1) select five common concerns raised against water birth and (2) examine whether research supports these concerns as being evidence-based.MethodA literature review was conducted to (1) select the concerns for review and to (2) review each selected concern as to whether they were supported by the current evidence. A recent review of women's access to, and uptake of, water immersion in Queensland, Australia, was also used to determine the concerns for review in order to better capture concerns relevant to Australian practice.FindingsThree clinical concerns were selected for review: water aspiration, neonatal and maternal infection, and neonatal and maternal thermo-regulation; and two concerns around the practice of water birth were selected: skills and education of workforce, and emergency procedures in case of maternal collapse. The three clinical concerns were not found to be supported by the available evidence and the two practice concerns can be addressed by appropriate policy, guidelines and practice.ConclusionThe reviewed common concerns against water birth are not evidence-based nor are they sufficient to prevent women from accessing the use of water in labour and birth. Health institutions and clinicians should ensure they take adequate precautions to enable women access to this valued and effective method of birth.     

Seeking control in the midst of uncertainty: Women’s experiences of choosing mode of birth after caesarean

Problem

Clinical practice guidelines indicate that over 80% of women with a previous caesarean should be offered a planned vaginal birth after caesarean (VBAC), however only one third of eligible women choose to plan a VBAC. To support informed choices for birth after caesarean, it is necessary to understand the factors that influence women’s decision-making.

Challenging the colonisation of birth: Koori women’s birthing knowledge and practice

Background

The 2007 United Nations Declaration on the Rights of Indigenous Peoples states that Indigenous peoples have the right to self-determination for social and cultural development. This fundamental right has been impeded worldwide through colonisation where many Indigenous peoples have had to adapt to ensure continuation of cultural knowledge and practice. In South East Australia colonisation was particularly brutal interrupting a 65,000 year-old oral culture and archives have increasing importance for cultural revival.

Puts the magic back into life: Fathers’ experience of planned home birth

BackgroundIn Ireland, planned home birth is seen as an alternative but safe choice of maternity care. Women's experience of home birth is reported as positive but little is known about fathers’ thoughts and feelings about planned home birth.AimThe aim of the study was to explore fathers’ experience of planned home birth.MethodHermeneutic phenomenology was selected to explore the experiences of eight fathers whose partners had a recent planned home birth. Data were analysed using Interpretative Phenomenological Analysis (IPA).ResultsThemes identified were ‘negotiating the decision’, ‘ownership of the birth’ and ‘changed way of being’. Fathers overcame their initial reservations about home birth before the decision to plan a home birth was agreed. They were actively involved with their partner in labour which gave themselves a sense of ownership of the experience and a valued post-birth intimacy. Their belief in natural birth was reaffirmed and the experience gave them a new perspective on life.ConclusionWhen men have a positive experience of childbirth they benefit personally and emotionally. This experience can strengthen their relationship with their partner and the family. Midwives are ideally placed to involve fathers actively in birth either in a home or hospital setting.     

Who decides the position for birth? A follow-up study of a randomised controlled trial

BackgroundPhysical benefits are suggested for women and their babies when women adopt an upright position of their choice at birth. Available care options during labour influence women's impressions of what intrapartum care is. This indicates that choice of birth positions may be determined more by midwives than by women's preferences.QuestionThe aims of this study were to investigate factors associated with adherence to allocated birth position and also to investigate factors associated with decision-making for birth position.MethodAn invitation to answer an on-line questionnaire was mailed.FindingsDespite being randomised, women who gave birth on the seat were statistically significantly more likely to report that they participated in decision-making and that they took the opportunity to choose their preferred birth position. They also reported statistically significantly more often than non-adherers that they felt powerful, protected and self-confident.ConclusionsMidwives should be conscious of the potential impact that birth positions have on women's birth experiences and on maternal outcomes. Midwives should encourage women's autonomy by giving unbiased information about the birth seat. An upright birth position may lead to greater childbirth satisfaction. Women's experience of and preferences for birth positions are consistent with current evidence for best practice.     

Women’s attitudes towards the medicalization of childbirth and their associations with planned and actual modes of birth

Problem

Rates of medical interventions in childbirth have greatly increased in the Western world.

Comment on ‘expectancy of life at birth in 36 nationalities of the Soviet Union: 1958–60’

In D. Peter Mazur's recent article, ‘Expectancy of Life at Birth in 36 Nationalities of the Soviet Union: 1958–1960’, crude rates of death and expectancies of life for nationalities are derived from a scant base of data that includes crude rates of natural increase for administrative units and various ratios of composition of the populations of both administrative units and nationalities. Students of Soviet demography genuinely appreciate Mazur's attempt to derive rich results from meagre data. Of course, to do this strong assumptions are required and Mazur warns that ‘the quantitative results ... are valid only to the extent that the underlying methodology is theoretically sound’. One way to test the quantitative results is to examine how well the crude death rates for the nationalities calculated by Mazur reproduce the crude death rates for administrative units with which Mazur started. Mazur feels that the estimated death rates for nationalities closely agree with the death rates for administrative areas. The present author is sceptical. Application of the method described below does not show close correspondence, and this matter, which is crucial in the evaluation of Mazur's results, seems problematical.     

Women's stories of birth: a suitable form of research evidence?

In the past one to two decades, midwifery care has taken a new direction, which encompasses a valuing of women's birth experiences. This move has been contingent upon, and congruent with the adoption of 'woman centred' care and a renewed emphasis on normal birth. In line with these developments, women's stories and anecdotes of birth and midwives stories of experience increasingly form the basis of presentations at midwifery conferences and forums. Overall, this philosophical realignment, which commenced in Australia in the early 1990s, has been applauded by many midwives in terms of a greater valuing of the wishes and experiences of childbearing women and as being consistent with a greater promotion of normal birth. Nonetheless, it also gives rise to several questions, regarding the suitability of this form of research evidence. In a bid to answer some of those questions, this paper aims to evaluate the use of stories and anecdotal evidence within midwifery. First, an overview is presented of the way in which stories of pregnancy and birth appear in the literature. Secondly, the value of stories as evidence is critiqued and, finally, the ratio of story based publications, compared to traditional research methodologies, is reviewed. This review aims to address an area poorly attended in the literature and asks specifically: Are women's birth stories a suitable form of research evidence in midwifery?     

Can concern for the long-term care of older parents explain son preference at birth in India?

This study examines whether concern for the long-term care of older parents is the primary reason for son preference in India. Controlling for important socioeconomic factors that are believed to affect son preference, we find that concern for long-term care is the principal cause of son preference in India. Sons serve as the primary caregivers to elderly parents, while daughters are mostly engaged in caring for parents-in-law. This trend is more acute in rural than in urban areas. Our study also finds a strong implication of the filial relationship for the long-term care of elderly parents.     

Countering technocracy: “natural” birth in The Business of Being Born and Call the Midwife

Feminist media studies scholars concur that representations of childbirth in popular media normalize medical domination of maternity care and women’s subordination to it. This article aims to fill the gap in the dearth of academic analysis of alternative representations of childbearing by examining the documentary film The Business of Being Born and the BBC TV drama series Call the Midwife. Although they are situated in disparate socio-historical contexts, both productions push against medicalization and present positive images of “natural” childbirth. Business systematically critiques medicalization of birth in the US and presents midwifery-assisted homebirth as the solution. Call counters the dogma of necessary medical attention during childbirth by showing how midwifery dominated during the mid-twentieth century in a London neighborhood. Call also portrays midwives and a physician collaboratively providing maternal care in an impoverished neighborhood. Reviewed together, Business and Call augment each other as the former reveals the contemporary struggles and solutions devised to de-medicalize birth and the latter serves as an example of how homebirths may be supported by medico–midwifery collaboration in an urban community.     

Genetic influence on age at first birth of female twins born in the UK, 1919–68

Using a sample of monozygotic (945, 42?per cent) and dizygotic (1,329, 58?per cent) twin pairs born 1919–68 in the UK, we applied innovative tobit models to investigate genetic and environmental influences on age at first birth (AFB). We found that a substantial part (40?per cent) of the variation in AFB is caused by latent family characteristics. Genetic dispositions (26?per cent) play a more important role than the shared environment of siblings (14?per cent), with the non-shared environment/measurement error having the strongest influence (60?per cent). Like previous studies, this study reveals marked changes in estimates over time, and supports the idea that environmental constraints (war or economic crisis) suppress and normative freedom (sexual revolution) promotes the activation of genetic predispositions that affect fertility. We show that the exclusion of censored information (i.e., on the childless) by previous studies biased their results.

Supplementary material for this article is available at: http://dx.doi.org/10.1080/00324728.2015.1056823     

Are young cohorts of women delaying first birth in Mexico?

In the last decades, female permanent sterilisation became the most used method of contraception in Mexico. During this time, the demand for pills, condoms and other short-term contraceptives fell consistently. The shift in the demand for contraceptives raises concerns among demographers that the timing of children may remain unchanged regardless of observed reductions in period fertility rates. This paper assesses such ideas in the context of the timing of a first child using duration models as the main analysis tool. Findings suggest that young cohorts of women are effectively delaying first birth relative to the experience of older generations.

Guilty until proven innocent? – The Assumption of Care of a baby at birth

BackgroundThis paper provides an overview of the history of child protection, the associated law and the 2008 amendments to the Child and Young Persons (Care and Protection) Act 1998 in relation to the Assumption of Care at birth Practice.ObjectiveTo explore the current practice of an Assumption of Care (AOC) where a newborn baby is removed from his/her mother at the time of birth, particularly focussing on the impact of the AOC on midwives.DiscussionAssumption of Care practices in NSW raise significant issues for midwives in relation to the midwifery codes of ethics and conduct and importantly, to their ability to work in ways that honour a “woman-centred care” philosophy. When midwives are exposed to conflict between workplace and personal or professional values such as the practice of AOC cognitive dissonance can occur.ConclusionsFurther research is required to understand the impact of current Assumption of Care. Broader research to not only look at effect on the midwife but also on other health professionals involved and the women who personally experience the removal of their baby at the time of birth. Consideration must also be given to ways of working with vulnerable families to enhance the acceptability and efficacy of maternity services and with associated agencies will decrease the need for Assumption of Care at birth.