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.     

Women's birth expectations,are they fulfilled? Findings from a longitudinal Swedish cohort study

BackgroundThe importance of women's expectations on the experience of birth has shown contradictory results regarding fulfilment. The aim of this study was to describe pregnant women's expectations of birth and to investigate if these expectations were fulfilled. An additional aim was to determine if unfulfilled expectations were related to the mode of birth, use of epidural and the birth experience.MethodsThis research investigated a prospective regional cohort study of 1042 Swedish-speaking women who completed a questionnaire about birth expectations in late pregnancy and were followed up with two months after birth. Five areas were under study: support from partner, support from midwife, control, participation in decision making and the midwife's presence during labour and birth. An index combining expectations and experiences was created.ResultsCertain background characteristics were associated with expectations as well as experiences. Statistically significant differences were shown between expectations and experiences in support from midwife (mean 3.41 vs 3.32), support from partner (mean 3.70 vs 3.77), and midwife's presence (mean 3.00 vs 3.39). Experiences ‘worse than expected’ regarding decision making and control were associated with modes of birth other than vaginal and four out of five areas were associated with a less positive birth experience.ConclusionSome women had high birth expectations of which some were fulfilled. An expectation on support from the midwife was less likely to be achieved, while support from partner and the midwives’ presence were fulfilled. If the woman's expectations were not fulfilled, e.g. became ‘worse than expected’ this was associated with a less positive overall birth experience as well as with instrumental or surgical mode of birth.     

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.

As low birth weight babies grow,can well-educated parents buffer this adverse factor? A research note

This research note combines two national Taiwanese data sets to investigate the relationships among low birth weight (LBW) babies, their parents' educational levels, and their future academic outcomes. We find that LBW is negatively correlated with the probability of such children attending college at age 18; however, when both parents are college or high school graduates, such negative effects may be partially offset. We also show that discrimination against daughters occurs, but only for daughters who were LBW babies. Moreover high parental education can buffer the LBW shock only among moderately LBW children (as compared with very LBW children) and full-term LBW children (as compared with preterm LBW children).     

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     

The commonalities and differences in health professionals’ views on home birth in Tasmania,Australia: A qualitative study

ObjectivesHome birth has attracted great controversy in the current context. There is a need for the public and health professionals to understand why maternity care providers have such different views on home birth, why they debate, what divides them into two opposite sides and if they have anything in common.MethodA qualitative study involving twenty maternity health providers in Tasmania was conducted. It used semi-structured interview which included closed and open-ended questions to provide opportunities for exploring emerging insights from the voices of the participants.FindingsHealth practitioners who support home birth do so for three reasons. Firstly, women have the right to choose the place of birth. Secondly, home birth may be more cost effective compared to hospital birth. Thirdly, if home birth is not supported, some women might choose to have a free birth. Those who opposed home birth argue that complications could occur at childbirth and the transfer time is critical for women's and babies’ safety. These differences in opinions can be due to the differences in the training and philosophy of the maternity care providers. Despite the differing views on home births, health professionals share a common goal to protect the women and the newborns from unexpected situations during childbirth.ConclusionThis article provides some significant insights derived from the study of home birth from the maternity health professionals’ perspectives and could contribute to the enhancement of mutual understanding and collaboration of health professionals in their services to expectant mothers.     

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.

Temporal and spatial trends in the sex ratio at birth in Greece, 1960–2006: exploring potential environmental factors

Numerous studies have shown that the sex ratio at birth, defined as the relative number of male and female births, may be dramatically lower for small cohorts with high chemical exposures. Meanwhile, reports from different countries have shown recent declines in male births for the general population, perhaps implicating environmental factors. The sex ratio at birth has, therefore, been suggested by some as a sentinel environmental health indicator. This paper examines variation observed in sex ratio at birth in Greece since 1960. The analysis incorporates a number of demographic parameters including the age and nationality of the mother, partnership status and birth order, as well as urbanisation level. The latter is considered an indirect indicator of potential environmental incidence. Our main finding is that the sex ratio in Greece has experienced a slight, albeit statistically significant, downward trend, especially since 1980. Further, this decline is not attributable to changing demographics. Geographical differentiations were found to be quite significant: the sex ratio is significantly higher in rural areas compared to urban centres or Greater Athens, and this difference is increasing over time. We offer a preliminary interpretation suggesting that these temporal and spatial trends may, at least partly, be attributed to chemicals’ exposure due to higher levels of indoor and outdoor air pollution and different consumption habits encountered in urban settings. We argue that such possibilities warrant further research with explicit measures of exposure.

Epidurals during normal labour and birth — Midwives’ attitudes and experiences

BackgroundMidwives have their own beliefs and values regarding pain during childbirth. Their preferences concerning labour pain management may influence women’s choices.AimTo gain a deeper understanding of midwives’ attitudes and experiences regarding the use of an epidural during normal labour.MethodsA qualitative approach was chosen for data collection. Ten in-depth interviews were conducted with midwives working in three different obstetric units in Norway. The transcribed interviews were analysed using Malterud’s systematic text condensation.FindingsThe analysis provided two main themes: “Normal childbirth as the goal” and “Challenges to the practice, knowledge, philosophy and experience of midwives”. Distinctive differences in experiences and attitudes were found. The workplace culture in the obstetric units affected the midwives’ attitudes and their midwifery practice. How they attended to women with epidural also differed. An epidural was often used as a substitute for continuous support when the obstetric unit was busy.DiscussionMidwives estimate labour pain differently, and this might impact the midwifery care. However, midwives’ interests and preferences concerning labour pain management should not influence women’s choices. Midwives are affected by the setting where they work, and research highlights that an epidural might lead to a focus on medical procedures instead of the normality of labour.ConclusionMidwives should be aware of how powerful their position is and how the workplace culture might influence their attitudes. The focus should be on “working with” women to promote a normal birth process, even with an epidural.     

The influence of wives’ and husbands’ fertility preferences on progression to a third birth in Nepal, 1997–2009

As couples across the globe increasingly exercise conscious control over their reproduction, both spouses’ family-size preferences have the opportunity to influence their fertility. Using couple-level measures of rural Nepalese spouses’ family-size preferences and more than a decade of monthly panel data collected subsequently on fertility outcomes, we investigate how both spouses’ preferences influence progression to a third birth in a country where the widely professed ideal family size is two children. Contrary to expectations based on women's relative disadvantage, we find that it is wives’ preferences that drive couples’ progression to a third birth. We find also that the influence of wives’ preferences is not explained by contraceptive use but that this influence is moderated by couple communication about family planning. Wives’ preferences drive progression to a third birth among couples who had discussed how many children to have.     

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?     

Canada’s forced birth travel: towards feminist indigenous reproductive mobilities

ABSTRACT

The mandatory travel for birth experienced by Indigenous women living in rural and remote areas of Canada is examined using an emergent lens of Indigenous reproductive mobilities. Current evacuation practices are contextualized within the historic and ongoing systems of oppression experienced by Indigenous people in Canada. Indigenous feminist and decolonial theoretical approaches are used to outline one way in which Indigenous women counter settler colonialism to assert sovereignty over their birth experiences – through the resurgence of culturally-based doulas or birth workers. A further contribution of these analyses is the inclusion and centering of the voices and experiences of those previously neglected within this particular body of scholarship, shifting the power relations underpinning reproductive mobilities.     

Coparenting and nonresident fathers’ involvement with young children after a nonmarital birth

We use data from the Fragile Families and Child Wellbeing Study to investigate the association between coparenting quality and nonresident fathers' involvement with children over the first five years after a nonmarital birth. We find that about one year after a nonmarital birth, 48% of fathers are living away from their child, rising to 56% and then to 63% at three and five years, respectively Using structural equation models to estimate cross-lagged effects, we find that positive coparenting is a strong predictor of nonresident fathers' future involvement, whereas fathers' involvement is only a weak (but significant) predictor of future coparenting quality. The positive effect of coparenting quality on fathers' involvement is robust across several techniques designed to address unobserved heterogeneity and across different strategies for handling missing data. We conclude that parents' ability to work together in rearing their common child across households helps keep nonresident fathers connected to their children and that programs aimed at improving parents' ability to communicate may have benefits for children irrespective of whether the parents' romantic relationship remains intact.