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.

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.

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.     

‘Maternity migration’ and the increased sex ratio at birth in Hong Kong SAR

The sex ratio at birth (SRB) in Hong Kong SAR (Special Administrative Region) has recently increased dramatically. Using a data set (N = 850,331) of all recorded births in Hong Kong between 1995 and 2009, we calculated SRBs by parity and immigrant status. The findings indicate a strong son preference among Mainland Chinese who have travelled to Hong Kong to give birth, especially at parity two or above. Logistic regression models show that this tendency is significantly greater among more affluent couples and remains strong even among Mainland Chinese women resident in Hong Kong for any length of time. The SRB of Hong Kong-born couples, though elevated at higher parities, is less skewed. Hong Kong has been serving as an outlet for ‘elite’ Mainland couples to circumvent family planning restrictions. The analysis also suggests the advantages of a wider set of immigrant variables over a binary construct.     

Home birth and the National Australian Maternity Services Review: too hot to handle?

Background

In February 2009 the Improving Maternity Services in Australia – The Report of the Maternity Services Review (MSR) was released, with the personal stories of women making up 407 of the more than 900 submissions received. A significant proportion (53%) of the women were said to have had personal experience with homebirth. Little information is provided on what was said about homebirth in these submissions and the decision by the MSR not to include homebirth in the funding and insurance reforms being proposed is at odds with the apparent demand for this option of care.

Method

Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Aging website. All 832 submissions were downloaded, coded and then entered into NVivo. Content analysis was used to analyse the data that related to homebirth.

Findings

450 of the submissions were from consumers of maternity services (54%). Four hundred and seventy (60%) of the submissions mentioned homebirth. Overall there were 715 references to home birth in the submissions. The submissions mentioning homebirth most commonly discussed the ‘Benefits’ and ‘Barriers’ in accessing this option of care. Benefits to the baby, mother and family were described, along with the benefits obtained from having a midwife at the birth, receiving continuity of care and having a good birth experience. Barriers were described as not having access to a midwife, no funding, no insurance and lack of clinical privileging for midwives.

Conclusion

Many positive recommendations have come from the MSR, however the decision to exclude homebirth from these reforms is perplexing considering the large number of submissions describing the benefits of and barriers to homebirth in Australia. A concerning number of submissions discuss having had or having considered an unattended birth at home due to these barriers. Overall there is the belief that not enabling access to funded, insured homebirth in Australia is a violation of human rights. It appears that homebirth was considered by the MSR as ‘too hot to handle’ and by dismissing it as a minority issue the government sought to avoided dealing with homebirth as a ‘sensitive and controversial issue.’     

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.

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.     

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.     

Residential proximity of parents and their adult offspring in the United Kingdom, 2009–10

Using data from a large household survey representative of the UK population, we studied how closely parents and adult children live to each other. We show that residential mobility over the life course tends to increase with the physical distance between the homes of parent and child. There are large differences in intergenerational proximity between the foreign-born and UK-born, and between ethnic groups. The determinants of intergenerational proximity from the parent's viewpoint are not identical to those from the child's viewpoint. Contrary to the findings of some earlier studies, intergenerational proximity, from the child's viewpoint, does not vary with the number of siblings. But from the parent's viewpoint, having more children is unambiguously associated with a higher probability of living close to at least one child. We end with a brief discussion of some possible implications of several long-term demographic trends in the UK for intergenerational proximity.     

Comment on “compromised birth outcomes and infant mortality among racial and ethnic groups”

Frisbie, Forbes, and Pullum (1996) show that it is meaningful to account for low birth weight, preterm delivery, and intrauterine growth-retardation when analyzing differences in compromised birth outcomes and infant mortality among racial and ethnic groups. I compare their findings for the 1987 U.S. birth cohort with findings for the 1988 U.S. birth cohort, using linked birth and infant death vital statistics from the National Center for Health Statistics. I focus on their calculation of fetal growth curves, which are highly at odds with the curves commonly used in the obstetric and pediatric literature. I compare birth outcome distributions and infant death probabilities using Frisbie et al. 's method and other standards. I conclude that Frisbie et al. 's method is not suited for the study of intrauterine growth-retardation at the population level because of the major flaws in gestational age measurement that exist in the type of data they use. An appropriate alternative is to apply a standard of normal intrauterine growth derived from antenatal estimation of fetal weight-for-gestational-age to the vital statistics data.     

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.     

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.

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.