Women's experiences of coping with pain during childbirth: a critical review of qualitative research

Novel grouping of planned coping strategies for managing the intensity of labour: A survey study of Australian nulliparous women

BACKGROUND

It is common for women to explore and plan strategies to cope during labour. These strategies are usually focused on pain control and described as either pharmacological or non-pharmacological. As labour is an individual experience, each woman should be enabled to choose strategies that best suit them, and that reflect what they feel influences their sense of capacity to cope.

AIM

By exploring women's intentions and choices of strategies, this study aimed to understand how coping strategies can better reflect women's individual needs and expectations.

METHODS

Fifty-six primiparous women were recruited from one tertiary hospital in Melbourne, Australia between February and May 2021. Data were collected via a survey in late pregnancy using open-ended questions. Content and thematic analyses were used to analyse responses.

RESULTS

Themes related to how women frame the intensity of labour, how they strive for a relationally safe environment and a need to be prepared and knowledgeable. Strategies chosen by women could be grouped into two categories: intrinsic and extrinsic. Intrinsic strategies could be self-generated by women (such as breathing techniques and movement), while extrinsic strategies required either equipment (such as a bath) or others to administer (such as epidural analgesia).

CONCLUSIONS

Women value having a range of intrinsic and extrinsic strategies that enable autonomy or require external support. This moves beyond the 'pharmacological and non-pharmacological' categorisation of strategies, and we propose that reframing strategies as intrinsic and extrinsic could have a number of benefits on women's sense of autonomy and utilisation of strategies. The findings provide a foundation for more targeted research into how women can be supported to individualise and implement these coping strategies in labour.

Women's and maternity care providers' perceptions of pain management during childbirth in hospitals in Southern Tanzania

BACKGROUND

The majority of women experience pain during childbirth. Offering and supporting women to use different methods for coping with pain is an essential competency for maternity care providers globally. Research suggests a gap between what women desire for pain management and what is available and provided in many low-and middle-income settings. The study aimed to understand how pain management is perceived by those involved: women experiencing childbirth and maternity care providers.

METHODS

Individual semi-structured interviews with women (n = 23), maternity care providers (n = 17) and focus group discussions (n = 4) with both providers and women were conducted in two hospitals in Southern Tanzania in 2021. Transcribed interviews were analysed using reflexive thematic analysis. Coding and analysis were supported by the software MAXQDA.

RESULTS

Three main themes were generated from the data. The first, 'pain management is multifaceted', describes how some providers and women perceived pain management as entailing various methods to manage pain. Providers perceived themselves as having a role in utilization of pain management to varying degree. The second theme 'pain management is primarily a woman's task' highlights a perception of pain management as unnecessary, which appeared to link with some providers' perceptions of pain as natural and necessary for successful childbirth. Few women explicitly shared this perception. The third theme 'practice of pain management can be improved' illustrates how women and maternity care providers perceived current practices of pain management as suboptimal. According to providers, this is primarily due to contextual factors such as shortage of staff and poor ward infrastructure.

CONCLUSION

Women's and maternity care providers' perceptions ranged from perceiving pain management as involving a combination of physiological, psychological and social aspects to perceive it as related with limited to no pain relief and/or support. While some women and providers had similar perceptions about pain management, other women also reported a dissonance between what they experienced and what they would have preferred. Efforts should be made to increase women's access to respectful pain management in Tanzania.

The Effect of Labor Dance in the First Stage of Labor on Labor Pain, Anxiety, Duration of Labor, and Maternal Satisfaction with Labor: A Randomized Controlled Study

Objective: The study aimed to examine the effects of labor dance applied in the first stage of labor on perceived labor pain, anxiety, duration of labor, and maternal satisfaction with labor. Design: This study is a randomized controlled trial. Methods: A sample size of 128 pregnant women was randomly assigned to a control (n = 64) or experimental (n = 64) group while ensuring equal numbers of primiparous and multiparous participants in each group. After admission to the hospital for parturition, and during the first stage of labor, the women in the experimental group were exposed to a 15-min labor dance every hour when the cervical dilation was between 3 and 8 cm. The labor dance included movements of the sacrum and waist massaged by a partner using a massage glove, which was accompanied by self-selected music. Outcome measures included the Visual Analogue Scale (VAS), the State Anxiety Scale (SAS), and the Scale for Measuring Maternal Satisfaction (SMMS)-normal birth and labor duration. These were administered before the labor dance and at the end of the labor dance at three points of cervical dilation: 3, 5-6, and 7-8 cm for the experimental group, and at similar points in the control group: at the start of dilation and 15 min later. The data were analyzed using the generalized linear model and Mann-Whitney U tests. Results: In comparison to the control group, for the group performing the labor dance, the mean VAS scores were lower (p < 0.05) at each evaluation period, and the mean scores of total SMMS and some of its subdivisions were significantly higher in the experimental group (p < 0.05). There was no statistically significant difference between the SAS scores at any evaluation point, including postpartum (p > 0.05). Similarly, there were no significant differences in labor time (p > 0.05) between groups. Conclusions: The practice of labor dance was found to be effective in reducing the perceived labor pain in pregnant women and increasing maternal satisfaction at birth, but not on the duration of labor, and anxiety. Trial registration: ClinicalTrials.gov (NCT04746170).

Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies

BACKGROUND

The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are.

OBJECTIVE

To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience.

METHODS

Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis.

FINDINGS

Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions.

CONCLUSIONS

The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.

Prompting and Modeling of Coping Strategies during Childbirth

There is ample evidence to suggest that upright positions and mobility during labor improve birth outcome, including shorter duration of childbirth and reduced risk of cesarean section. The use of nonpharmacological interventions for pain management during childbirth are recommended by major health-care institutions and medical providers, however, the current methodologies for training coping strategies for use during labor have not shown to be effective on mobility or birth outcome. The purpose of this study was to apply an in-vivo teaching technology to the current childbirth model to prompt an imitative repertoire of empirically demonstrated labor coping strategies. Results of this study concluded that the introduction of a software using immediate prompting and video modeling increased the frequency and variability of labor behaviors during unmedicated labor for birthing persons and their partners.

Tools for assessing labour pain: a comprehensive review of research literature

ABSTRACT

The experience of pain associated with labour is complex and challenging to assess. A range of pain measurement tools are reported in the literature. This review aimed to identify current tools used in research to assess labour pain across the past decade and to evaluate their implementation and adequacy when used in the context of labour pain. A literature search was conducted in databases MEDLINE and Cumulative Index of Nursing and Allied Health Literature, using search terms relating to labour, pain, and measurement. A total of 363 articles were selected for inclusion. Most studies (89.9%) assessed pain as a unidimensional experience, with the most common tool being the Visual Analogue Scale, followed by the Numerical Rating Scale. Where studies assessed pain as a multidimensional experience, the most common measurement tool was the McGill Pain Questionnaire. Only 4 studies that used multidimensional tools selected a tool that was capable of capturing positive affective states. Numerous variations in the implementation of scales were noted. This included 35 variations found in the wording of the upper and lower anchors of the Visual Analogue Scale, some assessment tools not allowing an option for "no pain," and instances where only sections of validated tools were used. It is clear that development of a standardised pain assessment strategy, which evaluates the multidimensions of labour pain efficiently and effectively and allows for both positive and negative experiences of pain to be reported, is needed.

Women's perspectives of nitrous oxide for labour and procedural analgesia: A prospective clinical audit and cross-sectional study. "It's the best thing"

PROBLEM

There is limited data regarding dose and duration of nitrous oxide use by women in peripartum care. Experiences of using nitrous in Australian settings have not previously been explored BACKGROUND: More than 1:2 women use nitrous oxide analgesia during labour and birth, despite this, there are limited published data on nitrous oxide use for labour or procedural analgesia in Australia.

AIM

To explore the use of nitrous oxide during labour and birth or procedural care.

METHODS

A two-phased sequential design was used; clinical audit (n = 183) and cross-sectional survey (n = 137) approaches supported data collection. Quantitative data were analysed using descriptive and inferential statistics, qualitative data underwent content analysis.

FINDINGS

Nitrous oxide was used by primiparous and multiparous women evenly. Duration of labour-use ranged from < 15 min (10.9%) to > 5 h (10.8%), with equal representation between > 50% concentration (43%) and < 50% (43%). At audit, 75% found nitrous useful; postpartum maternal satisfaction scores remained high, mean indicators were 75%. More multiparous women found nitrous oxide useful than primiparous (95%vs80%,p = 0.009). There was no association between perceived usefulness and whether women were in spontaneous, augmented or induced labour; regardless of concentrations reached. Three key themes described women's perspectives of physical and psycho-emotional effects and challenges.

DISCUSSION

Nitrous oxide plays an important role in the provision of analgesia during procedural or labour and birth care. Service provision, parent and professional education, and future service design will benefit from these novel findings confirming the utility and acceptability of nitrous oxide use in contemporary maternity care.

Awe and Trepidation: The Role of Perinatal Care Providers in Black Fathers' Experiences of Childbirth in the U.S

Care provider communication with Black birthing families is impactful. This cross-sectional study asked 216 Black fathers to recall treatment by birthing care providers and tested variables contributing to birth satisfaction and fathering identity salience. Most fathers reported that care providers were respectful resulting in a positive birthing experience; however, 15% reported negative experiences with care providers. Perceived social support was shown to be a mediator between disrespect, mistreatment, inclusive communication, trust, and positive emotion with birth satisfaction and fathering identity salience. Care provider disrespect served as a "spoiler" of the birthing experience and subsequently diminished positive fathering identity salience. Analysis of open-ended comments showed that contrary to stereotypes about absent, disengaged Black fathers, fathers in this study were caring toward their newborns, present for them, and engaged in fathering. More work needs to be done with care provider communication to make every birth a positive and inclusive experience for Black fathers and their partners.

Vaginal Birth at Term - Part 1. Guideline of the DGGG, OEGGG and SGGG (S3-Level, AWMF Registry No. 015/083, December 2020)

Purpose This guideline aims to summarize the current state of knowledge about vaginal birth at term. The guideline focuses on definitions of the physiological stages of labor as well as differentiating between various pathological developments and conditions. It also assesses the need for intervention and the options to avoid interventions. This first part presents recommendations and statements about patient information and counselling, general patient care, monitoring of patients, pain management and quality control measures for vaginal birth. Methods The German recommendations largely reproduce the recommendations of the National Institute for Health and Care Excellence (NICE) CG 190 guideline "Intrapartum care for healthy women and babies". Other international guidelines were also consulted in specific cases when compiling this guideline. In addition, a systematic search and analysis of the literature was carried out using PICO questions, if this was considered necessary, and other systematic reviews and individual studies were taken into account. For easier comprehension, the assessment tools of the Scottish Intercollegiate Guidelines Network (SIGN) were used to evaluate the quality of the additionally consulted studies. Otherwise, the GRADE system was used for the NICE guideline and the evidence reports of the IQWiG were used to evaluate the quality of the evidence. Recommendations Recommendations and statements were formulated based on identified evidence and/or a structured consensus.

Loneliness in pregnant and postpartum people and parents of children aged 5 years or younger: a scoping review

BACKGROUND

Despite evidence that loneliness increases during times of transition, and that the incidence of loneliness is highest in young adults, loneliness during pregnancy and new parenthood has not been developed as a program of research. Because loneliness research has primarily focused on older adults and other high-risk populations, the concept of loneliness and its effects on this population are not well understood, leaving a gap in our understanding of the psychosocial needs and health risks of loneliness on pregnant people and new parents. A scoping review has been completed in order to map and synthesize the literature on loneliness experienced during pregnancy and the first 5 years of parenthood prior to the COVID-19 pandemic.

METHODS

To address the aim of this review, a wide net was cast in order to detect experiences of perinatal or parental loneliness and/or instances where loneliness was measured in this population. Among the inclusion criteria were loneliness in people who were pregnant, who were parents in the postpartum period, or who had children aged 5 years or younger. A search for literature was conducted in December 2020 using nine databases: MEDLINE (Ovid), EMBASE (Elsevier), SCOPUS (Elsevier), Cochrane Library including CENTRAL (Wiley), CINAHL (Ebscohost), PsycINFO (Ebscohost), Dissertations & Theses Global (ProQuest) and Sociological Abstracts (ProQuest), and the Web of Science Core Collection (Clarivate).

RESULTS

Perinatal and parental loneliness studies are limited and have rarely been targeted and developed through a program of research. Loneliness inquiry in this population was frequently studied in relation to other concepts of interest (e.g., postpartum depression). Alternatively, the importance of loneliness emerged from study participants as relevant to the research topic during qualitative inquiry. Across studies, the prevalence of loneliness ranged from 32 to 100%. Loneliness was commonly experienced alongside parenting difficulties, with parents feeling as though they were alone in their struggles.

CONCLUSIONS

As loneliness has been called a sensitive indicator of mental wellbeing, we believe screening will help healthcare professionals identify common difficulties and early signs of depression experienced during pregnancy and parenthood.

SYSTEMATIC REVIEW REGISTRATION

The protocol is available on Open Science Framework at DOI 10.17605/OSF.IO/BFVPZ.

A Descriptive Study of Maternal Choices for Labor Pain Relief

DESIGN

In a setting with a wider than usual variety of available labor pain relief methods, a prospective, descriptive study was conducted of labor pain relief methods desired by low-risk women prenatally, during labor, and at delivery.

SUBJECTS/METHODS

Of all women registering for care between 2017 and 2020, a total of 2562 women were screened for low-risk status and then offered study participation, if eligible. Of 1185 eligible women, 512 remained at low risk until admission in labor and completed the study. Pain relief methods chosen were compared with the type of labor, type of delivery, and between delivery sites.

RESULTS/CONCLUSIONS

Hydrotherapy and a "none/unmedicated" labor were favored by a majority of subjects, regardless of ultimate method used. Multiple labor pain relief methods were used by 54.5% of subjects. Epidural analgesia most often occurred with augmented labor. Hydrotherapy was used more by those with spontaneous labors, water birth deliveries, and birth center births. Effectiveness of all pain relief measures was rated above average. Differences between planned hospital and planned birth center births were clear on most variables. Results can be used by childbirth educators, health professionals, and administrators to respect and improve the individualization of care and satisfaction of laboring women.

Self-Care Mobile Application for South Korean Pregnant Women at Work: Development and Usability Study

Background

Pregnant women at work often encounter barriers to participating in prenatal education or conducting appropriate self-care practices due to their working conditions.

Purpose

We aimed at developing a mobile-based intervention application (SPWW) for Korean pregnant women at work and testing its usability and preliminary effects to enhance their self-care practices.

Patients and Methods

The application was developed and tested with thirty-one pregnant women at work and thirteen women's healthcare providers. The instruments used in this study were a modified Health Practices in Pregnancy Questionnaire II and a System Usability Scale. Descriptive analyses and t-tests were performed using SPSS 25.0. The participants' open-ended answers were analyzed using ATLAS. ti 8.

Results

We developed the application focusing on four self-care topics: healthy diet, physical activity, sufficient rest, and stress management. After using the application for two weeks, participants' levels of exercise (p = 0.006), adequate fluid intake (p = 0.002), and limiting daily caffeine intake (p = 0.048) significantly improved. In addition to good usability scores, the suggestions for improvement made by the participants included diversifying the educational materials and adding individually customizable functions to the application.

Conclusion

The application developed in this study enhanced self-care practices of pregnant women at work and showed adequate levels of usability. We expect the developmental process and details of the application provided in this study to serve as a sample guide for future studies.

Allophone immigrant women's knowledge and perceptions of epidural analgesia for labour pain: a qualitative study

OBJECTIVES

To explore allophone immigrant women's knowledge and perceptions of epidural analgesia for labour pain, in order to identify their information needs prior to the procedure.

DESIGN

We conducted focus groups interviews with allophone women from five different linguistic immigrant communities, with the aid of professional interpreters. Thematic analysis of focus group transcripts was carried out by all authors.

SETTING

Women were recruited at two non-profit associations offering French language and cultural integration training to non-French speaking immigrant women in Geneva.

PARTICIPANTS

Forty women from 10 countries who spoke either Albanian, Arabic, Farsi/Dari, Tamil or Tigrigna took part in the five focus groups. Four participants were nulliparous, but all others had previous experience of labour and delivery, often in European countries. A single focus group was conducted for each of the five language groups.

RESULTS

We identified five main themes: (1) Women's partial knowledge of epidural analgesia procedures; (2) Strong fears of short-term and long-term negative consequences of epidural analgesia during childbirth; (3) Reliance on multiple sources of information regarding epidural analgesia for childbirth; (4) Presentation of salient narratives of labour pain to justify their attitudes toward epidural analgesia; and (5) Complex community positioning of pro-epidural women.

CONCLUSIONS

Women in our study had partial knowledge of epidural analgesia for labour pain and held perceptions of a high risk-to-benefits ratio for this procedure. Diverse and sometimes conflicting information about epidural analgesia can interfere with women's decisions regarding this treatment option for labour pain. Our study suggests that women need comprehensive but also tailored information in their own language to support their decision-making regarding epidural labour analgesia.

Relationship between Religious Coping, Pain Severity, and Childbirth Self-Efficacy in Iranian Primipara Women

Background. One of the important goals of midwifery support and care is to control labor pain and increase the ability to cope with pain. The use of religious coping may be effective in counteracting the stressors of labor, especially labor pain, as well as increasing the self-efficacy of labor. This study was conducted to determine the relationship between religious coping, pain severity, and childbirth self-efficacy in Iranian primipara women. Materials and Methods. This cross-sectional study was performed on 200 Iranian primiparous women referred to eight health centers in the capital of Hormozgan Province who were intending to have a normal vaginal delivery (NVD) in the Persian Gulf and Sharifi Hospitals. The sampling was multistage. Data were collected by demographic and fertility questionnaires, the Iranian Religious Coping Scale, the Childbirth Self-Efficacy Inventory, and the Visual Analog Scale for pain measurement. Results. Among the dimensions of religious coping, benevolent reappraisal had a significant direct relationship with pain severity, and negative religious coping had a significant inverse relationship with pain severity. In the case of childbirth self-efficacy subscales, the results showed dimensions of religious practices, benevolent reappraisal, and active religious coping had a significant direct relationship with outcome expectancy, and negative religious coping had a significant indirect relationship with outcome expectancy. Also, there was a significant direct relationship between religious practices and efficacy expectancy and a significant inverse relationship between negative and passive religious coping and efficacy expectancy. Conclusion. With increasing some dimensions of positive religious coping, the severity of labor pain and childbirth self-efficacy increases, and with increasing dimensions of negative and passive religious coping, childbirth self-efficacy decreases. These correlations were weak in all the mentioned results.

Psychometric properties of the perinatal missed care survey and missed care during labor and birth

Aim:

To evaluate the psychometric characteristics of the Perinatal Missed Care Survey and assess the prevalence of nurse-reported missed care during labor and birth.

Background:

Nursing care during labor and birth differs from other nursing care. Empirical evidence is scant regarding nursing quality and missed nursing care during labor and birth, which are important aspects of quality in maternity care.

Methods:

We conducted exploratory and confirmatory factor analysis on a previously developed perinatal missed nursing care instrument using data from 3,466 registered nurses. Measures included missed nursing care, reasons for missed nursing care, and demographic characteristics. All birth hospitals in each of 37 states were invited to distribute surveys electronically via email to their labor and delivery RN staff. The overall response rate from 277 hospitals that facilitated the survey was 35%.

Results:

Some missed care was reported for each of 25 missed care items. Labor support, intake and output, patient teaching, timely documentation, timely medication administration, and thorough review of prenatal records were missed at least occasionally by >50% respondents. Labor resources (83%), material resources (77%), and communication (60%) were reported reasons for missed nursing care. Exploratory factor analysis aligned with previous testing. Confirmatory factor analysis demonstrated good model fit.

Conclusions:

The Perinatal Missed Care Survey demonstrates good validity and reliability as a measure of missed nursing care during labor and birth. Our findings suggest missed nursing care during labor and birth is prevalent and occurs in aspects of care that could contribute to patient harm when missed.

The concept, importance and values of support during childbearing and breastfeeding - A discourse paper

BACKGROUND

Professional support in childbearing has beneficial effects on childbirth experience, interactions within the family, breastfeeding and medical outcomes. However, more knowledge is needed about prerequisites for professional support to be valuable and satisfactory during childbearing.

AIM

The aim of this discourse paper is to describe and explore prerequisites for professional support that are of value for women and their families during childbearing as well as how healthcare organizations can be formed to facilitate these prerequisites.

DESIGN

Discourse paper.

METHODS

This discourse paper is based on our own experiences and is supported by literature and theory.

RESULTS

Well-functioning structures and processes facilitate professional support that leads to safe, secure, calm and prepared parents with the ability to handle the challenges of childbearing and parenting. When organizing care in childbearing, prerequisites for support needs must also be considered.

[S3 guidelines on "full-term vaginal birth" from an anesthesiological perspective : Worthwhile knowledge for anesthesiologists]

The publication of the new S3 guidelines on "full-term vaginal birth" and the guidelines on cesarean section, also published in 2020, provide further steps towards the promotion of evidence-based medicine in obstetrics, even if the exact configuration of neonatal monitoring during birth, in particular, is still the subject of current discussions. The multiprofessionality in the medical supervision of a birth is also fundamentally well-represented in the compilation of the S3 guidelines by the participating actors and specialist societies. Important from an anesthesiological perspective is the fact that neuraxial procedures still represent the gold standard in obstetric analgesia. With remifentanil PCA an alternative option is available that enables a reliable analgesia to be accomplished, e.g. when there are contraindications to performing neuraxial methods, if this is appropriate under the prevailing circumstances (1:1 support and appropriate monitoring). During an uncomplicated birth the strict fasting rules are relaxed. Overall, the guidelines underline the importance of self-determination and self-control for the expectant mother and give the highest priority to the safety and well-being of mother and child; however, this presupposes that the expectant mother is sufficiently informed about the value of neuraxial analgesia. For this it appears to be of importance to initiate information proposals, which go beyond the usual information sessions for parents that are often organized exclusively by midwives.

Effect of aerobic water exercise during pregnancy on epidural use and pain: A multi-centre, randomised, controlled trial

OBJECTIVE

The physical and psychological benefits of exercise during pregnancy are well established. However, the impact of exercise on pain during labour and the use of epidural analgesia has been less explored. The main aim of this study was to analyse the effectiveness and safety of moderate aerobic water exercise by pregnant women on the subsequent use of epidural analgesia during labour, induction of labour, mode of delivery, and pain perception.

DESIGN

A multi-centre, parallel, randomised, evaluator blinded, controlled trial in a primary care setting.

SETTING

Primary care centres in a health district of a tertiary obstetric metropolitan hospital in Mallorca, Spain.

PARTICIPANTS

Pregnant women (14 to 20 weeks' gestation) who had low risk of complications.

METHODS

Three hundred and twenty pregnant women were randomly assigned to two groups: women who practiced moderate aquatic aerobic exercise with usual antenatal care, and those who received usual prenatal care alone. The gynaecologist, anaesthesiologist and midwife who assisted the women during labour were blinded to group allocations. Principal outcome: use of epidural analgesia during labour. Other outcomes: use of epidural analgesia before 6 cm cervical dilation, labour pain, type of delivery, time of active labour, episiotomy or perineal tear, and induction of labour.

RESULTS

The exercise program did not affect the use of epidural analgesia (OR = 0.79, 95% CI = 0.44 to 1.40), vaginal delivery (OR = 1.35, 95% CI = 0.73 to 2.41), or caesarean section (OR = 0.94, 95% CI = 0.47 to 1.89). However, women in the exercise group reported less pain during labour (mean difference: -0.6, 95% CI = -1.11 to -0.09). The two groups (moderate aquatic aerobic exercise versus usual antenatal care) showed no significant differences in maternal or newborn adverse events.

CONCLUSION

Aquatic aerobic exercise during pregnancy had no effect on the use of epidural analgesia during labour, whereas pain perception was lower after aquatic exercise compared to usual care in pregnancy. The intervention was safe for pregnant women and their newborns.

A longitudinal study of women's representations and experiences of pregnancy and childbirth

OBJECTIVE

To explore women's representations of pregnancy and childbirth and how these representations are constructed and have changed.

BACKGROUND

In the 1980s, many women in Quebec demanded that the birthing process be both demedicalised and humanised, resulting in the legalisation of the midwife profession while expanding their choices over birthing locations within the public health system (e.g., birthing centres, the home, or hospitals). Birth-related technologies were also improving at that time. Nearly 40 years later, we wanted to learn about their perceptions.

METHOD

This qualitative and contextualised phenomenological study surveyed 25 first-time mothers who had received care from midwives, general practitioners, or obstetricians. Each participant met with the researcher twice during her pregnancy and once after giving birth to engage in narrative conversations, which were analysed from an interdisciplinary viewpoint (socio-anthropology).

FINDINGS

Participant perceptions of pregnancy varied. Some saw it as a state that distorted the body, while others saw it as a long period of struggle with a compulsory step that was also fascinating and/or even happy. Women undergo an incremental process of change before contemplating childbirth, and typically undergo a transitional period when nearing the event itself. They may think of childbirth as joyful and/or painful. Representations are built intersubjectively through influences involving family, the media, and care providers. Stories from their mothers, therefore, created undeniable impressions.

CONCLUSION

In a context heavily influenced by technology, easy pregnancies and/or childbirth events are typically deemed "lucky." This negatively reinforces both the cultural and intergenerational values transmitted regarding these events.

Childbirth experiences of immigrant women in Chile: Trading human rights and autonomy for dignity and good care

BACKGROUND

Childbirth is a transcendent life experience but may also be a moment of great vulnerability, especially when it occurs outside the mother's country of origin.

OBJECTIVE

To explore the perceptions and experiences of Spanish-speaking immigrant women regarding the healthcare they received during labour and childbirth in Santiago, Chile.

METHODS

This qualitative, transcendental phenomenological research was performed at two maternity hospitals using purposive criterion sampling. Eighteen individual and two group interviews were conducted. The resulting information was transcribed and then coded and categorised using phenomenological analysis.

RESULTS

Six categories were extracted from the narratives which reflect a pragmatic relationship with the healthcare team that included a perception of 'justified' lack of care. The mothers' exercise of autonomy was subjugated by power-knowledge relations between the women and caregiver that compelled them to refrain from expressing their needs and preferences out of fear of abuse. The women valued emotional support, pain relief and satisfaction of needs in association with medical procedures and companionship. The women rated their experiences as positive if they avoided mistreatment and, as 'the essence of the experience', perceived the care as a favour rather than a right.

CONCLUSION

Most immigrant women felt that they had received treatment similar to that of native-born mothers. However, low expectations of autonomy shaped their evaluations of the experiences. Also, a high value on companionship and pain relief, characterised the women's experiences of childbirth. These findings of the interviews reflect a need for a stronger focus on empowerment with an emphasis on gender and rights.

Quality of intrapartum care assessed by women participating in a midwifery model of continuity of care

INTRODUCTION

Continuity models are rare in Sweden. The aim was to compare the intrapartum care experiences between women who had or not a known midwife attending their birth.

METHODS

A cohort study was conducted in a rural area with long distance to a labor ward in Sweden. From August 2017 to June 2019, a continuity model with a known midwife was offered between 7 a.m. and 11 p.m. daily. Questions about intrapartum care were assessed in two aspects; the perceived reality and the subjective importance.

RESULTS

A total of 226 women recruited in early pregnancy were followed up two months after giving birth. Women who had a known midwife providing labor care reported higher overall satisfaction and were more likely to value the subjective importance and the perceived reality significantly higher than women who received intrapartum care without a known midwife assisting. When analyzing the medical aspects of intrapartum care, the most important factors for not being satisfied were deficiencies in the partner's involvement and insufficient pain relief. For the emotional aspects, deficiencies in participation in decision making was the most important aspect.

CONCLUSIONS

Having a known midwife assisting at birth reduced discrepancies between women's subjective importance and perceived reality of intrapartum care, especially regarding support and the involvement of the partner. A known midwife generated higher overall satisfaction with the medical and emotional aspects of intrapartum care. To improve satisfaction and the quality of intrapartum care, continuity midwifery models of care should be implemented.

Turkish midwives' experiences and opinions in promoting normal births: A grounded theory study

INTRODUCTION

Worldwide, the biomedical model of maternity care has been dominant, with the overuse of interventions.

AIM

This study aimed to gain a deeper understanding of the experiences and opinions of Turkish midwives regarding the promotion of normal births.

METHODS

In-depth interviews were conducted with 12 midwives; data were analysed using grounded theory. The data were analysed according to the constant comparative method.

FINDINGS

The study generated a core category (We want to promote normal births, but have no power to do it), which means all participants wanted to promote normal births. However, they have been disempowered by the medicalised systems of care. There were also three main categories (different ideologies in the labour ward, the midwives have no power, unempowered women). The participants reported that different ideologies in the labour ward were a challenge to promoting normal births. Their working conditions and education level were not enough to support normal birth. The pregnant women were described as unempowered due to a lack of antenatal education and having a fear of childbirth.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Normal birth could be promoted by enhancing the power and responsibilities of midwives. The women need antenatal education to have a normal birth. The normal birth may promote the enhanced readiness of women and midwives.

Experiences as Actors: Labor Pains in Childbirth Care in Germany

Taking labor pains in childbirth care in Germany as a case study, I develop a practice-based notion of experience. Labor pains are sociomaterial experiences and effected actors that are shared and "worked with." Drawing on fieldwork, I show an extensive repertoire of possible interventions used to deal with, and to co-enact, continuously shifting actorships of labor pains in childbirth care. These actorships include helpful tools, unproductive sensations, effective work, fruitless investments, products of bodily tension, and pure labor pains. Experiences such as labor pains are not only passively known, felt and done but also take active part in shaping (childbirth care) practices.

Trait mindfulness during pregnancy and perception of childbirth

Women's subjective childbirth experience is a risk factor for postpartum depression and childbirth-related posttraumatic stress symptoms. Subjective childbirth experience is influenced not only by characteristics of the childbirth itself but also by maternal characteristics. A maternal characteristic that may be associated with a more positive childbirth experience is trait mindfulness. The current study aimed to assess this association and to assess whether trait mindfulness during pregnancy had a moderating role in the possible association between non-spontaneous delivery and perception of childbirth. A subsample of 486 women, participating in a longitudinal prospective cohort study (Holistic Approach to Pregnancy and the first Postpartum Year study), completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy. Women completed the Childbirth Perception Scale and the Edinburgh Postnatal Depression Scale between 7 and 21 days postpartum. The mindfulness facets acting with awareness and non-reacting were significantly associated with a more positive perception of childbirth, after adjusting for covariates. Moderation analyses showed a significant interaction between acting with awareness and non-spontaneous delivery and non-judging and non-spontaneous delivery. Non-spontaneous delivery was associated with a more negative perception of childbirth for low/medium scores of acting with awareness and non-judging, but not for high scores on these mindfulness facets. Trait mindfulness during pregnancy may enhance a positive perception of childbirth. Because this is among the first studies examining the association between maternal dispositional mindfulness and perception of childbirth, future research is needed to confirm the results of the current study.

Development of the Labor Pain Relief Attitude Questionnaire for pregnant women (LPRAQ-p)

BACKGROUND

Receiving epidural analgesia during labor can possibly have negative consequences for mother and child. Yet, the use of epidural analgesia rapidly increased in the Netherlands over the last decade. Since antenatal plans for labor pain relief have been related to epidural analgesia use during labor, the aim of the current study was to develop a Labor Pain Relief Attitude Questionnaire for pregnant women (LPRAQ-p).

METHODS

Three focus group interviews were conducted with pregnant women, new mothers and caregivers and 13 candidate items were derived. Psychometric properties were tested with explorative factor analysis in sample I (N = 429) and a subsequent confirmatory factor analysis in a different sample II (N = 432).

RESULTS

The explorative factor analysis suggested a two-factor seven-item solution: a 'women's perception' and 'social environment' subscale. The confirmatory factor analysis confirmed an excellent six-item model fit with appropriate internal consistency. Higher scores on the six-item LPRAQ-p indicate greater willingness for request of pain relief medication during labor. Two-tailed t-tests showed that women with elevated levels of depression and pregnancy-specific distress symptoms, nulliparous women and multiparous women with complications during a previous delivery had greater willingness for request of pain relief medication during labor. Linear regression showed that the most important association with higher scores on the LPRAQ-p were high pregnancy-specific distress symptoms.

CONCLUSIONS

This study showed the LPRAQ-p to be a valid instrument to evaluate attitude towards labor pain relief in pregnant women. High scores on this questionnaire are associated with high levels of pregnancy-specific distress symptoms.

Fear of childbirth (FOC): pregnant women's perceptions towards the impending hospital birth and coping resources - a reconstructive study

Background: To provide obstetric care which meets the needs of pregnant women with fear of childbirth (FOC), a deeper understanding is required of the beliefs of these women regarding their impending birth and the coping resources they possess to cope with their fear.Methods: Problem-centred interviews were carried out with 12 pregnant women who self-reported high FOC. Data analysis was performed using Bohnsack's Documentary Method to reconstruct collective frames of orientation and implicit and explicit orientations in daily practice and interaction.Results: The interviewees see birth as a field of tension between the poles of naturalness and medicalization. Their need for information displays a need to be in control and fear of losing control. Medical and technological monitoring and one-to-one care promote security. Pregnant women with FOC want to know how they can contribute to a physiological birth.Conclusions: Structural, organizational and conceptual changes in obstetric care are needed to cater to the needs of pregnant women with FOC. Alongside the need for evidence-based information about non-medical and medical pain-relief as well as decision-making aids, the provision of a continuity model of midwifery care is important.

The effect of labor dance on perceived labor pain, birth satisfaction, and neonatal outcomes

OBJECTIVE

This research was conducted to determine the effects of labor dance on perceived birth pain, birth satisfaction, and neonatal outcomes.

DESIGN

This is an experimental study. Data were collected under three groups during the active phase of labor: the dance practitioner midwife group (DPMG, comprising 40 pregnant women), the dance practitioner spouse/partner group (DPSG, comprising 40 pregnant women) and the control group (CG, comprising 80 pregnant women).

SETTING

This study was conducted between 1 April 2017 and 31 October 2017 in Turkey.

PARTICIPANTS

This study was administered on pregnant women volunteers with no risk during the active phase of labor.

INTERVENTIONS

During the active phase, pregnant women in DPMG danced with the midwife; pregnant women in DPSG, on the other hand, danced with their spouses/partners throughout the active phase. When vaginal dilatation reached 4 cm and 9 cm, labor pain was measured by employing the visual analog scale (VAS). In the postpartum phase, newborn babies' first, fifth, and tenth minute Apgar scores and oxygen saturation levels were measured and registered. In the first hour after delivery, the Mackey Birth Satisfaction Scale was administered. CG, on the other hand, received only the routine procedures offered in the hospital.

FINDINGS

The mean scores of VAS 1 and VAS 2 in DPSG and DPMG were lower than in CG. The fifth and tenth minute Apgar scores and the first, fifth, and tenth minute oxygen saturation levels of the newborns in the experimental groups, as well as the level of birth satisfaction, were significantly higher than in CG.

KEY CONCLUSIONS

The study showed a positive effect of labor dancing on the labor process.

Childbirth Experiences of Women With Autism Spectrum Disorder in an Acute Care Setting

OBJECTIVE

To describe the childbirth experiences of women with autism spectrum disorder.

DESIGN

Qualitative interpretive description design and data analysis using Knafl and Webster.

SETTING

Women were interviewed in the environment of their choosing: in the home, over the telephone, or via Skype or Facebook Messenger.

PARTICIPANTS

Twenty-four women ages 29 to 65 years from the United States, United Kingdom, and Australia, all of whom gave birth to healthy newborns in an acute care setting.

METHOD

Interviews were conducted using a semistructured interview guide.

RESULTS

Three main themes emerged from the data: Having Difficulty Communicating, Feeling Stressed in an Uncertain Environment, and Being an Autistic Mother. Each of these themes also included several subthemes.

CONCLUSION

Study participants expressed difficulty communicating with nurses in a variety of ways. The degree of difficulty in communication varied among participants. Problems in communication included trouble conveying needs, alerting nurses when they felt ill, or not understanding what was said to them. Ineffective communication with nurses resulted in feelings of anxiety and being scared and inhibited participants in further attempts at communication. Nurses caring for women with ASD through the childbirth period should be aware that communication needs will vary for each woman, and interventions to facilitate safe and effective communication in labor should be individualized to each woman.

Birthing Consciousness as a Case of Adaptive Altered State of Consciousness Associated With Transient Hypofrontality

In this article, I present the concept of “birthing consciousness,” a psychophysical altered state of women that can occur during natural and undisturbed birth. I demonstrate that this altered state of consciousness (ASC) has phenomenological and cognitive features of hypofrontality; thus, birthing consciousness probably shares a similar brain mechanism to that postulated by the transient-hypofrontality theory (THT). I argue that until recently (with the advent of modern medical intervention), in evolutionary terms, women lacking the proclivity for this specific brain mechanism had a lower chance of reproducing successfully. Hence, I suggest a general and preliminary hypothesis concerning THT: Birthing consciousness is one example of an adaptive pain-induced ASC associated with transient hypofrontality.

A meta-ethnographic synthesis of qualitative research on women's experience of midwifery care

Labor and birth constitute a significant emotional event for a childbearing woman. The aim was to explore women's reflections on their experiences of labor and birth and how these were influenced by the midwifery care they received. A modified version of Noblit and Hare's meta-ethnographic approach was used to develop an inductive and interpretive synthesis of nine qualitative articles. Relevant databases were searched and qualitative articles appraised by means of the Critical Appraisal Skills Program. Two metaphors were identified: The guide-Please share your knowledge and The motherly midwife as an anchor. The comprehensive understanding of the images evoked by the metaphors resulted in an overall metaphoric representation of the women's experiences: The midwife as a birth pilot, that is, a positive labor and birth experience is dependent on the relationship with the midwife. This finding confirms previous knowledge that a trusting relationship results in confidence, while feeling secure leads to a positive birth experience. The metaphors facilitate understanding of the significance of the midwife for women's labor and birth experiences. Knowledge of labor and birth experiences helps to broaden understanding of the necessity of midwives being willing to engage, act, be aware of errors that may affect women's birth experience, and employ tools to predict unexpected adverse events.

Perceptions of paternal involvement and labour pain management in Chinese couples during childbirth: A qualitative study

BACKGROUND

Labour pain is an individual experience embedded in a socio-cultural context. In childbirth, the father's involvement provides important support to the mother during labour. However, few published studies have evaluated couples' experiences of paternal involvement and labour pain management in the Chinese context.

AIM

This study aimed to understand the experience of labour pain management and the father's involvement in childbirth from the perspectives of women and their partners in Hong Kong.

METHODS

An exploratory qualitative design was adopted. A purposive sample of 45 Chinese parents was recruited at the postnatal unit of a regional hospital. Data were collected through semi-structured face-to-face interviews within 1 month after birth. The data were subjected to content analysis.

FINDINGS

The findings revealed six major themes: the mothers' experience of labour pain, effectiveness of pain relief measures, mothers' perceptions of support from their partners, mothers' perceptions of support from healthcare professionals, fathers' experience of involvement in childbirth and suggested improvements to maternity services.

DISCUSSION

Chinese mothers experienced intense labour pain and used various pain relief measures. Both parents considered the involvement of fathers and support from healthcare professionals to be highly significant during childbirth.

CONCLUSIONS

This study highlights the need for a family-centred model of care during childbirth that involves both parents in the decision-making process. Chinese maternity services should implement individualised birth plans that acknowledge both parents' expectations and preferences, thus promoting a positive childbirth experience for the parents.

Parents' experiences of care following the loss of a baby at the margins between miscarriage, stillbirth and neonatal death: a UK qualitative study

OBJECTIVE

To explore the healthcare experiences of parents whose baby died either before, during or shortly after birth between 20⁺⁰ and 23⁺⁶  weeks of gestation in order to identify practical ways to improve healthcare provision.

DESIGN

Qualitative interview study.

SETTING

England through two parent support organisations and four NHS Trusts.

SAMPLE

A purposive sample of parents.

METHODS

Thematic analysis of semi-structured in-depth narrative interviews.

MAIN OUTCOME MEASURES

Parents' healthcare experiences.

RESULTS

The key overarching theme to emerge from interviews with 38 parents was the importance of the terminology used to refer to the death of their baby. Parents who were told they were 'losing a baby' rather than 'having a miscarriage' were more prepared for the realities of labour, the birth experience and for making decisions around seeing and holding their baby. Appropriate terminology validated their loss, and impacted on parents' health and wellbeing immediately following bereavement and in the longer term.

CONCLUSION

For parents experiencing the death of their baby at the margins between miscarriage, stillbirth and neonatal death, ensuring the use of appropriate terminology that reflects parents' preferences is vital. This helps to validate their loss and prepare them for the experiences of labour and birth. Reflecting parents' language preferences combined with compassionate bereavement care is likely to have a positive impact on parents' experiences and improve longer-term outcomes.

TWEETABLE ABSTRACT

Describing baby loss shortly before 24 weeks of gestation as a 'miscarriage' does not prepare parents for labour and birth, seeing their baby and making memories.

Being in charge in an encounter with extremes. A survey study on how women experience and work with labour pain in a Nordic home birth setting

PROBLEM

There is a knowledge gap regarding women's experiences of coping with labour pain when not soliciting or not having access to pharmacological pain relief.

BACKGROUND

How women manage labour pain is complex, multifaceted and only the woman giving birth can assess the experienced pain. Women in the Nordic countries planning for a homebirth have little or no access to pharmacologic pain relief during labour.

AIM

The aim of this study was to explore how women experience and work with labour pain when giving birth in their own home.

METHODS

Quantitative and qualitative data was prospectively collected and altogether 1649 women with a planned homebirth answered closed and open-ended questions about labour pain and birth experience.

RESULTS

While labour pain was often experienced as positive or very positive, the intensity was experienced as severe or the worst imaginable pain. Two main themes arose from the womens´ descriptions of their birth experience regarding labour pain: An encounter with extremes and Being in charge at home.

DISCUSSION

Women perceived labour pain as severe but manageable and were dedicated to completing the birth at home. Being at home enabled the women to exercise autonomy and work with labour pain on their own terms, together with the midwife and support persons.

CONCLUSIONS

This study provides knowledge about women's experiences of labour pain in a home birth setting who used varying strategies to work with labour pain. This is a subject that should be explored further since results could also apply to facility-based birth settings.

Vulnerability in birth: A negative capability

AIM

This article explores the literature on women's expectations for birth, the sociocultural context from which these expectations originate and their impact on the interpretation of birth experience.

BACKGROUND

Childbirth is associated with specific expectations from women with the potential for dissatisfaction if these expectations are not met.

DESIGN

This paper presents a systematic analysis of the concept of vulnerability in childbirth.

FINDINGS

A framework was extracted from the literature that linked the themes of a discourse of control, construction of inadequacy and shame of exposure to explain the sociocultural origin of dominant childbirth expectations in the literature. The experience of vulnerability unique to the birthing event is suggested as exposing the woman to this underlying contextual framework and impacting the interpretation of her birth.

CONCLUSION

This synthesis has exposed the transient experience of vulnerability during birth as a significant contributor to the birthing woman's interpretation of the birth and her place within it.

RELEVANCE TO CLINICAL PRACTICE

An explanatory framework is offered to clinicians that could increase their awareness of sociocultural and historical factors impacting a woman's expectations for birth. Appreciation of the woman's vulnerability in birth, exposing her to the influence of this framework, can assist clinicians to facilitate a quality birth experience for women. Furthermore, supporting women and midwives to accept this experience of birth vulnerability as a "negative capability," can facilitate an empowering birth experience.

The role and outcomes of music listening for women in childbirth: An integrative review

AIM

To synthesise primary research on the role and use of music listening for women in childbirth.

DESIGN

Integrative review.

METHODS

Whittemore and Knafl's (2005) five-stage integrative review method was utilized to complete a systematic search of the literature. Studies were included if they were (a) peer-reviewed, (b) written in the English language, (c) published between 1 January 1979 and 5 April 2019 and (d) described the use of music listening during labour and birth. Studies were appraised for quality and methodological rigor using standardised assessment tools including the Critical Appraisal Skills Programmes (CASP) checklist for the qualitative studies and the Joanna Briggs Institute Critical Appraisal Tool for the quasi-experimental studies and randomised control trials. Data extrapolation, methodological quality assessment and Thematic Content Analysis (Braun and Clarke, 2006) were carried out.

FINDINGS

A total of 931 articles were retrieved and 24 papers were included in the review (12 randomized controlled trials, 9 quasi-experimental and 3 qualitative). The quality of the studies was moderately good overall. Two overarching themes emerged including 'outcomes of using music in childbirth' and, 'music application during childbirth'. Within 'outcomes of using music in childbirth' four subthemes are described: 'pain', 'anxiety', 'psychological supports' and 'progression of labour'. Within 'music application during childbirth' four themes are presented: 'timing of the music application', 'type of music', 'birth preparation using music' and 'mode of music listening'.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

The findings indicate that music listening has a significant role to play for women in childbirth. This non-pharmacological intervention can reduce pain and anxiety while offering a multifaceted form of psychological support to alleviate stress and promote an increased sense of control in women during labour. However, further awareness is needed around the idiosyncratic nature of the music listening experience.

The childbirth experience: obstetric and psychological predictors in Italian primiparous women

BACKGROUND

The experience of childbirth crucially impacts a mother's psychological well-being and the mother-infant relationship. It is recognised that negative births can be linked to different forms of discomfort, both for the mother as well as for the infant. This prospective longitudinal study aimed to study the effect of obstetric and psychological variables on women's subjective experience of childbirth.

METHODS

111 primiparous Italian women completed a set of questionnaires at 38-40 weeks of pregnancy (Time 1) and 1-5 days after childbirth (Time 2). Sociodemographic and obstetric information were collected. Data about the childbirth were obtained from the mother's ward birth records. Women completed the Wijma Delivery Expectancy/Experience Questionnaire both before and after childbirth.

RESULTS

The subjective experience of birth was significantly predicted by the duration of the expulsive phase (β = .26; p < .05), the use of epidural analgesia (β = .21;  p< .05) and by fear of birth (β = .21; p < .05). The effect of mode of birth and duration of the dilatation phase on women's birth experience was not found.

CONCLUSIONS

In our study, neither instrumental childbirth nor caesarean section have a significant effect on women's birth experience. Instead, both a longer expulsion phase and epidural analgesia contribute to the negative experience. Moreover, the higher the fear of birth, the worse the women's emotional experience. These findings confirmed the role of obstetric and psychological variables on birth experience. More investigation about this topic could be useful to develop specific interventions to prepare women for birth.

Intentions and influencing factors regarding natural childbirth among urban pregnant women in China, based on the theory of reasoned action and structural equation modeling

Objectives

In the present study, we aimed to analyze the status of natural childbirth and factors influencing delivery behaviors among pregnant women in urban areas based on the theory of reasoned action, to provide a basis for health education on natural childbirth.

Methods

We recruited 658 pregnant women at West China Second University Hospital, Sichuan University. Using a literature review, expert consultation, and self-report questionnaires based on the theory of reasoned action, we investigated delivery behaviors and influencing factors among the included pregnant women. The questionnaires primarily comprised general situations and behavioral intentions regarding natural childbirth among pregnant women. The data were analyzed using IBM SPSS 21.0 software.

Results

According to structural equation modeling, participants’ behavioral intentions regarding natural childbirth were influenced by normative beliefs (standardized regression coefficient 0.402), outcome evaluation (standardized regression coefficient 0.123), and behavioral beliefs (standardized regression coefficient 0.316). Conformity motivation and knowledge about childbirth affected the choice of natural childbirth via normative beliefs (standardized regression coefficients 0.431 and 0.338, respectively).

Conclusions

We found that the behavioral intentions of urban pregnant women with respect to natural childbirth were affected by normative beliefs, outcome evaluations, behavioral beliefs, conformity motivation, and knowledge about childbirth.

Relation between Length of Exposure to Epidural Analgesia during Labour and Birth Mode

Objective: To appraise the relationship between the length of exposure to epidural analgesia and the risk of non-spontaneous birth, and to identify additional risk factors. This study is framed within the MidconBirth project. Study design: A multicentre prospective study was conducted between July 2016 and November 2017 in three maternity hospitals in different Spanish regions. The independent variable of the study was the length of exposure to epidural analgesia, and the dependent variable was the type of birth in women with uncomplicated pregnancies. The data was analyzed separately by parity. A multivariate logistic regression was performed. The odds ratios (OR), using 95% confidence intervals (CI) were constructed. Main outcome measures: During the study period, 807 eligible women gave birth. Non-spontaneous births occurred in 29.37% of the sample, and 75.59% received oxytocin for augmentation of labour. The mean exposure length to epidural analgesia when non-spontaneous birth happened was 8.05 for primiparous and 6.32 for multiparous women (5.98 and 3.37 in spontaneous birth, respectively). A logistic regression showed the length of exposure to epidural during labour was the major predictor for non-spontaneous births in primiparous and multiparous women followed by use of oxytocin (multiparous group). Conclusions: The length of exposure to epidural analgesia during labour is associated with non-spontaneous births in our study. It highlights the need for practice change through the development of clinical guidelines, training programs for professionals and the continuity of midwifery care in order to support women to cope with labour pain using less invasive forms of analgesia. Women also need to be provided with evidence-based information.

Perceptions of obstetric analgesia: a qualitative study among midwives attending normal vaginal deliveries in Durame Hospital, Southern Ethiopia

Background

Labor pain is distressing and produces undue side effects to both woman and fetus. In low-income countries like Ethiopia, addressing pain relief is often neglected. Professionals attending labor may not have awareness of obstetric analgesia. Besides this, there is a lack of published research on perceptions of obstetric analgesia among health professionals in Ethiopia. The aim of this study was to explore perceptions of obstetric analgesia among midwives attending normal vaginal deliveries in Durame Hospital.

Methods

The study adopted an exploratory descriptive qualitative approach in Durame General Hospital, Kembata Tembaro Zone, Southern Ethiopia from March 1 to April 2, 2017. Fifteen midwives were purposely selected and participated in in-depth interviews. Data from interviews were transcribed, translated to English, coded, and categorized into themes. Data analysis was initiated alongside data collection using a thematic approach. Written informed consent was obtained from all study participants.

Results

Scarcity of knowledge, negative attitudes, lack of trained personnel, and absence of protocols were impediments to using labor analgesia for midwives to relieve labor pain.

Conclusion

This study suggests that perceptions and practices of midwives with regard to labor analgesia needs special attention to address labor pain by scaling up forms and practice of labor analgesia in such a way that internationally accepted standards are met.

Effect of an educational program based on cognitive behavioral techniques on fear of childbirth and the birth process

Objective: This study determined the effect of an educational program based on cognitive behavioral techniques (CBT) provided for pregnant women to address their fear of childbirth. Methods: This study was conducted experimentally using pretest-posttest and a control group. A total of 111 Turkish pregnant women were recruited with 52 in the intervention group and 59 in the control group. The intervention group attended the educational program on coping with childbirth fears based on CBT, which took 3 weeks over six sessions. The Wijma Delivery Expectancy/Experience Questionnaire, version-A (W-DEQ-A) was administered to both groups as the posttest. The researchers monitored the pregnant women's labor and delivery and the State Anxiety Inventory (SAI), Numeric Pain Rating Scale (NPRS) and Birth Process Evaluation Form were completed. Results: The post-education W-DEQ-A score was 63.5 in the control group and 39.4 in the intervention group (p < .001). Their labor pain was lower, the second stage of labor was shorter and birth was more satisfactory for the intervention group than for the control group (p < .05). The CBT-based educational program and pain severity during childbirth were the significant predictors of satisfaction with childbirth (β = 0.354; β = -0.324, respectively; p < .05 for all). Conclusions: The CBT-based educational program on coping with childbirth fears reduced pregnant women's fear of childbirth and positively affected their birth experience.

Correlates of the Pregnancy Experience and Attitude regarding Weight Change during Pregnancy in Primigravida Women

PURPOSE

We aimed to examine the correlations between pregnancy experience and attitude regarding weight change during pregnancy.

METHODS

This correlative study was conducted from July 2017 to October 2017 by involving 156 primigravida women who were over pregnancy 20 weeks in Seoul and Gyeonggi-do province. Data were collected using a questionnaire, which included questions on demographic data, experience during pregnancy, and attitude regarding weight change during pregnancy. Descriptive statistics were calculated. Also, independent t-test, ANOVA, and Pearson's correlation coefficients were used for data analysis.

RESULTS

The mean age of the participants was 30.62 years and their score of attitude regarding weight gain during pregnancy was low. Moreover, a significant correlation was found between the pregnancy experience and attitude regarding weight gain during pregnancy in primigravida women.

CONCLUSION

As a result of analyzing the correlation between pregnancy experience and attitude towards weight gain during pregnancy, it is apparent that attitudes toward weight change are different according to experience during pregnancy in women. Based on these results, it can be concluded that nursing intervention programs are necessitated to enhance the attitude of pregnant primigravida women towards pregnancy and weight gain.

Women's experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review

BACKGROUND

Many women use pharmacological or non-pharmacological pain relief during childbirth. Evidence from Cochrane reviews shows that effective pain relief is not always associated with high maternal satisfaction scores. However, understanding women's views is important for good quality maternity care provision. We undertook a qualitative evidence synthesis of women's views and experiences of pharmacological (epidural, opioid analgesia) and non-pharmacological (relaxation, massage techniques) pain relief options, to understand what affects women's decisions and choices and to inform guidelines, policy, and practice.

METHODS

We searched seven electronic databases (MEDLINE, CINAHL, PsycINFO, AMED, EMBASE, Global Index Medicus, AJOL), tracked citations and checked references. We used thematic and meta-ethnographic techniques for analysis purposes, and GRADE-CERQual tool to assess confidence in review findings. We developed review findings for each method. We then re-analysed the review findings thematically to highlight similarities and differences in women's accounts of different pain relief methods.

RESULTS

From 11,782 hits, we screened full 58 papers. Twenty-four studies provided findings for the synthesis: epidural (n = 12), opioids (n = 3), relaxation (n = 8) and massage (n = 4) - all conducted in upper-middle and high-income countries (HMICs). Re-analysis of the review findings produced five key themes. 'Desires for pain relief' illuminates different reasons for using pharmacological or non-pharmacological pain relief. 'Impact on pain' describes varying levels of effectiveness of the methods used. 'Influence and experience of support' highlights women's positive or negative experiences of support from professionals and/or birth companions. 'Influence on focus and capabilities' illustrates that all pain relief methods can facilitate maternal control, but some found non-pharmacological techniques less effective than anticipated, and others reported complications associated with medication use. Finally, 'impact on wellbeing and health' reports that whilst some women were satisfied with their pain relief method, medication was associated with negative self-reprisals, whereas women taught relaxation techniques often continued to use these methods with beneficial outcomes.

CONCLUSION

Women report mixed experiences of different pain relief methods. Pharmacological methods can reduce pain but have negative side-effects. Non-pharmacological methods may not reduce labour pain but can facilitate bonding with professionals and birth supporters. Women need information on risks and benefits of all available pain relief methods.