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Beviláqua JC, Dos Reis LC, Alves VH, Penna LHG, da Silva SÉD, Parente AT, de Jesus Dias Sousa F, Vieira BDG, Pereira AV, Fernandes MES, Rodrigues DP. Health professionals' perceptions of planned home birth care within the Brazilian health system. BMC Pregnancy Childbirth 2023; 23:844. [PMID: 38066510 PMCID: PMC10704750 DOI: 10.1186/s12884-023-06161-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 11/26/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The American College of Obstetricians and Gynecologists, in its opinion of the Committee on Midwifery Practice, points out that planned home birth is a woman's and family's right to experience, but also to choose and be informed about, their baby's place of birth. The aim of this study was to understand obstetric nurses' perceptions of planned home childbirth care within the framework of the Brazilian obstetric model. METHOD A qualitative study, with Snowball Sampling recruitment, totaling 20 obstetric nurses through semi-structured interviews between September 2022 and January 2023, remotely, using the Google Meet application and the recording feature. After the data had been collected, the material was transcribed in full and subjected to content analysis in the thematic modality with the support of ATLAS.ti 8.0 software. RESULTS Obstetric care at home emerged as a counterpoint to hospital care and the biomedical model, providing care at home based on scientific evidence and humanization, bringing qualified information as a facilitator of access and financial costs as an obstacle to effective home birth. CONCLUSION Understanding obstetric nurses' perceptions of planned home birth care in the context of the Brazilian obstetric model shows the need for progress as a public policy and for strategies to ensure quality and regulation.
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Affiliation(s)
| | | | - Valdecyr Herdy Alves
- School of Nursing, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
| | | | | | | | | | | | - Audrey Vidal Pereira
- School of Nursing, Federal Fluminense University, Niterói, Rio de Janeiro, Brazil
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Abdominal examination during pregnancy may enhance relationships between midwife, mother and child: a qualitative study of pregnant women's experiences. BMC Pregnancy Childbirth 2023; 23:84. [PMID: 36721122 PMCID: PMC9887567 DOI: 10.1186/s12884-023-05392-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 01/18/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Abdominal examination is a routine procedure performed by midwives several times during pregnancy to monitor the growth and well-being of the baby. Literature and instructions regarding abdominal examination focus on the technical performance, with limited attention paid to the women's experience of the examination or the bonding-related aspects between the mother and baby. The aim of the study was to explore how pregnant women experience the abdominal examination and how the examination affects maternal-fetal attachment. METHODS Participant observation and semi-structured interviews with 10 pregnant women. We used thematic analysis to identify themes across the empirical material. RESULTS We identified the following four central themes: an essential examination, the baby becomes real, the importance of being involved and different senses provide different experiences. These themes describe how the women regarded the abdominal examination as an essential part of the midwifery consultation and considered it the occasion when the baby became real and tangible. Being prepared and involved before and during the examination were pivotal for how the examination was experienced by the women. The abdominal examination was crucial to the pregnant women because it provided them with important sensory aspects that were not obtained from ultrasound examination. CONCLUSION The abdominal examination is regarded as essential in midwifery consultations and has the potential for supporting a woman's bodily sensation of her baby, which is reinforced by the midwife's manual palpation. Touch can be a way for a pregnant woman to become acquainted with her unborn child, which provides midwives a profound potential to facilitate the process of maternal-fetal attachment.
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Expectations of the upcoming birth – A survey of women’s self-efficacy and birth positions. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100783. [DOI: 10.1016/j.srhc.2022.100783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/05/2022] [Accepted: 09/21/2022] [Indexed: 11/27/2022]
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Lou S, Dahlen HG, Gefke Hansen S, Ørneborg Rodkjær L, Maimburg RD. Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women's motivations and preparations for freebirth. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100789. [PMID: 36332498 DOI: 10.1016/j.srhc.2022.100789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Even in maternity care systems with free midwifery care, some women intentionally choose to birth unattended by any health professional (freebirth). Women who choose freebirth represent an enigma for many, and a provocation to some. However, people who do not conform to dominant medical practices are a source of valuable insights that can reveal shortcomings in the mainstream health care system. Thus, the aim of this study was to explore and understand women's motivations and preparations for freebirth. METHODS The study was informed by the theoretical lens of the 'undisciplined patient'. Qualitative, in-depth interviews were performed with ten Danish women, who for their most recent birth had planned to freebirth. Data were analysed using reflexive thematic analysis. RESULTS Four themes were identified. "The standard system is not for me" describes negative experiences during previous births and the desire for more individualised support. "Re-establishing trust in myself" describes the women's quest for recognizing their own needs and re-building autonomy and inner strength. "I do my research" describes how the women sought new ways of knowing and prioritised experiential knowledge. And finally, "I create my safe space" describes the women's efforts to create the best possible physical and emotional space for themselves and their babies in order to have a safe and autonomous birth experience. CONCLUSION Freebirth is not undertaken lightly or without preparation by women. Improved continuity of care as well as greater flexibility in hospital guidelines could accommodate some of these women's demand for autonomy in birth.
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Affiliation(s)
- Stina Lou
- Defactum - Public health & Health Services Research, Central Denmark Region, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Sofie Gefke Hansen
- Defactum - Public health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Lotte Ørneborg Rodkjær
- Research Centre for Patient Involvement (ResCenPI), Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Department of Public Health, Health, Aarhus University, Aarhus, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia; Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark
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Gerzen L, Tietjen SL, Heep A, Puth MT, Schmid M, Gembruch U, Merz WM. Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany. J Perinat Med 2022; 50:1124-1134. [PMID: 35611852 DOI: 10.1515/jpm-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES For healthy women entering labor after an uneventful pregnancy, advantages of birth in midwife-led models of care have been demonstrated. We aimed to study the level of awareness regarding care in alongside midwifery units (AMU), factors involved in the decision for birth in obstetrician-led units (OLU), and wishes for care and concerns about birth in women registering for birth in OLU who would have been eligible for care in AMU. METHODS Healthy women with a term singleton cephalic fetus after an uneventful pregnancy course booking for birth in OLU were prospectively recruited. Data were collected by questionnaire. RESULTS In total, 324 questionnaires were analyzed. One quarter (23.1%) of participants never had heard of care in AMU. Two thirds (64.2%) of women had made their choice regarding model of care before entering late pregnancy; only 16.4% indicated that health professionals had the biggest impact on their decision. One-to-one care and the availability of a pediatrician were most commonly quoted wishes (30.8 and 34.0%, respectively), and the occurrence of an adverse maternal or perinatal event the greatest concern (69.5%). CONCLUSIONS Although the majority of respondents had some knowledge about care in AMU, expressed wishes for birth matching core features of AMU and concerns matching those of OLU, a decision for birth in OLU was taken. This finding may be a result of lack of knowledge about details of care in AMU; additionally, wishes and concerns may be put aside in favor of other criteria.
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Affiliation(s)
| | | | - Andrea Heep
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Marie-Therese Puth
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
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Tietjen SL, Schmitz MT, Heep A, Kocks A, Gerzen L, Schmid M, Gembruch U, Merz WM. Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia. BMC Pregnancy Childbirth 2021; 21:849. [PMID: 34969368 PMCID: PMC8719397 DOI: 10.1186/s12884-021-04323-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. Methods A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed. Results Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% – 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). Conclusion Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.
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Affiliation(s)
- Sophia L Tietjen
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andrea Heep
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andreas Kocks
- Directorate of Nursing, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lydia Gerzen
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Alcaraz-Vidal L, Escuriet R, Sàrries Zgonc I, Robleda G. Planned homebirth in Catalonia (Spain): A descriptive study. Midwifery 2021; 98:102977. [PMID: 33751929 DOI: 10.1016/j.midw.2021.102977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Affiliation(s)
- L Alcaraz-Vidal
- PhD candidate, Biomedicine Programme, Department of Experimental and Health Sciences, University Pompeu Fabra. Barcelona, Spain; Midwife Coordinator Birth Centre Project, Germans Trias i Pujol Hospital, Carretera del Canyet S/N 08, Badalona, Spain; Sexual and Reproductive Health Research Group, (GRASSIR), Catalan Health Institute Barcelona, Spain; Catalan Association of Homebirth Midwives, Spain.
| | - R Escuriet
- Faculty of Health Sciences, Universitat Ramon Llull. Global Health Gender and Society (GHenderS) Research Group. Barcelona, Spain; Catalan Health Service. Government of Catalonia, Spain
| | - I Sàrries Zgonc
- Catalan Association of Homebirth Midwives, Spain; Independent RM, Spain
| | - G Robleda
- Campus Docent Fundació Privada Sant Joan de Déu, School of Nursing, University of Barcelona. Spain; Iberoamerican Cochrane Centre. Barcelona, Spain
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Offerhaus P, Jans S, Hukkelhoven C, de Vries R, Nieuwenhuijze M. Women's characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:517. [PMID: 32894082 PMCID: PMC7487921 DOI: 10.1186/s12884-020-03204-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care - one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. METHODS We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. RESULTS In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. CONCLUSIONS We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care - both antenatally and in the intrapartum period - and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
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Affiliation(s)
- Pien Offerhaus
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Suze Jans
- TNO, Department of Child Health, Schipholweg 77, 2316 ZL Leiden, The Netherlands
| | | | - Raymond de Vries
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
- CAPHRI (School for Public Health and Primary Care), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 14, CBSSM, Ann Arbor, MI 48109-2800 USA
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
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Thies-Lagergren L, Ólafsdóttir ÓÁ, Sjöblom I. 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. Women Birth 2020; 34:122-127. [PMID: 32057663 DOI: 10.1016/j.wombi.2020.01.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Li Thies-Lagergren
- Department of Midwifery Research - Reproductive, Perinatal and Sexual health, Lund University, Sweden; Department of Obstetrics and Gynaecology, Helsingborg Lasarett, Sweden.
| | - Ólöf Ásta Ólafsdóttir
- Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland
| | - Ingela Sjöblom
- Department of Midwifery Research - Reproductive, Perinatal and Sexual health, Lund University, Sweden
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Maimburg RD, De Vries R. Coaching a slow birth with the woman in an empowered position may be less harmful than routine hands-on practice to protect against severe tears in birth - A discussion paper. SEXUAL & REPRODUCTIVE HEALTHCARE 2019; 20:38-41. [PMID: 31084816 DOI: 10.1016/j.srhc.2019.02.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 02/04/2019] [Accepted: 02/21/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Different hands-on interventions to protect women from severe perineal tears after birth have been widely implemented. Evidence to support the routine use of hands-on interventions to reduce severe tears is mainly based on aggregated data from observational studies. AIM To critically discuss the current evidence for the implementation of hands-on intervention as a routine practice to protect women from severe tears after birth. DISCUSSION Observational studies have been used to justify the routine use of hands-on intervention to protect women from severe perineal tears despite randomized controlled trials and systematic reviews showing lack of benefit. There is strong evidence supporting the slow speed at the time of birth to prevent severe perineal tears. While hands-on intervention does reduce the speed of birth, it may have a negative effect on the birth process, on neonatal outcomes and women's agency. CONCLUSION Evidence-based practice requires sufficient evaluation of interventions before being implemented in clinical practice as well as valuing the level of evidence when making clinical decisions. Evaluation of hands-on interventions to protect women from severe perineal tears must include not just one outcome of interest, but also an assessment of how the intervention interferes with the normal mechanism of birth, and how it affects neonatal outcomes and the autonomy of women.
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Affiliation(s)
- Rikke Damkjær Maimburg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark; Department of Gynaecology and Obstetrics, Aarhus University Hospital, Aarhus, Denmark.
| | - Raymond De Vries
- Research Centre for Midwifery Science, Zuyd University, Maastricht, the Netherlands; Caphri School for Publich Health and Primary Care, Maastricht University, Maastricht, the Netherlands
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