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Capper T, Ferguson B. Evaluating women's experiences of labour pain: beyond a generic pain scale. Evid Based Nurs 2024; 27:88. [PMID: 38071566 DOI: 10.1136/ebnurs-2023-103850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/22/2023]
Affiliation(s)
- Tanya Capper
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Banyo, Queensland, Australia
| | - Bridget Ferguson
- School of Nursing, Midwifery and Social Sciences, CQUniversity Australia, Norman Gardens, Queensland, Australia
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Shifman J, Jones LE, Davey MA, East CE, Whitburn LY. Novel grouping of planned coping strategies for managing the intensity of labour: A survey study of Australian nulliparous women. Midwifery 2024; 136:104055. [PMID: 38917572 DOI: 10.1016/j.midw.2024.104055] [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: 11/01/2023] [Revised: 05/16/2024] [Accepted: 06/07/2024] [Indexed: 06/27/2024]
Abstract
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.
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Affiliation(s)
- Janine Shifman
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia
| | - Lester E Jones
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Singapore Institute of Technology, Dover Drive, 129784, Singapore
| | - Mary-Ann Davey
- Department of Obstetrics and Gynaecology, School of Medicine, Nursing and Health Sciences, Monash University, Clayton 3168, Australia
| | - Christine E East
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Mercy Hospital for Women, Heidelberg 3084, Australia
| | - Laura Y Whitburn
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, VIC 3086, Australia; Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora 3086, Australia.
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Massov L, Robinson B, Rodriguez-Ramirez E, Maude R. 'Giving birth on a beach': Women's experiences of using virtual reality in labour. PLoS One 2024; 19:e0304349. [PMID: 38865321 PMCID: PMC11168694 DOI: 10.1371/journal.pone.0304349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Birth is a normal physiological process, and many women want a natural birth. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using Virtual Reality as a non-pharmacological method of pain relief in labour. Virtual Reality has been shown to be an effective distraction technique in other acute pain settings which also reduces anxiety. METHODS This study conducted qualitative in-depth interviews postnatally with women who used Virtual Reality in labour. Thematic analysis was used to analyse the qualitative data. RESULTS Nineteen women used Virtual Reality in labour. Results from interviews with nineteen women in the postnatal period identified three main themes: impact of virtual reality on experience of labour, managing the pain of labour and challenges of using virtual reality in labour. CONCLUSION This study identified that Virtual Reality was effective as a relaxation technique and helped in pain management by the use of self-efficacy techniques. Women in this study also identified preferred virtual environments specifically to use during labour and birth. This study provides a unique and original contribution to the field of Virtual Reality in labour and birth. It also identifies Virtual Reality as an acceptable and positive experience in the management of anxiety and labour pain.
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Affiliation(s)
- Lorna Massov
- School of Nursing, Midwifery and Health Practice, Victoria University Wellington, Wellington, New Zealand
| | - Brian Robinson
- School of Nursing, Midwifery and Health Practice, Victoria University Wellington, Wellington, New Zealand
| | | | - Robyn Maude
- School of Nursing, Midwifery and Health Practice, Victoria University Wellington, Wellington, New Zealand
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Zhang EW, Jones LE, Whitburn LY. Tools for assessing labour pain: a comprehensive review of research literature. Pain 2023; 164:2642-2652. [PMID: 37556378 DOI: 10.1097/j.pain.0000000000003004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/31/2023] [Indexed: 08/11/2023]
Abstract
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.
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Affiliation(s)
- Erina W Zhang
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, Australia
| | - Lester E Jones
- Health Social Sciences Cluster, Singapore Institute of Technology, Singapore
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
| | - Laura Y Whitburn
- Department of Microbiology, Anatomy, Physiology and Pharmacology, School of Agriculture, Biomedicine and Environment, La Trobe University, Bundoora, Australia
- Judith Lumley Centre, School of Nursing and Midwifery, La Trobe University, Bundoora, Australia
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Nori W, Kassim MAK, Helmi ZR, Pantazi AC, Brezeanu D, Brezeanu AM, Penciu RC, Serbanescu L. Non-Pharmacological Pain Management in Labor: A Systematic Review. J Clin Med 2023; 12:7203. [PMID: 38068274 PMCID: PMC10707619 DOI: 10.3390/jcm12237203] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/15/2023] [Accepted: 11/18/2023] [Indexed: 04/22/2024] Open
Abstract
Childbirth is a remarkable, life-changing process and is frequently regarded as an excruciating, physically and emotionally demanding experience that women endure. Labor pain management poses a significant challenge for obstetricians and expectant mothers. Although pharmacological pain management is the gold standard, it still imposes risks on the mother and baby. Recently, non-pharmacological pain management (NPPM) has emerged as a safe, effective option. Six databases were searched for articles published up to 2023 using specific related keywords and defined inclusion and exclusion criteria. The extraction and gathering of data was made so as to be categorized into physical, psychological, and complementary NPPM techniques. In light of the enormous development and diversity of NPPM techniques, the present review aims to examine contemporary NPPM knowledge and application, discussing efficacy, advantages, limitations, and potential adverse effects, with a specific focus on women's individual requirements, to strengthen obstetricians' knowledge in guiding decision-making for women in childbirth.
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Affiliation(s)
- Wassan Nori
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Mustafa Ali Kassim Kassim
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Zeena Raad Helmi
- College of Medicine, Mustansiriyah University, Baghdad 10052, Iraq;
| | - Alexandru Cosmin Pantazi
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
| | - Dragos Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Ana Maria Brezeanu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Roxana Cleopatra Penciu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
| | - Lucian Serbanescu
- Faculty of Medicine, “Ovidius” University of Constanta, 900470 Constanta, Romania; (D.B.); (A.M.B.); (R.C.P.); (L.S.)
- Obstetrics and Gynecology Department, Clinical Emergency Hospital of Constanta, 900591 Constanta, Romania
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Bradfield Z, Rose MS, Freeman N, Leefhelm E, Wood J, Barnes C. Women's perspectives of nitrous oxide for labour and procedural analgesia: A prospective clinical audit and cross-sectional study. "It's the best thing". Women Birth 2023; 36:529-537. [PMID: 37423802 DOI: 10.1016/j.wombi.2023.06.007] [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: 03/02/2023] [Revised: 06/24/2023] [Accepted: 06/25/2023] [Indexed: 07/11/2023]
Abstract
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.
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Affiliation(s)
- Zoe Bradfield
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia; King Edward Memorial Hospital, Bagot Rd, Subiaco, Perth, Western Australia, Australia.
| | - Monique S Rose
- King Edward Memorial Hospital, Bagot Rd, Subiaco, Perth, Western Australia, Australia
| | - Nicole Freeman
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia; King Edward Memorial Hospital, Bagot Rd, Subiaco, Perth, Western Australia, Australia
| | - Emily Leefhelm
- School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia; King Edward Memorial Hospital, Bagot Rd, Subiaco, Perth, Western Australia, Australia
| | - Jennifer Wood
- King Edward Memorial Hospital, Bagot Rd, Subiaco, Perth, Western Australia, Australia
| | - Courtney Barnes
- King Edward Memorial Hospital, Bagot Rd, Subiaco, Perth, Western Australia, Australia
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Abdelhafeez AM, Alomari FK, Al Ghashmari HM, Newera A, Alshehri HO, Alzulfi FM, Khreisat KA, Osman AA, Osman MA. Awareness and Attitude Toward Epidural Analgesia During Labor Among Pregnant Women in Taif City: A Hospital-Based Study. Cureus 2023; 15:e49367. [PMID: 38146556 PMCID: PMC10749264 DOI: 10.7759/cureus.49367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/24/2023] [Indexed: 12/27/2023] Open
Abstract
Objectives This study aimed to investigate the awareness and attitudes towards epidural analgesia (EA) among pregnant women in Taif City, Saudi Arabia. The rationale was to identify potential barriers to the acceptance and use of EA, which is an effective pain management option during labor. Methods We conducted a cross-sectional survey at a single healthcare center in Taif City. The participants, pregnant women visiting the center, were recruited using a convenience sampling method. Data collection was facilitated by a questionnaire distributed through a quick response (QR) code. The questionnaire assessed demographic information, awareness levels, previous exposure to EA, and personal attitudes toward its use during labor. Data analysis focused on quantifying the levels of awareness and identifying patterns in attitudes. Results The results revealed a low level of awareness about EA among the participants, with a significant proportion having never been exposed to it before the survey. Attitudes towards EA were varied, with some expressing openness to its use and others displaying apprehension or resistance, which appeared to be influenced by cultural perceptions and a lack of information. Conclusions The study highlighted a substantial lack of awareness and varied attitudes towards EA among pregnant women in Taif City. Educational interventions are necessary to increase awareness and address cultural misconceptions. The study's limited scope and potential sample bias suggest the need for broader culturally tailored research to inform strategies for improving the acceptance and utilization of labor analgesia.
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Affiliation(s)
- Alaa M Abdelhafeez
- Department of Anesthesia, Prince Sultan Military Hospital, Taif, SAU
- Department of Anesthesia and Critical Care, Faculty of Medicine, Omdurman Islamic University, Khartoum, SDN
- Specialization of Anesthesia, The College of Anaesthesiologist of Ireland (FCAI), Duplin, IRL
- Specialization of Anesthesia and Intensive Care, Jordanian Board, Amman, JOR
- Specialization of Anesthesia and Intensive Care, Arab Board, Amman, JOR
| | - Fahad K Alomari
- Department of Family Medicine, Prince Sultan Military Hospital, Taif, SAU
- Specialization of Family Medicine, Saudi Board, Riyadh, SAU
- Specialization of Family Medicine, Arab Board, Riyadh, SAU
| | - Hassan M Al Ghashmari
- Department of Family Medicine, Prince Sultan Military Hospital, Taif, SAU
- Specialization of Family Medicine, Arab Board, Riyadh, SAU
- Specialization of Health Sciences, King Abdulaziz University, Jeddah, SAU
| | - Ahmed Newera
- Department of Continuous Quality Improvement and Patient Safety, Prince Sultan Military Hospital, Taif, SAU
- Specialization of Social and Preventive Medicine, University of Malaya, Kuala Lumpur, MYS
| | - Hussain O Alshehri
- Department of Anaesthesia, Taif and Alhada Military Hospital, Taif, SAU
- Specialization of Anaesthesia, King Saud University Board, Riyadh, SAU
| | - Fahad M Alzulfi
- Department of Family Medicine, Prince Sultan Military Hospital, Taif, SAU
- Specialization of Family Medicine, Saudi Board, Riyadh, SAU
| | - Khaled A Khreisat
- Department of Anaesthesia, Prince Sultan Military Hospital, Taif, SAU
- Specialization of Anesthesia and Intensive Care, Jordanian Board, Amman, JOR
| | - Awad A Osman
- Department of Obstetrics and Gynaecology, Prince Sultan Military Hospital, Taif, SAU
- Specialization of Obstetrics and Gynaecology, The Royal College of Obstetricians and Gynaecologists, London, GBR
| | - Mardi A Osman
- Department of Obstetrics and Gynaecology, Prince Sultan Military Hospital, Taif, SAU
- Specialization of Obstetrics and Gynaecology, The Royal College of Obstetricians and Gynaecologists, London, GBR
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Jose Henrique A, Rodney P, Hall W, Thorne S, Joolaee S. Women's autonomy for managing labour pain in a relational context: An interpretive description study. J Clin Nurs 2023; 32:7390-7401. [PMID: 37272285 DOI: 10.1111/jocn.16780] [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: 11/26/2022] [Revised: 05/08/2023] [Accepted: 05/22/2023] [Indexed: 06/06/2023]
Abstract
AIM To describe how women perceived relational autonomy for decision-making during childbirth pain and illuminate influencing factors. BACKGROUND Most women report challenging pain during birth. Circumstances can affect their ability to engage in pain management decisions. DESIGN We used an interpretative description approach to conduct this study. METHOD A purposive sample of ten women who reported pain during childbirth participated in semi-structured interviews. The study was conducted between July 2019 and November 2020 and reported according to the COREQ checklist. RESULTS Circumstances during childbirth, such as women's expectations and relationships, influenced their efforts to engage in relational autonomy. Care providers dealt with the unpredictability of childbirth and challenges with pain management using decision-making practices that could disrupt women's expectations, undermine women's trust, demonstrate disrespect for women and rely on inadequate communication. Women who felt dependent on others were less likely to participate in decision-making. When care providers' perceptions about pain differed from women's reports of pain, participants became distressed because care providers did not acknowledge their subjective pain experiences. CONCLUSIONS Women regarded their relationships and communication with care providers as foundational to relational autonomy in decision-making about pain management during childbirth. RELEVANCE TO CLINICAL PRACTICE Study findings can support care providers' considerations of the complexity of childbirth pain and factors affecting women's relational autonomy in decision-making about pain. In particular, the findings highlight the importance of women's expectations and care providers' recognition of women's experiences of pain. PATIENT OR PUBLIC CONTRIBUTION Women who shared their stories of childbirth pain contributed to the data collected. The chief nursing officers in the data collection setting facilitated the recruitment and data collection.
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Affiliation(s)
| | - Patricia Rodney
- University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
| | - Wendy Hall
- University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
- BC Children's Hospital Research Institute, Vancouver, British Columbia, Canada
| | - Sally Thorne
- University of British Columbia School of Nursing, Vancouver, British Columbia, Canada
| | - Soodabeh Joolaee
- Iran University of Medical Sciences, Tehran, Iran
- Research Ethics & Regulatory Specialist, Fraser Health Authority, Vancouver, British Columbia, Canada
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Dastjerd F, Erfanian Arghavanian F, Sazegarnia A, Akhlaghi F, Esmaily H, Kordi M. Effect of infrared belt and hot water bag on labor pain intensity among primiparous: a randomized controlled trial. BMC Pregnancy Childbirth 2023; 23:405. [PMID: 37264341 DOI: 10.1186/s12884-023-05689-0] [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: 07/09/2022] [Accepted: 05/08/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Labor pain is complex, paradoxical and varied in every parturient woman. Management of labor pain has been a crucial component in maternity care. Heat therapy is one of the proposed method for labor pain relief. Infrared is one of the methods of heat therapy but there is any study in this regard. This study aimed to compare the effect of the infrared belt and hot water bag on the severity of pain in the first stage of labor among primiparous women. METHODS In this clinical trial in the first stage of labor, 20-min cycles of heat therapy were conducted at the dilations of 4-5 and 6-7 cm in the intervention group 1 by an infrared belt and in the intervention group 2 by hot water bag, respectively. The control group received routine care. The severity of the pain was measured by the short-form McGill Pain Questionnaire. RESULTS In total, 136 women consented to participate in this clinical trial study. The mean score of pain intensity was significantly lower in the two intervention groups compared to the control group (P < 0.001). The mean pain intensity was significantly lower in the infrared belt group than in the hot water bag group (P < 0.001). CONCLUSIONS Based on these findings, heat therapy with an infrared belt reduced the severity of pain in the first stage of labor. The infrared belt could be used and recommended as a safe and effective pain relief in childbirth and maternity care. TRIAL REGISTRATION This study was registered in the Iran Clinical Trial Center with the code of IRCT20190805044446N1 .
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Affiliation(s)
- Fatemeh Dastjerd
- School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Fatemeh Erfanian Arghavanian
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Ameneh Sazegarnia
- Department of Medical Physics, Medical Physics Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Farideh Akhlaghi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Habibollah Esmaily
- Department of Biostatistics, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Masoumeh Kordi
- Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
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Blumenstock AK, Mauter D. [Pain assessment during birth : Which assessment tools comprehensibly depict the labor pains during physiological birth?]. Schmerz 2023:10.1007/s00482-023-00715-8. [PMID: 37184642 DOI: 10.1007/s00482-023-00715-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 02/10/2023] [Accepted: 03/06/2023] [Indexed: 05/16/2023]
Abstract
BACKGROUND Labor pain is a complex phenomenon, which is influenced by many factors. Therefore, an effective pain management during birth requires an assessment of the labor pains; however, there is currently no standardized and valid tool to assess labor pains. OBJECTIVE The aim of this article is to demonstrate which assessment instruments are available for labor pains during a physiological birth and how comprehensibly they depict the pain. MATERIAL AND METHODS The study is an integrative review of the literature based on a literature search conducted in the electronic databases PubMed and CINAHL. To ensure the quality of the review article, COSMIN, AMSTAR 2 and the instrument for assessment of qualitative research of the Association of Women's Health, Obstetric and Neonatal Nurses (AWHONN) were used as assessment instruments. RESULTS Taking the various inclusion and exclusion criteria into consideration, five studies could be included. The following assessment instruments were identified: visual analog scale (VAS), the acceptance symptom assessment scale (ASAS), the angle labor pain questionnaire (A-LPQ), the rating scale of pain expression during childbirth (Escala de Valoración de la Expresión del Dolor durante el Trabajo de Parto, ESVADPA) and the coping with labor pain algorithm (CWLA). These were supplemented by a study on the perspectives of women. CONCLUSION None of the assessment instruments found could assess the birth pain in its full complexity. Therefore, midwives have to rely on their competence to evaluate labor pain on an individual basis. Further research is necessary to identify the relevant influencing factors of labor pains and to be able to develop suitable instruments.
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Affiliation(s)
- Ann-Kathrin Blumenstock
- Station 2, Wochenbettstation, St. Joseph Krankenhaus, Wüsthoffstr. 15, 12101, Berlin, Deutschland.
| | - Daniel Mauter
- Bachelor of Nursing, Evangelische Hochschule, Berlin, Deutschland
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Borrelli SE, Lecis A, Antolini L, Miglietta M, Zanini AA, Nespoli A, Fumagalli S. Pain Intensity, coping and maternal satisfaction in Low-Risk labouring Women: A prospective descriptive correlational study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 36:100848. [PMID: 37084524 DOI: 10.1016/j.srhc.2023.100848] [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: 11/14/2022] [Revised: 03/27/2023] [Accepted: 04/10/2023] [Indexed: 04/23/2023]
Abstract
OBJECTIVES The primary aim of the study was to explore pain intensity (PI) and pain coping (PC) scores and the relationship between them. The secondary aim was to explore the correlation between PI and PC scores with labour progress, parity, labour acceleration, labour augmentation and maternal satisfaction. METHODS A prospective descriptive correlational study was conducted in a maternity hospital in Northern Italy. The sample included 54 low-risk women in active labour at term of pregnancy. A data record sheet was used to collect the relevant variables and the Italian Birth Satisfaction Scale Revised (I-BSS-R) was administered to participants at least 24 h after birth. RESULTS In the first labour stage, the average PI score was 6.99 (SD = 1.95) and the average PC score was 6.5 (SD = 2.22). During the second labour stage, the average PI score was 7.75 (SD = 1.74) and the average PC score was 4.97 (SD = 2.76). The average PI score trend increased with labour progress. The average PC score improved between 4 and 7 cm of cervical dilatation. A significant positive correlation between PI scores and oxytocin augmentation (p < 0.001) and labour progression (p < 0.001) was noted. A significant positive correlation between PC scores and oxytocin augmentation (p = 0.02) was also observed. No significant differences were found for maternal satisfaction in regard to PI and PC scores. CONCLUSION coping in labour do not solely depend on PI but also on labour progress and oxytocin augmentation. Additional support to empower women to cope with pain may be required in case of labour augmentation.
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Affiliation(s)
- S E Borrelli
- University of Nottingham, School of Health Sciences, United Kingdom.
| | - A Lecis
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - L Antolini
- Department of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy
| | - M Miglietta
- Department of Obstetrics and Gynecology, Sacra Famiglia Hospital, Ordine Ospedaliero Fatebenefratelli, Erba (CO), Italy
| | - A A Zanini
- Department of Obstetrics and Gynecology, Sacra Famiglia Hospital, Ordine Ospedaliero Fatebenefratelli, Erba (CO), Italy
| | - A Nespoli
- University of Milano Bicocca, Dipartimento di Medicina e Chirurgia, Italy.
| | - S Fumagalli
- University of Milano Bicocca, School of Medicine and Surgery, Italy.
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Røseth I, Lyberg AM, Sommerseth E, Sandvik BM, Dahl B. “Out of This World”: Norwegian Women’s Experiences of Medical Abortion Pain. J Multidiscip Healthc 2023; 16:889-898. [PMID: 37038454 PMCID: PMC10082597 DOI: 10.2147/jmdh.s399209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 02/21/2023] [Indexed: 04/07/2023] Open
Abstract
Introduction Medical abortion has rapidly become the dominant abortion method in western countries. Pain is a known adverse effect; however, few studies have explored women's subjective experience of medical abortion pain. Purpose To explore Norwegian women's experiences of pain when performing a medical abortion at home. Material and Methods We recruited 24 women through an advertisement on Facebook and conducted semi-structured, face-to-face interviews. The interviews were transcribed verbatim and the data were analyzed using a phenomenological hermeneutical method. Results Our findings consisted of two main themes: 1) Being in pain or becoming pain, and 2) Being caught off guard and struggling to cope. Participants described undergoing severe pain, comparable to giving birth, during the medical abortion. Unprepared for the type and intensity of the pain, they felt anxious and insecure. Pain is physical, but it also has important psychological, social, and existential dimensions. Our culture (in)forms our thoughts and feelings about our pain, affecting our ability to endure suffering. The participants' experiences of abortion pain prompt timely questions concerning gendered socio-cultural and existential meanings connected to pain, specifically in relation to female reproductive functions. Conclusion Women need realistic information about the type and intensity of abortion pain, as well as evidence-based pain medication. Psychological factors may affect the experience of abortion pain and should therefore be taken into account in abortion care.
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Affiliation(s)
- Idun Røseth
- Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Borre, Norway
- Correspondence: Idun Røseth, Department of Child and Adolescent Psychiatry, Telemark Hospital Trust, P.O Box 2900 Kjørbekk, Skien, 3710, Norway, Tel +47 41200462, Email
| | - Anne Marit Lyberg
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Borre, Norway
| | - Eva Sommerseth
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Borre, Norway
| | - Berit Margethe Sandvik
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Borre, Norway
| | - Bente Dahl
- Centre for Women’s, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Borre, Norway
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Yan W, Kan Z, Yin J, Ma Y. Efficacy and Safety of Transcutaneous Electrical Acupoint Stimulation (TEAS) As An Analgesic Intervention for Labor Pain: A Network Meta-analysis of Randomized Controlled Trials. Pain Ther 2023; 12:631-644. [PMID: 36934401 PMCID: PMC10199978 DOI: 10.1007/s40122-023-00496-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 03/20/2023] Open
Abstract
INTRODUCTION Epidural analgesia (EA) is the most widely used intervention for the reduction of labor pain; however, it is contra-indicated for patients with spinal deformity or allergy to anesthetics and may be refused by parturients. As a noninvasive and nonnarcotic analgesic intervention, transcutaneous electrical acupoint stimulation (TEAS) has gained increasing attention in recent years. Therefore, we performed a network meta-analysis to compare the efficacy and safety of TEAS and EA as measured by visual analog scale score, the failure rate of natural delivery, adverse events, and Apgar scores. METHODS Relevant randomized controlled trials (RCTs) from four electronic databases (PubMed, EMBASE, Web of Science, and Cochrane CENTRAL) and clinical trials.gov were searched from inception until September 4, 2022. A random effects model was used during analysis, and outcomes were evaluated as standard mean difference (SMD), odds ratio (OR), and 95% confidence intervals (CrI) using STATA (version SE15.0), R (version 3.6.1), and ADDIS (version 1.16.8) software. RESULTS Ten RCTs comprising 1214 parturients were identified by screening. Six RCTs compared TEAS and controls, three compared EA and controls, and one compared TEAS and EA. No heterogeneity was found within the four outcomes. There was no significant difference in any outcomes between interventions or control treatments in terms of SMD, OR, and CrI. Combined with the highest surface under the cumulative ranking curve score, TEAS demonstrated possible better effects in the aspects of analgesic efficacy and safety under certain circumstances. CONCLUSIONS TEAS may be a potential alternative for parturients as a simple, noninvasive, and non-pharmacological intervention compared with EA in terms of analgesic efficacy and safety for mothers and neonates.
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Affiliation(s)
- Wenli Yan
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Zunqi Kan
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Jiahui Yin
- College of Chinese Medicine, Shandong University of Traditional Chinese Medicine, Shandong, China
| | - Yuxia Ma
- Department of Acupuncture-Moxibustion and Tuina, Shandong University of Traditional Chinese Medicine, Shandong, China.
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Mäkelä K, Palomäki O, Korpiharju H, Helminen M, Uotila J. Satisfaction and Dissatisfaction With Pain Relief and Birth Experience Among Induced and Spontaneous-onset Labours Ending in Vaginal Birth: A Prospective Cohort Study. Eur J Obstet Gynecol Reprod Biol X 2023; 18:100185. [PMID: 37035413 PMCID: PMC10073637 DOI: 10.1016/j.eurox.2023.100185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/10/2023] [Accepted: 03/15/2023] [Indexed: 03/18/2023] Open
Abstract
Objective To assess pain relief and overall birth experience in induced vs. spontaneous-onset labours and to clarify variables among induced parturients determining satisfaction and dissatisfaction. Study design A prospective study of 2042 women. 575 women with induced and 1467 with spontaneous-onset labour answered multiple questions in a questionnaire regarding the experience of birth giving. Satisfaction was numerically assessed via a visual analogue scale (VAS 0-10). Results Induction of labour (IOL) did not worsen the average experience of pain relief, but the proportion of women dissatisfied with pain relief was slightly higher after IOL compared with spontaneous-onset labour (SOL). IOL was associated with lower satisfaction with overall birth experience compared with SOL (VAS 8.0 vs. 8.4; p < 0.001). Among IOL parturients incorrect timing of pain relief was strongly associated with dissatisfaction with pain relief, as were deficient information and induction with misoprostol. Epidural blockade was the most important factor preventing dissatisfaction with pain relief. Unsatisfactory overall experience of birth was associated with deficient pain relief, its incorrect timing or deficient information, as well as vacuum extraction as the mode of delivery. Conclusions Induction of labour is a risk factor of dissatisfaction regarding pain relief and overall birth experience. The strongest impact on dissatisfaction among induced parturients concerning pain relief was delayed timing of effective labour analgesia. Poor pain relief, its incorrect timing and deficient information on pain relief were strong predictive factors of dissatisfaction with the overall birth experience.
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Affiliation(s)
- Katja Mäkelä
- Department of Obstetrics and Gynecology, Tampere University Hospital, PL 272, 33101 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, ARVO, PL 2000, 33521 Tampere, Finland
- Corresponding author at: Department of Obstetrics and Gynecology, Tampere University Hospital, PL 272, 33101 Tampere, Finland.
| | - Outi Palomäki
- Department of Obstetrics and Gynecology, Tampere University Hospital, PL 272, 33101 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, ARVO, PL 2000, 33521 Tampere, Finland
| | - Heli Korpiharju
- Faculty of Medicine and Health Technology, Tampere University, ARVO, PL 2000, 33521 Tampere, Finland
| | - Mika Helminen
- Tays Research Services, Tampere University Hospital, Pirkanmaa Hospital District, PL 2000, 33521 Tampere, Finland
- Faculty of Social Sciences, Health Sciences, Tampere University, ARVO, 33521 Tampere, Finland
| | - Jukka Uotila
- Department of Obstetrics and Gynecology, Tampere University Hospital, PL 272, 33101 Tampere, Finland
- Faculty of Medicine and Health Technology, Tampere University, ARVO, PL 2000, 33521 Tampere, Finland
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Dahan O. Navigating intensive altered states of consciousness: How can the set and setting key parameters promote the science of human birth? Front Psychiatry 2023; 14:1072047. [PMID: 36846223 PMCID: PMC9947299 DOI: 10.3389/fpsyt.2023.1072047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/24/2023] [Indexed: 02/11/2023] Open
Abstract
The subjective childbirth experience is crucial from a public health standpoint. There is a correlation between a negative childbirth experience and a poor mental state after birth, with effects that go far beyond the postpartum (PP) period. This paper offers a new approach as to how birthing experiences, and birth in general, can be navigated. The theory of set and setting proves that psychedelic experiences are shaped, first and foremost, by the mindset of an individual entering a psychedelic experience (set) and by the surroundings in which the experience happens (setting). In research on altered states of consciousness during psychedelic experiences, this theory explains how the same substance can lead to a positive and life-changing experience or to a traumatic and frightening experience. Because recent studies suggest that birthing women enter an altered state of consciousness during physiological birth ("birthing consciousness"), I suggest analyzing the typical modern birthing experience in terms of set and setting theory. I argue that the set and setting key parameters can help design, navigate, and explain many psychological and physiological elements of the human birth process. Thus, an operative conclusion that emerges from the theoretical analysis presented in this paper is that framing and characterizing the birth environment and birth preparations in terms of set and setting is a central tool that could be used to promote physiological births as well as subjective positive birthing experiences, which is currently a primary, yet unreached goal, in modern obstetrics and public health.
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Affiliation(s)
- Orli Dahan
- Department of Multidisciplinary Studies, Faculty of Social Sciences and Humanities, Tel-Hai College, Tel-Hai, Israel
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16
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Psychological impact of hypnosis for pregnancy and childbirth: A systematic review. Complement Ther Clin Pract 2023; 50:101713. [PMID: 36509031 DOI: 10.1016/j.ctcp.2022.101713] [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: 09/09/2022] [Revised: 11/26/2022] [Accepted: 12/03/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND The use of hypnosis as a complementary therapy in the perinatal field is expanding, however, there is little research for its impact on perinatal mental health. Here, we review studies that evaluate the effect of hypnosis on women's mental health and subjective experiences. METHODS A systematic review was conducted according to the PRISMA protocol for articles with experimental designs of hypnosis that measured their impact on several psychological variables, such as the presence of symptoms of anxiety, depression or fear of childbirth. Studies were evaluated according to the Critical Appraisal Skills Program Checklists (CASP), and analyzed for their designs and intervention themes. RESULTS Seven studies were included and six themes emerged: preparation for birth and unexpected events; change in the perception and experience of pain; pregnant body as a natural process; connection with the baby during pregnancy; development of inner resources; and progressive relaxation and guided imagery. Although results were partly mitigated, most studies found positive effects of hypnosis in alleviating anxiety, depression, and fear towards birth, empowering women with a higher sense of confidence and improving the overall emotional experience. Two studies also indicate encouraging outcomes in postnatal wellbeing. CONCLUSION While it is still argued as to what extent hypnosis has positive effects on physical aspects of labor, the empowerment and the increase in confidence associated with hypnosis seem to bring a significant contribution to a more positive subjective experience of pregnancy and childbirth, and on women's overall wellbeing in the perinatal period.
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Xu MM, Tian Q, Yu L, Yang S, Liu YT, Yu SH, Cao ML, Zhang W. The effectiveness of auricular acupressure on pain management during labor: A systematic review and meta-analysis of randomized controlled trials. Jpn J Nurs Sci 2023; 20:e12512. [PMID: 36134507 DOI: 10.1111/jjns.12512] [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: 03/01/2022] [Revised: 08/03/2022] [Accepted: 08/23/2022] [Indexed: 01/05/2023]
Abstract
AIM This meta-analysis aimed to systematically evaluate the effectiveness of auricular acupressure on pain management during labor. METHODS Six English and three Chinese electronic databases were comprehensively searched from inception to 6 November 2021. The PRISMA checklist was followed. The methodological quality of the included studies was assessed with the Cochrane Collaboration Bias Risk Assessment Tool. The meta-analysis was performed using Review Manager 5.3 software. Heterogeneity between studies was calculated using I2 . RESULTS Five studies comprising 312 participants were included. The labor pain scores of the auricular acupressure group were significantly lower than those of the usual care group at cervix dilations of 6, 8, and 10 cm, with mean differences (95% confidence intervals) of -1.05 (-1.41, -0.69), -1.44 (-2.07, -0.82), and -1.96 (-3.30, -0.61), respectively. Auricular acupressure can thus effectively improve the labor pain perception at cervix dilations of 6, 8, and 10 cm. Moreover, auricular acupressure shortened the active phase, and had the trend of shortening the second and third stages of labor. There was no evidence that auricular acupressure had an effect on the rate of cesarean section or the 1 and 5 min Apgar scores. CONCLUSION Effective labor pain relief, better labor pain perception, and the lack of adverse effects support the use of auricular acupressure. More high-quality and rigorous trials are needed to verify our findings before we can make strong recommendations.
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Affiliation(s)
- Meng-Meng Xu
- Nursing School, Jilin University, Jilin Province, China
| | - Qi Tian
- Nursing School, Jilin University, Jilin Province, China
| | - Lin Yu
- Nursing School, Jilin University, Jilin Province, China
| | - Shu Yang
- Nursing School, Jilin University, Jilin Province, China
| | - Yan-Tong Liu
- Nursing School, Jilin University, Jilin Province, China
| | - Shuang-Han Yu
- Nursing School, Jilin University, Jilin Province, China
| | - Ming-Lu Cao
- Nursing School, Jilin University, Jilin Province, China
| | - Wei Zhang
- Nursing School, Jilin University, Jilin Province, China
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Women's sense of control during labour and birth with epidural analgesia: A qualitative descriptive study. Midwifery 2023; 116:103496. [PMID: 36223662 DOI: 10.1016/j.midw.2022.103496] [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: 11/23/2021] [Revised: 09/08/2022] [Accepted: 09/25/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sense of control during childbirth is a critical issue concerning the association between high-quality maternity care and infant health. This study explored the facilitators of or barriers to a sense of control and the need for interventions to raise women's experience in childbirth. METHODS The data came from 17 participants. Data collection was conducted in the childbirth room and within three days following childbirth, respectively. For tackling the research problems, participant observation and interviewing were applied. Thematic analysis was applied to the data analyzed. RESULTS Two themes were identified: (1) facilitators of or barriers to practice a sense of control and (2) Care needed for a sense of control. The effectiveness of a sense of control is related to energy refill, mental loading subsided, control over decisions, non-pharmacological usage, and support from the meaningful person. Care needed includes showing empathy, providing information, using complementary pain-relief strategies, and adjusting care by parturient conditions. CONCLUSION This study highlights the influencing factors and interventions relating to women's sense of control during childbirth with epidural analgesia. The findings suggest that many approaches, such as white noise, benefit women's sense of control after an epidural. Using non-pharmacological methods, such as a birth ball, should be appropriately regulated by situations to enhance women's sense of control. Through the assessment, education, attention to maternal needs, and recognizing the barriers to a sense of control, women will benefit from the interventions designed to improve their sense of control during childbirth.
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Kuipers PYJ, van Beeck E. Predictors associated with low-risk women's pre-labour intention for intrapartum pain relief: a cross-sectional study. INTERNATIONAL JOURNAL OF NURSING STUDIES ADVANCES 2022; 4:100070. [PMID: 38745603 PMCID: PMC11080486 DOI: 10.1016/j.ijnsa.2022.100070] [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: 12/20/2021] [Revised: 02/15/2022] [Accepted: 02/18/2022] [Indexed: 11/19/2022] Open
Abstract
Background Pregnant women have preferences about how they intend to manage labour pain. Unmet intentions can result in negative emotions and/or birth experiences. Objective To examine the antenatal level of intention for intrapartum pain relief and the factors that might predict this intention. Design A cross-sectional online survey-based study. Setting and participants 414 healthy pregnant women in the Netherlands, predominantly receiving antenatal care from the community-based midwife who were recruited via maternity healthcare professionals and social media platforms. Methods The attitude towards intrapartum pain relief was measured with the Labour Pain Relief Attitude Questionnaire for pregnant women. Personality traits with the HEXACO-60 questionnaire, general psychological health with the Mental Health Inventory-5 and labour and birth anxiety with the Tilburg Pregnancy Distress Scale. Multiple linear regression was performed with the intention for pain relief as the dependant variable. Results The obstetrician as birth companion (p<.001), the perception that because of the impact of pregnancy on the woman's body, using pain relief during labour is self-evident (p<.001), feeling convinced that pain relief contributes to self-confidence during labour (p=.023), and fear of the forthcoming birth (p=.003) predicted women were more likely to use pain relief. The midwife as birth companion (p=.047) and considering the partner in requesting pain relief (p=.045) predicted women were less likely to use pain relief. Conclusion Understanding the reasons predicting women's intention of pain management during labour, provides insight in low-risk women's supportive needs prior to labour and are worth paying attention to during the antenatal period.
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Affiliation(s)
- Prof. Yvonne J Kuipers
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands
- Edinburgh Napier University, School of Health and Social Care, 9 Sighthill Court, Edinburgh EH11 4BN, Scotland, UK
| | - Elise van Beeck
- Rotterdam University of Applied Sciences, Institute of Healthcare, Rochussenstraat 198, 3015 EK Rotterdam, Netherlands
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Fumagalli S, Borrelli S, Bulgarelli M, Zanoni A, Serafini M, Colciago E, Nespoli A. Coping strategies for labor pain, related outcomes and influencing factors: A systematic review. Eur J Midwifery 2022. [DOI: 10.18332/ejm/156440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
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Goswami S, Jelly P, Sharma S, Negi R, Sharma R. The effect of heat therapy on pain intensity, duration of labor during first stage among primiparous women and Apgar scores: A systematic review and meta-analysis. Eur J Midwifery 2022; 6:66. [DOI: 10.18332/ejm/156487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 11/12/2022] [Accepted: 11/21/2022] [Indexed: 11/29/2022] Open
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Xu N, Chen S, Liu Y, Jing Y, Gu P. The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e36695. [DOI: 10.2196/36695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/04/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background
Extreme labor pain has negative effects; pharmacologic analgesic modalities are effective but are accompanied by adverse effects. Virtual reality (VR) works as a distracting nonpharmacologic intervention for pain and anxiety relief; however, the effects of VR use in laboring women is unknown.
Objective
Our study aimed to determine the safety and effectiveness of VR technology during labor and delivery and investigate whether it impacts labor and patient satisfaction.
Methods
In all, 7 databases (PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, and Wan-Fang Database) were systematically searched for randomized controlled trials of VR use in pregnancy and childbirth from the time of database construction until November 24, 2021. Two researchers extracted data and evaluated study quality using the Cochrane Risk of Bias tool 2.0. Outcome measures were labor pain, anxiety, duration, satisfaction, and adverse events. Meta-analyses were performed where possible.
Results
A total of 12 studies with 1095 participants were included, of which 1 and 11 studies were rated as “Low risk” and “Some concerns” for risk of bias, respectively. Of the 12 studies, 11 reported labor pain, 7 reported labor anxiety, and 4 reported labor duration. Meta-analysis revealed that VR use could relieve pain during labor (mean difference –1.81, 95% CI –2.04 to –1.57; P<.001) and the active period (standardized mean difference [SMD] –0.41, 95% CI –0.68 to –0.14; P=.003); reduce anxiety (SMD –1.39, 95% CI –1.99 to –0.78; P<.001); and improve satisfaction with delivery (relative risk 1.32, 95% CI 1.10-1.59; P=.003). The effects of VR on the duration of the first (SMD –1.12, 95% CI –2.38 to 0.13; P=.08) and second (SMD –0.22, 95% CI –0.67 to 0.24; P=.35) stages of labor were not statistically significant.
Conclusions
VR is safe and effective in relieving maternal labor pain and anxiety; however, due to the heterogeneity among studies conducted to date, more rigorous, large-scale, and standardized randomized controlled trials are required to provide a higher-quality evidence base for the use of VR technology in maternal labor, with the aim of improving experience and outcomes.
Trial Registration
PROSPERO CRD42021295410; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295410
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Women's perceptions of counselling on pain assessment and management during labour in Finland: A cross-sectional survey. Midwifery 2022; 114:103471. [DOI: 10.1016/j.midw.2022.103471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 08/12/2022] [Accepted: 08/26/2022] [Indexed: 11/19/2022]
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Effects of acupressure and shower applied in the delivery on the intensity of labor pain and postpartum comfort. Eur J Obstet Gynecol Reprod Biol 2022; 273:98-104. [PMID: 35552080 DOI: 10.1016/j.ejogrb.2022.04.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 04/13/2022] [Accepted: 04/19/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND PURPOSE Labour pain is a constantly increasing pain. This study thus aims to determine the effects of acupressure and shower on labour pain and postpartum comfort. METHODS In this randomized controlled trial (RCT), the control group consisted of 40 pregnant women, while the experimental groups consisted of 80 pregnant women in total. The experimental groups received routine labour care and either acupressure or showers upon reaching three cervical dilations (4-5, 6-7 and 8-10 cm). The control group only received routine labour care. A maternal information form (MIF), the Visual Analog Scale (VAS) and the Postpartum Comfort Questionnaire (PPCQ) were used to collect data. RESULTS Pain was significantly reduced in both of the experimental groups, in contrast to the control group, in all periods of the study (p < 0.001). Postpartum comfort also significantly increased in the experimental groups compared to the control group (p < 0.05). CONCLUSION Acupressure and showering are effective in reducing labour pain and increasing postpartum comfort. Midwives and nurses can therefore apply them as inexpensive and easy to administer methods for labour pain relief.
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Rantala A, Hakala M, Pölkki T. Women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor: A cross-sectional survey. Eur J Midwifery 2022; 6:21. [PMID: 35515089 PMCID: PMC9006186 DOI: 10.18332/ejm/146136] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 06/10/2021] [Accepted: 01/26/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION The use of non-pharmacological pain relief methods and pain assessment scales during labor has received limited research attention. This study aimed to describe women’s perceptions of the pain assessment and non-pharmacological pain relief methods used during labor. METHODS A descriptive, cross-sectional survey was conducted. A convenience sample of women (n=204) from one Finnish maternity ward participated in the study. Women who had given birth were asked to respond to a validated questionnaire between November 2018 and February 2019. The statistical significance of observed differences was analyzed using the chi-squared test. RESULTS Less than half (46%) of the women who gave birth at the hospital were asked to assess the intensity of their pain on a pain assessment scale. The most commonly used non-pharmacological pain relief methods were encouragement (92%), the presence of a midwife (82%), and proper breathing technique that was taught by a midwife (81%). Aqua blisters (3%), reflexology (e.g. zone magnets, 5%), and music (9%) were the least commonly used non-pharmacological methods during labor. The participants’ experiences of fear and pain were significantly associated with the implementation of pain assessment. CONCLUSIONS Women’s pain was rarely evaluated by using a certain pain assessment scale. In addition, non-pharmacological pain relief methods were inadequately used during labor. More specifically, methods that required midwives’ own personal contributions were rarely offered to the women.
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Affiliation(s)
- Arja Rantala
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Children and Women, Oulu University Hospital, Northern Ostrobothnia Hospital District, Oulu, Finland
- Oulu University of Applied Sciences, Oulu, Finland
| | - Mervi Hakala
- Department of Children and Women, Oulu University Hospital, Northern Ostrobothnia Hospital District, Oulu, Finland
| | - Tarja Pölkki
- Research Unit of Nursing Science and Health Management, Faculty of Medicine, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital, Oulu, Finland
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Tan A, Wilson AN, Eghrari D, Clark H, Tse WC, Bohren MA, Homer C, Vogel JP. Outcomes to measure the effects of pharmacological interventions for pain management for women during labour and birth: a review of systematic reviews and randomised trials. BJOG 2021; 129:845-854. [PMID: 34839565 DOI: 10.1111/1471-0528.17031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Pharmacological pain management options can relieve women's pain during labour and birth. Trials of these interventions have used a wide variety of outcomes, complicating meaningful comparisons of their effects. To facilitate better assessment of the effectiveness of labour pain management in trials and meta-analyses, consensus about key outcomes and the development of a core outcome set is essential. OBJECTIVE To identify all outcomes used in studies of pharmacological pain management interventions during labour and birth. DESIGN A review of systematic reviews and their included randomised controlled trials was undertaken. SEARCH STRATEGY Cochrane CENTRAL was searched to identify all Cochrane systematic reviews describing pharmacological pain management options for labour and birth. Search terms included 'pain management', 'labour' and variants, with no limits on year of publication or language. SELECTION CRITERIA Cochrane reviews and randomised controlled trials contained within these reviews were included, provided they compared a pharmacological intervention with other pain management options, placebo or no treatment. DATA COLLECTION AND ANALYSIS All outcomes reported by reviews or trials were extracted and tabulated, with frequencies of individual outcomes reported. MAIN RESULTS Nine Cochrane reviews and 227 unique trials were included. In total, 146 unique outcomes were identified and categorised into maternal, fetal, neonatal, child, health service, provider's perspective or economic outcome domains. CONCLUSIONS Outcomes of pharmacological pain management interventions during labour and birth vary widely between trials. The standardisation of trial outcomes would permit the assessment of meta-analyses for best clinical practice. TWEETABLE ABSTRACT Outcomes to measure pharmacological pain management options during labour are highly variable and require standardisation.
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Affiliation(s)
- A Tan
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - A N Wilson
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - D Eghrari
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - H Clark
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - W C Tse
- School of Medicine, Faculty of Medicine, Nursing, and Health Science, Monash University, Clayton, Vic., Australia
| | - M A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Carlton, Vic., Australia
| | - Cse Homer
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - J P Vogel
- Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, Vic., Australia
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Maghalian M, Mirghafourvand M, Ghaderi F, Abbasalizadeh S, Pak S, Kamalifard M. Comparison the effect of Swedish massage and interferential electrical stimulation on labor pain and childbirth experience in primiparous women: a randomized controlled clinical trial. Arch Gynecol Obstet 2021; 306:37-47. [PMID: 34716820 DOI: 10.1007/s00404-021-06220-6] [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: 01/07/2021] [Accepted: 08/31/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Since mothers are more inclined toward non-pharmacological labor pain management methods, this study aimed to compare the effect of interferential electrical stimulation (IES) and Swedish massage (SM) on labor pain and childbirth experience (primary outcomes) and childbirth satisfaction, duration of active phase and side effects (secondary outcomes) in primiparous women. METHODS This randomized controlled trial was performed on 90 primiparous women. Participants were randomly assigned into three groups through the block randomization method. The SM group received two massage techniques of effleurage and petrissage, on T10-L1 and S2-S4 at cervical dilatation of 4 and 8-10 cm. The IES group received electrical stimulation in a similar way to SM group, with a base frequency of 4000 Hz and a pulse frequency of 80-120 Hz by a physiotherapist. Control group received only routine care. RESULTS The mean pain was significantly lower in the SM group (adjusted mean difference (AMD) - 0.86; 95% confidence interval (95% CI) - 1.60 to - 0.11) and the IES group (AMD - 0.95; 95% CI - 1.70 to - 0.21) compared to the control group. The mean score of childbirth experience was significantly higher in the SM (MD 5.63; 95% CI 2.15-9.11) and IES (MD 3.66; 95% CI 0.18-7.14) group compared to the control group. The mean childbirth satisfaction in the SM (p = 0.003) and IES (p = 0.046) groups was significantly higher than the control group; and duration of the active phase of labor was significantly lower (p < 0.001) than the control group. No serious side effects were occurred in none of the groups. CONCLUSION SM and IES are safe methods that can significantly reduce pain and duration of active phase and improve the experience and satisfaction of childbirth.
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Affiliation(s)
- Mahsa Maghalian
- Student Research Committee, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Centre, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Fariba Ghaderi
- Department of Physiotherapy, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shamsi Abbasalizadeh
- Department of Obstetrics and Gynecology, Women's Reproductive Health Research Center, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Sahar Pak
- Student Research Committee, Department of Physiotherapy, Faculty of Rehabilitation, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mahin Kamalifard
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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Martínez-Burnes J, Muns R, Barrios-García H, Villanueva-García D, Domínguez-Oliva A, Mota-Rojas D. Parturition in Mammals: Animal Models, Pain and Distress. Animals (Basel) 2021; 11:2960. [PMID: 34679979 PMCID: PMC8532935 DOI: 10.3390/ani11102960] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 10/11/2021] [Accepted: 10/12/2021] [Indexed: 12/11/2022] Open
Abstract
Parturition is a complex physiological process and involves many hormonal, morphological, physiological, and behavioural changes. Labour is a crucial moment for numerous species and is usually the most painful experience in females. Contrary to the extensive research in humans, there are limited pain studies associated with the birth process in domestic animals. Nonetheless, awareness of parturition has increased among the public, owners, and the scientific community during recent years. Dystocia is a significant factor that increases the level of parturition pain. It is considered less common in polytocous species because newborns' number and small size might lead to the belief that the parturition process is less painful than in monotocous animal species and humans. This review aims to provide elements of the current knowledge about human labour pain (monotocous species), the relevant contribution of the rat model to human labour pain, and the current clinical and experimental knowledge of parturition pain mechanisms in domestic animals that support the fact that domestic polytocous species also experience pain. Moreover, both for women and domestic animal species, parturition's pain represents a potential welfare concern, and information on pain indicators and the appropriate analgesic therapy are discussed.
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Affiliation(s)
- Julio Martínez-Burnes
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Tamaulipas, Mexico;
| | - Ramon Muns
- Agri-Food and Biosciences Institute, Hillsborough, Co Down BT26 6DR, Northern Ireland, UK;
| | - Hugo Barrios-García
- Animal Health Group, Facultad de Medicina Veterinaria y Zootecnia, Universidad Autónoma de Tamaulipas, Victoria City 87000, Tamaulipas, Mexico;
| | - Dina Villanueva-García
- Division of Neonatology, Hospital Infantil de México Federico Gómez, Mexico City 06720, Mexico;
| | - Adriana Domínguez-Oliva
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico;
| | - Daniel Mota-Rojas
- Neurophysiology, Behavior and Animal Welfare Assessment, DPAA, Universidad Autónoma Metropolitana (UAM), Unidad Xochimilco, Mexico City 04960, Mexico;
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Lindgren H, Rådestad I, Pettersson K, Skokic V, Akselsson A. Epidural use among women with spontaneous onset of labour - an observational study using data from a cluster-randomised controlled trial. Midwifery 2021; 103:103156. [PMID: 34634721 DOI: 10.1016/j.midw.2021.103156] [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: 11/24/2020] [Revised: 08/11/2021] [Accepted: 09/27/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To investigate whether the proportion of pregnant women who use epidural analgesia during birth differed between women registered at a maternity clinic randomised to Mindfetalness or to routine care. DESIGN An observational study including women born in Sweden with singleton pregnancies, with spontaneous onset of labour from 32 weeks' gestation. Data used from a cluster-randomised controlled trial applying the intention-to-treat principle in 67 maternity clinics where women were randomised to Mindfetalness or to routine care. ClinicalTrials.gov (NCT02865759). INTERVENTIONS Midwives were instructed to distribute a leaflet about Mindfetalness to pregnant women at 25 weeks' gestation. Mindfetalness is a self-assessment method for the woman to use to become familiar with the unborn baby's fetal movement pattern. When practising the method in third trimester, the women are instructed to daily lie down on their side, when the baby is awake, and focus on the movements' intensity, character and frequency (but not to count each movement). FINDINGS Of the 18 501 women with spontaneous onset of labour, 47 percent used epidural during birth. Epidural was used to a lower extent among women registered at a maternity clinic randomised to Mindfetalness than women in the routine-care group (46.2% versus 47.8%, RR 0.97, CI 0.94-1.00, p= 0.04). Epidural was more common among primiparous women, women younger than 35 years, those with educational levels below university, with BMI ≥25 and with a history of receiving psychiatric care or psychological treatment for mental illness. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Pregnant women who were informed about a self-assessment method, with the aim of becoming familiar with the unborn baby's fetal movement pattern, used epidural to a lower extent than women who were not informed about the method. Future studies are needed to investigate and understand the association between Mindfetalness and the reduced usage of epidural during birth.
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Affiliation(s)
- Helena Lindgren
- Department of Women and Children's Health, Karolinska Institutet, Stockholm, Sweden.
| | | | - Karin Pettersson
- Department of Clinical Science, Intervention and Technology, Stockholm, Sweden.
| | - Viktor Skokic
- Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Anna Akselsson
- Department of Health Promoting Science, Sophiahemmet University, Stockholm, Sweden.
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Gagnon R. A longitudinal study of women's representations and experiences of pregnancy and childbirth. Midwifery 2021; 103:103101. [PMID: 34352599 DOI: 10.1016/j.midw.2021.103101] [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: 03/22/2021] [Revised: 06/02/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Raymonde Gagnon
- Université du Québec à Trois-Rivières, Département sage-femme, Local 4009b Ringuet, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7 (Québec, Canada).
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Whitburn LY, Jones LE. Looking for Meaning in Labour Pain: Are Current Pain Measurement Tools Adequate? PAIN MEDICINE 2021; 22:1023-1028. [PMID: 33200211 DOI: 10.1093/pm/pnaa380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Laura Yvette Whitburn
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia
| | - Lester Edmund Jones
- Department of Physiology, Anatomy and Microbiology, La Trobe University, Bundoora, Victoria, Australia.,Singapore Institute of Technology, Singapore
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Zinsser LA, Stoll K, Gross MM. Challenges in using Mental Contrasting with Implementation Intentions (MCII) for preparation for natural birth: A feasibility study. SEXUAL & REPRODUCTIVE HEALTHCARE 2021; 29:100642. [PMID: 34186269 DOI: 10.1016/j.srhc.2021.100642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 05/10/2021] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Women who plan a natural birth can benefit from strategies and/or resources that help them prepare for and cope with labour pain. This study aims to identify the feasibility of using Mental Contrasting with Implementation Intentions (MCII) for preparation of primiparous women for natural childbirth. Secondary aims are to test the acceptability of a health-focused information leaflet, and to describe how participants with high natural birth intentions cognitively prepare for birth. METHODS In third trimester, ten primiparous women participated in this interventional study with follow-up. A health-focused information leaflet on physiological childbirth, MCII, a mental strategy that helps people achieve a desired goal by envisioning obstacles and how to overcome them, and a researcher-developed questionnaire which contained the CBSEI-C32, was used. Survey data were analysed using a combination of descriptive statistics and deductive theoretical thematic analysis. RESULTS The health-focused leaflet was exclusively judged positively. Nine women did not use MCII as instructed, they did not find it helpful for childbirth preparation and wished to have a more positive, health-focused approach towards childbirth. Two themes emerged from the participants' responses: 'the ability to give birth' which was supported through childbirth preparedness, coping strategies, confidence and external supports and 'the uncertainty of giving birth' which included fears and worries about possible adverse events and the baby's health. CONCLUSION MCII was not a promising tool for natural childbirth preparation among primiparous women in Germany. Our findings show that women prefer a positive, health-focused approach, rather than thinking about overcoming obstacles, when they prepare for childbirth.
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Affiliation(s)
- Laura A Zinsser
- Hannover Medical School, Midwifery Research and Education Unit Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Kathrin Stoll
- Hannover Medical School, Midwifery Research and Education Unit Carl-Neuberg-Str. 1, 30625 Hannover, Germany; University of British Columbia, Midwifery Program, Faculty of Medicine, 5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada.
| | - Mechthild M Gross
- Hannover Medical School, Midwifery Research and Education Unit Carl-Neuberg-Str. 1, 30625 Hannover, Germany
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Effect of Regiosacralis Counterpressure Treatment on the Pain and Interleukin-6 Levels Among Primigravid Mothers During the First Stage Labor. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-20-00005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUNDSevere pain experienced by mother during the labor can cause fear and anxiety which can interfere with the overall labor process. Controlling pain during the labor process is important. Regiosacralis counterpressure pain management without altering the interleukin-6 (IL-6) level is expected to reduce the pain.OBJECTIVEThis study was aimed to investigate the effects of regiosacralis counterpressure on the pain and IL-6 levels during the first stage of labor among primigravid mothers.METHODA quasiexperiment method with pretest–posttest control group design was applied. Regiosacralis counter-pressure pain management was applied to all study participants who non-randomly recruited by consecutive sampling methods. A total of 52 primigravid mothers were selected and divided into both the intervention group (n = 26) and the control group (n = 26).RESULTThe statistical analysis of the intervention on the pain and IL-6 level revealed a significant difference between the pretest and posttest in the intervention group (p < .001; M pretest pain = 8.96 ± .528; M posttest pain = 6.96 ± .774; M pretest IL-6 = 175.539 ± 92.281; M posttest IL-6 = 170,764 ± 70,026).CONCLUSIONRegiosacralis counterpressure treatment is effective in controlling and reducing the pain level during the first stage labor.
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Dahan O. The riddle of the extreme ends of the birth experience: Birthing consciousness and its fragility. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-01439-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Komann M, Baumbach P, Stamer UM, Weinmann C, Arnold C, Pogatzki-Zahn E, Meißner W. Desire to Receive More Pain Treatment - A Relevant Patient-Reported Outcome Measure to Assess Quality of Post-Operative Pain Management? Results From 79,996 Patients Enrolled in the Pain Registry QUIPS from 2016 to 2019. THE JOURNAL OF PAIN 2021; 22:730-738. [PMID: 33482323 DOI: 10.1016/j.jpain.2021.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/16/2020] [Accepted: 01/03/2021] [Indexed: 12/21/2022]
Abstract
Acute postoperative pain is frequently evaluated by pain intensity scores. However, interpretation of the results is difficult and thresholds requiring treatment are not well defined. Additional patient-reported outcome measures (PROMs) might be helpful to better understand individual pain experience and quality of pain management after surgery. We used data from the QUIPS pain registry for a cross-sectional study in order to investigate associations between the desire to receive more pain treatment (D2RMPT) with pain intensity ratings and other PROMs. Responses from 79,996 patients were analyzed, of whom 10.7% reported D2RMPT. A generalized estimating equation Poisson model showed that women had a lower risk ratio (RR) to answer this question with "yes" (RR: .92, P < .001). Factors that increased the risk most were "maximal pain intensity ≥ 6/10 on a numerical rating scale" (RR: 2.48, P < .001) and "any pain interference" (RR: 2.48, P < .001). The largest reduction in risk was observed if patients were "allowed to participate in pain treatment decisions" (RR: .41, P < .001) and if they felt that they "received sufficient treatment information" (RR: .58, P < .001). Our results indicate that the (easily assessed) question D2RMPT gives additional information to other PROMs like pain intensity. The small proportion of patients with D2RMPT (even for high pain scores) opens the discussion about clinicians' understanding of over- und under-treatment and questions the exclusive use of pain intensity as quality indicator. Future studies need to investigate whether asking about D2RMPT in clinical routine can improve postoperative pain outcome. PERSPECTIVE: This article presents characteristics of the patient-reported outcome measure "Desire to receive more pain treatment." This measure could be used to apply pain treatment in a more individualized way and lead to improved treatment strategies and quality.
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Affiliation(s)
- Marcus Komann
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany.
| | - Philipp Baumbach
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Ulrike M Stamer
- Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department for BioMedical Research, University of Bern, Bern, Switzerland
| | - Claudia Weinmann
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Christin Arnold
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
| | - Esther Pogatzki-Zahn
- Department of Anesthesiology, Intensive Care and Pain Medicine, University Hospital Muenster, Münster, Germany
| | - Winfried Meißner
- Department of Anesthesiology and Intensive Care Medicine, Jena University Hospital, Jena, Germany
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Skeide A. Experiences as Actors: Labor Pains in Childbirth Care in Germany. Med Anthropol 2021; 40:446-457. [PMID: 33400594 DOI: 10.1080/01459740.2020.1860963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
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.
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Affiliation(s)
- Annekatrin Skeide
- Department of Health and Nursing Care, Ernst-Abbe-Hochschule Jena, Jena, Germany
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Qiu C, Lin JC, Shi JM, Chow T, Desai VN, Nguyen VT, Riewerts RJ, Feldman RK, Segal S, Xiang AH. Association Between Epidural Analgesia During Labor and Risk of Autism Spectrum Disorders in Offspring. JAMA Pediatr 2020; 174:1168-1175. [PMID: 33044486 PMCID: PMC7551212 DOI: 10.1001/jamapediatrics.2020.3231] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
IMPORTANCE Although the safety of labor epidural analgesia (LEA) for neonates has been well documented, the long-term health effects of LEA on offspring remain to be investigated. OBJECTIVE To assess the association between maternal LEA exposure and risk of autism spectrum disorders (ASDs) in offspring. DESIGN, SETTING, AND PARTICIPANTS Data for this retrospective longitudinal birth cohort study were derived from electronic medical records from a population-based clinical birth cohort. A total of 147 895 singleton children delivered vaginally between January 1, 2008, and December 31, 2015, in a single integrated health care system were included. Children were followed up from the age of 1 year until the first date of the following occurrences: clinical diagnosis of ASD, last date of health plan enrollment, death, or the study end date of December 31, 2018. EXPOSURES Use and duration of LEA. MAIN OUTCOMES AND MEASURES The main outcome was clinical diagnosis of ASD. Cox proportional hazards regression analysis was used to estimate the hazard ratio (HR) of ASD associated with LEA exposure. RESULTS Among the cohort of 147 895 singleton children (74 425 boys [50.3%]; mean [SD] gestational age at delivery, 38.9 [1.5] weeks), 109 719 (74.2%) were exposed to maternal LEA. Fever during labor was observed in 13 055 mothers (11.9%) in the LEA group and 510 of 38 176 mothers (1.3%) in the non-LEA group. Autism spectrum disorders were diagnosed in 2039 children (1.9%) in the LEA group and 485 children (1.3%) in the non-LEA group. After adjusting for potential confounders, including birth year, medical center, maternal age at delivery, parity, race/ethnicity, educational level, household income, history of comorbidity, diabetes during pregnancy, smoking during pregnancy, preeclampsia or eclampsia, prepregnancy body mass index, gestational weight gain, gestational age at delivery, and birth weight, the HR associated with LEA vs non-LEA exposure was 1.37 (95% CI, 1.23-1.53). Relative to the unexposed group, the adjusted HR associated with LEA exposure of less than 4 hours was 1.33 (95% CI, 1.17-1.53), with LEA exposure of 4 to 8 hours was 1.35 (95% CI, 1.20-1.53), and with LEA exposure of more than 8 hours was 1.46 (95% CI, 1.27-1.69). Within the LEA group, there was a significant trend of ASD risk associated with increasing duration of LEA exposure after adjusting for covariates (HR for linear trend, 1.05 [95% CI, 1.01-1.09] per 4 hours). Adding fever to the model did not change the HR estimate associated with LEA exposure (adjusted HR for LEA vs non-LEA, 1.37 [95% CI, 1.22-1.53]). CONCLUSIONS AND RELEVANCE This study suggests that maternal LEA may be associated with increased ASD risk in children. The risk appears to not be directly associated with epidural-related maternal fever.
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Affiliation(s)
- Chunyuan Qiu
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Jane C. Lin
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Jiaxiao M. Shi
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Ting Chow
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
| | - Vimal N. Desai
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Vu T. Nguyen
- Department of Anesthesiology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California,Department of Internal Medicine, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Robert J. Riewerts
- Department of Pediatrics, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - R. Klara Feldman
- Department of Obstetrics & Gynecology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, California
| | - Scott Segal
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Anny H. Xiang
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena
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Tilden EL, Phillippi JC, Carlson N, Dissanayake M, Lee CS, Caughey AB, Snowden JM. The association between longer durations of the latent phase of labor and subsequent perinatal processes and outcomes among midwifery patients. Birth 2020; 47:418-429. [PMID: 32687226 PMCID: PMC7755745 DOI: 10.1111/birt.12494] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 04/28/2020] [Accepted: 05/17/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVE To evaluate the association between the duration of the latent phase of labor and subsequent processes and outcomes. METHODS Secondary analysis of prospectively collected data among 1,189 women with low-risk pregnancies and spontaneous labor. RESULTS Longer latent phase duration was associated with labor dystocia (eg, nulliparous ≥ mean [compared with < mean] aOR 3.95 [2.70-5.79]; multiparous ≥ mean [compared with < mean] aOR 5.45 [3.43-8.65]), interventions to ameliorate dystocia, and epidurals to cope or rest (eg, oxytocin augmentation: nulliparous > 80th% [compared with < 80th%] aOR 6.39 [4.04-10.12]; multiparous ≥ 80th% [compared with < 80th%] aOR 6.35 [3.79-10.64]). Longer latent phase duration was also associated with longer active phase and second stage. There were no associations between latent phase duration and risk for cesarean delivery or postpartum hemorrhage in a practice setting with relatively low rates of primary cesarean. Newborns born to multiparous women with latent phase of labor durations at and beyond the 80th% were more frequently admitted to the NICU (≥80th% [compared with < 80th%] aOR 2.7 [1.22-5.84]); however, two-thirds of these NICU admissions were likely for observation only. CONCLUSIONS Longer duration of the spontaneous latent phase of labor among women with low-risk pregnancies may signal longer total labor processes, leading to an increase in diagnosis of dystocia, interventions to manage dystocia, and epidural use. Apart from multiparous neonatal NICU admission, no other maternal or child morbidity outcomes were elevated with longer duration of the latent phase of labor.
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Affiliation(s)
- Ellen L. Tilden
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon, USA,Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | | | - Mekhala Dissanayake
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | | | - Aaron B. Caughey
- Department of Nurse-Midwifery, Oregon Health & Science University School of Nursing, Portland, Oregon, USA,Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA
| | - Jonathan M. Snowden
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, Oregon, USA,School of Public Health, Oregon Health & Science University and Portland State University, Portland, Oregon, USA
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Hulsbosch LP, Nyklíček I, Potharst ES, Boekhorst MG, Pop VJ. Development of the Labor Pain Relief Attitude Questionnaire for pregnant women (LPRAQ-p). BMC Pregnancy Childbirth 2020; 20:718. [PMID: 33228637 PMCID: PMC7686754 DOI: 10.1186/s12884-020-03415-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/12/2020] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Lianne P Hulsbosch
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. BOX 90153, 5000 LE, Tilburg, the Netherlands.
| | - Ivan Nyklíček
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. BOX 90153, 5000 LE, Tilburg, the Netherlands
| | - Eva S Potharst
- UvA minds, University of Amsterdam, Amsterdam, the Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
| | - Myrthe Gbm Boekhorst
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. BOX 90153, 5000 LE, Tilburg, the Netherlands
| | - Victor Jm Pop
- Center of Research in Psychological and Somatic disorders (CoRPS), Department of Medical and Clinical Psychology, Tilburg University, P.O. BOX 90153, 5000 LE, Tilburg, the Netherlands
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Souza MA, Cecatti JG, Guida JP, Souza JP, Gulmezoglu AM, Betran AP, R Torloni M, Vogel JP, Costa ML. Analgesia for vaginal birth: Secondary analysis from the WHO Multicountry Survey on Maternal and Newborn Health. Int J Gynaecol Obstet 2020; 152:401-408. [PMID: 33064850 DOI: 10.1002/ijgo.13424] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/10/2020] [Accepted: 10/13/2020] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To evaluate the use of analgesia during labor in women who had a vaginal birth and to determine the factors associated with its use. METHODS A secondary analysis was performed of the WHO Multicountry Survey on Maternal and Newborn Health, a cross-sectional, facility-based survey including 359 healthcare facilities in 29 countries. The prevalence of analgesia use for vaginal birth in different countries was reported according to the Human Development Index (HDI). Sociodemographic and obstetric characteristics of the participants with and without analgesia were compared. The prevalence ratios were compared across countries, HDI groups, and regions using a design-based χ2 test. RESULTS Among the 221 345 women who had a vaginal birth, only 4% received labor analgesia, mainly epidural. The prevalence of women receiving analgesia was significantly higher in countries with a higher HDI than in countries with a lower HDI. Education was significantly associated with increased use of analgesia; nulliparous women and women undergoing previous cesarean delivery had a significantly increased likelihood of receiving analgesia. CONCLUSION Use of analgesia for women undergoing labor and vaginal delivery was low, specifically in low-HDI countries. Whether low use of analgesia reflects women's desire or an unmet need for pain relief requires further studies.
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Affiliation(s)
- Marcio A Souza
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose G Cecatti
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Jose P Guida
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
| | - Joao P Souza
- Department of Social Medicine, Ribeirao Preto Medical School, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - Ahmet M Gulmezoglu
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Ana P Betran
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | | | - Joshua P Vogel
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.,Maternal and Child Health Program, Burnet Institute, Melbourne, Vic., Australia
| | - Maria L Costa
- Department of Obstetrics and Gynaecology, School of Medical Sciences, University of Campinas, Campinas, Brazil
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Henrique AJ, Rodney P, Joolaee S, Cox S, Shriver A, Moreira CB, Climaco J, Schirmer J. Understanding childbirth pain in Brazilian women: A qualitative descriptive study. Women Birth 2020; 34:e368-e375. [PMID: 32873527 DOI: 10.1016/j.wombi.2020.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/07/2020] [Accepted: 08/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The pain associated with childbirth is a cause of severe pain, and the literature suggests that it can be influenced by psychosocial influences, the environment, and cognitive processes, creating the overall experience of childbirth. Therefore, the investigation of women's childbirth pain experience is essential. AIM The purpose of this study is to understand women's childbirth pain and determine which influences can contribute to building different experiences. METHOD A qualitative descriptive approach was adopted to explore the women's childbirth pain experiences, by understanding the influences on their experiences. Data were collected through in-depth interviews with 21 women in a hospital setting in São Paulo, Brazil, and analysed by thematic analysis. RESULTS Three major themes emerged from the analysis: (1) experiencing childbirth pain, (2) face-to-face with pain, and (3) empowerment needs. DISCUSSION Many factors influence how Brazilian women manage pain and shape their experience during childbirth. The findings suggest that when women had a positive experience, they asked for minimal support, demonstrated balance, and expressed that the pain was manageable; when they had unfavourable experiences, they regarded pain as a threat and a punishment and associated it with unpleasant emotions. CONCLUSION The results outlined concerns that should be addressed in the provision of specific, appropriate care for women, to support them in improving their experience during childbirth.
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Affiliation(s)
- Angelita J Henrique
- Paulista School of Nursing, Department of Women's Health, Federal University of São Paulo, São Paulo, São Paulo, Brazil; The W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Patricia Rodney
- The W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Soodabeh Joolaee
- The W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Nursing Care Research Center, School of Nursing, Iran University of Medical Sciences, Tehran, Iran
| | - Susan Cox
- The W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Adam Shriver
- The Oxford Uehiro Centre for Practical Ethics, Oxford University, United Kingdom
| | - Camila B Moreira
- Paulista School of Nursing, Department of Women's Health, Federal University of São Paulo, São Paulo, São Paulo, Brazil; School of Nursing, Faculty of Applied Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Julia Climaco
- The W. Maurice Young Centre for Applied Ethics, School of Population and Public Health, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Institute of Psychology, University of Brasilia, Brasilia, Federal District, Brazil
| | - Janine Schirmer
- Paulista School of Nursing, Department of Women's Health, Federal University of São Paulo, São Paulo, São Paulo, Brazil
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Coates R, Cupples G, Scamell A, McCourt C, Bhide A. Women's experiences of outpatient induction of labour with double balloon catheter or prostaglandin pessary: A qualitative study. Women Birth 2020; 34:e406-e415. [PMID: 32800469 DOI: 10.1016/j.wombi.2020.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 07/08/2020] [Accepted: 07/23/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND One quarter to one third of women experience induction of labour. Outpatient induction of labour may be safe and effective but women's views of this setting and of different methods of induction are sparse. AIM To explore women's experiences of outpatient induction of labour with either prostaglandin pessary or double balloon catheter. METHODS Qualitative study using semi-structured, audio-recorded interviews with twenty-one women recruited to a feasibility trial of outpatient induction of labour. Transcripts were coded and analysed using a thematic framework approach. FINDINGS Two key themes were identified. 'Ownership of induction of labour' concerned how women understood and experienced the induction of labour process and tried to maintain control of a procedure managed by medical professionals. Women felt unprepared for the steps in the process and for the time it would take. The balloon method was preferred as it was considered a gentler start to the process, although some women reported it was painful on insertion. 'Importance of place' reflected women's associations of the home with comfort, ease of support and distraction, and the hospital with safety yet also with discomfort and delays. DISCUSSION This sample of women were keen to start induction without hormones. The randomised controlled trial design may have biased the sample towards women who wanted to experience the balloon method and outpatient setting where these were not usually offered, thus further cohort studies would be beneficial. CONCLUSIONS Women were positive about experiencing the early stages of induction of labour at home with the balloon catheter.
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Affiliation(s)
- Rose Coates
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, Northampton Square, London EC1V 0HB, UK.
| | - Georgina Cupples
- St. Georges University Hospital, Maternal-Fetal Research Department, Blackshaw Road, London SW17 0QT, UK.
| | - Amanda Scamell
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, Northampton Square, London EC1V 0HB, UK.
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health Sciences, City University of London, Northampton Square, London EC1V 0HB, UK.
| | - Amarnath Bhide
- St. Georges University Hospital, Maternal-Fetal Research Department, Blackshaw Road, London SW17 0QT, UK.
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Símonardóttir S, Rúdólfsdóttir AG. The “good” epidural: Women’s use of epidurals in relation to dominant discourses on “natural” birth. FEMINISM & PSYCHOLOGY 2020. [DOI: 10.1177/0959353520944808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Childbirth is widely recognized to be among the most painful of experiences, and the most common and effective pain relief for birthing women is known to be the use of epidural analgesia. The increase in the use of epidural analgesia for birthing women has been described by some critics as a by-product of the medicalized model of birth, although there remains a notable dearth of research regarding women’s experiences of epidurals. The present paper seeks to address this research gap by examining how first-time mothers in Iceland discuss their intentions concerning pain relief during birth, along with how they construct childbirth-related pain and the use of epidural analgesia in the context of a midwife-led model of care and an institutionalized preference for “natural” birth. The findings demonstrate that, despite initial intentions, most of the women end up having an epidural, and most describe their epidurals as both wonderful and immensely helpful. The dominant narrative about “natural” childbirth being preferable is not fully refuted by this. Instead, the women either align themselves with the ideology of the capable and knowing body or resist and contest this narrative by constructing their birthing bodies as open to, and in need of, assistance.
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Cultural conceptions of Women's labor pain and labor pain management: A mixed-method analysis. Soc Sci Med 2020; 261:113240. [PMID: 32758799 DOI: 10.1016/j.socscimed.2020.113240] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/09/2020] [Accepted: 07/20/2020] [Indexed: 01/25/2023]
Abstract
AIM We assess American cultural beliefs about labor pain and labor pain management, including stereotypical and disparate beliefs about labor pain of women from different racial groups. RATIONALE Understanding cultural beliefs about labor pain is critical as these beliefs influence experience, interpretation, and treatment of labor pain. METHOD We used an online survey with quantitative and qualitative questions about American labor pain beliefs. Participants were recruited and compensated using TurkPrime's Panels during the first week in August 2017 and the last week in May 2018. The completion rate was 76.86 percent (n = 214). After screening using quality control items, the final sample included 200 respondents. RESULTS Qualitative results indicate that 56.5 percent (n = 113) of respondents have an accurate understanding of nociceptive/sensory drivers of labor pain, and 55.8 percent (n = 63) of those respondents focused on the second stage of labor. However, only two respondents (1%) mentioned non-sensory (i.e., psychological) causes of labor pain - reflecting a lack of cultural knowledge of the biopsychosocial nature of pain. Categorical responses indicate almost all respondents (95%; n = 190) believe women have a right to labor pain relief, and the majority believe labor pain has value (68%; n = 136) and should be treated medically (87%; n = 174). Quantitative results document stereotypical beliefs that women of color experience less labor pain than white women. Belief that there is value in experiencing labor pain and that pain should not be treated medically were both associated with greater racial disparities in beliefs about labor pain severity. Beliefs were not related to respondent sociodemographic identity, suggesting they are American cultural constructs. CONCLUSION Future consideration of the influence of dominant American cultural beliefs about labor pain - including misunderstanding of the nature of labor pain and racial bias in expectations of labor pain - on individuals, norms, and structures is expected to improve quality of patient care.
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Baljon KJ, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of breathing exercises, foot reflexology and back massage (BRM) on labour pain, anxiety, duration, satisfaction, stress hormones and newborn outcomes among primigravidae during the first stage of labour in Saudi Arabia: a study protocol for a randomised controlled trial. BMJ Open 2020; 10:e033844. [PMID: 32540887 PMCID: PMC7299053 DOI: 10.1136/bmjopen-2019-033844] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Labour pain is among the severest pains primigravidae may experience during pregnancy. Failure to address labour pain and anxiety may lead to abnormal labour. Despite the many complementary non-pharmacological approaches to coping with labour pain, the quality of evidence is low and best approaches are not established. This study protocol describes a proposed investigation of the effects of a combination of breathing exercises, foot reflexology and back massage (BRM) on the labour experiences of primigravidae. METHODS AND ANALYSIS This randomised controlled trial will involve an intervention group receiving BRM and standard labour care, and a control group receiving only standard labour care. Primigravidae of 26-34 weeks of gestation without chronic diseases or pregnancy-related complications will be recruited from antenatal clinics. Eligible and consenting patients will be randomly allocated to the intervention or the control group stratified by intramuscular pethidine use. The BRM intervention will be delivered by a trained massage therapist. The primary outcomes of labour pain and anxiety will be measured during and after uterine contractions at baseline (cervical dilatation 6 cm) and post BRM hourly for 2 hours. The secondary outcomes include maternal stress hormone (adrenocorticotropic hormone, cortisol and oxytocin) levels, maternal vital signs (V/S), fetal heart rate, labour duration, Apgar scores and maternal satisfaction. The sample size is estimated based on the between-group difference of 0.6 in anxiety scores, 95% power and 5% α error, which yields a required sample size of 154 (77 in each group) accounting for a 20% attrition rate. The between-group and within-group outcome measures will be examined with mixed-effect regression models, time series analyses and paired t-test or equivalent non-parametric tests, respectively. ETHICS AND DISSEMINATION Ethical approval was obtained from the Ethical Committee for Research Involving Human Subjects of the Ministry of Health in the Saudi Arabia (H-02-K-076-0319-109) on 14 April 2019, and from the Ethics Committee for Research Involving Human Subjects (JKEUPM) Universiti Putra Malaysia on 23 October 2019, reference number: JKEUPM-2019-169. Written informed consent will be obtained from all participants. Results from this trial will be presented at regional, national and international conferences and published in indexed journals. TRIAL REGISTRATION NUMBER ISRCTN87414969, registered 3 May 2019.
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Affiliation(s)
- Kamilya Jamel Baljon
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
- Department of Nursing, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Muhammad Hibatullah Romli
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Adibah Hanim Ismail
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Lee Khuan
- Department of Nursing & Rehabilitation, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
| | - Boon How Chew
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Malaysia
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Smorti M, Ponti L, Simoncini T, Pancetti F, Mauri G, Gemignani A. Psychological factors and maternal-fetal attachment in relation to epidural choice. Midwifery 2020; 88:102762. [PMID: 32521408 DOI: 10.1016/j.midw.2020.102762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 04/17/2020] [Accepted: 05/20/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION A woman's first childbirth is an event of great importance to her life, involving her transition to parenthood. Many studies have analyzed the roles of depression, anxiety and fear of childbirth linked to childbirth expectations and the consequent choice of an epidural to avoid pain. Few studies have investigated the predictor role of maternal-fetal attachment on the choice of epidural. OBJECTIVE Explore, in a sample of low-risk pregnant nulliparous women, differences regarding the preference, or not, of epidural for vaginal childbirth. DESIGN AND SETTING 87 nulliparous women, aged 24 to 44 years of age, were recruited in the maternity ward of a public hospital of the metropolitan area of Tuscany (Italy) during the 3rd trimester of gestation. Participants were asked to complete the Pregnancy Related Anxiety Questionnaire-R, Wijma Delivery Expectancy Questionnaire, Centrality of Events Scale, and Prenatal Attachment Inventory. FINDINGS Multivariate analyses of variance showed that women who chose delivery without epidural reported lower levels of fear of childbirth and anxiety, and higher levels of centrality of pregnancy and prenatal attachment to unborn child, than women who chose epidural. KEY CONCLUSIONS Our data highlight the importance that medical staff focus on the maternal bond, to help future mothers have the best possible childbirth experience.
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Affiliation(s)
- Martina Smorti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.
| | - Lucia Ponti
- Department of Education, Languages, Intercultures, Literatures and Psychology, University of Florence, Italy.
| | - Tommaso Simoncini
- Department of Reproductive Medicine and Child Development, Division of Obstetrics and Gynaecology, University of Pisa, Italy.
| | - Federica Pancetti
- Division of Obstetrics and Gynaecology, Department of Clinical and Experimental Medicine, University of Pisa, Italy.
| | - Giulia Mauri
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy
| | - Angelo Gemignani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Italy.
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Raana HN, Fan XN. The effect of acupressure on pain reduction during first stage of labour: A systematic review and meta-analysis. Complement Ther Clin Pract 2020; 39:101126. [DOI: 10.1016/j.ctcp.2020.101126] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 01/28/2020] [Accepted: 02/27/2020] [Indexed: 01/24/2023]
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Dahan O. Birthing Consciousness as a Case of Adaptive Altered State of Consciousness Associated With Transient Hypofrontality. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2020; 15:794-808. [DOI: 10.1177/1745691620901546] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
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.
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Affiliation(s)
- Orli Dahan
- Faculty of Social Sciences & Humanities, Tel-Hai College
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Ngai FW, Xiao X. Perceptions of paternal involvement and labour pain management in Chinese couples during childbirth: A qualitative study. Women Birth 2020; 34:288-295. [PMID: 32222355 DOI: 10.1016/j.wombi.2020.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/22/2020] [Accepted: 03/03/2020] [Indexed: 10/24/2022]
Abstract
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.
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Affiliation(s)
- Fei-Wan Ngai
- School of Nursing, The Hong Kong Polytechnic University, HKSAR.
| | - Xiao Xiao
- School of Nursing, The Hong Kong Polytechnic University, HKSAR.
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Deng Y, Li H, Dai Y, Yang H, Morse AN, Liang H, Lin Y. Are there differences in pain intensity between two consecutive vaginal childbirths? A retrospective cohort study. Int J Nurs Stud 2020; 105:103549. [PMID: 32199151 DOI: 10.1016/j.ijnurstu.2020.103549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 02/01/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Pain assessment is crucial for in-labour pain management. Even though women's self-rated pain intensity is the standard for pain relief or analgesic administration, multiparas appear to receive worse in-labour pain management than primiparas do. The discrepancy in pain perception between primiparas and multiparas remains unclear. Healthcare providers tend to think that multiparas endure the pain and report less pain because they have experienced childbirth. OBJECTIVE To retrospectively analyse the intensity of in-labour pain during first and second vaginal childbirth within the same group of women and explore whether parity may be an influential factor in labour pain intensity. DESIGN Retrospective cohort study. SETTING Labour and delivery in a large academic specialized hospital in Guangzhou, China. PARTICIPANTS Women were included if they had two consecutive vaginal childbirths with singleton cephalic presentations and cervical dilation ≤ 3 cm for the first childbirth and ≤ 2 cm for the second childbirth. The final study sample consisted of 417 women. METHODS All childbirth case records between January 2015 and August 2018 were scanned using a structured electronic medical system. Maternal and neonatal demographics as well as obstetric and neonatal outcomes were extracted. The in-labour pain for each childbirth was compared between first and second births. Paired t-tests, McNemar's chi-square tests and mixed-effects modelling were applied to compare the differences in labour pain intensity between the two vaginal childbirths and explore the factors that influenced maximum labour pain scores during the second childbirth. RESULTS Four hundred seventeen women were included, with an average birth interval of 1.7 years. The average maximum labour pain score during the latent phase was 6 (5,6) for the first childbirth and 5 (4,6) for the second childbirth (paired t =-6.13, P <0.001). Pain scores decreased in 28.1% (117/417) of women and increased in 13.7% (57/417) of women from the first to the second childbirth. More than half of the women in our study experienced the same maximum labour pain score during the first and second labour. Mixed-effects modelling revealed that parity, education and pregnancy complications were independently associated with maximum labour pain scores. CONCLUSIONS From a clinical point of view, in-labour pain is not clinically different for women when comparing their first and second labours. Health care professionals may underestimate in-labour pain in primiparas when comparing them with nulliparas. More studies are warranted to explore options for achieving better pain management for women with more childbirths.
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Affiliation(s)
- Yongfang Deng
- Dlivery and Labor Room, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, No.9 Jinsui Rd, Tianhe District, Guangzhou 510623, China
| | - Huixian Li
- Statistician, Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ying Dai
- Department of Pediatric Surgery, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Hongmei Yang
- Department of Pediatric operation room, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Abraham N Morse
- Department of Urogynecology, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China.
| | - Huiying Liang
- Institute of Pediatrics, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, Guangzhou, China
| | - Yan Lin
- Department of Nursing Administrative Office, Guangzhou Women and Children's Medical Center Guangzhou, Guangzhou Medical University, No.9 Jinsui Rd, Tianhe District, Guangzhou 510623, China.
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