Birth in the United States: an overview of trends past and present

Influence of mode of delivery on satisfaction with hospitalization for childbirth in the study Birth in Brazil

Controversial results have been reported on the association between mode of delivery and patient satisfaction. This study investigates which mode of delivery leads to greater satisfaction with hospital admission for childbirth. A cohort study was conducted with data from the Birth in Brazil study, which began in 2011. A total of 23,046 postpartum women were included from a random sample of hospitals, selected by conglomerates with a three level stratification. At the first follow-up, 15,582 women were re-interviewed. Mode of delivery, dichotomized into vaginal or cesarean section, and confounders were collected before hospital discharge. The outcome maternal satisfaction, investigated as a 10-item unidimensional construct, was measured by the Hospital Birth Satisfaction Scale up to six months after discharge. We used a directed acyclic graph to define minimal adjustment variables for confounding. The effect of mode of delivery on satisfaction was estimated using a structural equation model with weighting by the inverse of the probability of selection, considering the complex sampling design. The weight was estimated considering the different sample selection probabilities, the losses to follow-up, and the propensity score, which was estimated in a logistic regression model. The analysis revealed no significant difference in satisfaction with hospitalization for childbirth between respondents who had vaginal delivery and cesarean section in the adjusted analysis (standardized coefficient = 0.089; p-value = 0.056). Therefore, women who had vaginal delivery and cesarean section were equally satisfied with their hospitalization for childbirth.

Interest in Home Birth During the COVID-19 Pandemic: Analysis of Google Trends Data

Introduction

Nearly all (94%‐99%) pregnant persons in developed countries search for pregnancy‐related information online. The advent of the novel coronavirus disease 2019 (COVID‐19) and the associated restrictions in hospital policies may have pushed pregnant persons in the United States to consider giving birth at home to achieve their desired birth experience.

Methods

Google Trends is an open, rich source of real‐time, anonymized, relative data on disease patterns and population behavior that provides data in the form of search volume index (SVI): the search volume for a queried term relative to overall search volume for a given time frame and geographic location. The SVI is normalized to a scale of 0 to 100. After the World Health Organization declared COVID‐19 a pandemic on March 11, 2020, Google Trends was queried on February 21, 2021, for the search term home birth with location set to the United States and the time frame March 11, 2019 to February 21, 2021.

Results

The median SVI for home birth during nominally pre‐COVID‐19 baseline (weeks of March 17, 2019 to March 8, 2020) was relatively constant at 43 (range, 25‐56) and increased sharply to 77 during the week of March 15, to 86 during the week of March 22, and peaked at 100 during the week of March 29, 2020. The SVI declined substantially in the following weeks but remained significantly elevated compared with baseline levels. During the approximate 2‐year period of query, the states with the highest SVI values (≥80) were Arkansas, Washington, Montana, and Georgia.

Discussion

Interest in home birth spiked in the United States immediately after COVID‐19 was declared a pandemic and remained significantly elevated thereafter. These results have implications for caregivers and health systems to ensure safe pregnancies and childbirths through the resolution of the ongoing pandemic.

The evolution of prenatal care delivery guidelines in the United States

The coronavirus disease 2019 pandemic led to some of the most drastic changes in clinical care delivery ever seen in the United States. Almost overnight, providers of prenatal care adopted virtual visits and reduced visit schedules. These changes stood in stark contrast to the 12 to 14 in-person prenatal visit schedule that had been previously recommended for almost a century. As maternity care providers consider what prenatal care delivery changes we should maintain following the acute pandemic, we may gain insight from understanding the evolution of prenatal care delivery guidelines. In this paper, we start by sketching out the relatively unstructured beginnings of prenatal care in the 19th century. Most medical care fell within the domain of laypeople, and childbirth was a central feature of female domestic culture. We explore how early discoveries about "toxemia" created the groundwork for future prenatal care interventions, including screening of urine and blood pressure-which in turn created a need for routine prenatal care visits. We then discuss the organization of the medical profession, including the field of obstetrics and gynecology. In the early 20th century, new data increasingly revealed high rates of both infant and maternal mortalities, leading to a greater emphasis on prenatal care. These discoveries culminated in the first codification of a prenatal visit schedule in 1930 by the Children's Bureau. Surprisingly, this schedule remained essentially unchanged for almost a century. Through the founding of the American College of Obstetricians and Gynecologists, significant technological advancements in laboratory testing and ultrasonography, and calls of the National Institutes of Health Task Force for changes in prenatal care delivery in 1989, prenatal care recommendations continued to be the same as they had been in 1930-monthly visits until 28 weeks' gestation, bimonthly visits until 36 weeks' gestation, and weekly visits until delivery. However, coronavirus disease 2019 forced us to change, to reconsider both the need for in-person visits and frequency of visits. Currently, as we transition from the acute pandemic, we should consider how to use what we have learned in this unprecedented time to shape future prenatal care. Lessons from a century of prenatal care provide valuable insights to inform the next generation of prenatal care delivery.

Norwegian midwives' perceptions of their practice environment: A mixed methods study

AIM

To investigate Norwegian midwives' perceptions of their working environment.

DESIGN

A nationwide postal survey in 2014 collected information from 489 midwives, including the Practice Environment Scale and seven open-ended questions concerning the workplace.

METHODS

Psychometric-, descriptive- and comparative analysis was used for the quantitative data and content analysis for the qualitative data.

RESULTS

Psychometric analyses yielded five subscales: Quality of management; Resource adequacy; Midwife-doctor relations; Opportunities for development; and Midwifery foundation for care. Content analyses identified four main themes: Lack of resources; Insufficient support; Staying in midwifery; and Lack of influence. Subthemes only found in the qualitative analysis were as follows: Fear of adverse events and The strain of shift work. Most midwives rated the PES subscales Midwife-doctor relations and Quality of management favourable. In contrast, the theme Lack of influence showed that midwives felt powerless in a constantly changing work environment and ruled by the medical model of care.

The communication and emotional support needs to improve women's experience of childbirth care in health facilities in Southwest Nigeria: A qualitative study

OBJECTIVE

To improve women's childbirth experiences in health facilities, their psychosocial and communication needs have to be met. However, what constitutes these specific needs is poorly understood, particularly in Sub-Saharan Africa. This paper explores women's needs for communication and emotional support during facility-based childbirth.

METHODS

Qualitative research was conducted in a large referral maternity hospital and its catchment communities in Akure, Nigeria. In-depth interviews (IDIs) and focus group discussions (FGDs) were conducted among women of reproductive age, midwives, doctors, and facility administrators. Thematic analysis was used to synthesize findings, and then interpreted within the context of this study and existing quality of care framework.

RESULTS

Forty-two IDIs and 10 FGDs are included in this analysis. Participants reported such needs as communication in simple words in local language by healthcare staff, having their husbands as birth companions, spiritual support, and prayers from family members and healthcare providers.

CONCLUSION

To increase, improve, and sustain facility-based childbirth in Nigeria, health systems should appreciate the uniqueness and importance of each woman's needs during childbirth. Practical and sustainable actions should be taken to meet these needs, within the confines of the acceptable sociocultural norms.

Doula Support and Attitudes of Intrapartum Nurses: A Qualitative Study from the Patient's Perspective

Although the roles of the intrapartum nurse and professional doula differ markedly, they serve women best if their roles complement each other. For doulas and nurses to work well together in order to facilitate a positive birth experience for the patient, they would logically need to develop a relationship based on mutual respect. The purpose of this pilot qualitative study was to examine the level of acceptance shown by intrapartum nurses for doula support, as perceived by the parturient woman. Implications for further research are addressed.

Stories from a Mexican American partera: life on the Texas-Mexico border

This is a case study about an 87-year-old Mexican American partera and her stories about her life and practice on the Texas-Mexico border from the 1930s until 1995. These stories describe strong and competent women who rode horses to remote areas to help with many deliveries of babies throughout their lives. Sra. B, the lay midwife agreed to be interviewed so that her work could be shared with others. The stories discussed told part of what she lived. These stories included clinical pearls that told about how to use "a few drops of oregano . . . and salt," and how to handle situations in which "the Lord was the only one who could help us," among others. These interviews tell part of the story about how Sra. B learned, lived, and practiced as a partera and how she is remembered by the families throughout the area.

Women's childbirth preferences and practices in the United States

Over the past two decades, research on childbirth worldwide has documented women's varied perceptions of and decision-making regarding childbirth. Scholars have demonstrated the impact of medical authority, religion, perception of risk, and access to care providers on the decisions women make about where to have their babies and with whom. Virtually all research on how women make these choices, however, has focused outside the United States. To address this gap in the literature, we analyze data collected during 2004-2010 through 135 in-depth interviews with women in the U.S. who have had hospital births, homebirths with midwives, and homebirths without professional assistance to explore the factors that led them to the births they had. We supplement these interview data with archival analysis of birth stories and ethnographic data to offer additional insight into women's birth experiences. In our analysis, we utilize Pierre Bourdieu's concepts of "habitus" and "field" to examine the ways women's preferences emerge and how a sense of risk and safety shape their decision-making around pregnancy and parturition. Our findings indicate that while women's birth preferences initially emerge from their habitus, their birth practices are ultimately shaped by broader structural forces, particularly economic position and the availability of birth options.

Child visitation policy and practice for maternity units

PURPOSE

: To examine policies and practices related to sibling and child visitation within southeastern U.S. hospital-based maternity units.

METHODS

: This descriptive telephone survey includes data from 69 hospitals about their intrapartum and postpartum sibling and child visitation policies. Data were collected from nurse representatives from each of these institutions. Frequency distributions were used to analyze the data.

RESULTS

: Visitation during labor was restricted to siblings only in 62.3% of the hospitals; in this sample, only 28.9% allowed open visitation by children during labor and four hospitals prohibited all children from visiting during labor. Postpartum visitation was less restrictive: The majority (82.6%) of the hospitals had open child visitation policies; only four hospitals physically assessed or observed children for signs of illness prior to visiting on the postpartum unit. In most cases, even if restrictive child visitation policies were in place, they were not routinely enforced.

CLINICAL IMPLICATIONS

: Nurses should examine current sibling and child visitation policies in their institutions to determine the need for revision, elimination, or creation of new policies. Moreover, continued research study on child and sibling visitation and related issues is warranted to generate updated evidence to support policies.

The emergence of high-tech birthing

The journey from "normal" to high-tech childbirth has taken place gradually over the past century. This article gives a historic review of maternity care and defines normal birth according to care practices adapted from the World Health Organization. The issues facing today's consumers, care providers, and caregivers that have led to the high-tech approach to birth are discussed. Recommendations for nursing practice are proposed to balance a normal approach to childbirth with a high-tech clinical environment.

Psychosocial sequelae of cesarean delivery: review and analysis of their causes and implications

A growing number of children around the world are being born by surgical delivery, or cesarean section. Concerns over rising rates of cesareans have focused on the risk of death and medical complications associated with surgical delivery but have largely neglected psychosocial and behavioral factors that affect and are affected by cesarean delivery. We summarize research which indicates that women who deliver by cesarean section have more negative perceptions of their birth experience, their selves, and their infants, exhibit poorer parenting behaviors, and may be at higher risk for postpartum mood disturbance compared to women delivering infants vaginally. We also review evidence that suggests that cesareans adversely influence women's moods and perceptions by restricting the control that they can exercise over birth and by violating expectations about childbirth. Based on these findings, we recommend ways to reduce the aversiveness of cesareans, offer recommendations for future research, and discuss implications of escalating rates of cesareans, including medically non-indicated cesareans by request.

Policies and Practices for Maternal Support Options during Childbirth and Breastfeeding Initiation After Cesarean in Southeastern Hospitals

OBJECTIVE

To describe policies, practices, and associated rationales of hospital obstetric units regarding mothers' support person options during childbirth and to explore practices concerning support of breastfeeding initiation after cesarean delivery.

DESIGN

Descriptive telephone survey.

SETTING

Hospitals in the southeastern region of the United States.

PARTICIPANTS

Convenience sample of 154 obstetric nurse manager and nurse representatives employed by the participating hospitals.

MAIN OUTCOME MEASURES

Types of policies regarding mothers' support person options during childbirth and immediate postpartum stage, initiation of breastfeeding after cesarean birth, and attitudes about policies.

RESULTS

All hospitals allowed two or more support persons during vaginal births, 89% permitted only one support person during nonemergent cesareans, and 58.0% of the nurse representatives believed that mothers should be allowed a second support person. Less than one third (31.2%) of the hospitals considered a mother's request to breastfeed in the operating room, and most (78.6%) allowed mothers to breastfeed in the recovery room.

CONCLUSIONS

Overall, maternal support policies, practices, and nurse representatives' attitudes were mother and family friendly, particularly related to vaginal births. Though breastfeeding initiation after cesarean birth was encouraging, support person options during nonemergent cesarean births and related rationales warrant further examination.