Are Routine Interventions Necessary in Normal Birth?

Effect of midwives' attitudes towards evidence-based practices on mothers' perceptions regarding childbirth practices and satisfaction

OBJECTIVE

The aim was to determine the effect of midwives' attitudes towards evidence-based practices in childbirth on mothers' perception and satisfaction with childbirth practices.

MATERIAL AND METHOD

This cross-sectional study was carried out with the participation of 34 midwives working in the delivery rooms of three public hospitals in a province in the south of Türkiye and 287 postpartum women whose deliveries were facilitated by these midwives. A Personal Information Form and the Midwives' Evidence-Based Practices Attitude Scale during Labor (MEBPAS) were administered to the midwives. A Personal Information Form, the Birth Practices Perception Scale (BPPS), and the Birth Satisfaction Scale-Revised (BSS-R) were administered to the postpartum women.

RESULTS

Because the skewness and kurtosis values were between -2 and + 2, the data showed normal distribution. The multiple linear regression model showed that the dimensions of MEBPAS (Interventional Practices, Supportive Care Practices, Movement and Nutrition Practices, Early Postpartum Period Practices) explained 29.4% of the total variance in BSS-R (F = 30.798; p = 0.041) and 53.4% of the total variance in BPPS (F = 83.094; p < 0.001). According to the Structural Equation Modeling, Interventional Practices, Movement and Nutrition Practices, and Early Postpartum Period Practices had statistically significant positive effects on BSS-R (respectively, β = 0.286, p < 0.001; β = 0.479, p = 0.016, and β = 1.009, p < 0.001), while Interventional Practices, Supportive Care Practices, and Early Postpartum Period Practices had statistically significant negative effects on BPPS (respectively, β=-0.048, p < 0.001; β=-0.026, p = 0.027, and β=-0.039, p = 0.034).

CONCLUSION

It was found that midwives' positive attitudes towards evidence-based practices in childbirth positively affected women's perceptions and satisfaction with birth practices.

Navigating intensive altered states of consciousness: How can the set and setting key parameters promote the science of human birth?

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.

Effects of the time of pregnant women's admission to the labor ward on the labor process and interventions

Our aim to conduct the study was to investigate the effects of the time of pregnant women's admission to the labor ward on the labor process and interventions. This study is a two-group, prospective, analytical study. Groups were determined according to their cervical dilation levels. The data were collected using the Labor Process Form, and analyzed using the Statistical Package for the Social Sciences version. Within this context, the rates of amniotomy, induction with oxytocin, episiotomy, and cesarean section in the participants who presented to the hospital in the latent phase of labor were higher.

First do no harm - interventions during labor and maternal satisfaction: a descriptive cross-sectional study

BACKGROUND

Interventions can be lifesaving when properly implemented but can also put the lives of both mother and child at risk by disrupting normal physiological childbirth when used indiscriminately without indications. Therefore, this study was performed to investigate the effect of frequent interventions during labor on maternal satisfaction and to provide evidence-based recommendations for labor management decisions.

METHODS

The study was performed in descriptive design in a state hospital in Kars, Turkey with 351 pregnant women who were recruited from the delivery ward. The data were collected using three questionnaires: a survey form containing sociodemographic and obstetric characteristics, the Scale for Measuring Maternal Satisfaction in Vaginal Birth, and an intervention observation form.

RESULTS

The average satisfaction scores of the mothers giving birth in our study were found to be low, at 139.59 ± 29.02 (≥150.5 = high satisfaction level, < 150.5 = low satisfaction level). The percentages of the interventions that were carried out were as follows: 80.6%, enema; 22.2%, perineal shaving; 70.7%, induction; 95.4%, continuous EFM; 92.3%, listening to fetal heart sounds; 72.9%, vaginal examination (two-hourly); 31.9%, amniotomy; 31.3%, medication for pain control; 74.9%, intravenous fluids; 80.3%, restricting food/liquid intake; 54.7%, palpation of contractions on the fundus; 35.0%, restriction of movement; 99.1%, vaginal irrigation with chlorhexidine; 85.5%, using a "hands on" method; 68.9%, episiotomy; 74.6%, closed glottis pushing; 43.3%, fundal pressure; 55.3%, delayed umbilical cord clamping; 86.0%, delayed skin-to-skin contact; 60.1%, controlled cord traction; 68.9%, postpartum hemorrhage control; and 27.6%, uterine massage. The satisfaction levels of those who experienced the interventions of induction, EFM, restriction of movement, two-hourly vaginal examinations, intravenous fluid, fundal pressure, episiotomy, palpation of contractions on the fundus, closed glottis pushing, delayed umbilical cord clamping, delayed skin-to-skin contact, fluid/food restriction, and of those who were not provided pharmacological pain control were found to be lower (p < 0.05).

CONCLUSION

Medical interventions carried out at high rates had a negative impact on women's childbirth experience. Therefore, a proper assessment in the light of medical evidence should be made before deciding that it is absolutely necessary to intervene in the birthing process and the interdisciplinary team should ensure that intrapartum caregivers will "first do no harm."

Routine perineal shaving on admission in labour

BackgroundPubic or perineal shaving is a procedure performed before birth in order to lessen the risk of infection if there is a spontaneous perinealtear or if an episiotomy is performed.ObjectivesTo assess the effects of routine perineal shaving before birth onmaternal and neonatal outcomes, according to the best available evidence.Search methodsWe searched the Cochrane Pregnancy and Childbirth Group’s Trials Register (12 June 2014).Selection criteriaAll controlled trials (including quasi-randomised) that compare perineal shaving versus no perineal shaving.Data collection and analysisTwo review authors independently assessed all potential studies for inclusion, assessed risk of bias and extracted the data using apredesigned form. Data were checked for accuracy.Main resultsThree randomised controlled trials (1039 women) published between 1922 and 2005 fulfilled the prespecified criteria. In the earliesttrial, 389 women were alternately allocated to receive either skin preparation and perineal shaving or clipping of vulval hair only. In thesecond trial, which included 150 participants, perineal shaving was compared with the cutting of long hairs for procedures only. In thethird and most recent trial, 500 women were randomly allocated to shaving of perineal area or cutting of perineal hair. The primaryoutcome for all three trials was maternal febrile morbidity; no differences were found (risk ratio (RR) 1.14, 95% confidence interval(CI) 0.73 to 1.76). No differences were found in terms of perineal wound infection (RR 1.47, 95% CI 0.80 to 2.70) and perinealwound dehiscence (RR 0.33, 95% CI 0.01 to 8.00) in the most recent trial involving 500 women, which was the only trial to assessthese outcomes. In the smallest trial, fewer women who had not been shaved had Gram-negative bacterial colonisation compared withwomen who had been shaved (RR 0.83, 95% CI 0.70 to 0.98). There were no instances of neonatal infection in either group in theone trial that reported this outcome. There were no differences in maternal satisfaction between groups in the larger trial reporting this outcome (mean difference (MD) 0.00, 95% CI -0.13 to 0.13). No trial reported on perineal trauma. One trial reported on side-effectsand these included irritation, redness, burning and itching.The overall quality of evidence ranged from very low (for the outcomes postpartum maternal febrile morbidity and neonatal infection)to low (for the outcome maternal satisfaction and wound infection).Authors’ conclusionsThere is insufficient evidence to recommend perineal shaving for women on admission in labour.

Exploring women's personal experiences of giving birth in Gonabad city: a qualitative study

BACKGROUND

Women's health is an important task in society. The aim of this qualitative study that used a phenomenological approach was to explain women's personal experiences of giving birth in Gonabad city that had positive experiences of giving birth in order to establish quality cares and the related factors of midwifery cares for this physiological phenomenon.

METHODS

The participants were 21 primiparae women who gave a normal and or uncomplicated giving birth in the hospital of Gonabad University of medical sciences. Based on a purposeful approach in-depth interviews were continued to reach data saturation. The data were collected through open and semi-structured interactional in-depth interviews with all the participants. All the interviews were taped, transcribed and then analyzed through a qualitative content analysis method to identify the concepts and themes.

FINDINGS

Some categories were emerged. A quiet and safe environment was the most urgent need of the most women giving birth. Unnecessary routine interventions that are performed on all women regardless of their needs and should be avoided were considered such as: "absolute rest, establishing vein, frequent vaginal examinations, fasting and early Amniotomy". All the women wanted to take part actively in their giving birth, because they believed it could affect their giving birth.

CONCLUSION

We hope that the women's experiences of giving birth will be a pleasant and enjoyable experience for all the mothers giving birth.

Ultrasound-Based Fetal Tracking Technology During Labor: Is It the Next Best Thing?

In this column, the author reprises a recent selection from the Lamaze International research blog, Science & Sensibility. With the introduction of a new technology intended to acutely track fetal station and position during labor through birth, questions are being raised about the necessity—and possible danger—of this technology and its potential impact on normal birth.