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Zang Y, Lu H, Zhang H, Zhang X, Yang M, Huang J. Chinese midwives' perceptions on upright positions during the second stage of labour: A qualitative study. Midwifery 2021; 98:102993. [PMID: 33823359 DOI: 10.1016/j.midw.2021.102993] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 02/24/2021] [Accepted: 03/16/2021] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Upright positions are recommended by many international organizations due to their positive effects on improving birth outcomes. The effects can only be achieved when upright positions are properly adopted by women under the guidance of midwives. However, whether midwives in China have a clear understanding of upright positions during the second stage of labour is an issue that has not been explored. The aim of this study was to explore midwives' perceptions on assisting women in upright positions during the second stage of labour in the context of China. DESIGN A qualitative descriptive design was adopted. We analysed the data using the conventional content analysis and reported the study in line with the COREQ checklist. SETTING The study was conducted at the labour wards of two maternity hospitals and two general hospitals in China where the adoption of upright positions was encouraged during the second stage of labour. PARTICIPANTS Semi-structured individual interviews with 17 midwives were conducted between May and July 2020. FINDINGS Three main themes were identified: (1) safety and availability; (2) unclear method of implementation; (3) lack of knowledge of the potential risks and precautions. Midwives' perceptions were based primarily on clinical experience rather than evidence-based practice. Their perceptions on the indications and contraindications of upright positions were divergent and ambiguous. Midwives' suggested that the indications and contraindications should be adjusted in the context of China. Time limit for keeping an upright position and maternal pushing during uterine contractions were two questions that still confused midwives. Midwives lacked knowledge of the potential risks of upright positions and rarely systematically summarized the precautions. KEY CONCLUSIONS This study shows that assisting women to give birth in upright positions during the second stage of labour can be a challenge for midwives in China, and also highlights the need for clarifying the detailed implementation methods of upright positions in the context of China by evidence-based approaches. IMPLICATIONS FOR PRACTICE An evidence-based protocol for implementing upright positions during the second stage of labour should be developed to guide midwives' practice and facilitate the successful use of upright positions in China.
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Affiliation(s)
- Yu Zang
- School of Nursing, Peking University, Beijing, China; School of Nursing, Hebei Medical University, Shijiazhuang, China
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China.
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xiaoli Zhang
- Department of Obstetrics and Gynaecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Minghui Yang
- Department of Obstetrics and Gynaecology, the First Hospital of Kunming Medical University, Kunming, China
| | - Jing Huang
- School of Nursing, Peking University, Beijing, China
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Zang Y, Lu H, Zhang H, Huang J, Zhao Y, Ren L. Benefits and risks of upright positions during the second stage of labour: An overview of systematic reviews. Int J Nurs Stud 2020; 114:103812. [PMID: 33217662 DOI: 10.1016/j.ijnurstu.2020.103812] [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: 07/17/2020] [Revised: 10/12/2020] [Accepted: 10/21/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Upright positions during the second stage of labour are assumed to have many physiological advantages that may facilitate normal birth. Clarifying the underlying benefits and risks of upright positions plays an important role in the implementation of upright positions. The benefits and risks of upright positions during the second stage of labour have been explored in several systematic reviews, but the results are divergent. OBJECTIVE To summarize the evidence on the underlying benefits and risks of upright positions during the second stage of labour by searching available systematic reviews to explore the best evidence for clinical practice and decision making. DESIGN Overview of systematic reviews. DATA SOURCES We systematically searched five English databases and four Chinese databases from inception to 15th March 2020 for any published and ongoing systematic reviews. REVIEW METHODS Two reviewers independently evaluated the methodological and the reporting quality of the included systematic reviews using the AMSTAR 2 tool and the PRISMA checklist. A descriptive synthesis was used by reporting the results of the highest quality reviews. RESULTS Seven systematic reviews met the eligibility criteria, of which two Cochrane reviews had the highest methodological and reporting quality. In women without epidural analgesia, upright positions significantly reduced the rate of instrumental vaginal birth (moderate-quality evidence), shortened the second stage of labour (very low-quality evidence), reduced the rate of episiotomy (very low-quality evidence) and abnormal foetal heart rate patterns requiring intervention (very low-quality evidence), but significantly increased the risk of blood loss greater than 500 ml (moderate-quality evidence) and second-degree perineal trauma (low-quality evidence). However, no definite benefits or risks of upright positions were found in women with epidural analgesia based on the current evidence. CONCLUSIONS This overview demonstrates that upright positions have both benefits and risks but the quality of the current evidence is relatively low. It is necessary for the researchers to conduct robust studies to provide stronger evidence. In addition, upright positions are recommended to be used depending on women's preferences and labour progress, but should also be carefully monitored especially in women with epidural analgesia. Registration number: CRD42020175820.
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Affiliation(s)
- Yu Zang
- School of Nursing, Peking University, Beijing 100191, China; School of Nursing, Hebei Medical University, Shijiazhuang, China.
| | - Hong Lu
- School of Nursing, Peking University, Beijing 100191, China.
| | - Huixin Zhang
- Department of Obstetrics and Gynaecology, the Fourth Hospital of Hebei Medical University, Shijiazhuang, China.
| | - Jing Huang
- School of Nursing, Peking University, Beijing 100191, China.
| | - Yang Zhao
- School of Nursing, Peking University, Beijing 100191, China.
| | - Lihua Ren
- School of Nursing, Peking University, Beijing 100191, China.
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Levett KM, Lord SJ, Dahlen HG, Smith CA, Girosi F, Downe S, Finlayson KW, Fleet J, Steen M, Davey MA, Newnham E, Werner A, Arnott L, Sutcliffe K, Seidler AL, Hunter KE, Askie L. The AEDUCATE Collaboration. Comprehensive antenatal education birth preparation programmes to reduce the rates of caesarean section in nulliparous women. Protocol for an individual participant data prospective meta-analysis. BMJ Open 2020; 10:e037175. [PMID: 32967876 PMCID: PMC7513601 DOI: 10.1136/bmjopen-2020-037175] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 07/09/2020] [Accepted: 08/14/2020] [Indexed: 01/10/2023] Open
Abstract
INTRODUCTION Rates of medical interventions in normal labour and birth are increasing. This prospective meta-analysis (PMA) proposes to assess whether the addition of a comprehensive multicomponent birth preparation programme reduces caesarean section (CS) in nulliparous women compared with standard hospital care. Additionally, do participant characteristics, intervention components or hospital characteristics modify the effectiveness of the programme? METHODS AND ANALYSIS: Population: women with singleton vertex pregnancies, no planned caesarean section (CS) or epidural.Intervention: in addition to hospital-based standard care, a comprehensive antenatal education programme that includes multiple components for birth preparation, addressing the three objectives: preparing women and their birth partner/support person for childbirth through education on physiological/hormonal birth (knowledge and understanding); building women's confidence through psychological preparation (positive mindset) and support their ability to birth without pain relief using evidence-based tools (tools and techniques). The intervention could occur in a hospital-based or community setting.Comparator: standard care alone in hospital-based maternity units. OUTCOMES Primary: CS.Secondary: epidural analgesia, mode of birth, perineal trauma, postpartum haemorrhage, newborn resuscitation, psychosocial well-being.Subgroup analysis: parity, model of care, maternal risk status, maternal education, maternal socio-economic status, intervention components. STUDY DESIGN An individual participant data (IPD) prospective meta-analysis (PMA) of randomised controlled trials, including cluster design. Each trial is conducted independently but share core protocol elements to contribute data to the PMA. Participating trials are deemed eligible for the PMA if their results are not yet known outside their Data Monitoring Committees. ETHICS AND DISSEMINATION Participants in the individual trials will consent to participation, with respective trials receiving ethical approval by their local Human Research Ethics Committees. Individual datasets remain the property of trialists, and can be published prior to the publication of final PMA results. The overall data for meta-analysis will be held, analysed and published by the collaborative group, led by the Cochrane PMA group. TRIAL REGISTRATION NUMBER CRD42020103857.
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Affiliation(s)
- Kate M Levett
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
| | - Sarah J Lord
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
- NHMRC Clinical Trials Centre, Camperdown, New South Wales, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Parramatta, New South Wales, Australia
| | - Caroline A Smith
- NICM Health Research Institute, University of Western Sydney, Penrith South, New South Wales, Australia
- Graduate Research School, University of Western Sydney, Kingswood, New South Wales, Australia
| | - Federico Girosi
- Translational Health Research Institute, Western Sydney University, Penrith, New South Wales, Australia
- Capital Markets CRC, New South Wales, Australia, Sydney, New South Wales, Australia
| | - Soo Downe
- School of Midwifery and Community Health, University of Central Lancashire, Preston, Lancashire, UK
| | | | - Julie Fleet
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary Steen
- School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Mary-Ann Davey
- Obstetrics & Gynaecology, Monash Health, Monash University Central Clinical School, Melbourne, Victoria, Australia
| | - Elizabeth Newnham
- School of Nursing & Midwifery, Griffith University, Medowbrook, Queensland, Australia
| | - Anette Werner
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Leslie Arnott
- The B.E.A.R. Program, Lamaze Australia, Melbourne, Victoria, Australia
| | - Kerry Sutcliffe
- School of Medicine Sydney, University of Notre Dame Australia, Darlinghurst, New South Wales, Australia
| | - Anna Lene Seidler
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Kylie Elizabeth Hunter
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
| | - Lisa Askie
- NHMRC Clinical Trials Centre, The University of Sydney, Camperdown, New South Wales, Australia
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Pereira GMV, Hosoume RS, de Castro Monteiro MV, Juliato CRT, Brito LGO. Selective episiotomy versus no episiotomy for severe perineal trauma: a systematic review with meta-analysis. Int Urogynecol J 2020; 31:2291-2299. [PMID: 32333062 DOI: 10.1007/s00192-020-04308-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 04/07/2020] [Indexed: 01/10/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We hypothesized whether a non-episiotomy protocol or administration of selective episiotomy as an intrapartum intervention would modify the incidence of obstetric anal sphincter injuries (OASIS). METHODS We registered this systematic review with the PROSPERO database (CRD42018111018). Prospective randomized controlled trials (RCTs) were included from databases until February 2019. The primary outcome was OASIS, and the secondary outcomes were any perineal trauma, duration of the second stage of labor, instrumental delivery, and post-partum hemorrhage. The risk of bias (Cochrane Handbook) and the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) criteria were used to assess the RCTs. RESULTS A total of 1,833 results (PubMed 650, SCOPUS 1,144, Cochrane Library 33, LILACS 6) were obtained. However, only 2 studies fulfilled the criteria for quantitative analysis and meta-analysis (n = 574). The non-episiotomy arm included two episiotomies (1.7% of deliveries), whereas the selective episiotomy included 33 episiotomies (21.4%). Performance of selective episiotomy demonstrated no difference compared with that of the non-episiotomy group with regard to OASIS (OR = 0.46 [0.15-1.39]; n = 543; I2 = 0%,p = 0.17), any perineal trauma (OR = 0.90 [0.61-1.33]; I2 = 0%, n = 546, p = 0.59), instrumental delivery (OR = 1.40 [0.80-2.45]; I2 = 0%, n = 545, p = 0.24), duration of the second stage of labor (MD = -3.71 [-21.56, 14.14]; I2 = 72%,n = 546, p = 0.68), perineal pain (MD = 0.59 [0.01-1.17]; I2 = 0%,p = 0.05), and post-partum hemorrhage (OR = 1.75 [0.87-3.54]; I2 = 0%,n = 546,p = 0.12). The evaluated studies displayed a low risk of bias in at least four of the seven categories analyzed. GRADE demonstrated a low certainty for severe perineal tears, postpartum hemorrhage, duration of the second stage of labor, and a moderate certainty for any perineal tear. CONCLUSIONS There was no significant difference between non-episiotomy and selective episiotomy regarding OASIS. No RCT was able to confirm a benefit of the non-performance of episiotomies in the non-episiotomy arm.
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Affiliation(s)
- Gláucia Miranda Varella Pereira
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas, 13148-254, Brazil
| | | | | | - Cassia Raquel Teatin Juliato
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas, 13148-254, Brazil
| | - Luiz Gustavo Oliveira Brito
- Department of Obstetrics and Gynecology, State University of Campinas (UNICAMP), Rua Alexander Fleming, 101, Cidade Universitária, Campinas, 13148-254, Brazil.
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Vertical Delivery as a Method of Prevention of Obstetric and Perinatal Complications. ACTA BIOMEDICA SCIENTIFICA 2019. [DOI: 10.29413/abs.2019-4.5.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Currently, there are many points of view on management of physiological labor, in particular, it concerns the intrapartum position of a woman. Tactics of modern obstetrics should ensure the safety of motherhood, which in future ensures the prosperity of the state. One of the alternative methods of delivery is the vertical position of a woman in the intrapartum period. It is impossible to describe the whole range of possible positions of a woman in the intrapartum period, the common ones being: lying position (lateral, reclining, lithotomy, Trendelenburg’s, etc.) or upright position (sitting, using a chair for childbirth, standing, squatting, standing on the knees, etc.). Opinions about how the vertical position of a mother in the intrapartum period affects the outcome of childbirth are quite ambiguous. The conclusions of various authors on that matter often contradict each other.The aim of the research was to study the role of vertical delivery in reducing the frequency of obstetric and perinatal complications.Materials: publications of foreign and domestic authors within the period from 1989 to 2017.Methods: systematic analysis and synthesis of literature data.Conclusion: Despite a significant number of studies, it is not possible to determine the universality of the vertical position in childbirth, therefore, the selection of patients for the management of vertical childbirth should be approached carefully. In the presence of pregnancy complications, preference should be given to the classic version of the position in childbirth. In women who have a low risk of perinatal complications, an upright position can be a worthy alternative. To prevent the development of bleeding in the III stage of labor and the early postpartum period, a woman should take a horizontal position after the birth of the fetus. This condition must also be observed when examining the birth canal. Thus, the rational tactics of conducting childbirth is to determine the optimal combination of vertical and horizontal positions at different periods of the childbirth process, taking into account the convenience for the woman in labor.
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Barasinski C, Debost-Legrand A, Lemery D, Vendittelli F. Practices during the active second stage of labor: A survey of French midwives. Midwifery 2018; 60:48-55. [PMID: 29494852 DOI: 10.1016/j.midw.2018.02.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2017] [Revised: 01/30/2018] [Accepted: 02/02/2018] [Indexed: 10/18/2022]
Abstract
OBJECTIVE the principal objective of our study was to describe the practices reported by French midwives during the active second stage of labor (expulsion phase). DESIGN this cross-sectional Internet survey questioned French midwives who attended at least one childbirth in 2013. SETTING this open survey was posted on a website from June 15 through December 1, 2014. PARTICIPANTS 1496 midwives from 377 maternity units participated in the study. MEASUREMENTS AND FINDINGS the midwives most often reported suggesting horizontal positions during the active second stage (supine with footholds, lithotomy, lithotomy with knees turned in, or lateral positions). Non-horizontal positions were more often proposed by midwives in level I units (p<0.0001). Almost half the midwives responding (46.4%), especially those working in level III units (51.1%, p = 0.006), advised Valsalva pushing. The mean maximum pushing time was 35.3 minutes±12.8 minutes. Nearly all the midwives favored the 'hands on' technique at childbirth (91.4%), and 24% reported using warm compresses on the perineum at childbirth. KEY CONCLUSION most midwives advised horizontal positions for childbirth. The practices of French midwives differed as a function of where they worked. The midwives, especially those in level III facilities, reported that they cannot always ensure 'physiological childbirth'. IMPLICATIONS FOR PRACTICE the practices of French midwives must become more evidence-based. The development of professional guidelines for midwives in France appears essential. This study also helps to prioritise national training for midwives.
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Affiliation(s)
- Chloé Barasinski
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France.
| | - Anne Debost-Legrand
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France
| | - Didier Lemery
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique; et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
| | - Françoise Vendittelli
- Université Clermont Auvergne, CNRS, CHU Clermont-Ferrand, SIGMA, INSTITUT PASCAL, F-63000 Clermont-Ferrand, France; Réseau de Santé en Périnatalité d'Auvergne, F-63000 Clermont-Ferrand, France; AUDIPOG (Association des Utilisateurs de Dossiers Informatisés en Pédiatrie, Obstétrique; et Gynécologie), RTH Laennec Medical University, 7 rue Guillaume Paradin, 69372 Lyon Cedex 08, France
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Deliktas A, Kukulu K. A meta-analysis of the effect on maternal health of upright positions during the second stage of labour, without routine epidural analgesia. J Adv Nurs 2017; 74:263-278. [DOI: 10.1111/jan.13447] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Ayse Deliktas
- Faculty of Nursing; Department of Obstetrics & Gynaecological Nursing; Akdeniz University; Antalya Turkey
| | - Kamile Kukulu
- Faculty of Nursing; Department of Obstetrics & Gynaecological Nursing; Akdeniz University; Antalya Turkey
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Rubio-Álvarez A, Molina-Alarcón M, Hernández-Martínez A. Relationship between the degree of perineal trauma at vaginal birth and change in haemoglobin concentration. Women Birth 2017; 30:382-388. [PMID: 28412037 DOI: 10.1016/j.wombi.2017.02.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 02/21/2017] [Accepted: 02/26/2017] [Indexed: 01/19/2023]
Abstract
BACKGROUND Postpartum anaemia is a problem with high prevalence that significantly affects maternal recovery. Among the causal factors is perineal trauma. However, it is still not known what degree of perineal trauma produces a greater reduction of haemoglobin. AIM To assess the relationship between the degree of perineal trauma and change in haemoglobin concentration at vaginal birth. METHODS An observational, analytical retrospective cohort study was performed at the Mancha-Centro Hospital (Spain) during the period 2010-2014. Data were collected regarding 3479 women who gave birth vaginally. The main outcome variable was the change in haemoglobin concentration. Multivariate analysis by means of multiple linear regression was performed to control possible confounding factors and to determine the net effect of each degree of perineal trauma on haemoglobin reduction. FINDINGS Of the total sample, 20.1% of women (699) had an intact perineum, 41.6% (1446) experienced some form of perineal trauma, but not episiotomy, and the remaining 38.3% of women (1334) underwent an episiotomy. The average reduction of haemoglobin was 1.46g/dL (Standard Deviation (SD)=1.09g/dL) for women without episiotomy with a second degree tear and 2.07g/dL (SD=1.24g/dL) for women who had an episiotomy and no perineal tear. The greatest reduction occurred among women with episiotomy and a third or fourth degree tear with a decrease of 3.10g/dL (SD=1.32g/dL). CONCLUSION Episiotomy is related to greater reduction of haemoglobin concentration in comparison with all degrees of spontaneous perineal trauma. The use of episiotomy should be strictly limited.
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Abstract
OBJECTIVE This study was performed to assess the differences in the birth canal lacerations following the lateral and fours posture deliveries compared with those following the supine posture deliveries. METHODS We examined the birth canal lacerations of our "low risk" pregnant women under the midwife-led delivery care at Japanese Red Cross Katsushika Maternity Hospital between April 2006 and March 2015. RESULTS There were 3826, 1754 and 719 women who delivered with supine, lateral and fours postures. The rate of no laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.630, 95% CI 0.56-0.71, p < 0.01); however, the incidence of perineal laceration in the women who delivered with lateral posture was significant lower than that in the women who delivered with supine posture (OR 0.856, 95% CI 0.76-0.90, p < 0.01). The incidence of perineal laceration of third- or fourth-degree in the women who delivered with fours posture was significant higher than that in the women who delivered with supine posture (OR 2.28, 95% CI 1.2-4.2, p < 0.01). CONCLUSION The current results may be to help for self-determination of birthing postures in prenatal women.
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Affiliation(s)
- Shunji Suzuki
- a Department of Obstetrics and Gynecology , Japanese Red Cross Katsushika Maternity Hospital , Tokyo , Japan
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Zileni BD, Glover P, Jones M, Teoh KK, Zileni CW, Muller A. Malawi women's knowledge and use of labour and birthing positions: A cross-sectional descriptive survey. Women Birth 2016; 30:e1-e8. [PMID: 27329996 DOI: 10.1016/j.wombi.2016.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 05/18/2016] [Accepted: 06/06/2016] [Indexed: 11/17/2022]
Abstract
PROBLEM Despite research evidence supporting use of upright birthing positions, most women give birth in supine position. Little is known about women's knowledge and use of labour and birthing positions. Specifically, there is a lack of evidence on Malawi women's knowledge and use of birthing positions, and this limits the possibility of improvement in childbirth practices. AIM To assess women's knowledge and use of different positions during labour and birthing. METHODS The study used a cross-sectional descriptive survey in a Malawi maternity unit where 373 low-risk postnatal women participated in face-to-face exit interviews, using a structured questionnaire. A descriptive analysis of the categorical variables was conducted to examine frequencies and percentages. FINDINGS The majority of women knew about walking (66.4%) and lateral (60.6%) as labour positions, whereas 99.2% knew about the supine as a birthing position. Half of the women (50%) walked during labour and the majority (91.4%) gave birth whilst in supine position. Midwives were the main source of information on positions used during childbirth. DISCUSSION Education about different birthing positions is needed for women who deliver at the maternity unit so that they can make informed decisions on their own options for childbirth. However, midwives must have the competence to encourage and assist women give birth in different positions, so professional development of midwives in childbirth positions is a priority. CONCLUSION Childbirth education should include information on the various labour and birthing positions. Midwives should be equipped with appropriate skills to help women use different positions during childbirth.
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Affiliation(s)
- Barbara Debra Zileni
- Kamuzu College of Nursing, Maternal and Child Health Department, Chipatala Avenue, off Mzimba Street, Opposite Kamuzu Central Hospital, Lilongwe, Malawi.
| | - Pauline Glover
- School of Nursing & Midwifery, Faculty of Health Science, Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia
| | - Meril Jones
- School of Nursing & Midwifery, Faculty of Health Science, Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia
| | - Kung-Keat Teoh
- Student Learning Centre, Affiliate member, School of Computer Science, Engineering and Mathematics, Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia
| | | | - Amanda Muller
- School of Nursing & Midwifery, Faculty of Health Science, Flinders University, Sturt Road, Bedford Park 5042, South Australia, Australia
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Warmink-Perdijk WDB, Koelewijn JM, de Jonge A, van Diem MT, Lagro-Janssen ALM. Better perineal outcomes in sitting birthing position cannot be explained by changing from upright to supine position for performing an episiotomy. Midwifery 2016; 34:1-6. [PMID: 26971440 DOI: 10.1016/j.midw.2016.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Revised: 12/15/2015] [Accepted: 01/20/2016] [Indexed: 11/26/2022]
Abstract
BACKGROUND women who give birth in supine position are more likely to have an episiotomy than women who give birth in sitting position. A confounding effect may be that women in upright positions in second stage of labour are asked to lie down if a professional needs to perform an episiotomy. This prospective cohort study aimed to determine whether this factor can explain the lower rate of episiotomy in sitting compared to supine position. METHODS data from 1196 women who had a spontaneous, vaginal birth were analysed. Positions during second stage and at birth were carefully recorded. Three groups of birthing positions were compared in multivariable analyses: 1) horizontal during second stage and supine at birth (horizontal/supine), 2) horizontal and upright during second stage and supine at birth (various/supine), 3) sitting at birth regardless of the position in second stage. Logistic regression analysis was used to adjust for known risk factors for perineal damage. FINDINGS women in sitting position at birth compared to those in the horizontal/supine group had a lower episiotomy rate (adjusted OR 0.28;95%-CI 0.14-0.56) and a non-significant higher intact perineum rate (adjusted OR 1.40, 95% CI 0.96-2.04). Women in the various/supine group compared to the horizontal/supine group had a similar episiotomy rate (adjusted OR 1.12;95%-CI 0.69-1.83). CONCLUSIONS we did not confirm our hypothesis that more women in supine compared to sitting position have an episiotomy because women in upright position are asked to lie down if an episiotomy is necessary.
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Affiliation(s)
- Willemijn D B Warmink-Perdijk
- Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands; Academic Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands
| | - Joke M Koelewijn
- Academic Medical Center, University of Amsterdam, Department of Obstetrics and Gynaecology, Amsterdam, The Netherlands; University Medical Center Groningen, Department of General Practice, A. Deusinglaan 1, 9713 CX Groningen, The Netherlands; Sanquin Research, Department of Experimental Immunohematology, The Netherlands.
| | - Ank de Jonge
- Midwifery Science, AVAG and the EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Mariet Th van Diem
- University Medical Center Groningen, Department of Obstetrics and Gynaecology, Groningen, The Netherlands
| | - Antoine L M Lagro-Janssen
- University Medical Center St Radboud, Department of General Practice, Women Studies Medicine, Nijmegen, The Netherlands
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Dahlen HG, Priddis H, Thornton C. Severe perineal trauma is rising, but let us not overreact. Midwifery 2015; 31:1-8. [DOI: 10.1016/j.midw.2014.09.004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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[Analysis of potential for research on giving birth in an upright position in German hospitals]. ZEITSCHRIFT FUR EVIDENZ FORTBILDUNG UND QUALITAET IM GESUNDHEITSWESEN 2014; 108 Suppl 1:S20-8. [PMID: 25458395 DOI: 10.1016/j.zefq.2014.09.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 09/04/2014] [Accepted: 09/04/2014] [Indexed: 11/21/2022]
Abstract
HEALTH PROBLEM In German hospitals, three quarters of all low-risk pregnant women give birth in the supine position, despite the fact that German, British and WHO guidelines do not recommend a supine birthing position which is associated with a higher risk to the health of both mother and fetus. CORPUS OF EVIDENCE Based on 22 RCTs with 7,280 participants, a systematic Cochrane review (Gupta et al., 2012) revealed that an upright position - compared with a supine or lithotomy position - (1) has a positive impact on fetal heart rate patterns, (2) reduces the requirement for analgesic or anaesthetic medications in the second stage of labour, and (3) results in fewer episiotomies and (4) fewer instrumental deliveries. There is a lack of evidence regarding perceived maternal autonomy, self-efficacy and anxiety when giving birth. Furthermore, evidence on long-term effects is absent. Some studies indicate that the choice of an upright birthing position might be boosted by a supporting physical and social environment and by specially trained midwives. IMPLICATION FOR RESEARCH There is a need for a feasibility study and a subsequent cluster RCT in the German healthcare context in order to investigate the effects of the upright posture for birthing on perceived maternal autonomy, self-efficacy and anxiety, on the reduction of perinatal complications and on long-term complaints. The complex experimental intervention consists of (1) evidence-based and user-friendly information for women and their partners, (2) facilitating the choice for an upright labour position by special training for midwives and (3) providing a supportive physical and social environment. Within the first study phase, the exploration of feasibility in terms of access to the target group and acceptance of the intervention by pregnant women, their partners and midwives is recommended. Thereby, the implementation of guidelines for upright labour and birth, the documentation and collection of outcome and cost data could be evaluated. Non-German instruments for measuring benefits, harms and long-term effects could be adapted to and validated for the German context.
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Women's choice of positions during labour: return to the past or a modern way to give birth? A cohort study in Italy. BIOMED RESEARCH INTERNATIONAL 2014; 2014:638093. [PMID: 24955365 PMCID: PMC4052104 DOI: 10.1155/2014/638093] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2014] [Revised: 04/03/2014] [Accepted: 04/29/2014] [Indexed: 11/18/2022]
Abstract
Background. Childbirth medicalization has reduced the parturient's opportunity to labour and deliver in a spontaneous position, constricting her to assume the recumbent one. The aim of the study was to compare recumbent and alternative positions in terms of labour process, type of delivery, neonatal wellbeing, and intrapartum fetal head rotation. Methods. We conducted an observational cohort study on women at pregnancy term. Primiparous women with physiological pregnancies and single cephalic fetuses were eligible for the study. We considered data about maternal-general characteristics, labour process, type of delivery, and neonatal wellbeing at birth. Patients were divided into two groups: Group-A if they spent more than 50% of labour in a recumbent position and Group-B when in alternative ones. Results. 225 women were recruited (69 in Group-A and 156 in Group-B). We found significant differences between the groups in terms of labour length, Numeric Rating Scale score and analgesia request rate, type of delivery, need of episiotomy, and fetal occiput rotation. No differences were found in terms of neonatal outcomes. Conclusion. Alternative maternal positioning may positively influence labour process reducing maternal pain, operative vaginal delivery, caesarean section, and episiotomy rate. Women should be encouraged to move and deliver in the most comfortable position.
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Nieuwenhuijze MJ, Low LK, Korstjens I, Lagro-Janssen T. The role of maternity care providers in promoting shared decision making regarding birthing positions during the second stage of labor. J Midwifery Womens Health 2014; 59:277-85. [PMID: 24800933 PMCID: PMC4064714 DOI: 10.1111/jmwh.12187] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Through the use of a variety of birthing positions during the second stage of labor, a woman can increase progress, improve outcomes, and have a positive birth experience. The role that a maternity care provider has in determining which position a woman uses during the second stage of labor has not been thoroughly explored. The purpose of this qualitative investigation was to explore how maternity care providers communicate with women during the second stage of labor regarding birthing position. METHODS A literature-informed framework was developed to conduct a process of deductive content analysis of communication patterns between nulliparous women and their maternity care providers during the second stage of labor. Literature discussing shared decision making, control, and predictors of positive birth experiences were reviewed to develop a coding framework. The framework included the following categories: listening to women, encouragement, information, offering choices, and style of support. Forty-one audiotapes of women and their maternity care providers during the second stage of labor were transcribed verbatim and analyzed. RESULTS Themes identified in the transcripts included all those in the analytic framework, plus 2 added categories of communication: empathy and interaction. Maternity care providers in this study enabled women to select various birthing positions using a dynamic process that moved between open, informative approaches and more closed, directive approaches, depending on the woman's needs and clinical condition. As clinical conditions unfolded, women became more actively involved in shared decision making regarding birthing positions, and maternity care providers found the right balance between being responsive to the woman's questions or directives. DISCUSSION Enabling shared decision making during birth is not a linear process using a single approach; it is dynamic process that requires a variety of approaches. Maternity care providers can support a woman to use different birthing positions during the second stage of labor by employing a flexible style that incorporates clinical assessment and the woman's responses.
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Gabrielloni MC, Armellini CJ, Barbieri M, Schirmer J. Análise da hemorragia no parto vaginal pelos índices de eritrócitos e hematócrito. ACTA PAUL ENFERM 2014. [DOI: 10.1590/1982-0194201400032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objetivo: Analisar a hemorragia no parto vaginal através dos índices de eritrócitos e hematócrito. Métodos: Estudo transversal realizado em 328 partos vaginais divididos em: espontâneo, com e sem episiotomia, e parto fórceps. A amostragem foi aleatória estratificada por tipo de parto vaginal. Os dados foram coletados na internação para o parto, na alta hospitalar e no retorno puerperal. Resultados: Foram estudados 122 (37,2%) partos sem episiotomia, 147 (44,8%) com episiotomia e 59 (18,0%) com uso de fórceps e episiotomia. O valor individual de hemoglobina, entre a internação para o parto e a alta hospitalar variou de -5,9 g/dl a 0,7 g/dl.A redução da hemoglobina foi significativamente maior no parto fórceps comparado aos partos espontâneos, com e sem episiotomia, p=0,0133 e p<0,0001, respectivamente. No parto fórceps a hemorragia é maior quando comparada aos outros tipos de parto. Conclusão: A análise da hemorragia no parto vaginal através dos índices de eritrócitos e hematócrito evidenciou que há variação nos três tipos de parto vaginal estudados, sendo a hemorragia maior no parto fórceps e menor no parto vaginal espontâneo. No puerpério, nos casos de partos fórceps estes índices mantiveram-se inferiores aos da internação.
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Dahlen HG, Dowling H, Tracy M, Schmied V, Tracy S. Maternal and perinatal outcomes amongst low risk women giving birth in water compared to six birth positions on land. A descriptive cross sectional study in a birth centre over 12 years. Midwifery 2013; 29:759-64. [DOI: 10.1016/j.midw.2012.07.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2011] [Revised: 07/04/2012] [Accepted: 07/08/2012] [Indexed: 10/28/2022]
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Thies-Lagergren L, Kvist LJ, Christensson K, Hildingsson I. Striving for scientific stringency: a re-analysis of a randomised controlled trial considering first-time mothers' obstetric outcomes in relation to birth position. BMC Pregnancy Childbirth 2012; 12:135. [PMID: 23173988 PMCID: PMC3542096 DOI: 10.1186/1471-2393-12-135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 11/20/2012] [Indexed: 11/30/2022] Open
Abstract
Background The aim of this study was to compare maternal labour and birth outcomes between women who gave birth on a birth seat or in any other position for vaginal birth and further, to study the relationship between synthetic oxytocin augmentation and maternal blood loss, in a stratified sample. Methods A re-analysis of a randomized controlled trial in Sweden. An on-treatment analysis was used to study obstetrical outcomes for nulliparous women who gave birth on a birth seat (birth seat group) compared to birth in any other position for vaginal birth (control group). Data were collected between November 2006 and July 2009. The outcome measurements included perineal outcome, post partum blood loss, epidural analgesia, synthetic oxytocin augmentation and duration of labour. Results The major findings of this paper were that women giving birth on the birth seat had shorter duration of labour and were significantly less likely to receive synthetic oxytocin for augmentation in the second stage of labour. Significantly more women had an increased blood loss when giving birth on the birth seat, but had no difference in perineal outcomes. Blood loss was increased regardless of birth position if women had been exposed to synthetic oxytocin augmentation during the first stage of labour. Conclusions The results of this analysis imply that women with a straightforward birth process may well benefit from giving birth on a birth seat without risk for any adverse obstetrical outcomes. However it is important to bear in mind that, women who received synthetic oxytocin during the first stage of labour may have an increased risk for greater blood loss when giving birth on a birth seat. Finally it is of vital importance to scrutinize the influence of synthetic oxytocin administered during the first stage of labour on blood loss postpartum, since excessive blood loss is a well-documented cause of maternal mortality worldwide and may cause severe maternal morbidity in high-income countries. Trial registration Unique Protocol ID: NCT01182038 (
http://register.clinicaltrials.gov)
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Affiliation(s)
- Li Thies-Lagergren
- Department of Women’s and Children’s Health, Division of Reproductive Health, Karolinska Institutet, Stockholm SE-171 76, Sweden
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Park SH, Hwang J, Choi YK, Kang CB. Effect of Postpartum Outcomes in Mother's Upright Position During the Second Stage of Labor: Systematic Review. KOREAN JOURNAL OF WOMEN HEALTH NURSING 2012; 18:209-222. [PMID: 37697513 DOI: 10.4069/kjwhn.2012.18.3.209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023] Open
Abstract
PURPOSE The purpose of this study was to determine whether upright position is effective in labor through systematic review in randomized controlled trials. METHODS We established the PICO (Patient-Intervention-Comparator-Outcome) strategy, and reviewed 282 literatures from national and international electronic databases, and finally selected 9 references based on inclusion and exclusion criteria. We evaluated the quality of references and carried out a meta-analysis. RESULTS The maternal outcomes showed that the duration of their second-stage labor was 2.29 minutes shorter than that of the women in the recumbent position, and were less likely to have episiotomy. The other outcomes, including the mode of delivery, blood loss, hemoglobin level, use of oxytocin, use of analgesics, and perineal laceration, did not differ between the groups. The fetal heart rate abnormality occurred less than in the control group. The Apgar scores of the groups did not differ. CONCLUSION There is evidence that an upright position in the second stage of labor reduces the duration of the second stage of labor, the incidence of episiotomy, and an abnormal fetal heart rate.
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Affiliation(s)
- Seong Hi Park
- School of Nursing, Hanzhong University, Donghae, Korea
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Nieuwenhuijze M, de Jonge A, Korstjens I, Lagro-Jansse T. Factors influencing the fulfillment of women's preferences for birthing positions during second stage of labor. J Psychosom Obstet Gynaecol 2012; 33:25-31. [PMID: 22211960 DOI: 10.3109/0167482x.2011.642428] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Having choices and being involved in decision making contributes to women's positive childbirth experiences. During a physiological birth, women's preferences can play a leading role in the choice of birthing positions. In this study, we explored women's preferences with regard to birthing positions during second stage of labor, with a special focus on women who preferred positions other than common supine positions. A questionnaire survey was conducted among women in 54 Dutch midwifery practices. Of the 1154 women in the study, 58.9% preferred supine positions, 19.6% preferred other positions (e.g. sitting or standing), and 21.5% had no distinct preference. Women who preferred supine positions gave birth in these positions more often than women with preferences for other positions. Among the women having a preference for other positions, the actual fulfillment of their preference was related to longer duration of second stage of labor, higher levels of education, the strength of the preference, and giving birth at home. These results demonstrate differences in women's use of preferred positions during childbirth. Midwives can contribute to women-centered care by proactively exploring women's preferences for birthing positions throughout pregnancy and birth, supporting women in developing well-informed choices and facilitating these choices where possible.
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Affiliation(s)
- Marianne Nieuwenhuijze
- Midwifery Science Research Department, Zuyd University, Faculty of Midwifery Education & Studies, Maastricht, the Netherlands.
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Suzuki S. Obstetric outcomes of low-risk labors at 'Japanese tatami' mat delivery room: a preliminary study. J Perinat Med 2010; 37:709-11. [PMID: 19591552 DOI: 10.1515/jpm.2009.102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We examined the obstetric outcomes of low-risk labors at the 'Japanese tatami' mat compared with Western-style delivery room. METHODS A retrospective cohort study was performed on 201 deliveries at the 'Japanese tatami' delivery room and 360 deliveries at the standard Western-style delivery room. RESULTS There were no measurable differences in the duration of labor, the incidence of perineal laceration, total maternal blood loss and the incidence of low Apgar score and umbilical artery pH between the two groups. CONCLUSIONS We found no evidence that the Japanese room is unsafe for low-risk infants and mothers in comparison with the standard Western-style delivery room.
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Affiliation(s)
- Shunji Suzuki
- Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan.
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de Jonge A, Teunissen DAM, van Diem MT, Scheepers PLH, Lagro-Janssen ALM. Women's positions during the second stage of labour: views of primary care midwives. J Adv Nurs 2008; 63:347-56. [PMID: 18727762 DOI: 10.1111/j.1365-2648.2008.04703.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM This paper is a report of a study to explore the views of midwives on women's positions during the second stage of labour. BACKGROUND Many authors recommend encouraging women to use positions that are most comfortable to them. Others advocate encouragement of non-supine positions, because offering 'choice' is not enough to reverse the strong cultural norm of giving birth in the supine position. Midwives' views on women's positions have rarely been explored. METHOD Six focus groups were conducted in 2006-2007 with a purposive sample of 31 midwives. The data were interpreted using Thachuk's models of informed consent and informed choice. FINDINGS The models were useful in distinguishing between two different approaches of midwives to women's positions during labour. When giving informed consent, midwives implicitly or explicitly ask a woman's consent for what they themselves prefer. When offering informed choice, a woman's preference is the starting point, but midwives will suggest other options if this is in the woman's interest. Obstetric factors and working conditions are reasons to deviate from women's preferences. CONCLUSIONS To give women an informed choice about birthing positions, midwives need to give them information during pregnancy and discuss their position preferences. Women should be prepared for the unpredictability of their feelings in labour and for obstetric factors that may interfere with their choice of position. Equipment for non-supine births should be more midwife-friendly. In addition, midwives and students need to be able to gain experience in assisting births in non-supine positions.
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Affiliation(s)
- Ank de Jonge
- Department of General Practice, Women Studies Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands.
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de Jonge A, Rijnders MEB, van Diem MT, Scheepers PLH, Lagro-Janssen ALM. Are there inequalities in choice of birthing position? Sociodemographic and labour factors associated with the supine position during the second stage of labour. Midwifery 2007; 25:439-48. [PMID: 18082298 DOI: 10.1016/j.midw.2007.07.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2007] [Revised: 06/22/2007] [Accepted: 07/30/2007] [Indexed: 11/16/2022]
Abstract
OBJECTIVE to establish which factors are associated with birthing positions throughout the second stage of labour and at the time of birth. DESIGN retrospective cohort study. SETTING primary care midwifery practices in the Netherlands. PARTICIPANTS 665 low-risk women who received midwife-led care. MEASUREMENTS AND FINDINGS a postal questionnaire was sent to women 3-4 years after birth. The number of women who remained in the supine position throughout the second stage varied between midwifery practices, ranging from 31.3% to 95.9% (p<0.001). The majority of women pushed and gave birth in the supine position. For positions used throughout the second stage of labour, a stepwise forward logistic regression analysis was used to examine effects controlled for other factors. Women aged 36 years and highly educated women were less likely to use the supine pushing position alone [odds ratio (OR) 0.54, 95% confidence intervals (CI) 0.31-0.94; OR 0.40, 95% CI 0.21-0.73, respectively]. Women who pushed for longer than 60 minutes and who were referred during the second stage of labour were also less likely to use the supine position alone (OR 0.32, 95% CI 0.16-0.64; OR 0.44, 95% CI 0.23-0.86, respectively). Bivariate analyses were conducted for effects on position at the time of birth. Age 36 years, higher education and homebirth were associated with giving birth in a non-supine position. KEY CONCLUSIONS the finding that highly educated and older women were more likely to use non-supine birthing positions suggests inequalities in position choice. Although the Dutch maternity care system empowers women to choose their own place of birth, many may not be encouraged to make choices in birthing positions. IMPLICATIONS FOR PRACTICE education of women, midwives, obstetricians and perhaps the public in general is necessary to make alternatives to the supine position a logical option for all women. Future studies need to establish midwife, clinical and other factors that have an effect on women's choice of birthing positions, and identify strategies that empower women to make their own choices.
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Affiliation(s)
- Ank de Jonge
- Department of General Practice, Women Studies Medicine, University Medical Centre St Radboud, Nijmegen, The Netherlands.
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De Jonge A, Lagro-Janssen ALM. Increased blood loss in upright positions originates from perineal damage. BJOG 2007; 114:1446-7; author reply 1447. [DOI: 10.1111/j.1471-0528.2007.01500.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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