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Yao J, Roth H, Anderson D, Lu H, Rong H, Baird K. Comparison of Spontaneous Pushing and Directed Pushing During the Second Stage of Labor Among Chinese Women Without Epidural Analgesia: Protocol for a Noninferior Feasibility Study. JMIR Res Protoc 2024; 13:e55701. [PMID: 38530330 PMCID: PMC11005428 DOI: 10.2196/55701] [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: 12/20/2023] [Revised: 02/18/2024] [Accepted: 02/26/2024] [Indexed: 03/27/2024] Open
Abstract
BACKGROUND Maternal pushing during the second stage of labor could influence labor progress and maternal-neonatal outcomes. Although the image of health care providers directing the laboring women to push during the second stage of labor could be commonly observed globally, this practice is not sufficiently researched and is questioned regarding its effectiveness and outcomes on the mother and baby. Meanwhile, a strategy referred to as "spontaneous pushing," which supports women to push by following their bodily urges, has been evaluated in several trials. However, in China, spontaneous pushing is not common practice. Notwithstanding the evaluation of spontaneous pushing, there is a lack of high-quality evidence to support either strategies of directed pushing or spontaneous pushing. OBJECTIVE This study aims to test the feasibility of a future randomized controlled trial to compare the effects of spontaneous pushing and directed pushing during the second stage of labor for maternal and neonatal outcomes in China. METHODS A nonrandomized, single-group, noninferiority feasibility study will be conducted in a public hospital in Hebei Province, China. In total, 105 women meeting the selection criteria will be recruited to receive the intervention (spontaneous pushing), while 105 sets of medical notes from women who received routine care (directed pushing) will be identified and reviewed to compare outcomes for both cohorts. A mixed methods approach will be used to assess primary outcomes (feasibility and acceptability) and secondary outcomes (effectiveness). RESULTS Data collection took place between May and October 2023. A total of 110 women were invited to participate in the intervention of spontaneous pushing. Midwives' interviews were conducted and will be transcribed for analysis in March 2024. The data analysis is planned to be completed by May 2024. CONCLUSIONS This feasibility study will provide important information by conducting a full-scale clinical trial in the future as well as the potential facilitators and barriers of it. A future randomized controlled trial is likely to have considerable policy and funding impacts regarding pushing management during the second stage of labor and improvement in women's childbirth experience. TRIAL REGISTRATION Chinese Clinical Trial Register ChiCTR2300071178; https://tinyurl.com/mudtnbft. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/55701.
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Affiliation(s)
- Jiasi Yao
- School of Nursing, Hebei Medical University, Shijiazhuang, China
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Heike Roth
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Collective for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Debra Anderson
- Faculty of Health, University of Technology Sydney, Sydney, Australia
| | - Hong Lu
- School of Nursing, Peking University, Beijing, China
| | - Huijuan Rong
- Department of Nursing, The Fourth Hospital of Shijiazhuang, Shijiazhuang, China
| | - Kathleen Baird
- School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
- Collective for Midwifery, Child and Family Health, School of Nursing and Midwifery, Faculty of Health, University of Technology Sydney, Sydney, Australia
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Haseli A, Khosravi S, Hajimirzaie SS, Feli R, Rasoal D. Midwifery students' experiences: Violations of dignity during childbirth. Nurs Ethics 2024; 31:296-310. [PMID: 37650382 PMCID: PMC11181724 DOI: 10.1177/09697330231197703] [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] [Indexed: 09/01/2023]
Abstract
BACKGROUND The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. RESEARCH OBJECTIVES The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. RESEARCH DESIGN This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. RESULTS Four key themes described the threats to women's dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. CONCLUSION The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth.
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Affiliation(s)
| | | | | | | | - Dara Rasoal
- School of Health and Welfare, Dalarna University, Sweden
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Shorey S, Ng ED. Midwives' perceptions of and experiences with normal physiologic birth: A qualitative systematic review. Birth 2023; 50:749-763. [PMID: 37712184 DOI: 10.1111/birt.12763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 03/06/2023] [Accepted: 08/01/2023] [Indexed: 09/16/2023]
Abstract
BACKGROUND Normal physiologic birth has been shown to result in optimal maternal-infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised. OBJECTIVE In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births. METHODS Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home-based, community-based, and hospital-based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically. RESULTS Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self-confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person-centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision-making. The midwife-client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth. CONCLUSIONS This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth.
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Affiliation(s)
- Shefaly Shorey
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Esperanza Debby Ng
- Alice Lee Center for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
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Erickson EN. A prolonged latent phase: An early career in oxytocin during birth. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2023; 15:100190. [PMID: 37405229 PMCID: PMC10316000 DOI: 10.1016/j.cpnec.2023.100190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
•The author, a nurse-midwife scientist, shares her path to the study of the causes and consequences of clinical oxytocin use.•This paper highlights mentors and key research that informed new thinking about the role of oxytocin during parturition.•Future directions for improving maternal care during childbirth are presented, including genetic and epigenetic perspectives.
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Tadokoro Y, Takahata K, Shuo T, Shinohara K, Horiuchi S. Changes in Salivary Oxytocin Level of Term Pregnant Women after Aromatherapy Footbath for Spontaneous Labor Onset: A Non-Randomized Experimental Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6262. [PMID: 37444109 PMCID: PMC10341564 DOI: 10.3390/ijerph20136262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/09/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND Aromatherapy is usually used to stimulate labor. However, its specific physiological effects have been scarcely examined. We evaluated whether an aromatherapy footbath increases oxytocin levels in term pregnant women. METHODS In this quasi-experimental study, low-risk term pregnant women in Japan underwent aromatherapy using a footbath (1) infused with clary sage and lavender essential oils, (2) infused with jasmine oil, or (3) with no infused oils (control group). The primary outcome was the salivary oxytocin level. The secondary outcomes were uterine contractions and cortisol levels. RESULTS In the clary sage and lavender group (n = 28), the oxytocin level increased significantly after the footbath (p = 0.035). The jasmine group (n = 27) and control group (n = 27) exhibited trends toward a respective increase and decrease in the oxytocin level; however, the changes in the oxytocin levels between the clary sage and lavender group and the control group showed no significance difference. There were no significant differences in the changes in the uterine contractions and cortisol levels between the experiment and control groups. CONCLUSIONS The changes in the oxytocin levels in the clary sage and lavender group did not differ significantly with those in the control group, possibly because of the small sample size. Further studies are required to examine the effects of repeated aromatherapy footbaths to stimulate labor.
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Affiliation(s)
- Yuriko Tadokoro
- Chiba Faculty of Nursing, Tokyo Healthcare University, Funabashi 273-8710, Japan
| | - Kaori Takahata
- School of Nursing, Shonan Kamakura University of Medical Sciences, Kamakura 247-0066, Japan;
| | - Takuya Shuo
- Faculty of Health and Medical Sciences, Hokuriku University, Kanazawa 920-1180, Japan;
| | - Kazuyuki Shinohara
- Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki 852-8523, Japan;
| | - Shigeko Horiuchi
- Women’s Health and Midwifery, School of Nursing Science, St. Luke’s International University, Tokyo 104-0044, Japan;
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Masters RK, Tilstra AM, Coleman-Minahan K. Increases in Obstetric Interventions and Changes in Gestational Age Distributions of U.S. Births. J Womens Health (Larchmt) 2023; 32:641-651. [PMID: 36897311 PMCID: PMC10277997 DOI: 10.1089/jwh.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/11/2023] Open
Abstract
Objective: To examine how changes in induction of labor (IOL) and cesarean deliveries between 1990 and 2017 affected gestational age distributions of births in the United States. Materials and Methods: Singleton first births were drawn from the National Vital Statistics System Birth Data for years 1990-2017. Separate analytic samples were created (1) by maternal race/ethnicity (Hispanic, non-Hispanic Black, non-Hispanic Asian, and non-Hispanic white), (2) by maternal age (15-19, 20-24, 25-29, 30-34, 35-39, 40-49), (3) by U.S. states, and (4) for women at low risk for obstetric interventions (e.g., age 20-34, no hypertension, no diabetes, no tobacco use). Gestational age was measured in weeks, and obstetric intervention status was measured as: (1) no IOL, vaginal delivery; (2) no IOL, cesarean delivery; and (3) IOL, all deliveries. The joint probabilities of birth at each gestational week by obstetric intervention status for years 1990-1991, 1998-1999, 2007-2008, and 2016-2017 were estimated. Results: Between 1990 and 2017, the percent of singleton first births occurring between 37 and 39 weeks of gestation increased from 38.5% to 49.5%. The changes were driven by increases in IOL and a shift in the use of cesarean deliveries toward earlier gestations. The changes were observed among all racial/ethnic groups and all maternal ages, and across all U.S. states. The same changes were also observed among U.S. women at low risk for interventions. Conclusion: Changes in gestational age distributions of U.S. births and their underlying causes are likely national-level phenomena and do not appear to be responding to increases in maternal risk for interventions.
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Affiliation(s)
- Ryan K. Masters
- Department of Sociology, University of Colorado Boulder, Boulder, Colorado, USA
- University of Colorado Population Center, University of Colorado Boulder, Boulder, Colorado, USA
| | - Andrea M. Tilstra
- University of Colorado Population Center, University of Colorado Boulder, Boulder, Colorado, USA
- Department of Sociology, Nuffield College, University of Oxford, Oxford, United Kingdom
- Leverhulme Centre for Demographic Science, University of Oxford, Oxford, United Kingdom
| | - Kate Coleman-Minahan
- University of Colorado Population Center, University of Colorado Boulder, Boulder, Colorado, USA
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
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Combellick JL, Telfer ML, Ibrahim BB, Novick G, Morelli EM, James-Conterelli S, Kennedy HP. Midwifery care during labor and birth in the United States. Am J Obstet Gynecol 2023; 228:S983-S993. [PMID: 37164503 DOI: 10.1016/j.ajog.2022.09.044] [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: 07/21/2022] [Revised: 09/30/2022] [Accepted: 09/30/2022] [Indexed: 05/12/2023]
Abstract
The intrapartum period is a crucial time in the continuum of pregnancy and parenting. Events during this time are shaped by individuals' unique sociocultural and health characteristics and by their healthcare providers, practice protocols, and the physical environment in which care is delivered. Childbearing people in the United States have less opportunity for midwifery care than in other high-income countries. In the United States, there are 4 midwives for every 1000 live births, whereas, in most other high-income countries, there are between 30 and 70 midwives. Furthermore, these countries have lower maternal and neonatal mortality rates and have consistently lower costs of care. National and international evidences consistently report that births attended by midwives have fewer interventions, cesarean deliveries, preterm births, inductions of labor, and more vaginal births after cesarean delivery. In addition, midwifery care is consistently associated with respectful care and high patient satisfaction. Midwife-physician collaboration exists along a continuum, including births attended independently by midwives, births managed in consultation with a physician, and births attended primarily by a physician with a midwife acting as consultant on the normal aspects of care. This expert review defined midwifery care and provided an overview of midwifery in the United States with an emphasis on the intrapartum setting. Health outcomes associated with midwifery care, specific models of intrapartum care, and workforce issues have been presented within national and international contexts. Recommendations that align with the integration of midwifery have been suggested to improve national outcomes and reduce pregnancy-related disparities.
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Affiliation(s)
| | | | | | - Gina Novick
- Yale University School of Nursing, Orange, CT
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Oxytocin receptor DNA methylation is associated with exogenous oxytocin needs during parturition and postpartum hemorrhage. COMMUNICATIONS MEDICINE 2023; 3:11. [PMID: 36707542 PMCID: PMC9882749 DOI: 10.1038/s43856-023-00244-6] [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] [Received: 03/28/2022] [Accepted: 01/12/2023] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND The oxytocin receptor gene (OXTR) is regulated, in part, by DNA methylation. This mechanism has implications for uterine contractility during labor and for prevention or treatment of postpartum hemorrhage, an important contributor to global maternal morbidity and mortality. METHODS We measured and compared the level of OXTR DNA methylation between matched blood and uterine myometrium to evaluate blood as an indicator of uterine methylation status using targeted pyrosequencing and sites from the Illumina EPIC Array. Next, we tested for OXTR DNA methylation differences in blood between individuals who experienced a postpartum hemorrhage arising from uterine atony and matched controls following vaginal birth. Bivariate statistical tests, generalized linear modeling and Poisson regression were used in the analyses. RESULTS Here we show a significant positive correlation between blood and uterine DNA methylation levels at several OXTR loci. Females with higher OXTR DNA methylation in blood had required significantly more exogenous oxytocin during parturition. With higher DNA methylation, those who had oxytocin administered during labor had significantly greater relative risk for postpartum hemorrhage (IRR 2.95, 95% CI 1.53-5.71). CONCLUSIONS We provide evidence that epigenetic variability in OXTR is associated with the amount of oxytocin administered during parturition and moderates subsequent postpartum hemorrhage. Methylation can be measured using a peripheral tissue, suggesting potential use in identifying individuals susceptible to postpartum hemorrhage. Future studies are needed to quantify myometrial gene expression in connection with OXTR methylation.
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Kroll C, Murphy J, Poston L, You W, Premkumar A. Cultivating the ideal obstetrical patient: How physicians-in-training describe pain associated with childbirth. Soc Sci Med 2022; 312:115365. [PMID: 36155358 DOI: 10.1016/j.socscimed.2022.115365] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 09/05/2022] [Accepted: 09/06/2022] [Indexed: 10/31/2022]
Abstract
We explore the work labor pain does in cultivating obstetrics and gynecology (OB/GYN) resident physicians' conceptualization of the "ideal" obstetrical patient - replete with moral, pharmacological, classed, and racialized dimensions. Our data is derived from a single-site, qualitative study conducted at an urban academic OB/GYN residency program in the midwestern U.S. between 2018 and 2019. 36 residents, 9 from each post-graduate year, were randomly selected to complete a semi-structured interview on their perceptions of patient pain surrounding OB/GYN procedures. Grounded theory analysis of the OB/GYN residents' interviews revealed the idealized obstetrical patient is quiet and easily controlled. Residents praised women whom they believed were suppressing their labor pain, a racialized and classed concept that furthers misconceptions about the "obstetric hardiness" of Black women and the hypersensitivity of wealthy White women. Participants' conceptions of "bad" patients included those with less cultural health capital due to low health literacy and socioeconomic status, which impeded the patients' ability to participate in shared decision-making. Despite acknowledging the importance of patient autonomy regarding pain control during labor, the interviewed residents positioned themselves as the ultimate authority. Their subjective assessment of patients' pain inherently invoked their personal biases, such as conflating low socioeconomic status and race. Some participants posited an inverse relationship between hardship and pain, while others questioned whether those with low health literacy exaggerate their pain due to fear of the clinical encounter or to secure medical attention. Both framings have concerning implications for inadequate pain control and the unintentional perpetuation of obstetric violence and obstetric racism within the profession.
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Affiliation(s)
- Camille Kroll
- Center for Bioethics and Medical Humanities at Northwestern University, 420 E Superior St, Suite 628, Chicago, IL, 60611, USA.
| | - Julia Murphy
- Feinberg School of Medicine at Northwestern University, 420 E Superior St, Chicago, IL, 60611, USA
| | - Lindsay Poston
- Department of Obstetrics and Gynecology, Feinberg School of Medicine at Northwestern University, 250 E Superior St, Suite 03-2303, Chicago, IL, 60611, USA
| | - Whitney You
- Department of Obstetrics and Gynecology, Feinberg School of Medicine at Northwestern University, 250 E Superior St, Suite 03-2303, Chicago, IL, 60611, USA
| | - Ashish Premkumar
- Department of Obstetrics and Gynecology, Feinberg School of Medicine at Northwestern University, 250 E Superior St, Suite 03-2303, Chicago, IL, 60611, USA
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Mbwali I, Mbalinda SN, Kaye DK, Ngabirano TD. Factors associated with low childbirth self-efficacy for normal birth among women attending an urban prenatal clinic in Eastern Uganda. Midwifery 2022; 111:103358. [PMID: 35594804 DOI: 10.1016/j.midw.2022.103358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 02/18/2022] [Accepted: 04/29/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE While childbirth self-efficacy is a very important feature for normal birth, this concept has received limited scholarly attention, particularly in developing countries. This study explored childbirth self-efficacy and the associated factors amongst pregnant women. DESIGN A descriptive cross-sectional study. We used the Childbirth Self-Efficacy Inventory to assess childbirth self-efficacy for normal birth. and determined the associated factors. SETTING Jinja regional referral hospital, Uganda. PARTICIPANTS 425 pregnant women at ≥ 28 weeks of gestation were included. MEASUREMENTS Participants with summated self-efficacy scores ≥ median were considered to have high childbirth self-efficacy, and those with less than the median summated score were considered to have low childbirth self-efficacy. Bivariate and multivariate binary logistic regressions were used to determine the factors associated with low childbirth self-efficacy. FINDINGS The Childbirth Self-Efficacy Inventory items consistently measured childbirth self-efficacy with a Cronbach's α 0.934. Childbirth self-efficacy scores ranged from 84 to 303 with a median score of 233 and a mean score of 228.7 (SD: 40.9). Dissatisfaction with prenatal care (aOR = 2.687; 95% CI: 1.124-6.427; P = 0.026), perception of community social support for women during childbirth as lacking (aOR = 2.274; 95% CI: 1.159-4.458; P = 0.017) and use and/or intention to use herbal medicines in the current pregnancy (aOR = 2.850; 95% CI: 1.553-5.232; P = 0.001) were associated with low childbirth self-efficacy for normal birth. CONCLUSION AND IMPLICATIONS FOR PRACTICE Low childbirth self-efficacy for normal birth was associated with dissatisfaction with prenatal care, lack of community social support for women during childbirth and use or intention to use herbal medicines in the current pregnancy. Identifying the associated characteristics and developing interventions for low childbirth self-efficacy is of clinical importance to promote normal birth.
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Grant AD, Erickson EN. Birth, love, and fear: Physiological networks from pregnancy to parenthood. COMPREHENSIVE PSYCHONEUROENDOCRINOLOGY 2022; 11:100138. [PMID: 35757173 PMCID: PMC9227990 DOI: 10.1016/j.cpnec.2022.100138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 04/21/2022] [Accepted: 04/21/2022] [Indexed: 12/01/2022] Open
Abstract
Pregnancy and childbirth are among the most dramatic physiological and emotional transformations of a lifetime. Despite their central importance to human survival, many gaps remain in our understanding of the temporal progression of and mechanisms underlying the transition to new parenthood. The goal of this paper is to outline the physiological and emotional development of the maternal-infant dyad from late pregnancy to the postpartum period, and to provide a framework to investigate this development using non-invasive timeseries. We focus on the interaction among neuroendocrine, emotional, and autonomic outputs in the context of late pregnancy, parturition, and post-partum. We then propose that coupled dynamics in these outputs can be leveraged to map both physiologic and pathologic pregnancy, parturition, and parenthood. This approach could address gaps in our knowledge and enable early detection or prediction of problems, with both personalized depth and broad population scale. Giving birth and caring for offspring are dynamic processes that can instill both love and fear. Maternal physiology continuously integrates fetal, social, and environmental cues. The result is coupled change in hormonal, autonomic nervous, and emotional output. Coupling may allow internal state to be assessed from peripheral autonomic markers. Such markers may identify healthy or pathologic pregnancy, parturition, and parenting, and enable creation of real-world tools.
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Erickson EN, Carlson NS. Maternal Morbidity Predicted by an Intersectional Social Determinants of Health Phenotype: A Secondary Analysis of the NuMoM2b Dataset. Reprod Sci 2022; 29:2013-2029. [PMID: 35312992 DOI: 10.1007/s43032-022-00913-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 03/05/2022] [Indexed: 12/24/2022]
Abstract
Maternal race, ethnicity and socio-economic position are known to be associated with increased risk for a range of poor pregnancy outcomes, including maternal morbidity and mortality. Previously, researchers seeking to identify the contributing factors focused on maternal behaviors and pregnancy complications. Less understood is the contribution of the social determinants of health (SDoH) in observed differences by race/ethnicity in these key outcomes. In this secondary analysis of the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-Be (nuMoM2b) dataset, latent mixture modeling was used to construct groups of healthy, nulliparous participants with a non-anomalous fetus in a cephalic presentation having a trial of labor (N = 5763) based on SDoH variables. The primary outcome was a composite score of postpartum maternal morbidity. A postpartum maternal morbidity event was experienced by 350 individuals (6.1%). Latent class analysis using SDoH variables revealed six groups of participants, with postpartum maternal morbidity rates ranging from 8.7% to 4.5% across groups (p < 0.001). Two SDoH groups had the highest odds for maternal morbidity. These higher-risk groups were comprised of participants with the lowest income and highest stress and those who had lived in the USA for the shortest periods of time. SDoH phenotype predicted MM outcomes and identified two important, yet distinct groups of pregnant people who were the most likely have a maternal morbidity event.
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Affiliation(s)
- Elise N Erickson
- Oregon Health & Sciences University School of Nursing, 3455 SW US Veterans Hospital Rd, Portland, OR, 97239, USA
| | - Nicole S Carlson
- Emory University Nell Hodgson Woodruff School of Nursing, Atlanta, GA, USA
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13
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Niemczyk NA, Ren D, Stapleton SR. Associations between prolonged second stage of labor and maternal and neonatal outcomes in freestanding birth centers: a retrospective analysis. BMC Pregnancy Childbirth 2022; 22:99. [PMID: 35120470 PMCID: PMC8815242 DOI: 10.1186/s12884-022-04421-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 01/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Current guidelines for second stage management do not provide guidance for community birth providers about when best to transfer women to hospital care for prolonged second stage. Our goal was to increase the evidence base for these providers by: 1) describing the lengths of second stage labor in freestanding birth centers, and 2) determining whether proportions of postpartum women and newborns experiencing complications change as length of second stage labor increases. METHODS This study is a retrospective analysis of de-identified client-level data collected in the American Association of Birth Centers Perinatal Data Registry, including women giving birth in freestanding birth centers January 1, 2007 to December 31, 2016. We plotted proportions of postpartum women and newborns transferred to hospital care against length of the second stage of labor, and assessed significance of these with the Cochran-Armitage test for trend or chi-square test. Secondary maternal and newborn outcomes were compared for dyads with normal and prolonged second stages of labor using Fisher's exact test. RESULTS Second stage labor exceeded 3 hours for 2.3% of primiparous women and 2 hours for 6.6% of multiparous women. Newborn transfers increased as second stage increased from < 15 minutes to > 2 hours (0.6% to 6.33%, p for trend = 0.0008, for primiparous women, and 1.4% to 10.6%, p for trend < 0.0001, for multiparous women.) Postpartum transfers for multiparous women increased from 1.4% after second stage < 15 minutes to greater than 4% for women after second stage exceeding 2 hours (p for trend < 0.0001.) CONCLUSIONS: Complications requiring hospitalization of postpartum women and newborns become more common as the length of the second stage increases. Birth center guidelines should consider not just presence of progress but also absolute length of time as indications for transfer.
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Affiliation(s)
- Nancy A Niemczyk
- Department of Health Promotion and Development, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA, 15261, USA.
| | - Dianxu Ren
- Center for Research and Evaluation, School of Nursing, University of Pittsburgh, 3500 Victoria Street, 440 Victoria Building, Pittsburgh, PA, 15261, USA
| | - Susan R Stapleton
- American Association of Birth Centers, 3123 Gottschall Road, Perkiomenville, PA, 18074, USA
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Lewis S, Zhao Z, Schorn M. Elective Induction of Labor or Expectant Management: Outcomes Among Nulliparous Women with Uncomplicated Pregnancies. J Midwifery Womens Health 2022; 67:170-177. [PMID: 35107213 DOI: 10.1111/jmwh.13313] [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: 04/29/2021] [Revised: 10/11/2021] [Accepted: 10/16/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Cesarean birth rates among women who are nulliparous with uncomplicated full-term pregnancies have been shown to decrease if labor is electively induced. The purpose of this study was to compare the cesarean birth rate for women with pregnancies at 39.0 weeks' gestation or later admitted for spontaneous labor or medically indicated induction of labor (IOL) with that of women receiving elective IOL at term. METHODS A retrospective cohort study was conducted by searching electronic health records of all nulliparous women with uncomplicated pregnancies who gave birth between January 2018 through February 2020 at one academic medical center. Select maternal demographic data and approach to labor management were the primary variables analyzed in determining the odds of cesarean birth. RESULTS A total of 1528 women were included in this study. Among these, 158 received elective IOL, and 1370 did not. The cesarean birth rates (31.0% vs 23.9%, elective induction of labor vs expectant management, respectively, P = .048), neonatal intensive care admissions (9.5% vs 7.6%, P = .41), and Apgar scores were similar among women in both management groups, respectively (P = .08). Accounting for other potential risk factors, the odds of having cesarean birth were not statistically different between management groups (adjusted odds ratio, 0.73; 95% CI, 0.5-1.1; P = .09). There were 2 fetal deaths among women whose labor was not electively induced. In the total cohort, women who were older, who had higher body mass index (BMI), and who identified as non-Hispanic Black had an increased odds of experiencing a cesarean birth. The associations between women in management groups and cesarean birth were not modified by age, BMI, race, or ethnicity (P = .33, .67, and .87, respectively). DISCUSSION Elective IOL was not associated with lower cesarean rates in this study. Further research is needed before implementing clinical practice changes that encourage more use of IOL.
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Affiliation(s)
- Susan Lewis
- Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mavis Schorn
- School of Nursing, Vanderbilt University, Nashville, Tennessee
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15
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Erickson EN, Bailey JM, Colo SD, Carlson NS, Tilden EL. Induction of labor or expectant management? Birth outcomes for nulliparous individuals choosing midwifery care. Birth 2021; 48:501-513. [PMID: 34047405 PMCID: PMC9123647 DOI: 10.1111/birt.12560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 05/11/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND Induction of labor (IOL) has been studied as a strategy to reduce rates of cesarean birth (CB). Midwifery care models are also associated with lower CB rates, even considering that midwives perform fewer IOLs. In this study, we examined childbirth outcomes among individuals undergoing IOL in certified nurse-midwifery (CNM) care as compared to two categories of expectant management (EM). METHODS Data were from two CNM practices in the United States (2007-2018). The sample was limited to term nulliparous, nondiabetic, singleton, vertex pregnancies. Individuals having an IOL in each week of gestation (37th, 38th, etc) were compared with those having EM. Two methods for defining EM were considered as each method when used alone limits interpretation. Inclusive EM included all births starting in the same week as IOL. The exclusive EM group was comprised of all births occurring in the next gestational age week relative to the IOL cases (ie, 39th week IOL versus all births occurring at 40 weeks or later). Adjusted regression models were used to examine differences in CB by IOL versus EM (inclusive or exclusive) at each week of gestation. RESULTS Among 4057 CNM-attended pregnancies, the overall rate of IOL was 28.9% (95% CI 27.5%-30.3%) and CB was 19.4% (95% CI 18.1%-20.6%). Most IOLs involved obstetric indications. CB rates did not differ by IOL versus inclusive EM when performed between 37 and 40 weeks, though post hoc power calculations indicate these comparisons were low-powered. In multivarable models, IOL in the 40th week was associated with lower odds for CB versus exclusive EM definition (ie, births occurring at 41 0/7 weeks or later, OR (95% CI) = 0.57 (0.36-0.90)). This finding is explained by the large increase in CB rates after IOL during the 41st week (34.3%, up from 21.9% in the 40th week). Furthermore, the adjusted odds for CB in the 41st week were 55% higher relative to inclusive EM (all labors 41st week and later), OR (95% CI) = 1.55(1.11-2.15). Neonatal outcomes (aside from macrosomia) did not differ by IOL/EM at any gestational age. DISCUSSION Outcomes for nulliparous individuals having IOL or EM in the context of a midwifery model of care include low overall use of CB and low frequency of IOL before 41 weeks. In this model, IOL in the 40th week may lower CB odds, especially in comparison to those who do not have spontaneous labor and later undergo an IOL in the 41st week.
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Affiliation(s)
- Elise N Erickson
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Joanne M Bailey
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Shanti D Colo
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Nicole S Carlson
- School of Nursing, Oregon Health & Science University, Portland, Oregon
| | - Ellen L Tilden
- School of Nursing, Oregon Health & Science University, Portland, Oregon
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16
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Hands KK, Davies CC, Brockopp D, Monroe M. The Effect of Hospital-Based Childbirth Classes on Birth Outcomes. J Perinat Educ 2021; 30:196-202. [PMID: 34908818 PMCID: PMC8663765 DOI: 10.1891/j-pe-d-20-00050] [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] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to examine the effect of a hospital-based childbirth preparation class on birth outcomes in nulliparous women (N = 222). Outcomes of expectant mothers who attended the class were compared to a matched control cohort who did not attend preparation classes. Findings revealed women in the intervention group were more likely to give birth vaginally. While trends in a positive direction occurred, no significant difference was found in the frequency of elective induction, preterm birth, or length of stay. Data were also analyzed pre COVID-19 pandemic and 14 weeks after. A shorter time between hospital arrival and birth was significant for the intervention group. In addition, a significant change in elective induction (increase) occurred in the control group.
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17
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Carlson N, Ellis J, Page K, Dunn Amore A, Phillippi J. Review of Evidence-Based Methods for Successful Labor Induction. J Midwifery Womens Health 2021; 66:459-469. [PMID: 33984171 PMCID: PMC8363560 DOI: 10.1111/jmwh.13238] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 03/20/2021] [Accepted: 03/24/2021] [Indexed: 11/30/2022]
Abstract
Induction of labor is increasingly a common component of the intrapartum care. Knowledge of the current evidence on methods of labor induction is an essential component of shared decision-making to determine which induction method meets an individual's health needs and personal preferences. This article provides a review of the current research evidence on labor induction methods, including cervical ripening techniques, and contraction stimulation techniques. Current evidence about expected duration of labor following induction, use of the Bishop score to guide induction, and guidance on the use of combination methods for labor induction are reviewed.
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Affiliation(s)
- Nicole Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Jessica Ellis
- College of Nursing, University of Utah, Salt Lake City, Utah
| | - Katie Page
- Centra Medical Group Women's Center, Forest, Virginia
| | - Alexis Dunn Amore
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| | - Julia Phillippi
- School of Nursing, Vanderbilt University, Nashville, Tennessee
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18
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Zang Y, Lu H, Zhang H, Huang J, Ren L, Li C. Effects of upright positions during the second stage of labour for women without epidural analgesia: A meta‐analysis. J Adv Nurs 2020; 76:3293-3306. [PMID: 33009847 DOI: 10.1111/jan.14587] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/12/2020] [Accepted: 08/27/2020] [Indexed: 01/09/2023]
Affiliation(s)
- Yu Zang
- School of Nursing Peking University Beijing 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
| | - Jing Huang
- School of Nursing Peking University Beijing China
| | - Lihua Ren
- School of Nursing Peking University Beijing China
| | - Chunying Li
- Health Science Library Peking University Beijing China
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19
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Romano A, Kennedy HP, Avery MD. Improving US Maternity Care: A 2020 Call to Action to Scale Up Midwifery. J Midwifery Womens Health 2020; 65:595-604. [PMID: 32979000 DOI: 10.1111/jmwh.13158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 06/29/2020] [Accepted: 07/05/2020] [Indexed: 11/28/2022]
Affiliation(s)
- Amy Romano
- Independent consultant, Milford, Connecticut
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20
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Schorn MN. Management Terminology During the Third Stage of Labor. J Midwifery Womens Health 2020; 65:301-305. [PMID: 32424873 DOI: 10.1111/jmwh.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 01/17/2020] [Accepted: 01/24/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Mavis N Schorn
- School of Nursing, Vanderbilt University, Nashville, Tennessee
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21
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Brady SS, Berry A, Camenga DR, Fitzgerald CM, Gahagan S, Hardacker CT, Harlow BL, Hebert-Beirne J, LaCoursiere DY, Lewis JB, Low LK, Lowder JL, Markland AD, McGwin G, Newman DK, Palmer MH, Shoham DA, Smith AL, Stapleton A, Williams BR, Sutcliffe S. Applying concepts of life course theory and life course epidemiology to the study of bladder health and lower urinary tract symptoms among girls and women. Neurourol Urodyn 2020; 39:1185-1202. [PMID: 32119156 PMCID: PMC7659467 DOI: 10.1002/nau.24325] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 01/23/2020] [Indexed: 01/18/2023]
Abstract
AIMS Although lower urinary tract symptoms (LUTS) may occur at different periods during the life course of women, a little research on LUTS has adopted a life course perspective. The purpose of this conceptual paper is to demonstrate how life course theory and life course epidemiology can be applied to study bladder health and LUTS trajectories. We highlight conceptual work from the Prevention of Lower Urinary Tract Symptoms Research Consortium to enhance the understanding of life course concepts. METHODS Consortium members worked in transdisciplinary teams to generate examples of how life course concepts may be applied to research on bladder health and LUTS in eight prioritized areas: (a) biopsychosocial ecology of stress and brain health; (b) toileting environment, access, habits, and techniques; (c) pregnancy and childbirth; (d) physical health and medical conditions; (e) musculoskeletal health; (f) lifestyle behaviors; (g) infections and microbiome; and (h) hormonal status across the life span. RESULTS Life course concepts guided consortium members' conceptualization of how potential risk and protective factors may influence women's health. For example, intrapartum interventions across multiple pregnancies may influence trajectories of bladder health and LUTS, illustrating the principle of life span development. Consortium members also identified and summarized methodologic and practical considerations in designing life course research. CONCLUSIONS This paper may assist researchers from a variety of disciplines to design and implement research identifying key risk and protective factors for LUTS and bladder health across the life course of women. Results from life course research may inform health promotion programs, policies, and practices.
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Affiliation(s)
- Sonya S Brady
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, Minnesota
| | - Amanda Berry
- Department of Surgery, Division of Urology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Deepa R Camenga
- Department of Emergency Medicine and Pediatrics, Yale School of Medicine, New Haven, Connecticut
| | - Colleen M Fitzgerald
- Department of Obstetrics and Gynecology, Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Sheila Gahagan
- Department of Pediatrics, Division of Academic General Pediatrics, University of California San Diego School of Medicine, San Diego, California
| | | | - Bernard L Harlow
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Jeni Hebert-Beirne
- Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, Illinois
| | - D Yvette LaCoursiere
- Department of Obstetrics, Gynecology, and Reproductive Sciences, UC San Diego School of Medicine, San Diego, California
| | - Jessica B Lewis
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Lisa K Low
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, Michigan
| | - Jerry L Lowder
- Department of Obstetrics and Gynecology, Division of Female Pelvic Medicine and Reconstructive Surgery, Washington University in St. Louis School of Medicine, St. Louis, Missouri
| | - Alayne D Markland
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
- Geriatric Research, Education, and Clinical Center, Birmingham VA Medical Center, Birmingham, Alabama
| | - Gerald McGwin
- Department of Epidemiology, University of Alabama at Birmingham School of Public Health, Birmingham, Alabama
| | - Diane K Newman
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mary H Palmer
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| | - David A Shoham
- Department of Public Health Sciences, Loyola University Chicago, Maywood, Illinois
| | - Ariana L Smith
- Department of Surgery, Division of Urology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ann Stapleton
- Department of Medicine, Division of Allergy and Infectious Disease, University of Washington, Seattle, Washington
| | - Beverly R Williams
- Department of Medicine, Division of Gerontology, Geriatrics, and Palliative Care, School of Medicine, University of Alabama, Birmingham, Alabama
| | - Siobhan Sutcliffe
- Department of Surgery, Division of Public Health Sciences, Washington University School of Medicine, St. Louis, Missouri
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22
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Barger MK. Current Resources for Evidence-Based Practice, November/December 2019. J Midwifery Womens Health 2019; 64:775-781. [PMID: 31691482 DOI: 10.1111/jmwh.13064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 10/10/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Mary K Barger
- Hahn School of Nursing and Health Science, Beyster Institute for Nursing Research, San Diego, California
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23
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Carmichael SL, Snowden JM. The ARRIVE Trial: Interpretation from an Epidemiologic Perspective. J Midwifery Womens Health 2019; 64:657-663. [PMID: 31264773 DOI: 10.1111/jmwh.12996] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 04/22/2019] [Accepted: 04/25/2019] [Indexed: 01/24/2023]
Abstract
The findings of the ARRIVE trial (A Randomized Trial of Induction Versus Expectant Management) were recently published. This multisite randomized trial was designed to provide evidence regarding whether labor induction or expectant management is associated with increased adverse perinatal outcomes and risk of cesarean birth among healthy nulliparous women at term. The trial reported that the primary outcome, a composite of adverse neonatal outcomes, was not significantly different between the 2 groups; the principal secondary outcome, cesarean birth, was significantly more common among women whose pregnancy was expectantly managed than among women whose labor was induced at 39 weeks. These results have the potential to change existing practice. Several aspects of the study design may influence its potential internal and external validity and should be considered in order to make sound causal inferences from this trial, which will in turn affect how its findings are translated to practice. Although chance and confounding are of minimal concern, given the sample size and randomization used in the study, selection bias may be a concern. Studies are vulnerable to selection bias when the sample population differs from eligible nonparticipants, including in randomized controlled trials. External validity is defined as the extent to which the study population and setting are representative of the larger source population the study intends to represent. External validity may be limited given the characteristics of the women enrolled in the ARRIVE trial and the practice settings where the study was conducted. This brief report provides concrete suggestions for further analyses that could help solidify conclusions from the trial, and for further research questions that will continue advancement toward answering this complex question of how best to manage labor and birth decisions at full term among low-risk women.
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Affiliation(s)
- Suzan L Carmichael
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Jonathan M Snowden
- School of Public Health, Oregon Health and Science University-Portland State University, Portland, Oregon.,Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, Oregon
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24
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Greiner KS, Hersh AR, Hersh SR, Remer JM, Gallagher AC, Caughey AB, Tilden EL. The Cost‐Effectiveness of Professional Doula Care for a Woman's First Two Births: A Decision Analysis Model. J Midwifery Womens Health 2019; 64:410-420. [DOI: 10.1111/jmwh.12972] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2018] [Revised: 02/16/2019] [Accepted: 02/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Karen S. Greiner
- Department of Obstetrics and GynecologyOregon Health & Science University Portland Oregon
| | - Alyssa R. Hersh
- Department of Obstetrics and GynecologyOregon Health & Science University Portland Oregon
| | - Sally R. Hersh
- Oregon Health & Science University School of NursingOregon Health & Science University Portland Oregon
| | - Jesse M. Remer
- Mother Tree Doula Services and Oregon Doula Association Portland Oregon
| | - Alexandra C. Gallagher
- Department of Obstetrics and GynecologyOregon Health & Science University Portland Oregon
| | - Aaron B. Caughey
- Department of Obstetrics and GynecologyOregon Health & Science University Portland Oregon
| | - Ellen L. Tilden
- Department of Obstetrics and GynecologyOregon Health & Science University Portland Oregon
- Oregon Health & Science University School of NursingOregon Health & Science University Portland Oregon
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25
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Ondeck M. Healthy Birth Practice #2: Walk, Move Around, and Change Positions Throughout Labor. J Perinat Educ 2019; 28:81-87. [PMID: 31118544 PMCID: PMC6503896 DOI: 10.1891/1058-1243.28.2.81] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Women who use upright positions and are mobile during labor have shorter labors, less intervention, fewer cesarean births, and report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. The evidence for supporting physiologic childbearing for optimal birth fails to disrupt intervention intensive hospital practices that deny 60% of women mobility in labor despite calls by maternity care organizations to not restrict mobility for low risk women in spontaneous labor.
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26
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Erickson EN, Lee CS, Grose E, Emeis C. Physiologic childbirth and active management of the third stage of labor: A latent class model of risk for postpartum hemorrhage. Birth 2019; 46:69-79. [PMID: 30168198 PMCID: PMC8191508 DOI: 10.1111/birt.12384] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/23/2018] [Accepted: 06/27/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Postpartum hemorrhage (PPH) is a threat to maternal mortality worldwide. Evidence supports active management of third stage labor (AMTSL) for preventing PPH. However, trials of AMTSL include women at varying risk levels, such as women undergoing physiologic labor and those with labor complications. Counseling women about their risk for PPH and AMTSL is difficult as many women who appear low-risk can still have PPH. METHODS This study uses outcomes of 2322 vaginal births from a hospital midwifery service in the United States to examine risks for PPH and effectiveness of AMTSL. Using a latent class analysis approach, physiologic birth practices and other risk factors for PPH were analyzed to understand if discrete classes of clinical characteristics would emerge. The effect of AMTSL on the PPH outcome was also considered by class. RESULTS A four-class solution best fit the data; each class was clinically distinct. The two largest Classes (A and B) represented women with term births and lower average parity, with higher rates of nulliparity in Class B. Class A women had more physiologic birth elements and less labor induction or labor dysfunction compared with Class B. PPH and AMTSL use was higher in Class B. In Class B, AMTSL lowered risk for PPH. However, in Class A, AMTSL was associated with higher risk for PPH and delayed placental delivery (>30 minutes). DISCUSSION AMTSL may not be as beneficial to women undergoing physiologic birth. Further study of the etiology of PPH in these women is indicated to inform preventive care.
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Affiliation(s)
| | | | - Emily Grose
- Southdale ObGyn Consultants in Edina, Edina, Minnesota
| | - Cathy Emeis
- Oregon Health and Science University, Portland, Oregon
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27
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Neal JL, Lowe NK, Caughey AB, Bennett KA, Tilden EL, Carlson NS, Phillippi JC, Dietrich MS. Applying a physiologic partograph to Consortium on Safe Labor data to identify opportunities for safely decreasing cesarean births among nulliparous women. Birth 2018; 45:358-367. [PMID: 29851163 PMCID: PMC6342020 DOI: 10.1111/birt.12358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/17/2018] [Accepted: 04/20/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND The timing of hospital admission for women with spontaneous labor onset and the criteria used to assess active labor progress and diagnose labor dystocia may significantly influence women's risk for primary cesarean birth. Our aims were to assess associations of labor status at admission (i.e., preactive or active) and active labor progress (i.e., dystocic or physiologic) with oxytocin augmentation, cesarean birth, and adverse neonatal outcome rates. METHODS A sample of low-risk, nulliparous women admitted to hospitals for spontaneous labor onset was extracted from the Consortium on Safe Labor (n = 27 077). Binomial logistic regression was used to assess associations between labor classifications and outcomes. RESULTS At admission, 68.0% of women were in preactive labor and 32.0% were in active labor. Cesarean rates for these groups were 18.0% and 7.2%, respectively (adjusted odds ratio [AOR] 2.69; 95% CI 2.45-2.96). Oxytocin augmentation and adverse neonatal outcomes were more likely for women admitted in preactive labor. Among women admitted in active labor, 9.3% experienced labor dystocia and 90.7% progressed physiologically. Cesarean rates for these groups were 20.4% and 5.9%, respectively (AOR 3.02; 95% CI 2.45-3.73). Nearly half of the cesareans performed for dystocia among women admitted in active labor occurred when cervical dilation was physiologic. Oxytocin augmentation and adverse neonatal outcomes were more likely when active labor was dystocic. CONCLUSIONS Adoption of evidence-based, standardized approaches for diagnosing active labor onset, assessing labor progress, and diagnosing dystocia may safely decrease oxytocin augmentation and cesarean birth rates in the United States.
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Affiliation(s)
- Jeremy L. Neal
- Vanderbilt University School of Nursing, Nashville, TN, USA
| | - Nancy K. Lowe
- University of Colorado College of Nursing, Aurora, CO, USA
| | - Aaron B. Caughey
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR, USA
| | - Kelly A. Bennett
- Department of Obstetrics and Gynecology, Vanderbilt University, Nashville, TN, USA
| | - Ellen L. Tilden
- Oregon Health and Science University School of Nursing, Portland, OR, USA
| | - Nicole S. Carlson
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA, USA
| | | | - Mary S. Dietrich
- Schools of Nursing and Medicine, Vanderbilt University, Nashville, TN, USA
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28
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Tilden EL, Snowden JM. The Causal Inference Framework: A Primer on Concepts and Methods for Improving the Study of Well-Woman Childbearing Processes. J Midwifery Womens Health 2018; 63:700-709. [PMID: 29883528 PMCID: PMC6235714 DOI: 10.1111/jmwh.12710] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 09/14/2017] [Accepted: 09/20/2017] [Indexed: 01/16/2023]
Abstract
The causal inference framework and related methods have emerged as vital within epidemiology. Scientists in many fields have found that this framework and a variety of designs and analytic approaches facilitate the conduct of strong science. These approaches have proven particularly important for catalyzing knowledge development using existing data and addressing questions for which randomized clinical trials are neither feasible nor ethical. The study of healthy women and normal childbearing processes may benefit from more direct and deliberate engagement with the process of inferring causes and, further, may be strengthened through use of methods appropriate for this undertaking. The purpose of this primer, the first in a series of 3 articles, is to provide the reader an introduction to concepts and methods relevant for causal inference, aimed at the clinician scientist and offer details and references supporting further application of epidemiologic knowledge. The causal inference framework and associated methods hold promise for generating strong, broadly representative, and actionable science to improve the outcomes of healthy women during the childbearing cycle and their children.
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29
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Avery MD, Neerland CE, Saftner MA. Women's Perceptions of Prenatal Influences on Maternal Confidence for Physiologic Birth. J Midwifery Womens Health 2018; 64:201-208. [DOI: 10.1111/jmwh.12897] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 06/05/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
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30
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Snowden JM, Guise JM, Kozhimannil KB. Promoting inclusive and person-centered care: Starting with birth. Birth 2018; 45:232-235. [PMID: 29770494 DOI: 10.1111/birt.12351] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jonathan M Snowden
- School of Public Health, Oregon Health & Science University/Portland State University, Portland, OR, USA
| | - Jeanne-Marie Guise
- Department of Obstetrics & Gynecology, Oregon Health & Science University, Portland, OR, USA
| | - Katy B Kozhimannil
- Division of Health Policy and Management, University of Minnesota School of Public Health, Minneapolis, MN, USA
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Snowden JM, Tilden EL. Further Applications of Advanced Methods to Infer Causes in the Study of Physiologic Childbirth. J Midwifery Womens Health 2018; 63:710-720. [DOI: 10.1111/jmwh.12732] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 12/08/2017] [Accepted: 12/19/2017] [Indexed: 01/07/2023]
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Neerland CE. Maternal Confidence for Physiologic Childbirth: A Concept Analysis. J Midwifery Womens Health 2018; 63:425-435. [DOI: 10.1111/jmwh.12719] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Revised: 11/14/2017] [Accepted: 11/16/2017] [Indexed: 11/30/2022]
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Kennedy HP, Myers-Ciecko JA, Carr KC, Breedlove G, Bailey T, Farrell MV, Lawlor M, Darragh I. United States Model Midwifery Legislation and Regulation: Development of a Consensus Document. J Midwifery Womens Health 2018; 63:652-659. [DOI: 10.1111/jmwh.12727] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Revised: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/29/2022]
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Tadokoro Y, Horiuchi S, Takahata K, Shuo T, Sawano E, Shinohara K. Changes in salivary oxytocin after inhalation of clary sage essential oil scent in term-pregnant women: a feasibility pilot study. BMC Res Notes 2017; 10:717. [PMID: 29216912 PMCID: PMC5721455 DOI: 10.1186/s13104-017-3053-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 11/30/2017] [Indexed: 12/24/2022] Open
Abstract
Objectives This pilot study using a quasi-experimental design was conducted to evaluate the feasibility (i.e., limited efficacy, practicality, and acceptability) of our intervention protocol involving inhalation of the scent of clary sage essential oil by pregnant women and measurement of their preinhalation and postinhalation oxytocin levels. Results Participants were women of singleton pregnancies between 38 and 40 gestation weeks (N = 11). The experiment group (n = 5) inhaled the scent of clary sage essential oil diluted 50-fold with 10 mL of odorless propylene glycol for 20 min. Regarding limited efficacy, the oxytocin level 15 min postinhalation increased in 3 women and was unmeasurable in 2. The control group (n = 6) inhaled similarly without the 50-fold dilution of clary sage essential oil. Their oxytocin level increased in 2 women, decreased in 2, and was unmeasurable in 2. Uterine contraction was not observed in both groups. Regarding practicality, 3 of the 11 women could not collect sufficient saliva. The cortisol level decreased in both groups postinhalation. The protocol had no negative effects. Regarding acceptability, burden of the protocol was not observed. Trial registration The Clinical Trials Registry of University Hospital Medical Information Network in Japan—UMIN000017830. Registered: June 8, 2015 Electronic supplementary material The online version of this article (10.1186/s13104-017-3053-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuriko Tadokoro
- St. Luke's International University, 10-1 Akashicho, Chuo, Tokyo, 104-0044, Japan.
| | - Shigeko Horiuchi
- Graduate School of Nursing Science, St. Luke's International University, 10-1 Akashicho, Chuo, Tokyo, 104-0044, Japan.,St. Luke's Maternity Care Home, 24 Akashicho, Chuo, Tokyo, 104-0044, Japan
| | - Kaori Takahata
- St. Luke's International University, 10-1 Akashicho, Chuo, Tokyo, 104-0044, Japan
| | - Takuya Shuo
- Hokuriku University, 3 Ho, Kanagawamachi, Kanazawa, Ishikawa, 920-1181, Japan
| | - Erika Sawano
- Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
| | - Kazuyuki Shinohara
- Graduate School of Biomedical Sciences, Nagasaki University, 1-12-4 Sakamoto, Nagasaki, 852-8523, Japan
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Phillippi JC, Neal JL, Carlson NS, Biel FM, Snowden JM, Tilden EL. Utilizing Datasets to Advance Perinatal Research. J Midwifery Womens Health 2017; 62:545-561. [PMID: 28799702 PMCID: PMC5808896 DOI: 10.1111/jmwh.12640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 04/13/2017] [Accepted: 04/29/2017] [Indexed: 11/29/2022]
Abstract
Many organizations collect and make available perinatal data for research and quality improvement initiatives. Analysis of existing data and use of retrospective study design has many advantages for perinatal researchers. These advantages include large samples, inclusion of women from diverse groups, data reflective of actual clinical processes and outcomes, and decreased risk of direct maternal and fetal harm. We review 11 publicly available datasets relevant to perinatal research and quality improvement, detail the availability of interactive websites, and discuss strategies to locate additional datasets. While analysis of existing data has limitations, it may provide statistical power to study rare perinatal outcomes, support research applicable to diverse populations, and facilitate timely and ethical well-woman research immediately relevant to clinical care.
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Systematic Review of Hydrotherapy Research: Does a Warm Bath in Labor Promote Normal Physiologic Childbirth? J Perinat Neonatal Nurs 2017; 31:303-316. [PMID: 28520654 DOI: 10.1097/jpn.0000000000000260] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Health sciences research was systematically reviewed to assess randomized controlled trials of standard care versus immersion hydrotherapy in labor before conventional childbirth. Seven studies of 2615 women were included. Six trials examined hydrotherapy in midwifery care and found an effect of pain relief; of these, 2 examined analgesia and found reduced use among women who bathed in labor. One study each found that hydrotherapy reduced maternal anxiety and fetal malpresentation, increased maternal satisfaction with movement and privacy, and resulted in cervical dilation progress equivalent to standard labor augmentation practices. Studies examined more than 30 fetal and neonatal outcomes, and no benefit or harm of hydrotherapy was identified. Two trials had anomalous findings of increased newborn resuscitation or nursery admission after hydrotherapy, which were not supported by additional results in the same or other studies. Review findings demonstrate that intrapartum immersion hydrotherapy is a helpful and benign practice. Hydrotherapy facilitates physiologic childbirth and may increase satisfaction with care. Maternity care providers are recommended to include hydrotherapy among routine labor pain management options and consider immersion to promote progress of normal or protracted labor, particularly among women with preferences to avoid obstetric medications and procedures.
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Kennedy HP, Cheyney M, Lawlor M, Myers S, Schuiling K, Tanner T. The development of a consensus statement on normal physiologic birth: a modified Delphi study. J Midwifery Womens Health 2016; 60:140-5. [PMID: 25782847 DOI: 10.1111/jmwh.12254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
INTRODUCTION This article describes the process of developing consensus on a definition of, and best practices for, normal physiologic birth in the United States. Evidence supports the use of physiologic birth practices, yet a working definition of this term has been elusive. METHODS We began by convening a task force of 21 individuals from 3 midwifery organizations and various childbirth advocacy and consumer groups. A modified Delphi approach was utilized to achieve consensus around 2 research questions: 1) What is normal physiologic birth? and 2) What practices most effectively support its achievement? Answers to these questions were collected anonymously from task force members during multiple phases that included a preliminary briefing, an initial face-to-face roundtable, 9 iterative Delphi rounds, and reciprocal feedback from a wider audience of stakeholders at national and international conferences. Content analysis identified specific statements and concepts in the first Delphi round, which were subsequently ranked in following rounds. An initial draft was constructed based on the priorities that emerged and presented for feedback to peers and childbirth advocates whose comments were incorporated into the final document. RESULTS Four key themes were identified from our initial questions; these provided the framework for the document: 1) definitions of normal physiologic birth, 2) mechanisms and outcomes of normal physiologic birth, 3) factors that influence normal physiologic birth, and 4) recommendations for increasing normal physiologic birth. These areas comprised the final sections in the multi-organizational consensus statement. DISCUSSION The modified Delphi approach we employed allowed for the development of a consensus statement that will serve as a template for education, practice, and future research in maternity care. The completion of this statement marks the beginning of a project to promote systemic changes that support normal physiologic birth, and thus, have the potential to improve outcomes for mothers and infants.
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Avery MD, Saftner MA, Larson B, Weinfurter EV. A Systematic Review of Maternal Confidence for Physiologic Birth: Characteristics of Prenatal Care and Confidence Measurement. J Midwifery Womens Health 2014; 59:586-595. [DOI: 10.1111/jmwh.12269] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Vedam S, Stoll K, Schummers L, Fairbrother N, Klein MC, Thordarson D, Kornelsen J, Dharamsi S, Rogers J, Liston R, Kaczorowski J. The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth. BMC Pregnancy Childbirth 2014; 14:353. [PMID: 25352366 PMCID: PMC4287472 DOI: 10.1186/1471-2393-14-353] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2014] [Accepted: 09/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. METHODS In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students' t tests and ANOVA for categorical variables and correlational analysis (Pearson's r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. RESULTS Median favourability scores on the PAPHB-m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability to manage obstetric emergencies at a home birth. CONCLUSIONS Increasing the knowledge base among all maternity providers about planned home birth may increase favourability. Key learning competencies include criteria for birth site selection, management of obstetric emergencies at planned home births, critical appraisal of literature on safety of home birth, and inter-professional communication and collaboration when women are transferred from home to hospital.
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Affiliation(s)
- Saraswathi Vedam
- />Faculty of Medicine, University of British Columbia, B54-2194 Health Sciences Mall Vancouver, Vancouver, BC V6T 1Z3 Canada
| | - Kathrin Stoll
- />Faculty of Medicine, University of British Columbia, B54-2194 Health Sciences Mall Vancouver, Vancouver, BC V6T 1Z3 Canada
| | - Laura Schummers
- />Department of Epidemiology, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA 02115 USA
| | - Nichole Fairbrother
- />Island Medical Program, University of British Columbia, Royal Jubilee Hospital, Room 141 Eric Martin Pavilion, 2328 Trent Street, Victoria, BC V8R 4Z3 Canada
| | - Michael C Klein
- />Child and Family Research Institute, 950 West 28th Avenue, Vancouver, BC V5Z 4H4 Canada
| | - Dana Thordarson
- />Faculty of Medicine, University of British Columbia, B54-2194 Health Sciences Mall Vancouver, Vancouver, BC V6T 1Z3 Canada
| | - Jude Kornelsen
- />Centre for Rural Health Research, University of British Columbia, Suite 300 David Strangway Bldg, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Shafik Dharamsi
- />Department of Family Practice, University of British Columbia, Suite 300 David Strangway Bldg, 5950 University Boulevard, Vancouver, BC V6T 1Z3 Canada
| | - Judy Rogers
- />Midwifery Education Program, Ryerson University, 99 Gerrard Street East Room SHE-582, Toronto, ON M5B 2L4 Canada
| | - Robert Liston
- />Faculty of Medicine, University of British Columbia, C420 - 4500 Oak Street, Vancouver, BC V6H 3N1 Canada
| | - Janusz Kaczorowski
- />Department of Family and Emergency Medicine, University of Montreal Hospital Research Centre (CRCHUM), Tour Saint-Antoine, Office: S03.416, 850 rue St-Denis, Montreal, QC H2X 0A9 Canada
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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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Hersh S, Megregian M, Emeis C. Intermittent auscultation of the fetal heart rate during labor: an opportunity for shared decision making. J Midwifery Womens Health 2014; 59:344-9. [PMID: 24758413 DOI: 10.1111/jmwh.12178] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Electronic fetal heart rate monitoring is the most common form of intrapartal fetal assessment in the United States. Intermittent auscultation of the fetal heart rate is an acceptable option for low-risk laboring women, yet it is underutilized in the hospital setting. Several expert organizations have proposed the use of intermittent auscultation as a means of promoting physiologic childbirth. Within a shared decision-making model, the low-risk pregnant woman should be presented with current evidence about options for fetal heart rate assessment during labor.
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Bond S. OBSTETRIC INTERVENTIONS UNDERESTIMATED AND USED WITHOUT DOCUMENTED CLINICAL INDICATION. J Midwifery Womens Health 2014; 59:216-217. [PMID: 24618020 DOI: 10.1111/jmwh.12179_1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Phillippi JC, Avery MD. The 2012 American College of Nurse‐Midwives Core Competencies for Basic Midwifery Practice: History and Revision. J Midwifery Womens Health 2014; 59:82-90. [DOI: 10.1111/jmwh.12148] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Development and Validation of a National Data Registry for Midwife‐Led Births: The Midwives Alliance of North America Statistics Project 2.0 Dataset. J Midwifery Womens Health 2014; 59:8-16. [DOI: 10.1111/jmwh.12165] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Abstract
As cesarean rates have climbed to almost one-third of all births in the United States, current research and professional organizations have identified letting labor begin on its own as one of the most important strategies for reducing the primary cesarean rate. At least equally important, letting labor begin on its own supports normal physiology, prevents iatrogenic prematurity, and prevents the cascade of interventions caused by labor induction. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #1: Let Labor Begin on Its Own," published in The Journal of Perinatal Education, 16(3), 2007.
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Ondeck M. Healthy birth practice #2: walk, move around, and change positions throughout labor. J Perinat Educ 2014; 23:188-93. [PMID: 25411538 PMCID: PMC4235058 DOI: 10.1891/1058-1243.23.4.188] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In the United States, obstetric care is intervention intensive, resulting in 1 in 3 women undergoing cesarean surgery wherein mobility is treated as an intervention rather than supporting the natural physiologic process for optimal birth. Women who use upright positions and are mobile during labor have shorter labors, receive less intervention, report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor," published in The Journal of Perinatal Education, 16(3), 2007.
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Fullerton JT, Thompson JB. International Confederation of Midwives core documents: their added value for US midwifery associations. J Midwifery Womens Health 2013; 58:130-2. [PMID: 23590484 DOI: 10.1111/jmwh.12037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Fullerton JT, Thompson JE. 2013 Amendments to International Confederation of Midwive’s Essential Compentencies and Education Standards Core Documents: Clarification and Rationale. INTERNATIONAL JOURNAL OF CHILDBIRTH 2013. [DOI: 10.1891/2156-5287.3.4.184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The International Confederation of Midwives (ICM) Council of Delegates approved the revision of the Essential Competencies for Basic Midwifery Practice and endorsed the newly crafted Global Standards for Midwifery Education with Companion Guidelines in June 2011. ICM views each of their documents as “living” documents, subject to change based on emerging evidence from science, implementation, and practice. This article informs the users of these two core documents about revisions and amendments that were made over the 3-year period from 2011 to 2013 in response to changing evidence, end-user questions, and concerns. The evidence that underpins the revisions made to the basic knowledge and/or skills statements in the Essential Competencies document is presented. The rationale for amendment to the format of the education standards and expansion of the guidelines document is offered. These changes were accepted by the ICM Board in 2013 and will be presented for endorsement by ICM Council of Delegates at the triennial meeting in Prague, Czech Republic, in June 2014.
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Frances EL. Advancing Midwifery: The American College of Nurse-Midwives’ Documents and Publications. J Midwifery Womens Health 2012; 57:431-2. [DOI: 10.1111/j.1542-2011.2012.00236.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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