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Lai MYK, Wong MM, Kearney L, Lee N. The effect of antenatal hypnosis training on pharmacological analgesia use during labour and birth: A systematic review and meta-analysis. Midwifery 2024; 137:104113. [PMID: 39047320 DOI: 10.1016/j.midw.2024.104113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 07/01/2024] [Accepted: 07/17/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND The use of hypnosis as a means of pain management during labour is becoming increasingly popular. While recent reviews have reported on pain perception, relaxation and other psychological benefits the impact of hypnosis on the use of pharmacological analgesia use has not been specifically examined. QUESTION For women in labour at term, does antenatal hypnosis instruction compared to no instruction result in decreased use of pharmacological analgesia and influence maternal and infant birth outcomes. METHODS Databases such as PubMed, CINAHL, Cochrane Central Register of Controlled Trials and Embase were searched with dates ranging from 1947-2024. We included randomised controlled trials (RCTs) that compared antenatal hypnosis training to no hypnosis control groups, published in English and reported on pharmacological analgesia use. The Cochrane's Risk of Bias 2 for RCTs was used to assess design quality. Study selection, quality assessment, data extraction and analysis were undertaken by two independent researchers. FINDINGS Six RCTs met the inclusion criteria (n=2937). The use of hypnosis did not result in a significant reduction in the risk of epidural use (RR. 0.79 95% CI 0.39-1.61) or other forms of pharmacological analgesia. Factors such as blinding of care providers to the participants allocated group may have reduced the chances of successful use of hypnosis. Variations in the presentation of hypnosis between studies may also impact on outcomes. DISCUSSION AND CONCLUSION This review reports no effect on the use of pharmacological analgesia in women trained in hypnosis antenatally compared with those who were not. Our review does highlight several RCT design characteristics that could impact on the measurement and analysis of the use and efficacy of hypnosis.
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Affiliation(s)
- Ms Yee Kay Lai
- School of Nursing Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Queensland, Australia
| | - Ms Michelle Wong
- School of Nursing Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Queensland, Australia
| | - Lauren Kearney
- School of Nursing Midwifery and Social Work, University of Queensland/Royal Brisbane Women's Hospital, Level 6, Ned Hanlon Building, Queensland, Australia
| | - Nigel Lee
- School of Nursing Midwifery and Social Work, University of Queensland, Level 3 Chamberlain Building, St Lucia, Queensland, Australia.
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Grylka-Baeschlin S, Mueller AN. Symptoms of onset of labour and early labour: A scoping review. Women Birth 2023; 36:483-494. [PMID: 37059644 DOI: 10.1016/j.wombi.2023.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 03/05/2023] [Accepted: 03/30/2023] [Indexed: 04/16/2023]
Abstract
BACKGROUND Early labour care often insufficiently addresses the individual needs of pregnant women leading to great dissatisfaction. In-depth knowledge about symptoms of onset of labour and early labour is necessary to develop women-centred interventions. QUESTION OR AIM To provide an overview on the current evidence about pregnant women's symptoms of onset of labour and early labour. METHODS We conducted a scoping review in the five databases PubMed, Web of Science, CINHAL Complete, PsychInfo and MIDIRS in May 2021 and August 2022 using a sensitive search strategy. A total of 2861 titles and abstracts and 290 full texts were screened independently by two researchers using Covidence. For this article, data was extracted from 91 articles and summarised descriptively and narratively. FINDINGS The most frequently mentioned symptoms were 'Contractions, labour pain' (n = 78, 85.7 %), 'Details about the contractions' (n = 51 articles, 56.0 %), 'Positive and negative emotions' (n = 50, 54.9 %) and 'Fear and worries' (n = 48 articles, 52.7 %). Details about the contractions ranged from a slight pulling to unbearable pain and the emotional condition varied from joy to great fear, showing an extraordinary diversity of symptoms highlighting the very individual character of early labour. DISCUSSION A comprehensive picture of varying and contradicting symptoms of onset of labour and early labour was drawn. Different experiences indicate different needs. This knowledge builds a good basis to develop women-centred approaches to improve early labour care. CONCLUSION Further research is necessary to design individualised early labour interventions and evaluate their effectiveness.
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Affiliation(s)
- Susanne Grylka-Baeschlin
- Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400 Winterthur, Switzerland.
| | - Antonia N Mueller
- Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8400 Winterthur, Switzerland
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Uldal T, Østmoen MS, Dahl B, Røseth I. Women's experiences with hypnobirth - A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100890. [PMID: 37541096 DOI: 10.1016/j.srhc.2023.100890] [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] [Received: 12/30/2022] [Revised: 06/15/2023] [Accepted: 07/16/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE Hypnobirth is a technique that incorporates elements from hypnosis and is used to prepare women for birth. It aims to promote a normal birth and create a positive birth experience by equipping women with knowledge and tools to reduce fear, anxiety, and pain during labor. The objective of this study was to investigate women's experiences in using this technique during childbirth. METHODS Qualitative study with nine in-depth interviews, analysed using a descriptive phenomenological method. RESULTS The women changed their perspective on birth and got to know their inherent resources. They acquired various coping strategies and techniques that enhanced their sense of control. The women gained ownership of their birth and found their active participation to be meaningful. They were informed of different options concerning their birth which made it possible to make informed decisions. The participation in hypnobirth classes, and personal experience from giving birth, made women wish for integration of mental birth preparation in the public health service, thus strengthening women's trust in ther ability to give birth, which was pivotal to the participants' birth satisfaction. CONCLUSION The participants experienced an empowered birth because of the knowledge, coping strategies and mental training they gained from hypnobirth classes.
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Affiliation(s)
- Tiril Uldal
- Centre for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Borre, Norway
| | - Marita Strand Østmoen
- Centre for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Borre, Norway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Borre, Norway
| | - Idun Røseth
- Centre for Women's, Family and Child Health, Faculty of Health and Social Sciences, University of South-Eastern Norway (USN), Borre, Norway; Department of Child and Adolescent Mental Health, Telemark Hospital Trust, Skien, Norway.
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Newnham EC, Moran PS, Begley CM, Carroll M, Daly D. Comparison of labour and birth outcomes between nulliparous women who used epidural analgesia in labour and those who did not: A prospective cohort study. Women Birth 2021; 34:e435-e441. [DOI: 10.1016/j.wombi.2020.09.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 09/01/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
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5
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Gagnon R. A longitudinal study of women's representations and experiences of pregnancy and childbirth. Midwifery 2021; 103:103101. [PMID: 34352599 DOI: 10.1016/j.midw.2021.103101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 06/02/2021] [Accepted: 07/15/2021] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore women's representations of pregnancy and childbirth and how these representations are constructed and have changed. BACKGROUND In the 1980s, many women in Quebec demanded that the birthing process be both demedicalised and humanised, resulting in the legalisation of the midwife profession while expanding their choices over birthing locations within the public health system (e.g., birthing centres, the home, or hospitals). Birth-related technologies were also improving at that time. Nearly 40 years later, we wanted to learn about their perceptions. METHOD This qualitative and contextualised phenomenological study surveyed 25 first-time mothers who had received care from midwives, general practitioners, or obstetricians. Each participant met with the researcher twice during her pregnancy and once after giving birth to engage in narrative conversations, which were analysed from an interdisciplinary viewpoint (socio-anthropology). FINDINGS Participant perceptions of pregnancy varied. Some saw it as a state that distorted the body, while others saw it as a long period of struggle with a compulsory step that was also fascinating and/or even happy. Women undergo an incremental process of change before contemplating childbirth, and typically undergo a transitional period when nearing the event itself. They may think of childbirth as joyful and/or painful. Representations are built intersubjectively through influences involving family, the media, and care providers. Stories from their mothers, therefore, created undeniable impressions. CONCLUSION In a context heavily influenced by technology, easy pregnancies and/or childbirth events are typically deemed "lucky." This negatively reinforces both the cultural and intergenerational values transmitted regarding these events.
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Affiliation(s)
- Raymonde Gagnon
- Université du Québec à Trois-Rivières, Département sage-femme, Local 4009b Ringuet, 3351, boul. des Forges, C.P. 500, Trois-Rivières G9A 5H7 (Québec, Canada).
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Skúladóttir H, Gunnarsdóttir TJ, Halldórsdóttir S, Sveinsdóttir H, Holden JE, Björnsdóttir A. Breaking the vicious circle: Experiences of people in chronic pain on the pain rehabilitation journey. Nurs Open 2020; 7:1412-1423. [PMID: 32802361 PMCID: PMC7424485 DOI: 10.1002/nop2.512] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 04/02/2020] [Accepted: 04/21/2020] [Indexed: 11/25/2022] Open
Abstract
Aim To explore the lived experience of individuals' in chronic pain of participating in a pain rehabilitation programme in Iceland. Design Phenomenological research. Method The Vancouver School of Doing Phenomenology. Eleven participants were interviewed. Results The overarching theme was as follows: "the journey of breaking the vicious circle of chronic pain." Before the programme, the participants felt they were in survival mode, trying to survive each day; they were stuck in a vicious circle of chronic pain, simultaneously trying to ease and conceal the pain. Reaching out for professional help was a turning point. While attending the programme, participants began deconstructing their old ways of dealing with chronic pain. After completing the programme, they were still reconstructing their daily lives. In conclusion, pain rehabilitation programmes can be the first step towards breaking the vicious circle of chronic pain.
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Affiliation(s)
- Hafdís Skúladóttir
- Faculty of NursingSchool of Health SciencesUniversity of AkureyriAkureyriIceland
| | | | | | - Herdís Sveinsdóttir
- Faculty of NursingSchool of Health SciencesUniversity of IcelandReykjavikIceland
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Aannestad M, Herstad M, Severinsson E. A meta-ethnographic synthesis of qualitative research on women's experience of midwifery care. Nurs Health Sci 2020; 22:171-183. [PMID: 32170804 DOI: 10.1111/nhs.12714] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 03/10/2020] [Accepted: 03/10/2020] [Indexed: 12/19/2022]
Abstract
Labor and birth constitute a significant emotional event for a childbearing woman. The aim was to explore women's reflections on their experiences of labor and birth and how these were influenced by the midwifery care they received. A modified version of Noblit and Hare's meta-ethnographic approach was used to develop an inductive and interpretive synthesis of nine qualitative articles. Relevant databases were searched and qualitative articles appraised by means of the Critical Appraisal Skills Program. Two metaphors were identified: The guide-Please share your knowledge and The motherly midwife as an anchor. The comprehensive understanding of the images evoked by the metaphors resulted in an overall metaphoric representation of the women's experiences: The midwife as a birth pilot, that is, a positive labor and birth experience is dependent on the relationship with the midwife. This finding confirms previous knowledge that a trusting relationship results in confidence, while feeling secure leads to a positive birth experience. The metaphors facilitate understanding of the significance of the midwife for women's labor and birth experiences. Knowledge of labor and birth experiences helps to broaden understanding of the necessity of midwives being willing to engage, act, be aware of errors that may affect women's birth experience, and employ tools to predict unexpected adverse events.
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Affiliation(s)
| | - Marit Herstad
- Obstetric Care, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Elisabeth Severinsson
- Department of Research, Nursing and Healthcare Research Group, Stavanger University Hospital, Stavanger, Norway
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Moran VH, Thomson G, Cook J, Storey H, Beeson L, MacArthur C, Wilson M. Qualitative exploration of women's experiences of intramuscular pethidine or remifentanil patient-controlled analgesia for labour pain. BMJ Open 2019; 9:e032203. [PMID: 31874879 PMCID: PMC7008414 DOI: 10.1136/bmjopen-2019-032203] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVES To explore women's experiences of remifentanil or pethidine for labour pain and infant feeding behaviours at 6weeks post partum. DESIGN Qualitative postnatal sub-study to the randomised controlled trial of remifentanil intravenous patient controlled analgesia (PCA) versus intramuscular pethidine for pain relief in labour (RESPITE). Semistructured telephone interviews were conducted at 6 weeks post partum, and thematic analysis was undertaken. SETTING Women recruited to the RESPITE trial from seven UK hospitals. PARTICIPANTS Eighty women consented and 49 (30 remifentanil group and 19 pethidine group) completed the interview. RESULTS Eight themes emerged which encompassed women's antenatal plans for pain management (Birth Expectations) through to their future preferences for pain relief (Reflections for Future Choices). Many women who used remifentanil felt it provided effective pain relief (Effectiveness of Pain Relief), whereas women in the pethidine group expressed more mixed views. Both groups described side effects, with women using pethidine frequently reporting nausea (Negative Physiological Responses) and women using remifentanil describing more cognitive effects (Cognitive Effects). Some women who used remifentanil reported restricted movements due to technical aspects of drug administration and fear of analgesia running out (Issues with Drug Administration). Women described how remifentanil enabled them to maintain their ability to stay focused during the birth (Enabling a Sense of Control). There was little difference in reported breastfeeding initiation and continuation between pethidine and remifentanil groups (Impact on Infant Behaviour and Breastfeeding). CONCLUSIONS Qualitative insights from a follow-up study to a trial which explored experiences of intravenous remifentanil PCA with intramuscular pethidine injection found that remifentanil appeared to provide effective pain relief while allowing women to remain alert and focused during labour, although as with pethidine, some side effects were noted. Overall, there was little difference in reported breastfeeding initiation and duration between the two groups. TRIAL REGISTRATION NUMBER ISRCTN29654603.
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Affiliation(s)
- Victoria Hall Moran
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Gillian Thomson
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Julie Cook
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Hannah Storey
- College of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Leanne Beeson
- Birmingham Clinical Trials Unit, The University of Birmingham, Birmingham, UK
| | - Christine MacArthur
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Matthew Wilson
- Centre for Urgent and Emergency Care Research, University of Sheffield, Sheffield, UK
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Dias PF, Miranda TPS, Santos RDP, Paula EMD, Bem MMDS, Mendes MA. Concept formation of ambience for labor and normal institutionalized delivery. Rev Bras Enferm 2019; 72:348-359. [PMID: 31851273 DOI: 10.1590/0034-7167-2018-0698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 06/17/2019] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to develop the concept ambience for labor and normal institutionalized delivery, identifying in the literature its antecedent, defining attributes and the consequent. METHOD the method used was the analysis of literature, corresponding to the first stage of the qualitative method of concept analysis. The theoretical operation was performed in the databases CINAHL COCHRANE, LILACS, PsycINFO, and PubMed. RESULTS aspects of the parturient woman and the qualification of the physical and social space are presented as the antecedent. The defining attributes outline the assistance interaction process with Non-Invasive Technologies. As the consequent, we highlight the outcome for normal delivery, pain relief and comfort, woman satisfaction and well-being. FINAL CONSIDERATIONS the analysis of the antecedent, defining attributes and the consequent allowed the elaboration of an unprecedent theoretical proposition of this concept.
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Thomson G, Feeley C, Moran VH, Downe S, Oladapo OT. Women's experiences of pharmacological and non-pharmacological pain relief methods for labour and childbirth: a qualitative systematic review. Reprod Health 2019; 16:71. [PMID: 31146759 PMCID: PMC6543627 DOI: 10.1186/s12978-019-0735-4] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/08/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many women use pharmacological or non-pharmacological pain relief during childbirth. Evidence from Cochrane reviews shows that effective pain relief is not always associated with high maternal satisfaction scores. However, understanding women's views is important for good quality maternity care provision. We undertook a qualitative evidence synthesis of women's views and experiences of pharmacological (epidural, opioid analgesia) and non-pharmacological (relaxation, massage techniques) pain relief options, to understand what affects women's decisions and choices and to inform guidelines, policy, and practice. METHODS We searched seven electronic databases (MEDLINE, CINAHL, PsycINFO, AMED, EMBASE, Global Index Medicus, AJOL), tracked citations and checked references. We used thematic and meta-ethnographic techniques for analysis purposes, and GRADE-CERQual tool to assess confidence in review findings. We developed review findings for each method. We then re-analysed the review findings thematically to highlight similarities and differences in women's accounts of different pain relief methods. RESULTS From 11,782 hits, we screened full 58 papers. Twenty-four studies provided findings for the synthesis: epidural (n = 12), opioids (n = 3), relaxation (n = 8) and massage (n = 4) - all conducted in upper-middle and high-income countries (HMICs). Re-analysis of the review findings produced five key themes. 'Desires for pain relief' illuminates different reasons for using pharmacological or non-pharmacological pain relief. 'Impact on pain' describes varying levels of effectiveness of the methods used. 'Influence and experience of support' highlights women's positive or negative experiences of support from professionals and/or birth companions. 'Influence on focus and capabilities' illustrates that all pain relief methods can facilitate maternal control, but some found non-pharmacological techniques less effective than anticipated, and others reported complications associated with medication use. Finally, 'impact on wellbeing and health' reports that whilst some women were satisfied with their pain relief method, medication was associated with negative self-reprisals, whereas women taught relaxation techniques often continued to use these methods with beneficial outcomes. CONCLUSION Women report mixed experiences of different pain relief methods. Pharmacological methods can reduce pain but have negative side-effects. Non-pharmacological methods may not reduce labour pain but can facilitate bonding with professionals and birth supporters. Women need information on risks and benefits of all available pain relief methods.
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Affiliation(s)
- Gill Thomson
- School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK.
| | - Claire Feeley
- School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Victoria Hall Moran
- School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Soo Downe
- School of Community Health & Midwifery, University of Central Lancashire, Preston, Lancashire, PR1 2HE, UK
| | - Olufemi T Oladapo
- Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, 1211, Geneva, Switzerland
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Campbell V, Nolan M. 'It definitely made a difference': A grounded theory study of yoga for pregnancy and women's self-efficacy for labour. Midwifery 2018; 68:74-83. [PMID: 30396001 DOI: 10.1016/j.midw.2018.10.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 10/07/2018] [Accepted: 10/16/2018] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To explore women's experience of attending yoga for pregnancy classes in order to generate a theory about which aspects, if any, are effective in enhancing self-efficacy for labour and birth. DESIGN A longitudinal grounded theory study. METHODS Semi-structured interviews were undertaken with women before they started yoga for pregnancy classes, after they had attended at least six classes, and finally, postnatally. Interview transcripts were analysed using constructive grounded theory and a self-efficacy framework. SETTING Three yoga for pregnancy teachers' classes in England. PARTICIPANTS Twenty two women attending yoga for pregnancy classes. FINDINGS Analysis of interviews with women at three time points led to a propositional theory that yoga for pregnancy enhances women's self-efficacy for labour by building their confidence and competence through a combination of techniques. These include repeated practice of a variety of pain management strategies, use of affirming language and the telling of positive labour stories, underpinned by yoga practice to lower somatic response to stress.
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Affiliation(s)
- Virginia Campbell
- University of Worcester, St John's Campus, Henwick Grove, Worcester WR2 6AJ, United Kingdom.
| | - Mary Nolan
- University of Worcester, St John's Campus, Henwick Grove, Worcester WR2 6AJ, United Kingdom.
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Karlsdottir SI, Sveinsdottir H, Kristjansdottir H, Aspelund T, Olafsdottir OA. Predictors of women’s positive childbirth pain experience: Findings from an Icelandic national study. Women Birth 2018; 31:e178-e184. [DOI: 10.1016/j.wombi.2017.09.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 02/16/2017] [Accepted: 09/08/2017] [Indexed: 01/02/2023]
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Whitburn LY, Jones LE, Davey MA, McDonald S. The nature of labour pain: An updated review of the literature. Women Birth 2018; 32:28-38. [PMID: 29685345 DOI: 10.1016/j.wombi.2018.03.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/07/2018] [Accepted: 03/15/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND The pain experience associated with labour is complex. Literature indicates psychosocial and environmental determinants of labour pain, and yet methods to support women usually target physiological attributes via pharmacological interventions. AIM To provide an update of our understanding of labour pain based on modern pain science. The review aims to help explain why women can experience labour pain so differently - why some cope well, whilst others experience great suffering. This understanding is pertinent to providing optimal support to women in labour. METHOD A literature search was conducted in databases Medline, Cumulative Index to Nursing and Allied Health Literature and PsycINFO, using search terms labor/labour, childbirth, pain, experience and perception. Thirty-one papers were selected for inclusion. FINDINGS Labour pain is a highly individual experience. It is a challenging, emotional and meaningful pain and is very different from other types of pain. Key determinants and influences of labour pain were identified and grouped into cognitive, social and environmental factors. CONCLUSION If a woman can sustain the belief that her pain is purposeful (i.e. her body working to birth her baby), if she interprets her pain as productive (i.e. taking her through a process to a desired goal) and the birthing environment is safe and supportive, it would be expected she would experience the pain as a non-threatening, transformative life event. Changing the conceptualisation of labour pain to a purposeful and productive pain may be one step to improving women's experiences of it, and reducing their need for pain interventions.
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Affiliation(s)
- Laura Y Whitburn
- School of Life Sciences, La Trobe University, Bundoora, Victoria 3086, Australia; Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia.
| | - Lester E Jones
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia
| | - Mary-Ann Davey
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3186, Australia
| | - Susan McDonald
- Judith Lumley Centre, La Trobe University, Bundoora, Victoria 3086, Australia; Mercy Hospital for Women, Mercy Health, Heidelberg, Victoria 3084, Australia
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14
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Najafi TF, Roudsari RL, Ebrahimipour H. A historical review of the concept of labor support in technocratic, humanistic and holistic paradigms of childbirth. Electron Physician 2017; 9:5446-5451. [PMID: 29238482 PMCID: PMC5718846 DOI: 10.19082/5446] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 06/25/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In the past century, maternal support during childbirth has been changed according to the different approaches suggested by various health care paradigms. OBJECTIVE The aim of this review was to argue the maternity supportive care paradigms of the past century and to closely analyze each paradigm. METHODS This is a historical review, in which published articles were retrieved from databases including Scopus, Science Direct, PubMed and Google Scholar. Sage Journals and Springer's publications were also searched due to the high citation rate of their articles. The keywords entered were "Labor support", "Normal delivery", "Birth attendance", "Supportive approaches", "Health care paradigms", and "Midwifery models of care". They were entered alone or in combinations using "AND". Also, Persian articles were searched in local databases including Irandoc, SID, IranMedex, and Magiran using the above-mentioned keywords in Persian. Sixty articles met inclusion criteria. RESULTS The review revealed four main themes including the definitions of continuous labor support, the technocratic paradigm, the humanistic paradigm and the naturalistic paradigm as models of labor support. According to the evidence, labor support has changed from technocratic to humanistic and holistic approaches, which in turn, caused some changes in midwifery models of care used by midwives in the practice. CONCLUSION Labor support based on the holistic approaches and the naturalistic paradigms could bring about remarkable outcomes, the most important being satisfied with the birth experience, increased mother's self-confidence, enhanced mother's ability in childbirth and better completion of the childbirth process.
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Affiliation(s)
- Tahereh Fathi Najafi
- Ph.D. Student of Reproductive Health, Student Research Committee, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Robab Latifnejad Roudsari
- Ph.D. of Reproductive Health, Associate Professor, Evidence-Based Care Research Centre, Mashhad University of Medical Sciences, Mashhad, Iran
- Ph.D. of Reproductive Health, Associate Professor, Department of Midwifery, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hossein Ebrahimipour
- Ph.D. of Health Management, Associate Professor, Social Determinants of Health Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
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'It's your body, but…' Mixed messages in childbirth education: Findings from a hospital ethnography. Midwifery 2017; 55:53-59. [PMID: 28942214 DOI: 10.1016/j.midw.2017.09.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 09/05/2017] [Accepted: 09/08/2017] [Indexed: 11/24/2022]
Abstract
OBJECTIVE to investigate the personal, social, cultural and institutional influences on women making decisions about using epidural analgesia in labour. In this article we discuss the findings that describe practices around the gaining of consent for an epidural in labour, which we juxtapose with similar processes relating to use of water for labour and/or birth. DESIGN ethnography. SETTING tertiary hospital in Australian city. PARTICIPANTS sequential interviews were conducted with 16 women; hospital staff (primarily midwives and doctors) participated during six months of participatory observation fieldwork. FINDINGS women were not given full disclosure of either practice and midwives tailored the information they gave according to the institutional policies rather than evidence. KEY CONCLUSIONS informed consent is an oft-cited human right in health care, yet in maternity care the micro-politics of how informed consent is gained is difficult to ascertain, leading to a situation whereby the concept of informed consent is more robust than the reality of practice; an illusion of informed consent exists, yet information is often biased towards medicalised birth practices. IMPLICATIONS FOR PRACTICE as primary maternity care-givers, midwives have a role in providing unbiased information to women; however it appears that hospital culture and policy affect the way that this information is presented. It is arguable whether women in such instances are giving true informed consent, and for this reason, the ethics of these hidden practices are questioned.
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Klomp T, Witteveen AB, de Jonge A, Hutton EK, Lagro-Janssen ALM. A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands. J Psychosom Obstet Gynaecol 2017; 38:94-102. [PMID: 27778527 DOI: 10.1080/0167482x.2016.1244522] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study's objective was to explore women's postpartum perception and view of how they dealt with labor pain. METHODS Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010. RESULTS Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time. DISCUSSION It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.
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Affiliation(s)
- Trudy Klomp
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Anke B Witteveen
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Ank de Jonge
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands
| | - Eileen K Hutton
- a Department of Midwifery Science , AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam , the Netherlands.,c Midwifery Education Program , McMaster University Hamilton , Ontario , Canada
| | - Antoine L M Lagro-Janssen
- b Department of Primary Care and Community Care, Women's Studies Medicine , Radboud University Medical Center Nijmegen , the Netherlands
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Larsson Å, Wärnå-Furu C, Näsman Y. The meaning of caring in prenatal care from Swedish women's perspectives. Scand J Caring Sci 2016; 31:702-709. [PMID: 27859526 DOI: 10.1111/scs.12383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2016] [Accepted: 07/19/2016] [Indexed: 11/30/2022]
Abstract
AIM To deepen understanding of the meaning of caring in prenatal care from Swedish women's perspectives. METHOD Ten women, who had given birth between 1 and 2 months previously, were interviewed. The women have taken part in the routine programme that constitutes maternity care Sweden. A hermeneutic approach inspired by Gadamer was used to analyse the data and gain a deeper understanding of the women's experiences. FINDINGS Three themes were identified in the hermeneutical analysis. The themes highlight an existential and ontological aspect for caring as experienced of the women in the study: invitation and caring promise, witnessing and confirmation, and caring emerges in vulnerability. CONCLUSION The life-changing gravidity and vulnerability motivates caritative care during pregnancy. Reception of caring is not just a superficial feeling, but gives a new understanding of life on an ontological level. In a genuine caring relationship, the pregnant woman not only receives something but also a power and an opportunity to go further and find her own inner strength.
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Affiliation(s)
- Åsa Larsson
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Carola Wärnå-Furu
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
| | - Yvonne Näsman
- Faculty of Education and Welfare Studies, Åbo Akademi University, Vasa, Finland
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Klomp T, de Jonge A, Hutton EK, Hers S, Lagro-Janssen ALM. Perceptions of labour pain management of Dutch primary care midwives: a focus group study. BMC Pregnancy Childbirth 2016; 16:6. [PMID: 26775154 PMCID: PMC4715289 DOI: 10.1186/s12884-015-0795-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 12/31/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Labour pain is a major concern for women, their partners and maternity health care professionals. However, little is known about Dutch midwives' perceptions of working with women experiencing labour pain. The aim of this study was to explore midwives' perceptions of supporting women in dealing with pain during labour. METHODS We conducted a qualitative focus group study with four focus groups, including a total of 23 midwives from 23 midwifery practices across the country. Purposive sampling was used to select the practices. The constant comparison method of Glaser and Straus (1967, ren. 1995) was used to gain an understanding of midwives' perceptions regarding labour pain management. RESULTS We found two main themes. The first theme concerned the midwives' experienced professional role conflict, which was reflected in their approach of labour pain management along a spectrum from "working with pain" to a "pain relief" approach. The second theme identified situational factors, including time constraints; discontinuity of care; role of the partner; and various cultural influences, that altered the context in which care was provided and how midwives saw their professional role. CONCLUSION Midwives felt challenged by the need to balance their professional attitude towards normal birth and labour pain, which favours working with pain, with the shift in society towards a wider acceptance of pharmacological pain management during labour. This shift compelled them to redefine their professional identity.
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Affiliation(s)
- Trudy Klomp
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands.
| | - Ank de Jonge
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands
| | - Eileen K Hutton
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands
- Midwifery Education Program, McMaster University Hamilton, Hamilton, ON, Canada
| | - Suzanne Hers
- Department of Midwifery Science, AVAG and EMGO Institute for Health and Care Research, VU University Medical Center Amsterdam, Van der Boechorststraat 7, D4-40, 1081, BT, Amsterdam, The Netherlands
| | - Antoine L M Lagro-Janssen
- Department of Primary Care and Community Care, Women's Studies Medicine, Radboud University Medical Centre Nijmegen, Nijmegen, The Netherlands
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Pregnant women's expectations about pain intensity during childbirth and their attitudes towards pain management: Findings from an Icelandic national study. SEXUAL & REPRODUCTIVE HEALTHCARE 2015; 6:211-8. [DOI: 10.1016/j.srhc.2015.05.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 05/13/2015] [Accepted: 05/19/2015] [Indexed: 11/17/2022]
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Sanders R. Functional discomfort and a shift in midwifery paradigm. Women Birth 2015; 28:e87-91. [DOI: 10.1016/j.wombi.2015.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
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Lee N, Kildea S, Stapleton H. 'Facing the wrong way': Exploring the Occipito Posterior position/back pain discourse from women's and midwives perspectives. Midwifery 2015; 31:1008-14. [PMID: 26144367 DOI: 10.1016/j.midw.2015.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 05/08/2015] [Accepted: 06/05/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to explore back pain in labour from the perspectives of women and midwives. DESIGN a qualitative study, which generated data through individual semi-structured interviews with postnatal women and focus groups with midwives. Data were analysed thematically. SETTING two metropolitan maternity units in Queensland, Australia. PARTICIPANTS nine postnatal women and 11 midwives, all of whom had participated in a randomized controlled trial investigating the use of sterile water injections for back pain in labour. FINDINGS two major themes were identified, including back pain in labour: accounts, rationalisations and coping strategies, and fetal position: destabilising the Occipito Posterior-back pain discourse. KEY CONCLUSIONS back pain may be severe in labour, may impact negatively upon women׳s labour and birth experiences, and interfere with their ability to cope as planned. The assumed relationship between fetal position and back pain in labour is a dominant discourse, albeit one which is lacking in empirical credibility. Nonetheless, the information provided to women by maternity professionals tended to reiterate customary practices and beliefs rather than factual knowledge. Increasingly, women refer to other sources, which may challenge the information provided by health professionals. IMPLICATIONS FOR PRACTICE Back pain in labour is an under-researched area and the lack of solid evidence underpinning the advice provided to women has implications for labour management, and possibly for maternal and fetal outcomes. Care providers might usefully consider back pain as multifactorial, not always associated with OP position, and continue to seek evidence-based management strategies which address women׳s needs.
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Affiliation(s)
- Nigel Lee
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland 4072, Australia; Midwifery Research Unit, Mater Research Institute-UQ, Aubigny Place, Raymond Terrace, South Brisbane 4101, Queensland, Australia.
| | - Sue Kildea
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland 4072, Australia; Midwifery Research Unit, Mater Research Institute-UQ, Aubigny Place, Raymond Terrace, South Brisbane 4101, Queensland, Australia; Mater Mothers׳ Hospital, Mater Health Services, Raymond Terrace, South Brisbane 4101, Australia
| | - Helen Stapleton
- School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Queensland 4072, Australia; Midwifery Research Unit, Mater Research Institute-UQ, Aubigny Place, Raymond Terrace, South Brisbane 4101, Queensland, Australia
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Van der Gucht N, Lewis K. Women's experiences of coping with pain during childbirth: a critical review of qualitative research. Midwifery 2014; 31:349-58. [PMID: 25600326 DOI: 10.1016/j.midw.2014.12.005] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 12/12/2014] [Accepted: 12/21/2014] [Indexed: 11/18/2022]
Abstract
OBJECTIVE to identify and analyse qualitative literature exploring women's experiences of coping with pain during childbirth. DESIGN critical review of qualitative research. FINDINGS ten studies were included, conducted in Australia, England, Finland, Iceland, Indonesia, Iran and Sweden. Eight of the studies employed a phenomenological perspective with the remaining two without a specific qualitative methodological perspective. Thematic analysis was used as the approach for synthesising the data in this review. Two main themes emerged as the most significant influences upon a woman's ability to cope with pain: (i) the importance of individualised, continuous support and (ii) an acceptance of pain during childbirth. This review found that women felt vulnerable during childbirth and valued the relationships they had with health professionals. Many of the women perceived childbirth pain as challenging, however, they described the inherent paradox for the need for pain to birth their child. This allowed them to embrace the pain subsequently enhancing their coping ability. KEY CONCLUSIONS women's experience of coping with pain during childbirth is complex and multifaceted. Many women felt the need for effective support throughout childbirth and described the potential implications where this support failed to be provided. Feeling safe through the concept of continuous support was a key element of care to enhance the coping ability and avoid feelings of loneliness and fear. A positive outlook and acceptance of pain was acknowledged by many of the women, demonstrating the beneficial implications for coping ability. These findings were consistent despite the socio-economic, cultural and contextual differences observed within the studies suggesting that experiences of coping with pain during childbirth are universal. IMPLICATIONS FOR PRACTICE the findings suggest there is a dissonance between what women want in order to enhance their ability to cope with pain and the reality of clinical practice. This review found women would like health professionals to maintain a continuous presence throughout childbirth and support a social model of care that promotes continuity of care and an increasing acceptance of pain as part of normal childbirth. It is suggested future research regarding the role of antenatal provision for instilling such a viewpoint in preparation of birth be undertaken to inform policy makers. The need for a shift in societal norms is also suggested to disseminate expectations and positive or negative views of what the role of pain during childbirth should be to empower women to cope with childbirth and embrace this transition to motherhood as part of a normal process.
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Affiliation(s)
- Natalie Van der Gucht
- Bradford Teaching Hospital, Bradford Royal Infirmary, Duckworth Lane, Bradford BD9 6RJ, UK.
| | - Kiara Lewis
- University of Huddersfield, Institute for Research in Citizenship and Applied Human Sciences, Queensgate Campus, Huddersfield HD1 3DH, UK.
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Sanders R, Lamb K. An exploration of the benefits and drawbacks of intrapartum pain management strategies. ACTA ACUST UNITED AC 2014. [DOI: 10.12968/bjom.2014.22.9.642] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ruth Sanders
- Student Midwife School of Nursing Sciences University of East Anglia
| | - Kathryn Lamb
- Student Midwife School of Nursing Sciences University of East Anglia
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Floris L, Irion O. Association between anxiety and pain in the latent phase of labour upon admission to the maternity hospital: a prospective, descriptive study. J Health Psychol 2013; 20:446-55. [PMID: 24155186 DOI: 10.1177/1359105313502695] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This study investigated the association between anxiety experienced by the mother, a request for analgesia, and the level of pain at maternity hospital admission in early labour. Anxiety levels were measured by the State-Trait Anxiety Inventory and pain was assessed using a Visual Analogue Scale. Anxiety and Visual Analogue Scale scores were compared using a linear regression model and indicated a statistically significant association between the anxiety state and degree of pain (p < 0.016; Y = 0.895 x score + 32.656). There was no significant association between anxiety and a request for epidural analgesia. During labour, an evaluation of anxiety should be associated with an assessment of the perceived degree of pain.
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Affiliation(s)
- Lucia Floris
- University of Geneva Hospitals, Geneva, Switzerland University of Applied Sciences Western Switzerland, Lausanne, Switzerland
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