Anxiety or Nervousness Disturbs the Progress of Birth Based on Human Behavioral Evolutionary Biology

Effects of Multi-Mechanism Complementary Therapy on Pain and Anxiety During Labor Latency in Primiparous Women

Objective: Evaluate the efficacy of single and mixed complementary therapies, with different analgesic mechanisms, in relieving pain and anxiety during the late labor period. Design and method: In this study, 145 primiparous women with 2-3 cm dilation of the cervix were randomly assigned to one of five groups: control group (psychological comfort), comprehensive group, aroma group, auricular acupuncture group, and music group. The groups were distributed equally (1:1:1:1 ratio), and pain and anxiety scores were assessed at 30, 60, and 120 minutes post-intervention in each group. Outcomes and measures: Compared to the control group, all intervention groups showed lower pain scores. The comprehensive group had the largest reduction in pain scores at 30, 60, and 120 minutes post-intervention. The auricular point, aroma, and music groups also demonstrated significant reductions in pain scores at different time points. Only the comprehensive group had a statistically significant reduction in anxiety at 30 minutes post-intervention compared to the control group. However, at 60 and 120 minutes post-intervention, all intervention groups showed lower anxiety scores compared to the control group. Conclusion: The optimal effects of each therapy varied in terms of timing and duration. Combination therapy showed a greater effect size than single complementary therapy.

Psyche: The 5th 'P' and its Associated Impact on the Second Stage of Labor

OBJECTIVE

Patients with depression during labor display dysregulated patterns of oxytocin release and this may impact second stage of labor. The objective of this study was to evaluate the association between maternal preconception and antenatal depressive disorders on the duration of second stage of labor and perinatal outcomes.

STUDY DESIGN

Secondary analysis of patients enrolled in the Behavioral and Mood in Mothers, Behavior in Infants study who reached the second stage of labor. Participants were assigned to: pre-conception only major depressive disorder (MDD), prenatal major depressive disorder, and non-depressed controls. Primary outcome was prolonged second stage of labor. Secondary outcomes included perinatal morbidities.

RESULTS

172 patients were included. 24.4% (42/172) participants had preconception-only MDD, 42.4% (73/172) patients had prenatal MDD, and 33.1% (57/172) patients had as non-depressed controls. The adjusted pair-wise analysis between groups showed no significant difference in the duration of second stage. No statistically significant differences were noted between groups for adverse neonatal outcomes.

CONCLUSION

Maternal depressive disorders did not impact length of second stage of labor or immediate perinatal outcomes.

Not Just Mechanical Birthing Bodies: Birthing Consciousness and Birth Reflexes

There are two concepts of neuroendocrine reflexes associated with the expulsion of the fetus through the birth canal during the second stage of birth: the Ferguson reflex and the fetus ejection reflex. These concepts are often confused with one another and treated synonymously, thus interchangeable. However, the two not only refer to different phenomena, but they also represent the birthing woman differently. The Ferguson reflex treats the birthing woman as simply a biomechanical body. In contrast, the fetus ejection reflex does not ignore women's conscious states during birth and recognizes what is currently a well-known empirical fact: The event of birth is a complex biophysical process affected by many mental, social, and environmental factors. In that, it has a connection to the phenomenon of birthing consciousness, which is the positive altered state sometimes experienced during a physiological and undisturbed childbirth. We argue that birthing consciousness and the fetus ejection reflex, made possible by reduced cortical control, are extremely helpful in promoting physiological human childbirth. Therefore, treating a woman giving birth as a biomechanical body is not only erroneous but can also lead to medical mismanagement of the second stage of physiological childbirth with associated mental and physiological consequences.

Association between high levels of comorbid anxiety and depressive symptoms and decreased likelihood of birth without intervention: A longitudinal prospective cohort study

OBJECTIVE

To assess the association between trajectories of comorbid anxiety and depressive (CAD) symptoms assessed in each pregnancy trimester and physiological birth.

DESIGN

Large longitudinal prospective cohort study with recruitment between January 2013 and September 2014.

SETTING

Primary care, in the Netherlands.

POPULATION

Dutch-speaking pregnant women with gestational age at birth ≥37 weeks, and without multiple pregnancy, severe psychiatric disorder or chronic disease history.

METHODS

Pregnancy-specific anxiety and depressive symptoms were measured prospectively in each trimester of pregnancy using the negative affect subscale of the Tilburg Pregnancy Distress Scale and Edinburgh (Postnatal) Depression Scale. Data on physiological birth were obtained from obstetric records. Multivariate growth mixture modelling was performed in MPLUS to determine longitudinal trajectories of CAD symptoms. Multiple logistic regression analysis was used to examine the association between trajectories and physiological birth.

MAIN OUTCOME MEASURES

Trajectories of CAD symptoms and physiological birth.

RESULTS

Seven trajectories (classes) of CAD symptoms were identified in 1682 women and subsequently merged into three groups: group 1-persistently low levels of symptoms (reference class 1; 79.0%), group 2-intermittently high levels of symptoms (classes 3, 6 and 7; 11.2%), and group 3-persistently high levels of symptoms (classes 2, 4 and 5; 9.8%). Persistently high levels of CAD symptoms (group 3) were associated with a lower likelihood of physiological birth (odds ratio 0.67, 95% confidence interval 0.47-0.95, P = 0.027) compared with the reference group (persistently low levels of symptoms), after adjusting for confounders.

CONCLUSIONS

This study is the first showing evidence that persistently high CAD levels, assessed in each pregnancy trimester, are associated with a lower likelihood of physiological birth.

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

The subjective childbirth experience is crucial from a public health standpoint. There is a correlation between a negative childbirth experience and a poor mental state after birth, with effects that go far beyond the postpartum (PP) period. This paper offers a new approach as to how birthing experiences, and birth in general, can be navigated. The theory of set and setting proves that psychedelic experiences are shaped, first and foremost, by the mindset of an individual entering a psychedelic experience (set) and by the surroundings in which the experience happens (setting). In research on altered states of consciousness during psychedelic experiences, this theory explains how the same substance can lead to a positive and life-changing experience or to a traumatic and frightening experience. Because recent studies suggest that birthing women enter an altered state of consciousness during physiological birth ("birthing consciousness"), I suggest analyzing the typical modern birthing experience in terms of set and setting theory. I argue that the set and setting key parameters can help design, navigate, and explain many psychological and physiological elements of the human birth process. Thus, an operative conclusion that emerges from the theoretical analysis presented in this paper is that framing and characterizing the birth environment and birth preparations in terms of set and setting is a central tool that could be used to promote physiological births as well as subjective positive birthing experiences, which is currently a primary, yet unreached goal, in modern obstetrics and public health.

Quantitative cardiac autonomic outcomes of hydrotherapy in women during the first stage of labor

Introduction

Most hydrotherapy studies during childbirth report findings related to pain using a widespread set of subjective measures. In this study, ECG biomarkers as quantitative cardiac autonomic outcomes were used to assess the effects of warm shower hydrotherapy on laboring women during the first stage of labor.

Methods

This was a prospective single-blind cohort study on stage I delivering women. Their cardiac autonomic function was assessed using heart rate variability (HRV) measures during a deep breathing test using point-of-care testing comprised of an HRV scanner system with wireless ECG enabling real-time data analysis and visualization. Labor pain and anxiety were assessed using the Visual Analog Scale for Pain (VASP) and the Beck Anxiety Inventory (BAI). A total of 105 pregnant women in the first stage of labor who received warm shower hydrotherapy, intravenous analgesia (scopolamine + sodium dipyrone), or spinal anesthetic (bupivacaine + morphine) were enrolled.

Results

In women during the first stage of labor, parasympathetic modulation reflected through RMSSD (root mean square of successive RR interval differences) was significantly reduced by hydrotherapy and intravenous analgesia (before vs. after mean rank diff. 35.73 and 65.93, respectively, p < 0.05). Overall HRV (SDNN, standard deviation of RR intervals) was significantly decreased only by intravenous analgesia (before vs. after mean rank diff. 65.43, p < 0.001). Mean heart rate was significantly increased by intravenous analgesia, while spinal anesthesia reduced it, and hydrotherapy did not alter it (before vs. after mean rank diff. -49.35*, 70.38*, -24.20 ^NS , respectively, *p < 0.05, ^NS not significant).

Conclusion

This study demonstrates that warm shower therapy may impact the sympathovagal balance via parasympathetic withdrawal in women during the initial stage of labor. The findings of this study provide quantitative support for using warm shower hydrotherapy during labor via point-of-care testing. The dependability of hydrotherapy as a non-pharmacological treatment is linked to the completion of more clinical research demonstrating quantitative evidence via outcome biomarkers to support indications on stress and birth progress.

Unpacking the interaction between foreign language learners’ emotion, cognition, and activity in the flipped classroom in higher education: A perezhivanie perspective

Few studies have investigated learners’ emotional experiences and the interactions between emotion, cognition, and activity in the flipped foreign language classroom (i.e., a mixed teaching mode that combines in-class teaching and off-class self-directed learning). This study, from the perspective of perezhivanie (a concept from sociocultural theory), addressed these research gaps by exercising a longitudinal narrative study on a total of 32 Chinese-as-the-first-language university students of English who attended a 15-week English course with this teaching design. Among them, eight focal students were randomly selected for further evidence of the characteristics of the interactions between emotion, cognition, and activity. The results showed that the participants experienced more of positive emotions than negative emotions in the flipped classroom (FC) context, which supports the efficacy of the pedagogy. But most importantly, complex interactions between emotion, cognition, and activity were revealed. Generally, (negative) positive emotion, cognition, and activity were interconnected; however, what is also evident is that learners’ emotions either promoted or inhibited their cognitive functions, and positive and negative emotions did not necessarily correspond to positive and negative activities, respectively. This is due to the presence of dynamic, developmental, and historical sociocultural mediators in learners perezhivanija, be it teacher, peers, technology, teaching materials, teaching activities in an FC, or the learners’ previous English learning anecdotes, etc.

Physiological plateaus during normal labor and birth: A scoping review of contemporary concepts and definitions

BACKGROUND

Physiological plateaus (slowing, stalling, pausing) during normal labor and birth have been reported for decades, but have received limited attention in research and clinical practice. To date, heterogeneous conceptualizations and terminology have impeded effective communication and research in this area, raising concern as to whether some physiological plateaus might be misinterpreted as dystocia. To address this issue, we provide a point of orientation, mapping contemporary concepts, and terminologies of physiological plateaus during normal labor and birth.

METHODS

We conducted a scoping review, considering published and unpublished reports of physiological plateaus, reported in any language, between 1990 and 2021. Database searches of CINAHL, EMBASE, Emcare, MIDIRS, MEDLINE, Scopus, and Open Grey yielded 1,953 records, with an additional 35 reports identified by hand searching. In total, 43 reports from eleven countries were included in this scoping review.

RESULTS

Conceptualizations of physiological plateaus are heterogeneous and can be allocated to six conceptual groups: cervical reversal or recoil, plateaus, lulls during transition, "rest and be thankful" stage, deceleration phase, and latent phases. Across included material, we identified over 60 different terms referring to physiological plateaus. Overall, physiological plateaus are reported across the entire continuum of normal labor and birth.

CONCLUSIONS

Physiological plateaus may be an essential mechanism of self-regulation of the mother-infant dyad, facilitating feto-maternal adaptation and preventing maternal and fetal distress during labor and birth.

The birthing brain: A lacuna in neuroscience

During pregnancy, maternal brain neuroplasticity indicates vast neurofunctional and neuroanatomical changes. Recent findings documented a similarly massive readjustment after pregnancy. Currently, these brain changes are interpreted as preparation for and adjustment of the maternal brain to motherhood. Yet, this perspective leaves many questions unsolved. Neuroscientific studies have not yet been conducted to determine the brain areas that function during natural childbirth even though physiological birth is the natural process of women who have reproduced successfully throughout two million years of evolution of the genus Homo. It is rational to believe that the female brain is an active and crucial actor during birth and that birth, itself, is a process that requires brain neuroplasticity. Lack of studies of the birthing brain and brain preparation for birth is a significant lacuna in neuroscience research. I demonstrate theoretically that a new hypothesis for complementary interpretation of maternal brain neuroplasticity is reasonable: Certain maternal brain changes during pregnancy can be interpreted asbrain preparation for birth and certain maternal brain changes after birth can be interpreted asbrain recovery after the tremendous event of birth. This essay can be a starting point for new directions in neuroscience studies.

Continuous Support Promotes Obstetric Labor Progress and Vaginal Delivery in Primiparous Women - A Randomized Controlled Study

Background: Obstetric labor and childbirth are mostly regarded as a physiological process, whereas social, cultural, psychological and transcendental aspects have received less attention. Labor support has been suggested to promote labor progress. The aim of this study was to investigate whether continuous labor support by a midwife promotes labor progress and vaginal delivery. Material and Methods: A randomized controlled study at a university hospital in Sweden in 2015-17. Primiparous women with singleton pregnancy and spontaneous labor onset were randomized to continuous support (n = 30) or standard care (n = 29) during delivery. The primary outcome was the duration of active labor. Secondary outcomes were delivery mode, women's need of labor analgesia and satisfaction with delivery, maternal cortisol levels, and neonatal morbidity. Results: Continuous support was followed by shorter active labor 11.0 ± 5.7 h compared to 13.7 ± 3.9 h with standard care (p = 0.001). Women in the continuous support group tended to have lower cortisol levels and low cortisol during the first (p = 0.02) and second (p = 0.04) stages of labor were correlated with shorter active labor. Continuous support was followed by spontaneous delivery in 73%, instrumental delivery in 24% and emergency cesarean section in 3% in contrast to standard care which was followed by spontaneous delivery in 62%, instrumental delivery in 24% and cesarean in 14% (p = 0.19). The continuous support group received combined analgesic methods more often (p = 0.04). Women's satisfaction with delivery and neonatal morbidity were comparable. Conclusion: Continuous labor support was followed by shorter active labor compared to standard care. Women with continuous support had a high rate of vaginal delivery and tended to have lower cortisol levels during all stages of active labor reflecting a lower stress level. Low cortisol was correlated to shorter active labor. Based on these results, we recommend continuous labor support for all primiparous women during active labor.