Normal birth rates before and after the merging of mixed-risk and low-risk maternity wards in Iceland: A retrospective cohort study on the impact of inter-professional preventative measures

BACKGROUND

In 2014, the National University Hospital of Iceland (NUHI) merged a mixed-risk birth unit and a midwifery-led low-risk unit into one mixed-risk unit. Interprofessional preventative and mitigating measures were implemented since there was a known threat of cultural contamination between mixed-risk and low-risk birth environments. The aim of the study was to assess whether the NUHI's goal of protecting the rates of birth without intervention had been achieved and to support further development of labor services.

METHODS

A retrospective cohort study of all women who had singleton births at NUHI birth units in two 2-year periods, 2012-2013 and 2015-2016. The primary outcome variables, birth without intervention, with or without artificial rupture of membranes (AROM), were adjusted for confounding variables using logistic regression analysis. Secondary outcome variables (individual interventions and maternal and neonatal complications) were analyzed using descriptive statistics, t test, and Chi-square test.

RESULTS

The rate of births without interventions, both with and without AROM, increased significantly after the unit merger and accompanying preventative measures. The rates of AROM, oxytocin augmentation, episiotomies, and epidural analgesia decreased significantly. The rate of induction increased significantly. There were no significant differences in maternal or neonatal complication rates.

CONCLUSIONS

Interprofessional preventative measures, implemented alongside a mixed-risk and low-risk birth unit merger, can increase rates of births without interventions in a mixed-risk hospital setting. However, it is necessary to maintain awareness of the possible effects of a mixed-risk birth environment on the use of childbirth interventions and examine the long-term effects of preventative measures.

Being in charge in an encounter with extremes. A survey study on how women experience and work with labour pain in a Nordic home birth setting

PROBLEM

There is a knowledge gap regarding women's experiences of coping with labour pain when not soliciting or not having access to pharmacological pain relief.

BACKGROUND

How women manage labour pain is complex, multifaceted and only the woman giving birth can assess the experienced pain. Women in the Nordic countries planning for a homebirth have little or no access to pharmacologic pain relief during labour.

AIM

The aim of this study was to explore how women experience and work with labour pain when giving birth in their own home.

METHODS

Quantitative and qualitative data was prospectively collected and altogether 1649 women with a planned homebirth answered closed and open-ended questions about labour pain and birth experience.

RESULTS

While labour pain was often experienced as positive or very positive, the intensity was experienced as severe or the worst imaginable pain. Two main themes arose from the womens´ descriptions of their birth experience regarding labour pain: An encounter with extremes and Being in charge at home.

DISCUSSION

Women perceived labour pain as severe but manageable and were dedicated to completing the birth at home. Being at home enabled the women to exercise autonomy and work with labour pain on their own terms, together with the midwife and support persons.

CONCLUSIONS

This study provides knowledge about women's experiences of labour pain in a home birth setting who used varying strategies to work with labour pain. This is a subject that should be explored further since results could also apply to facility-based birth settings.