Updated Decision Aid Enabling Women to Choose between with or without Epidural Analgesia during Childbirth, and Confirmation of Validity

BACKGROUND

The use of a decision aid for choosing whether to have or not have anesthesia during childbirth has been shown to increase both knowledge about birth and the proportion of women who made their own decisions compared with women who did not use a decision aid. Herein, we updated the first version of our decision aid into a second version and evaluated this updated decision aid. We evaluated the face validity and content appropriateness of the updated decision aid developed to enhance the ability of women to choose between childbirth with or without epidural analgesia.

METHODS

This was a descriptive study based on a literature review of updated information for addition to the first version. PubMed and Cochrane Library were searched from 2003 to May 2021. Thereafter, obstetricians, anesthesiologists, and midwives were asked to respond to a questionnaire regarding the face validity and content appropriateness of the updated decision aid regarding whether it meets the IPDASi (Version 4.0) quality standards.

RESULTS

One obstetrician, one anesthesiologist, and three midwives who had performed epidural anesthesia for at least three years responded to the questionnaire. The responses to the evaluation items of face validity (i.e., style and clarity) were positive. There were 38 specific comments regarding content appropriateness classified into seven categories: "addition or revision of text", "unification of expressions", "need for explanation/information", "lack of evidence", "potential to mislead", "questionable", and "structure".

CONCLUSION

The face validity and content appropriateness of the updated decision aid was confirmed. The next step is evaluation of the updated decision aid by pregnant women who give birth.

Effectiveness of antepartum breathing exercises on the outcome of labour: A randomized controlled trial

Background Childbirth is a life-transforming intense event to a woman and her family. Even though a variety of non-pharmacological techniques are readily available to alleviate the distress of women in labour, the majority of women are unaware of its benefits. The objective of the study was to explore the impact of a simple non-pharmacological technique i.e., antepartum breathing exercises on maternal outcomes of labour among primigravid women. Methods A single centre prospective, single-blinded, randomized controlled trial was conducted at the antenatal outpatient clinic of a secondary healthcare institution. Eligible primigravid women were randomized into intervention and standard care groups. Both groups received standard obstetrical care. In addition, the intervention group were taught antepartum breathing exercises and were advised to practise daily and also during the active stage of labour. The primary outcome of the trial was the maternal outcome of labour measured in terms of onset of labour, nature of delivery, duration of labour, and need for augmentation of labour. Data was collected using World Health Organization (WHO) partograph, structured observational record on the outcome of labour. Results A total of 98 (70%) primigravid women who practised antepartum breathing exercises had spontaneous onset of labour. The odds of spontaneous onset of labour after randomization in the intervention group was 2.192 times more when compared to standard care at a (95% confidence interval 1.31-3.36, p<.001). Also, the requirement for augmentation of labour was minimal and there was a reduction in the rate of caesarean deliveries ( p <.05) based on the χ2 test. The overall mean duration of labour was less compared to standard care group F(1)= 133.800, p <.001. Conclusion Antepartum breathing exercises during labour can facilitate spontaneous vaginal birth, shorten the duration of labour, and reduce the need for operative interference.

The effects of interferential electrical stimulation current on labor pain and duration of active phase of labor in primiparous women: A randomized controlled trial

BACKGROUND

Labor pain is one of the most severe pains experienced by a woman during her life. Interferential current (IFC) is a type of transcutaneous electrical stimulation that can reduce pain, especially deep ones.

OBJECTIVE

This randomized controlled clinical trial (RCT) aimed to study the effects of quadripolar IFC on pain and the duration of the active phase of labor in primiparous women.

METHOD

In this RCT, 60 primiparous women were randomized into two groups of IFC and sham IFC. The IFC group received IFC in two periods. The sham group received sham IFC. Primary outcomes were labor pain in different times of active phase and duration of active phase, and secondary outcomes were delivery satisfaction; the number of infants transferred to neonatal intensive care units (NICUs), fetal heart rate (FHR) disorders, Apgar score, partograph variables, and adverse side effects were recorded.

RESULT

Between-group changes showed a significant decrease in labor pain during the active phase in the IFC group compared to the sham IFC group (mean difference (MD) = -0.95; 95% confidence interval (95% CI) = -1.35 to -0.55; P < .001). The mean of active phase duration was significantly shorter in the IFC group than in the sham IFC group (MD = -38.25; 95% CI = -62.84 to -13.67; P = .003).

CONCLUSION

This study showed the effectiveness of interferential electrical stimulation during labor to reduce pain and duration of the active phase, which can be valuable in improving the quality of care and encouraging natural childbirth.

Peer Review Ensures Quality

In this column, the editor of The Journal of Perinatal Education (JPE) discusses the peer-review process utilized by JPE and why it is essential for quality. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

An Account of Labor and Birth Following a High-Risk Pregnancy That Ended in Induction of Labor at 37 Weeks: An Acknowledgment of When Option B Can Still Lead to a Positive Birth Experience

After two textbook pregnancies, I was not expecting my third to be any different. However, despite feeling well and exercising regularly, at 29 weeks, I was diagnosed with gestational diabetes. After taking insulin, I developed pregnancy-induced hypertension and oligohydramnios. Having studied to become a Lamaze Certified Childbirth Educator in 2017, I was keen to utilize all my learning and follow the six Healthy Birth Practices to avoid repeating the birth experiences I had had in 2012 and 2014. This is an account of when option B is presented as the best option for the safest end to pregnancy and the ways I tried to gain control of what I could the Lamaze way.

Birth Photos: #No Filter!

In this column, the editor of The Journal of Perinatal Education (JPE) shares a letter to the editor from a reader commenting on photos selected for the cover of JPE. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

A comparative study between the pioneer cohort of waterbirths and conventional vaginal deliveries in an obstetrician-led unit in Singapore

OBJECTIVE

Waterbirth has been increasing in popularity in Asia (Lea W. Water babies. The Straits Times 17 February 2011. Available at http://www.nuh.com.sg/news/media-articles_1504.html). National University Hospital, Singapore, is the pioneer hospital offering waterbirths to women since 2006 in a unique setting of a consultant-led service and continuous foetal monitoring. To date, no studies have been done on the conduct of waterbirths in an Asia. This study aims to evaluate if water immersion during delivery is associated with increased rates of adverse maternal and foetal outcomes as compared with conventional vaginal deliveries.

MATERIALS AND METHODS

Clinical records of women who birthed underwater at National University Hospital between 2010 and 2013 were retrospectively reviewed. Outcomes of interest were estimated blood loss, third- or fourth degree tears, incidence of postpartum infections or haemorrhage, neonatal Apgars at 1 and 5 min, and neonatal complications requiring intensive care unit admission. Outcomes were compared against a matched control group of women who had conventional vaginal deliveries within ≤1 month.

RESULTS

Records of 118 women who birthed underwater were accrued. There was no significant difference in estimated blood loss and postpartum haemorrhage between groups, and there were no cases of maternal infection, third- or fourth-degree perineal tears, or adverse neonatal outcomes in either group. Women in the control group were more likely to have episiotomies (63.6% vs. 0.85%; p < 0.01). Three cases of retained placenta were reported in the waterbirth group (0.03%).

CONCLUSION

Waterbirth at our centre does not appear to be associated with an increased incidence of adverse neonatal and maternal outcomes. The results of this study supported waterbirth as a birthing option to groups of low-risk women in an obstetrician-led setting with good midwifery support.

Factors Associated with Preference for Vaginal Birth among Undergraduate Students from Southern Brazil

BACKROUND

Cesarean rates in Brazil have reached over 50 percent of all births. Multiple factors have been studied aiming to explain these rates. Mode of delivery preferences among university students may provide insights into strategies to reduce those numbers.

METHODS

A cross-sectional study was conducted enrolling students who attended Health Sciences and Human Sciences undergraduate programs in 2013. Participants answered a semi-structured questionnaire about which mode of delivery they considered the "best" (less risky and more beneficial) and the "preferred" mode (the one they would choose for themselves or their partners). Pearson chi-square was used to assess association among variables. Multiple regression analysis identified independent factors associated with the outcome measures.

RESULTS

Among the 797 students who provided complete responses (76% response rate), the mean age was 22.6 years, 61.6 percent were female, 2.6 percent had previous pregnancies, and 56.7 percent were born by cesarean. Vaginal birth was chosen as the "best" mode of delivery by 91.2 percent, and the "preferred" mode by 75.5 percent of students. Being male, born vaginally, and a Health Sciences student was associated with a preference for vaginal birth. Being a Health Sciences student and born vaginally was associated with considering vaginal birth the "best" mode of delivery.

CONCLUSIONS

Our findings indicate that the recognition of the benefits of vaginal birth do not always translate into a personal preference for vaginal birth. The student's own mode of birth was a strong predictor of their preferences for mode of delivery.

Midwifery-Led Maternity Care: Back to Basics

In this column, the editor of The Journal of Perinatal Education discusses Britain's National Health Service's updated evidence-based guidelines stating that women with uncomplicated pregnancies are better off in the hands of midwives than hospital physicians during birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth. Women with uncomplicated pregnancies are better off in the hands of midwives than hospital physicians during birth.

Choosing Wisely for Birth

In this column, the editor of The Journal of Perinatal Education describes the American Academy of Nursing's engagement in the national Choosing Wisely campaign and how it has implications for promoting normal birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Kristen's Birth Story

Kristen shares the story of the birth of her son. She had a rapid labor and was not sure, because she was moving so quickly, that she could have the natural birth she planned. After a wait in triage, Kristen, with the support of her husband and mother, and with the encouragement, support, and protection of her midwife, gave birth to her son.

The Value of the Maternity Care Team in the Promotion of Physiologic Birth

The benefits of normal, physiologic birth have been well documented. Health care providers such as nurses, midwives, and physicians have distinct and significant roles in the promotion of physiologic birth processes. By supporting women and families, doulas can enhance the maternity care team and further facilitate physiologic birth. A collaborative maternity care team can foster and support a common goal of safe, satisfying, and affordable care practices associated with physiologic birth.

What to teach?

In this column, the editor of The Journal of Perinatal Education discusses why Lamaze International conducts a comprehensive job analysis of what childbirth educators are teaching and their beliefs of what is important for pregnant women and their partners to learn. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Whose Choice? Advocating Birthing Practices According to Baby's Biological Needs

Modern western society and media often present the mother's choices for her birth as paramount. Various gurus provide the mother with often conflicting advice. But the reality is that childbirth often becomes a medicalized event with many interventions and less than ideal outcomes. In many instances, the choices are made to suit health professionals and hospital routines rather than the mother. All the aforementioned are based on ideas and assumptions which predate evidence-based medicine and recent neuroscience. In reproductive biology, the newborn is an active participant and agent in birthing (Alberts, 1994). Based on this, the perspective which has been lacking is what is best for the baby; our choices should be primarily based on the basic biological needs of the infant.

The experience of perinatal care at a birthing center: a qualitative pilot study

The purpose of this qualitative descriptive pilot study was to describe women's experiences of care and satisfaction at a freestanding birth center. Data were collected through semistructured interviews with seven women who had given birth within 12 months of participant selection. Using qualitative content analysis, three themes emerged: (1) Empowerment, (2) Sense of Motherhood, and (3) Establishing and Strengthening Relationships. Data revealed that women value caring providers, that caring providers may affect positive outcomes, and that those outcomes may lead to a satisfactory experience.

Making a difference with evidence

In this column, the editor of The Journal of Perinatal Education describes how, despite the many challenges confronting childbirth educators today in our complex health-care environment, there is still a ray of hope that committed individuals translating evidence into practice can make a difference. The editor also describes the contents of this special issue, which celebrates the 50th anniversary of Lamaze International and offers a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth.

From psychoprophylactic to orgasmic birth

The assumptions on which educators based childbirth education principles were valid when psychoprophylactic birth became available. Yet, educators and health-care providers have changed their assumptions about birth as they have learned more from the midwifery model of care, how women want to give birth, and how capable the body is to give birth. Educators' teaching must now emphasize the synchrony of hormones that facilitates birth, the Sphincter Law, and the sharing of woman-to-woman stories throughout the generations if birth is to be set in its rightful place-in the hands of the mothers.

Health-care reform for childbirth

In this column, the editor of The Journal of Perinatal Education discusses the current health-care crisis and the need for health-care reform to promote, support, and protect natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.

Home birth matters-for all women

Although it remains rare in the United States, planned home birth has drawn increasing attention and criticism in the mainstream media and has come under attack from organized medicine. Yet, recent peer-reviewed studies contribute to the evidence base supporting home birth as a safe option for low-risk women attended by skilled midwives. The author of this editorial argues that home birth is an important cultural touchstone in the landscape of American maternity care.

Role models for pregnancy, birth, and breastfeeding

In this column, the editor of The Journal of Perinatal Education discusses how the media provide role models-good and bad-for pregnancy, birth, and breastfeeding. There is a critical need for more positive role models that promote natural, safe, and healthy pregnancy and birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth.

Teaching physiologic birth in maternal-newborn courses in undergraduate nursing programs: current challenges

For low-risk childbearing women, fewer technological interventions are associated with better physical and psychosocial outcomes; yet, the number of unmedicated physiologic births is decreasing. As a result, fewer undergraduate nursing students experience caring for women who choose physiologic birth, which presents a challenge for nurse educators and implications for preparing students to provide appropriate care for all childbearing women after the students graduate. This exploratory descriptive qualitative study was conducted among 150 randomly selected undergraduate nursing programs in the United States to explore the challenges of educating nursing students about low-intervention birth. Four themes described current challenges: lack of placement opportunities, education versus clinical practice, evidence-based support of physiologic birth, and the need for more research on pedagogical strategies that effectively educate future nurses to advocate for minimal intervention birth options for all women.

Witnessing a natural, safe, and healthy birth

In this column, the editor of The Journal of Perinatal Education discusses her experience witnessing a natural, safe, and healthy home birth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.

Creating community

In this column, the editor of The Journal of Perinatal Education describes ways that Lamaze International is helping to create a community for those who share a common interest in promoting, supporting, and protecting natural, safe, and healthy childbirth. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote normal birth.

Turning the tide for birth

In this column, the editor of The Journal of Perinatal Education discusses the escalating cesarean surgery rate and the need for evidence-based practice changes that support vaginal birth after cesarean. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth practices.

Ratings and rankings

In this column, the editor of The Journal of Perinatal Education describes ranking systems for scholarly journals. The editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote natural, safe, and healthy birth.

New resources for childbirth educators and parents

In this column, reviewers offer perspectives and comments on a variety of new media resources for childbirth educators and for expectant and new parents. The DVDs and books reviewed in this issue's column address the following topics: cultural views of labor and birth, as portrayed in the U.S. media; natural, safe, and healthy birth practices; memoirs of a midwife; a description of doula care to share with the children of expectant parents; baby behaviors; empowering women to choose the birth experience they want; making informed decisions about cesarean surgery; information and stories of hope for parents dealing with an infant in the neonatal intensive care unit; ways for parents to cope with perinatal or neonatal loss; and fathers' supportive role during the prenatal and postpartum periods.

Persuasion: The Key to Changing Women's Ideas About Birth

Although standard maternity care is not evidence-based and, in many cases, increases risks for mothers and babies, few women make birth decisions that reflect this knowledge. This column discusses persuasion as a way to change women's ideas about safe, healthy birth. The relationship between persuasion and choice is discussed, and the differences between presenting information and persuading women that natural birth is the safest and healthiest way to give birth are explored.

Hitting the right notes

In this guest editorial, the author discusses her personal birth experiences, how her health-care provider's perceptions affected her care management, and how advocates for mother-friendly maternity care can impact the perceptions of health-care providers, families, and communities by using the most powerful messages about the value of natural birth.

First, do no harm: how routine interventions, common restrictions, and the organization of our health-care system affect the health of mothers and newborns

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the "First, do no harm" principle in a different way. New research on the potentially harmful effects of intravenous lines demonstrates that refraining from routine interventions in labor protects the safety of women and babies. A new systematic review of movement and position changes in labor shows that eliminating unfounded restrictions also protects maternal and infant health and well-being. Finally, a study of patterns of use of neonatal intensive care units reveals how the organization of the maternity care system itself can affect the health outcomes of its beneficiaries.

Deconstruction junction: how to separate the good evidence from the bad (from the ugly)

In this column, the author reprises recent selections from the Lamaze International research blog, Science & Sensibility. Each selection discusses a new study that demonstrates the need to look closely at research articles to avoid being misled. Examples include new research on the effectiveness of intrapartum antibiotics for preventing early onset Group B streptococcal disease in newborns, a recent study on the incidence of infection after cesarean surgery and vaginal birth, and a new study demonstrating long-term benefits of skin-to-skin contact between the mother and infant after birth.

Post-ecstatic birth syndrome

In this column, the author suggests the use of positive terminology as a way to influence the dominant viewpoint of childbirth towards the midwifery model of care.

Home birth: safely protecting and supporting normal birth

In this column, the author examines the safety and advantages of home birth. She urges childbirth educators to promote normal birth by encouraging pregnant women to consider the option of home birth.

Promoting, protecting, and supporting normal birth

This column discusses ways in which childbirth educators can promote, protect, and support normal birth to help make it the standard.

Can visions of natural births dance in our heads?

Through the observations of a childbirth educator of women who are planning epidurals, these women's vision of birth can be contrasted with a vision of the inner-strength-promoting experience that birth can be.

Does lamaze "work"?

In answer to a reader's question, this column affirms that Lamaze preparation for birth is important and valuable.