Natural childbirth and cesarean section - descriptive analysis of queries in Google search engine

OBJECTIVES

The use of internet-based search engines for health information is very popular and common. The Internet has become an important source of health information and has a considerable impact on patient's decision making process. Knowledge of pregnant women about childbirth comes from health professionals and personal experiences described by friends or family members. There is a growing interest in digital sources used by pregnant women. Analysis of queries related to regarding to natural childbirth and cesarean section in the Google search engine.

MATERIAL AND METHODS

In this infodemiology, descriptive study tool "AlsoAsked" was used. This is a tool for analyzing data appearing in Google search results. "AlsoAsked" search was conducted on April 19, 2023. Search phrases "natural childbirth" and "cesarean section" in polish language were used. Questions that were typed into the Google search engine, ranked according to popularity (volume) and thematic connections have been discussed.

RESULTS

The most frequently asked questions were related to the course and duration of labor as well as the preparation for labor and cesarean section (CS). Comparison between a natural labour and CS in the context of safety and pain received a great deal of attention.

CONCLUSIONS

The most popular questions regarding CS were related to elective CS and indications for it. Some questions concerned the connection between labor and clinical state of a newborn.

Prevalence and factors associated with the perception of perineal laceration: a cross-sectional study with data from the Nascer no Brasil Survey, 2011 and 2012

OBJECTIVE

To describe the prevalence of perineal laceration, based on the self-reported perception of postpartum women, and to analyze factors associated with its occurrence in Brazil.

METHODS

This was a cross-sectional study conducted with 23,894 postpartum women, excluding twin pregnancies, cesarean sections, and births with episiotomies, between 2011 and 2012. Prevalence ratios (PR) and 95% confidence intervals (95%CI) of association between the event and maternal, fetus/newborn, obstetric and clinical management characteristics were estimated in hierarchical Poisson regression models.

RESULTS

Out of 4,606 postpartum women, 49.5% (95%CI 46.1;42.9) self-reported perineal laceration. Being an adolescent (PR = 1.12; 95%CI 1.02;1.25), primipara (PR = 1.47; 95%CI 1.33;1.63), having had excessive gestational weight gain (PR = 1.17; 95%CI 1.07;1.29) and having undergone the Kristeller maneuver (PR = 1.18; 95%CI 1.08;1.29) increased the proportion of the outcome.

CONCLUSION

The results found call for prenatal care and adjustments to childbirth care so as to be in accordance with current recommendations.

MAIN RESULTS

Prevalence of self-reported perineal laceration was 49.5%. Being in the adolescent age group, primiparity, excessive gestational weight and the Kristeller maneuver were risk factors associated with the event.

IMPLICATIONS FOR SERVICES

Studying self-reported prevalence of perineal laceration supports new care practices, highlights the prevention of risk factors considered modifiable and confirms the need to follow current guidelines.

PERSPECTIVES

New national studies are needed comparing prevalence of self-reported perineal laceration with that recorded in medical records in order to support care practices and public obstetric policies.

The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice

The "A Randomized Trial of Induction Versus Expectant Management" trial (ARRIVE trial) published in 2018 suggested that induction of labor can be considered a "reasonable option" for low-risk nulliparous women at ≥39 weeks of gestation. The study results led some professional societies to endorse the option for elective induction of labor at 39 weeks of gestation in low-risk nulliparas, and this has begun to change obstetrical practice. The ARRIVE trial provided valuable information supporting the benefits of induction of labor; however, the trial is insufficient to serve as the primary justification for widespread elective induction of labor at 39 weeks of gestation in low-risk nulliparas because of concerns about external validity. Thus, the French ARRIVE trial was designed to test the hypothesis in a different setting that elective induction of labor at 39 weeks of gestation in low-risk nulliparas leads to a lower cesarean delivery rate than expectant management. This ongoing trial has been criticized as "pseudoscientific" and telling "women where, when, and how to give birth." We reject these allegations and extensively examine the ethical framework that should govern clinical and research interventions, including elective induction of labor at 39 weeks of gestation in low-risk nulliparas. This study aimed to discuss the ethical issues that emerge from randomized trials of elective induction of labor at 39 weeks of gestation in low-risk nulliparas and the ethics of the clinical practice itself. The analysis of existing evidence shows the importance of further research on induction of labor at 39 weeks of gestation in low-risk women. Certain aspects of research ethics in this area, particularly the consent of pregnant women in a context where autonomy remains fragile, call for vigilance. In addition, we emphasize that childbirth is not only a medical object but also a social phenomenon that cannot be regarded only from the perspective of a health risk to be managed by clinical research. Further research on this issue is needed to allow pregnant women to make informed decisions, and the results should be integrated with social issues. The perspective of women is required in constructing, evaluating, and implementing medical interventions in childbirth, such as induction of labor at 39 weeks of gestation.

Comparison of the Percentage of Umbilical Cord Nucleated Red Blood Cells in Preterm Neonates during Vaginal Delivery and Emergency Cesarean Section

Background

There are insufficient and contradictory reports regarding the effect of delivery method on the rate of umbilical cord Nucleated Red Blood Cell (NRBC). Therefore, the present study aimed to compare the percentages of umbilical cord NRBC in vaginal delivery and emergency cesarean section (C-section) in preterm neonates.

Materials and Methods

The present cross-sectional study was performed on mothers with vaginal delivery and C-section, from 2020 to 2021. The samples (n = 221) were preterm neonates selected using the convenience sampling method. The percentages of NRBC in neonates born by natural childbirth and by emergency C-section were measured and compared in this research. A researcher-made checklist, which included maternal and neonatal characteristics and laboratory evaluation, was used as a data collection tool.

Results

The statistical population of thisresearch included 93 (42.10%) and 128 (57.90%) neonates born by vaginal delivery and by C-section, respectively.The mean (SD) score of gestational ages at birth was 30.75 (2.81) weeks. The mean (SD) score of umbilical cord NRBC level were estimated at 8.01 (5.93) and 25.64 (22.61) for the neonates born by natural childbirth and by emergency C-section, respectively (t=-8.43, df = 150, p<0.001). Statistically significant differences were observed in the gestational age (t=-3.36, df = 218, p = 0.001), fifth-minute Apgar score (t=-2.32, df = 200, p = 0.021), umbilical cord NRBC (t=-8.43, df = 160, p<0.001), and short-term prognosis (p = 0.032) between the two groups. It was also revealed that the number of NRBCs in the dead neonates was about 1.5 times higher than that in the discharged neonates.

Conclusions

Based on the results of the present study, emergency C-section increased the mean of umbilical cord NRBC by three times, compared to that of normal delivery. Since an increase in the NRBC raises the risk of infant death, it is advisable to take steps to maintain the health of children by identifying high-risk neonates through umbilical cord NRBC measurement immediately after delivery and special care.

Midwives' perceptions of and experiences with normal physiologic birth: A qualitative systematic review

BACKGROUND

Normal physiologic birth has been shown to result in optimal maternal-infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised.

OBJECTIVE

In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births.

METHODS

Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home-based, community-based, and hospital-based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically.

RESULTS

Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self-confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person-centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision-making. The midwife-client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth.

CONCLUSIONS

This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth.

Characteristics of women who underwent one or more previous cesarean sections according to Nascer no Brasil

OBJECTIVE

To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil.

METHODS

The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2). Variables with significant differences (p < 0.05) were incorporated into logistic regression.

FINDINGS

Out of the total of 23,894 women, 20.9% had undergone a previous cesarean section. The majority (85.1%) underwent another cesarean section, with 75.5% occurring before the onset of labor. The rate of Vaginal Birth After Cesarean (VBAC) was 14.9%, with a success rate of 60.8%. Women who underwent three or more cesarean sections displayed greater social vulnerability. The chances of VBAC were higher among those who opted for a vaginal birth towards the end of gestation, had a prior vaginal birth, underwent labor induction, were admitted with over 4 centimeters of dilation, and without partner. Receiving care from the private health care system, having two or more prior cesarean sections, obstetric complications, and deciding on cesarean delivery late in gestation reduced the chances of VBAC. Age group, educational background, prenatal care adequacy, and the reason for the previous cesarean section did not result in significant differences.

CONCLUSION

The majority of women who underwent a previous cesarean section in Brazil are directed towards another surgery, and a higher number of cesarean sections is linked to greater social inequality. Factors associated with VBAC included choosing vaginal birth towards the end of gestation, having had a previous vaginal birth, higher cervical dilation upon admission, induction, assistance from the public health care system, absence of obstetric complications, and without a partner. Efforts to promote VBAC are necessary to reduce overall cesarean rates and their repercussions on maternal and child health.

The Experience of Women Giving Birth after Cesarean Section-A Longitudinal Observational Study

Natural childbirth after a previous cesarean section is a debated issue despite scientific research and international recommendations. This study aimed to examine the experiences of women giving birth after a previous cesarean section, their preferences, and changes in attitudes towards childbirth after labor. This longitudinal study involved 288 pregnant women who had a previous cesarean section and completed a web-based questionnaire before and after labor, including information about their obstetric history, birth beliefs, and preferred mode of delivery. Among women who preferred a vaginal birth, nearly 80% tried it and 49.78% finished delivery by this mode. Among women declaring a preference for an elective cesarean section, 30% attempted a vaginal birth. Choosing a hospital where staff supported their decision (regardless of the decision) was the most helpful factor in preparing for labor after a cesarean section (63.19%). Women's birth preferences changed after labor, with women who had a vaginal birth after a cesarean section preferring this mode of delivery in their next pregnancy (89.34%). The mode of birth did not always follow the women's preferences, with some women who preferred a natural childbirth undergoing an elective cesarean section for medical reasons. A variety of changes were noticeable among women giving birth after a cesarean section, with a large proportion preferring natural birth in their next pregnancy. Hospitals should support women's birth preferences after a cesarean section (if medically appropriate), providing comprehensive counseling, resources, and emotional support to ensure informed decisions and positive birth experiences.

Women's Birth Beliefs During Pregnancy and Postpartum in the Netherlands: A Quantitative Cross-Sectional Study

INTRODUCTION

Women and care providers increasingly regard childbirth as a medical process, resulting in high use of medical interventions, which could negatively affect a woman's childbirth experience. Women's birth beliefs may be key to understanding the decisions they make and the acceptance of medical interventions in childbirth. In this study we explore women's beliefs about birth as a natural and medical process and the factors that are associated with women's birth beliefs.

METHODS

Data were obtained from a cross-sectional survey of women living in the Netherlands asking them about their experiences during pregnancy and childbirth, including their beliefs about birth as a natural and medical process.

RESULTS

A total of 3494 women were included in this study. Mean scores of natural birth beliefs ranged between 3.73 and 4.01 points, and medical birth belief scores ranged between 2.92 and 3.12 points. There were significant but very small changes between prenatal and postnatal birth beliefs. Regression analyses showed that (previous) childbirth experiences were the most consistent predictor of women's birth beliefs.

DISCUSSION

Women's high scores on natural birth beliefs and lower scores on medical birth beliefs correspond with the philosophy of Dutch perinatal care that considers pregnancy and childbirth to be natural processes. Perinatal care providers must be aware of women's birth beliefs and recognize that they as professionals influence women's birth beliefs. They make an important contribution to women's perinatal experiences, which affects both women's natural and medical birth beliefs.

Birthing balls to decrease labor pain and peanut balls to decrease length of labor: what is the evidence?

Birthing balls and peanut balls have been used for decades by nurses and midwives as a nonpharmacologic adjunct to labor management based on anecdotal evidence. This article aimed to review the evidence regarding their safety and efficacy based on randomized controlled trials. Birthing balls are round exercise balls that a laboring individual can use for sitting, rocking, and pelvic rotation. The use of the birthing balls has been thought to increase maternal comfort and mimic upright positioning to widen the pelvic outlet for those laboring without an epidural. A recent meta-analysis showed that the use of the birthing ball in labor significantly reduces maternal pain in labor by 1.7 points on a standard visual analog scale of 1 to 10 (mean difference, -1.70 points; 95% confidence interval, -2.20 to -1.20). The use of the birthing ball does not significantly affect the mode of delivery or the rate of other obstetrical complications. This suggests that its use is safe and can offer subjective improvement in maternal pain experienced during labor. The peanut ball is a peanut-shaped plastic ball placed between the knees of a person laboring in the lateral recumbent position, a position common in those laboring with an epidural. Traditionally, its use has been thought to allow for bent-knee positioning that can mimic a squatting position and facilitate frequent and optimal position changes during labor. Data regarding the effects of the peanut ball are mixed. A recent systematic review and meta-analysis found that the use of the peanut ball compared with no peanut ball is associated with a significantly decreased first stage of labor (mean difference, -87.42 minutes; 95% confidence interval, -94.49 to -80.34) and an 11% higher relative risk of vaginal delivery (relative risk, 1.11; 95% confidence interval, 1.02-1.22; n=669). The use of the peanut ball is not associated with increased incidences of obstetrical complications. As such, it is reasonable to offer to individuals in labor. There has been no reported risk of the use of either the birthing ball or the peanut ball. As such, both interventions can be offered to individuals in labor as an adjunct to labor management techniques based on moderate quality evidence.

Effect of birth plans integrated into childbirth preparation classes on maternal and neonatal outcomes of Iranian women: A randomized controlled trial

Background

Involvement of women in the decision-making process during childbirth plays an important role in their physical and psychosocial preparation. A birth plan allows the woman to express her expectations and facilitates her participation in her own care. The present study is the first to assess the implementation of birth plans integrated into childbirth preparation classes in Tehran, Iran.

Methods

This study is a randomized controlled clinical trial performed on 300 pregnant women at 32-33 weeks of gestation referring to four public health centers in Tehran, Iran. The participants were randomly allocated into intervention and control groups using block randomization method. A training session on the items of the birth plan checklist was held in the fifth session of childbirth preparation classes for the participants in the intervention group. Accordingly, a birth plan was prepared according to the requests of mothers. The birth plan was implemented after the women were admitted to the maternity ward. The primary outcomes were frequency of vaginal birth, mean duration of labor stages, and mean score of childbirth satisfaction. We used a checklist of maternal and neonatal outcomes, Mackey's childbirth satisfaction questionnaire, and a partogram form for data collection. Independent t-test, Mann-Whitney U-test, Chi-square test, Fisher's exact test, and logistic regression were used for data analysis.

Results

Vaginal birth rates were significantly higher in women who had birth plans compared with those without (81.9% vs. 48.7%, p < 0.001). Also, the lengths of the first and the second stages of labor were significantly shorter in women having a birth plan (p = 0.02). Women in the birth plan group were significantly more satisfied with the process of labor and childbearing (p < 0.001), and started breastfeeding after birth earlier than those in the control group (p < 0.001).

Conclusion

Having a birth plan and attending childbirth preparation classes can increase the rate of normal vaginal birth. Also, according to our results, women's participation in the decision- making process and fulfilling their preferences during birth can improve maternal and neonatal outcomes and childbirth satisfaction.Trial registration: IRCT20190415043283N2. 2020-12-07.

"Dispatcher, Can You Help Me? A Woman Is Giving Birth". A Pilot Study of Remote Video Assistance with Smart Glasses

Smart glasses (SG) could be a breakthrough in emergency situations, so the aim of this work was to assess the potential benefits of teleassistance with smart glasses (SG) from a midwife to a lifeguard in a simulated, unplanned, out-of-hospital birth (OHB). Thirty-eight lifeguards were randomized into SG and control (CG) groups. All participants were required to act in a simulated imminent childbirth with a maternal−fetal simulator (PROMPT Flex, Laerdal, Norway). The CG acted autonomously, while the SG group was video-assisted by a midwife through SG (Vuzix Blade, New York, NY, USA). The video assistance was based on the OHB protocol, speaking and receiving images on the SG. The performance time, compliance with the protocol steps, and perceived performance with the SG were evaluated. The midwife’s video assistance with SG allowed 35% of the SG participants to perform the complete OHB protocol. No CG participant was able to perform it (p = 0.005). All OHB protocol variables were significantly better in the SG group than in the CG (p < 0.05). Telemedicine through video assistance with SG is feasible so that a lifeguard with no knowledge of childbirth care can act according to the recommendations in a simulated, unplanned, uncomplicated OHB. Communication with the midwife by speaking and sending images to the SG is perceived as an important benefit to the performance.

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 effect of backup midwife on maternal experience after vaginal childbirth - a qualitative study

One of the goals of reproductive health enhancement is to ensure the desired experience of safe childbirth by reducing possible complications, fears, and worries about delivery by ongoing midwife backup care. This study explains women's experiences with a backup midwife during labor and childbirth. This was a qualitative study involving 19 women who had natural childbirth in Hamadan, 2020. Purposeful sampling and data collection were performed using semi-structured in-depth interviews. Data were analyzed by conventional content analysis using MAXQDA software version 10. Data analysis showed three themes and six main categories. The themes included security, high-quality care, and respectful care, consisting of two main categories of perceived empowerment and support, physiological approach and reassuring care, and respect for the mother's privacy and optimal accountability. The presence of a backup midwife during labor caused a sense of security, control, and perceived empowerment, thus a positive childbirth experience. Therefore, it is necessary to train and employ midwifery in the healthcare system. It is recommended to train and employ midwifery graduates for this purpose and include it as one of the basic principles in the current planning to promote natural childbirth.

Celebrate Birth!-A Life's Journey

In this column, the author describes her experience of being with a woman giving birth naturally and the profound effect this had on her life personally and professionally. The experience set the stage for her own natural births and a lifetime of advocating for safe, healthy birth.

Does pregnancy influence eye parameters? Assessment of choroidal thickness using EDI-OCT before and after labour depending on the way of delivery method

OBJECTIVES

The aim of this study is to assess the choroidal thickness (CT) with use of EDI-OCT in patients before and after delivery depending on the mode of delivery.

MATERIAL AND METHODS

The study involved 146 eyes of 73 patients aged 20-34 years, after natural labour (66 eyes) and C-section (80 eyes). Main inclusion criteria: Informed consent to participate in the study, age 18-35 years, single pregnancy, spherical refraction error -4.00 to +4.00 D, no eye pathologies, no surgery and ophthalmic procedures-including refractive surgery, childbirth after 36 weeks of pregnancy, BCVA = 1.0. Patients were examined twice: in 36 WG and on 6th week after the birth. All examinations were carried out between 8:00 am and 10:00 am in order to avoid daily cycle fluctuations. CT measurements were made manually by two independent researchers at: subfoveal and 500 μm, 1000 μm, 1500 μm, 3000 μm temporally and nasally. The student's t-test was made.

RESULTS

In C-section group CT differences before and after delivery were statistically significant in 7/9 of the analysed areas. Mean subfoveal choroidal thickness was 370.86 μm vs 388.71 μm in 36 WG and in 6th week postpartum respectively (p = 0.0003). In women after natural labour, differences were statistically significant in 3/9 of the analysed areas. Mean subfoveal choroidal thickness was 303.27 μm vs 308,34 μm in 36 WG and in 6th week postpartum respectively (p = 0.4800).

CONCLUSIONS

The thickness of the choroid was lower in women in 36 WG in comparison to 6th week after birth. Changes in the thickness of the choroid are particularly noticeable in women after caesarean section.

Informed consent and birth preparedness/complication readiness: A qualitative study at two tertiary maternity units

BACKGROUND

Informed consent in obstetrics should involve full disclosure of risks, benefits and alternative interventions. However, we have found no evidence of a formal informed consent process before an attempt at vaginal delivery in published policy or practice. The idea of informed consent in vaginal birth has attracted controversy and has been the subject of some debate.

AIM

To explore the perspectives and experiences of informed consent and birth preparedness/complication readiness for birthing women in a high resource setting.

MATERIALS AND METHODS

Qualitative study using semi-structured interviews to examine experiences and perspectives of women following birth.

RESULTS

Forty telephone interviews were concluded. Eight statement categories were identified: (i) no issues of consent, (ii) absent/inadequate informed consent, (iii) adequate birth preparedness/complication readiness, (iv) inadequate birth preparedness/complication readiness, (v) desire to forfeit decision making to a trusted and accountable health professional, (vi) belief that informed consent is not realistic in birth under some circumstances, (vii) negative feelings related to birth and (viii) poor postnatal follow-up.

CONCLUSIONS

When complications arose during birth, 20% of participants felt that informed consent was absent/inadequate, 25% of participants suggested policy change in favour of a formal informed consent process and 55% of participants suggested policy change in favour of increased birth preparedness/complication readiness. Our study suggests that informed consent for vaginal birth and formal birth preparedness/complication readiness should form part of routine antenatal care. Women's preferences for decision-making and informed consent should be established before birth.

Can pelvic floor muscle training prevent perineal laceration? A systematic review and meta-analysis

BACKGROUND

Pelvic floor muscle training (PFMT) is reportedly able to reduce risk factors for perineal trauma. However, the effects of these exercises on perineal injuries are unclear.

OBJECTIVE

To investigate the effectiveness of PFMT in the prevention of perineal laceration.

SEARCH STRATEGY

Searches were conducted in PubMed/Medline, LILACS, Scopus, Cochrane Library, Web of Science, and CINAHL. For search strategies, we combined the terms PFMT, tear, laceration, perineum, and delivery.

SELECTION CRITERIA

We included randomized controlled trials that evaluated the effectiveness of PFMT for the prevention of perineal laceration during vaginal delivery. There were no period or language limitations.

DATA COLLECTION AND ANALYSIS

We conducted data extraction and synthesis. We performed a quality appraisal, a qualitative synthesis, and for meta-analysis we used the Software R.

MAIN RESULTS

Nine studies were included. In most studies, PFMT was performed daily, with a wide range of the number of contractions and sustainability. Prevalence of perineal laceration had a wide range and information on laceration degree was limited. Meta-analysis showed that PFMT was not effective to prevent perineal laceration.

CONCLUSION

Pelvic floor muscle training does not prevent perineal laceration. Further studies are needed to investigate different protocols and interventions.

Effectiveness of Moderate-Intensity Aerobic Water Exercise during Pregnancy on Quality of Life and Postpartum Depression: A Multi-Center, Randomized Controlled Trial

Background: The global prevalence of postpartum depression is about 20%. This disease has serious consequences for women, their infants, and their families. The aim of this randomized clinical trial was to analyze the effectiveness and safety of a moderate-intensity aerobic water exercise program on postpartum depression, sleep problems, and quality of life in women at one month after delivery. Methods: This was a multi-center, parallel, randomized, evaluator blinded, controlled trial in a primary care setting. Pregnant women (14–20 weeks gestational age) who had low risk of complications and were from five primary care centers in the area covered by the obstetrics unit of Son Llatzer Hospital (Mallorca, Spain) were invited to participate. A total of 320 pregnant women were randomly assigned to two groups, an intervention group (moderate aquatic aerobic exercise) and a control group (usual prenatal care). One month after birth, sleep quality (MOS sleep), quality of life (EQ-5D), and presence of anxiety or depression (EPDS) were recorded. Findings: Women in the intervention group were less likely to report anxiety or depression on the EQ5D (11.5% vs. 22.7%; p < 0.05) and had a lower mean EPDS score (6.1 ± 1.9 vs. 6.8 ± 2.4, p < 0.010). The two groups had no significant differences in other outcomes, maternal adverse events, and indicators of the newborn status. Conclusion: Moderate-intensity aquatic exercise during pregnancy decreased postpartum anxiety and depressive symptoms in mothers and was safe for mothers and their newborns.

The Challenges and Achievements in the Implementation of the Natural Childbirth Instruction Program: A Qualitative Study

Background

The natural childbirth instruction program, which aims to reduce the cesarean section (C-section) rates in the country and pay attention to demographic policies, has achieved significant accomplishments in the short time span since it was implemented throughout the country. In the present study, the advantages and challenges of the implementation of this program have been analyzed.

Materials and Methods

This qualitative study carried out with the participation of 32 knowledgeable individuals who were selected using purposeful sampling and snowball sampling methods among the personnel of Kerman University of Medical Sciences, and it's affiliated educational (university) hospital. The data were collected through semi-structured interviews based on the research objectives, review of texts, and experts' experiences. Data analysis was performed using content analysis method in MaxQDA software.

Results

Data analysis provided the 5 main categories of implementation instructions' strengths, implementation instructions' defects, implementation instructions' achievements, implementation instructions' challenges and threats, and suggestions.

Conclusions

Accountability in the system that provides health care services for pregnant mothers in public hospitals has been created through the implementation of the natural childbirth promotion package. If managerial barriers and executive and legal inefficiencies are followed up and suitable measures are taken for solving the intra-system conflicts, we can hope that the package, which has been one of the most serious efforts made by the Ministry of Health over the past decades to reduce cesarean delivery, will achieve significant accomplishments.

Birthing ball for reducing labor pain: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

Multiple factors are thought to affect a woman's sensation of pain during the process of labor. Birthing balls are round exercise balls upon which a woman sits during labor and performs different movements such as rocking back and forth and pelvic rotation. Midwives and nurses have been using birthing balls (also known as Swiss balls) to increase maternal comfort, widen the pelvic outlet, and facilitate progression of labor for women laboring without an epidural. Therefore, the aim of this systematic review and meta-analysis of randomized controlled trials is to assess whether the use of the birthing ball in labor decreases maternal pain during labor.

DATA SOURCES

Research was conducted using PubMed, Scopus, ClinicalTrial.gov, OVID and Cochrane Library as electronic databases. Randomized controlled trials were identified using the following search strategy: "birthing ball" OR "birth ball" OR "swiss ball" OR "exercise ball" AND labor from the inception of each database to June 2019. No restrictions for language or geographic location were applied.

STUDY ELIGIBILITY CRITERIA

Selection criteria included randomized trials of pregnant women with a singleton, cephalic fetus who were randomized to either birthing ball or control group (i.e. no birthing ball) for use in labor.

STUDY APPRAISAL AND SYNTHESIS METHODS

Seven trials with 533 pregnant women were included. 287 (53.8%) were randomized to the intervention group (birthing ball) and 246 (46.2%) were randomized to the control group (no birthing ball). All analyses were done using an intention-to-treat approach, evaluating women according to the treatment group to which they were randomly allocated in the original trials. The primary outcome was labor pain in the first stage of labor. The summary measures were reported as summary relative risk (RR) or as summary mean difference (MD) with 95% of confidence interval (CI) using the random-effects model of DerSimonian and Laird.

RESULTS

Labor pain significantly decreased by 1.70 points in the birthing ball group compared to the control group (MD -1.70 points; 95% CI -2.20 to -1.20). Use of the birthing ball versus no birthing ball did not result in a significant difference in incidence of spontaneous vaginal delivery, operative vaginal delivery, cesarean delivery, or perineal lacerations.

CONCLUSION

The birthing ball is an effective method of pain reduction during labor for women laboring without an epidural.

Exploring Why Birth Center Clients Choose Hospitalization for Labor and Birth

OBJECTIVE

To identify demographic and clinical factors associated with birth center clients electing hospitalization for labor and birth and to explore the timing and rationale for elective hospitalization via health records.

DESIGN

A secondary analysis of multiyear data from a quality assurance project at a single birth center. We compared two subsamples-birth center preference group and hospital preference group-and described the apparent rationale for transfers among clients in the latter group.

SETTING

A single freestanding birth center where all midwives have admitting privileges at a local hospital and can accompany labor transfers.

PARTICIPANTS

All cases included in the analytic sample represent women with low-risk pregnancies who were eligible for birth center birth. The birth center preference group represents clients planning to give birth at the center, and the hospital preference group consists of clients who elected for hospitalization.

MEASUREMENTS

Relevant demographic and clinical information was provided for the entire analytic sample and was matched with available data collected systematically by birth center staff via chart review. The data set also included anonymous responses to an e-mailed questionnaire from clients identified by birth center staff.

RESULTS

Approximately 56.1% (N = 1,155) of the cases in the data set were eligible for comparative analysis. The birth center preference and hospital preference groups included 899 (77.8%) and 256 (22.2%) individuals, respectively. In the hospital preference group, Black clients (n = 23), those who were publicly insured (n = 49), and primiparas (n = 101) were significantly overrepresented. Chart review data and questionnaire responses highlighted insurance restrictions, family preferences, pain relief options, and postpartum care as influential factors among members of the hospital preference subsample.

CONCLUSION

The present analysis shows associations between certain individual characteristics and elective hospitalization during labor for birth center clients. Health record data and questionnaire responses indicated a variety of reasons for electing hospitalization, illustrating the complexity of clients' decision-making during pregnancy and birth.

Association between Birth Plan Use and Maternal and Neonatal Outcomes in Southern Spain: A Case-Control Study

BACKGROUND

Birth plans are used for pregnant women to express their wishes and expectations about childbirth. The aim of this study was to compare obstetric and neonatal outcomes between women with and without birth plans.

METHODS

A multicentre, retrospective case-control study at tertiary hospitals in southern Spain between 2009 and 2013 was conducted. A total of 457 pregnant women were included, 178 with and 279 without birth plans. Women with low-risk gestation, at full-term and having been in labour were included. Sociodemographic, obstetric and neonatal variables were analysed and comparisons were established.

RESULTS

Women with birth plans were older, more educated and more commonly primiparous. Caesarean sections were less common in primiparous women with birth plans (18% vs. 29%, p = 0.027); however, no significant differences were found in instrumented births, 3rd-4th-degree tears or episiotomy rates. Newborns of primiparous women with birth plans obtained better results on 1 min Apgar scores, umbilical cord pH and advanced neonatal resuscitation. No significant differences were found on 5 min Apgar scores or other variables for multiparous women.

CONCLUSIONS

Birth plans were related to less intervention, a more natural process of birth and better outcomes for mothers and newborns. Birth plans can improve the welfare of the mother and newborn, leading to birth in a more natural way.

Implementation of national childbirth guidelines in Brazil: barriers and strategies

The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the Implementation of the National Guidelines for Normal Childbirth in Brazil, as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as the basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote use of the Guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. Effective implementation of the Guidelines is important for improving the care provided during labor and childbirth in Brazil.

The Effect of Type of Delivery on the Nitric Oxide Metabolites and Endothelial Dysfunction in Pregnant Women

Background:

Since endothelial dysfunction is related to atherosclerosis, this study was planned to determine the effect of type of delivery on Nitric Oxide (NO) metabolites and endothelial function.

Materials and Methods:

This Cohort study was conducted in 2015 in selected hospitals of Isfahan. 88 nulliparous women with gestational age of 39 weeks and above were enrolled in this study using convenience sampling method and finally, after giving birth, 51 mothers with vaginal delivery, 21 with urgent C-section and 13 with elective C-section were considered for data analysis. The serum levels of NO metabolites were measured in the laboratory with standard kits and data was analyzed using student and paired t-test, one-way ANOVA, and Chi-square test. The significance level was considered less than 0.05 for all tests.

Results:

The NO metabolites levels in mothers who had vaginal delivery or urgent C-section showed a significant difference before and after delivery (normal vaginal delivery (NVD): t₅₀ = 5.61, p < 0.001, Urgent C-section: t₂₃ = 5.38, p < 0.001). But those with elective C-section showed no significant difference in the nitrate and total nitrite levels before and after delivery (p > 0.05).

Conclusions:

Since reduction in serum levels of NO metabolites may possibly indicate endothelial dysfunction and predict cardiovascular disease, especially atherosclerosis in the future, it could be concluded that, childbirth, regardless of the type of delivery, could damage the endothelial cells but C-section (urgent or elective) could cause more disruption than vaginal delivery.

[Implementation of the National Childbirth Guidelines in Brazil: barriers and trategiesObstáculos y estrategias para la aplicación de las Directrices Nacionales para el Parto Normal en el Brasil]

The present report describes the process and results obtained with a knowledge translation project developed in three stages to identify barriers to the National Childbirth Guidelines in Brazil as well strategies for effective implementation. The Improving Programme Implementation through Embedded Research (iPIER) model and the Supporting Policy Relevant Reviews and Trials (SUPPORT) tools provided the methodological framework for the project. In the first stage, the quality of the Guidelines was evaluated and the barriers preventing implementation of the recommendations were identified through review of the global evidence and analysis of contributions obtained in a public consultation process. In the second stage, an evidence synthesis was used as basis for a deliberative dialogue aimed at prioritizing the barriers identified. Finally, a second evidence synthesis was presented in a new deliberative dialogue to discuss six options to address the prioritized barriers: 1) promote the use of multifaceted interventions; 2) promote educational interventions for the adoption of guidelines; 3) perform audits and provide feedback to adjust professional practice; 4) use reminders to mediate the interaction between workers and service users; 5) enable patient-mediated interventions; and 6) engage opinion leaders to promote the use of guidelines. The processes and results associated with each stage were documented and formulated to inform a review and update of the Guidelines and the development of an implementation plan for the recommendations. An effective implementation of the Guidelines is relevant to improve the care provided during labor and childbirth in Brazil.

Beliefs and Perspectives of Women and Obstetrical Providers in Northern Ontario on Water Births

OBJECTIVE

This study sought to understand the beliefs and perspectives of women in northern Ontario and their obstetrical providers with respect to water birthing as access to this service is limited in this region METHODS: All midwives, family physicians (FPs), and obstetricians providing labour and delivery services in northern Ontario were surveyed, as were a sample of labour and delivery nurses in the region and convenience samples of regional women.

RESULTS

Of the 362 women who completed the survey (a 90.5% response rate), 81.8% (95% CI 77.5-85.4) believed water births to be safe, 40.9% (95% CI 35.9-46) were interested in having a water birth, and 76.5% (95% CI 71.8-80.5) wanted to have the option of a hospital-based water birth. Perceptions of water birth safety varied significantly by provider type (χ²P < 0.001) with 100% (95% CI 89.6-100) of midwives but 0% (95% CI 52.3-94.9) of obstetricians considering them to be safe. Perceptions of the specific risks and benefits of water birth also varied significantly by provider type, as did understanding of consumer interest. Reflecting these perceptions, 97.1% (95% CI 85.1-99.5) of midwives and 0% (95% CI 0-27.8) of obstetricians would consider assisting in or providing hospital-based water births.

CONCLUSIONS

Women in northern Ontario are interested in water birth and in having this service available in hospitals. However, given the widely divergent views of the professional groups providing labour and delivery care in the region, hospitals should be strongly encouraged to explore interprofessional development opportunities to enable patient-centred care in this context.

Distance to Hospital-based Intrapartum Care and Planned Home Birth in Minnesota

INTRODUCTION

Loss of hospital-based intrapartum services is associated with increases in out-of-hospital births, but less is known about associations with planned home birth. This study explores the impact of distance to hospital-based intrapartum care on planned home birth.

METHODS

Public-use Minnesota birth certificate data were merged with Minnesota Hospital Annual Report data (2011-2016) to test the relationship of miles from maternal residence to hospital-based intrapartum care with planned home birth in Minnesota. Logistic regression models estimated the odds of a planned home birth versus hospital birth as a function of miles to hospital-based intrapartum care.

RESULTS

The number of hospitals offering birth services in Minnesota declined by 11% from 2011 to 2016. Moderate (>20-50 miles) and great (>50 miles) distances to nearest hospital-based intrapartum care were associated with increased odds of planned home birth compared with short distances (≤20 miles). Adjusted odds ratios were 3.31 (95% CI, 3.04-3.61) and 3.89 (95% CI, 2.37-6.37), respectively, after adjusting for maternal education, age, and race. Planned home birth was the intended birth setting in 4.3% of births among those living great distances from hospital-based intrapartum care, compared with 1.0% among those living a short distance from hospital-based intrapartum care.

DISCUSSION

Better understanding of how geographical barriers affect preferred birth settings can inform efforts to reduce the impact of hospital-based intrapartum service loss on rural women and their birth outcomes.

[Natural Childbirth after the Previous Caesarian Section is a Solved Problem]

Тhe rapid increase in the frequency of сesarian section (CS) observed in recent years (up to 60% in some countries) is alarming and reduces the reproductive potential of the population. The operated uterus remains the main indication for CS (up to 40%). This is the factor which may allow reducing the frequency of the CS by subsequent delivering through the birth canal. A comparative analysis of maternal and neonatal outcomes enabled the authors to develop a two-stage delivery technology for patients with a caesarean scar, including the usage of the programmed delivery method. The presented algorithm confirmed the validity of vaginal delivery in such patients, and reduced the number of complications up to 4 times. Neonatal morbidity in children born through the birth canal in such patients was comparable to physiological birth.

Exploring Contributing Factors to Psychological Traumatic Childbirth from the Perspective of Midwives: A Qualitative Study

PURPOSE

As midwives witness and attend the whole process of childbirth, they have a better understanding of which factors may cause traumatic childbirth. However, because most of the studies paid their attention on mothers, little is known about psychological birth trauma from the perspective of midwives. This study aims to gain a full understanding of which factors may contribute to psychological traumatic childbirth from the perspective of midwives.

METHODS

A qualitative research was conducted using in-depth interviews, which involved fourteen midwives from the maternal ward of a tertiary hospital. The interviews were recorded and transcribed, and then, Colaizzi's method was used to analyze the contents of the interviews.

RESULTS

We proposed four themes and eight subthemes on the influencing factors of psychological traumatic childbirth from the perspective of midwives: low perceived social support (lack of support from family and lack of support from medical staff), hard times (protracted labor in the first stage and futile efforts during the second stage), poor birth outcomes (poor birth outcomes of the mother and poor birth outcomes of the baby), and excruciating pain (unbearable pain of uterine contraction and labor pain was incongruent with the mother's expectations).

CONCLUSION

Medical staff should pay attention to psychological traumatic childbirth and its effects, and emphasis on the screening and assessment of birthing women with negative feelings so that their psychological traumatic childbirth can be prevented and decreased.

Outcomes of Waterbirth in a US Hospital-Based Midwifery Practice: A Retrospective Cohort Study of Water Immersion During Labor and Birth

INTRODUCTION

Although the safety of water immersion during labor is largely supported by evidence from research, the risks to women and neonates during waterbirth are not well established. The purpose of this study was to generate evidence regarding maternal and neonatal outcomes related to water immersion in labor and during birth.

METHODS

A retrospective cohort study included a convenience sample of women receiving prenatal care at a nurse-midwifery practice. Participants were categorized into 3 groups: 1) waterbirth, 2) water labor, or 3) neither. Participant characteristics, maternal outcomes, and newborn outcomes were collected at time of birth and health record abstraction. At the 6-week postpartum visit, another maternal outcome, satisfaction with birth, was measured using the Care in Obstetrics: Measure for Testing Satisfaction (COMFORTS) scale. Analysis included effect size, descriptive statistics (sample characteristics), and maternal and neonatal group differences (analysis of variance and chi-square) with a significance level of P < .05.

RESULTS

Women in the waterbirth (n = 58), water labor (n = 61), and neither (n = 111) groups were primarily white, married, and college educated and did not differ by age or education. Women in the waterbirth group were more likely to be multiparous. Nulliparous women who had a waterbirth had a significantly shorter second stage of labor than nulliparous women who did not have a waterbirth (P = .03). The most commonly cited reasons for discontinuation of hydrotherapy were maternal choice (42.6%) and need for pain medication (29.5%). Significantly more women in the waterbirth group experienced a postpartum hemorrhage, compared with water labor or neither (n = 5, n = 3, n = 1, respectively; P = .045); there was no difference in related clinical measures. Neonatal outcomes were not significantly different. Maternal satisfaction was high across all groups.

DISCUSSION

The results of this study suggest that waterbirth, attended by qualified intrapartum care providers in hospital settings in the United States, is a reasonable option for low-risk women and their neonates.

Cesarean Section or Natural Childbirth? Cesarean Birth May Damage Your Health

The increasing popularity of Cesarean birth has become a social concern in many countries. This paper reviews the literature on the effects of Cesarean section on children's psychological health. The results show that Cesarean birth may have adverse effects on children's sensory perception, sensory integration ability, neuropsychiatric development, and the infant-mother relationship. However, there remain deficiencies in extant research methods, research content, subject groupings, and interpretation of research results. Future research should improve research methods, broaden the research content, and refine the grouping of children born by Cesarean section. The exploration of neural mechanisms is also needed, as well as research directed toward suggesting effective interventions to reduce unnecessary Cesarean sections.

Birth of Lasya: Emphasizing the Need for Support in Home Births

This article explores the support structures required for home births. Written by a first-time mother who is a physician, it details her journey toward having a home birth and how these support structures shaped her confidence in having a natural birth. She also elaborates on her preparations during pregnancy, her labor, and the insights she gained during this process.

[Budgetary impact of spontaneous vaginal delivery and elective cesarean section without clinical indication in BrazilImpacto presupuestario del parto vaginal espontáneo y de la cesárea electiva sin indicación clínica en Brasil]

Objetivos

Estimar o impacto orçamentário do excesso de cesarianas sem indicação clínica em comparação ao parto vaginal para gestantes de risco habitual no Sistema Único de Saúde (SUS) no Brasil.

Métodos

A análise se baseou em um modelo estático. A população de referência foi a de gestantes de risco habitual. O horizonte temporal foi de 5 anos. Utilizou-se um modelo de regressão de Poisson para projetar o número de nascidos vivos de 2016 a 2020. O cálculo do custo direto da cesariana eletiva e do parto vaginal foi baseado em dois estudos prévios, nos quais foi calculado o valor esperado dos procedimentos através de um modelo de decisão analítico que incluiu as intercorrências clínicas da internação até a alta da maternidade. O cenário de referência dessa análise considerou 29% de cesarianas em excesso no país.

Resultados

O custo total da assistência ao parto e nascimento para as primíparas e multíparas sem cicatriz uterina no cenário de referência foi de US$ 707,5 milhões para o ano de 2016. No cenário 1 (melhor cenário), que considerou apenas o parto vaginal para essas gestantes, houve uma redução de custos de US$ 76,5 milhões ao ano. Para multíparas, a comparação do cenário de referência com o melhor cenário gerou economia de mais de US$ 4 milhões ao ano.

Conclusões

Os resultados indicam que o incentivo ao parto vaginal gera economia.

Implementation of evidence-based practices in normal delivery care

OBJECTIVE

to evaluate the impact of the implementation of evidence-based practices on normal delivery care.

METHOD

quasi-experimental, before-and-after intervention study conducted in a public maternity hospital, Amapá. Forty-two professionals and 280 puerperal women were interviewed and data from 555 medical records were analyzed. The study was developed in three phases: baseline audit (phase 1), educational intervention (phase 2) and post-intervention audit (phase 3).

RESULTS

after the intervention, there was an increase of 5.3 percentage points (p.p.) in the normal delivery rate. Interviews with the women revealed a significant increase of the presence of companions during labor (10.0 p.p.) and of adoption of the upright or squatting position (31.4 p.p.); significant reduction of amniotomy (16.8 p.p.), lithotomy position (24.3 p.p.), and intravenous oxytocin (17.1 p.p.). From the professionals' perspective, there was a statistical reduction in the prescription/administration of oxytocin (29.6 p.p.). In the analysis of medical records, a significant reduction in the rate of amniotomy (29.5 p.p.) and lithotomy position (1.5 p.p.) was observed; the rate of adoption of the upright or squatting position presented a statistical increase of 2.2 p.p.

CONCLUSIONS

there was a positive impact of the educational intervention on the improvement of parturition assistance, but the implementation process was not completely successful in the adoption of scientific evidence in normal delivery care in this institution.

Perineal Pain Management with Cryotherapy after Vaginal Delivery: A Randomized Clinical Trial

Introduction Systematic reviews that evaluate the perineal cryotherapy to reduce pain in the vaginal postpartum are inconclusive. Purpose To evaluate clinical effectiveness of cryotherapy in the management of humanized postpartum perineal pain and vaginal edema. Methods A double-bind randomized controlled clinical trial (UTN number: U1111-1131-8433) was conducted in a hospital in Northeastern, Brazil. Women were included following humanized childbirth. All had vaginal deliveries of a single, full-term pregnancy with cephalic presentation. Exclusion criteria included previous perineal lesion, episiotomy during the current delivery, instrumental delivery, uterine curettage and postpartum hemorrhage. In the experimental group, an ice pack was applied six times on the perineum for 20 minutes, reducing the temperature between 10 and 15 ° C, then 60 minutes without exposure to cold. In the non-cryotherapy, a water bag unable to reduce the temperature to this extent was used, compliance with the same application protocol of the first group. Perineal temperature was monitored at zero, 10 and 20 minutes for application in both groups. Evaluations were made immediately before and after the applications and 24 hours after delivery spontaneous, to determine the association between variables. Results A total of 80 women were included in the study, 40 in each group. There was no significant difference in scores of perineal pain and edema between the groups with or without cryotherapy until 24 hours after childbirth. There was no difference between groups when accomplished repeated measures analysis over the 24 hours after delivery, considering the median perineal pain (p = 0.3) and edema (p = 0.9). Perineal cryotherapy did not influence the amount of analgesics used (p = 0.07) and no adverse effect was registered. Conclusion The use of cryotherapy following normal vaginal delivery within the concept of humanized minimally interventionist childbirth had no effect on perineal pain and edema, since it was already substantially lower, nor the need for pain medicaments.

Supporting and Sharing-Home Birth: Fathers' Perspective

The planned home birth has provoked discussion around the world. Home birth has been described as a positive experience, but results regarding the safety of home birth are controversial. To date, the phenomenon has mainly been examined from the mother's point of view, and there is only one previous study reporting fathers' perspective. The purpose of the present phenomenological qualitative interview study was to investigate fathers' experiences of planned home birth. Eleven fathers were interviewed, and the data were analyzed using Colaizzi's phenomenological method. The fathers followed the woman's wish in choosing the birthplace and set aside their own views. Furthermore, hospital birth was not an option for the fathers due to their own prior negative experiences of hospital births such as disturbing the natural progress of birth. The fathers' experience of home birth included sharing the responsibility, supporting the woman, and participating in the home birth process. The experience was challenging; fathers had to take the role of a midwife, and no support or information on organizing home birth was offered by public health services. The fathers felt that the home birth connected them as family, and the experience was empowering. Our study results suggest that the health care professionals need more education and information on home birth and that the families (including fathers) interested in home birth need greater support from health care professionals. There is a need for proper national home birth guidelines, while family-and client-centered care has to be improved in birthing hospitals.

Low primary cesarean rate and high VBAC rate with good outcomes in an Amish birthing center

PURPOSE

Recent national guidelines encourage a trial of labor after cesarean (TOLAC) as a means of increasing vaginal births after cesarean (VBACs) and decreasing the high US cesarean birth rate and its consequences (2010 National Institute of Health Consensus Statement and American College of Obstetricians and Gynecologists revised guideline). A birthing center serving Amish women in Southwestern Wisconsin offered an opportunity to look at the effects of local culture and practices that support vaginal birth and TOLAC. This study describes childbirth and perinatal outcomes during a 17-year period in LaFarge, Wisconsin.

METHODS

We undertook a retrospective analysis of the records of all women admitted to the birth center in labor. Main outcome measures include rates of cesarean deliveries, TOLAC and VBAC deliveries, and perinatal outcomes for 927 deliveries between 1993 and 2010.

RESULTS

The cesarean rate was 4% (35 of 927), the TOLAC rate was 100%, and the VBAC rate was 95% (88 of 92). There were no cases of uterine rupture and no maternal deaths. The neonatal death rate of 5.4 of 1,000 was comparable to that of Wisconsin (4.6 of 1,000) and the United States (4.5 of 1,000).

CONCLUSIONS

Both the culture of the population served and a number of factors relating to the management of labor at the birthing center have affected the rates of cesarean delivery and TOLAC. The results of the LaFarge Amish study support a low-technology approach to delivery where good outcomes are achieved with low cesarean and high VBAC rates.

Naomi's Birth

A first-time mother, who is also a nurse, tells the story of her drug-free birth at a free-standing birth center.

Do birthing options really exist?

In this column, the author answers the question, "Is choosing to give birth naturally a realistic option in today's birth environment?" Women's choices of health care provider and place of birth are limited by the general belief that birth is safe only in the hospital and when managed by obstetric medicine. In the typical hospital environment, women rarely have access to the wide variety of comfort measures and the continuous emotional and physical support required to give birth naturally. Routine care practices further limit women's birthing options. The Coalition for Improving Maternity Services' document, the "Mother-Friendly Childbirth Initiative," offers direction for creating birth environments that ensure options for women who choose to give birth naturally.