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Mousa O, Salameh B, Alqahtani M, David M, Almefarfesh AA, Duhilan DA, Ghaly AS, Alsadaan N, Reshia FAA, Alsandal ZMA. Women's attitudes, prevalence, related factors, and perceived barriers of birth companionship in Saudi Arabia. Womens Health (Lond) 2024; 20:17455057231224553. [PMID: 38279816 PMCID: PMC10822074 DOI: 10.1177/17455057231224553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 01/29/2024]
Abstract
BACKGROUND The World Health Organization recommends companionship as a critical element of respectful maternity care. However, there is paucity of literature regarding women's attitudes, related factors, and barriers of implementation in Saudi Arabia. OBJECTIVE This study aimed to assess women's attitudes toward birth companionship during labor and delivery, related factors, and barriers of implementing labor companionship in Saudi Arabia. DESIGN/METHODS This study was carried out in Al Ahsa, Saudi Arabia, using a cross-sectional design. The data collection took place over a period of approximately 6 months, specifically from 16 August 2021 to 20 February 2022. A total of 418 women who had given birth at three governmental hospitals and three private hospitals in Al Ahsa participated in the survey. The study included women between the ages of 18 and 49 years who had delivered during the study period. RESULTS The study revealed that while around 82.8% of mothers expressed a desire for companionship during labor, only 43.2% actually had a labor companion present during delivery. The primary obstacle to labor companionship reported by 21.5% of respondents was hospital policies. Other barriers identified included husbands' fear of being present during labor (4.7%) and limited availability of time for companionship (3.8%). CONCLUSION The study concludes that birth companionship is highly desired by women in the study area. However, various physical, emotional, and institutional barriers, such as hospital policies and regulations, impede its implementation. Addressing these barriers and promoting supportive policies are essential to facilitate the provision of birth companionship and improve the childbirth experience for women in Al Ahsa.
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Affiliation(s)
- Ola Mousa
- Faculty of Nursing, Minia University, Minia, Egypt
| | - Basma Salameh
- Department of Nursing, Arab American University, Jenin, Palestine
| | - Mohammed Alqahtani
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Alahsa, Saudi Arabia
| | - Maryshela David
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Alahsa, Saudi Arabia
| | - Aishah A Almefarfesh
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Alahsa, Saudi Arabia
| | - Duaa Al Duhilan
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Alahsa, Saudi Arabia
| | - Asmaa Saber Ghaly
- Department of Nursing, College of Applied Medical Sciences, King Faisal University, Alahsa, Saudi Arabia
- Obstetric and Gynecologic Nursing, Faculty of Nursing, Alexandria University, Alexandria, Egypt
| | - Nourah Alsadaan
- Nursing Administration and Education Department, College of Nursing, Jouf University, Sakaka, Saudi Arabia
| | - Fadia Ahmed Abdelkader Reshia
- Medical Surgical Nursing Department, College of Nursing, Jouf University, Sakaka, Saudi Arabia
- Critical Care and Emergency Nursing, Faculty of Nursing, Mansoura University, Mansoura, Egypt
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Herriott AL, Etling S, Hans SL. Community-Based Doulas' Roles Within the Birth Support System: Young Black Mothers' Perspectives. J Midwifery Womens Health 2024; 69:33-40. [PMID: 37766383 DOI: 10.1111/jmwh.13570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/05/2023] [Indexed: 09/29/2023]
Abstract
INTRODUCTION Doulas have been found to be beneficial to pregnant adolescents during childbirth, but little is known about their role within the larger system of people providing birth support, including family and health care providers. The purpose of this study was to examine, from the perspectives of young mothers, the role of the doula within their broader birth support system. METHODS One hundred pregnant Black adolescents and young women (aged 13 to 21) who were provided perinatal community-based and racially concordant doula services at no cost to them were interviewed after the birth of their newborn, prior to hospital discharge. Interviews generated birth story narratives and responses to focused questions about their experiences of birth support. Thematic analysis was conducted to examine the role of the doula within the context of the broader system of birth support. RESULTS Doulas functioned in 2 primary ways within the birth support system by (1) providing tandem support alongside family and health care providers and (2) filling gaps in health care not provided by family and providers. Laboring adolescents sometimes described their family members and doulas working in tandem to provide multiple types of support such as comfort measures, coaching, and help with pushing. They also identified gaps in their care or support filled by the doula, in particular gaps due to family members' physical or emotional unavailability or health care providers' many responsibilities. DISCUSSION The findings highlight the ways in which doulas support pregnant adolescents during childbirth through their deft navigation of the existing support system. Well-being was enhanced by the inclusion of the doula in the birth support system. The findings align with existing research that underscores the valuable role doulas play in supporting individuals during childbirth, particularly for those most affected by processes of marginalization.
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Affiliation(s)
- Anna L Herriott
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
| | - Sophia Etling
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
| | - Sydney L Hans
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, Chicago, Illinois
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Borer H, Dubovi I. Fostering childbirth education on upright positions and mobility during labor in nulliparous women. BMC Pregnancy Childbirth 2023; 23:870. [PMID: 38104069 PMCID: PMC10724979 DOI: 10.1186/s12884-023-06166-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 12/01/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Upright labor positions and movement during labor have a positive effect on childbirth, yet the predominant labor positions are still horizontal. Therefore, it is important to explore how it is possible to improve childbirth education, particularly its instructional design, to strengthen women's self-efficacy toward the use of upright positions and mobility during labor. The aim of the study was to evaluate the impact of an instructional approach based on a cognitive engagement ICAP (Interactive, Constructive, Active, Passive) framework on the development of knowledge, attitudes, and self-efficacy expectations toward upright positions and mobility during labor. METHODS A prospective quasi-experimental study was conducted among nulliparous women from the ultra-orthodox Jewish community (n = 74). While the control group (n = 34) participated in routine childbirth education, the intervention group (n = 36) learned with childbirth education that included interactive and constructive cognitive engagement activities. Participants in both groups completed a set of questionnaires regarding knowledge, attitudes, and self-efficacy. RESULTS The post-test analysis revealed that women in the intervention group compared to the control group gained significantly higher knowledge scores (p < 0.05), more positive attitudes (p < 0.001), and stronger self-efficacy expectations toward upright positions and mobility during labor (p < 0.01). CONCLUSIONS The findings suggest that by fostering women's cognitive engagement levels during childbirth education toward the interactive and constructive modes of the ICAP framework, women's self-efficacy to move during labor and to use upright positions can be induced. These results can serve as a foundation to improve the overall effectiveness of childbirth instruction. TRIAL REGISTRATION The study was registered retrospectively.
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Affiliation(s)
- Hanna Borer
- Nursing Department, Faculty of Medicine, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, 69978, Israel
| | - Ilana Dubovi
- Nursing Department, Faculty of Medicine, The Stanley Steyer School of Health Professions, Tel Aviv University, Tel Aviv, 69978, Israel.
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Chen LL, Pan WL, Mu PF, Gau ML. Birth environment interventions and outcomes: A scoping review. Birth 2023; 50:735-748. [PMID: 37650526 DOI: 10.1111/birt.12767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 08/03/2023] [Accepted: 08/05/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND The physical environments in which women give birth can contribute positively to meeting both physiologic and psychosocial needs during labor. Most studies on the labor and delivery processes have focused on mitigating pain and providing psychological support. Fewer have explored the influence of the physical birth environment. In this study, we performed a scoping review to compile and examine qualitative and quantitative studies related to the characteristics of physical birth environments and their effects on labor outcomes. METHODS We searched the PubMed, CINHAL, Cochrane, Web of Science, and MEDLINE databases from inception to May 2022. A total of 13 studies met the criteria for inclusion in our review. Two reviewers screened the titles and full-text articles and extracted data from the included studies. We used summary statistics and narrative summaries to describe the study characteristics, intervention implementation guidelines, intervention selection and tailoring rationale, and intervention effects. RESULTS In previous research, several elements of birth environments have been shown to provide physical and psychological support to birthing people and to improve outcomes related to the experience of care and pain management. We identified five main themes in the included studies: (1) "hominess;" (2) whether spaces are comfortable for activity; (3) demedicalization of the birth environment; (4) accommodations for birth partners; and (5) providing women with a sense of control over their birth environment. CONCLUSIONS Birth environments should be designed to promote positive birthing experiences, both physiologically and psychologically. Facilities and those who manage them can improve the experiences and outcomes of service users by modifying or designing spaces that are "homey," comfortable for activity, demedicalized, and include natural elements. In addition, policies that allow the birthing person to control her own environment are key to promoting positive outcomes and satisfaction with the birth experience.
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Affiliation(s)
- Li-Li Chen
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Wan-Lin Pan
- School of Nursing, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
| | - Pei-Fan Mu
- Institute of Clinical Nursing, National Yang-Ming University, Taipei, Taiwan, ROC
- Taiwan Evidence Based Practice Center: A Joanna Briggs Center of Excellence, Taipei, Taiwan, ROC
| | - Meei-Ling Gau
- Department of Nurse-Midwifery and Women Health, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan, ROC
- Core staff of the Taiwan Holistic Care Evidence Implementation Center, a JBI-Affiliated Center, Taipei, Taiwan, ROC
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Yount-Tavener SM, Fay RA. The impact of transfer from an alongside midwifery unit to labor and delivery on birthing women: A qualitative study. Midwifery 2023; 127:103841. [PMID: 37862952 DOI: 10.1016/j.midw.2023.103841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 10/04/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
OBJECTIVE To explore laboring women's thoughts, feelings, and experiences of transferring from an Alongside Midwifery Unit or free-standing birth center to labor and delivery. DESIGN A qualitative online survey was used for this research. SETTING An Alongside Midwifery Unit in the southwestern United States. PARTICIPANTS Eight women over the age of eighteen who had transferred to labor and delivery from either the AMU or free-standing birth center. FINDINGS Five themes emerging from the women's transfer experiences. It was important for the women to maintain their physiologic birth ideals. The initiation of transfer, even a discussion, altered the atmosphere in the birthing room. Women experienced a range of emotions surrounding the transfer. The stories spoke to mourning the loss of physiologic birth experience. Some women expressed guilt about the potential effects on their infants. Post-birth women had realizations about their mental and physical capabilities and limitations. KEY CONCLUSIONS This pertinent study addressed the effect on women when a transfer needs to occur from an Alongside Midwifery Unit or free-standing Birth Center to the Labor and Delivery Unit. Regardless of the reason, a transfer affected all participants. The psychological impact can have significant consequences on mother and baby's wellbeing. Women need an opportunity to share their story. The fifth theme of learning about themselves mentally and physically is new and not identified in other studies. IMPLICATIONS FOR PRACTICE Clinical recommendations are proposed to improve understanding and integrate into one's mindset, care processes, and clinical practice. Post-birth care should continue for these women until they completely process and come to a resolution of their experience of transferring to labor and delivery.
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Affiliation(s)
- Susan M Yount-Tavener
- The Midwifery Center at Tucson Medical Center for Women, 5301 E. Grant Road, Tucson, AZ 85712 USA; Frontier Nursing University, 2050 Lexington Road, Versailles, KY 40383, USA.
| | - Rebecca A Fay
- Frontier Nursing University, 2050 Lexington Road, Versailles, KY 40383, USA
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Evans K, Pallotti P, Spiby H, Evans C, Eldridge J. Supporting birth companions for women in labor, the views and experiences of birth companions, women and midwives: A mixed methods systematic review. Birth 2023; 50:689-710. [PMID: 37593922 DOI: 10.1111/birt.12736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 01/20/2023] [Accepted: 06/01/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Birth companions can have a positive effect on women's experiences in labor. However, companions can feel unprepared and need professional guidance to help them feel involved and provide effective support. METHODS A convergent segregated mixed-methods systematic review was conducted to explore women's, companions', and midwives' experiences of birth companion support and identify ways to improve the experience for women and companions. A thematic synthesis of qualitative data and a narrative summary of quantitative data were conducted followed by integration of the findings. RESULTS Companions who cope well in labor reported feeling involved, able to preserve women's internal focus and have a defined role, providing physical or emotional support. LBGTQ+ partners faced barriers to inclusion due to "forefronting" of their sexuality by staff and a lack of recognition in the language and processes used. The experience of birth companions can be enhanced by promoting their role as co-parent, guardian, and coach, provision of timely information and developing a trusting relationship with care providers. Only two papers reported midwives' views on birth companions in labor. CONCLUSIONS Women's and companions' satisfaction with birth is increased when companions can support the mother, feel supported themselves, and valued as a co-parent. The midwives' role in information provision and guidance can maximize birth companions' experience and ability to provide positive support. LBGTQ+ families need more support to feel included and recognized.
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Affiliation(s)
- Kerry Evans
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Phoebe Pallotti
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Helen Spiby
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Catrin Evans
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - Jeanette Eldridge
- School of Health Sciences, Queens Medical Centre, University of Nottingham, Nottingham, UK
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Kahraman HG, Gökçe İsbir G. The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial. Women Health 2023; 63:774-786. [PMID: 37807722 DOI: 10.1080/03630242.2023.2266009] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 09/26/2023] [Indexed: 10/10/2023]
Abstract
Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.
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Affiliation(s)
| | - Gözde Gökçe İsbir
- School of Health, Midwifery Department, Mersin University, Mersin, Türkiye
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Cooper M, Briley A. Sense of coherence as facilitated by water immersion during labour and birth: A concept analysis and synthesis. Midwifery 2023; 126:103824. [PMID: 37714044 DOI: 10.1016/j.midw.2023.103824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 07/22/2023] [Accepted: 09/07/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To explore the concept of sense of coherence as facilitated by water immersion during labour and/or birth. DESIGN A concept analysis and synthesis. A literature search of CINAHL, Medline, PubMed, PsycINFO and Emcare was undertaken in February 2022. Results were cross-checked with Google Scholar. No timeframe was specified, and results were restricted to research papers written in English. Overall, 2768 papers were retrieved and after removal of duplicates and unrelated papers, abstracts were screened to ensure the paper met the inclusion criteria i.e. women's experiences of water immersion for labour and/or birth. This process yielded a total of 37 articles and two theses, these were used for the concept analysis. Attributes were described and an exemplar case developed after mapping and charting of the data set. FINDINGS Three attributes were identified; agency, holistic and complete and more than pain relief which align with the three sense of coherence components: comprehensible, meaningfulness and manageability. KEY CONCLUSION There is a growing evidence base regarding the use of intrapartum water immersion. The literature exploring women's experiences and views of water immersion, appears to consistently report that women experience physiological, physical and psychological benefits and that these benefits complement each other to facilitate greater self-efficacy and a more holistic experience. This combination of benefits afforded by water immersion facilitates a sense of coherence and subsequently, increases the likelihood of the woman experiencing labour and birth as both positive and satisfying. IMPLICATIONS FOR PRACTICE A greater understanding of women's experiences of water immersion will provide rationale and reason for making the option a real choice while revealing the positive impacts that it can have on all outcomes beyond just the physical.
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Affiliation(s)
- Megan Cooper
- College of Nursing and Health Sciences, Flinders University, Sturt Campus Bedford Park, South Australia, Australia.
| | - Annette Briley
- College of Nursing and Health Sciences, Flinders University, Sturt Campus Bedford Park, South Australia, Australia
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Essén B, Eriksson L. Paradoxes in the cultural doula concept for migrant women: Implications for gender-inclusive care versus migrant-friendly maternity care. Midwifery 2023; 126:103805. [PMID: 37714043 DOI: 10.1016/j.midw.2023.103805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 08/15/2023] [Accepted: 08/28/2023] [Indexed: 09/17/2023]
Abstract
OBJECTIVE Swedish healthcare policies promote gender equality, shared parenting and cultural diversity. In response to the risk of adverse outcomes for migrant women, cultural doulas were introduced as support for migrant women during pregnancy and/or labour. The aim is to investigate potential tensions in the cultural doula concept in relation to policies of gender equality and diversity. DESIGN An interview study was designed to analyse perceptions of the cultural doula concept among healthcare providers in Swedish sexual and reproductive healthcare. Through the framework of Bacchi's approach 'What Is the Problem Represented to Be?' and Hochschild's concept of 'global care chains', we analyzed whether the introduction of the cultural doula concept is in line with the policies of gender equality and culturally sensitive care by exploring paradoxes, unintended consequences and what was not reflected upon. SETTING AND PARTICIPANTS Semi-structured interviews (n = 18) with midwives and obstetricians at hospitals in two Swedish counties during 2022. MEASUREMENTS AND FINDINGS The interviews were analyzed through thematic analysis. Cultural doulas were perceived as multi-tasking resources for facilitating integration and providing healthcare information and psychosocial support. Respondents did not identify doula support as a cultural practice in migrants' origin countries. Despite awareness of cultural differences in gender norms, many respondents stated that doula support included male partners. KEY CONCLUSIONS The cultural doula concept includes paradoxes in relation to gender equality and diversity. Rather than empowering migrant women, the cultural doula concept is related to gendered patterns of low-educated, underpaid care work. Labour support interventions including migrant women's social network and intensified partner involvement would be more in line with Swedish policies of gender equality, shared parenting and cultural sensitivity when needed. However, doulas may be an imperfect solution for women lacking partners or social networks, for example, newly arrived migrant women, if no support is to be found within the perinatal care system. IMPLICATIONS FOR PRACTICE Midwives and obstetricians need reflexivity about what the problem is represented to be when it comes to gender equality and cultural sensitivity in their collaboration with cultural doulas, boundaries between roles, how they handle confidentiality, and why cultural doulas are needed in relation to migrant women's integration.
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Affiliation(s)
- Birgitta Essén
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala SE-751 85, Sweden
| | - Lise Eriksson
- Department of Women's and Children's Health, Uppsala University, Akademiska sjukhuset, Uppsala SE-751 85, Sweden; Faculty of Social Sciences, Business and Economics, Åbo Akademi University, Vänrikinkatu 3 B, Turku FI-20500, Finland.
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Goldkuhl L, Tistad M, Gyllensten H, Berg M. Implementing a new birthing room design: a qualitative study with a care provider perspective. BMC Health Serv Res 2023; 23:1122. [PMID: 37858103 PMCID: PMC10585888 DOI: 10.1186/s12913-023-10051-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/22/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Research shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology. METHODS This qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n = 21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome. RESULTS The implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice. CONCLUSION Our findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment. TRIAL REGISTRATION ClinicalTrials.gov: NCT03948815, 14/05/2019.
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Affiliation(s)
- Lisa Goldkuhl
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Department of Obstetrics and Gynaecology, Sahlgrenska University Hospital, Gothenburg, Region Västra Götaland, Sweden.
| | - Malin Tistad
- School of Health and Welfare, Dalarna University, Falun, Sweden
- Department of Neurobiology, Care Sciences and Society, Karolinska Institute, Huddinge, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- Faculty of Medicine and Community Health, Evangelical University in Africa, Bukavu, Democratic Republic of Congo
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Abstract
OBJECTIVE Pregnancies complicated by perinatal mood disorders or a history of mental health disorder are at increased risk for complications including postpartum depression/anxiety. Patients' perceived control over childbirth is known to be an important factor for development of postpartum depression/anxiety. It is unclear whether women with preexisting and/or current depression and/or anxiety have different perceptions of control during childbirth compared with those without these comorbidities. This study aimed to evaluate the association between a current and/or prior diagnosis of depression and/or anxiety and scores on the Labour Agentry Scale (LAS), a validated tool evaluating patient's experience of control over their labor and delivery. STUDY DESIGN This is a cross-sectional study of nulliparous patients admitted at term to a single center. Participants completed the LAS after delivery. A trained researcher performed detailed chart reviews for all participants. Participants were identified as having a current or historical diagnosis of depression/anxiety by self-report confirmed by chart review. Scores on the LAS were compared between those with versus without a diagnosis of depression/anxiety prior to admission for delivery. RESULTS A total of 73 (44.8%) of the 149 participants held a current and/or prior diagnosis of depression and/or anxiety. Baseline demographics were similar between those with and without depression/anxiety. Mean scores on the LAS (range: 91-201) were significantly lower for those with depression/anxiety than those without a prior diagnosis (150.0 vs. 160.5, p < 0.01). Even after controlling for mode of delivery, admission indication, anesthesia, and Foley balloon usage, participants with anxiety and depression had scores that were on average 10.4 points lower on the LAS (95% confidence interval: -19.25, -1.62). CONCLUSION Participants with a current and/or prior diagnosis of depression and/or anxiety scored lower on the LAS as compared with those without psychiatric diagnoses. Patients with psychiatric diagnoses may benefit from increased education and support during childbirth. KEY POINTS · Control over childbirth is an important factor in the development of postpartum depression/anxiety.. · Patients with a prior or current diagnosis of anxiety and depression have lower labor agentry scores.. · These differences remained significant even when controlling for confounders such as delivery mode..
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Affiliation(s)
- Anna R. Whelan
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Olivia Recabo
- Department of Obstetrics and Gynecology, New York Medical College, Valhalla, New York
| | - Nina K. Ayala
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Melissa A. Clark
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
| | - Adam K. Lewkowitz
- Division of Maternal-Fetal Medicine, Women and Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, Rhode Island
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Mueller AN, Grylka-Baeschlin S. Self-management, care needs and clinical management of primiparous mothers during early labour - a qualitative content analysis. BMC Pregnancy Childbirth 2023; 23:191. [PMID: 36934219 PMCID: PMC10024386 DOI: 10.1186/s12884-023-05453-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 02/17/2023] [Indexed: 03/20/2023] Open
Abstract
BACKGROUND Childbearing women face the problem of managing spontaneous onset of labour without professional support. It is their responsibility to diagnose and react to early labour and subsequently recognise the right time to seek support. Institutional guidelines of clinics aim to admit childbearing women when in established labour. This explains why women in early labour are often advised to stay at home, which can be overwhelming and dissatisfying. This study aims to understand the self- and clinical management of early labour and care needs of first-time mothers during early labour. METHODS A qualitative approach was used involving four focus group discussions with a total of N = 18 mothers. Included were primiparous women who had given birth at term within the last 6 months and who experienced spontaneous onset of labour. Elective caesarean section or induction of labour were thereby exclusion criteria. The interviews followed a semi-structured, literature-based guide. Content analysis was applied. RESULTS Thirteen codes were summarised within three themes: 'self-management', 'care needs' and 'professional management'. Various coping strategies and measures such as positive thinking or taking a bath helped women in managing early labour at home. The need for reassurance, professional guidance and pain management led them to seek professional support, which was initially accompanied by a feeling of inhibition. This negative emotion was mostly unjustified since many women felt well cared for and taken seriously in their needs. CONCLUSION Coping strategies and professional care help women going through early labour. Yet, there still exists insecurity about the justified timing in seeking professional support. An individual assessment of the women's coping resources and their needs is required to promote shared decision making and give high-standard care.
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Affiliation(s)
- Antonia N. Mueller
- grid.19739.350000000122291644Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8401 Winterthur, Switzerland
| | - Susanne Grylka-Baeschlin
- grid.19739.350000000122291644Research Institute of Midwifery and Reproductive Health, School of Health Sciences, ZHAW Zurich University of Applied Sciences, Katharina-Sulzer-Platz 9, CH-8401 Winterthur, Switzerland
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13
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Mendonça PPDA, Vieira LB, Silva VL, Zveiter M. The use of your own voice in labor: a phenomenological study. Rev Gaucha Enferm 2023; 43:e20220215. [PMID: 36921144 DOI: 10.1590/1983-1447.2022.20220215.en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 10/17/2022] [Indexed: 03/18/2023] Open
Abstract
OBJECTIVE To understand the meaning attributed by women to the use of their own voice in labor. METHOD Descriptive qualitative study based on the theoretical-philosophical-methodological framework of Heidegger. Phenomenological interviews were carried out with 20 women who experienced vaginal delivery without interventions in the second quarter of 2020 in the city of Rio de Janeiro - Brazil. RESULTS The comprehensive analysis revealed that the voice can provoke a reaction from the environment that makes them suffer. The expression of the voice encompasses fear and despair. It is from what they hear that women fear being left in suffering for havingbothered the professionals. CONCLUSION The meaning of using one's own voice in childbirth was understood as a request for help or an expression of freedom. Based on this understanding, the professionals can be opened to sensitive and individualized care, which goes beyond technology.
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Affiliation(s)
| | - Letícia Becker Vieira
- Universidade Federal do Rio Grande do Sul (UFRGS). Porto Alegre, Rio Grande do Sul, Brasil
| | - Valéria Lindner Silva
- Hospital de Clínicas de Porto Alegre (HCPA). Porto Alegre, Rio Grande do Sul, Brasil
| | - Marcele Zveiter
- Universidade do Estado do Rio de Janeiro (UERJ). Rio de Janeiro, Rio de Janeiro, Brasil
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Myhre EL, Lukasse M, Dahl B, Reigstad MM. Early labour experience and labour characteristics after introduction of an electronic early labour educational intervention. Sex Reprod Healthc 2023; 35:100821. [PMID: 36791604 DOI: 10.1016/j.srhc.2023.100821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/11/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023]
Abstract
OBJECTIVE The study's aim was to compare first-time mothers' experience of early labour and subsequent labour characteristics before and after introducing an online early labour educational intervention. This article also reports on further testing of the underlying structure of the of the Early Labour Experience Questionnaire (ELEQ) in a Norwegian setting. METHODS Pre- and post-intervention cohorts were recruited. The ELEQ was translated into Norwegian, back-translated and distributed among primiparous mothers whilst in hospital. Confirmatory factor analyses were used to evaluate model fit, and the internal consistency of the scale was measured by Cronbach's α coefficient. The relationship between cohorts and demographic characteristics were analysed using chi-square statistics and t-tests. RESULTS Confirmatory factor analysis of the Swedish version of the ELEQ for primiparous women showed an acceptable fit. Neither the overall score nor the scores on the subscales for emotional well-being, emotional distress and perceptions of midwifery care differed significantly, but there was a significant difference between the groups on a few of the items. The cervix was significantly more dilated upon admission in the post-intervention group, and oxytocin use was significantly reduced. The number of telephone consultations increased significantly after the intervention was introduced. CONCLUSION The intervention did not improve women's experience with early labour. However, women who received the intervention were admitted in more advanced labour and required less oxytocin. The increased number of telephone consultations may indicate that an online early labour educational programme cannot replace women's need to communicate directly with staff.
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Affiliation(s)
- Enid Leren Myhre
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway.
| | - Mirjam Lukasse
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health Sciences, University of South-Eastern Norway, Kongsberg, Norway
| | - Marte Myhre Reigstad
- Norwegian Research Centre for Women's Health, Department of Obstetrics and Gynaecology, Oslo University Hospital, Oslo, Norway
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Hansen ML, Lorentzen IP, Andersen CS, Jensen HS, Fogsgaard A, Foureur M, Jepsen I, Nohr EA. The effect on the birth experience of women and partners of giving birth in a "birth environment room": A secondary analysis of a randomised controlled trial. Midwifery 2022; 112:103424. [PMID: 35850078 DOI: 10.1016/j.midw.2022.103424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Revised: 07/03/2022] [Accepted: 07/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To evaluate women and partners' experience of birth in a "birth environment room" compared to a standard birth room. DESIGN A single centre parallel randomised controlled trial. Women and partners were enrolled during a 3-year period (May 2015 to March 2018). SETTING The Department of Obstetrics and Gynaecology at Herning Hospital, Denmark. PARTICIPANTS AND INTERVENTION A total of 680 Danish speaking nulliparous women, more than 18 years old, with a singleton pregnancy in cephalic presentation, and a spontaneous onset of labour, and their partners were randomly assigned to give birth in a "birth environment room" (n = 340) or in a standard birth room (n = 340) on arrival at the birth unit. MEASUREMENTS AND FINDINGS Outcomes were the overall birth experience and overall satisfaction with care, measured on a Likert scale, obtained in the postpartum questionnaire sent to the women 6 weeks after birth and to their partners 1/2 weeks after birth. Other outcomes were "staff support for partner", "undisturbed contact with new-born", "feeling of being listened to", "level of information", "attention to psychological needs", "suggestions for pain-relief", "participation in decision-making", "midwife present when wanted", "support from midwife", "birth wishes were met", "loss of internal control" (only women), "loss of external control", "support from partner" (partners: "being supportive for partner"), "importance of physical environment for birth" and "importance of physical environment for staff´s ability to involve the women" (only women). All outcomes were prespecified. We applied Mann Whitney U test for comparing the two groups. Data were collected from 326 women and 236 partners in the intervention group and from 315 women and 209 partners in the control group. The intention-to-treat analysis revealed no difference in the overall experience of birth for women or partners (p 0.81 and p 0.17, respectively). Partners in the intervention group reported more overall satisfaction with care compared to partners in the control group (p 0.048). In the intervention group, fewer women and partners responded they had not had the opportunity for undisturbed contact with their new-born in the first hours after birth (RR 0.19 (95% CI 0.04-0.87) and OR 0.00 CI (0.00-0.83), respectively). Otherwise, there were no differences between groups. The thematic analysis revealed that many women and partners felt they were not able to benefit from the features in "the birth environment room" in the most intense hours of birth. KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE "The birth environment room" did not improve the overall experience of birth for women and partners. Partners in the intervention group were overall more satisfied with care. These findings are of importance in the developing of physical birth environments that support the mental/emotional process of labour.
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Affiliation(s)
| | | | - Charlotte S Andersen
- Department of Gynaecology and Obstetrics, Gl. Landevej 61, 7400 Herning, Denmark
| | | | - Ann Fogsgaard
- Department of Gynaecology and Obstetrics, Gl. Landevej 61, 7400 Herning, Denmark
| | - Maralyn Foureur
- Nursing and Midwifery Research Centre, Hunter New England Health and University of Newcastle, NSW 2300, Australia
| | - Ingrid Jepsen
- University College of Northern Denmark, Selma Lagerløfs Vej 2, 9220 Aalborg Ø, Denmark
| | - Ellen Aagaard Nohr
- Research Unit for Obstetrics and Gynaecology, Institute of Clinical Research, University of Southern Denmark, Campusvej 55, 5230 Odense C, Denmark
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Grylka-Baeschlin S, Gross MM, Mueller AN, Pehlke-Milde J. Development and validation of a tool for advising primiparous women during early labour: study protocol for the GebStart Study. BMJ Open 2022; 12:e062869. [PMID: 35760537 PMCID: PMC9237887 DOI: 10.1136/bmjopen-2022-062869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Pregnant women experience early labour with different physical and emotional symptoms. Early admission to hospital has been found to be associated with increased intervention and caesarean section rates. However, primiparous women often contact the hospital before labour progresses because they encounter difficulties coping with symptoms of onset of labour on their own. An evidence-based instrument for assessing the individual needs to advise primiparous women during early labour is currently missing. The study aims to develop and validate a tool to inform the joint decision for or against hospital admission. METHODS AND ANALYSIS A scale development and validation study will be conducted including following steps: (1) Generation of a pool with 99 items based on a scoping review and focus group discussions with primiparous women, (2) Assessment of content and face validity by an expert panel and item reduction to 32 items, (3) Multicentre data collection in six study sites in Switzerland, with application of the preliminary tool and the validation items with a target sample size of approximately n=400 women and (4), item reduction using exploratory factor analysis, factor loading and item-to-item correlation. Internal consistency of the tool will be assessed using Cronbach's alpha and convergent validity computing correlations of items of the tool with the German versions of the Childbirth Self-Efficacy Inventory and the Cambridge-Worry Scale. Analyses will be performed using Stata V.17. ETHICS AND DISSEMINATION Ethical approval was obtained by the Ethics Committees Zurich and Northwestern and Central Switzerland (BASEC-Nr. 2021-00687). Results will be disseminated at the final study conference, at national and international congresses and by peer reviewed and not peer-reviewed articles in scientific and professional journals. Approved and anonymised data will be shared. The dissemination of the findings will have a contributable impact on clinical practice, scientific discussions and future research. TRIAL REGISTRATION NUMBER DRKS00025572, SNCTP000004555.
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Affiliation(s)
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Antonia N Mueller
- Research Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Jessica Pehlke-Milde
- Research Institute of Midwifery, Zurich University of Applied Sciences, Winterthur, Switzerland
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17
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Fumić Dunkić L, Vuletić G. PAIN AND ANXIETY EXPERIENCE IN THE CHOICE OF EPIDURAL ANALGESIA IN DELIVERY. Acta Clin Croat 2022; 60:399-405. [PMID: 35282486 PMCID: PMC8907960 DOI: 10.20471/acc.2021.60.03.09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 08/07/2019] [Indexed: 11/24/2022] Open
Abstract
The experience of labor pain is a complex process that represents the interaction of the nociceptive stimulus within the physiologic process with a series of psychological factors. The aim of this study was to investigate the relation between the choice of epidural analgesia as a form of pain management and psychological state of woman in labor; moreover, whether the women in labor with a higher level of anxiety have a more intensive experience of pain during labor and therefore decide on epidural analgesia. Pain was evaluated by the visual analog scale, while the sensory and affective pain components were evaluated by the McGill Pain Questionnaire, and anxiety as a trait was measured with the State-Trait Anxiety Inventory-form X. Women in labor with a higher level of anxiety had a significantly increased affective component of pain, but did not significantly more frequently decide on labor with epidural analgesia. The women having chosen epidural analgesia experienced more intense pain during delivery before epidural analgesia, with the sensory component of pain being less pronounced in the women in labor without epidural analgesia, while there was no difference in the affective component of pain.
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18
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Ebrahimian A, Bilandi RR, Bilandī MRR, Sabzeh Z. Comparison of the effectiveness of virtual reality and chewing mint gum on labor pain and anxiety: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:49. [PMID: 35045813 PMCID: PMC8772130 DOI: 10.1186/s12884-021-04359-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 12/23/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Childbirth pain and anxiety are often unnatural, as opposed to being one of the most practical ways to use non-pharmacological methods. The aim of this study was to compare the effectiveness of virtual reality and chewing mint gum on childbirth pain and anxiety. METHODS This is a single-blind, three-group clinical trial study on 93 mothers referred to Allameh Bohlool Gonabadi and Sajjadieh Torbate Jam Hospitals for natural childbirth in 2018-2019. Subjects were randomly divided into three groups of chewing gum, virtual reality, and control using six blocks. Chewing gum interventions in one group and virtual reality in the other group were performed twice in 4-5 cm and 7-8 cm dilatations for 20 min. In the control group, no intervention except routine care was performed. The research tools included Visual Analogue Scale of Pain and Spielberger's Anxiety Inventory. Data were analyzed using SPSS) version 22(, ANOVA, Kruskal-Wallis, Chi-square and Tukey tests. Significance level was considered 0.05 in this study. RESULTS The main result was differences in pain and anxiety before and after the intervention. There was no significant difference between pre-intervention pain and anxiety scores in the three groups, but there was a significant difference between pain and anxiety scores immediately and 30 min after the intervention. CONCLUSION The results of this study showed that virtual reality and chewing mint gum intervention reduce pain and anxiety in the first stage of childbirth. TRIAL REGISTRATION IRCT20181214041963N1 .
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Affiliation(s)
- Atefeh Ebrahimian
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
- School of Nursing & Midwifery, Ahvaz Jundishapur University of Medical Science, Ahvaz, Iran
| | - Roghaieh Rahmani Bilandi
- Department of Midwifery, Faculty of Medicine, Social Development & Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran.
| | - Mohammad Reza Rahmani Bilandī
- Department of Midwifery, Faculty of Medicine, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
| | - Zahra Sabzeh
- Department of Midwifery, Gonabad University of Medical Sciences, Gonabad, Khorasan Razavi, Iran
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Colomar M, Opiyo N, Kingdon C, Long Q, Nion S, Bohren MA, Betran AP. Do women prefer caesarean sections? A qualitative evidence synthesis of their views and experiences. PLoS One 2021; 16:e0251072. [PMID: 33951101 PMCID: PMC8099111 DOI: 10.1371/journal.pone.0251072] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 04/19/2021] [Indexed: 11/19/2022] Open
Abstract
Background Caesarean sections (CS) continue to increase worldwide. Multiple and complex factors are contributing to the increase, including non-clinical factors related to individual women, families and their interactions with health providers. This global qualitative evidence synthesis explores women’s preferences for mode of birth and factors underlying preferences for CS. Methods Systematic database searches (MEDLINE, EMBASE, CINAHL, PsycINFO) were conducted in December 2016 and updated in May 2019 and February 2021. Studies conducted across all resource settings were eligible for inclusion, except those from China and Taiwan which have been reported in a companion publication. Phenomena of interest were opinions, views and perspectives of women regarding preferences for mode of birth, attributes of CS, societal and cultural beliefs about modes of birth, and right to choose mode of birth. Thematic synthesis of data was conducted. Confidence in findings was assessed using GRADE-CERQual. Results We included 52 studies, from 28 countries, encompassing the views and perspectives of pregnant women, non-pregnant women, women with previous CS, postpartum women, and women’s partners. Most of the studies were conducted in high-income countries and published between 2011 and 2021. Factors underlying women preferences for CS had to do mainly with strong fear of pain and injuries to the mother and child during labour or birth (High confidence), uncertainty regarding vaginal birth (High confidence), and positive views or perceived advantages of CS (High confidence). Women who preferred CS expressed resoluteness about it, but there were also many women who had a clear preference for vaginal birth and those who even developed strategies to keep their birth plans in environments that were not supportive of vaginal births (High confidence). The findings also identified that social, cultural and personal factors as well as attributes related to health systems impact on the reasons underlying women preferences for various modes of birth (High confidence). Conclusions A wide variety of factors underlie women’s preferences for CS in the absence of medical indications. Major factors contributing to perceptions of CS as preferable include fear of pain, uncertainty with vaginal birth and positive views on CS. Interventions need to address these factors to reduce unnecessary CS.
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Affiliation(s)
- Mercedes Colomar
- Montevideo Clinical and Epidemiological Research Unit, Montevideo, Uruguay
- * E-mail:
| | - Newton Opiyo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Carol Kingdon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Qian Long
- Global Health Research Center, Duke Kunshan University, Kunshan, Jiangsu Province, China
| | - Soledad Nion
- Faculty of Social Sciences, Sociology Department, Universidad de la República (UdelaR), Montevideo, Uruguay
| | - Meghan A. Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
- Gender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Ana Pilar Betran
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Abstract
This study conducted on 66 mothers aimed to investigate the effect of foot massages postpartum using an introductory information form, the Postpartum Comfort Scale, the visual analog scale, and a drug follow-up card. It was concluded that foot massages positively improved comfort, reduced pain levels, and reduced unnecessary medications.
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Affiliation(s)
- Sibel Icke
- Department of Midwifery, Faculty of Health Sciences, Mardin Artuklu University, Mardin, Turkey (Dr Icke); and Department of Midwifery, Faculty of Health Sciences, Ege University, Izmir, Turkey (Dr Genc)
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da Matta Machado Fernandes L, Lansky S, Reis Passos H, T. Bozlak C, A. Shaw B. Brazilian women's use of evidence-based practices in childbirth after participating in the Senses of Birth intervention: A mixed-methods study. PLoS One 2021; 16:e0248740. [PMID: 33861756 PMCID: PMC8051805 DOI: 10.1371/journal.pone.0248740] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Accepted: 03/04/2021] [Indexed: 01/02/2023] Open
Abstract
Brazil has a cesarean rate of 56% and low use of Intrapartum Evidence-based Practices (IEBP) of 3.4%, reflecting a medically centered and highly interventionist maternal health care model. The Senses of Birth (SoB) is a health education intervention created to promote normal birth, use of EBP, and reduce unnecessary c-sections. This study aimed to understand the use of intrapartum EBP by Brazilian women who participated in the SoB intervention. 555 women answered the questionnaire between 2015 and 2016. Bivariate analysis and ANOVA test were used to identify if social-demographic factors, childbirth information, and perceived knowledge were associated with the use of EBP. A qualitative analysis was performed to explore women’s experiences. Research participants used the following EBP: birth plan (55.2%), companionship during childbirth (81.6%), midwife care (54.2%), freedom of mobility during labor (57.7%), choice of position during delivery (57.2%), and non-pharmacological pain relief methods (74.2%). Doula support was low (26.9%). Being a black woman was associated with not using a birth plan or having doula support. Women who gave birth in private hospitals were more likely not to use the EBP. Barriers to the use of EBP identified by women were an absence of individualized care, non-respect for their choices or provision of EBP by health care providers, inadequate structure and ambiance in hospitals to use EBP, and rigid protocols not centered on women’s needs. The SoB intervention was identified as a potential facilitator. Women who used EBP described a sense of control over their bodies and perceived self-efficacy to advocate for their chosen practices. Women saw the strategies to overcome barriers as a path to become their childbirth protagonist. Health education is essential to increase the use of EBP; however, it should be implemented combined with changes in the maternal care system, promoting woman-centered and evidence-based models.
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Affiliation(s)
| | - Sônia Lansky
- Department of Health, Belo Horizonte, Minas Gerais, Brazil
| | | | - Christine T. Bozlak
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
| | - Benjamin A. Shaw
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany, State University of New York, Albany, NY, United States of America
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Fernandes S, Galacho J, Borrego A, Pereira D, Lança F, Ormonde L. Impact of Labor Epidural Analgesia on Maternal Satisfaction and Childbirth Expectations in a Tertiary Care Center in Portugal: A Prospective Study. ACTA MEDICA PORT 2021; 34:272-277. [PMID: 34214419 DOI: 10.20344/amp.13599] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION In the current century, increasing importance has been given to the opinions, expectations and experiences of women using healthcare services. The fulfillment of expectations is determined by satisfaction. This study aims to analyze both expectations and satisfaction during childbirth regarding labor epidural analgesia among parturients, with a focus on myths. MATERIAL AND METHODS A prospective observational study was conducted in parturients at the Centro Hospitalar Universitário Lisboa Norte - Santa Maria Hospital in Lisbon, Portugal, applying a questionnaire to 317 random women. SPSS v22.0 was used for data analysis. RESULTS Three hundred questionnaires were returned, from women with a mean age of 31. Among the respondents, 46.3% had a college degree and 64% were employed, 46% were primiparas and only 14% had a previous anesthesiology appointment for childbirth purposes. The overall degree of satisfaction surrounding the birth experience was good/excellent for 87% of women. Labor epidural analgesia was performed on 96% of all patients, with an excellent/good outcome for 82.1% and a higher than expected results for 40.7% of them. Regarding the myths, 52.5% believed that epidural analgesia imposes a dose limit and 58.9% that it often causes permanent back pain. The level of education was significantly associated with some myths (p < 0.05), since women with a higher level of education do not believe most of them. DISCUSSION This study supports the need for an evaluation of the current information that women have about labor epidural analgesia/childbirth. Women's individual needs can be met by multidisciplinary teams including Anesthesiology specialists. CONCLUSION Maternal satisfaction with childbirth and analgesia is a complex and dynamic process that includes and is not limited to the relief of pain.
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Affiliation(s)
- Sofia Fernandes
- Serviço de Anestesiologia. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - João Galacho
- Serviço de Anestesiologia. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Andreia Borrego
- Serviço de Anestesiologia. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Daniela Pereira
- Serviço de Anestesiologia. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Filipa Lança
- Serviço de Anestesiologia. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
| | - Lucindo Ormonde
- Serviço de Anestesiologia. Hospital de Santa Maria. Centro Hospitalar Universitário Lisboa Norte. Lisboa. Portugal
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Mukamurigo J, Berg M, Nyirazinyoye L, Bogren M, Dencker A. Women's childbirth experience emphasizing own capacity and safety: A cross-sectional Rwandan study. Women Birth 2021; 34:e146-e152. [PMID: 32192910 DOI: 10.1016/j.wombi.2020.03.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 02/29/2020] [Accepted: 03/01/2020] [Indexed: 01/01/2023]
Abstract
PROBLEM AND AIM Women's childbirth experience is central when assessing intrapartum care quality. This study accordingly measures women's childbirth experience in Rwandan health facilities, focusing on own capacity and perceived safety. METHODS A cross-sectional health facility-based study was conducted December 2014 to January 2015 in Kigali City and the Northern Province. Childbirth experience was assessed before discharge using an overall assessment and two subscales, Own capacity and Perceived safety, of the Childbirth Experience Questionnaire, with high scores reflecting a good experience. The questionnaire was translated from English into Kinyarwanda. Reliability was tested using Cronbach's alpha; and mean scores between groups were compared using Mann-Whitney U test. FINDINGS All invited women (n = 817) agreed to participate after informed consent. Mean age was 27.8 years and 63.6% were multiparous. A majority of women (82.3%) reported an overall positive childbirth experience (≥8 out of 10). Cronbach's alpha indicated good reliability for Own capacity (0.78) and Perceived safety (0.76). In both subscales multiparous women had higher mean scores than primiparous, married women scored higher than unmarried, older women (>35) scored higher than younger (<35), and women with higher level of education scored higher than those with lower level. Women with HIV scored lower on perceived safety. CONCLUSION A majority of the women reported a positive overall childbirth experience. Own capacity and perceived safety are important dimensions of childbirth experience and should be addressed in building high-quality intrapartum care. Further research is needed and should include exploration of specific groups.
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Affiliation(s)
- Judith Mukamurigo
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; School of Public Health, College of Medicine and Health and Care Sciences, Department of Epidemiology and Biostatistics, University of Rwanda, Rwanda.
| | - Marie Berg
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Obstetric Unit, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Laetitia Nyirazinyoye
- School of Public Health, College of Medicine and Health and Care Sciences, Department of Epidemiology and Biostatistics, University of Rwanda, Rwanda
| | - Malin Bogren
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anna Dencker
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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van der Pijl MSG, Kasperink M, Hollander MH, Verhoeven C, Kingma E, de Jonge A. Client-care provider interaction during labour and birth as experienced by women: Respect, communication, confidentiality and autonomy. PLoS One 2021; 16:e0246697. [PMID: 33577594 PMCID: PMC7880498 DOI: 10.1371/journal.pone.0246697] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 01/23/2021] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Respectful Maternity Care is important for achieving a positive labour and birth experience. Client-care provider interaction-specifically respect, communication, confidentiality and autonomy-is an important aspect of Respectful Maternity Care. The aim of this study was twofold: (1) to assess Dutch women's experience of respect, communication, confidentiality and autonomy during labour and birth and (2) to identify which client characteristics are associated with experiencing optimal respect, communication, confidentiality and autonomy. METHODS Pregnant women and women who recently gave birth in the Netherlands were recruited to fill out a validated web-based questionnaire (ReproQ). Mean scores per domain (scale 1-4) were calculated. Domains were dichotomised in non-optimal (score 1, 2,3) and optimal client-care provider interaction (score 4), and a multivariable logistic regression analysis was performed. RESULTS Of the 1367 recruited women, 804 respondents completed the questionnaire and 767 respondents completed enough questions to be included for analysis. Each domain had a mean score above 3.5. The domain confidentiality had the highest proportion of optimal scores (64.0%), followed by respect (53.3%), communication (45.1%) and autonomy (36.2%). In all four domains, women who gave birth at home with a community midwife had a higher proportion of optimal scores than women who gave birth in the hospital with a (resident) obstetrician or hospital-based midwife. Lower education level, being multiparous and giving birth spontaneously were also significantly associated with a higher proportion of optimal scores in (one of) the domains. DISCUSSION This study shows that on average women scored high on experienced client-care provider interaction in the domains respect, communication, confidentiality and autonomy. At the same time, client-care provider interaction in the Netherlands still fell short of being optimal for a large number of women, in particular regarding women's autonomy. These results show there is still room for improvement in client-care provider interaction during labour and birth.
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Affiliation(s)
- Marit S. G. van der Pijl
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
- * E-mail:
| | - Marlies Kasperink
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
| | - Martine H. Hollander
- Amalia Children’s Hospital, Department of Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Corine Verhoeven
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
- Division of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Department of Obstetrics and Gynaecology, Maxima Medical Centre, Veldhoven, The Netherlands
| | - Elselijn Kingma
- Department of Philosophy, University of Southampton, Southampton, United Kingdom
- Department of Industrial Engineering & Innovation Sciences, Philosophy & Ethics, Technical University Eindhoven, Eindhoven, The Netherlands
| | - Ank de Jonge
- Amsterdam University Medical Centre (UMC), Vrije Universiteit Amsterdam, Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam, The Netherlands
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Abstract
This mixed-methods pilot study investigated maternal perceived stress specific to infant neonatal intensive care unit (NICU) hospitalization as a moderator of the relationship between traumatic childbirth appraisal and symptoms of posttraumatic stress disorder (PTSD). NICU mothers (N = 77) were recruited via social media 1 to 4 months postpartum for a cross-sectional survey about perinatal experiences. Measures included traumatic childbirth, PTSD Checklist for DSM-5, and Parental Stressor Scale (PSS): NICU. Quantitative results indicated that, only at high levels of stress, women who reported traumatic childbirth (68%) reported significantly higher PTSD symptoms [b = 18.00, standard error = 7.18, t = 2.51, P = .015, 95% confidence interval (3.65, 32.36)]. Qualitative analysis identified additional stressors: maternal emotional well-being, dissatisfaction with care, infant health problems, breastfeeding, and additional characteristics of the NICU environment. Results provide supportive evidence that NICU mothers are at high risk for childbirth-related trauma and PTSD. Perceived stress related to the NICU may be an important intervention target when developing trauma-informed patient care. In addition to the domains captured by the PSS: NICU, maternal emotional well-being, interpersonal relationships with NICU staff, and stress related to breastfeeding are additional areas for improvement in the family-centered NICU.
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Affiliation(s)
- Meghan Sharp
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island (Drs Sharp and Ward); Women's Medicine Collaborative, The Miriam Hospital, Providence, Rhode Island (Dr Sharp); Department of Psychology, East Carolina University, Greenville, North Carolina (Ms Huber and Dr Dolbier); and Center for Behavioral and Preventative Medicine, The Miriam Hospital, Providence, Rhode Island (Dr Ward)
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Ingvarsson S, Schildmeijer K, Oscarsson M. Swedish midwives' experiences and views of amniotomy: An interview study. Midwifery 2020; 91:102840. [PMID: 32980755 PMCID: PMC7500359 DOI: 10.1016/j.midw.2020.102840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/18/2020] [Accepted: 09/10/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To explore midwives' experiences and views of amniotomy. DESIGN A qualitative inductive design was used. Data were collected using interviews and analysed with content analysis carried out with NVivo 12. SETTING AND PARTICIPANTS Sixteen midwives working at delivery wards at three hospitals in the south of Sweden. FINDINGS Three categories emerged: "Promote, protect and support the physiological process of labour", "To make the decision -to do or not to do" and "Unpredictable response". The overall theme linking the three categories was "We become our decisions", portraying how midwives carry the responsibility in the decision-making and represent themselves in their handling of amniotomy. CONCLUSIONS Amniotomy was experienced and viewed as both simple and complex, safe and risky, and deciding on it sometimes implied balancing contradicting perspectives. By using midwifery skills in the decision-making for an amniotomy, the midwives tried to predict the response, purposing to support physiological labour and promote health for women and babies.
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Affiliation(s)
- Sofia Ingvarsson
- Department of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
| | - Marie Oscarsson
- Department of Health and Caring Sciences, Linnaeus University, 391 82 Kalmar, Sweden.
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Moridi M, Pazandeh F, Hajian S, Potrata B. Development and psychometric properties of Midwives' Knowledge and Practice Scale on Respectful Maternity Care (MKP-RMC). PLoS One 2020; 15:e0241219. [PMID: 33141835 PMCID: PMC7608882 DOI: 10.1371/journal.pone.0241219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 10/09/2020] [Indexed: 11/18/2022] Open
Abstract
Objective To develop a scale for evaluating knowledge and practice of midwives on Respectful Maternity Care (RMC). Methods An exploratory sequential mixed method study was conducted from January 2018 to July 2019 in two non-teaching public hospitals in Tehran, Iran. In the first part of the study, a literature review and qualitative study were carried out in order to develop the preliminary item pool. Then face, content and construct validity and reliability (internal consistency and test-retest) were assessed. Results The MKP-RMC scale has 23-item in knowledge and 23-item in practice section that loaded in three factors: Giving emotional support, providing safe care and preventing mistreatment. Exploratory factor analysis accounted for 43.47% and 58.62% of observed variance in knowledge and practice sections, respectively. The internal consistency and internal correlation coefficient of both section of MKP-RMC indicated acceptable reliability. Conclusion The MKP-RMC is a valid and reliable tool for measuring midwives' knowledge and practice of respectful care during labor and childbirth. The MKP-RMC could be used in maternity services to evaluate and improve quality of childbirth care through development of educational interventions for effective behavioral change. Confirmation of validity and reliability of translated version of the scale in other maternity care providers and different contexts is recommended.
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Affiliation(s)
- Maryam Moridi
- Department of Midwifery and Reproductive Health, Student Research Committee, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- School of Health Sciences, University of Nottingham, Nottingham, United Kingdom
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Sepideh Hajian
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Sbrilli MD, Duncan LG, Laurent HK. Effects of prenatal mindfulness-based childbirth education on child-bearers' trajectories of distress: a randomized control trial. BMC Pregnancy Childbirth 2020; 20:623. [PMID: 33059638 PMCID: PMC7559171 DOI: 10.1186/s12884-020-03318-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The perinatal period is a time of immense change, which can be a period of stress and vulnerability for mental health difficulties. Mindfulness-based interventions have shown promise for reducing distress, but further research is needed to identify long-term effects and moderators of mindfulness training in the perinatal period. METHODS The current study used data from a pilot randomized control trial (RCT) comparing a condensed mindfulness-based childbirth preparation program-the Mind in Labor (MIL)-to treatment as usual (TAU) to examine whether prenatal mindfulness training results in lower distress across the perinatal period, and whether the degree of benefit depends on child-bearers' initial levels of risk (i.e., depression and anxiety symptoms) and protective (i.e., mindfulness) characteristics. Child-bearers (N = 30) in their third trimester were randomized to MIL or TAU and completed assessments of distress-perceived stress, anxiety, and depressive symptoms-at pre-intervention, post-intervention, six-weeks post-birth, and one-year postpartum. RESULTS Multilevel modeling of distress trajectories revealed greater decreases from pre-intervention to 12-months postpartum for those in MIL compared to TAU, especially among child-bearers who were higher in anxiety and/or lower in dispositional mindfulness at baseline. CONCLUSIONS The current study offers preliminary evidence for durable perinatal mental health benefits following a brief mindfulness-based program and suggests further investigation of these effects in larger samples is warranted. TRIAL REGISTRATION The ClinicalTrials.gov identifier for the study is: NCT02327559 . The study was retrospectively registered on June 23, 2014.
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Affiliation(s)
- Marissa D Sbrilli
- Department of Psychology, University of Illinois at Urbana-Champaign, Psychology Building, 603 E Daniel St, Champaign, IL, 61820, USA.
| | - Larissa G Duncan
- School of Human Ecology, University of Wisconsin-Madison, Madison, USA
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, USA
- Osher Center for Integrative Medicine, University of California, San Francisco (UCSF), San Francisco, USA
| | - Heidemarie K Laurent
- Department of Psychology, University of Illinois at Urbana-Champaign, Psychology Building, 603 E Daniel St, Champaign, IL, 61820, USA
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Iloghalu EI, Ugwu EO, Obi SN. Determinants of birth preparedness and complication readiness: A cross-sectional study of parturient in a tertiary health institution in South-East Nigeria. Niger J Clin Pract 2020; 23:1456-1461. [PMID: 33047706 DOI: 10.4103/njcp.njcp_254_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Birth preparedness and complication readiness (BPCR) is a strategy with specific interventions to reduce pregnancy related morbidity and mortality. AIM The study assessed the predictors of optimal birth preparedness and complication readiness among parturient in a tertiary health institution in Nigeria. SUBJECT AND METHODS This descriptive cross-sectional study was conducted among parturient at the labor and post-natal wards of University of Nigeria Teaching Hospital Enugu over a 6 months period. Demographic information and predictors of BPCR were analyzed by descriptive statistics and logistic regression respectively with P value of < 0.05 considered statistically significant. RESULTS Of the 420 parturient, 330 (78.6%) and 90 (21.4%) were booked and unbooked respectively. Majority (74.2%) of the booked and about half of the unbooked parturient were knowledgeable about BPCR. Most (92.4%) of the booked parturient were optimally birth prepared at delivery as against 22.2% of the unbooked. Higher parity (adj OR = 3.79; 95% CI = 1.46-9.82, P = 0.01), tertiary educational level (adj OR = 2.98; 95% CI = 1.23-7.20, P = 0.02), regular antenatal visit (adj OR = 2.68; 95% CI = 1.06-6.76, P = 0.04), information received on birth preparedness before delivery (adj OR = 0.21; 95% CI = 0.07-0.61, P = <0.01), and booked status (adj OR = 0.02; 95% CI = 0.01-0.05, P = <0.001) where significant predictors of optimal BPCR. CONCLUSION Encouraging female education, regular antenatal visits, and participation in health talk is advocated to improve BPCR and ultimately reduce maternal and perinatal mortality/morbidity among women in southeast Nigeria.
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Affiliation(s)
- Emeka I Iloghalu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Emmanuel O Ugwu
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
| | - Samuel N Obi
- Department of Obstetrics and Gynaecology, College of Medicine, University of Nigeria, Ituku-Ozalla Campus, Enugu, Nigeria
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Gür EY, Apay SE. The effect of cognitive behavioral techniques using virtual reality on birth pain: a randomized controlled trial. Midwifery 2020; 91:102856. [PMID: 33478718 DOI: 10.1016/j.midw.2020.102856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 09/02/2020] [Accepted: 09/27/2020] [Indexed: 12/26/2022]
Abstract
OBJECTIVE This study was conducted to investigate the effects of cognitive behavioral techniques using virtual reality on birth pain. DESING This study was planned as a double blind randomized controlled experimental study. SETTING AND PARTICIPANTS It was conducted with 273 pregnant women who were randomized between July 2016 and June 2019 at maternity hospital located in eastern Anatolia, Turkey. METHODS The study included 5 groups. (A: videos of newborn photographs with classical music, B: the video of the newborn photograph album, C: an introductory film of Turkey, D: only classical music, E: routine hospital care). The data were collected by using the "Personal Information Form", "Visual Analogue Scale", "Verbal Rating Scale" and "Virtual Reality". FINDINGS Groups show homogeneity in terms of demographic and obstetric variables. It was found that mean Visual Analogue Scale posttest mean score of the group A was 4.98 ± 1.69; group B 4.96 ± 1.72; group C 5.96 ± 2.05; group D 5.60 ± 1.63 and group E 6.38 ± 1.86. Mean Verbal Rating Scale posttest score was found that group A was 2.64 ± 0.73, group B 2.70 ± 0.87, group C 3.18 ± 1.14, group D was 2.80 ± 0.86 and group E was 3.96 ± 1.01. It was obtained that the groups' mean Visual Analogue Scale and Verbal Rating Scale posttest mean scores was statistically significant (p<0.05). CONCLUSION In this study, all cognitive techniques applied with virtual reality reduced labor pain during the active phase of labor. Especially the video of newborn photographs with classical music and newborn photograph album have been found more effective than other interventions evaluated in reducing labor pain. IMPLICATIONS FOR PRACTICE Midwives can use these techniques to reduce birth pain.
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Affiliation(s)
- Elif Yagmur Gür
- Ataturk University Health Science, Faculty Midwifery Department, Erzurum, Turkey.
| | - Serap Ejder Apay
- Ataturk University Health Science, Faculty Midwifery Department, Erzurum, Turkey
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Imtithal Adnan F, Noor NM, Mat Junoh NA. Associated factors of labor satisfaction and predictor of postnatal satisfaction in the north-east of Peninsular Malaysia. PLoS One 2020; 15:e0238310. [PMID: 32857816 PMCID: PMC7455019 DOI: 10.1371/journal.pone.0238310] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 08/03/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Identifying the factors contributing to maternal satisfaction is a proxy measure to improve the quality of care. It evaluates the health service provision by understanding maternal perceptions and expectations and promoting adherence to health services. This study aimed to identify the sociodemographic, obstetric, and medical factors contributing to labor satisfaction among postpartum women and examine the association between labor and postnatal satisfaction. METHODOLOGY A cross-sectional study using systematic random sampling in a ratio of 1:5 based on the delivery list in a labor room in a tertiary hospital was applied. Information was obtained from medical records for sociodemographic characteristics and obstetric and medical histories. Face-to-face interviews were performed to obtain responses for Malay versions of the Women's Views of Birth Labour Satisfaction Questionnaire and the Women's Views of Birth Postnatal Satisfaction Questionnaire. Simple and general linear regression analyses were performed. RESULTS A total of 110 participants responded, accounting for a response rate of 100%. High-risk color codes, the period of gestation, household income, and were significantly associated with maternal satisfaction during labor. The association between labor and postnatal satisfaction was significant. CONCLUSION Identifying these associated factors and differences may lead to understanding and contributing to specific and targeted strategies for tackling issues related to maternal satisfaction.
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Affiliation(s)
- Fatin Imtithal Adnan
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Norhayati Mohd Noor
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Nor Akma Mat Junoh
- Department of Family Medicine, School of Medical Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
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Olza I, Uvnas-Moberg K, Ekström-Bergström A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, Villarmea S, Hadjigeorgiou E, Kazmierczak M, Spyridou A, Buckley S. Birth as a neuro-psycho-social event: An integrative model of maternal experiences and their relation to neurohormonal events during childbirth. PLoS One 2020; 15:e0230992. [PMID: 32722725 PMCID: PMC7386571 DOI: 10.1371/journal.pone.0230992] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Psychological aspects of labor and birth have received little attention within maternity care service planning or clinical practice. The aim of this paper is to propose a model demonstrating how neurohormonal processes, in particular oxytocinergic mechanisms, not only control the physiological aspects of labor and birth, but also contribute to the subjective psychological experiences of birth. In addition, sensory information from the uterus as well as the external environment might influence these neurohormonal processes thereby influencing the progress of labor and the experience of birth. METHODOLOGY In this new model of childbirth, we integrated the findings from two previous systematic reviews, one on maternal plasma levels of oxytocin during physiological childbirth and one meta-synthesis of women´s subjective experiences of physiological childbirth. FINDINGS The neurobiological processes induced by the release of endogenous oxytocin during birth influence maternal behaviour and feelings in connection with birth in order to facilitate birth. The psychological experiences during birth may promote an optimal transition to motherhood. The spontaneous altered state of consciousness, that some women experience, may well be a hallmark of physiological childbirth in humans. The data also highlights the crucial role of one-to-one support during labor and birth. The physiological importance of social support to reduce labor stress and pain necessitates a reconsideration of many aspects of modern maternity care. CONCLUSION By listening to women's experiences and by observing women during childbirth, factors that contribute to an optimized process of labor, such as the mothers' wellbeing and feelings of safety, may be identified. These observations support the integrative role of endogenous oxytocin in coordinating the neuroendocrine, psychological and physiological aspects of labor and birth, including oxytocin mediated. decrease of pain, fear and stress, support the need for midwifery one-to-one support in labour as well as the need for maternity care that optimizes the function of these neuroendocrine processes even when birth interventions are used. Women and their partners would benefit from understanding the crucial role that endogenous oxytocin plays in the psychological and neuroendocrinological process of labor.
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Affiliation(s)
- Ibone Olza
- Faculty of Medicine, University of Alcalá, Henares, Spain
| | | | | | | | | | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science Maastricht, Zuyd University, Heerlen, The Netherlands
| | - Stella Villarmea
- Faculty of Philosophy, University of Alcalá, Henares, Spain
- Faculty of Philosophy, University of Oxford, Oxford, United Kingdom
| | - Eleni Hadjigeorgiou
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | | | - Andria Spyridou
- Nursing Department, Faculty of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - Sarah Buckley
- School of Public Health, The University of Queensland, Herston, Qld, Australia
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Whittaker D. Midwives experiences of providing midwifery care following their involvement in an obstetric emergency. Midwifery 2020; 83:102620. [PMID: 31935661 DOI: 10.1016/j.midw.2019.102620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 12/20/2019] [Accepted: 12/27/2019] [Indexed: 11/19/2022]
Affiliation(s)
- Dawn Whittaker
- School of Nursing and Midwifery, National University of Galway Ireland, Upper Newcastle Road, Galway, Ireland.
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Mselle LT, Eustace L. Why do women assume a supine position when giving birth? The perceptions and experiences of postnatal mothers and nurse-midwives in Tanzania. BMC Pregnancy Childbirth 2020; 20:36. [PMID: 31931780 PMCID: PMC6958681 DOI: 10.1186/s12884-020-2726-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 01/07/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Before the advent of Western medicine in Tanzania, women gave birth in an upright position either by sitting, squatting or kneeling. Birthing women would hold ropes or trees as a way of gaining strength and stability in order to push the baby with sufficient force. Despite the evidence supporting the upright position as beneficial to the woman and her unborn child, healthcare facilities consistently promote the use of the supine position. The purpose of this study was to explore the perceptions and experiences of mothers and nurse-midwives regarding the use of the supine position during labour and delivery. METHODS We used a descriptive qualitative design. We conducted seven semi-structured interviews with nurse-midwives and two focus group discussions with postnatal mothers who were purposively recruited for the study. Qualitative content analysis guided the analysis. RESULTS Four themes emerged from mothers' and midwives' description of their experiences and perceptions of using supine position during childbirth. These were: women adopted the supine position as instructed by midwives; women experience of using alternative birthing positions; midwives commonly decide birthing positions for labouring women and supine position is the best-known birthing position. CONCLUSION Women use the supine position during childbirth because they are instructed to do so by the nurse-midwives. Nurse-midwives believe that the supine position is the universally known and practised birthing position, and prefer it because it provides flexibility for them to continuously monitor the progress of labour and assist delivery most efficiently. Mothers in this study had no other choice than to labour and deliver their babies in the supine position as instructed because they trusted midwives as skilled professionals who knew what was best given the condition of the mother and her baby.
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Affiliation(s)
- Lilian Teddy Mselle
- Department of Clinical Nursing, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Lucia Eustace
- Department of Nursing and Midwifery, Missenyi District Council, Bukoba, Kagera Tanzania
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Lewis M, Passant L, Cooke H, Challis D. Women's experiences of antenatal transfer for threatened premature labour in NSW: A qualitative study. Women Birth 2020; 33:e535-e542. [PMID: 31899149 DOI: 10.1016/j.wombi.2019.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/14/2019] [Accepted: 12/15/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Each year thousands of pregnant women experiencing threatened premature labour are transferred considerable distances across Australia to access higher level facilities but only a small proportion of these women go on to actually give birth to a premature baby. Women from regional areas are required to move away from their home, children and support networks because of a perceived risk of birthing in a centre without neonatal intensive care facilities. AIM This study examines the experience of women undergoing antenatal transfer for threatened premature labour in New South Wales and the Australian Capital Territory who do not give birth during their transfer admission. METHODS Thirteen semi-structured in-depth interviews were held with women across five tertiary referral sites across New South Wales and the Australian Capital Territory, and analysed until saturation for themes. FINDINGS Seven urban and six rural women were interviewed. Women and their families were all negatively affected by antenatal transfer. Factors that helped enable a positive experience were; enhanced sense of safety in the tertiary unit, and individual qualities of staff. Factors that contributed to negative experiences were; inadequate and conflicting information, and no involvement or choice in the clinical decision-making process to move to another facility. CONCLUSIONS Antenatal transfer is an extremely stressful experience for women and their families. The provision of high quality written and verbal information, and the inclusion of women's perception of risk in the clinical decision making process will improve the experience for women and their families in NSW and the ACT.
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Affiliation(s)
- Melanie Lewis
- NSW Pregnancy and Newborn Services Network, Australia.
| | | | - Helen Cooke
- NSW Pregnancy and Newborn Services Network, Australia
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Habek D. Tocophobia: Is It Being Treated Surgically? Psychiatr Danub 2020; 32:447-448. [PMID: 33370751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Dubravko Habek
- University Department of Obstetrics and Gynecology, University Hospital "Sveti Duh", Sveti Duh 64, 10000 Zagreb, Croatia,
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Hopwood N, Blomberg M, Dahlberg J, Abrandt Dahlgren M. Three Principles Informing Simulation-Based Continuing Education to Promote Effective Interprofessional Collaboration: Reorganizing, Reframing, and Recontextualizing. J Contin Educ Health Prof 2020; 40:81-88. [PMID: 32404776 DOI: 10.1097/ceh.0000000000000292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
INTRODUCTION Shoulder dystocia is a complex birth emergency where patient outcomes remain a concern. This article investigates the detailed processes of simulation-based continuing education in a hospital where evidence over 10 years demonstrates improvements in practitioner knowledge, enacted practices, and maternal and child outcomes. METHODS Data were collected by video recording teams participating in a shoulder dystocia simulation and debrief. Analysis combined grounded thematic development with purposive coding of enactments of a relevant protocol (the ALSO HELPERR). RESULTS Three themes were identified (three Rs) that capture how effective interprofessional collaboration is promoted through collectively oriented reflection: Reorganizing roles and responsibilities between team members; Reframing the problem of shoulder dystocia from individuals correctly following a protocol, to a team of professionals who need to attune to, respond to, and support one another; and Recontextualizing by collectively "commingling" theoretical knowledge with practical experience to reflect on actions and judgements. DISCUSSION The three Rs are relevant to diverse clinical settings and address gaps in knowledge relating to the process of interprofessional simulation. Together, they constitute a set of principles to inform the design and conduct of continuing education for interprofessional practice through simulation.
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Affiliation(s)
- Nick Hopwood
- Dr. Hopwood: Associate Professor, School of International Studies and Education, University of Technology Sydney, Sydney, Australia, and Department of Curriculum Studies, Stellenbosch Universiteit, Stellenbosch, South Africa. Ms. Blomberg: Professor, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden, and Department of Obstetrics and Gynecology, Linköping University, Linköping, Sweden. Ms. Dahlberg: Senior Lecturer, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden. Ms. Abrandt Dahlgren: Professor in Medical Education, Department of Medicine and Health, Linköping University, Linköping, Sweden
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McMahon G, Rogers A, Woulfe Z, Tuthill E, Doyle M, Burke G, Imcha M. Women's Opinions on Cardiotocograph Monitoring and Staff Communication During Labour. Ir Med J 2019; 112:1022. [PMID: 32311252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- G McMahon
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - A Rogers
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - Z Woulfe
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - E Tuthill
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - M Doyle
- Labour Ward, University Maternity Hospital Limerick, Ireland
| | - G Burke
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
| | - M Imcha
- Dept. of Obstetrics and Gynaecology, University Maternity Hospital Limerick, Ireland
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Tadaumi M, Sweet L, Graham K. A qualitative study of factors that influence midwives' practice in relation to low-risk women's oral intake in labour in Australia. Women Birth 2019; 33:e455-e463. [PMID: 31796342 DOI: 10.1016/j.wombi.2019.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 11/14/2019] [Accepted: 11/14/2019] [Indexed: 11/19/2022]
Abstract
BACKGROUND Restriction of food and fluids during labour increases women's discomfort, anxiety and stress which are associated with obstruction of the normal process of labour. Whilst research evidence and clinical guidelines recommend that normal uncomplicated labouring women should not be limited in their oral intake during labour, some midwives continue to restrict or discourage women's oral intake. To promote best practice, it is important to understand the influencing factors which affect midwives' decision-making processes. OBJECTIVE This study aimed to investigate the influences that affect midwifery practice regarding oral food and fluid intake for low-risk labouring women. DESIGN An interpretive descriptive approach employed 12 semi-structured interviews with registered midwives with current labour and birthing experience in Australia. Data was analysed using thematic analysis. FINDINGS Three themes were identified: midwives' knowledge and beliefs; work environment and women's expectations of care. Midwives' practice was affected by their knowledge and values developed from professional and personal experiences of labour, their context of practice and work environment, the clinical guidelines, policies and obstetric control, and women's choice and comfort. CONCLUSION This study indicates that midwives' decision-making in relation to women's oral nutrition during labour is multifaceted and influenced by complicated environments, models of care, and power relations between doctors and midwives, more so than clinical guidelines. It is important for midwives to be aware of factors negatively influencing their decision-making processes to enable autonomy and empowerment in the provision of evidence-based care of labouring women.
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Affiliation(s)
- Mika Tadaumi
- College of Nursing and Health Science, Flinders University, Australia
| | - Linda Sweet
- College of Nursing and Health Science, Flinders University, Australia; Deakin University and Western Health Partnership, Australia.
| | - Kristen Graham
- College of Nursing and Health Science, Flinders University, Australia
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Perkins J, Rahman AE, Mhajabin S, Siddique AB, Mazumder T, Haider MR, El Arifeen S. Humanised childbirth: the status of emotional support of women in rural Bangladesh. Sex Reprod Health Matters 2019; 27:1610277. [PMID: 31533580 PMCID: PMC7887950 DOI: 10.1080/26410397.2019.1610277] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The World Health Organization has recently set standards emphasising the importance of emotional support during birth for improving the quality of maternal and newborn healthcare in facilities. In this study, we explore the emotional support status of women during birth in rural Bangladesh. A cross-sectional household survey of 1367 women was administered in 2018 in Brahmanbaria district. Outcomes of interest included: presence of a companion of choice; mobility; intake of fluids and food; and position of choice. Associations between outcomes of interest and background characteristics were explored through binary and multiple logistic regressions. Approximately 68% women had a companion of choice during labour or childbirth, significantly higher among women giving birth at home (75%) than in a health facility. Nearly 60% women were allowed to eat and drink during labour, also significantly higher among women giving birth at home. Seventy-per cent women were allowed to be ambulatory during labour (46% in a facility vs. 85% at home). Only 27% women were offered or allowed to give birth in the position of their choice at facility, compared to 54% giving birth at home. Among women giving birth in a facility who did not have a companion of choice, 39% reported that the health provider/health facility management did not allow this. Ensuring emotional support and thereby improving the quality of the experience of care within health facilities should be prioritised by the Bangladesh government both to improve health outcomes of women and newborns and also to promote more humanised, positive childbirth experiences.
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Affiliation(s)
- Janet Perkins
- PhD Student, Department of Social Anthropology, University of Edinburgh, Edinburgh, UK
| | - Ahmed Ehsanur Rahman
- Associate Scientist, International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh
- PhD Student, Usher Institute of Population Health Sciences and Informatics, Centre for Global Health Research, University of Edinburgh, Edinburgh, UK
| | - Shema Mhajabin
- Research Trainee, International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh
| | - Abu Bakkar Siddique
- Senior Statistical Officer, International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh
| | - Tapas Mazumder
- Research Investigator, International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh
| | - Mohammad Rifat Haider
- Assistant Professor, Department of Health Promotion, Education & Behaviour, University of South Carolina, Columbia, SC, USA
| | - Shams El Arifeen
- Senior Director and Senior Scientist, International Centre for Diarrhoeal Disease Research, Bangladesh, (icddr,b), Dhaka, Bangladesh
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Bohren MA, Mehrtash H, Fawole B, Maung TM, Balde MD, Maya E, Thwin SS, Aderoba AK, Vogel JP, Irinyenikan TA, Adeyanju AO, Mon NO, Adu-Bonsaffoh K, Landoulsi S, Guure C, Adanu R, Diallo BA, Gülmezoglu AM, Soumah AM, Sall AO, Tunçalp Ö. How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys. Lancet 2019; 394:1750-1763. [PMID: 31604660 PMCID: PMC6853169 DOI: 10.1016/s0140-6736(19)31992-0] [Citation(s) in RCA: 237] [Impact Index Per Article: 47.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Revised: 08/08/2019] [Accepted: 08/15/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Women across the world are mistreated during childbirth. We aimed to develop and implement evidence-informed, validated tools to measure mistreatment during childbirth, and report results from a cross-sectional study in four low-income and middle-income countries. METHODS We prospectively recruited women aged at least 15 years in twelve health facilities (three per country) in Ghana, Guinea, Myanmar, and Nigeria between Sept 19, 2016, and Jan 18, 2018. Continuous observations of labour and childbirth were done from admission up to 2 h post partum. Surveys were administered by interviewers in the community to women up to 8 weeks post partum. Labour observations were not done in Myanmar. Data were collected on sociodemographics, obstetric history, and experiences of mistreatment. FINDINGS 2016 labour observations and 2672 surveys were done. 838 (41·6%) of 2016 observed women and 945 (35·4%) of 2672 surveyed women experienced physical or verbal abuse, or stigma or discrimination. Physical and verbal abuse peaked 30 min before birth until 15 min after birth (observation). Many women did not consent for episiotomy (observation: 190 [75·1%] of 253; survey: 295 [56·1%] of 526) or caesarean section (observation: 35 [13·4%] of 261; survey: 52 [10·8%] of 483), despite receiving these procedures. 133 (5·0%) of 2672 women or their babies were detained in the facility because they were unable to pay the bill (survey). Younger age (15-19 years) and lack of education were the primary determinants of mistreatment (survey). For example, younger women with no education (odds ratio [OR] 3·6, 95% CI 1·6-8·0) and younger women with some education (OR 1·6, 1·1-2·3) were more likely to experience verbal abuse, compared with older women (≥30 years), adjusting for marital status and parity. INTERPRETATION More than a third of women experienced mistreatment and were particularly vulnerable around the time of birth. Women who were younger and less educated were most at risk, suggesting inequalities in how women are treated during childbirth. Understanding drivers and structural dimensions of mistreatment, including gender and social inequalities, is essential to ensure that interventions adequately account for the broader context. FUNDING United States Agency for International Development and the UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, WHO.
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Affiliation(s)
- Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Carlton, VIC, Australia; UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland.
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Bukola Fawole
- Department of Obstetrics and Gynaecology, National Institute of Maternal and Child Health, College of Medicine, University of Ibadan, Ibadan, Nigeria
| | | | - Mamadou Dioulde Balde
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - Ernest Maya
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, Ghana
| | - Soe Soe Thwin
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Adeniyi K Aderoba
- Department of Obstetrics and Gynaecology, Mother and Child Hospital, Oke-Aro, Akure, Ondo State, Nigeria
| | - Joshua P Vogel
- Maternal and Child Health Program, Burnet Institute, Melbourne, VIC, Australia
| | - Theresa Azonima Irinyenikan
- Department of Obstetrics and Gynaecology, Faculty of Clinical Sciences, University of Medical Sciences, Ondo, Ondo State, Nigeria; University of Medical Sciences Teaching Hospital, Akure, Ondo State, Nigeria
| | | | - Nwe Oo Mon
- Department of Medical Research, Yangon, Myanmar
| | - Kwame Adu-Bonsaffoh
- Department of Obstetrics and Gynaecology, School of Medicine and Dentistry, Unive rsity of Ghana, Accra, Ghana
| | - Sihem Landoulsi
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Chris Guure
- Department of Biostatistics, School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Richard Adanu
- School of Public Health, University of Ghana, Legon-Accra, Ghana
| | - Boubacar Alpha Diallo
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - A Metin Gülmezoglu
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Anne-Marie Soumah
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - Alpha Oumar Sall
- Cellule de Recherche en Sante de la Reproduction en Guinee (CERREGUI), Conakry, Guinea
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Reproductive Health and Research, World Health Organization, Geneva, Switzerland
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Miller N, Asali AA, Agassi-Zaitler M, Neumark E, Eisenberg MM, Hadi E, Elbaz M, Pasternak Y, Fishman A, Biron-Shental T. Physiological and psychological stress responses to labor and delivery as expressed by salivary cortisol: a prospective study. Am J Obstet Gynecol 2019; 221:351.e1-351.e7. [PMID: 31254523 DOI: 10.1016/j.ajog.2019.06.045] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Revised: 06/15/2019] [Accepted: 06/20/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Labor is considered a stressful event, yet no study has described the course of stress measured by cortisol during labor and postpartum. OBJECTIVE The objective of the study was to describe the patterns of physiological and psychological stress during labor as measured by salivary cortisol concentrations and stress questionnaires and their correlation to obstetric and neonatal outcomes. STUDY DESIGN This prospective, observational study included 167 women with low-risk, singleton, term deliveries at a tertiary academic center. Physiological stress was evaluated by salivary cortisol measurements and emotional stress by questionnaire (stress scale ranging from 0 to 10) during the latent phase, active phase, and full dilation stages of labor as well as 2 minutes, 2 hours, and 24 hours after delivery. Cord blood cortisol and pH were also obtained. Modes of delivery, complications during labor and delivery, and early neonatal outcomes were evaluated. RESULTS Salivary cortisol concentrations increased gradually from latent phase to active phase. The maximum increase was observed within 2 minutes of the delivery (from an average of 1.06 μg/dL to 1.67 μg/dL; 57% increase). Within 2 hours after delivery, cortisol decreased and reached a nongravid concentration after 24 hours (0.16 μg/dL). Cortisol concentrations during labor and up to 2 hours postpartum were above the average concentration of nongravid women (0.5 μg/dL). Women with epidural anesthesia had lower cortisol concentrations at complete dilation (P = .026) and 2 hours postpartum (P = .016) compared with women without epidural. Psychological stress peaked during latent and full dilation phases (mean 4.56 and 4.29, respectively). Maximum decrease from 4.29 to 2.04 (52%) occurred immediately postpartum. Cord cortisol was higher among women delivered by vacuum extraction compared with spontaneous vaginal delivery (17 ± 2 vs 11 ± 3.8, P = .03). CONCLUSION This study reveals the course of cortisol concentrations during labor for low-risk pregnancies, with maximum increase immediately postpartum. Subjective stress levels decreased over the course of labor. Salivary cortisol portrays stress during labor and may be used as a reference to evaluate complicated pregnancies and to evaluate the role of cortisol during these deliveries.
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Affiliation(s)
- Netanella Miller
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Aula Atamna Asali
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Agassi-Zaitler
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eran Neumark
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel
| | | | - Efrat Hadi
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Michal Elbaz
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Yael Pasternak
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ami Fishman
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Tal Biron-Shental
- Department of Obstetrics and Gynecology, Meir Medical Center, Kfar Saba, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Siyoum M, Mekonnen S. Labor pain control and associated factors among women who gave birth at Leku primary hospital, southern Ethiopia. BMC Res Notes 2019; 12:619. [PMID: 31547839 PMCID: PMC6757368 DOI: 10.1186/s13104-019-4645-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/13/2019] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To assess labor pain control and associated factors among women who give birth at Leku primary hospital, southern Ethiopia, 2018/19. A systematic random sampling technique was used to select 404 mothers who gave birth at Leku hospital during the data collection period. Data were collected by two first degree midwives immediately after delivery using Labor Agentry Scale (LAS). RESULTS In this study, 404 mothers were participated making the response rate of 100%. Among the participants, 104 (25.7%) of mothers reported Mild control of labor pain. Maternal age of 19 to 24 year AOR = 5.85 (95% CI 2.14, 15.98), being farmer AOR = 2.5 (1.14, 5.57), primi-para AOR = 0.13 (0.06, 0.3), good family support AOR = 2.8 (1.49, 5.3), short duration of labor (< 12 h) AOR = 3.2 (1.65, 6.23) and history of pregnancy loss AOR = 0.06 (0.03, 0.14) were significantly associated with greater control of labor pain. In general, compared to other studies, the level of labor pain control is good in this study area. Enhancing factors of labor pain control have to be strengthened to increase greater control of labor pain. Qualitative research is highly recommended to identify cultural factors related to labor pain control and management.
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Affiliation(s)
- Melese Siyoum
- Department of Midwifery, College of Medicine and Health Sciences, Hawassa University, P.O. box 1560, Hawassa, Ethiopia.
| | - Shewangizaw Mekonnen
- School of Nursing, College of Medicine and Health Sciences, Hawassa University, P.O. box 1560, Hawassa, Ethiopia
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McAlister BS. A Case of Perceived Lack of Prenatal Caring. Nurs Womens Health 2019; 23:351-356. [PMID: 31276629 DOI: 10.1016/j.nwh.2019.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Revised: 03/11/2019] [Accepted: 05/01/2019] [Indexed: 11/15/2022]
Abstract
This qualitative case study tells the story of one woman's experience of prenatal care through her own words and those of her mother, who is a nurse. Frequent sonograms, referral to a maternal-fetal medicine physician, and the unexpected recommendation to schedule an induction made this woman anxious about the well-being of her fetus, influenced her experience of pregnancy, and affected her developing identity as a mother. She felt neither cared for nor included as a partner in her own prenatal care. Although she reported feeling strong and capable in every other aspect of her life, she felt powerless to self-advocate with regard to her prenatal care experience. Ultimately, she asked her mother to accompany her to a prenatal appointment to advocate on her behalf.
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McLain SK. A Project to Increase Nurses' Comfort in Offering Bedpans to Women Laboring With Epidural Analgesia. Nurs Womens Health 2019; 23:200-216. [PMID: 31171242 DOI: 10.1016/j.nwh.2019.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 12/10/2018] [Accepted: 03/01/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To improve nurses' comfort in helping laboring woman void on a bedpan after initiation of epidural analgesia, to increase the frequency of bedpan use in the labor and birth unit, and to decrease the use of continuous indwelling Foley catheters during the intrapartum period. DESIGN Quality improvement project. SETTING A single large, midwestern U.S. hospital (>3,000 births annually), where bedpans are infrequently used after epidural placement. PARTICIPANTS Registered nurses on a labor and birth unit. INTERVENTION/MEASUREMENTS A 20-minute educational presentation that included current urinary catheter evidence-based practice, preferential use of bedpans, and methods to help women void successfully was taught to all registered nurses in the author's labor unit. Nurses rated on a scale of 0 (not comfortable at all) to 10 (extremely comfortable) their comfort level at helping a woman with a bedpan. Primary data were collected through a convenience sample of anonymous surveys (n = 52) completed by registered nurses regarding their experience with bedpan and catheter use during labor and their comfort level helping women be successful with voiding. This was followed by a retrospective chart audit for women with term, singleton pregnancies who labored with epidural analgesia. RESULTS Nurses' comfort levels increased from an average of 5.7 to 7.2 (p = .067). Postepidural bedpan use increased from 5.5% (n = 12) to 19% overall (n = 20; p < .001), with five women using bedpans exclusively. When assisted with bedpan use, 38% (n = 12) of women were able to void 34 of the 53 times it was offered (64%). Use of continuous indwelling Foley catheters decreased from 61.7% (n = 137) to 54.7% (n = 58), and use of intermittent catheterization increased from 30.6% (n = 68) to 37.7% (n = 40). CONCLUSION When assisted by nurses educated in and comfortable with different voiding techniques, women may be able to avoid medically unnecessary use of urinary catheters during labor.
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Wada K, Charland LC, Bellingham G. Can women in labor give informed consent to epidural analgesia? Bioethics 2019; 33:475-486. [PMID: 30358905 DOI: 10.1111/bioe.12517] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Revised: 06/20/2018] [Accepted: 07/27/2018] [Indexed: 06/08/2023]
Abstract
There are reasons to believe that decision-making capacity (mental competence) of women in labor may be compromised in relation to giving informed consent to epidural analgesia. Not only severe labor pain, but also stress, anxiety, and premedication of analgesics such as opioids, may influence women's decisional capacity. Decision-making capacity is a complex construct involving cognitive and emotional components which cannot be reduced to 'understanding' alone. A systematic literature search identified a total of 20 empirical studies focused on women's decision-making about epidural analgesia for labor pain. Our review of these studies suggests that empirical evidence to date is insufficient to determine whether women undergoing labor are capable of consenting to epidural analgesia. Given such uncertainties, sufficient information about pain management should be provided as part of prenatal education and the consent process must be carefully conducted to enhance women's autonomy. To fill in the significant gap in clinical knowledge about laboring women's decision-making capacity, well-designed prospective and retrospective studies may be required.
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Affiliation(s)
- Kyoko Wada
- Centre for Clinical Ethics, St. Joseph's Health Centre Toronto, Toronto, Canada
| | - Louis C Charland
- Philosophy and Psychiatry & School of Health Studies, Western University, London, Canada
| | - Geoff Bellingham
- Anesthesia & Perioperative Medicine, London Health Sciences Centre University Hospital, London, Canada
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Abstract
BACKGROUND Labour companionship refers to support provided to a woman during labour and childbirth, and may be provided by a partner, family member, friend, doula or healthcare professional. A Cochrane systematic review of interventions by Bohren and colleagues, concluded that having a labour companion improves outcomes for women and babies. The presence of a labour companion is therefore regarded as an important aspect of improving quality of care during labour and childbirth; however implementation of the intervention is not universal. Implementation of labour companionship may be hampered by limited understanding of factors affecting successful implementation across contexts. OBJECTIVES The objectives of the review were to describe and explore the perceptions and experiences of women, partners, community members, healthcare providers and administrators, and other key stakeholders regarding labour companionship; to identify factors affecting successful implementation and sustainability of labour companionship; and to explore how the findings of this review can enhance understanding of the related Cochrane systematic review of interventions. SEARCH METHODS We searched MEDLINE, CINAHL, and POPLINE K4Health databases for eligible studies from inception to 9 September 2018. There were no language, date or geographic restrictions. SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis; focused on women's, partners', family members', doulas', providers', or other relevant stakeholders' perceptions and experiences of labour companionship; and were from any type of health facility in any setting globally. DATA COLLECTION AND ANALYSIS We used a thematic analysis approach for data extraction and synthesis, and assessed the confidence in the findings using the GRADE-CERQual approach. We used two approaches to integrate qualitative findings with the intervention review findings. We used a logic model to theorise links between elements of the intervention and health and well-being outcomes. We also used a matrix model to compare features of labour companionship identified as important in the qualitative evidence synthesis with the interventions included in the intervention review. MAIN RESULTS We found 51 studies (52 papers), mostly from high-income countries and mostly describing women's perspectives. We assessed our level of confidence in each finding using the GRADE-CERQual approach. We had high or moderate confidence in many of our findings. Where we only had low or very low confidence in a finding, we have indicated this.Labour companions supported women in four different ways. Companions gave informational support by providing information about childbirth, bridging communication gaps between health workers and women, and facilitating non-pharmacological pain relief. Companions were advocates, which means they spoke up in support of the woman. Companions provided practical support, including encouraging women to move around, providing massage, and holding her hand. Finally, companions gave emotional support, using praise and reassurance to help women feel in control and confident, and providing a continuous physical presence.Women who wanted a companion present during labour and childbirth needed this person to be compassionate and trustworthy. Companionship helped women to have a positive birth experience. Women without a companion could perceive this as a negative birth experience. Women had mixed perspectives about wanting to have a male partner present (low confidence). Generally, men who were labour companions felt that their presence made a positive impact on both themselves (low confidence) and on the relationship with their partner and baby (low confidence), although some felt anxious witnessing labour pain (low confidence). Some male partners felt that they were not well integrated into the care team or decision-making.Doulas often met with women before birth to build rapport and manage expectations. Women could develop close bonds with their doulas (low confidence). Foreign-born women in high-income settings may appreciate support from community-based doulas to receive culturally-competent care (low confidence).Factors affecting implementation included health workers and women not recognising the benefits of companionship, lack of space and privacy, and fearing increased risk of infection (low confidence). Changing policies to allow companionship and addressing gaps between policy and practice were thought to be important (low confidence). Some providers were resistant to or not well trained on how to use companions, and this could lead to conflict. Lay companions were often not integrated into antenatal care, which may cause frustration (low confidence).We compared our findings from this synthesis to the companionship programmes/approaches assessed in Bohren's review of effectiveness. We found that most of these programmes did not appear to address these key features of labour companionship. AUTHORS' CONCLUSIONS We have high or moderate confidence in the evidence contributing to several of these review findings. Further research, especially in low- and middle-income settings and with different cadres of healthcare providers, could strengthen the evidence for low- or very low-confidence findings. Ahead of implementation of labour companionship, researchers and programmers should consider factors that may affect implementation, including training content and timing for providers, women and companions; physical structure of the labour ward; specifying clear roles for companions and providers; integration of companions; and measuring the impact of companionship on women's experiences of care. Implementation research or studies conducted on labour companionship should include a qualitative component to evaluate the process and context of implementation, in order to better interpret results and share findings across contexts.
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Affiliation(s)
- Meghan A Bohren
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Geneva, Geneve, Switzerland, 1211
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Abstract
BACKGROUND Labour companionship refers to support provided to a woman during labour and childbirth, and may be provided by a partner, family member, friend, doula or healthcare professional. A Cochrane systematic review of interventions by Bohren and colleagues, concluded that having a labour companion improves outcomes for women and babies. The presence of a labour companion is therefore regarded as an important aspect of improving quality of care during labour and childbirth; however implementation of the intervention is not universal. Implementation of labour companionship may be hampered by limited understanding of factors affecting successful implementation across contexts. OBJECTIVES The objectives of the review were to describe and explore the perceptions and experiences of women, partners, community members, healthcare providers and administrators, and other key stakeholders regarding labour companionship; to identify factors affecting successful implementation and sustainability of labour companionship; and to explore how the findings of this review can enhance understanding of the related Cochrane systematic review of interventions. SEARCH METHODS We searched MEDLINE, CINAHL, and POPLINE K4Health databases for eligible studies from inception to 9 September 2018. There were no language, date or geographic restrictions. SELECTION CRITERIA We included studies that used qualitative methods for data collection and analysis; focused on women's, partners', family members', doulas', providers', or other relevant stakeholders' perceptions and experiences of labour companionship; and were from any type of health facility in any setting globally. DATA COLLECTION AND ANALYSIS We used a thematic analysis approach for data extraction and synthesis, and assessed the confidence in the findings using the GRADE-CERQual approach. We used two approaches to integrate qualitative findings with the intervention review findings. We used a logic model to theorise links between elements of the intervention and health and well-being outcomes. We also used a matrix model to compare features of labour companionship identified as important in the qualitative evidence synthesis with the interventions included in the intervention review. MAIN RESULTS We found 51 studies (52 papers), mostly from high-income countries and mostly describing women's perspectives. We assessed our level of confidence in each finding using the GRADE-CERQual approach. We had high or moderate confidence in many of our findings. Where we only had low or very low confidence in a finding, we have indicated this.Labour companions supported women in four different ways. Companions gave informational support by providing information about childbirth, bridging communication gaps between health workers and women, and facilitating non-pharmacological pain relief. Companions were advocates, which means they spoke up in support of the woman. Companions provided practical support, including encouraging women to move around, providing massage, and holding her hand. Finally, companions gave emotional support, using praise and reassurance to help women feel in control and confident, and providing a continuous physical presence.Women who wanted a companion present during labour and childbirth needed this person to be compassionate and trustworthy. Companionship helped women to have a positive birth experience. Women without a companion could perceive this as a negative birth experience. Women had mixed perspectives about wanting to have a male partner present (low confidence). Generally, men who were labour companions felt that their presence made a positive impact on both themselves (low confidence) and on the relationship with their partner and baby (low confidence), although some felt anxious witnessing labour pain (low confidence). Some male partners felt that they were not well integrated into the care team or decision-making.Doulas often met with women before birth to build rapport and manage expectations. Women could develop close bonds with their doulas (low confidence). Foreign-born women in high-income settings may appreciate support from community-based doulas to receive culturally-competent care (low confidence).Factors affecting implementation included health workers and women not recognising the benefits of companionship, lack of space and privacy, and fearing increased risk of infection (low confidence). Changing policies to allow companionship and addressing gaps between policy and practice were thought to be important (low confidence). Some providers were resistant to or not well trained on how to use companions, and this could lead to conflict. Lay companions were often not integrated into antenatal care, which may cause frustration (low confidence).We compared our findings from this synthesis to the companionship programmes/approaches assessed in Bohren's review of effectiveness. We found that most of these programmes did not appear to address these key features of labour companionship. AUTHORS' CONCLUSIONS We have high or moderate confidence in the evidence contributing to several of these review findings. Further research, especially in low- and middle-income settings and with different cadres of healthcare providers, could strengthen the evidence for low- or very low-confidence findings. Ahead of implementation of labour companionship, researchers and programmers should consider factors that may affect implementation, including training content and timing for providers, women and companions; physical structure of the labour ward; specifying clear roles for companions and providers; integration of companions; and measuring the impact of companionship on women's experiences of care. Implementation research or studies conducted on labour companionship should include a qualitative component to evaluate the process and context of implementation, in order to better interpret results and share findings across contexts.
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Affiliation(s)
- Meghan A Bohren
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaGeneveSwitzerland1211
- University of MelbourneCentre for Health Equity, Melbourne School of Population and Global HealthLevel 4, 207 Bouverie StreetCarltonVictoriaAustralia3053
| | - Blair O Berger
- Johns Hopkins Bloomberg School of Public HealthDepartment of Population, Family and Reproductive HealthBaltimoreMarylandUSA
| | | | - Özge Tunçalp
- World Health OrganizationUNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research20 Avenue AppiaGenevaGeneveSwitzerland1211
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Takács L, Mlíková Seidlerová J, Čepický P. Psychosocial risk factors for emergency cesarean section. Ceska Gynekol 2019; 84:33-39. [PMID: 31213056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
OBJECTIVE To compare the effects of childbirth fear and trait anxiety on the risk of emergency cesarean section; to analyze whether emergency cesarean section is associated with low mastery and maternal self-esteem; to examine whether stress and low social support in pregnancy may be considered risk factors for emergency cesarean section. DESIGN Original study. SETTING Department of Psychology, Faculty of Arts, Charles University, Prague. METHODS The study sample consisted of 447 women who gave birth at a maternity hospital in Vysočina Region (Havlíčkův Brod, Jihlava, Pelhřimov, Třebíč, Nové Město na Moravě) between October 2013 and September 2014. In the last trimester of pregnancy, the women completed validated questionnaires designed to assess fear of childbirth, general anxiety, maternal self-esteem, mastery, perceived stress and social support. Data regarding the course of labor were extracted from medical records. The association between the psychosocial factors and the risk of delivery via emergency cesarean section was analyzed using multiple logistic regression adjusted for marital status, parity, childs sex and epidural anesthesia. RESULTS A total of 73 women (16.3%) delivered by emergency cesarean section. The only statistically significant psychosocial predictor of emergency cesarean section was fear of childbirth (the women with strong fear had a twice higher risk; OR = 2.01; p = 0.021), whereas low maternal self-esteem was marginally significant (OR = 1.68; p = 0.082) in the adjusted analysis. No association between emergency cesarean section and general anxiety, mastery, stress or social support in pregnancy was found. The risk of cesarean section was higher for primiparous women and lower for women who gave birth to a girl. CONCLUSION Fear of childbirth but not general anxiety is associated with a higher risk of emergency cesarean section. The women who experience strong fear of childbirth during pregnancy should be recommended to attend antenatal classes or, in case of extremely severe childbirth fear, to seek psychological counseling.
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