Healthy birth practice #2: walk, move around, and change positions throughout labor

How does the use of continuous electronic fetal monitoring influence women's experiences of labour? A systematic integrative review of the literature from high income countries

BACKGROUND

A variety of technologies are used to monitor fetal wellbeing in labour. Different types of fetal monitoring devices impact women's experiences of labour and birth.

AIM

This review aims to understand how continuous electronic fetal monitoring (CEFM) influences women's experiences, with a focus on sense of control, active decision-making and mobility.

METHODS

A systematic search of the literature was conducted. Findings from qualitative, quantitative and mixed methods studies were analysed to provide a review of current evidence.

FINDINGS

Eighteen publications were included. The findings were synthesised into three themes: 'Feeling reassured versus anxious about the welfare of their baby', 'Feeling comfortable and free to be mobile versus feeling uncomfortable and restricted', and 'Feeling respected and empowered to make decisions versus feeling depersonalised with minimal control '. Women experienced discomfort and a lack of mobility as a result of some CEFM technologies. They often felt anxious and had mixed feelings about their baby's welfare whilst these were in use. Some women valued the data produced by CEFM technologies about the welfare of their baby. Many women experienced a sense of depersonalisation and lack of control whilst CEFM technologies were used.

DISCUSSION

Fetal monitoring technologies influence women's experiences of labour both positively and negatively. Wireless devices were associated with the most positive response as they enabled greater freedom of movement.

CONCLUSION

The design of emerging fetal monitoring technologies should incorporate elements which foster freedom of movement, are comfortable and provide women with a sense of choice and control. The implementation of fetal monitoring that enables these elements should be prioritised by health professionals.

Prompting and Modeling of Coping Strategies during Childbirth

There is ample evidence to suggest that upright positions and mobility during labor improve birth outcome, including shorter duration of childbirth and reduced risk of cesarean section. The use of nonpharmacological interventions for pain management during childbirth are recommended by major health-care institutions and medical providers, however, the current methodologies for training coping strategies for use during labor have not shown to be effective on mobility or birth outcome. The purpose of this study was to apply an in-vivo teaching technology to the current childbirth model to prompt an imitative repertoire of empirically demonstrated labor coping strategies. Results of this study concluded that the introduction of a software using immediate prompting and video modeling increased the frequency and variability of labor behaviors during unmedicated labor for birthing persons and their partners.

A critical review: developing a birth integrity framework for epidemiological studies through meta-ethnography

Over the past decade, there has been growing evidence that women worldwide experience sub-standard care during facility-based childbirth. With this critical review, we synthesize concepts and measurement approaches used to assess maternity care conditions and provision, birth experiences and perceptions in epidemiological, quantitative research studies (e.g., obstetric violence, maternal satisfaction, disrespect or mistreatment during childbirth, person-centered care), aiming to propose an umbrella concept and framework under which the existing and future research strands can be situated. On the 82 studies included, we conduct a meta-ethnography (ME) using reciprocal translation, in-line argumentation, and higher-level synthesis to propose the birth integrity multilevel framework. We perform ME steps for the conceptual level and the measurement level. At the conceptual level, we organize the studies according to the similarity of approaches into clusters and derive key concepts (definitions). Then, we 'translate' the clusters into one another by elaborating each approach's specific angle and pointing out the affinities and differences between the clusters. Finally, we present an in-line argumentation that prepares ground for the synthesis. At the measurement level, we identify themes from items through content analysis, then organize themes into 14 categories and subthemes. Finally, we synthesize our result to the six-field, macro-to-micro level birth integrity framework that helps to analytically distinguish between the interwoven contributing factors that influence the birth situation as such and the integrity of those giving birth. The framework can guide survey development, interviews, or interventional studies.

The Effect on Birth Pain and Process of the Freedom of Movement in the First Stage of Labor: A Randomized Controlled Study

Objective: To determine the effect of freedom of movement implemented in the dilatation stage, which is the first stage of labor, on the labor process in pregnant women who will give their first birth. Methods: This study was designed as a randomized controlled trial. The study consisted of 70 primiparous women, including 35 in the study group (SG) and 35 in the control group (CG). Freedom of movement was provided to the study group in the first stage of labor. Data were collected using a Personal Information Questionnaire, a Labor Assessment Form, and the Visual Analog Scale (VAS) for perceived pain. Results: The SG was observed to be walking when dilatations were 4-7 cm and mostly squatting when 8-10 cm (94.2%). The level of effacement, frequency of contraction, and descent of the fetal head were faster (p

Exploring midwives’ experiences of implementing the Labour Hopscotch Framework: A midwifery innovation

INTRODUCTION

METHODS

RESULTS

CONCLUSIONS

[Birth integrity through the lens of medicalization, risk, embodiment, and intersectionality]

INTRODUCTION

Recent quantitative research in public health indicates that women across the globe report suboptimal treatment during institutional deliveries. The most common approaches used to comprehend this abuse, violence, or mistreatment have not fully achieved a balance between theoretical perspectives and empirical assessment. To contribute to a more accurate account of the cultural driving forces, institutional conditions, direct expressions, and individual perceptions that undermine or preserve what we define as “integrity at birth”, we develop a new theoretical approach and a multi-level model.

PURPOSE OF RESEARCH

We ground the terminology for integrity at birth upon theoretical foundations, referring to two theoretical discourses: medicalization and risk theory on the one hand, and embodiment and intersectionality theory on the other. We then contextualize this in a multi-level model in order to operationalize its potential for public health research.

RESULTS

The concept and model of “integrity at birth” recognize that women in labor suffer from a number of gender-specific violations, which can be expressed at all levels (macro to micro) as implicit, inherent, normalized and invisible, or explicit, intentional, visible and socially accepted. In distinguishing six separate domains, we propose a theoretical contribution for obstetric care practices.

CONCLUSION

Integrity at birth, as a multi-level and theoretically grounded approach, constitutes an important step towards raising awareness about this issue beyond the dimensions that have been studied to date in quantitative health research. Beyond available evidence of disrespectful and abusive practices constituting violations to integrity at birth, this study takes a step towards understanding gender-based violence and inequalities of health at childbirth.

Monica Healthcare: From the research laboratory to commercial reality-A real-life case study

The desire of many engineers is to see their work end up as a final product offering a real benefit to society-for a lecturer/professor at a university, this is a dream often out of reach of the majority. However, the university academic is a changed species from the early days of the binary line between Universities and Polytechnics and when a lecturer meant just that-teaching to future engineers. This article describes the process and experience gained by a university engineer to spin out their research from the university sector and achieve the goal of a product reaching a global audience.

Effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes among nulliparous women: randomized controlled clinical trial

Objective

To examine the effect of upright and ambulant positions versus lying down during the active first stage of labor on birth outcomes for nulliparous women.

Methods

This is a randomized controlled clinical trial conducted at the delivery department of Damanhour Educational Institute, El Behira Governorate, Egypt. The study sample involved 150 parturient women equally divided into intervention and control groups using randomization block technique. The researchers used four tools for data collection: Demographic data interview schedule, World Health Organization Partograph, Apgar's score, to evaluate neonatal outcomes, and visual analogue pain intensity scale. For the study group, the parturient women were encouraged to assume one of the upright positions or ambulating around the bed so as to maintain the pelvis in vertical plane as far as possible for 20–25 min for every 1 h. The control group received routine hospital care, which includes lying down in bed. IBM SPSS 23.0 was used to analyze the data.

Results

Significant differences (P < 0.05) were observed between the study and control groups in relation to cervical dilation, fetal head descent, uterine contractions interval, and frequency. The duration of the first stage of labor significantly reduced (P = 0.018) in the intervention group compared with control group. No significant differences (P > 0.05) were observed between both groups in term of emergency cesarean birth rates, oxytocin use, and neonatal outcomes.

Conclusions

This study proves that upright and ambulant positions significantly enhance uterine contractility, cervical dilatation, and fetal head descent and reduce the first stage duration.

Effects of Dance and Music on Pain and Fear During Childbirth

OBJECTIVE

To test the effects of dance and music and music alone on pain and fear during the active phase of labor among nulliparous women.

DESIGN

Single-blind, randomized, controlled study.

SETTING

A maternity and children's hospital in Konya Province, Turkey.

PARTICIPANTS

A total of 93 nulliparous, pregnant women who were in the active phase of labor at term gestation with single fetuses in cephalic presentation.

METHODS

We randomly assigned participants to one of three groups: dance and music, music alone, and usual care (control). We collected data four times during labor using a personal information form, labor monitoring form, visual analog scale (VAS), and Version A of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQA) to measure fear.

RESULTS

Based on multivariate analysis of variance, the effect of time and study group interaction on VAS and W-DEQA scores was statistically significant (p < .05), and the effect of study groups and time on VAS scores was statistically significant (p < .05). The effect of the study groups on W-DEQA scores was statistically significant (p < .05), but there was no statistically significant effect of time on W-DEQA scores (p > .05).

CONCLUSION

Dance and music and music alone significantly reduced pain and fear in nulliparous women during the active phase of labor. These interventions are easy for nurses and midwives to use, affordable, and effective, and they enable a woman and her partner to be actively engaged in the woman's care.

Effect of Peanut Ball and Position Changes in Women Laboring With an Epidural

OBJECTIVE

To examine the effect of a nurse-driven intervention using a peanut ball (PB) with position changes on length of labor and incidence of cesarean birth among women who receive epidural anesthesia.

DESIGN

Quasiexperimental comparison group design.

SETTING/LOCAL PROBLEM

A 407-bed, nonprofit, Magnet-designated, Baby-Friendly Hospital Initiative-designated hospital with 8 labor and delivery suites and an average of 100 births per month.

PARTICIPANTS

A total of 343 participants were included, with 164 women in the PB group.

INTERVENTION/MEASUREMENTS

The PB was placed after epidural administration; women were repositioned a minimum of every 1 to 2 hours, and the PB was removed at second stage of labor; duration was recorded.

RESULTS

Overall, women in the PB group were 50% less likely to have cesarean birth. For women with cervical dilation of 4 cm or less, rates of vaginal birth were 61% with use of the peanut ball. A multivariate analysis of outcomes was used. A multiple linear regression model showed, after adjusting for other variables, that PB placement alone did not shorten labor length (p = .4684). However, a stratified analysis indicated that for women with cervical dilation of 4 cm or less, length of the first stage of labor was affected by parity (p = .0042) and frequency of position change (p < .001). For women with cervical dilation greater than 4 cm, length of the first stage of labor was influenced by frequency of position changes (p = .0130) and effacement (p = .0050). Length of the second state of labor was affected by the frequency of position change (p = .0416).

CONCLUSION

The PB may be an effective intervention to reduce the incidence of cesarean birth. Changing position frequently was associated with reduced length of first and second stages of labor.

Safe Childbirth: A Call to Action

Since the publication of Lamaze's Six Healthy Birth Practice papers in 2014, there has been increasing concern with the safety of the current maternity care system. A doubling of the maternal mortality rate in the United States and the continued high cesarean rate, as well as ongoing research that supports physiologic birth and identifies the risks of interfering with the physiologic process, has resulted in updated guidelines for care and has spurred advocacy efforts to transform maternity care. This article presents a number of these advocacy efforts.

Healthy Birth Practice #4: Avoid Interventions Unless They Are Medically Necessary

Maternity care in the United States continues to be intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy has decreased but is still higher than it should be. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This paper describes the use and effect of routine interventions on the physiologic process of labor and birth and identifies the unintended consequences resulting from the routine use of these interventions in labor and birth.

Intrapartum Nurse Perception of Labor Support After Implementation of the Coping With Labor Algorithm

The purpose of this research project was to determine if using the Coping with Labor Algorithm would lead to changes in the perception of the intrapartum (IP) nurses' beliefs toward birth practices and frequency of labor support interventions. Twenty-three participants completed the preintervention survey, which included the IP Nurses' Belief Toward Birth Practice Scale and the Labor Support Scale. Following completion of the preintervention survey, participants received a copy of the Coping with Labor Algorithm and Toolkit and then began implementation of the Coping with Labor Algorithm. After implementation, 13 IP nurses completed the postintervention survey. The surveyed IP nurses reported positive changes in their perceived frequency of labor support and a slight change in their birth beliefs.

Midwifery care based on a precautionary approach: Promoting normal births in maternity wards: The thoughts and experiences of midwives

OBJECTIVE

The aim of this study was to gain a deeper understanding of the thoughts and experiences of midwives in the attempt to promote normal births in Norwegian maternity wards.

METHODS

A qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Nine midwives at three different maternity wards in Norway participated in the study. The qualitative data were analysed with the help of systematic text condensation.

RESULTS

The findings included two main themes: (1) "Individualized maternity care" (2) "A woman-centred and a biomedical perspective - a dilemma. Working in a small maternity ward increased the possibility for continuous support during labour and continuity of care throughout pregnancy, birth and the postnatal period. The midwives had a great desire to promote normal births with a minimum of interventions. Still, they adhered to an ideology based on both a woman-centred and a biomedical view of birth. Their work was often based on a precautionary approach in which problem-solving strategies were related to potential risks.

CONCLUSION

The midwives experienced challenges, as they worked in an environment where different ideologies prevailed. They utilized the positive aspects of small maternity wards, like the opportunity for continuous support during labour and continuity of care during the childbearing process. Midwives should encourage discussions about their precautionary approach and the use of technology for low-risk women, while reflecting on their own views on normal births.

Does Childbirth Education Make a Difference?

Childbirth education is designed to help women access accurate and up to date information about childbirth and make informed decisions about their care. Exposure to evidence based information about maternity care practices should assist women to make informed decisions that are based on that evidence. Evidence based childbirth education should ultimately affect outcomes but there is a dearth of research that looks at the outcomes of childbirth education. This editorial suggests that this research is long overdue.

How can midwives promote a normal birth and a positive birth experience? The experience of first-time Norwegian mothers

OBJECTIVE

The purpose of this study is to gain a deeper understanding of the experience of first-time mothers regarding how the midwife may promote a normal birth and a positive birth experience.

METHODS

A qualitative approach was chosen for data collection, and the data presented are based on in-depth interviews. Twelve healthy, first-time Norwegian mothers, aged 22-34, who had experienced a normal and positive childbirth were interviewed five to six weeks after giving birth. The transcribed interviews were analysed with the help of systematic text condensation.

RESULTS

The findings included two main themes: "To be seen as an individual" and "Health-promoting perspective". The experience of being cared for by a midwife who provides presence is vital for the woman to be seen as an individual. When the midwife has a health-promoting perspective, she can more easily assist the woman in developing inner strength and coping strategies.

CONCLUSION

Midwives have a pivotal role in helping to promote a normal birth and positive birth experience. The women consider the midwife's attitude and behaviour as essential for their ability to feel safe and cared for. The midwife's individualized and motivating approach promotes the women's inner strength and belief in their own capability to handle the birth. Based on this salutogenic view, the midwife must focus on the woman's resources in order to promote good health during the childbearing process.

Healthy birth practice #2: walk, move around, and change positions throughout labor

In the United States, obstetric care is intervention intensive, resulting in 1 in 3 women undergoing cesarean surgery wherein mobility is treated as an intervention rather than supporting the natural physiologic process for optimal birth. Women who use upright positions and are mobile during labor have shorter labors, receive less intervention, report less severe pain, and describe more satisfaction with their childbirth experience than women in recumbent positions. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #2: Freedom of Movement Throughout Labor," published in The Journal of Perinatal Education, 16(3), 2007.

Healthy birth practice #4: avoid interventions unless they are medically necessary

Maternity care in the United States is intervention intensive. The routine use of intravenous fluids, restrictions on eating and drinking, continuous electronic fetal monitoring, epidural analgesia, and augmentation of labor characterize most U.S. births. The use of episiotomy is far from restrictive. These interventions disturb the normal physiology of labor and birth and restrict women's ability to cope with labor. The result is a cascade of interventions that increase risk, including the risk of cesarean surgery, for women and babies. This article is an updated evidence-based review of the "Lamaze International Care Practices That Promote Normal Birth, Care Practice #4: No Routine Interventions," published in The Journal of Perinatal Education, 16(3), 2007.

Safe, healthy birth: what every pregnant woman needs to know

In spite of technology and medical science's ability to manage complex health problems, the current maternity care environment has increased risks for healthy women and their babies. It comes as a surprise to most women that standard maternity care does not reflect best scientific evidence. In this column, evidence-based maternity care practices are discussed with an emphasis on the practices that increase safety for mother and baby, and what pregnant women need to know in order to have safe, healthy births is described.