Eight studies on my ‘normal birth’ reading pile (part 1)

6912044050_068fe3f921Every so often, the pile of papers waiting for my attention and for possible inclusion on my blog begins to topple over under the weight of the interesting stuff contained within. The fact is, there’s just so much interesting birth-related research out there, I can’t always keep up!

So every now and then, I decide that I need to just share with you what’s still in the pile and be done with it! And that’s what we’re doing this week and next, with a special focus on studies that I’m looking at to update my Recipes for Normal Birth notes. Here are the first four studies, with more to follow next week.

 

Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort

I already shared this one on social media, but it’s too juicy not to mention again! A comparison of 6534 babies who were born underwater, 10,290 babies who weren’t born in water (and whose mums never intended them to be) and 1573 babies whose mums were intending to have a waterbirth but where this didn’t end up happening. The results show waterbirth in a great light, although the inclusion of the planned-but-not-achieved waterbirth group means that readers need to pay attention when reading, because this helps us see the wider picture and to include those women where things didn’t go as intended, for whatever reason. Babies born in water actually experienced fewer negative outcomes than those whose mums didn’t plan waterbirth, but women who planned waterbirth did experience more genital tract trauma than those who didn’t, so anyone who is interested in this topic might want to look at that area closely and ponder the issues.

Introduction: Data on the safety of waterbirth in the United States are lacking.

Methods: We used data from the Midwives Alliance of North America Statistics Project, birth years 2004 to 2009. We compared outcomes of neonates born underwater waterbirth (n = 6534), neonates not born underwater nonwaterbirth (n = 10,290), and neonates whose mothers intended a waterbirth but did not have one intended waterbirth (n = 1573). Neonatal outcomes included a 5-minute Apgar score of less than 7, neonatal hospital transfer, and hospitalization or neonatal intensive care unit (NICU) admission in the first 6 weeks. Maternal outcomes included genital tract trauma, postpartum hospital transfer, and hospitalization or infection (uterine, endometrial, perineal) in the first 6 weeks. We used logistic regression for all analyses, controlling for primiparity.

Results: Waterbirth neonates experienced fewer negative outcomes than nonwaterbirth neonates: the adjusted odds ratio (aOR) for hospital transfer was 0.46 (95% confidence interval [CI], 0.32-0.68; P < .001); the aOR for infant hospitalization in the first 6 weeks was 0.75 (95% CI, 0.63-0.88; P < .001); and the aOR for NICU admission was 0.59 (95% CI, 0.46-0.76; P < .001). By comparison, neonates in the intended waterbirth group experienced more negative outcomes than the nonwaterbirth group, although only 5-minute Apgar score was significant (aOR, 2.02; 95% CI, 1.40-2.93; P < 0001). For women, waterbirth (compared to nonwaterbirth) was associated with fewer postpartum transfers (aOR, 0.65; 95% CI, 0.50-0.84; P = .001) and hospitalizations in the first 6 weeks (aOR, 0.72; 95% CI, 0.59-0.87; P < 0.001) but with an increased odds of genital tract trauma (aOR, 1.11; 95% CI, 1.04-1.18; P = .002). Waterbirth was not associated with maternal infection. Women in the intended waterbirth group had increased odds for all maternal outcomes compared to women in the nonwaterbirth group, although only genital tract trauma was significant (aOR, 1.67; 95% CI, 1.49-1.87; P < .001).

Discussion: Waterbirth confers no additional risk to neonates; however, waterbirth may be associated with increased risk of genital tract trauma for women.

Bovbjerg ML, Cheyney M and Everson C (2016). Maternal and Newborn Outcomes Following Waterbirth: The Midwives Alliance of North America Statistics Project, 2004 to 2009 Cohort. JMWH. DOI: 10.1111/jmwh.12394

 

Primiparous women’s preferences for care during a prolonged latent phase of labour

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Are there things we could do to decrease the emphasis on time?

This is one of those papers whose findings won’t be wholly new to experienced midwives and birth folk, but which we love because they’re interesting as well as supportive of the value of midwifery care. This paper tells us that midwives play an important role in supporting women having their first baby who are having a prolonged latent phase of labour, and that women’s need for midwifery support increases as the time spent in latent phase increases. The trick now is working out how we can change maternity care systems to allow for that support…

Objective: To investigate primiparous women’s preferences for care during a prolonged latent phase of labour.

Methods: A qualitative study based on focus groups and individual interviews and analysed with inductive content analysis.

Results: Sixteen primiparous women with a prolonged latent phase of labour >18 hours were interviewed in five focus groups (n = 11) or individually (n = 5). One main category emerged “Beyond normality – a need of individual adapted guidance in order to understand and manage an extended latent phase of labour” which covers the women’s preferences during the prolonged latent phase. Five categories were generated from the data: “A welcoming manner and not being rejected”, “Individually adapted care”, “Important information which prepares for reality and coping”, “Participation and need for feedback” and “Staying nearby the labour ward or being admitted for midwifery support”. Women with a prolonged latent phase of labour sought to use their own resources, but their needs for professional support increased as time passed. A welcoming attitude from an available midwife during the latent phase created a feeling of security, and personally adapted care was perceived positively.

Conclusions: Women with a prolonged latent phase of labour preferred woman-centred care. Midwives play an important role in supporting these women. Women’s need for midwifery-support increases as the time spent in latent phase increases.

Ängeby K, Wilde-Larsson B, Hildingsson I et al (2015). Primiparous women’s preferences for care during a prolonged latent phase of labour. Sexual & Reproductive Healthcare 6(3): 145-150.

 

Participation in siblings’ birth at home from children’s viewpoint

I have long been a fan of family-filled births, but there hasn’t been tons of research into this important area, especially from the perspective of the children themselves. In this study, the children had a strong desire to participate in the birth of their sibling, and they described having a range of feelings about their experience. Overall, they learned a lot from their participation and were happy when they were able to help, and I think the latter of these findings carries an important message for those of us who work with women who want their other children to attend the birth of a sibling.

Background: Partners often participate in childbirth, and the effects on both partners have been intensively investigated, but children’s participation is rare in western countries and less studied. Thus, the aim of this study was to explore and construct a comprehensive structure of meaning of X children’s experiences of participating in birth of a sibling at home.

Design: A phenomenological study based on analysis of open-interview transcripts by Colaizzi’s approach and drawings.

Participants: Seven children aged 5 to 17 years who participated in birth of a sibling at home.

Findings: The children’s experience of participating in a sibling’s birth was multifaceted. Their feelings varied from joy to worry, they helped their mother and learned from the experience. They chose to participate. They experienced overwhelmingly strong and positive feelings, but were also worried about the well-being of other family members during the birth. Further, younger children were frustrated, especially if the birth took a long time and they were not allowed to do all they wanted, such as going to a birthing pool. It was important for the children to be able to help their mother and support younger siblings. They learned a lot about childbirth from their participation and information given by the adults. The children regarded home as safe, cosy and a better place to give birth than a hospital. The older children also regarded a home birth as a possible choice for them in the future. They celebrated the baby’s arrival and remembered the birth day as being joyful and happy. Participation in the sibling’s birth made relationships between the children closer and warmer. Children felt hurt when people outside the family were suspicious when told that the baby was born at home.

Conclusions: The children’s experience of participating in a sibling’s birth at home included varying feelings, learning from their experience and helping mother. The findings could be utilized in parent education if they are going to have their children with them during the childbirth.

Jouhki M-R, Suominen T, Peltonen K et al (2015). Participation in siblings’ birth at home from children’s viewpoint. Midwifery: In press. DOI: http://dx.doi.org/10.1016/j.midw.2015.11.018

 

Midwives’ experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting

3594314307_2aa808bffd_nI think that this study will be of interest to a number of people, particularly those who work in (or might like to work in) midwifery-led units. It looks at the experiences of midwives who do this, and the themes will be familiar to many. I was struck by how sensitive the researchers were to the fact that, although it can be exciting to move to working in an AMU or FMU, it can also be stressful as well as revitalising for midwives.

Objective: In some economically developed countries, women’s choice of birth care and birth place is encouraged. The aim of this study was to explore and describe the experiences of midwives who started working in alongside/free-standing midwifery units (AMU/FMU) and their experiences with labour care in this setting.

Methods: A qualitative explorative design using a phenomenographic approach was used. Semi-structured interviews were conducted with ten strategically sampled midwives working in midwifery units.

Results: The analysis revealed the following five categories of experiences noted by the midwives: mixed emotions and de-learning obstetric unit habits, revitalising midwifery philosophy, alertness and preparedness, presence and patience, and coping with time.

Conclusions: Starting to work in an AMU/FMU can be a distressing period for a midwife. First, it may require de-learning the medical approach to birth, and, second, it may entail a revitalisation (and re-learning) of birth care that promotes physiological birth. Midwifery, particularly in FMUs, requires an especially careful assessment of the labouring process, the ability to be foresighted, and capability in emergencies. The autonomy of midwives may be constrained also in AMUs/FMUs. However, working in these settings is also viewed as experiencing “the art of midwifery” and enables revitalisation of the midwifery philosophy.

Skogheim G; Hanssen TA, (2015). Midwives’ experiences of labour care in midwifery units. A qualitative interview study in a Norwegian setting. Sexual and Reproductive Healthcare  6(4): 230-235.

 

Read part two of this post here.

photo credits: Bunnies! via photopin (license),  clock via photopin (license) and: norway.dalsnibba–geiranger via photopin (license)

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