Abstract
BackgroundIn response to rising rates of medical intervention in birth, there has been increased international interest in promoting normal birth (without induction of labour, epidural/spinal/general anaesthesia, episiotomy, forceps/vacuum, or caesarean section). However, there is limited evidence for how best to achieve increased rates of normal birth. In this study we examined the role of modifiable and non-modifiable factors in experiencing a normal birth using retrospective, self-reported data.MethodsWomen who gave birth over a four-month period in Queensland, Australia, were invited to complete a questionnaire about their preferences for and experiences of pregnancy, labour, birth, and postnatal care. Responses (N = 5840) were analysed using multiple logistic regression models to identify associations with four aspects of normal birth: onset of labour, use of anaesthesia, mode of birth, and use of episiotomy. The probability of normal birth was then estimated by combining these models.ResultsOverall, 28.7% of women experienced a normal birth. Probability of a normal birth was reduced for women who were primiparous, had a history of caesarean, had a multiple pregnancy, were older, had a more advanced gestational age, experienced pregnancy-related health conditions (gestational diabetes, low-lying placenta, high blood pressure), had continuous electronic fetal monitoring during labour, and knew only some of their care providers for labour and birth. Women had a higher probability of normal birth if they lived outside major metropolitan areas, did not receive private obstetric care, had freedom of movement throughout labour, received continuity of care in labour and birth, did not have an augmented labour, or gave birth in a non-supine position.ConclusionsOur findings highlight several relevant modifiable factors including mobility, monitoring, and care provision during labour and birth, for increasing normal birth opportunity. An important step forward in promoting normal birth is increasing awareness of such relationships through patient involvement in informed decision-making and implementation of this evidence in care guidelines.
Highlights
In response to rising rates of medical intervention in birth, there has been increased international interest in promoting normal birth
Relative to private obstetric care, women had a higher probability of having a spontaneous labour if they were receiving General practitioner (GP) shared care, standard public care, public midwifery continuity care, or private midwifery care
Models of care provided in public facilities (GP shared care, public midwifery continuity care and standard public care) increase the probability of achieving a normal birth, and may be less likely to provide a known care provider at the time of labour and birth care
Summary
In response to rising rates of medical intervention in birth, there has been increased international interest in promoting normal birth (without induction of labour, epidural/spinal/general anaesthesia, episiotomy, forceps/vacuum, or caesarean section). The 1990s and 2000s saw a steady increase in rates of medical intervention during labour and birth across a number of developed countries [3] While such procedures can be life-saving, they bear risk to women [4,5,6,7] and their babies [8, 9] and should be limited to instances of medical necessity. Care providers in Canada have published a Joint Policy Statement on Normal Birth to support, promote and protect normal birth for women [11]. Normal birth guidelines were published in the Australian state of Queensland in 2012 to protect, promote and support normal birth [13]. The Towards Normal Birth in New South Wales policy directive required all birthing facilities in that Australian state to have a written policy for normal birth by 2015 [14]
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
