Birth Plan Research Articles

Coronavirus Pandemic and Worries during Pregnancy; a Letter to Editor.

Coronavirus (COVID-19) is a new respiratory disease that is spreading widely throughout the world (1). There is no valid information available on pregnant women and their complications. But given previous epidemics (SARS and MERS), as well as mental and physical changes during pregnancy (2), pregnant women are more likely to be exposed. On the other hand, the Coronavirus epidemic has created stress and anxiety for pregnant women in different parts of the world. Concern and stress in pregnancy are associated with side effects such as preeclampsia, preterm labor, depression, low birth weight, increased nausea and vomiting during pregnancy, preterm labor, low birth weight, low APGAR (3-5). In the Coronavirus pandemic, pregnant women cited the following causes of their concerns: - Many pregnant women have had a birth plan before pandemic, but are currently worried about how their families (mothers) will be present, given the urban and quarantine constraints, moreover, even if there is no inter-urban restriction, they may be worried about their families being transferred in transit. - Many pregnant women do not go to work due to concerns that they may be exposed to Coronavirus due to the hospital environment or the route of the hospital and may be postterm. Or even vice versa, because of stress and worry they want an early termination and elective cesarean section. - Many pregnant mothers are employed, constantly using sodium hypochlorite and alcohol detergents to control and prevent the virus, which can lead to poisoning. Some other pregnant mothers, on the other hand, become obsessed with stress and anxiety and are more likely to use these detergents. Some mothers are worried about their fetal or their neonate being born. Also, some mothers worry about postpartum such as breastfeeding, neonatal care (postpartum vaccination, screening). Increasing mothers 'awareness about the transmission of Coronavirus, risk factors, red flags , as well as providing tele counselling for pregnancy care and tele-triage help reduce anxiety and worry. It is also recommended that in cities where home birth and home services are available after birth and home care services, the medical team should provide these services at home while maintaining safety.

Identifying risk factors of prenatal depression among mothers in Indonesia

This study aimed to assess and identifying potential multifactor risks to aggravate the state of maternal depression in pregnant women. The cross-sectional study approach conducted in the sub-urban area of Makassar City, South Sulawesi, Indonesia. Data gathered from 329 research subjects from January to May 2019. The main instruments used are EPDS and several other valid instruments related to various observed risk factors including, sociodemographic, psychosocial, obstetric factors, nutritional factors, history of alcohol use, and exposure to the cigarette. The prevalence of depressive symptoms is quite high found in the sub-urban low-income family area. Family income (6.9±95% CI; 2.34-20.69), husband education (4.6±95% CI; 1.23-17.73), birth plan (1.9±95% CI; 1.03-3.79), sleep time (0.003±95% CI; 0.00-0.02), fear of birth (2.3±95% CI; 0.92-6.06), and husband support (2.6±95% CI; 0.97-7.33) are the most fit indicate model to describe depression symptom among pregnant mother. Creating sufficient, more comfortable, efficient screening tools to remove time barriers in measuring all risk factors, consider a promising program in the prenatal term. The antenatal care visit must provide a risk factor assessment to eliminate further problems during postpartum.

A Segmented Logistic Regression Approach to Evaluating Change in Caesarean Section Rate with Reform of Birth Planning Policy in Two Regions in China from 2012 to 2016.

ObjectiveThis study evaluated change in caesarean section rate with reform of birth planning policy in China from one-child to two-child policy.MethodsStudy data were collected from patient-level hospital records of 59,668 pregnant women who visited three major urban hospitals in Jiangsu Province and Inner Mongolia Autonomous Region of China between January 2012 and December 2016. A segmented logistic regression approach was developed to evaluate the changes in caesarean section rate in these regions with the launch of China’s new partial and universal two-child policies in January 2014 and January 2016, respectively.ResultsJiangsu Province had a significantly lower non-emergency caesarean rate (Jiangsu 8.15% vs Inner Mongolia 34.03%, p < 0.001) and a much lower percentage of minority population (Jiangsu 6.99% vs Inner Mongolia 21.76%, p < 0.001) than Inner Mongolia Autonomous Region. In Jiangsu Province, no change in caesarean section rate was detected with the two-child policies (all p-values > 0.05), although the unadjusted trend change (0.038, 95% confidence interval or CI: [0.016, 0.060], p < 0.001) in log odds after the implementation of the partial two-child policy was statistically significant. In Inner Mongolia Autonomous Region, an immediate jump in caesarean section rate was discovered by the segmented logistic regression with the implementation of both the partial (unadjusted level change 0.297, CI: [0.105, 0.489], p = 0.002) and universal two-child policies (unadjusted level change 1.945, CI: [1.277, 2.614], p < 0.001); but the rate reverted to the previous level thereafter. Ethnicity, maternal age, maternal reproduction history, insurance coverage type, infant weight, and infant gender were the significant factors associated with caesarean section rate (for odds ratios, all p-values < 0.05). However, the significance of infant gender may stem from the large sample size of the study and is not clinically meaningful.ConclusionChange in caesarean section rate was not observed with the launch of two-child policy in China.

Exploring the medicalisation of childbirth through women’s preferences for and use of pain relief

BackgroundSweden, along with other countries, is facing rising intrapartum intervention rates. AimTo explore the medicalisation of childbirth through women’s preferences for and use of pain relief, and to investigate whether the presence of a birth plan had any impact on use of pain relief, rate of intervention, and satisfaction with the birth experience. MethodsThe study was cross-sectional, and included 129 women with birth plans and 110 without, all of whom gave birth in one hospital in Sweden between March and June 2016. Data from birth plans and medical records was analysed through descriptive statistics and logistic regression. FindingsParity rather than birth plan was a greater determinant for use of pain relief, frequency of interventions, and level of satisfaction; primiparas used more pain relief, had more interventions, and were less satisfied with their birth experiences than multiparas. Epidural analgesia was associated with a two to threefold increase in interventions, but 79.5% of all women had some form of intervention during birth, regardless of having an epidural or not. Women were generally highly satisfied with their birth experiences, women without epidural analgesia and interventions slightly more so. ConclusionContrary to their initial plans, especially primiparas used more pharmacological pain relief than intended, and nearly all (94.6%) had some form of intervention during labour and birth. More interventions were associated with lower levels of satisfaction. The high rate of intervention in a healthy population of birthing women is disquieting and requires further attention.

Testing the birth attitude profile scale in a Swedish sample of women with fear of birth

Objective The aim of this study was to explore the “Birth Attitude Profile Scale (BAPS)” in a selected sample of women with fear of birth. Another aim was to develop profiles of women according to their birth attitudes and levels of childbirth fear in relation to background characteristics. Methods A secondary analysis of data collected in two different samples of women with fear of birth. Data were collected by a questionnaire in gestational week 36 and background data from mid-pregnancy. A principal component analysis and a cluster analysis were performed of the combined sample of 195 women. Results The principal component analysis revealed four domains of the BAPS: “personal impact, birth as a natural event, freedom of choice and safety concerns”. When adding the fear of birth scale, two clusters were identified: one with strong attitudes and lower fear, labeled “self-determiners”; and one with no strong attitudes but high levels of fear, labeled “fearful.” Women in the “Fearful” cluster more often reported previous and current mental health problems, which were the main difference between the clusters. Conclusion The BAPS instrument seems to be useful in identifying birth attitudes in women with fear of birth and could be a basis for discussions and birth planning during pregnancy. Mental health problems were the main difference in cluster membership; therefore, it is important to ask women with fear of childbirth about physical, mental and social aspects of health. In addition, a qualitative approach using techniques such as focus groups or interviews is needed to explore how women come to form their attitudes and beliefs about birth.

Factors influencing adoption of facility-assisted delivery - a qualitative study of women and other stakeholders in a Maasai community in Ngorongoro District, Tanzania

BackgroundTanzania’s One Plan II health sector program aims to increase facility deliveries from 50 to 80% from 2015 to 2020. Success is uneven among certain Maasai pastoralist women in Northern Tanzania who robustly prefer home births to facility births even after completing 4+ ANC visits. Ebiotishu Oondomonok Ongera (EbOO) is a program in Nainokanoka ward to promote facility births through a care-group model using trained traditional birth attendants (TBAs) as facilitators. Results to date are promising but show a consistent gap between women completing ANC and those going to a facility for delivery. A qualitative study was conducted to understand psychosocial preferences, agency for decision-making, and access barriers that influence where a woman in the ward will deliver.MethodsIn-depth interviews, focus group discussions and key-informant interviews were conducted with 24 pregnant and/or parous women, 24 TBAs, 3 nurse midwives at 3 health facilities, and 24 married men, living in Nainokanoka ward. Interviews and discussions were transcribed, translated, and analyzed thematically using a grounded theory approach.ResultsMost women interviewed expressed preference for a home birth with a TBA and even those who expressed agency and preference for a facility birth usually had their last delivery at home attributed to unexpected labor. TBAs are engaged by husbands and play a significant influential role in deciding place of delivery. TBAs report support for facility deliveries but in practice use them as a last resort, and a significant trust gap was documented based on a bad experience at a facility where women in labor were turned away.ConclusionsEbOO project data and study results show a slow but steady change in norms around delivery preference in Nainokanoka ward. Gaps between expressed intention and practice, especially around ‘unexpected labor’ present opportunities to accelerate this process by promoting birth plans and perhaps constructing a maternity waiting house in the ward. Rebuilding trust between facility midwives, TBAs, and the community on the availability of health facility services, and increased sensitivity to women’s cultural preferences, could also close the gap between the number of women who are currently using facilities for ANC and those returning for delivery.

The Perinatal Palliative Care Birth Plan as an Advance Care Planning Tool (FR403)

The Perinatal Palliative Care Birth Plan as an Advance Care Planning Tool (FR403)

IMPLEMENTATION OF 'VILLAGE FAMILY PLANNING ' PROGRAM IN RPTRA CIRACAS PRIMA, EAST JAKARTA

Some women did not know when they could get pregnant again. Choices in birth planning are very influential in preventing complications. This study was based on the launching of the Village family planning in RPTRA Ciracas Prima. The purpose of this study was to describe the implementation of the Village family planning in RPTRA Ciracas Prima. This study was qualitative with descriptive method — data collected by an in-depth interview by following the guidelines. The information obtained was recorded and made in the form of field notes a model on Policy Implementation developed by George C. Edward III. The results showed that the program in RPTRA Ciracas Prima based on four implementation indicators discovered that in communication, the transmission was carried out with an effort to socialize its clarity, which was not yet fully understood by the public. The bureaucratic structure and targets should be optimized. RPTRA had inadequate facility resources like a limited corridor, and particular medical space was incomplete. However, the last indicators showed from the optimization of cadre effort implementing the village family planning program. Population growth significantly increases know from the number of acceptors of long-acting reversible contraception. In the implementation of facilities and infrastructure such as Pos village family planning, it should be devoted to activities related to family planning. BKKBN must be able to motivate the community so that they can participate in the implementation of the village family planning program in RPTRA Ciracas Prima. Keyword : implementation, village family planning

Measuring fidelity, feasibility, costs: an implementation evaluation of a cluster-controlled trial of group antenatal care in rural Nepal

BackgroundAccess to high-quality antenatal care services has been shown to be beneficial for maternal and child health. In 2016, the WHO published evidence-based recommendations for antenatal care that aim to improve utilization, quality of care, and the patient experience. Prior research in Nepal has shown that a lack of social support, birth planning, and resources are barriers to accessing services in rural communities. The success of CenteringPregnancy and participatory action women’s groups suggests that group care models may both improve access to care and the quality of care delivered through women’s empowerment and the creation of social networks. We present a group antenatal care model in rural Nepal, designed and implemented by the healthcare delivery organization Nyaya Health Nepal, as well as an assessment of implementation outcomes.MethodsThe study was conducted at Bayalata Hospital in Achham, Nepal, via a public private partnership between the Nepali non-profit, Nyaya Health Nepal, and the Ministry of Health and Population, with financial and technical assistance from the American non-profit, Possible. We implemented group antenatal care as a prospective non-randomized cluster-controlled, type I hybrid effectiveness-implementation study in six village clusters. The implementation approach allows for iterative improvement in design, making changes to improve the quality of the intervention. Assessments of implementation process and model fidelity were undertaken using a mobile checklist completed by nurse supervisors, and observation forms completed by program leadership. We evaluated data quarterly using descriptive statistics to identify trends. Qualitative interviews and team communications were analyzed through immersion crystallization to identify major themes that evolved during the implementation process.ResultsA total of 141 group antenatal sessions were run during the study period. This paper reports on implementation results, whereas we analyze and present patient-level effectiveness outcomes in a complementary paper in this journal. There was high process fidelity to the model, with 85.7% (95% CI 77.1–91.5%) of visits completing all process elements, and high content fidelity, with all village clusters meeting the minimum target frequency for 80% of topics. The annual per capita cost for group antenatal care was 0.50 USD. Qualitative analysis revealed the compromise of stable gestation-matched composition of the group members in order to make the intervention feasible. Major adaptations were made in training, documentation, feedback and logistics.ConclusionGroup antenatal care provided in collaboration with local government clinics has the potential to provide accessible and high quality antenatal care to women in rural Nepal. The intervention is a feasible and affordable alternative to individual antenatal care. Our experience has shown that adaptation from prior models was important for the program to be successful in the local context within the national healthcare system.Trial registrationClinicalTrials.gov Identifier: NCT02330887, registered 01/05/2015, retroactively registered.

Why do women deliver where they had not planned to go? A qualitative study from peri-urban Nairobi Kenya

BackgroundIn urban Kenya, couples face a wide variety of choices for delivery options; however, many women end up delivering in different facilities from those they had intended while pregnant. One potential consequence of this is delivering in facilities that do not meet minimum quality standards and lack the capacity to provide treatment for obstetric and neonatal complications.MethodsThis study investigated why women in peri-urban Nairobi, Kenya deliver in facilities they had not intended to use. We used 60 in-depth audio-recorded interviews in which mothers shared their experiences 2–6 months after delivery. Descriptive statistics were used to summarize socio-demographic characteristics of participants. Qualitative data were analyzed in three steps i) exploration and generation of initial codes; ii) searching for themes by gathering coded data that addressed specific themes; and iii) defining and naming identified themes. Verbatim excerpts from participants were provided to illustrate study findings. The Health Belief Model was used to shed light on individual-level drivers of delivery location choice.ResultsFindings show a confluence of factors that predispose mothers to delivering in unintended facilities. At the individual level, precipitate labor, financial limitations, onset of pain, complications, changes in birth plans, undisclosed birth plans, travel during pregnancy, fear of health facility providers, misconception of onset of labor, wrong estimate of delivery date, and onset of labor at night, contributed to delivery at unplanned locations. On the supply side, the sudden referral to other facilities, poor services, wrong projection of delivery date, and long distance to chosen delivery facility, were factors in changes in delivery location. Lack of transport discouraged delivery at a chosen health facility. Social influences included others’ perspectives on delivery location and lack of aides/escorts.ConclusionsResults from this study suggest that manifold factors contribute to the occurrence of women delivering in facilities that they had not intended during pregnancy. Future studies should consider whether these changes in delivery location late in pregnancy contribute to late facility arrival and the use of lower quality facilities. Deliberate counseling during antenatal care regarding birth plans is likely to encourage timely arrival at facilities consistent with women’s preferences.

Perceptions of risk and influences of choice in pregnant women with obesity. An evidence synthesis of qualitative research.

Between 7-35% of the maternity population are obese in high income countries and 1-40% in lower or middle-income countries. Women with obesity are traditionally limited by the choices available to them during pregnancy and birth because of the higher risk of complications. This evidence synthesis set out to summarise how women with obesity's perceptions of pregnancy and birth risk influence the care choices that they make. A search of medical and health databases for qualitative studies written in the English language, published Jan 1993-April 2019 and reporting on pregnant women with obesity's perception of risk and influence of pregnancy and birth choices. Data was extracted by two reviewers onto a questions framework and then analysed using a thematic synthesis technique. Confidence in the qualitative findings was assessed using GRADE-CERQual. 23 full texts were included. The common themes on perception of risk were: 'Self-blame arising from others' stereotyped beliefs ', 'Normalisation', 'Lack of preparation', 'Fearful acceptance and inevitability' and 'Baby prioritised over mother'. For influence of choices, the themes were: 'External influences from personal stresses', 'Restrictive guidelines', 'Relationship with healthcare professional' and 'Perception of Risk'. Evidence on what influences women with obesity's pregnancy choices is limited. Further research is needed on the best methods to discuss the risks of pregnancy and birth for women with obesity in a sensitive and acceptable manner and to identify the key influences when women with obesity make choices antenatally and for birth planning.

Effect of Implementing Birth Plan on Women Childbirth Outcomes and Empowerment

Background: The birth plan raises women’s knowledge, improves empowerment, and promotes childbirth outcomes. Aim of the study was to implement a birth plan and evaluate its effect on women childbirth outcomes and empowerment. Design: A quasi-experimental comparative design. Sampling: A purposive sample of 194 pregnant women was enrolled and equally allocated into two groups (the intervention group who engaged in a birth plan to receive planned care during childbirth, a control group who received routine hospital care) 97 women each. Setting: The study was conducted at the obstetrics outpatient clinic and in the delivery room of Benha University Hospital. Tools: four tools were used for data collection; A Structured Self-Administration Questionnaire, Birth plan fulfillment sheet, childbirth outcomes sheet, Childbirth related Empowerment Scale. Results: that there were highly significant difference in most items of designed birth plan care during 1st, 2nd and 3rd stage between control and study group (P ≤ 0.001) and there was a significant decrease in mean ± SD of 1st stage duration and the total duration of childbirth stages of the study group comparing to the control group (P ≤ 0.05). Before implementing the birth plan, there was no statistical significance difference between control and study group regarding childbirth-related empowerment scale as (p ˃ 0.05) while after implementation, there were highly statistically significant differences regarding most items of birth-related empowerment scale as (P ≤ 0.001). Conclusion: the birth plan has a higher implementation of designed childbirth care, a positive effect on maternal and fetal outcomes and there was a highly significant increase in the total women`s empowerment scores after implementing birth plan (p<0,001) compared to control group. Recommendation: Raising awareness of healthcare staff of the outpatient clinic, delivery ward to implement birth plan toward increasing childbirth empowerment.

El plan de parto como documento de instrucciones previas.

Introduction In the last decades birth plans have been gaining relevance as instruments of manifestation of the will of women. They have been linked to satisfactory obstetric results but have been also referred to as a source of conflict between professionals and users, as well as a frustration source for the latter in case they cannot be accomplished. Objectives This article aims to clarify the legal status of birth plans in Spain. Methodology An experiment is carried out: an extensive birth plan is written, then notarized and finally registered in the Catalan Register of Advance Directives. Results and Conclusions According to the experiment, birth plans are an advance directive, which has legal consequences regarding their enforceability and application.

Practices suggested in social media for birth plans.

To describe and analyze the practices suggested in social media for the elaboration of Birth Plans, available on Blogs/Sites and not included in the WHO recommendations. Qualitative, exploratory, descriptive study with thematic analysis. A total of 41 e-mail addresses were selected for analysis among the 200 web addresses previously identified between March and July 2016. Three web addresses were in Portugal and the others in Brazil. 48 practices not included in the recommendations of the World Health Organization (WHO) were identified. Blogs/Websites, as means of transmission, circulation and production of knowledge, enable the horizontal expression of values, encourage women to plan the events considered important for their deliveries and put childbirth decisions on the hands of women, which has caused controversy in the discourse of humanization of childbirth.

El alivio del dolor en el parto. Empoderamiento y vulnerabilidad de las mujeres en la toma de decisiones. Estudio cualitativo.

Introduction In Spain the use of epidurals for pain relief during childbirth is widespread. Currently, we can observe a progressive change in attitude towards a less interventionist care and the use of non-pharmacological methods to reduce pain, unless the woman has left instructions otherwise. Aims To explore the decision-making process concerning pain relief methods in childbirth in order to detect the elements of vulnerability that are present in said process and examine the demands directed towards healthcare professionals. Methodology This study has applied a qualitative methodology with a phenomenological theoretical-methodological approach. The technique used to obtain information was the semistructured individual interview. The study was carried out in Catalonia. The participants were 17 adult women with low-risk pregnancies. Results Three categories have been identified after the analysis: (a) Completion of the birth plan: an approach to the decision; (b) The rationale of the decision: resources and barriers; and (c) The approach to pain in childbirth: elements of vulnerability. Conclusions Women do not always make firm decisions when completing the birth plan; The decisions expressed may be statements of intent. At the time of delivery, the perceived pain can be experienced as a threat that makes them feel vulnerable. The role of midwives and other healthcare professionals is to help work out this sense of vulnerability.

Case Study of Record of Program of Birth Planning and Complication Prevention (P4K) by Village Midwife, Kemawi Village, Semarang Regency

Kemawi Village is one of the active Alert Village in the Semarang District. Based on information from the Public Health Center (PHC), the reporting of the Birth Planning and Complication Prevention Program (P4K) has not been done scheduled by the village midwife. The purpose of this research is to know how is the knowledge of midwife about the importance of registration reporting of P4K and then to analyze how the reporting of P4K is done by the village midwife. Research conducted in 2014. The type of research is a case study, with a qualitative approach. The main informant was a Kemawi village midwife, with several triangulation informant persons. The research gives the results of the recording have been done according to the procedure but the filling of the P4K sticker has not been suitable, for example, blood donor candidate is not filled with a clear identity due to there is no data processing training and supervision. Further reporting of P4K programs is made by the midwife only when there is a request at any time, no scheduled reporting. Therefore, it is recommended to PHC and District PHC (DHO) to make training and supervision for the village midwife in order to improve the ability of P4K program data management in particular, including data reporting and Maternal Child Health (MCH) in general.

Birthing Stories and Techno-moral Change across Generations: Coping with Hospital Births and High-tech Medicalization in Rural South China, 1960s-2010s.

In the last 100 years, new biomedical technologies altered childbirth practices in China on virtually every level. This transformation was significantly accelerated after the launch of the Birth Planning Policy in 1979. At the turn of the millennium, the government enforced a policy of mandatory hospital births to bring the country closer to United Nations' Millennium Development Goals in terms of maternal and infant health, but these reforms were accompanied by a dramatic increase in cesarean rates. Drawing on oral history materials collected in a rural community in Guangdong province, this article shows how China's cesarean surge gave rise to complex generational frictions in women's techno-moral understandings of what should be the right way to give birth. These generational frictions show that the history of childbirth medicalization is not just a history of changing institutions, policies and technologies; it is also a history of changing technological selves and moral ideals.

Comparison of Perceived Requirements for Maternal Delivery between Medical versus Nursing Students

Purpose: The aim of this study was to investigate the perceptions of intervention and levels of care required for maternal delivery between medical and nursing students. The differences in perceived practices were then considered in relation to health care approaches explored in either the medical or nursing professions. Methods: The number of individuals surveyed in this study included 98 (6th year) medical students and 78 (4th year) nursing students in the Oita University’s Faculty of Medicine. Out of the total 98 medical students recruited to participate in the study, 20 of them did not agree the survey. On the other hand, among the total 78 nursing students recruited, like their peers in medicine, 10 did not agree, whereby, only 68 nursing students were participated. As a result, the final rate of valid responses is 82.9% (78+68/98+78=146/176) as shown in (Table 1). The survey questionnaires were completed anonymously during the three months from August to October in 2014. The topics surveyed included the necessity or not of procedures used in delivery and types of care extended on delivery for mothers or their partners, or awareness for natural childbirth. The ethics committee of the university approved the study. Results: In the survey of medical care and treatment for delivery, the number of medical students who desired lithotomy position and the use of oxytocin under the direction of obstetricians were significantly larger than that of nursing students (Table 2. Question No.9, No. 13, P=0.0001). As for the importance of the quality of the delivery experience in relation to the decision of birth place (P=0.0001, Table 2, Question No 2, Table 7, Question No. 2), and comfortable labor position using a location other than the childbirth table (P=0.0001, Table 2, Question No. 4), the number of nursing students was significantly higher than that of medical students. In accordance with the effective and recommended guidelines in “Care in normal birth: A practical guide (WHO1996)”, the authors highlighted survey questions that included consideration of “Planning of childbirth together with a partner”. This survey approach also included “Information for choice of birth place”, Respect for decisions as to who should be accompanying on childbirth and “Comfortable labor position or favorite birth or delivery places other than the childbirth delivery table.” (1) The ratio of medical students significantly supports that birth plan should be decided with partner was higher when compared with nursing students (Table 7. P=0.017). (2) As for information for choice of birthplace, more nursing students significantly support that birth place should be consented as compared with medical students (Table 7. P=0.0001). (3) More nursing students significantly support the person accompanying on delivery (Table 7. P=0.048). (4) Both nursing students and medical students agree with “Comfortable labor position or favorite delivery or birth places other than the childbirth delivery table” (Table 7. P=0.006) Table 8 has shown no recommendation by WHO such as enema, shaving, preventive vascular access, conventional lithotomy position. No such difference could be seen between both the medical students and nursing students as in Table 4. Consequently, the medical students indicated that higher preference for more medical treatment including promotion of delivery due to oxytocin treatment and lithotomy position was necessary compared to the nursing students’ expression of such desirability of the approach. Conclusion: The study showed a significant difference in the perceived requirements for child birth or delivery between medical students and nursing students. The main differences are suspected to be due to differences in the educational programs and backgrounds which both the medical students or nursing students received while studying and training for their respective professions.

The effect of childbirth preparation training on primiparous women’s birth plans and the childbirth processes

Purpose: The aim of this study is to analyze the effect of childbirth preparation training (education, Pilates, and breathing exercises) on the birth plans of primiparous women, as well as the effect of birth plans on the childbirth process. Materials and Methods: This is a quasi-experimental/non-randomized trials and prospective study. The population of the study included the primiparous women that came to two hospitals. Among these women, the sample of the study included 70 women (experimental group=35, control group=35). Results: The most common requests granted to the experimental group were having the support of the person they wanted during the birth process (80.6%) and being able to walk and change position (90.3%). The experimental group had a lower rate of planned cesarean, were more satisfied with their childbirth experiences, received more support during the birthing process, and used more techniques for coping with pain during labor (p &lt; 0.05). The experimental group was earlier to have contact with their infants, to the first breast feed their infants (p &lt; 0.05). Conclusion: Midwives and nurses play an active role in the realization of the birth plans that are within the framework of prenatal education courses.

Listening to women\u2019s voices: the experience of giving birth with paramedic care in Queensland, Australia

BackgroundUnplanned out-of-hospital birth is generally assumed to occur for women who are multiparous, have a history of a short pushing phase of labour or are experiencing a precipitate birth. However, there is little research that examines the woman’s perspective regarding factors that influenced their decision on when to access care. This research aimed to explore women’s experience of unplanned out-of-hospital birth in paramedic care. Due to the size of the data in the larger study of ‘Women’s experience of unplanned out-of-hospital birth in paramedic care’ [1], this paper will deal directly with the women’s narrative concerning her decision to access care and how previous birth experience and interactions with other healthcare professionals influenced her experience.MethodNarrative inquiry, underpinned from a feminist perspective, was used to guide the research. Twenty-two women who had experienced an unplanned out-of-hospital birth within the last 5 years in Queensland, Australia engaged in this research.ResultsThe decision of a woman in labour to attend hospital to birth her baby is influenced by information received from healthcare providers, fear of unnecessary medical intervention in birth, and previous birth experience. All themes and subthemes that emerged in the women’s narratives relate to the notion of birth knowledge. These specifically include perceptions of what constitutes authoritative knowledge, who possesses the authoritative knowledge on which actions are based, and when and how women use their own embodied knowledge to assess the validity of healthcare workers’ advice and the necessity for clinical intervention.ConclusionsThe women interviewed communicated a tension between women’s knowledge, beliefs and experience of the birth process, and the professional models of care traditionally associated with the hospital environment. It is essential that information provided to women antenatally is comprehensive and comprehensible. The decisions women make concerning their birth plan represent the women’s expectations for their birth and this should be used as a means to openly communicate issues that may impact the birth experience.