Childbirth Preparation Research Articles

Benefits of preparing for childbirth with mindfulness training: a randomized controlled trial with active comparison

BackgroundChildbirth fear is linked with lower labor pain tolerance and worse postpartum adjustment. Empirically validated childbirth preparation options are lacking for pregnant women facing this problem. Mindfulness approaches, now widely disseminated, can alleviate symptoms of both chronic and acute pain and improve psychological adjustment, suggesting potential benefit when applied to childbirth education.MethodsThis study, the Prenatal Education About Reducing Labor Stress (PEARLS) study, is a randomized controlled trial (RCT; n = 30) of a short, time-intensive, 2.5-day mindfulness-based childbirth preparation course offered as a weekend workshop, the Mind in Labor (MIL): Working with Pain in Childbirth, based on Mindfulness-Based Childbirth and Parenting (MBCP) education. First-time mothers in the late 3rd trimester of pregnancy were randomized to attend either the MIL course or a standard childbirth preparation course with no mind-body focus. Participants completed self-report assessments pre-intervention, post-intervention, and post-birth, and medical record data were collected.ResultsIn a demographically diverse sample, this small RCT demonstrated mindfulness-based childbirth education improved women’s childbirth-related appraisals and psychological functioning in comparison to standard childbirth education. MIL program participants showed greater childbirth self-efficacy and mindful body awareness (but no changes in dispositional mindfulness), lower post-course depression symptoms that were maintained through postpartum follow-up, and a trend toward a lower rate of opioid analgesia use in labor. They did not, however, retrospectively report lower perceived labor pain or use epidural less frequently than controls.ConclusionsThis study suggests mindfulness training carefully tailored to address fear and pain of childbirth may lead to important maternal mental health benefits, including improvements in childbirth-related appraisals and the prevention of postpartum depression symptoms. There is also some indication that MIL participants may use mindfulness coping in lieu of systemic opioid pain medication. A large-scale RCT that captures real-time pain perceptions during labor and length of labor is warranted to provide a more definitive test of these effects.Trial registrationThe ClinicalTrials.gov identifier for the PEARLS study is: NCT02327559. The study was retrospectively registered on June 23, 2014.

Skills-based childbirth preparation reduces stress for midwives

Objectiveto explore the potential benefits of skills-based childbirth preparation on the work related stress levels of midwives. Designa questionnaire was sent out to midwives who had clients participating in an RCT of an education package for childbirth preparation (The Pink Kit (PK) Method for Birthing Better®) delivered to parents. Settingmidwives were in private practice and acted as lead maternity carers to New Zealand first time mothers. Participantsone hundred and four independent midwives participated. Measurementsa brief questionnaire using a Visual Analogue Scale to portray perceptions of work-related stress and a yes/no question about expected and/or unexpected physical complications. Findingsmidwives working with clients in the intervention group experienced less work-related stress after correction for medical complications compared to the two control groups. Key conclusionsworking with mothers who have used a programme that increased their childbirth self-efficacy decreased the work-related stress experienced by midwives. Implications for practiceencouraging pregnant women to develop childbirth skills merits further investigation in an effort to reduce the work-related stress experienced by midwives.

Exploring perceptions of instructors about childbirth preparation training courses: A qualitative study.

BackgroundChildbirth preparation training courses on maternal and neonatal health increase awareness, and capability of pregnant women in overcoming fear and anxiety and managing labor pains.ObjectiveTo identify the affecting factors and barriers of these courses from the perspective of their instructors.MethodsThis qualitative study of the content analysis type, has been conducted on 16 certified teachers of the training courses of the Hamadan city in 2015. Data were collected by semi-structured in-depth interviews and were then analyzed by using MAXQDA10 application.ResultsParticipants’ experiences are indicated on three main themes including the objectives of the course, facilitators and barriers. The main objectives of the course were reported as to improve maternal and newborn health, promote natural childbirth and preparedness for parenting and breastfeeding. The main facilitators of the successful implementation include observing educational standards, strengthening the communication and relationship between mothers and staff, mobilization, and the role of instructor. The major barriers are reported as inadequate support from management system, insufficient intra-sector collaboration, poor attitude of obstetricians and physicians, inadequate access, theory-practice gap and not intended to labor naturally.ConclusionThe results of our study show that multiple factors are involved in the participation of pregnant women in antenatal classes. Promoting natural childbirth requires intra-sector and inter-sectoral collaboration, as well as the community participation.

The effect of attending a prenatal childbirth preparedness course on labor duration and outcomes.

To evaluate the effect of attending a prenatal childbirth preparation course (CPC) on labor duration and outcomes. A cross sectional study of 53 primiparous women who attended and 54 women who did not attend a CPC was conducted. The state-trait anxiety inventory (STAI) score was used to diagnose anxiety. Clinical and obstetrical data were collected from the perinatal database of our center. Through post-partum interviews, coping strategies were assessed, patients graded their childbirth experience and breastfeeding was evaluated. Data were analyzed using description analyses and a P-value <0.05 was considered statistically significant. The STAI score was significantly lower in the study group compared with controls (P=0.025). The first stage and the entire duration of labor were significantly shorter (P=0.036 and P=0.026, respectively) in women who attended the CPC. No significant differences were found with regard to the mode of delivery, rate of episiotomy, use of analgesics and neonatal outcomes between the groups. Women in the study group rated their labor experience significantly higher (P=0.016) and exhibited significantly higher rates of breastfeeding (P<0.001) than controls. The knowledge acquired in the CPC has positive effects on the course of labor and delivery outcomes as well as higher rates of breastfeeding.

The Sounds and Sights of Natural Childbirth: Films and Records in Antenatal Preparation Classes, 1950s-1980s.

Film and sound recordings are a ubiquitous part of the antenatal preparation courses that serve as a rite of passage to parenthood in Western Europe and North America. This article analyses a sample of these didactic tools used in classes from the 1950s to the 1980s, the heyday of the natural childbirth movement. These audio-visual artefacts both reflected and conditioned expectations for women's behaviour during labour and birth through their representation of pain. They demonstrate changing norms in the role of the father, but show how physician authority-and male authority more broadly-remained largely unchallenged. Two phases are discernable in these sources. From the 1950s through the mid-1960s, natural childbirth was presented as essentially painless. From the late 1960s through the 1980s, pain and effort in labour and birth found graphic representation on the screen, reflecting a shift in what was considered a desirable birth experience and what natural childbirth preparation could accomplish.

Opinions and attitudes of obstetricians and midwives in Turkey towards caesarean section and vaginal birth following a previous caesarean section.

AimTo determine the opinions and attitudes of Turkish obstetricians and midwives to caesarean section (C-section) and vaginal birth following a C-section.MethodsThe study involved obstetricians and midwives who were working in a state women’s hospital and two private hospitals in Gaziantep, Turkey. Participants were asked to complete questionnaires on sociodemographic data and provide opinions about C-section.ResultsA total of 88 midwives and 22 obstetricians participated in the study. Approximately one-third of midwives believed caesarean rates were high at their institution and more than 50% thought that the rate should be reduced. In contrast, although approximately 80% of obstetricians thought that caesarean rates in their institutions ranged between 25–50%, only 18% believed the rate was high and 68% believed that the rate of should be reduced. Midwives and obstetricians tended to agree on most suggested reasons for high C-section rates. When asked about interventions that may reduce the C-section rates, midwives and obstetricians had opposing views. However, most participants agreed that prenatal childbirth preparation courses would be beneficial.ConclusionsThis study showed that most midwives and obstetricians believe the rate of C-section at their institution is high and should be reduced.

Knowledge of Expectant Fathers on Childbirth Care

The knowledge of expectant fathers is vital to ensure that healthcare is sought early to prevent any complications related to pregnancy and childbirth. It is essential for the health care agencies to be aware of the existing knowledge of men on childbirth care so that educational sessions can be arranged to enhance it. The objective of the study was to assess the knowledge of expectant fathers on childbirth care and to associate it with selected socio-personal variables. A cross sectional descriptive study was carried out among husbands of pregnant women attending the maternity outpatients’ clinics. The results showed that knowledge of expectant fathers is poor on childbirth care and it is associated with age, education, occupation, monthly income, religion, attendance at childbirth classes and source of information on child birth classes. These findings are useful for healthcare agencies in tailoring childbirth preparation classes for expectant couples with diverse socio-personal characteristics.

Doğuma Hazırlık Sınıflarının Doğum Korkusu, Doğum Tercihi ve Doğuma Hazır Oluşluğa Etkisi

Amaç: Doğuma hazırlık eğitimleri; doğum korkusunu azaltmada, doğuma ilişkin olumlu düşünceleri ise artırmada etkili olan bir eğitim çeşididir. Bu çalışma, doğuma hazırlık sınıflarına (DHS) katılan kadınların doğum şekli tercihi, doğuma hazır oluşluk ve doğum korkusuna etkisini incelemek amacıyla yapılmıştır. Gereç ve Yöntemler: Bu çalışma, arşiv incelemesini içeren retrospektif bir araştırmadır. Çalışma, Dokuz Eylül Üniversitesi Hemşirelik Fakültesinde 2011-2015 yılları arasında gebelere yapılan DHS'nin arşivi kullanılarak gerçekleştirilmiştir. Araştırmanın evrenini DHS'ye katılan 43 gebe oluşturmuştur. Araştırmanın örneklemini ise kursun tüm derslerine eksiksiz olarak katılan, tüm ölçekleri ve bilgilendirilmiş onam formunu dolduran 38 gebe oluşturmuştur. Veriler; tanıtıcı bilgi formu ve Lederman'ın Gebelikte Kendini Değerlendirme Ölçeğinin ''doğuma hazır oluşluk'' ve ''doğum korkusu'' alt ölçekleriyle toplanmıştır. Verilerin analizinde SPSS 15 paket programı, sayı, yüzde ve bağımlı gruplarda t-testi kullanılmıştır. Bulgular: Eğitime katılan gebelerin yaş ortalaması 26±3,27 yıl olup, %97,4'ü üniversite mezunudur. Eğitimden önce gebelerin %55,3'ü epidural analjezili vajinal doğum tercih eder iken, eğitim sonrasında %65,8'i epidural analjezisiz vajinal doğumu tercih etmiştir. Eğitime katılan kadınların %33,3'ü eğitime katılma amacını, gebelikte yapılması gerekenleri öğrenmek olarak belirtmiştir. DHS sonunda katılımcıların doğuma hazır oluş durumları eğitim öncesine göre artmıştır (p=0,045). Ancak, DHS eğitimi öncesi ve sonrasında doğum korkuları arasında fark bulunmamıştır (p=0,198). Bu sonuç, eğitim programının özelliklerinden kaynaklanmaktadır. Sonuç: DHS eğitimi, kadınların vajinal doğum tercihlerini ve doğuma hazır oluşluklarını artırmakta etkilidir. Ancak doğum korkuları üzerine etki etmemektedir.

Motivating women and their partners to participate in childbirth education and increasing natural delivery rates in Iran

Childbearing involves profound physical, psychological and social changes, as well as the considerable challenge of personal and family transition and adaptation, and there are important decisions to be made. It might be assumed, therefore, that participation in childbirth preparation would hold the same importance for childbearing women and their partners as other aspects of care, for example making antenatal visits. Yet, in common with many other parts of the world, few women in Iran participate in the free childbirth preparation available (Rasouli et al.). It is surprising that given considerable development of different approaches and an evidence base in childbirth preparation (Leap & Hunter. Supporting women preparing for labour and birth. In: Leap & Hunter. Supporting Women for Labour and Birth: A Thoughtful Guide. London: Routledge, 2016; 57–84) little attention appears to have been paid to motivating women to attend classes. This in itself makes the results of a randomised trial conducted in Iran to determine the effectiveness of motivational interviewing (MI) on women's participation in childbirth classes and their subsequent natural delivery, of considerable interest. In this RCT women were randomised into one of three groups: motivational interviewing (MI), a lecture, or the control group: 90, 59.7, and 27.3% of the women in these groups, respectively, attended classes. The frequency of natural delivery was 68.4, 54.4, and 48.1%, respectively. Motivational interviewing is described as a client-centred approach to support change that emphasises helping the client make his or her own decision and change, rather than external pressure. The approach to motivational interviewing was one of eliciting concerns, enabling the expression of uncertainty and ambivalence, empathy and supporting self-efficacy in childbearing women (Rasouli et al.). Although the use of MI has been described to enable difficult conversations, for example in relation to obesity, smoking and substance abuse (Raymond & Clements. MIDIRS 2013; 23:435–40) using MI to encourage attendance at childbirth preparation classes is unique. Iran has a high caesarean section rate and has a comprehensive strategy to reduce it. This strategy includes a recommendation for the provision of childbirth preparation in all services. Improving participation in classes will be important. It is possible that motivational interviewing, through the development of a therapeutic relationship of the counsellor with participants, was responsible for the increase in natural birth rather than participation in childbirth education per se. Nevertheless, this appears to be a promising approach. Further understanding may be achieved through a qualitative survey of women's experiences and feelings. None declared. Completed disclosure of interests form available to view online as supporting Information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

Effectiveness of Childbirth Education on Nulliparous Women’s Knowledge of Childbirth Preparation, Pregnancy Anxiety and Pregnancy Outcomes

Background: The emerging number of cesarean sections among nulliparous women due to high pregnancy-related anxiety is a major concern of maternity care providers. Childbirth preparations enable women to cope with pregnancy anxiety and enhance pregnancy outcomes. Limited studies evaluated the impact of childbirth educational interventions on pregnancy-specific anxiety and pregnancy outcomes. Objectives: The aim of this study was to evaluate the effectiveness of childbirth educational intervention on nulliparous women’s knowledge on childbirth preparation, pregnancy anxiety, and pregnancy outcomes. Methods: A randomized controlled trial approach with a two-group pretest/ posttest design was used among hundred nulliparous third trimester pregnant women. All participants were pretested for their knowledge on childbirth preparation and pregnancy anxiety level using knowledge questionnaire, state trait anxiety inventory, and pregnancy-specific anxiety inventory. The experimental group (n = 50) received three sessions of childbirth education. All participants were post- tested before delivery, and their pregnancy outcomes were noted from labor records. Data were collected from a major maternity hospital in Kerala, India. GLM repeated measures analysis and paired t-test were used for data analysis. Results: The experimental group demonstrated a significantly higher level of knowledge on childbirth preparation (P < 0.001), with high reported mean knowledge scores of (54.30 ± 3.86) childbirth preparation than the control group (31.08 ± 1.96). A lower mean scores of pregnancy-specific anxiety among experimental group (102 ± 4.65) (P < 0.001) compared to control group (139.96 ± 4.9) signifies the relevance of childbirth education in reducing pregnancy-specific anxiety. Significant reductions of caesarean birth (50%) among nulliparous women along with a 12% increase in newborn’s birth weights were the main positive birth outcomes. Conclusions: Childbirth education significantly reduced pregnancy-specific anxiety and the adverse pregnancy outcomes. The emerging number of cesarean sections on maternal request due to childbirth anxiety could be reduced by empowering nulliparous women through childbirth education.

Effectiveness of Childbirth Education on Nulliparous Women’s Knowledge of Childbirth Preparation, Pregnancy Anxiety and Pregnancy Outcomes

Effectiveness of Childbirth Education on Nulliparous Women’s Knowledge of Childbirth Preparation, Pregnancy Anxiety and Pregnancy Outcomes

The impact of motivational interviewing on participation in childbirth preparation classes and having a natural delivery: a randomised trial

This study aimed to determine the effectiveness of motivational interviewing on women's participation in childbirth classes and their subsequent natural vaginal delivery. Randomised controlled trial. Prenatal clinic of the Shohada Women's Hospital, Behshahr, Mazandaran, Iran. This study was conducted with 230 nulliparous women. Participants were randomised into three groups, including 76 women in the motivational interviewing group, and 77 women in both the lecture and the control groups. Participants were assessed at three time points, including at baseline (16-19 weeks of gestation) and then following the intervention (at 21 and 37 weeks of gestation). The motivational interviewing group received two focus interviews and two telephone follow-up sessions (at 3 and 6 weeks after the last session of motivational interviewing). The lecture group received a speech session. The control group received routine care service. Frequency of participation in childbirth preparation classes and mode of delivery. Over 90% of women in the motivational interviewing group participated in childbirth preparation classes, whereas the rate of participation in the lecture and the control groups was 59.7 and 27.3%, respectively. The probability of maternal participation in childbirth classes in the motivational interviewing and in the lecture groups was 3.3 (95% CI 2.1-4.5) and 2.2 (95% CI 1.4-3.0) times the probability of maternal participation in the control group, respectively. Moreover, the intervention groups had 1.4 (95% CI 1.1-1.8) and 1.1 (95% CI 0.9-1.4) times the probability of natural delivery, compared with the control group. The frequency of natural delivery in motivational interviewing, lecture, and control groups was 68.4, 54.5, and 48.1%, respectively. The results showed a statistically significant difference between the mean scores for the awareness and attitude scores between the three groups in different time periods. We found that motivational interviewing can be a useful tool for encouraging pregnant women to attend childbirth preparation classes. Motivational interviewing with nulliparous women is strongly associated with their attendance in childbirth preparation classes.

A qualitative interview study into experiences of management of labor pain among women in midwife-led care in the Netherlands

Introduction: Many pregnant women are concerned about the pain they will experience in labor and how to deal with this. This study’s objective was to explore women’s postpartum perception and view of how they dealt with labor pain.Methods: Semistructured postpartum interviews were analyzed using the constant comparison method. Using purposive sampling, we selected 17 women from five midwifery practices across the Netherlands, from August 2009 to September 2010.Results: Women reported that control over decision making during labor (about dealing with pain) helped them to deal with labor pain, as did continuous midwife support at home and in hospital, and effective childbirth preparation. Some of these women implicitly or explicitly indicated that midwives should know which method of pain management they need during labor and arrange this in good time.Discussion: It may be difficult for midwives to discriminate between women who need continuous support through labor without pain medication and those who genuinely desire pain medication at a certain point in labor, and who will be dissatisfied postpartum if this need is unrecognized and unfulfilled.

Breastfeeding during the first year of life: estimates using records generated in general pediatrics.

The monitoring of breastfeeding during a child's first year of life is highly recommended. The proportion of children who are exclusively breastfed for at least six months is a strong indicator of breastfeeding promotion in the community. The objectives of the study were to survey the exclusive breastfeeding of children during the first year of life for cohorts born in Trentino (north-eastern Italy) in 2009 to 20013, to evaluate the decrease of exclusive breastfeeding at 6 months and to analyze possible relationships between the maintenance of breastfeeding up to the age of 6 months and certain maternal socio-demographic characteristics, as well as clinical aspects of the pregnancy and birth. Cohorts born in Trentino between 2009 and 2013 were studied, calculating the proportion of infants who were breastfed upon discharge from the hospital (source: data on the CedAP informative flow, that is the Italian Certificate of Delivery Assistance data-base). The data provided on the 12-Month Health Evaluation Form found in the Pediatric Health Booklet, completed by regional family pediatricians, was linked with that of the respective CedAP (96.7% linkage). The trend for exclusive breastfeeding and its monthly decrease was analyzed. The maintenance of exclusive breastfeeding until the age of 6 months was analyzed in relation to citizenship, area of residence, maternal education level and employment status, parity, single or multiple birth, infant exposure to passive smoke and attendance or non-attendance of a state-promoted childbirth preparation course. This final variable was studied solely for primiparous women, who are generally most likely to attend a childbirth preparation course. All results were adjusted for the following potential confounding variables: "birth type," "prematurity" and "feeding method upon discharge from the hospital." CedAP data revealed that 83.5% of live infants were exclusively breastfed and that this percentage decreased to 34.7% by the age of 6 months (35.4% among full-term infants and 27% among premature infants). Data from the Province of Trento demonstrates that exclusive breastfeeding up to the age of 6 months is influenced by the mother's citizenship, area of residence and education level, but not by her employment status. In addition, the study revealed a significant association with parity, passive smoke exposure and attendance of a childbirth preparation course. The Pediatric Health Booklet with its information on the state of health of children (in combination with data from the CedAP) offers a valid tool for monitoring breastfeeding during the first year of life. Data confirmed a decrease in the rate of breastfeeding between birth and the first month of life and between the first and sixth months of living at home. The results regarding the conditions that favour and discourage breastfeeding suggest potential public health care measures to improve children's health.

Perspectives on Promoting Hospital Primary Vaginal Birth: A Qualitative Study.

One in three women will deliver by cesarean, a procedure that can be life saving, but which also carries short- and long-term risks. There is growing interest in preventing primary cesarean deliveries, while optimizing the health of the mother and infant. The primary aim of this study was to use participatory action strategies and ethnographic interview data collected from diverse stakeholders in birth (caregivers, women, policymakers) about facilitators and barriers to the achievement of primary vaginal birth in first-time mothers in hospital settings. The secondary aim was to use the findings to identify strategies to promote primary vaginal birth and future areas of research. Individual and small group interviews were conducted with caregivers and policymakers (N = 79) and first-time mothers (N = 24) at a northeastern hospital. All interviews were audio-recorded, transcribed, and analyzed using Atlas.ti. Four broad themes were identified: 1) preparation for childbirth, 2) early labor management, 3) caregiver knowledge and practice style, and 4) birth environment (physical, cultural/emotional). The first two were closely linked from caregivers' perspectives. If the woman was not prepared for childbirth, it was perceived she would be more likely to present to the hospital in early labor. Once there, it was hard to prevent admission and interventions. A woman's knowledge and confidence were perceived as powerful mediators for vaginal birth. Caregivers and first-time mothers identified early labor management and childbirth preparation as important factors to promote primary vaginal birth in hospital settings. Both deserve further inquiry as potential strategies to decrease rising cesarean delivery rates.

Preparo e percepções de gestantes sobre as vias de parto

Objetivo: conhecer o preparo e as percepções de gestantes sobre as vias de parto. Método: pesquisa descritiva, qualitativa, desenvolvida com oito gestantes, em setembro de 2014, em um município no sudoeste do Estado do Paraná. Os dados foram coletados por meio de entrevista semiestruturada e analisados pela técnica de análise de conteúdo temática da proposta operativa. Resultados: o parto vaginal emergiu como a via preferencial das participantes. A preparação para o parto se deu, especialmente, durante o pré-natal, sendo o médico o profissional mais envolvido nas orientações, mas também aquele que mais influenciou na decisão sobre a via de parto. Conclusão: embora as participantes tenham revelado uma preferência pelo parto vaginal, frente às imposições e à falta de conhecimentos, no preparo pré-natal, elas foram convencidas a realizar a cesárea.

The effect of childbirth preparation courses on anxiety and self-efficacy in coping with childbirth

Objective: To evaluate the effect of childbirth preparation courses on anxiety and self-efficacy levels in coping with childbirth. Methods: A study was conducted on a convenience sample of nulliparous women. The intervention groups consisted of 31 women who attended a 5-week childbirth preparation course and 39 women who attended a 2-week course. A control group included 32 women who did not attend any of the childbirth preparation courses. Levels of anxiety and self-efficacy were measured before and after childbirth preparation courses. The setting was a large teaching hospital in central Israel. Results: After completing the preparation courses the anxiety level dropped significantly in the long and short course groups ( p = .04 and p = .01, respectively). The anxiety in both groups was significantly related to the self-efficacy for coping with childbirth ( r = -0.26, p = .03 and r = -0.48, p = .001, respectively). Nonetheless, attending the preparation courses did not raise the level of self-efficacy in coping with childbirth. Anxiety and self-efficacy levels in the control group were not significantly different from those of the other groups. Conclusions: Preparation courses are expected to reinforce the self-efficacy of the parturient. The overall impact of the findings indicated that while they had no effect on self-efficacy, they did constitute an anxiety-reducing factor. Midwife postgraduate programs should include training in preparing women for coping with childbirth. These findings are an important contribution to the examination of current strategies of teaching and training of midwives in conducting childbirth preparation courses.

Assessment of the implementation of the model of integrated and humanised midwifery health services in Chile

Objectivein 2010, a pilot study was conducted among women who were attended by midwives in the public sector in Santiago, Chile. The purpose of that study was to evaluate the implementation of the ‘Model of Integrated and Humanized Health Services’, and the Clinical Guide for Humanized Attention during Labour and Childbirth. Results of that study indicated 92.7% of women had medically augmented labours (artificial rupture of the membranes, oxytocin and epidural analgesia). One third of the women reported discontent with the care they received. This study replicated the pilot study (2010) and was conducted in seven regional hospitals across Chile. The objectives were to : (i) describe selected obstetric and neonatal outcomes of women who received care according to this new guide, (ii) identify the level of maternal–neonatal well-being after experiencing this modality of attention, and (iii) explore professionals׳ perceptions (obstetricians and midwives), as well as consumers׳ perceptions of this humanised assistance during labour and childbirth. Designthis is a cross sectional and descriptive, mixed methods study, conducted in two phases. The first phase was quantitative, measuring midwifery processes of care and maternal perceptions of well-being in labour and childbirth. The second phase was qualitative, exploring the perceptions of women, midwives and obstetricians regarding the discrepancy between the national guidelines and actual practice. Settingmaternity units from seven regional hospitals from the northern, central and southern regions and two metropolitan hospitals across Chile. Participants1882 parturient women in the quantitative phase (including the two Metropolitan hospitals published previously). Twenty-six focus groups discussions (FGD) participated from the regional and metropolitan hospitals for the qualitative phase. Measurements/Findingsall women started labour spontaneously; 74% of women had spontaneous vaginal childbirth. Caesarean section was the outcome for 20%, and 6% had childbirth assisted with forceps. A high number of medical interventions continued to be performed in all regions, deviating widely from adherence to the national clinical guidelines. Most of the women did not receive any oral hydration, almost all received intravenous hydration; most were under continuous foetal monitoring and medically augmented labour. The majority of women received artificial rupture of membranes, epidural anaesthesia and episiotomy. Most delivered in the lithotomy position. Two thirds of women surveyed perceived adequate well-being in labour and childbirth. Findings from focus group discussions of women (FGD=9; n=27 women), midwives (FGD=9; n=40) and doctors (FGD=8; n=29) indicated lack of infrastructure for family participation in birth, inadequate training and orientation to the national guidelines for practice, and lack of childbirth preparation among women. Some women reported mistreatment by personnel. Some midwives reported lack of autonomy to manage birth physiologically. Key conclusionsbirth is managed by midwives across the public sector in Chile. Despite evidence-based guidelines published in 2007 by the Ministry of Health, birth is not managed according to the guidelines in most cases. Women feel that care is adequate, although some women report mistreatment. Implications for practiceefforts to provide midwife-led care and include women in participatory models of antenatal care are recommended to promote women-centred care in accordance with the Chilean national guidelines.

Effect of Lamaze Method on Child Birth Experiences among Primi Gravid Women During First Stage of Labour in a Selected Hospital of Udupi

Background : Childbirth is a normal life event, yet women are exposed to a significant amount of stress. Many mothers may also experience unnecessary distress and anxiety simply because they did not anticipate or did not know about the normal physical and psychological upheavals that are integral to the childbearing process. In India, child birth preparation is still less of a formality. Pregnant women in general and first-time mothers in particular require a vast amount of information. The Lamaze is such a child birth education method that teaches that birth is a normal, natural, and healthy process and that woman should be empowered to approach it with confidence. Nursing interventions can change perceptions of childbirth experience; even for an unprepared couple. Therefore it is important that the nurse midwife understand the support and teaching roles in child birth education. Here the nurse midwife educates women about the ways they can decrease their perception of pain, such as through relaxation techniques, breathing exercises, distraction, or massage. The aim of this study is to determine the effect of Lamaze method on child birth experiences among primi gravid women in first stage of labour. Objectives of The Study : The objectives of the study were to: to find the effect of Lamaze method on child birth experiences among gravid women in terms of labour pain measured using visual analogue scale in experimental group and control group-to find the effect of Lamaze method on child birth experiences among gravid women in terms of behavioral responses as measured using observational check list in experimental and control group. -to find the difference in child birth experiences of gravid women in terms of labour pain in experimental and control group.-to find the difference child birth experiences of gravid women in terms of behavioral responses of experimental and control group. Method : A quasi-experimental time series nonequivalent control group design was used for the present study. Sample consisted of 30 primigravid mothers in the first stage of labour who met the inclusion criteria. They were selected using purposive sampling and were randomly assigned to experimental and control group (n=15 in each group). Tools used were baseline characteristics of the mother, numerical pain rating scale to assess the labour pain and a structured observation checklist to assess the behavioural responses of the primigravid women during first stage of labour. The data collected were analyzed using descriptive and inferential statistics. Results : The results reveal that the mean scores of labour pain of primigravid women in the first stage of labour in experimental group (2.4,3.86, 7.733) are less than those in control group (4.4, 6.33, 8.633) in all phases (latent, active, transient) respectively. The 't'value computed in all phases ('t' (28) =1.700 at 5% level) shows that there is a significant difference in the labour pains of primigravid women in the first stage of labour in all phases. In the present study most of the women (93.3%) in the experimental group had a high positive behavioral response and only 6.7% of the women had a positive behavioral response. All women belonged to the control group had a positive behavioral response. The results reveal that the mean scores of behavioural responses of primigravid women in the first stage of labour in experimental group were (102.47, 94.07) are higher than those in control group (78.53, 74.6) in both the areas (during contractions and in between contractions).The 't'value computed in two areas ('t' (28) =1.700 at 5% level) shows that there is a significant difference in the behavioural responses of primigravid women in the first stage of labour in both the areas. Interpretation : Lamaze method is effective in improving the child birth experience in terms of labour pain and behavioural responses of primigravid women during the first stage of labour. Conclusion : The findings of the study suggest Lamaze method is very effective for the primigravid to reduce the labour pain and improve their behaviors in a positive way during labour and to have a pleasurable childbirth experience.

Effectiveness of PTP on childbirth preparation regarding childbirth practice during labor among primigravid women

Context: Childbirth is a natural and universal phenomenon. Although labor is often thought of as one of the most painful events in human experience, supportive care is intended to ease a woman's anxiety and discomfort. A wide variety of pain relief measures, pharmacological and nonpharmacological, are available for women in labor. Aim: To assess the practices adopted during labor among the primigravid women in the experimental and control group, to compare the practices adopted during labor among the primigravid women in control and experimental group, and to find the association between selected baseline variables and childbirth practices. Settings and Design: Father Muller Medical College Hospital, Mangalore, Quasi-experimental design. Materials and Methods: Observational checklist to assess the childbirth practices. Statistical Analysis: Frequency, mean, standard deviation (SD), mean percentage, Spearman's rank correlation coefficient, chi-square for association. Result: The mean practice scores are higher among the experimental group compared to the control group, which indicates that the Planned teaching Programme has helped to adopt the practices during labor among primigravid women specially in the experimental group. No association was found between demographic variables and childbirth practices. Conclusion: Planned Teaching Programme is a simple and cost-effective method that can be initiated by nurses who are to be used by mothers during labor.