Childbirth Settings Research Articles

Predictors of decision making about childbirth setting in the southeast of Iran: home or hospital

Aim This study is designed to explore how childbirth setting (homebirth or hospital birth) can be predicted by independent variables.

U.S. Nulliparas' Reasons for Expected Provider Type and Childbirth Setting.

The objective of this study was to describe nulliparas' reasons for the type of provider (i.e., midwife, physician) and childbirth setting (i.e., home, hospital, hospital-based birth center) that respondents expected for their births. Data were collected via a cross-sectional, descriptive, self-administered, Web-based survey including both close- and open-ended questions and were analyzed using conventional content analysis. Respondents were 220 nulliparous women aged 18-40 years, living in the United States, and pregnant at 20 or fewer weeks' gestation. Women's reasons were categorized broadly as relating to provider/setting attributes, relationship with provider/setting, normative choices, respondent attributes, and practical considerations. Respondents' reasons highlight misconceptions about childbirth care options, especially regarding midwifery and nonhospital settings, which may be addressed by childbirth education.

Methodological insights from a study using video-ethnography to conduct interdisciplinary research in the study of birth unit design

Little is known about how the physical design of a birthing unit can influence the experiences of labour and birth for women, their supporters and midwives. We proposed that an interdisciplinary approach (disciplines of midwifery, architecture, design, communication and public health) was likely to be the most effective way to better understand the complexities and interactions of design, behaviour, communication and experiences. In this methodological paper we aim to provide a roadmap that other researchers may find helpful when considering the use of video as a data collection technique, especially in the study of the powerful and intimate setting of childbirth. The paper also outlines our process for engaging both researchers and participants in reviewing video footage with the aim to contribute multiple perspectives to the analysis process.

Access or Egress? Questioning the “Ethics” of Ethics Committee Review for an Ethnographic Doctoral Research Study in a Childbirth Setting

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Women's Health Disparities in Honduras: Indicators and Determinants

Disparities in women's health indicators exist throughout the Americas. Health data about indigenous women in the remote highland communities of Honduras are lacking. Our objective was to assess women's health indicators and to suggest potential interventions. An anonymous questionnaire was administered to women ≥age 18 in the Yamaranguila municipality. We assessed rates of Pap smear, breastfeeding, family planning (FP), and prenatal care (PNC); childbirth setting; access issues; and self-health perceptions. Of the 134 participants, 30% were aged < 25 and 10% were ≥ 45. Most attended some primary school, and 11% had no education; 56% reported fair or poor self-health, and 90% had heard of the Pap smear, but only 20% had one within 1 year. Despite knowledge of various FP methods, only 42% in a union were using FP, which is significantly lower than national rates (p<0.01). Thirty-six percent of the respondents' most recent childbirths took place outside a health center. Seventy-six percent exclusively breastfed their youngest child for 6 months, higher than the national rate of 30% (p<0.01). Distance from the municipal center, reflecting more traditional indigenous identity, predicted lower rates of FP use (p<0.05), Pap smear (p<0.01), and prenatal care (PNC) (p<0.05), but age and education level did not. In Honduras, the rural indigenous people have some of the worst health indicators compared to urban and nonindigenous people. Women's health status might be improved by implementing mobile care teams, training indigenous women as community health workers, and employing alternate modalities of cervical screening. Fundamental socioeconomic causes of poor health, such as remote residence, indigenous identity, and gender inequality, should be considered in future interventions to alleviate disparities in health status.

Skin‐to‐skin contact of fullterm infants: an explorative study of promoting and hindering factors in two Nordic childbirth settings

To explore factors that promote or hinder skin-to-skin contact (SSC) during the first days after birth between parents and healthy fullterm infants. A total of 117 postnatal mothers and 107 fathers/partners attending two childbirth settings, where Kangaroo mother care (KMC) was implemented as a standard routine of care, one in Sweden and one in Norway, were recruited consecutively and answered questionnaires two weeks postpartum. Satisfaction with support for SSC in postnatal care and being a mother in the Swedish setting was found to promote SSC during the first day postpartum; previous knowledge about SSC increased the practice also during the 2nd and 3rd days. Receiving visitors apart from partner and siblings emerged as a hindering factor. SSC was known of and practised to a larger extent in the Swedish setting, whereas parents in the Norwegian setting received more visitors and were more satisfied with the received information and support for SSC in postnatal care. The results highlight the need for caregivers to give parents adequate support for practising SSC with their newborn healthy fullterm infants and indicate the importance of developing information routines during the antenatal period as well as in relation to the birth of the child, to effectively introduce and implement SSC.

Home births revisited: the continuing search for better evidence

Childbirth, the extension of the family, has a prominent place in communities and cultures around the world. Yet, in modern society, the actual setting of childbirth has become the hospital—that detached place of ‘sickness repair’—rather than the community and family environment. This has for many years sustained a debate in obstetrics, about the wisdom of this ‘medicalisation’ of childbirth. Medical professionals including general practitioners, midwives and obstetricians and increasingly women as the prime stake holders of ‘their’ delivery, have questioned why in healthier than ever societies, the hospital should be the host environment for the significant event of the birth of a new child. The discussion is a mixture of ideology—‘home is best’ versus ‘hospital is safe’—and of clinical evidence of the risks related to a community-based delivery, and on the ability of the hospital setting to reduce this risk. In June’s issue of the journal, two papers that contribute evidence to the debate are published, a critical appraisal of the outcome of intentional and unintentional home births in the UK, and an analysis of primary care midwives’ deliveries in the Netherlands. Three themes develop from these papers that warrant further discussion: first, the quality of evidence on place of birth; secondly, the effectiveness of risk selection in primary midwifery care and thirdly the need to give women a truly informed choice. The gist of the papers is that there is insufficient evidence of an elevated risk of home deliveries, and consequently there are no grounds to discourage healthy, low-risk women from giving birth at home. Gyte et al. present a critical appraisal of an earlier study of intentional and unintentional home deliveries in the UK. They correctly argue for the appropriate denominator—planned home deliveries—in calculating adverse outcomes of home births and make a convincing case that the number of intrapartum related neonatal deaths is in all probability lower than earlier reported. But this does not answer the question of ‘how low an intrapartum related neonatal death rate is good enough’ And more disturbing is their overall conclusion that no reliable data are available for the UK, and that the prevailing guidelines may be based on wrong assumptions. Given the demand for home birth, this is an unsatisfactory state of affairs. The first issue to consider is the place of delivery. This brings us to the second paper Amelink-Verburg et al., which shows that there is more at stake than ‘home versus hospital’. In the Dutch healthcare system, community-based midwives play a leading role in the delivery of low-risk women and they operate as independent professionals in primary care. Their domains of supervising deliveries are the family’s home and also the primary care obstetric facilities in the hospital. This is a different perspective, in particular with respect to one of the main ‘outcomes’, intrapartum referral. In this context, an important indicator is the ability of early intrapartum referral, allowing nonurgent transfer to the hospital. Here, the ‘primary care’ function of the midwife becomes evident. An essential feature of primary care is the assessment of risk as early as possible in the episode. From this point, the most appropriate level of care is determined (self-care; professional care within the primary care team; or referral to a specialist). This ensures access to care for all (equality), while focusing care to those with the highest needs (equity), and guarantees cost-effectiveness. The ‘Dutch’ approach to birth at home follows from this approach. The quality of risk assessment is vital in this context, in this case to help the pregnant woman to make an informed choice for her place of delivery. The analysis of Dutch midwifery practice gives some insight into the risk selection in primary obstetric care. This risk-selection is built on consensus between midwives, obstetricians and general practitioners. In fact, this consensus between obstetricians and general practitioners has much deeper roots and

A Descriptive Study of “Being with Woman” During Labor and Birth

The objective of this study was to learn more about women's perceptions of the nurse-midwifery practice of "being with woman" during childbirth. The descriptive, correlational design used a convenience sample of 238 low-risk postpartum women in a hospital nurse-midwifery practice, with two childbirth settings: a standard labor and delivery unit and an in-hospital birth center. The main outcome measure was a 29-item seven-response Likert scale questionnaire, the Positive Presence Index (PPI), administered to women cared for during labor and birth by nurse-midwives to measure the concept of being with woman. Statistical analysis demonstrated women who gave birth in the in-hospital birth center or who began labor in the in-hospital birth center prior to an indicated transfer to the standard labor and delivery unit gave higher PPI scores than women who were admitted to and gave birth on the standard labor and delivery unit. Parity, ethnicity, number of midwives attending, presence of personal support persons, length of labor, and pain relief medications were unrelated to PPI scores. Two coping/comfort techniques, music therapy and breathing, were found to be correlated with reported higher PPI scores than those of women who did not use the techniques. These results can be used to encourage continued use of midwifery care and for low client to midwife caseloads during childbirth, and to modify hospital settings to include more in-hospital birth centers.

Preparing for the first birth: mothers' experiences at home and in hospital in australia.

The aim of this research was to explore the experiences of a group of first-time mothers who had given birth at home or in hospital in Australia. Data were generated from in-depth interviews with 19 women and analyzed using a grounded theory approach. One of the categories to emerge from the analysis, "Preparing for Birth," is discussed in this article. Preparing for Birth consisted of two subcategories, "Finding a Childbirth Setting" and "Setting Up Birth Expectations," which were mediated by beliefs, convenience, finances, reputation, imagination, education and knowledge, birth stories, and previous life experiences. Overall, the women who had planned home births felt more prepared for birth and were better supported by their midwives compared with women who had planned hospital births.

A Qualitative Analysis of Women’s Short Accounts of Labour and Birth in a Western Australian Public Tertiary Hospital

This paper reports the findings of the postnatal qualitative arm of a larger study, which investigated women's prenatal and postnatal levels of childbirth fear. Women's expectations and experiences of labour and birth in a Western Australian public tertiary hospital were identified following thematic analysis of short written accounts from 141 participants who had given birth in the previous 6 to 14 weeks. Four major categories emerged to describe features and mediating factors in the trajectory of childbirth and the early puerperium. "Anticipating Labour and Birth," "Labour and Birth Depicted," "Mediating Factors and their Consequences," and "Evaluating, Resolving, and Looking Ahead" portray women's comparative reflections on expectations and realities of birth, on mediating influences, and on moving on from their experience. These findings will provide maternity care professionals with insight into the personal and environmental features of the childbirth setting which colours women's recollections. Being aware of what women value during labour and birth will reinforce the need for professionals to provide care using a mindful approach that considers the potential psychological, emotional, and behavioural implications of events.

Postnatal Debriefing Interventions to Prevent Maternal Mental Health Problems After Birth: Exploring the Gap Between the Evidence and UK Policy and Practice

Postnatal mental health problems range from transient psychological problems to depression, anxiety, psychosis, and post-traumatic stress disorder (PTSD). Debriefing is a structured psychological intervention to prevent postnatal psychological problems, particularly PTSD and depression. Many UK maternity service providers have established postnatal debriefing services, in some cases supported by policy, despite a lack of robust evidence. In this article, current evidence of the effectiveness of postnatal debriefing and the availability and current provision of debriefing offered in UK maternity services is described. A structured literature review was undertaken. Eight randomized controlled trials were conducted to evaluate debriefing or counseling interventions in childbirth settings, and seven studies were done to evaluate debriefing or counseling interventions provided within UK maternity services or describe the availability of such services. Results of six RCTs were that no differences in outcomes were found, one report indicated possible harm from debriefing, and two indicated a positive association related to a psychological intervention. Methodological issues might account for differing trial outcomes. No standard intervention was used in any RCTs or service interventions. Confusion apparently exists in use of the term "debriefing" in UK maternity service policy and practice. Although service evaluations showed that women valued opportunities to discuss their birth, evidence to support the content and timing of service provision and effectiveness of this was lacking. It might be appropriate to consider offering women an opportunity to discuss their childbirth experience and to differentiate this discussion from the offer of a formal debriefing, which is unsupported by evidence. IMPLICATIONS FOR PRACTICE/CONCLUSION: Midwives and other health care professionals who provide opportunities for women to talk about childbirth should be clear about terms used to describe the intervention, as well as the purpose and content of this. Differentiating between women who perceive their experience of childbirth as traumatic and those who develop symptoms of PTSD (for whom specific treatment may be required) is important. All health care professionals should be aware of the signs and symptoms of mental health problems after birth, which may include depression, anxiety, or psychosis in addition to PTSD.

Stability Balls: Reviewing the Literature Regarding Their Use and Effectiveness

The purpose of this review is to examine current literature about stability balls and review their various uses in athletic training, physical therapy, strength and conditioning, education, childbirth, and various other settings. Areas of interest include improving neuromuscular control, balance, strength, stability, and overall health. A comprehensive and thorough examination of all the uses and benefits of stability balls is presented. Peer-reviewed research articles and text books about stability balls were summarized in this literature review.

A Novel Umbilical Cord Blood Collection System.

Hematopoietic stem cell transplant procedures are limited by the availability of suitable matched donor cells. Banked, umbilical cord blood (UCB) is a favorable alternative stem cell source for transplantation therapy, due to the more primitive nature of stem cells in UCB and the ability to increase recruitment of donors of minority ethnic backgrounds. However, low collection volumes, the single most important factor for successful cord blood transplants, leads to discarding a large portion of UCB units. We report an improved method based on a single use, disposable device that allows semi-skilled personnel to collect UCB rapidly, aseptically, and without the need to utilize a needle puncture of the cord. This facilitates the safe and efficient collection of a greater number of acceptable UCB units.The placenta and the attached umbilical cord were collected after delivery and transferred to a stand that allowed collection of UCB by gravitational force by either needle collection (n=40) or application of the new clamp/cutting/collection device (n=60). The device clamps around the cord providing a biological seal. The cord is subsequently severed by an internal blade and UCB is allowed to freely flow into the collection device and then into a blood collection bag. Alternatively, the umbilical vein in the cord was punctured by a needle. A typical variety of placenta and cord sizes was encountered. Using either method, blood was collected in standard collection bags. Ease of use, time of collection, and blood volume collected were compared. Nucleated cell and CD34 counts were obtained on the UCB units. The collection device, cord and placenta were discarded as biological waste. Collected UCB units were used for research purposes, and not stored for transplantation or any therapeutic purpose.Application of the new device was straightforward; after closing cutting could be performed in one simple and fast movement. In contrast standard collection using venipuncture needed more careful attention. After start of the collection, UCB drained in 45± 10 (n=60) seconds from placenta and cord into the device, and subsequently into the standard collection bag within 3 ± 1 minutes. Needle collection required approximately twice as much time. The volume collected using the device (65–126 ml, 95±19 ml, n=60) compared favorably with the units collected with a needle (0–128 ml, 63±31 ml, n=40). Virtually identical concentrations of CD34 cells were found in units collected with both procedures. Since the average UCB volume increased with the new method, the average total number of CD34 cells per unit collected increased accordingly.In conclusion, we developed a non-invasive needle-free device to ensure the safe, efficacious, and aseptic collection of UCB during normal birthing or after cesarean section. The ease of use, speed of collection and UCB volumes collected compare favorably with traditional methods. The design of the device prevents medical personnel from being exposed to blood borne disease from blood splashing and accidental needle sticks. Because no careful placement of needles is required, semi-skilled personnel can perform the procedure in place of physicians, nurses, and highly trained technicians, improving the UCB collection procedure with minimal interference in the childbirth setting, potentially increasing the number of UCB units collected.

Reevaluation of Friedman's Labor Curve: A Pilot Study

ObjectiveTo reevaluate the average length of each phase/stage of labor for multiparous and primiparous women in North America who received no regional anesthesia or oxytocin augmentation or induction, to describe a range of labor lengths associated with good childbirth outcomes, and to determine if there is a consensus among labor and delivery nurse managers responding to the survey regarding the need to revise Friedman's Labor Curve. DesignThis pilot study used a descriptive and anonymous cross-sectional survey design. Surveys were mailed to 500 maternity care agencies in the United States, Canada, and Mexico with a return rate of 17.8% (n = 89). Each participating agency was asked to submit five patient cases to be included in the analysis. Sample and SettingThe sample of patient cases (n = 419) was drawn from randomly selected maternity care agencies throughout North America representing all sizes of agencies and geographic locations. The cases submitted for analysis represented women 14 to 44 years of age with varying ethnicities who received no regional anesthesia or oxytocin augmentation or induction. Twenty-three percent of the women in the sample (n = 97) were primigravidas. ResultsThe average length of labor for primiparous and multiparous women today is similar to the average length of labor described by Friedman in 1954. However, a wider range of “normal” was found in cases included in the current study. Primiparous women remained in the first stage of labor for up to 26 hours and the second stage of labor up to 8 hours with no adverse effects to mother or infant. Multiparous women remained in the first stage of labor for up to 23 hours and the second stage of labor for up to 4.5 hours with good birth outcomes. In addition, 87.6% of nurse managers responding to the survey believed that Friedman's Labor Curve should be revised to meet the needs of current patient populations, technological advances, and nursing responsibilities. ConclusionsThis study suggests that the parameters to determine if a labor is progressing satisfactorily may need to be expanded. With the availability of technology to assess maternal and fetal well-being, labor should be allowed to progress past the rigid 2-hour time limit for the second stage of labor artificially imposed on women in some childbirth settings. More emphasis should be placed on the nursing assessment techniques used to reassure the family and health care practitioners that labor is progressing safely and the nursing interventions that may have an impact on the length of each stage of labor.

Streptococcal toxic shock syndrome and sepsis manifesting in a patient with chronic rheumatoid arthritis

Streptococcal-toxic-shock syndrome is caused by virulent strains of exotoxin-producing streptococcus, almost always group-A organisms such as Streptococcus pyogenes. It has often been described in the setting of surgical wounds, burns, childbirth, diabetics, elderly, neonates, and immunocompromised hosts, where the portal of entry is the skin. Our patient was on steroids and nonsteroidal anti-inflammatory drugs for chronic rheumatoid arthritis and developed this deadly infection after a fall.

Autonomic Dysreflexia

The purpose of this article is to help perinatal nurses understand how to more effectively care for women in labor who have spinal cord injuries (SCIs), especially those women who develop the complication of autonomic dysreflexia (AD). AD is a syndrome that can occur in patients with SCIs above the level of T6. Its symptoms include dangerous paroxysmal hypertension, resulting from abnormal interplay between the parasympathetic and sympathetic nervous systems. While this syndrome was not commonly encountered by perinatal nurses in childbirth settings in the past, the dramatic improvements in both acute care and rehabilitation for women with SCI has increased the numbers of women with SCI who become pregnant and experience childbirth. Therefore, it is essential that perinatal nurses be made aware of how to effectively identify AD, and what steps to take should it occur.

Psychiatric Consultation in Childbirth Settings: Parent- and Child-Oriented Approaches

Back to table of contents Previous article Next article ArticleNo AccessPsychiatric Consultation in Childbirth Settings: Parent- and Child-Oriented ApproachesIAN F. BROCKINGTONIAN F. BROCKINGTONSearch for more papers by this authorPublished Online:1 Apr 2006https://doi.org/10.1176/ajp.148.4.534AboutSections ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail "Psychiatric Consultation in Childbirth Settings: Parent- and Child-Oriented Approaches." American Journal of Psychiatry, 148(4), p. 534 Access content To read the fulltext, please use one of the options below to sign in or purchase access. Personal login Institutional Login Sign in via OpenAthens Purchase Save for later Item saved, go to cart PPV Articles - American Journal of Psychiatry $35.00 Add to cart PPV Articles - American Journal of Psychiatry Checkout Please login/register if you wish to pair your device and check access availability. Not a subscriber? Subscribe Now / Learn More PsychiatryOnline subscription options offer access to the DSM-5 library, books, journals, CME, and patient resources. This all-in-one virtual library provides psychiatrists and mental health professionals with key resources for diagnosis, treatment, research, and professional development. Need more help? PsychiatryOnline Customer Service may be reached by emailing [email protected] or by calling 800-368-5777 (in the U.S.) or 703-907-7322 (outside the U.S.). FiguresReferencesCited byDetailsCited byNone Volume 148Issue 4 April 1991Pages 534-534 Metrics History Published online 1 April 2006 Published in print 1 April 1991

Women's choice of childbirth setting

As part of a larger study on women's views of the childbirth experience, this study was focused on women's choice of childbirth setting. Sixty-one Lamaze-prepared, married multigravidae between the ages of 21 and 37 and experiencing a normal pregnancy were interviewed twice: at 36-38 weeks gestation in their homes and during their postpartum stay in the hospital. Data were collected using (a) two semistructured interview guides consisting of open-ended questions about choosing a caregiver and the place of birth and about describing the actual childbirth experience, (b) a self-administered sociodemographic questionnaire, and (c) an obstetrical and infant data form. The tape-recorded interviews were transcribed verbatim. Qualitative data analysis was focused on reasons for choosing a hospital and a physician, reasons for choosing or not choosing a birthing room, and the outcomes of the decisions. An understanding of women's childbirth needs as reflected in their choices can suggest areas where flexibility might be built into maternity care programs.

Personal control and the birth environment: comparisons between home and hospital settings

The purpose of this study was to investigate the factors which influenced experienced control during childbirth in low-risk women choosing two different birth environments. Eighty women choosing hospital birth and 80 choosing home birth were interviewed prenatally and again at two weeks postpartum. Those who chose home birth had a greater degree of affiliation with caregivers and more freedom of exploration and self-expression, while those who gave birth in hospital experienced more aversive stimuli (intrusive procedures and unfamiliar people). The home birth group had significantly higher levels of perceived control during childbirth. In the total sample, the combination of expectations of control and the type of childbirth setting accounted for 33·5% of the variance in perceived control scores. The findings provided partial support for a model of person-environment interaction during childbirth.

Female infanticide and amniocentesis

Clinical services offering amniocentesis to inform women of the sex of their foetuses have appeared in North India in the past 10 years. They fit into cultural patterns in which girls are devalued, and some authors have seen direct links between female infanticide (assumed to have been eradicated by 1900), female neglect leading to higher infant and child mortality rates for girls, and ‘female foeticide’. This paper contributes to this debate by presenting some material on the nature of female infanticide, the cultural setting of childbirth and decision-making with respect to fertility and child mortality, largely drawn from a recent research project in Bijnor District, in Uttar Pradesh, North India.