Intrapartum Care Research Articles

Objective To explore and analyze the current research status, hotspots, and development trend of labor and delivery experience, to provide a reference for subsequent related research and clinical practice. Methods We searched the Web of Science database for literature related to labor and delivery experience published between its establishment and December 20, 2024, and conducted bibliometric analysis using CiteSpace software. Results After screening, 1089 papers were included in the analysis, and the number of annual publications showed a growing trend, reaching its highest in 2024. The United States and Sweden dominated the list. The research hotspots focused on maternal mental health, delivery methods, and quality of Intrapartum care. Conclusion The field of birth experiences is currently undergoing rapid development, with leading trends including innovations in delivery methods, prenatal care, research in the cognitive neuroscience of childbirth, and a focus on mothers undergoing induced labor and those in low-income areas to optimize the overall birth experience.

Ultrasound imaging has been the most important diagnostic technique in Obstetrics and Gynaecology for well over a generation. However, while it is entirely dominant in Obstetrics, this is less obvious in Gynaecology. Urogynaecology or pelvic floor medicine remains a Cinderella subject even within Gynaecology, and imaging still has only a niche existence in Urogynaecology. The latter is partly due to a lack of equipment and sometimes of reimbursement, partly due to the strong surgical orientation of the subspecialty, and partly due to simple human inertia. In regard to birth trauma, political factors such as natural childbirth ideology with its denial of maternal birth trauma, and pressure on Caesarean section rates, have delayed the utilisation of pelvic floor ultrasound, despite its obvious potential in clinical audit and practice improvement. The origins of ultrasound imaging in Urogynaecology go back nearly 50years to a time when B mode realtime sonographic imaging using solid-state curved array transducers had just become ubiquitous in Obstetrics, impacting onantenatal care worldwide. Pelvic floor ultrasound is now changing both intrapartum care and Urogynaecology, but much work remains to be done. This contribution tries to chronicle the evolution of pelvic floor ultrasound from its inception in the mid-1980s until the present day.

BackgroundStillbirth remains a major global health challenge, with India bearing a substantial share of the burden. Despite the availability of evidence-based interventions, stillbirth rates (SBRs) remain high due to gaps in healthcare access, quality and the effective delivery of maternal and neonatal care. This study aims to develop and implement an optimised, context-specific model to reduce SBRs in Sangrur district, Punjab.Methods and analysisThis mixed-methods implementation research will adopt a sequential explanatory design. The study will be conducted over 3 years in four blocks of Sangrur. Data will be collected through baseline and endline surveys, verbal autopsies of stillbirths, direct observations of antenatal and intrapartum care, and qualitative interviews with community members and healthcare providers. The intervention package will focus on preconception and antepartum care, intrapartum care and strengthening health systems. The study will use the plan-do-check-act model for continuous improvement, and real-time data collection through electronic systems will support timely decision-making.The study expects to achieve a 25% reduction in SBRs through the optimised delivery of high-quality antenatal and intrapartum care services. Additionally, the research will provide critical evidence on the barriers and facilitators to optimise service delivery, as well as insights into the health system and community factors influencing stillbirth outcomes. This study aims to create a scalable and adaptable intervention model to reduce SBRs in low-resource settings like Sangrur and Punjab. The findings will inform future maternal and neonatal health policies and provide a framework for the broader implementation of similar interventions in other regions of India.Ethics and disseminationThe study protocol has been approved by the International Institute of Health Management Research, Delhi (IIHMR) Institutional Ethics Committee (IRB/2024-2025/01). The study is funded through a competitive call for proposals on stillbirths by the Indian Council of Medical Research (ICMR) under the National Health Research Priority Projects (5/7BMIPR/2022-RBMCH). The research has been awarded by ICMR (project ID NHRP05586) to IIHMR under grant number 5/7/BMIPR/2022-RCN.

Risk assessment as routine: A conversation analysis of midwives' risk surveillance practices in midwife-led care during labour.

BackgroundDespite the availability of clear guidelines, evidence from low- and middle-income countries, including Ethiopia, shows persistent gaps in implementing evidence-based intrapartum practices, contributing to high maternal and neonatal morbidity and mortality. In southern Ethiopia, including the Wolaita Zone, where resource constraints are common, the extent of adherence to these practices and factors influencing their implementation is not well understood. Therefore, this study aimed to assess the implementation level of evidence-based intrapartum care practice and its associated factors among obstetric care providers working in hospitals in Wolaita Zone in 2022.MethodsA facility-based cross-sectional study was conducted from August 1–31, 2022, among 332 obstetric care providers in the hospitals of the Wolaita Zone. The data were collected using structured interviewer-administered questionnaires and non-participatory observation with a standard checklist supplemented with record review. Data were entered into EpiData version 4.6.0.2 and then exported to Stata Version 15 for analysis. Binary logistic regression analyses were conducted to identify factors associated with evidence-based intrapartum care among obstetric care providers. An adjusted odds ratio (AOR) with a 95% confidence interval was reported.ResultsThe implementation of evidence-based intrapartum practice was 52.5% [95% CI (47.1%-57.9%)]. Work experience >5 years [AOR:1.74;95%CI (1.04,2.91)], knowledge [AOR:1.77; 95% CI (1.06,2.95)], in-service training [AOR = 1.83; 95% CI (1.05,3.17)], access to EBP guidelines [AOR:1.70; 95% CI (1.01,2.85)], and managerial support [AOR:3.1; 95% CI (1.11,8.67)] were associated with the implementation of evidence-based intrapartum care.ConclusionEvidence-based intrapartum care practice implementation was low in the study area. Years of work experience, knowledge, in-service training, availability of EBP guidelines, and support from managers were the factors with a significant association with evidence-based intrapartum care practice. Strengthening these enabling factors may help creating an environment that facilitates greater adherence to recommended intrapartum care practices, thereby improving maternal and newborn outcomes.

Effleurage massage is a gentle, rhythmic technique that may promote relaxation and reduce psychological distress during labor is of interest. Therefore, it is of interest to assess the effectiveness of effleurage back massage on reducing anxiety and labor duration among 180 primigravida mothers in Bharuch, Gujarat. The findings showed a significant reduction in anxiety scores and shorter mean labor duration in the experimental group (p < 0.001). Data shows that effleurage massage is a simple, effective intervention to improve psychological well-being and labor outcomes. It may be recommended as part of intrapartum nursing care for first-time mothers.

Labor pain is one of the most intense physiological pains experienced by primigravida mothers. Therefore, it is of interest to assess the effectiveness of effleurage back massage in reducing labor pain among 180 primigravida women in selected hospitals of Bharuch, Gujarat. Hence, Participants were divided into experimental (n=90) and control (n=90) groups. The experimental group received effleurage massage during active labor, showing a significant reduction in pain scores compared to the control group (p < 0.001). Data shows that effleurage massage is a safe, cost-effective and evidence-based non-pharmacological intervention for labor pain management. Integration of effleurage massage into routine intrapartum care is recommended to improve maternal comfort.

In many places globally, midwifery scope is inclusive of preconception care and fertility counselling. In British Columbia (BC), Canada, midwifery scope is limited to pregnancy, intrapartum and postpartum care. This article discusses the rationale for potential midwifery scope expansion to include preconception care. Further, it discusses the required changes to legislation and regulation of scope of practice that would need to take place as precedent.

Understanding the expectations and experiences of women during facility-based childbirth in Eastern Uganda: What do women want during childbirth?

Background: Maternal satisfaction with intrapartum care is crucial for the well-being of the mother and newborn. It also serves as a direct indicator for future utilization and recommendation of the facility. Aim: To explore maternal satisfaction with intrapartum care among postpartum women. Methods: This qualitative study employed a narrative inquiry design and involved in-depth interviews with 11 women. The interviews were transcribed, translated, and thematically analysed to identify patterns and themes related to maternal satisfaction with intrapartum care. Result: The findings of the study revealed high levels of maternal satisfaction with intrapartum care at the hospital. Participants expressed gratitude for the emotional support and reassurance provided by healthcare staff, with many noting the positive impact of staff interactions on their overall experience. Factors contributing to satisfaction included the presence of multiple supportive midwives, prompt medical interventions, effective communication, and the successful management of deliveries. Participants also highlighted areas for improvement, such as reducing waiting times to see healthcare workers, improving the conditions in specific hospital rooms, and increasing staff numbers and respectfulness. Conclusion: The study reveals a high level of maternal satisfaction with intrapartum care, underscoring the positive impact of effective support and compassionate interactions from healthcare staff.

Postpartum care for hypertensive disorders of pregnancy (HDP) varies in terms of content, quality, and duration. People postpartum from pregnancies complicated by an HDP are known to have a variety of physical and emotional sequelae both from the HDP itself and associated complications (e.g., prematurity, traumatic birth). This study interviewed a geographically and socially diverse sample of recently postpartum people who had HDPs to better understand the needs of this population. Semi-structured interviews were conducted with participants recruited from social media. Both qualitative and quantitative methods were used to characterize the resulting transcripts. Transcripts were reviewed for patient-reported obstetric history and variables pertaining to intrapartum and postpartum care (e.g., gestational age at delivery, delivery mode). Birth experience was then categorized as positive, neutral, or negative by reviewer assessment. Sentiment analysis was performed to objectively identify elements of participants' transcribed speech with emotive content. The emotive content of positive and negatively framed birth experiences was then qualitatively reviewed by thematic analysis. 67 interviews were analyzed from individuals affected by the entire spectrum of HDPs: 38.8% (N = 26) had gestational hypertension, 56.7% (N = 38) had a form of preeclampsia, and 4.5% (N = 3) had eclampsia or HELLP. Among those with negative birth experiences, fear was the dominant negative emotion identified in the sentiment analysis. This was driven by mentions of "anxiety" in reference to both the birth process and blood pressure management. Trust was the characteristic positive emotion, largely expressed by uses of the word "helpful". Participants used "helpful" to identify services such as peer support communities that would have been beneficial to them or counseling they would have liked to receive about HDPs or their long-term effects. They identified lack of information and education about HDPs as a key gap in current practice. People postpartum from HDPs who described negative experiences felt that more information about their diagnosis and its management from their obstetric providers would have improved their experience along with postpartum support from people who had similar lived experiences. These insights point to practical interventions that can be undertaken both nationally and institutionally to enhance postpartum HDP care.

Episiotomy and obstetric anal sphincter injuries (OASIS) are recognized indicators of intrapartum care quality. The aim of this study was to assess episiotomy trends in non-instrumental vaginal deliveries across all Portuguese public maternities over the last decade. Rates of third- and fourth-degree perineal lacerations were also evaluated. A retrospective secondary data analysis was conducted using data from an official national health entity, including all non-instrumental vaginal deliveries in the Portuguese National Health Service between January 1, 2013 and December 31, 2022. Information on episiotomy and third- and fourth-degree perineal lacerations was extracted. Descriptive statistics were presented using absolute and relative frequencies. Linear regression was used to assess trends. Additional national databases were consulted to validate findings, and data quality was assessed using the intraclass correlation coefficient (ICC). A significance level of 5% was considered. Of 689 908 registered deliveries, 490 322 (71%) were vaginal, and 361 887 (52%) were non-instrumental vaginal deliveries. Among the latter, the episiotomy rate was 42.5%. A significant decrease was observed in episiotomy rates, from 63% in 2013 to 21% in 2022, (P < 0.001), accompanied by a significant increase in third-degree perineal lacerations (0.15% to 0.31%, P < 0.001), while fourth-degree perineal lacerations remained stable (0.03% to 0.02%, P = 0.001). A restrictive episiotomy policy was increasingly adopted in Portugal over the last decade. Although rare, third-degree perineal lacerations increased during this period. Further research is needed to determine optimal intrapartum care practices regarding episiotomy use. Standardized data coding and improved access to anonymized national datasets are essential for accurate monitoring and cross-country comparability.

ABSTRACTSince 2016, the National Health Service (NHS) in England has been aiming to implement midwifery continuity of carer (MCoC), a model of maternity care in which the same midwife or small group of midwives provides antenatal, intrapartum and postnatal care for women, other birthing people and their babies. However, the implementation has faced significant difficulties. As part of a wider investigation into barriers to and facilitators of MCoC implementation, we carried out qualitative interviews with senior stakeholders involved in the implementation of MCoC at regional or national level in England. In this paper, we present an analysis of sociocultural values in the accounts of these stakeholders. We find these expert accounts of MCoC implementation are underpinned by a ‘moral regime’ which privileges certain norms and practices whilst deterring others. These accounts produce an idealised midwife‐subject who is passionate and evangelical about MCoC as a form of care and seeks to persuade others to their cause, including through the use of evidence. We conclude with some thoughts about the range of possible consequences produced by this moral regime regarding the implementation of MCoC as a maternity policy in the English NHS, and the role of moral regimes in healthcare politics.

Individuals with substance use disorders (SUD) often encounter challenges in healthcare, including provider attitudes, stigma, and gaps in clinical education. For pregnant and birthing individuals with SUD, these challenges are further compounded by moral blame, judgment, clinician burnout, and limited institutional support. Each of the aforementioned factors are barrier to evidence-based, person-centered care, and contributes to adverse outcomes for both birthing individuals and newborns. This study aims to address those barriers by designing and implementing a stigma-reduction and clinical empathy training package tailored for the intrapartum healthcare workforce. Focusing on the in-patient labor and delivery period, the intervention aims to foster institutional change, grow clinician confidence, and promote a culture of empathy and understanding. The proposed intervention, Interprofessional Simulation Program for Clinical Resilience and Empathy (INPSIRE), will include multi-component training modules and an adaptive intervention designed to address provider clinical knowledge, stigma, and burnout among clinicians and will promote the use of practical tools for demonstrating clinical empathy and support. In developing the intervention, the study will examine quality and stigma in intrapartum care from clinician and patient perspectives through focus group discussions, key informant interviews, restorative justice story circles, and postpartum patient interviews. Drawing insights from these qualitative methods, the INSPIRE intervention will then be co-designed with stakeholders to ensure relevance and effectiveness. The impact of the INSPIRE intervention will be evaluated using a quasi-experimental design, assessing its effects on healthcare team outcomes, patient outcomes, and scalability. Through self-directed online learning and in-person team simulation, the INSPIRE intervention aims to enhance provider skills, promote respectful care, and ultimately improve maternal health outcomes for individuals with SUD.

Implementation of the clinical practice guideline on intrapartum care for low-risk births in Belgium.

Studies suggest that midwifery care can decrease the rate of unplanned cesarean birth. In this study, we compared unplanned cesarean rates, labor interventions, and birth outcomes for mixed-risk patients receiving intrapartum care from obstetricians or midwives. We conducted a retrospective cohort study using perinatal data from a single academic tertiary center from 2013 to 2018. The sample included nulliparous and multiparous patients with a term, singleton, vertex fetus. We included induced and spontaneous labor as well as trial of labor after cesarean. We excluded patients with planned cesarean delivery or any high-risk diagnosis requiring obstetrician care. Our cohort included 7694 patients. Of those, 3543 (46.0%) received intrapartum care from an obstetrician and 4151 (54.0%) from a midwife. The overall cesarean rate was 11.8%. Patients receiving midwifery care had significantly lower cesarean rates (8.9% vs. 15.2%; p < 0.01) overall and by adjusted analysis [aOR 0.49 (0.40-0.60) 95% CI]. Patients receiving obstetrician care more frequently experienced induction/augmentation, neuraxial anesthesia, and operative vaginal delivery. Obstetrician-led care was associated with increased lacerations, intra-amniotic infection, and severe maternal morbidity, while midwifery-led care was associated with increased rates of postpartum hemorrhage, blood transfusion, and shoulder dystocia. Midwifery intrapartum care was associated with lower rates of unplanned cesarean birth in this mixed-risk cohort of laboring and induced patients. Wider integration of midwives for intrapartum care could increase vaginal delivery rates. Additional studies are needed to explore underlying mechanisms and implications for systems- and practice-based changes in the United States.

Sonography only, few internal examinations (SOFIE): Birth progress in normal deliveries followed with intrapartum ultrasound.

The annual World Health Organization reports confirm over 295 000 maternal deaths globally with most of these occurring during delivery. Interestingly, some studies have established a significant relationship between environmental factors and hospital-based intrapartum care. This study investigated the associated environmental factors among women presenting for peripartum care at the Ketté District Hospital. The study was conducted at the Ketté District Hospital. This quantitative cross-sectional study was conducted at the Ketté District Hospital on women presenting for peripartum care. A convenient sampling was used while a self-administered questionnaire was the data collecting tool to measure environmental factors affecting the delivery practices. Using IBM-SPSS version 29.0, logistic regression served for data analysis with statistical significance considered atp 0.05. The study involved 471 women presenting for peripartum care, of whom 325 (69.0%) were aged 18-25 years. Most women, 429 (91.1%), indicated having used earthed road links to the hospital. The majority agreed having suffered complications during delivery. Means of transportation (p= 0.010), number of past pregnancies (p= 0.044), place of delivery (p= 0.001) and delivery outcome (p= 0.001) were significantly associated with delivery complications. The study found that delivery complications were significantly associated with means of transportation to antenatal visit, place of delivery, delivery outcome and number of pregnancies.Contribution:This study contributed to a better understanding of the effects of environmental factors on the utilisation of healthcare services during the intrapartum period in rural communities of Cameroon.

The importance of clinical supervision and teaching methods for midwifery students' confidence in intrapartum care. A mixed method study.

IntroductionThe Saving Babies’ Lives Care Bundle (SBLCB) was introduced in England in 2015 and was updated in 2019 (SBLCBv2). This study aimed to describe the degree to which SBLCBv2 was implemented in practice and describe contemporary experiences of receiving and delivering antenatal and intrapartum care informed by the recommendations of SBLCBv2.MethodsThis cross-sectional questionnaire study was conducted in 28 National Health Service maternity units across England between October and December 2023. The study had two arms, one for maternity service users and one for healthcare professionals. Maternity service users aged ≥16 years who had given birth in the last 12 months were invited to participate in an online survey which contained closed questions about elements of the SBLCBv2, and two free-text questions about their experiences of receiving antenatal and intrapartum care. Maternity healthcare professionals from participating sites were invited to complete a separate questionnaire about delivering care. Responses were summarised by descriptive statistics.Results1140 women and 633 healthcare professionals participated. The majority of staff reported implementing all five elements of SBLCBv2, though this varied from 57% (prevention of preterm birth) to 99% (smoking cessation). Service users frequently reported receiving interventions that were part of SBLCBv2: 26% were offered Aspirin and 97% monitored fetal movement. Staff generally reported positive experiences of implementing the SBLCBv2, feeling that it supported clinical decision making. 89% and 86% of service users reported a positive experience in pregnancy and labour, respectively. This was underpinned by positive staff attitudes, behaviours and communication, and being listened to and involved in decisions about care.ConclusionsSBLCBv2 has been integrated into clinical practice, though some elements require additional focus to increase implementation (e.g., preterm birth). Maternity staff may benefit from additional training to discuss the reasons for and results of interventions to reduce the risk of pregnancy complications.