Natural Childbirth Research Articles

A Study on the Perinatal Outcomes of Natural Childbirth Led by Midwives: A Retrospective Study

Purpose: The purpose of this study was to suggest the importance of natural childbirth by investigating the results of midwife-led perinatal periods and whether they were positive experiences for both individual women and their families.Methods: This retrospective study aimed to confirm the perinatal outcomes of midwife-attended vaginal births. Among 1,127 women who gave midwife-led birth in Gyeonggi-do, Seoul between January 1, 2019 and December 31, 2021, data were collected for 829 women. Records were excluded that were missing necessary data. Data on childbirth were analyzed using frequency, percentage, mean, standard deviation, and the chi-square test.Results: Among the mothers who underwent natural childbirth, 549 (66.2%) were multiparous. In addition, all 829 patients (100%) breast-fed their infants. First-degree perineal lacerations occurred in 29.2% of patients, and second-degree lacerations occurred in 48%. Non–high-risk subjects made up 56.0% of the study sample. The average bleeding amount was 281.44±4.50, and the average 1-minute Apgar score for infants was 8.25±0.02.Conclusion: Compared to childbirth in a hospital, natural childbirth was associated with a lower risk of birth canal laceration, postpartum bleeding, and Cesarean section. In addition, the health statuses of the newborns were confirmed to be good . Based on the results of this study, there is a need for a strategy in which midwife-led natural childbirth is integrated into the local medical system, as well as a need to raise women's awareness of natural childbirth and positively influence the experience.

Prior childbirth experience and attitude towards subsequent vaginal birth after one caesarean delivery in Lagos, Nigeria: a cross-sectional study

BackgroundPrior caesarean delivery (CD) impacts CD rates in many parts of the world. In low and middle-income countries, few women attempt a trial of labour after caesarean delivery (TOLAC) due to inadequate resources for safe vaginal birth after caesarean delivery (VBAC). The CD rates continue to rise as more women undergo repeat CD. In Nigeria, VBAC rate is low and the contribution of women’s prior childbirth experiences and delivery wishes to this situation deserves further investigation. This study examined the parturient factor in the low VBAC rate to recommend strategies for change.ObjectiveTo describe prior caesarean-related childbirth experiences and attitudes towards subsequent vaginal birth in pregnant women with one previous CD.MethodThis cross-sectional study of antenatal clinic attendees in a tertiary hospital employed the convenience sampling method to recruit 216 consenting women with one previous CD. Structured questionnaires were used to collect information on participants' prior caesarean-related birth experiences, attitudes to vaginal birth in the index pregnancy, future delivery intentions and eventual delivery route. Univariate and bivariate analyses compared delivery wishes based on CD type. SPSS version 22.0 was used for data analysis.ResultsThe modal maternal and gestational age groups were 30–39 years (68.1%) and 29–34 weeks (49.1%) respectively; majorities (60.6%) were secundigravida; 61.6% experienced labour before their CDs while 76.9% had emergency CDs. Complications were documented in 1.4% and 11.1% of mothers and babies respectively. Ninety percent reported a satisfactory overall childbirth experience. A majority (83.3%) preferred TOLAC in the index pregnancy because they desired natural childbirth while 16.7% wanted a repeat CD due to the fear of fetal-maternal complications. The previous CD type and desire for more babies were significantly associated with respondents' preferred mode of delivery (p = 0.001 and 0.023 respectively). Women with previous emergency CD were more likely to prefer vaginal delivery.ConclusionsAntenatal women prefer TOLAC in subsequent pregnancies despite prior satisfactory caesarean-related birth experiences. Adoption of TOLAC in appropriately selected cases will impact women's psyche positively and reduce CD rate.

Difficulties in Adaptation of the Mother and Newborn via Cesarean Section versus Natural Birth-A Narrative Review.

Birth is a physiological act that is part of the morpho-functional economy of the maternal body. Each stage in the act of birth has a predetermined pathway that is neurohormonally induced and morpho-functionally established through specific and characteristic adaptations. Like maternity, childbirth also has an important impact on the maternal body as a biological structure and psycho-emotional behavior. Cesarean section performed at the request of the mother with no medical underlying conditions besides the prolonged hospitalization risk can also cause breathing problems in children, delayed breastfeeding, and possible complications in a future pregnancy. Vaginal birth remains the path of choice for a physiological evolution pregnancy. Although erroneously considered safe and easy today, cesarean section delivery must remain an emergency procedure or a procedure recommended for pregnancies where birth is a risk to the mother and to the child, as cesarean section itself is a risk factor for negative outcomes for both mother and baby. This review summarizes the impact that both cesarean section and natural birth have on mother and newborn in their attempt to adapt to postpartum events and extrauterine life.

Why are western diet and western lifestyle pro-inflammatory risk factors of celiac disease?

The prevalence of celiac disease increased in recent years. In addition to the genetic and immunological factors, it appears that environmental determinants are also involved in the pathophysiology of celiac disease. Gastrointestinal infections impact the development of celiac disease. Current research does not directly confirm the protective effect of natural childbirth and breastfeeding on celiac disease. However, it seems that in genetically predisposed children, the amount of gluten introduced into the diet may have an impact on celiac disease development. Also western lifestyle, including western dietary patterns high in fat, sugar, and gliadin, potentially may increase the risk of celiac disease due to changes in intestinal microbiota, intestinal permeability, or mucosal inflammation. Further research is needed to expand the knowledge of the relationship between environmental factors and the development of celiac disease to define evidence-based preventive interventions against the development of celiac disease. The manuscript summarizes current knowledge on factors predisposing to the development of celiac disease including factors associated with the western lifestyle.

Impact of Lamaze Breathing on Natural Childbirth: Comparison between Primigravid and Multigravid Women

Impact of Lamaze Breathing on Natural Childbirth: Comparison between Primigravid and Multigravid Women

Клинико-морфологическая оценка рубцов на матке после кесарева сечения у пациенток с гинекологическими и экстрагенитальными заболеваниями

Introduction. The article studies excised scars on the uterus after Gusakov’s and Stark’s cesarean sections, with an assessment of the impact of gynecological and extragenital diseases on the viability of the scar. Cesarean scar pregnancy is known to be a frequent indication for surgical delivery. However, if the uterine scar is stable, it is advisable to deliver the baby through the natural birth canal. At present, natural delivery of pregnant women with a scar on the uterus through natural childbirth is an important task in modern obstetrics. Thus, the aim of our study was to perform a multifaceted clinical and morphological evaluation of uterine scars after cesarean section in patients with gynecological and extragenital diseases. Materials and methods. We analyzed samples of scar tissue on the uterus after cesarean section performed in 68 patients. A pathomorphological study was carried out with Mallory staining with hematoxylin and eosin. Immunohistochemical study was performed with antibodies to collagen IV, vimentin, desmin, and von Willebrand factor. Results. In 56 out of 68 puerperas (82.3%), the scars on the uterus were stable with complete replacement of the defect with muscle (63.2%) or connective tissue (19.1%), regardless of the operation duration and the suturing technique. This was confirmed by additional diagnostic methods (Mallory stain and IHC with an antibody panel). We found that connective tissue dysplasia, which is indirectly indicated by the presence of myopia in 5 patients with wealthy fibrous scars, can affect excessive connective tissue in the scar. Twelve out of 68 puerperas (17.6%) had the scars (according to pathomorphological criteria) with severe edema, hemorrhages, tissue with different fibers, and uneven thinning. These patients had extragenital diseases, such as type 2 diabetes mellitus (36.4%) and anemia (18.2%). We did not reveal any influence of existing gynecological diseases on the scar stability. Conclusion. The healing of the postoperative uterine wound was mostly influenced by extragenital diseases (type 2 diabetes mellitus, anemia, connective tissue dysplasia) associated with metabolic disorders and having systemic effects on the body. The Gusakov’s or Stark’s incision closure techniques did not affect the quality of the scar. However, the scars after cesarean section using the Stark incision technique had significantly more connective than muscular tissue. Keywords: cesarean section, incompetent uterine scar, type 2 diabetes mellitus, anemia, connective tissue dysplasia, pathological examination, immunohistochemical study

Labour analgesia-epidural/combined spinal epidural/dural puncture epidural/entonox - A cafeteria choice for the patient or just research!

Labour analgesia-epidural/combined spinal epidural/dural puncture epidural/entonox - A cafeteria choice for the patient or just research!

Comparison of Sexual Function, Body Image Concern, and Sexual Self-esteem in Women After Natural Childbirth With Episiotomy and Cesarean Delivery

Objectives The purpose of this study was to compare sexual function, body image concern, and sexual self-esteem in women after natural delivery with episiotomy and cesarean delivery. Methods This research was causal-comparative. The statistical population included all women referring to medical centers affiliated with the Tehran University of Medical Sciences in 2021, of whom 200 participants (100 women with natural delivery and 100 women with cesarean delivery) were selected as a sample using the available sampling method. The female Sexual Function Index, Body Image Concern Inventory, and Sexual Self-Esteem Index were used to collect the data. The data were analyzed via independent t-test and multivariate analysis of variance. Results The results showed a significant difference between sexual function and sexual self-esteem in women with a natural delivery and cesarean delivery (P=0.05). In addition, although both groups experienced body image concerns, no significant difference was found between the scores in the two groups (P=0.05). Conclusion The evidence indicates that although women with natural delivery experience better sexual function than women with cesarean delivery, they may suffer from lower sexual self-esteem and appearance dissatisfaction compared to the other group.

Pain in Labor: Making Plans.

In this column, the associate editor of The Journal of Perinatal Education introduces Henci Goer's new book, Labor Pain: What's Your Best Strategy?: Get the Data. Make a Plan. Take Charge of Your Birth. The associate editor also describes the contents of this issue, which offer a broad range of resources, research, and inspiration for childbirth educators in their efforts to promote, support, and protect natural, safe, and healthy birth.

Роды с рубцом на матке через естественные родовые пути: клинический опыт

The article presents the clinical experience of conservative delivery of 1124 women with a scar on the uterus at Republican Clinical Perinatal Center in Ufa. It was established that a woman’s age less than 40 years, certain indications for the previous caesarean section and the absence of indications for the previous cesarean section at this gestation, the history of vaginal delivery, the development of spontaneous labor should be considered criteria associated with the success of «trial» births. Pregnant women who meet these criteria can be delivered through the natural birth canal. Such a tactic allows avoiding unnecessary caesarean sections and improving maternal morbidity and mortality.

Human placenta/umbilical cord derivatives in regenerative medicine - Prospects and challenges.

The human placenta and umbilical cord, natural birth biowaste, are a housing unit for numerous bioactive macromolecules, growth factors, collagen and GAGs, with an array of high-quality stem cells. MSCs isolated from the human placenta and umbilical cord are utilized in both research and medical applications due to their sustainable sourcing, high viability, multipotent lineage and potency. They present an unprecedented opportunity in the tissue engineering, biomedical and biotechnology fields with minimal ethical constraints and nominal cost. Considering the world population and daily birth rates, with appropriate utilization and management, they could resolve the MSC shortage in the global stem cell therapy market and present biomedical waste disposal. A considerable number of clinical trials are presently underway where placenta-derived stem cells have been administered for different pathologies. Since the umbilical cord and placenta's primary function is to sustain the fetus until delivery, it has an ample supply of nutrients, proteins and essential factors necessary to assist cell viability and proliferation. Present research and medical applications include the fabrication of ECM-based nanofibers, disease models, micro-tissue, hybrid models and artificial implants. Future utilization of birthing biomedical waste in medical engineering and research will provide a rich and sustainable source of stem cells and extracellular matrix for enhanced biocompatibility and regeneration.

Cerebral oxygenation during the period of transition to extrauterine life after natural versus cesarean birth

Objective. We aim to evaluate the implications of cesarean delivery compared to natural birth by analyzing newborns’ systemic and cerebral oxygenation levels during the first 10 minutes of life. Design. This paper presents a 4-year prospective cohort study. Setting. Polizu Maternity, "Alessandrescu-Rusescu" National Institute for Mother and Child's Protection, Bucharest, Romania. Patients. Randomly selected pregnant women and their fetuses. Interventions. During the 10 min following umbilical cord clamping, regional cerebral oxygen saturation (rcSO2) was measured using the INVOS 5100 device and peripheral oxygen saturation (SpO2) was determined using the Masimo SET pulse oximeter in neonates from cesarean and natural deliveries. Main outcome measures. The cerebral fractional tissue oxygen extraction (cFTOE) in the first 10 minutes of life was calculated based on these values. Results. Newborns delivered vaginally showed higher rcSO2 levels at 1 minute of life than those born via C-section (40.5 ± 16.5% vs 33.7 ± 14.8%, AUC = 0.625; IC 95%: 0.506 - 0.743; p = 0.043). Neonatal cFTOE at 1 minute of life was significantly higher in caesarean-delivered newborns versus naturally born neonates (0.40 ± 0.25 vs 0.50 ± 0.19, p = 0.03; AUC = 0.638; IC 95%: 0.517-0.758; p = 0.023). Conclusions. Prelabor cesarean delivery seemingly plays a significant role in the process of fetal and neonatal cerebral oxygenation immediately postnatally, which is highlighted by lower rcSO2 and higher cFTOE values. Cerebral oxygen saturation monitoring in the delivery room allows the optimization of oxygen therapy in order to prevent the consequences of hypoxia or hyperoxia.

Gebelerin Doğum İnançları ile Travmatik Doğum Algı Düzeyleri, Doğum Sonuçları ve Doğum Sonu Depresyon Görülme Durumları Arasındaki İlişki

Introduction: From the beginning of pregnancy, pregnant women think about their birth and the birth is shaped according to the birth belief of the person. Objective: This study aims to determine the relationship between the birth beliefs of pregnant women and birth outcomes, traumatic birth perception levels and postpartum depression. Materials and Methods: This cross-sectional study was conducted in a province in eastern Türkiye. The data was collected using the Personal Information Form, Birth Beliefs Scale, Traumatic Birth Perception Scale, and Edinburgh Postpartum Depression Scale. Results: While there was no significant difference between the medical birth beliefs of women according to their descriptive characteristics (p>0.5), those who were at 28-36 weeks of gestation, who did not have a curettage, and those who went to pregnancy control ≥4 times, considered the birth more natural (p<0.05). While there was a positive and significant relationship between Natural Process Belief and Postpartum Depression (r=0.116, p=0.009), the regression model (stepwise) was also found to be significant (F=6.944, p=0.009). Conclusion: The study determined a positive and significant relationship between natural birth belief and postpartum depression, and the regression model established between these two was significant.

Anatomical and functional conditions of the pelvic floor muscles after assisted vaginal delivery

BACKGROUND: The main function of the muscles of the perineum is to preserve the syntopy and topography of the organs of the abdominal cavity and small pelvis. Clinically, various groups of complaints that significantly worsen the patients quality of life manifest pelvic floor muscle failure. Currently, one of the most commonly discussed causes of pelvic organ prolapse is still considered obstetric trauma.
 AIM: The aim of this study was to assess the anatomical and functional conditions of the pelvic floor muscles after normal physiologic childbirth and childbirth with the use of obstetric forceps.
 MATERIALS AND METHODS: The study was conducted in Maternity Hospital No. 13 (Saint Petersburg, Russia) in 20202021, which involved 137 patients who delivered through the natural birth canal with the use of obstetric forceps (main group, n = 47) or without the use of delivery instruments (control group, n = 90) six months after delivery. A comprehensive assessment of the condition of the pelvic floor muscles was carried out using the validated PFDI-20 questionnaire and ultrasound examination of the pelvic floor structures at rest. A functional assessment of the condition was carried out using the Pneumatic Pelvic Muscle Trainer XFT-0010.
 RESULTS: Evaluating complaints using the PFDI-20 scale revealed that the median was 6.00 1.77 points in the main group and 5.50 1.29 points in the control group, the differences being not significant (p = 0.8). The ultrasound examination showed no significant difference in decreases in the thickness of the tendon center of the perineum and m. bulbocavernosus between the study groups; m. puborectalis thickness in the main group did not differ significantly from the norm either. The assessment of the functional condition of the pelvic floor muscles revealed no significant differences between the patients of the study groups.
 CONCLUSIONS: The data obtained demonstrate the safety of the use of obstetric forceps for the anatomical and functional viabilities of the pelvic floor muscles and do not have significant differences compared to childbirth performed without the use of delivery instruments. However, the use of obstetric forceps in the practice of obstetricians and gynecologists can be a reliable tool that does not affect the quality of life of patients in the long term.

Study of the possibility of osteopathic correction inclusion in the complex therapy of pelvic pain syndrome in women at the late postpartum period

Introduction. Pain during childbirth and pain after childbirth are unavoidable. Most often, the occurrence of pelvic pain syndrome after childbirth is associated with the manifestation of physiological changes in the joints and bones of the pelvis during pregnancy and during childbirth. The musculoskeletal system of a woman after childbirth passes to normal functioning gradually, and some stages of this process may be accompanied by pain syndrome of various localization and severity. In the late postpartum period and during lactation, non-drug treatment of pain syndrome is preferable. One of the promising non-drug approaches may be the timely application of osteopathic correction methods. However, the available scientific literature presents relatively few studies on the possibility of osteopathic methods using for the pelvic pain syndrome correction in women at the postpartum period.The aim of the study was to research the possibility of osteopathic correction inclusion in the complex therapy of pelvic pain syndrome in women at the late postpartum period.Materials and methods. A group of women after physiological childbirth was randomly formed homogeneous by age, parity of childbirth. The study involved 40 primiparous women aged 30–40 years with no organic diseases, and with the presence of pelvic pain syndrome, which first appeared in the late postpartum period (2–8 weeks after physiological birth through the natural birth canal). Two groups were formed by the randomization envelopes method: the main group (20 participants) and the control group (20 participants). In both groups, the patients received therapy in the form of applications of anesthetic ointments (gels), the use of the Lyapko applicator, elements of therapeutic physical culture (static gymnastic exercises in the supine position). Patients of the main group additionally received osteopathic correction (3 sessions with an interval of 10–14 days). Before and after treatment, osteopathic status, quality of life according to the MOS-SF-36 questionnaire, and intensity of pain syndrome according to the visual analog scale (VAS) were assessed in both groups.Results. Prior to the treatment start in the both groups, patients had biomechanical disorders of the neck region (structural component — in 50 % of the participants in the main group and 40 % of the control group), thoracic region (structural component — in 55 and 60 %, respectively), lumbar region (structural component — 95 and 55 %, and the visceral component — 45 and 20 %), the pelvic region (structural component — 100 and 95 %). In the main group, regional biomechanical disorders of the pelvic region were also detected, the visceral component — in 50 % of the participants. After the treatment, the patients of both groups had no regional biomechanical disorders of the thoracic region (structural component), the lumbar region (visceral component), and the pelvic region (visceral component). In the main group, in addition, there was a statistically significant (p<0,05) positive dynamics in relation to dysfunctions of the neck region (structural component), lumbar region (structural component), pelvic region (structural component). The groups began to differ significantly (p<0,05) in relation to the following regional disorders: lumbar region (structural component) and pelvic region (structural component). At the study start, the participants in the both groups were characterized by low quality of life, assessed by SF-36, and severe pain by VAS. After the treatment in both groups, there were statistically significant (p<0,05) positive dynamics in all of the above indicators: the pain syndrome severity decreased, and the life quality indicators increased; and in the main group the results were statistically significantly (p<0,05) more pronounced.Conclusion. Based on the obtained results, it is possible to recommend the inclusion of osteopathic correction in the complex therapy of pelvic pain syndrome in women at the late postpartum period. But also it is recommended to continue the study with the involvement of a larger number of participants.

Analysis of Delivery Data by Medical Staff Using The K-Means Algorithm in Sleman District

The process of childbirth has many factors that result in the death of the baby and the mother during the delivery process, namely the lack of medical staff or health workers (midwife, doctor, or another paramedic). There needs to be an analysis of the delivery process assisted by medical staff. This analysis maps the readiness of medical staff with the needs in the field. Both natural and cesarean births have the same main goal, to make labor run smoothly and ensure that the mother and baby are safe. Deliveries assisted by health workers use secure, clean, and sterile equipment to prevent infection and other health hazards. The hope is to minimize the number of mothers who are not helped during childbirth. This study aims to analyze data on deliveries assisted by medical staff for case studies in Sleman District, Province of Yogyakarta Special Administrative Region, Indonesia, with the K-Means Algorithm. K-means is an unsupervised learning algorithm that has a function to group data into data clusters. This algorithm can accept data without any category labels, the learning process requires a relatively fast time, is quite easy to understand and implement, and the algorithm is quite popular. The research used 13,869 data in 2018. In 2019, the decrease in the number of mothers giving birth from 13,470 who were rescued was 13,469. The 2018 data produced 3 (three) clusters. In 2019 data produced 4 (four) clusters. With different levels of levels assisted by medical staff starting from the high, medium, and low groups.

Caleb's Stillbirth, 5 Years Later

Caleb's Stillbirth, 5 Years Later Jill Wieber Lens My son Caleb should have turned five this summer and started kindergarten in the fall. I was so happy to be pregnant with him. I had two daughters and couldn't wait to meet my first son. I bought so many baby boy clothes for my sweet little guy. So many. I couldn't wait to bring him home from the hospital in his little rocket outfit and hat that said, "Beyond Cute." We had a doctor's appointment when I was 36 weeks and 6 days pregnant. Everything looked good and we had started to talk about scheduling an induction. I hadn't convinced my husband yet, but I wanted to have labor induced when I was 39 weeks pregnant. Two days later, on Father's Day 2017, I installed Caleb's car seat to prepare for his birth. That night, I woke up around 11:00 feeling uncomfortable. I walked around a little and went back to sleep. I woke up again around midnight, feeling the same discomfort. I knew something was off, but I wasn't that concerned (certainly not to the extent I should have been). We went to the hospital around 2:00 am because my brother was in town and could watch my daughters. When the nurses put the monitors on my belly, they couldn't find his heartbeat. I remember them getting more nurses to try. At some point, they stopped trying. But no one said it out loud. I remember when all the nurses later rushed back in when I started screaming, processing the fact that Caleb had died in my belly only weeks before his due date. Hours later, an ultrasound confirmed what was already obvious. Still though, no one said it out loud. I texted my doctor at 4:00 am that they couldn't find Caleb's heartbeat. Around an hour later, as the on-call doctor finally told us that Caleb had died, my doctor joined us. I was also told that I needed to give birth immediately because I was bleeding internally. (At the time, the doctors thought I had a placental abruption—that my placenta had detached from my uterus, depriving Caleb of oxygen and killing him. I learned about three years later from a placental specialist that I likely did not have an abruption. Regardless, I was bleeding internally and needed to give birth to Caleb right away). I was unable to get an epidural because of my internal bleeding. I remember asking my doctor how I was supposed to do this—natural childbirth, which I had never done before, and for my dead son. She offered to do a c-section, but I didn't want surgery on top of everything else. My doctor gave me drugs to knock me out. I don't remember much of Caleb's birth. The pain of the contractions woke me up numerous times. I remember reaching down to try to figure out what was causing me such pain. I didn't need to be there mentally though; my body knew how to give birth. I woke up later to see my husband holding Caleb. My first words were, "is that our baby"? It was. Caleb Marcus Lens was 5 pounds, 15.8 ounces, and 19 inches long. He was beautiful and looked like a sleeping baby. The only noticeable difference was that his body was not as warm as it should have been. Honestly though, I doubt I would have noticed had I not previously held my daughters right after their births. ______ Caleb changed everything. I grew up that day in a way no one should have to. I don't know that I'll ever really appreciate the trauma I went through and continue to go through. I'm a different person now. I'm grateful for the person that Caleb made me. But please don't suggest that I should focus on any good that has come out of Caleb's death. And spare me the idea that "everything happens for a reason." Nothing can make Caleb's death justifiable. Nothing can make it okay...

Choosing cesarean section over natural birth: Challenges of decision making among pregnant women with pre-eclampsia in Ado-Ekiti.

Although Caesarean section has greatly improved obstetric care throughout the world, there is a great aversion to caesarean section in developing countries. This study was carried out to examine the rate at which pregnant women with Pre-eclampsia decide to choose caesarean section over natural birth. A descriptive study was conducted among a sample of 112 pregnant women with Pre-eclampsia, aged 18-40years, whose gestation period has exceeded 20weeks and are registered in the hospitals. The sample selection was purposive. Data collection was done through self-administered structured questionnaire. Data analysis was presented using simple percentages. 94% of respondents had no prior information about Pre-eclampsia and its associated complications. Pre-eclampsia has a prevalence rate of 12.3% among respondents in Ado-Ekiti as at the time this study was conducted. 38% of respondent favored caesarean section because they believed it is safer, less painful with little or no complications. If caesarean section is given as an only medical option for safe childbirth to respondents who preferred natural birth, 46.4% would opt for religious interventions while 10.7% would opt for traditional healthcare. Respondents who preferred natural birth would not choose caesarean section because of fear, cultural belief, religious beliefs and the cost. Level of education, religion and employment status were found to influence respondents' decision to choose. Hence the need to encourage research in awareness creation, patient education and best ways to assist patients decide on mode of delivery and plan on how to finance treatment.

Pentingnya Memilih KB yang Tepat untuk Keluarga Sejahtera di Posyandu Edelweiss Wilayah Kerja Puskesmas Baloi Permai Batam Kota

The family planning (KB) program is one of the government programs organized to limit births to reduce population growth. The purpose of this community service is to improve the family planning program in an effort to regulate the birth of children, distance, and the ideal age of childbirth, regulate pregnancy, through promotion, protection and assistance in accordance with reproductive rights to create a quality and prosperous family. This community service method is carried out by conducting socialization, counseling, and health promotion to 26 couples of childbearing age at the Edelweiss Posyandu Working Area of the Baloi Permai Health Center, Batam City, Riau Islands. This counseling uses measuring instruments by taking data directly from respondents through filling out pre-test and post-test checklist sheets that have been distributed to participants. Various contraceptives were also explained to 26 couples of childbearing age, namely natural birth control, pills, injections and long-term birth control. This counseling was carried out at the Edelweiss Posyandu working area of the Baloi Permai Health Center, Batam City, Riau Islands, on Tuesday, June 28, 2022, which was attended by 26 couples of childbearing age by producing an increase in pus knowledge and insight. It can be concluded that the community at the Edelweiss Posyandu was enthusiastic by giving questions and did not die from the community service counseling site.

The Role of Midwives in the Course of Natural Childbirth-Analysis of Sociodemographic and Psychosocial Factors-A Cross-Sectional Study.

An important role in the course of natural childbirth is played by midwives, who should effectively work on relieving pain. This study aims to present the opinions of midwives on non-pharmacological methods of relieving labor pain; the frequency of their use and reasons for their abandonment; and the relationship between the use of non-pharmacological methods of relieving labor pain and perceived job satisfaction, burnout, and self-efficacy of the midwife. The study was conducted online, with the participation of 135 Polish midwives working in the delivery room. The author's survey questionnaire, the Generalized Self-Efficacy Scale (GSES), the LBQ Burnout Questionnaire, and the Scale of Job Satisfaction were used. Among the surveyed midwives, 77% use vertical positions in work with a patient giving birth. Almost all respondents consider vertical positions as an example of a non-pharmacological method of relieving labor pain; those with master's degree felt more prepared for their use (p = 0.02). The most common reason for abandoning their use was disagreement on the part of co-workers (p = 0.005). An association was observed between the use of vertical positions and the level of burnout (p = 0.001) and a significant correlation between preparation for their use and self-efficacy assessment, burnout, and job satisfaction. Our research shows that it would be important to conduct additional training on the use of non-pharmacological methods to relieve labor pain and to present their benefits. In contrast to other research results, our results showed that midwives feel well prepared to use these methods; however, similar to other research, we found that they often feel disagreement from colleagues and a lack of support from their leaders. The use of vertical positions is related to burnout.