Labor Outcomes Research Articles

Establishment of Labor Epidural Analgesia Service and its Assessment: An Experience in a Hospital of a Middle-Income Country.

Even though the idea of painless birth is more than 100 years old, it is still underrepresented in some parts of the world despite progress in science, education, anesthesia, spinal and epidural needles, development of catheters, new drugs, and infusion pumps. Maternal care should basically be the safety of the patient (in this case two patients) and also provide all kinds of protection in the form of a multidisciplinary team with an anesthesiologist, especially when it comes to pain therapy and anesthesia for women in labor. In this direction, our hospital departments with low or moderate volume of annual births made the decision to educate ourselves for painless childbirth and contribute more to the care of women in labor. The enthusiasm and dedication of our clinical team prevailed and today we have a high standard of labor epidural service. The aim of this study was to evaluate the establishment of the epidural labor service by comparing the effects of epidural analgesia on labor pain and the course of labor. The secondary objectives were to compare satisfaction with epidural analgesia and the impact of epidural analgesia on the delivery mode. This was a prospective observational hospital-based study conducted on100 patients after the establishment of epidural service. Parturients who were signed to receive epidural analgesia formed Group A and parturients who did not request epidural analgesia formed Group B. All parturients are induced in the delivery room with a Bishop score of 5 or higher. Pain intensity measured through the visual analog scale of pain (VAS score) was significantly lower in Group A (n = 46) compared to Group B (n = 50) at measured points of time (p<0.001). There was a fall in the mean VAS score in Group A from 7.94 to 3.86 within 20 minutes of the bolus dose and starting a continuous infusion.Labor progress according to the Bishop score and till the end of the second stage of labor, or to the transfer to the operating theatre, according to the monitored time in Group A was 176 minutes and it was lower in Group B with 155 minutes; however, by test of linearity we do not gain significance(p = 0.2). There were eight parturients in each group(17% vs 16%) who were indicated for surgical delivery. According to Pearson's correlation test for the outcome of labor between parturients receiving epidural analgesia and parturients without epidural analgesia (p = 0.8), we cannot say that epidural analgesia in labor is correlated with the outcome of surgical delivery. Establishing a new hospital procedure such as an epidural painless service for childbirth in low or moderate-volume settings of annual births is very challenging. By evaluating epidural labor services in our hospital, we created the best environment for continuous improvement and long-term efficacy and safety of our analgesic techniques aimed at providing excellent care to mothers and their babies.

Development of a novel labour monitoring tool: Improving labour care quality in the Indian setting.

Efficient care by labour monitoring tools manages labour, identifies the abnormalities and avoids the fatalities. Various studies are being undertaken by the researchers to understand the limited use of these therapeutic tools. The present study aimed to develop a novel labour monitoring instrument after understanding the barriers and enablers of the currently used tools and using it in the health setting for improving clinical outcomes. Methodological research design was adopted to develop the novel tool. Item pool was generated by literature review, focus group discussions and retrospective observations of the partographs. Developed tool was evaluated by various experts by undergoing three rounds and was found to be reliable in terms of stability and equivalency. After undergoing pilot runs by researcher and nurses, tool was found to be feasible and understandable. The developed novel labour monitoring tool was used on 200 intranatal women. Focus group discussions revealed various barriers in the current labour tools, such as lack of clarity, complexity, staff shortage, workload etc. Retrospective observation of filled partographs revealed the incomplete recording of the components of the partograph. The prepared first draft underwent rigorous review by the experts. The prepared novel tool, after being used on 200 intranatal women resulted in 90% of normal vaginal deliveries. Duration of 1st stage of labour was around 5 hours. A novel labour monitoring tool was developed after methodological approach resulting in adequate monitoring and improved labour outcomes.

Labor force effects of Medicaid and Marketplace expansions: Variation by gender, parental status, and household structure

AbstractWe revisit the Affordable Care Act (ACA)'s Medicaid expansion's labor market effects and build upon it by estimating effects of subsidized Marketplace insurance. Using American Community Survey data, we jointly model the effects of Medicaid and Marketplace expansion on labor force outcomes using simulated eligibility measures. Throughout our analysis, we focus on heterogeneity by gender, parental status, and single versus two‐headed households. Consequently, this is the first paper presenting labor outcomes of the ACA among women with children, an important group, which may be particularly responsive to increased flexibility in meeting income, childcare, and insurance needs. Even among women, we find little evidence that Medicaid eligibility reduced labor force participation. Any significant reductions among women are small in magnitude and not well corroborated by placebo tests. Alternatively, women with children gaining Marketplace eligibility had statistically significant reductions in labor force participation, reductions in hours, and increases in part‐time work.

Prolonged Labor and Adverse Cardiac Outcomes in Pregnant Patients With Congenital Heart Disease

(Am J Obstet Gynecol. 2023;228(6):728.e1–728.e8) Congenital heart disease (CHD) is one of the most common types of birth defects and affects 8 to 9 per 1000 births. Many patients who have it are diagnosed in infancy, but some are not diagnosed until later in life. The number of patients with CHD who reach childbearing years has increased substantially. Pregnancy can pose difficult challenges, especially in labor and delivery. The physiologic changes that occur during delivery, including increased cardiac demand, rapid changes in intravascular volume, and blood loss, result in significant risk for patients with CHD. The European Registry of Pregnancy and Cardiac disease and the Cardiac Disease in Pregnancy 2 studies have demonstrated that the immediate postpartum period is the highest risk time for heart failure.

A cross-sectional study on incidence and indications for induction of labor and the factors associated with failure of induction

Background: Induction fails in about 20% of induced pregnancies and has no universally accepted definition. Failed induction is the failure to establish labor or inability to achieve the active stage of labor, considering the definition of induction of labor (IOL). It needs to be differentiated from the failure of progress of labor. There is no evidence to recommend treatment for failed induction, but usually, delivery by cesarean section will be required. Aims and Objectives: The study was designed to start induction for an indication that justifies operative delivery in cases of failure. Materials and Methods: A prospective observational study was done over a period of 1 year among antenatal women confirmed to be at term with cephalic presentation in the absence of active labor with unscarred uterus. Results: The incidence of IOL was found to be 25.97% and failure was observed in 50 (21.83%) of those included in the study. Among those with failure, failed pre-induction ripening was seen in 26 (11.3%) and failed induction in 24 (10.4%). Although many variables were found to be associated with the outcome of labor, a statistically significant association was observed with premature rupture of membranes, pre-induction Bishop score, and birth weight of the baby. Conclusion: The study helps in better clinical judgment of patients who will have a successful induction or a failed induction and the patients could be counseled accordingly. This judgment will also help to avoid unnecessary inductions in those who have the risk factors for failed induction unless the induction is absolutely necessary.

Parental Educational Attainment and Child Labor: Evidence From Malawi

AbstractThis paper examines child labor response to parental education. Prior studies present anecdotal evidence with a causal interpretation of this relationship rarely explored. Hence, conditional on a range of parental characteristics and multigenerational co-residence, I use as a set of instruments grandparents’ educational attainment to exploit plausibly exogenous variation in parents’ schooling. I generally find evidence of a negative parental education impact on child labor outcomes. The effect of maternal education on household farm work, however, is not significant. With respect to potential mechanisms, the results suggest that engagement in nonfarm employment pursuits among educated parents may mediate these effects.

A descriptive study to assess the knowledge and anxiety level of birth companion in relation to their support during childbirth and the influence of support on the outcome of labor among primipara women at selected hospitals of district Mohali, Punjab

This is a “Descriptive study to assess the Knowledge and Anxiety Level of Birth Companion in Relation to their Support during Childbirth and the Influence of Support on the Outcome of Labor among Primipara Women at Selected Hospitals of District Mohali, Punjab.” A women’s pain during childbirth is unique to each mother and influenced by a variety of factors such as culture, anxiety, fear, previous birth experience, childbirth preparation and support given by the health team members. Continuous support can be used to decrease anxiety in the delivery room. Pre-labor sessions help to decrease anxiety in expectant mothers and help them to have control of the situation they face. Support by a companion of the mother’s during labor and delivery had a positive effect on her satisfaction with the birth experience. Objectives of the study: To assess the level of knowledge of Birth Companion in relation to their Support in Childbirth among primipara women at selected hospitals of district Mohali, Punjab, To assess the level of Anxiety of Birth Companion in relation to their Support in Childbirth among primipara women, To assess the outcome of labor among primipara women in the influence of support provided by the birth companion during labor. Methodology: Research methodology is also called Research Design, Research Plan or Research Strategy of a research study that gives guidelines which direct the research steps, the research study process and enables in systematic data collection, logical data organization and accurate data analysis and data interpretation. After approval the ethical committee, a study was conducted on 50Primipara women, 50 birth Companions selected by Convenient sample technique, Self-structured interview schedule to assess the knowledge and anxiety level, Check list to assess the level of support to women throughout the labor process, Tool to assess the experience and outcome of labor after the presence of birth companion Content Validity (determined by expert) and reliability (0.76 by correlation coefficient) was checked and data was collected. Data was analyzed by Descriptive and Inferential statistics. Results: The present study results revealed that majority 70% Birth Companion had average knowledge, 22% Birth Companion had good knowledge and only 8% of Birth Companion had poor knowledge in relation to their Support in Childbirth among primipara women. In this the level of anxiety shows that majority 88% Birth Companion had moderate level of anxiety, 12% Birth Companion had high level of anxiety, and noun of them had low level of anxiety in relation to their Support in Childbirth among primipara women, The present study finding depicts that majority 56% of Birth Companion provide high support, 14% Birth Companion provide moderate support and 30% Birth Companion provide low support during labor among primipara women. The present study finding depicts the frequency and percentage of primipara Woman Regarding Perception of birthing experience. During labor as per the diagram majority 80% of primipara were moderately satisfied 10% were highly satisfied and 10% were not at all satisfied in the influence of support provided by the birth companion during labor in selected hospitals. Conclusion: The present study shows that birth companion had an overall moderate knowledge of labor process regarding the care to be given for the woman in labor. Levels of anxiety shows that majority of the birth companion had moderate anxiety related to labor. A majority of the birth companions provided a moderate support to the woman throughout labor. A view of woman regarding birthing experience as most of the women was moderately satisfied with the support given by birth companion. The presence of birth companion provides moderate satisfaction for the woman in labor. Recommendations: The study can be replicated on the large sample to validate and generalize its findings.

The Rate of Epidural Analgesia in Labor with Maternal And Neonatal Outcome at Tertiary Hospital in Oman

Objectives: The primary objective is to determine the epidural analgesia rate and its effect on the mode of delivery. The secondary objectives are to assess patient satisfaction, duration of second stage of labour and incidence of maternal, fetal and neonatal outcomes. Methods: A retrospective cohort design utilized in this study, involving all pregnant women received epidural analgesia in labour at Sultan Qaboos University Hospital over 3 years period (March 2020 to March 2023). All data is collected from the delivery register at Delivery ward, SQUH track care system, and epidural record chart. Women’s information remained confidential. All entered data in the SPSS program is stored in a passwordprotected computer. Results: There was a total of 7076 deliveries, out of which 389 received epidural analgesia, with a rate of 5.0% (95% CI: 5.0 – 6.0). Out of 389 deliveries, around half were nulliparous and the other half were multiparous. The rate of spontaneous vaginal delivery constituted 60.7%. On the other hand, instrumental deliveries and LSCS constituted 14.9% and 24.4% respectively. The median and mean (±SD) period of 2nd stage were 24.0 and 38.3±40.1. Only 1% of all included patients had prolonged second stage of labor. The rate of oxytocin use was 54.5%, and around 52.4% of it was among nulliparous. 148 patients (52.5% ) reported full benefit from epidural analgesia use, compared to 6% who reported no benefit. In addition, 12.7% of CTG showed fetal distress and postpartum hemorrhage constituted 6.7% among delivered ladies. The study showed that 10.0% of included ladies suffered one or more of post-partum complications, including fever (n 13, 3.3%), headache (n 10, 2.6%), backache (n 3, 0.8%), hypotension (n 9, 2.3%), urine retention (n 3, 0.8%), pruritus (n 1, 0.3%), and nausea and vomiting (n 1, 0.3%). 6.2% was the rate of NICU admissions among the newborns. Conclusions: The study revealed that 5% was the rate of epidural analgesia usage and spontaneous vaginal delivery was the main mode of delivery. However, the indications for delivery by cesarean section or instruments were not related to epidural analgesia in labour. In addition, there was no significant adverse effect on maternal, fetal and neonatal outcome. Based on that, we need to elaborate more on epidural analgesia awareness and usage in order to be offered. Although some previous reviewed studies reported adverse effects of epidural analgesia on labour outcome. Future researches are recommended including prospective design study, bigger sample size, wider variation and multicenter studies.

New definitions, old complications: The association between duration of transition from latent to active labor and adverse obstetrical outcomes.

To explore the relationship between the duration of transition from latent to active labor and various obstetric, maternal, fetal, and neonatal outcomes. A retrospective cohort study was conducted on term, singleton deliveries at Soroka University Medical Center from 2013 to 2018. Data were extracted from electronic medical records. The exposure variable was defined as prolonged transition, which was itself defined as the upper 10th centile of dilation duration from 4 to 6 cm. Clinical and demographic characteristics were compared using χ2 test. Multivariate logistic regression was used to estimate the contribution of a prolonged transition with each adverse outcome adjusting for potential confounders. In all, 12 104 deliveries met the inclusion criteria. The mean ± standard deviation of duration of dilation from 4 to 6 cm was 03:07:58 ± 03:03:42 (hours:minutes:seconds). Progress curves varied significantly among patients with different obstetrical and demographic characteristics. Prolonged transition was significantly linked to an increased risk of cesarean delivery (adjusted odds raito 2.607, 95% confidence interval 2.171-3.130, area under the curve 0.689) and higher rates of maternal and neonatal morbidity. Patients experiencing transition phases exceeding the 90th centile faced an elevated risk of cesarean delivery and postpartum complications. Future studies should focus on interventions during the transition phase to improve pregnancy outcomes and enhance patient safety.

Men, mindsets and birth: results of a prospective longitudinal study

ABSTRACT Aims/Background In recent years, there has been an increased interested in the contribution of fathers to childbirth. In the present paper we explore whether the father’s birth-related mindset (being either more natural or more medical) can predict the mother’s labour and birth outcomes and whether the father’s experience and evaluation of the birth can predict his psychological well-being after the birth. Design/Methods We conducted a longitudinal study (N = 304 expecting fathers) spanning the first trimester of pregnancy up to six months after birth. Results The study results could be integrated into a Single Indicator Model. They indicated that a father’s more natural birth-related mindset predicted low-intervention birth for the mother. A low-intervention birth led to a more positive birth experience for the father, and in turn to better postpartum adjustment, fewer symptoms of postpartum paternal depression eight weeks after birth, and more secure bonding to the infant six months after birth Conclusion The study results indicate that fathers do not take a merely passive role in childbirth. On the contrary, analogous to pregnant mothers, fathers’ views about childbirth might contribute to the course of birth, and their own postpartum psychological well-being. The results of the present study, thus, highlight the importance of fathers for childbirth and in a broader sense, the results also contribute to a better understanding of the psychological framework of birth and represents a valuable starting point for further research.

Impacted fetal head extraction methods at second stage cesarean and subsequent preterm delivery: A multicenter study.

Second-stage cesarean delivery (CD) is associated with subsequent preterm birth (PTB). It has been suggested that an increased risk of PTB after second-stage cesarean delivery could be linked to a higher chance of cervical injury due to the extension of the uterine incision. Previous studies have shown that reverse breech extraction is associated with lower rates of uterine incision extensions compared to the "push" method. We aimed to investigate the association between the method of fetal extraction during second-stage CD and the rate of spontaneous PTB (sPTB), as well as other maternal and neonatal outcomes during the subsequent pregnancy. This was a multicenter retrospective cohort study. The study population included women in their first subsequent singleton delivery following a second-stage CD between 2004 and 2021. The main exposure of interest was the method of fetal extraction in the index CD ("push" method vs. reverse breech extraction). The primary outcome of this study was sPTB <37 weeks in the subsequent pregnancy. Secondary outcomes were overall PTB, trial of labor, and other adverse maternal and neonatal outcomes. Univariate analysis was followed by multiple logistic regression modeling. During the study period, 2969 index CD during second stage were performed, of those 583 met the inclusion criteria, of whom 234 (40.1%) had fetal extraction using the reverse breech extraction method, while 349 (59.9%) had the "push" method for extraction. In univariate analysis, women in those two groups had statistically similar rates of sPTB (3.7% vs. 3.0%; odds ratio [OR] 1.25, 95% CI: 0.49-3.19) and overall PTB (<37, <34 and <32 weeks), as well as other maternal, neonatal, and trial of labor outcomes. This was confirmed by multivariate analyses with an adjusted OR of 1.27 (95% CI: 0.43-3.71) for sPTB. Among women with a previous second-stage CD, no significant difference was observed in PTB rates in the subsequent pregnancies following the "push" method compared to the reverse breech extraction method.

Effect of Pethidine Injection on the Duration of Labor and Pregnancy Outcomes: A Retrospective Cohort Study.

Background and Objectives: Long and ineffective labor causes hardships for mothers and doctors and increases the rate of cesarean sections and medical comorbidities. Several factors contribute to effective and less painful labor, including maternal age, parity, fetal characteristics, and the medications or procedures that obstetricians use for labor. We aimed to study the factors that affect labor duration and identify those that make labor more effective. Materials and Methods: This retrospective study included 141 patients who underwent normal vaginal deliveries at the Daegu Catholic University Medical Center between April 2013 and April 2022. Among the 141 patients, 44 received pethidine intravenously, 88 received oxytocin intravenously, and 64 received epidural anesthesia. The duration of the active phase and second stage of labor were recorded according to the findings of a manual examination of the cervix and continuous external electronic monitoring. We analyzed maternal and neonatal medical records and performed binomial logistic regression to identify the factors associated with a shorter active phase of labor. The clinical outcomes in mothers and neonates were also evaluated. Results: Among the various clinical factors, multiparity (odds ratio of parity 0.325) and the use of pethidine (odds ratio 2.906) were significantly associated with shortening the active phase of labor to less than 60 min. The use of epidural anesthesia or oxytocin was not significantly associated with reducing the active phase of labor. When patients were divided into two groups based on whether a pethidine injection had been used during labor, the duration of the active phase was shorter in the pethidine injection group than in the control group for both nulliparas and multiparas. No significant differences in the duration of the second stage of labor were observed between the pethidine injection and control groups. There were no significant differences in pregnancy outcomes, including the need for mechanical ventilation of neonates, Apgar scores, neonatal intensive care unit admissions, number of precipitous deliveries, maternal adverse side effects of drugs, or duration of maternal hospitalization between the two groups. Conclusions: Pethidine can be safely administered to women during labor to help reduce the duration of the active phase by promoting dilatation of the cervix and preventing complications that may result from prolonged labor. Pethidine may be helpful, especially for those who cannot receive epidural anesthesia or who cannot afford it. However, large-scale randomized controlled studies are required to evaluate the efficacy and safety of this drug during labor. Furthermore, it would be helpful if various studies were conducted depending on the timing of administration and indications for delivery.

Racial disparities in labor outcomes: The effects of hiring discrimination over the business cycle

The resume audit literature provides strong evidence of discriminatory practices in hiring, raising critical concerns regarding equitable labor market outcomes. While the impacts of these practices on disparities in labor market levels are better understood, their cyclical effects are less known. In this paper, we research how hiring discrimination affects the volatility of labor market outcomes for disadvantaged groups by integrating empirical findings from audit studies into a search-and-matching model with a modified urn-ball matching function. Intuitively, in recessions, there are more applicants per job opening, which hurts discriminated groups. Applying this model to the U.S. economy, we find that it accounts for approximately 70% of the excess business cycle volatility in the unemployment rates of African Americans, as recorded in CPS data. Our research highlights the broader economic implications of discrimination, stressing the necessity for policy interventions, and offers a novel framework for future studies on labor market inequalities.

Evaluating the effect of maternal non-communicable disease on adverse pregnancy outcomes and birthweight in Pakistan, a facility based retrospective cohort study

Non-communicable diseases (NCDs) claim 74% of global lives, disproportionately affecting lower and middle-income countries like Pakistan. NCDs may increase the risk of preterm birth (PTB), caesarean section (CS), and low birthweight. This study aims to determine whether the high prevalence of NCDs in Pakistan play a role in the high rates of preterm births, and CS. This retrospective cohort study from Aga Khan University Hospital, Pakistan, investigated effects of pre-existing NCDs on pregnancy outcomes of 817 pregnant women. Medical records were used to generate odds ratios for the risk of PTB, labour outcome and birthweight in women with type 1 and type 2 diabetes, hypertension, asthma and thyroid disorders. Multinomial logistic regression and general linear models were used to adjust for confounding variables using IBM SPSS Statistics (v27). Type 2 diabetes significantly increased the risk of PTB and elective CS (both P < 0.05). Elective CS was significantly increased by hypertension and asthma (both, P < 0.05). Surprisingly, asthma halved the risk of PTB (P < 0.05), while type 1 diabetes significantly increased birthweight from 2832 to 3253g (P < 0.001). In conclusion, pre-existing NCDs increase the risk of negative pregnancy outcomes, including PTB, elective CS and birthweight. Asthma, however reduced PTB and justifies further investigation.

Effects of maternal posture and cognitive-behavioral interventions on labor outcomes in primigravidas with abnormal fetal head position: a randomized controlled clinical trial

Objective Fetal head malposition can result in neonatal and maternal complications. Fetal head malposition occurs frequently in labor. Appropriate and timely managements are required. Maternal posture and cognitive-behavioral interventions could improve labor outcomes in primigravidas with fetal head malposition. Methods A randomized controlled clinical trial was performed between January and December 2022 (Chinese Clinical Trial Registry, ChiCTR2100049359). Eligible primigravidas were randomly assigned into four groups. Group A received traditional perinatal care. Group B, C, and D received posture management, posture management with music therapy, and posture management with video education, respectively, in addition to traditional perinatal care. The maternal postures referred to place pregnant women in certain positions (lateral, lateral-prone, hands and knees, open knee-chest) to change the anatomical structure of pelvis, thus, to facilitate the fetal downward movement and birth. Maternal and neonatal outcomes were recorded and compared. Results A total of 136 primigravidas were included, with 34, 35, 34, and 33 women in group A, B, C, and D, respectively. The incidences of cesarean section were lower in groups B, C, and D than that in group A (5.7%, 2.9%, and 3.0% versus 20.6%, p < 0.05). The fetal position correction rates at the time of full dilation of cervix were higher in groups B, C, and D than that in group A (66.7%, 63.6%, 68.8% versus 27.6%, p < 0.05). Primigravidas in groups B, C, and D had better experiences and a lower anxiety level than those in group A (p < 0.001). The four groups had no statistically significant differences in the total labor duration, operative vaginal delivery, umbilical artery blood pH, and neonatal Apgar scores. Conclusion Fetal head malposition could happen in primigravidas. Maternal posture management and cognitive-behavioral interventions during labor could improve labor outcomes in primigravidas with fetal head malposition.

The impact of health on labour outcomes among middle-aged and elderly: Insights from India.

The impact of ill-health on labour force participation is a well-recognized concern in both developed and developing countries. However, previous studies have often overlooked age differentials in this relationship, assuming uniform effects across age groups. This study aims to fill this gap by examining how ill-health affects labour outcomes among different age segments in India. Utilizing data from the Longitudinal Ageing Study in India (LASI) Wave 1, which covers over 72,000 individuals aged 45 and above, this research investigates the linkage between health and labour force outcomes. The labour outcomes in this study includes labour force participation, labour earnings and hours worked. Present study used instrumental variable approach to mitigate endogeneity issues and establish causal relationships between health and labour outcomes. The Heckman selection model is utilized to address selection bias in analysing wage and hours worked. The study reveals several key findings. Firstly, ill-health consistently leads to a decline in labour force participation among both middle-aged (28 percent) and elderly (36 percent) individuals in India. This underscores the pervasive impact of health on workforce engagement, particularly in a context with limited social security measures. Secondly, the research identifies significant variations in the effects of ill-health on wages and hours worked based on age. Among elderly individuals, there is a pronounced reduction in both wages and hours worked due to ill-health. However, this effect is less pronounced among middle-aged adults. Furthermore, socioeconomic factors play a pivotal role in shaping how ill-health influences labour outcomes among different age groups. This study underscores the importance of considering age differentials in the impact of ill-health on labour outcomes, offering valuable insights for policymakers, practitioners, and researchers seeking to address this critical issue in India's dynamic socio-economic landscape.

The Level and Outcomes of Emotional Labor in Nurses: A Scoping Review

Aims: This scoping review aims to examine the level and outcomes of emotional labor in nurses.Background: Nursing is a highly emotional profession that requires nurses to experience a wide range of emotions and control their emotional expressions in nursing practice. Chronic emotional labor and emotional burden not only impact nurses’ individual well‐being and professional performance but also their job satisfaction and turnover intention.Evaluation: This scoping review was guided by a five‐stage scoping review framework and the PRISMA‐ScR checklist. Eight databases were searched and 41 studies were reviewed.Key Issues: The Emotional Labor Scale and the Emotional Labor Scale for Nurses were the most commonly used instruments. Significant associations were found between emotional labor and 52 outcomes, which were categorized into two main themes: nurses’ personal well‐being and organizational well‐being. There were 19 mediators and 12 moderators between nurses’ emotional labor and 26 different outcomes.Conclusions: While the level of emotional labor among nurses remains uncertain, its consequences are plentiful and intricate. Studies have shown an important relationship between nurses’ emotional labor and individual and organizational well‐being, which is crucial for nurse managers. There is a need to explore the positive effects of nurses’ emotional labor and its impact on patients. Additionally, validation studies of the instruments used to measure nurses’ emotional labor are necessary.Implications for Nursing Management: The insights gained from this scoping review provided a more comprehensive understanding of emotional labor for nurse managers. This knowledge can be utilized to design training programs on emotional management and to explore different interventions aimed at alleviating the adverse impacts of nurses’ emotional labor.

Effectiveness of Childbirth Self-Efficacy Enhancing Classes on Labor Length and Outcomes among Egyptian Primiparous Women: A Quasi-Experimental Study.

Childbirth self-efficacy has repeatedly been shown to raise satisfaction with childbirth, reduce the need for analgesic, and promote the use of different childbirth alternatives. However, the measures to improve the childbirth self-efficacy had rarely been investigated among Egyptian primiparous women. The aim of this study is to evaluate the effectiveness of childbirth self-efficacy enhancing classes on labor length and outcomes among Egyptian primiparous women. A quasi-experimental research approach was carried out on prospective, consecutive sample of 148 pregnant women at the end of pregnancy. A prenatal education study group (n = 74) and a control group receiving standard antenatal care (n = 74) make up the first and second groups, respectively. Between October 2021 and October 2022, the study was conducted at the antenatal clinic. The following four tools were employed to fulfill the study's objective: A structured interviewing form, a childbirth self-efficacy inventory, a follow-up checklist for monitoring maternal and neonatal outcomes during labor, and three antenatal education sessions to boost childbirth self-efficacy are all examples of tools that can be used. All statistical analyses were performed using SPSS for windows version 20.0. Approximately 68.9% of women in the experimental group gave birth vaginally, compared to 29.7% of those in the control group with (p = .001), according to the study's findings. In the experimental group, regular labor took an average of 8 to 12 h, but it took more than 12 h in the control group. Birth weight (>3000g) in the experimental group compared to (2000-3000 g) in the control group, as well as the Apgar score at 1 min and 5 min, were highly statistically significance between two groups with (p = .001). The means±SD of the childbirth self-efficacy result scores were better in the study group than in control groups regarding length of delivery and vaginal delivery (248.2 ± 19.4 versus 144.6 ± 21.6 and 250.1 ± 18.2 versus 137.9 ± 21.5, respectively). According to the findings of this study, antenatal education classes have a real chance of assisting primiparous women in increasing their childbirth self-efficacy and improving maternal and neonatal outcomes.

Association of Squatting Activities of Pregnant Women during the Antenatal Period and Labor Outcomes

Association of Squatting Activities of Pregnant Women during the Antenatal Period and Labor Outcomes

Outcome of Trial of Labor after Cesarean Delivery: Evaluating the Flamm Scoring System in Two Hospitals in Cameroon: A 5-year Retrospective Study

Abstract Background: Outcomes of trial of scar (TOS) correlate well with predictions provided by vaginal birth after cesarean scoring systems. In Cameroon, there is limited data on the implementation and effectiveness of these scoring systems, as well as the materno-fetal outcomes of TOS. Objectives: The objective was to utilize the Flamm score in predicting the success of TOS, and to evaluate the maternal and fetal outcomes observed following TOS in Yaounde and Douala Gyneco-Obstetric and Pediatric Hospitals from 2017 to 2021. Material and Methods: We included files of 310 parturient women with single transverse lower uterine segment cesarean section, who had TOS. Data on sociodemographic, reproductive health, Flamm scoring, and labor outcomes were documented using a structured data extraction form and analyzed using the Statistical Package for the Social Sciences version 25. Results: Of the 310 patients, 73.9% had successful vaginal deliveries (VDs) and 26.1% had repeated emergency cesarean. Flamm score predictions were associated with TOS outcomes (P = 0.0001), with mean score of 5.87 ± 0.01 for successful VD compared to 3.72 ± 0.126 for repeat cesarean. Probability of successful VD increased with Flamm score, ranging from 0% for scores of two to 100% for scores &gt; 7, with a cutoff score of 4.5 (Se = 75.0%, Sp = 75.3%). The main maternal complication was one uterine rupture (0.32%) and neonatal complications were three stillbirths (0.98%) and one early neonatal death (0.32%) after repeat cesarean. Conclusions: TOS is associated with high success rates in tertiary hospitals in Cameroon. Applying Flamm score will improve the chances of a successful VD following TOS, and should be encouraged.