Physiological Birth Research Articles

How does place impact intrapartum practice for midwives and obstetricians?

BackgroundRising rates of labour and birth interventions are causing concern, having the potential to cause harm if used inappropriately. International evidence demonstrates that place itself influences birth outcomes, but evidence is limited as to how. In New Zealand there are differences in the rates of spontaneous vaginal births by place, along with differences when benchmarking uncomplicated primiparae birthing in hospital maternity facilities throughout the country. AimTo develop understanding of how place influenced midwives’ and obstetricians’ practice in relation to supporting physiological birth. MethodFor this Hermeneutic Phenomenological study participants were purposively selected and consisted of nine midwives (employed and self-employed) and three obstetricians, all practising in midwifery led units or hospital maternity facilities. Data was collected using semi-structured interviews. The method of analysis involved writing and rewriting to surface interpretive insights, drawing on philosophical notions from Heidegger and Gadamer. FindingsThe findings revealed that place influences what practitioners are attuned to, what is easier for them to achieve, and their ability to provide woman-centred care. Competing tensions and pressures within place can blur the perceived relationship between normality and risk, influencing what is considered to be safe. SummaryPlace is not neutral; it influences how midwives and obstetricians practise and shapes how they support physiological labour and birth. The findings of this research contribute to a deeper understanding of the barriers and enablers to supporting physiological birth within place.

P9 - The PRIMROSE Project: What is ‘Physiological Birth’? A Qualitative Approach to the Perceptions of the Australian Population using Interpretive Hermeneutic Phenomenology

P9 - The PRIMROSE Project: What is ‘Physiological Birth’? A Qualitative Approach to the Perceptions of the Australian Population using Interpretive Hermeneutic Phenomenology

The Effect of Spinning Babies® Education on Confidence in Implementing Techniques and Knowledge Regarding Safety Related to Labor Positioning Among Birth Professionals.

In order to support labor and delivery nurses' desire for education regarding labor positioning, we hosted an 8-hour class presenting the Spinning Babies® class for birth professionals. Labor and delivery nurses and certified nurse midwives (CNMs; N = 109) from three hospitals participated in a study evaluating the effect of the Spinning Babies® class on their confidence in implementing techniques and knowledge regarding safety related to labor positioning. After the class, participants demonstrated significant improvement in scores related to the variables of interest. This study supports educating labor and delivery nurses and CNMs on how to support laboring women using positioning techniques to promote physiologic (vaginal) birth.

Birthing consciousness and the flow experience during physiological childbirth

ProblemIt has been demonstrated that birth without medical intervention conveys significant physical and psychological benefits to the mother and her newborn baby. However, there is a need to include women's subjective experience of physiological birth to understand and promote it. BackgroundThe theoretical concept of “birthing consciousness” hypothesizes that women during natural childbirth sometimes experience a specific altered state of consciousness, which is a positive peak experience that resembles “flow” in many aspects. AimTo investigate the underexplored connection between the physiological mode of childbirth and altered states of consciousness during childbirth. MethodsIsraeli women with childbirth experience were recruited through social media (Facebook groups with a focus on childbirth and motherhood). Participants (n = 766) completed an online survey: the Flow State Scale (FSS) and a demographic questionnaire. FindingsDifferences were found between modes of birth as to flow state, as women who experienced physiological childbirth (i.e., with no epidural anesthesia or instrumental interventions) had a higher flow state during birth. DiscussionThis link empirically confirms the phenomenon of birthing consciousness. All nine dimensions of the mental state of flow apply to childbirth: challenge-skill balance, action-awareness merging, clear goals, unambiguous feedback, concentration on the task, sense of control, loss of self-consciousness, transformation of time, and autotelic experience. ConclusionUnderstanding a women's subjective experience during physiological birth can enhance clinical understanding of physiological birth thus promoting positive physiological birth experiences – which has crucial health benefits. We propose that more studies need to be done to promote experiencing flow during physiological birth.

Characteristics of the hemostatic system “P-selectin — von Willebrand factor — metalloprotease ADAMTS13” during childbirth

Introduction. The physiological task of the blood coagulation system during childbirth is to prevent excessive blood loss.Aim: to evaluate the quantitative and qualitative characteristics in the system P-selectin-von Willebrand factor (vWF)-metallo-protease ADAMTS13 during natural and uncomplicated childbirth in women with a physiological pregnancy.Materials and methods. The study included 40 pregnant women without somatic pathology, with a physiologically progressing pregnancy that ended with physiological birth (general group). Of these, 16 women had their first birth (group 1), 18 had their second birth (group 2) and 6 had their third birth (group 3). Venous blood sampling was performed at three points throughout the study: 1st point — the onset of labor, 2nd point — 2 hours after childbirth and 3rd point — 24 hours after child -birth. The control group consisted of 25 healthy non-pregnant women. The blood samples were examined for: vWF antigen (vWF:Ag), binding ability of vWF to platelet receptor GPIb (vWF:GPIb), binding ability of vWF to collagen type I (vWF:CBAI) and type III (vWF:CBAIII), antigen and activity ADAMTS13 (ADAMTS13:Ag and ADAMTS13:AC), antibodies to ADAMTS13 (ADAMTS13:AB) and P-selectin.Results. The medians of the studied vWF characteristics in the genera l group were statistically significantly higher compared to the control group at all study points, with the exception of the medians of the vWF:GPIb/vWF:Ag ratio, which in the general group were statistically significantly lower at all study points when compared with the control group. The median values of vWF:GPIb and vWF:Ag in women in the second group were statistically significantly higher at all points of the study, compared with similar indicators in both the first and third groups. The median values of ADAMTS13:AC and ADAMTS13:AB in the overall group were statistically significantly higher when compared with the control group at all study points. Median ADAMTS13:Ag and ADAMTS13:AC/ADAMTS13:Ag ratios were statistically significantly lower at all study points. Individual P-selectin values varied widely from 212.1 to 1398 ng/ml, but the medians of this indicator were statistically significantly higher in all study groups and at all study points compared to the control group.Conclusion. The increase in platelet-binding and collagen-binding abilities of vWF suggests that these adhesive properties of the hemostatic protein play an important role in preventing excessive bleeding during labor. Taking into account the decrease in the vWF:GPIb/vWF:Ag ratio compared to the control group, the adhesion of vWF to collagen is more important under these conditions. Despite the fact that ADAMTS13 concentration does not decrease, an actual twofold increase in its activity provides a sufficient antithrombotic effect. The interaction between vWF and ADAMTS13 under conditions of physiological labor does not lead to excessive formation and accumulation of high-affinity antibodies to ADAMTS13.

Brain Training to Facilitate Labor and Birth: Impact of a Mobile Health Application

The purpose of this study was to evaluate the effects of cognitive training strategies, inclusive of mindfulness-based techniques and pain neuroscience education (PNE), during pregnancy. Using a pre–posttest design, primiparous women seeking a physiological birth used a novel mobile application (GentleBirth) and a web-based PNE course as a means of labor/birth preparation. Self-report questionnaires at baseline, prebirth, and postbirth assessed all studied outcomes (pain knowledge, pain and birth self-efficacy, and birth outcomes). Use of the GentleBirth app combined with PNE during pregnancy was associated with improved pain knowledge, χ2(2) = 95.9,p< .001, and birth self-efficacy,F(2, 268) = 71.54,p< .001; high rates of labor coping, 7.48 (standard deviation 2.29); and lower rates of cesarean births and epidural use.

Impact of the midwife-led care model on mode of birth: a systematic review and meta-analysis

Background/Aims Increased rates of caesarean sections globally have potential short- and long-term impacts for mothers and babies. Research on models of care and mode of birth has reported varied results. The aim of this study was to analyse the relationship between the midwife-led model of care and mode of birth. Methods This systematic review and meta-analysis searched PubMed, Scopus and Web of Science. Quantitative full-text open access research articles published between 2010 and 2023 in Indonesian or English were included. Research that assessed the relationship between the model and birth planning were excluded. Results A total of 16 articles were included. Two were experimental, and the remaining 14 were observational, with a total sample of 125 201 people. The midwife-led model supported spontaneous vaginal birth (odds ratio: 1.64, P=0.01) when compared to other models. Conclusions Implementing the midwife-led model of care may increase the likelihood of physiological birth and reduce the incidence of caesarean section, especially in low-risk pregnancies.

Introducing waterbirth in a university hospital setting in Sweden: A qualitative study of midwives' experiences.

Waterbirth is a popular and increasing care option in several countries but is still debated. In Sweden, there are challenges in the process of reintroducing waterbirth after decades of interruption invoked by a dissuasion. The aim of this study was to explore factors affecting midwives' provision of waterbirth at a university birthing clinic in Sweden. A qualitative research design was used with three focus group interviews with 18 midwives at three birthing units. The data were analyzed using the principles of inductive content analysis. The midwives in the study expressed positive attitudes and potentiality about waterbirth, contributing to their desire to support physiological birth. However, obstacles were also disclosed, maiming waterbirth evolvement. Hence, two categories emerged, promoting factors and obstructing factors. The subcategories were: Provides a good experience whilst promoting physiological birth; Increased knowledge and information about waterbirth; Support from management; Updated guidelines; Ergonomic challenges; Lacking practical conditions; Lack of knowledge; Paradigm conflicts; and Limiting guidelines. The study concluded that midwives recognized both promoting and obstructing factors affecting the provision of waterbirth. The predominant factor highlighted was the care-culture, with a clear distinction between a risk-focused, medicalized approach that inhibits waterbirth and a salutogenic perspective advocating for it. This dichotomy underscores the importance of providing opportunities that support women's choices to facilitate an empowering birth experience.

The association between waterbirth and perineal injury or other adverse outcomes among low-risk women with physiological birth: Results from the Nordic Home Birth Cohort Study

Problem/backgroundImmersion in water has known benefits, such as reducing pain and shortening the duration of labour. The relationship between waterbirth and perineal injury remains unclear. AimTo compare the incidence of perineal injury in waterbirth and birth on land among low-risk women. Secondary outcomes were postpartum haemorrhage and 5-minute Apgar scores <7. MethodsProspective cohort study of 2875 low-risk women who planned a home birth in Denmark, Iceland, Norway, and Sweden in 2008–2013 and had a spontaneous vaginal birth without intervention. Descriptive statistics and logistic regression were performed. FindingsA total of 942 women had a waterbirth, and 1933 gave birth on land. The groups differed in their various background variables. Multiparous women had moderately lower rates of intact perineum (59.3% vs. 63.9%) and primiparous women had lower rates of episiotomies (1.1% vs. 4.8%) in waterbirth than in birth on land. No statistically significant differences were detected in adjusted regression analysis on intact perineum in waterbirth (primiparous women’s aOR = 1.03, CI 0.68–1.58; multiparous women’s aOR = 0.84, CI 0.67–1.05). The rates of sphincter injuries (0.9% vs. 0.6%) were low in both groups. No significant differences were detected in secondary outcomes. DiscussionThe decreased incidence of intact perineum among multiparous women was modest and inconclusive, and the prevalence of sphincter injury was low. ConclusionLow-risk women contemplating waterbirth should be advised to weigh the risks and benefits detected in this study against previously established benefits of waterbirth and should make an informed choice based on their values.

The Birth Shell for the Second Stage of Labour: A Modern Tool to Support Physiological Birth

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Factors influencing midwives’ intentions to facilitate normal physiological birth: A qualitative study

BackgroundWhilst most women desire to birth vaginally, research highlights reducing rates of normal physiological birth worldwide. Previous studies have focussed largely on clinical practices associated with vaginal birth however health care professionals’ intentions are also known to effect behaviour; a factor not well understood within the context of midwifery and normal physiological birth. Question/AimTo explore factors influencing midwives’ intentions to facilitate normal physiological birth. MethodsA qualitative study using individual interviews was conducted. The Theory of Planned Behaviour was used to develop a semi-structured interview guide to gather perceptions, thoughts, knowledge, and experience of normal physiological birth from participants. Data were analysed thematically within the theoretical constructs: attitudes, subjective norms, and perceived behavioural control. FindingsFourteen midwives from various practice settings, models, and locations in Australia were interviewed. Major factors influencing midwives’ intentions to facilitate normal physiological birth were influenced by workplace culture, values and influence of leaders, the need to prioritise collaborative interdisciplinary relationships and support autonomy in midwifery. DiscussionFactors influencing the midwives’ intentions of facilitating normal physiological birth were multifaceted. Some influences are more obvious and observable through practice, while others were rooted in underlying beliefs and attitudes that were hidden in the subconscious of those involved. However, all contributing influences ultimately shape midwives’ intentions and the way in which they facilitate normal physiological birth. ConclusionsMidwives intend to support normal physiological birth; however multiple factors influence their intentions over time. Prioritising collaborative interdisciplinary relationships and supporting autonomy in midwifery could address known barriers.

Bouncing your way to labour and birth using biomechanics and fetal optimal positioning

Background/Aims ‘Labour hopscotch’ is a visual tool that encourages activity during pregnancy and childbirth. It has been used in one advanced midwife practitioner service since 2017 and more widely across in Ireland since 2020. The biomechanics for birth toolkit was added to advanced midwife practitioner care in 2022. This study's aim was to ascertain if the biomechanics for birth toolkit impacted gestation of spontaneous onset of labour rates and birth outcomes. Methods A retrospective study of onset of labour and birth outcomes was conducted for women before (n=155) and after (n=154) the biomechanics for birth toolkit was incorporated into care. Results Before the toolkit was included, there was a 57.2% spontaneous onset of labour rate, with 33.2% birthing before 41 weeks. After the kit's inclusion, there was a 72.2% spontaneous onset of labour, with 91.8% birthing before 41 weeks. Induction rates dropped from 42.8% to 27.8%, with emergency caesarean section rates following induction dropping from 33.1% to 23.8%. Conclusions Using the biomechanics for birth toolkit alongside the labour hopscotch tool could increase spontaneous onset of labour rates, optimise physiological birth, reduce inductions and emergency caesarean section following induction.

Comparative Investigation of Genital Self-image and Sexual Function in Women with and Without a History of Female Genital Cosmetic Procedures: A Cross-sectional Study.

Despite the increasing growth of female genital cosmetic procedures, the long-term effects of these procedures are not clearly understood. This study was conducted to compare the genital self-image and sexual function in women with and without female genital cosmetic procedures. This cross-sectional study was conducted on 315 participants (210 women without a history of genital cosmetic surgery and 105 women with it) in Alborz province, Iran, from early February 2023 to mid-May 2023. The sampling was done conveniently. Data collection instruments were Female Genital Self Image Scale and Female Sexual Function Index. Statistical analysis was done in SPSS 16 software using t-test, chi-square, and logistic regression, and P<0.05 was considered statistically significant. The use of laser to tighten the vagina with 77.77% and Perineoplasty with 29.2% were the main cosmetic procedures. The mean duration passed from the surgical procedures was 4.79±3.60 years, while it was 1.13±0.74 years for non-surgical procedures. Women with a history of genital procedures had a higher mean age (39.45±10.38, P=0.023). However, they were lower regarding the level of education (P<0.001), family income (P<0.001), and exercise (P<0.001). Also, they showed a higher number of pregnancies (P<0.001), deliveries (P<0.001), vaginal delivery (P<0.001), episiotomy (P<0.001), and neonates with a weight of ≥3.5 kg (P=0.002). In both groups, midwives and doctors were the most important sources of information about the appearance and function of reproductive system. However, the genital self-image and sexual function of the two groups did not differ significantly (P>0.05). No difference in sexual self-image and lack of difference in sexual function after cosmetic procedures show the need to pay attention to recommending and selecting these procedures. Public awareness about the diverse and natural forms of the female genitalia, education about the variety of the factors affecting sexual function, reduction of unnecessary interventions, increase in physiological births, retraining doctors and midwives, and multidimensional counseling can help to choose more appropriate candidates for cosmetic procedures.

Effect of Interventions to Reduce Fear of Childbirth in Pregnancy: Meta-Analysis

BACKGROUND:Some pregnant women have negative emotions that may predominate and they may develop a fear of childbirth. This causes negative consequences for their health and well-being. A complete definition of the causes of childbirth fear has not yet been established in the literature, but in a systematic review, various factors were found.OBJECTIVE:This study aimed to reveal the effect of educational, cognitive and behavioral interventions on the reduction of fear of childbirth in pregnant women.METHODS:For this meta-analysis study, articles in PubMed, EBSCOhost, Web of Science, YÖK Thesis Center and Google Scholar databases were searched without any year limitation in between September 2022 and February 2023. 25 studies were included in this meta-analysis. The data were analyzed by meta-analysis and narrative methods.RESULTS:This meta-analysis showed that educational, cognitive and behavioral interventions were effective in reducing FOC in pregnant women (SMD: −1.229, 95% CI: (−1.586)−(−0.872); Z= −6,746,p= 0.000) , I2 = 94.225%). In subgroup analyzes, intervention types such as antenatal education, mindfulness, psychoeducation and psychotherapy were found to be effective in reducing FOC. Interventions applied to women who have FOC reduce the FOC and provide a more positive birth experience.CONCLUSION:Results of present study showed that educational program could be serving as an important tool in reducing women fear from natural childbirth and in choosing of physiologic birth.

HOW IT WORKS 5: PHYSIOLOGICAL BIRTH OF THE PLACENTA

In this article I talk about physiological birth of the placenta by exploring the anatomy and physiology of the placenta and its role in childbirth, pairing this with the skills required to facilitate a physiological placental birth. It is important for midwives to understand the anatomy and physiology behind the skill set required to provide care during physiological birth of the placenta and to understand how midwifery practice can influence achieving this for women and birthing people.

What matters to migrant women during labor and birth: Chinese mothers’ experiences in Switzerland

BackgroundIn Switzerland, foreigners account for 25.3% of the permanent resident population, and the fertility rate of migrant women is higher than that of Swiss women. However, migrant women from non-European countries are more likely to report having negative childbirth experiences than Swiss women. For example, during pregnancy, Chinese migrant mothers often felt dissatisfied with the follow-up pregnancy complications and lacked information on medical procedures and prenatal courses. In this paper, we explored their childbirth experiences in Swiss hospitals and how Swiss healthcare providers supported them.MethodA qualitative study employing in-depth, semi-structured interviews was conducted with 14 Chinese mothers and 13 family members. All interviews were audio-recorded, transcribed, and translated into English for data analysis. Thematic analysis was employed to generate a detailed description.ResultsThree main themes were extracted from the transcripts: (1) Sense of security, (2) Intrapartum care, and (3) Postpartum needs.ConclusionsOur study shows Chinese migrant mothers prioritized giving birth in a physically and psychologically safe environment, with pain control and practical and emotional support from their intimate partners. They desired a physiological labor and birth with minimal obstetric interventions. Our research also reveals their postpartum needs, emphasizing the importance of postpartum support and obtaining culturally sensitive care during their postpartum hospital stay. The study adds new knowledge of specific migrant studies in Switzerland, as called for by the Swiss Federal Office of Public Health. The results call for the transcultural care skills training of Swiss healthcare providers to enable migrant women to have a more positive childbirth experience.

ЭКСПРЕССИЯ ОКСИТОЦИНА И ПРОСТАГЛАНДИНА Е2 В МИОМЕТРИИ ПРИ СЛАБОСТИ РОДОВОЙ ДЕЯТЕЛЬНОСТИ

We examined 66 postpartum women (average age 27.6±2.3 years) who were on duty at the postpartum department of the 3rd City Clinical Hospital named after E.V. Klumova, Minsk for 2022–2024. The first inclusion included 34 patients whose birth ended with an emergency cesarean section. The comparison group included 32 patients with cesarean section caused by reasons not related to the weakness of labor. An immunohistochemical study of the expression levels of oxytocin (OT) and prostaglandin E2 (PG E2) in myometrial tissues obtained from the lower segment of the uterus during cesarean section was carried out using antibodies Oxytocin, Prostaglandin. Studies of potassium content in tissues were carried out using high-performance liquid chromatography. It was found that in patients with impaired contractile function and hypotonic dysfunction of the uterus, a strong inverse relationship was revealed between the tone of the uterus and the size of the uterine cavity (correlation coefficient r = -0.9751; p &lt; 0.001; 95% confidence interval) and a strong direct relationship between the tone of the uterus and index of resistance of the uterine vessels (correlation coefficient r = 0.93712; p = 0.001; 95% confidence interval), which reflects a close association between a decrease in myometrial contractility and its tone. During postpartum uterine subinvolution, compared with physiological birth, an unreliable increase in the expression of oxytocin and prostaglandin E2, respectively, to 8.94 ± 2.8 and 21.47 ± 3.2 and an unreliable decrease in the level of potassium in tissues was revealed, which dictates the search for other pathognomonic and diagnostic markers violations of the contractile function of the uterus and its hypotension during childbirth.

Academic education of midwives in Germany (part 2): Opportunities and challenges for the further development of the profession of midwifery. Position paper of the Midwifery Science Committee (AHW) in the DACH Association for Medical Education (GMA).

The objective of academic training is to prepare midwives as independent healthcare professionals to make a substantial contribution to the healthcare of women in their reproductive years as well as to the health of their children and families. This article therefore describes the professional and educational requirements derived from the legal midwifery competencies within the new midwifery act. Furthermore, it identifies the conditions that need to be established to enable midwives in Germany to practise to their full scope in compliance with statutory responsibilities. Educational science, academic efforts, policymaking and accompanying research should work in synergy. This in turn enables midwives to achieve the maximum scope of their skills, with the objective of promoting physiological pregnancies and births. Consequently, it can strengthen early parenthood in alignment with the national health objectives of "health around childbirth". The academisation of the midwifery profession presents a profound opportunity for professional development in Germany. It is essential that midwives receive training based on the principles of educational science and care structures that are yet to be developed. This can enable them to perform within the wide range of their professional tasks to the highest standards, thereby ensuring the optimal care of their clients. Moreover, there is a chance to implement sustainable improvements in healthcare provision for women and their families during the reproductive phase and the period of parenthood in Germany.

A Quest for a Physiological Twin Birth

In 2019, I achieved my dream twin birth. In comparison with the stressful journey I had been through to exercise my choice of a more physiological birth, the labour was easy! As a busy mum-of-three it has taken me until now to find the space in my life and head to put my experience into words. I hope my reflections will help make midwives and obstetricians more aware and improve care for other women.

How midwives facilitate informed decisions in the third stage of labour – an exploration through portraiture

ProblemMidwifery philosophy promotes informed decision-making. Despite this, midwives report a lack of informed decision-making in standard maternity care systems. BackgroundPrevious research has shown a woman's ability to make informed decisions within her maternity care significantly impacts her childbearing experience. When informed decision-making is facilitated, women report positive experiences, whereas when lacking, there is an increased potential for birth trauma. AimTo explore midwives’ experiences of facilitating informed decision-making, using third-stage management as context. MethodsFive midwives from Victoria, Australia, were interviewed about their experiences with informed decision-making. These interviews were guided by portraiture methodology whereby individual narrative portraits were created. This paper explores the shared themes among these five portraits. FindingsFive individual narrative portraits tell the stories of each midwife, providing rich insight into their philosophies, practices, barriers and enablers of informed decision-making. These are then examined as a whole dataset to explore shared themes, and include; ‘informed decision-making is fundamental to midwifery practice’ ‘the system’, and ‘navigating the system’. The system contained the sub-themes; hierarchy in hospitals, the medicalisation of birth, and the impact on midwifery practice, and ‘navigating the system’ – contained; safety of the woman and safety of the midwife, and the gold-standard of midwifery. Discussion and conclusionMidwives in this study valued informed decision-making as fundamental to their philosophy but also faced barriers in their ability to facilitate it. Barriers to informed decision-making included: power-imbalances; de-skilling in physiological birth; fear of blame, and interdisciplinary disparities. Conversely enablers included continuity models of midwifery care, quality antenatal education, respectful interdisciplinary collaboration and an aim toward a resurgence of fundamental midwifery skills.