Physiological Birth Research Articles

Reconciling relationships with physical activity: a qualitative study of women\u2019s postnatal physical activity decision-making

BackgroundChallenges with engaging in postnatal physical activity can negatively affect the health of women and their families. This study investigated women’s physical activity decision-making processes and strategies to support their physical activity as part of a healthy postpartum transition.MethodsThirty healthy women with infants aged 2.5–12 months completed 3-day activity diaries and an individual interview. Using Glaser and Charmaz’s grounded theory methodology, the core category, reconciling relationships with physical activity, was constructed, which explained women’s processes of postnatal physical activity decision-making.ResultsThrough reconciling relationships with physical activity, women discerned the types of physical activity they were comfortable pursuing at various points in the postpartum transition. Based on the meaning physical activity held for participants and their views about risks, supports, and resources, women gauged their capacity and the workability of their physical activity desires. Most women were uncertain of their capacity (physical, emotional) to return to physical activity and viewed the achievement of several or all of their desired physical activities as unworkable. Only a small group of women fully pursued the desirable physical activities they viewed as important for their well-being. Women adjusted the strategies they used to achieve physical activity when their expectations of capacity and workability did not align with their experiences. Some women lacked access to resources or supportive messaging about postpartum physical activity and downgraded their physical activity pursuit after negative personal physical or childcare experiences.ConclusionsWomen can benefit from discussions about physiological birth recovery and navigating community and peer resources to support physical activity access and the safe return to physical activity following birth.

Electrocardiographic Aspects of Singleton Pregnancy and Neonatal Period in American Miniature Horse Breed

Background: During pregnancy, cardiovascular adaptations occur in order to meet maternal demands and adequate support for fetal development, but they are still unclear in the equine species, especially in the American Miniature horse breed. The main hemodynamic changes that occur during pregnancy are increased heart rate, cardiac output, and blood volume. It is necessary to use the reference values for the miniature breeds, in addition to the age range and reproductive condition, so the objective of this study was to evaluate the effect of pregnancy on electrocardiographic (ECG) parameters in mares and also of age in newborns foals of American Miniature horse breed. Materials, Methods & Results: Ten American Miniature Horse mares, between 7 and 19 years old (12.14 ± 4.05 years), 116.85 ± 24.09 kg of body weight were used in the experiment. All these mares were pluriparous, with 5.9 ± 3.5 of births, minimum of 2, and maximum of 12 foaling times. They were maintained in common social group in an indoor house stable with straw bed, with access to an outdoor paddock for several h per day. Twice a day they were fed with hay. Mineral supplements and water were available ad libitum. The ECG were obtained in 10 pregnant mares and in 10 neonates. All females were examined at a representative time of each trimester of pregnancy, at 30, 210, 300 days before and 21 days after delivery. Neonates were examined on different times: first 24 h after delivery, weekly on the 7th, 14th, 21st, 28th and 35th days of age. The ECG parameters considered were the heart rate and rhythm, duration and intervals (P, PR, QRS, QT, T) and amplitude (P, R, S, T) of ECG waves. The mean of pregnancy duration was 319.4 ± 4.97 days. Heart Rate (HR) varied between 51 to 59 bpm during pregnancy and 56 bpm on the 21st day after delivery. Comparing the clinical parameters of pregnant mares, non-pregnant mares and foal a difference was found for HR, Respiration Rate (RR) and Temperature (P = 0.001). All ECG parameters of pregnant, non-pregnant and foal mares showed a significant difference (P = 0.0001), except for the amplitude of the P1, P2 and R waves, which was similar for the 3 groups. The mean values of HR and amplitude of the positive T wave were higher in foals when compared to pregnant and non-pregnant mares, which in turn did not differ from each other. The mean duration of the P wave, PR segment, QRS complex, QT segment and T wave were the same among mares and greater than in foals. Comparing pregnant and non-pregnant mares, there was a difference in only 3 parameters: duration of the QTc segment, amplitude of the S wave and negative T wave. The non-pregnant mares had a longer duration of the QTc segment and a greater amplitude of the negative T wave, while the foals had a greater amplitude of the S wave.Discussion: Although this study did not measure HR at delivery time, it is worth to consider the action of the parasympathetic autonomic nervous system close to delivery, which reduces the HR of mares. This is because at delivery, sympathetic-adrenal activation should be avoided since the increase in sympathetic tone can cause uterine atony via B2 receptors. For this reason, it has been shown that, during physiological birth, horses are under parasympathetic control, and stress response mechanisms are not activated. It was conclude that the morphometry of the waves, intervals and ECG complexes, during the evolution of the reproductive state, the electrocardiographic aspects were generally associated with heart rate (PR and QT intervals). As for neonates, there was a discrepancy among the most of ECG parameters when compared to the adult female, regardless of reproductive status, clarifying the importance of ECG patterns not only for the breed, but also for the age group.

CD68+ M1 MACROPHAGES IS ASSOCIATED WITH PLACENTAL INSUFFICIENCY UNDER FETAL GROWTH RESTRICTION

The aim: To elucidate the possible involvement of M1 and M2 macrophages in the placentas of women, whose pregnancies were complicated by fetal growth restriction (FGR) and resulted in term births after 37 weeks of gestation and preterm births up to 37 weeks of gestation. Materials and methods: CD68+ and CD163+ macrophages were studied by immunohistochemical method, placental morphology in the placentas of 16 women whose pregnancies were complicated by FGR and resulted in term births at a gestational age after 37 weeks (1-st group, n = 7) or resulted in preterm births at a gestational age up to 37 weeks (2-nd group, n = 9). The control group consisted of 10 placentas of women with physiological pregnancies and births. Results: Women 2-nd group showed significantly low weight of the placenta, a short gestation period at the time of delivery, and a prolonged labor period than women of the control group (p <0.001; p <0.001; p <0.05, respectively). The level of CD68+ and CD163+ macrophages in the placentas of women 2-nd group was significantly higher than in woman 1-st group (p <0.001, p <0.001, respectively). A significant correlation was found between the expression level of CD68+ monocytes in the intervillous space and the weight of a newborn (r = - 0.765; p = 0.016) in women 2-nd group. Conclusions: These studies suggest that in the placentas of women whose pregnancies were complicated by FGR and resulted in preterm births, the increased activation of CD68+ macrophages of the pro-inflammatory pool may be associated with disorders of the vascular and stromal component of the villous chorion with the development of involutive and dystrophic changes. In general, this fact probably determines the progress of chronic placental insufficiency and aggravates the development of fetal growth restriction.

Normal Birth: Understanding and Facilitating Women’s Comfort Measures During Labour/birth

There’s a magic that is an inherent part of the word ‘midwife’, and that is its literal meaning: ‘with woman’. While excellent clinical skills are essential for all midwives, equally important is the ability to emotionally connect with labouring women and people during the transformation that is birth, to help their bodies to work as effectively as possible, and to help them to have a positive, enjoyable birth. True midwifery magic comes when these two skills come together. This article focuses on ways that midwives can offer practical and emotional comfort, creating connections which work like a charm to help to support physiological and enjoyable births.

CURRENT ASPECTS OF DELIVERY IN HEALTHY WOMEN IN ACCORDANCE WITH THE DATA OF RETROSPECTIVE ANALYSIS

The aim: to study the current aspects of the course of labor in healthy women using retrospective indicators. Materials and methods: To study this topic, an analysis of 1,078 births on the basis of the maternity ward for pregnant women with obstetric pathology of the State Institution «IPAG. acad. O.M. Lukyanova National Academy of Medical Sciences of Ukraine». It was found that among all births, the share of first-borns was 602 (55.8 %) women, of whom 451 (41.8 %) were pregnant for the first time, and only 86 (8 %) were healthy pregnant women. Results: It was found that among 86 births the frequency of physiological births was 64%, of which in 47.7% of cases the birth was complicated, and pathological – 36%. The most common complications during childbirth were: premature rupture of membranes (PRPO), episio- and perineotomy, trauma to the birth canal. The main causes of pathological childbirth: abnormalities of labor, fetal distress, defect of the placenta and membranes, clinically narrow pelvis, malposition of the fetus and early postpartum hemorrhage. All children were born alive. It should be noted that all births where the Apgar score was ≤ 6 had no partner support, and the women themselves did not receive any preparation for childbirth. Conclusions: According to our data, in almost healthy women who gave birth for the first time and had no perinatal loss in the anamnesis, did not undergo prenatal training and did not have partner support during childbirth, the number of complications during childbirth is increasing. Therefore, this group of healthy pregnant women needs more detailed study and analysis, development of prenatal training algorithms to improve perinatal indicators.

The birthing room and its influence on the promotion of a normal physiological childbirth - a qualitative interview study with midwives in Sweden

ABSTRACT The birthing room is a major workplace for midwives but how it influences them in practice is not enough investigated. Purpose: This study aimed to explore midwives´ experiences of how the birthing room affects them in their work to promote a normal physiological birth. Methods: A phenomenological reflective lifeworld research approach was used and included individual interviews with 15 midwives working at four different hospitals in western Sweden, and of which two also assisted at homebirths. The analysis focused on the meanings of the study phenomenon. Results: A birthing room can by its design either support a normal physiological birth or support a risk approach to childbirth. Four opposing constituents complete the essential meaning of the birthing rooms, and to which the midwives need to relate in their roles as guardians for normal birth: i) a private or a public room; ii) a home-like or hospital-like room; iii) a room promoting activity or passivity; iv) a room promoting the midwife´s presence or absence. Conclusions: The birthing room mirrors a pathogenic-oriented care approach. A presupposition for the work to keep the birth bubble intact is to protect the mother from disturbing elements both inside and outside the room.

Wait and transfer, curate and prosume: Women’s social experiences of birth spaces architecture

BackgroundThe birth environment can help or hinder physiological birth and influence a woman’s level of satisfaction with birth. AimThis paper gives new theoretical insights into how spatial architecture influences birthing women and their birth processes. It builds the architectural awareness of midwives/ designers need by linking design regulations/recommendations and experiential aspects of birth spaces architecture. MethodsTwo qualitative methods were used: (1) a regulation/policy document critique, and (2) childbearing women’s spatial experiences explored in semi-structured interviews with drawing methods (24 mothers in a case study location in the north of England, UK). Themes emerged from semiotic (documents/visual data) and thematic (transcripts) analysis, and their relationships explored. FindingsThe regulatory documents revealed four spatial categorization concepts: (1) medical risk; (2) a tripartite clinical approach; (3) single-function birth space; and (4) a woman-centered approach. In contrast, women experience birth spaces architecture as an amalgam of all the spaces they use and in affective, interpersonal. Two patterns of spatial use emerged from the interviews: (1) ‘wait and transfer’ (more common in healthcare buildings); and (2) ‘curate and prosume’ (more common in women’s homes). Women gave greater positive descriptions of the ‘curate and prosume’ pattern. ConclusionsThe influence of building regulations on hospital settings and women’s prior experiences of such spaces through appointments and antenatal education, shape women’s spatial experiences of childbirth. This new evidence can act as a catalyst to evolve birth space design towards delivering woman-centered and personalized care in spaces designed for women to ‘curate and prosume’.

Are There Epigenetic Oxytocin-Mediated Effects on the Mother and Infant during Physiological Childbirth?

Introduction: Studies have shown that long-term positive behavioural and physiological changes are induced in connection with vaginal, physiological birth, and skin-to-skin contact after birth in mothers and babies. Some of these effects are consistent with the effect profile of oxytocin. This scoping review explores whether epigenetic changes of the oxytocin gene and of the oxytocin receptor gene (OTR) are involved in these effects. Methods: We searched Pubmed, Medline, BioMed Central, Cochrane Library, OVID, and Web of Science for evidence of epigenetic changes in connection with childbirth in humans, with a particular focus on the oxytocin system. Results: There were no published studies identified that were related to epigenetic changes of oxytocin and its receptor in connection with labour, birth, and skin-to-skin contact after birth in mothers and babies. However, some studies were identified that showed polymorphisms of the oxytocin receptor influenced the progress of labour. We also identified studies in which the level of global methylation was measured in vaginal birth and caesarean section, with conflicting results. Some studies identified differences in the level of methylation of single genes linked to various effects, for example, immune response, metabolism, and inflammation. In some of these cases, the level of methylation was associated with the duration of labour or mode of birth. We also identified some studies that demonstrated long-term effects of mode of birth and of skin-to-skin contact linked to changes in oxytocin function. Conclusion: There were no studies identified that showed epigenetic changes of the oxytocin system in connection with physiological birth. The lack of evidence, so far, regarding epigenetic changes did not exclude future demonstrations of such effects, as there was a definite role of oxytocin in creating long-term effects during the perinatal period. Such studies may not have been performed. Alternatively, the oxytocin linked effects might be indirectly mediated via other receptors and signalling systems. We conclude that there is a significant lack of research examining long-term changes of oxytocin function and long-term oxytocin mediated adaptive effects induced during physiological birth and skin-to-skin contact after birth in mothers and their infants.

Understanding how midwives employed by the National Health Service facilitate women's alternative birthing choices: Findings from a feminist pragmatist study.

UK legislation and government policy favour women’s rights to bodily autonomy and active involvement in childbirth decision-making including the right to decline recommendations of care/treatment. However, evidence suggests that both women and maternity professionals can face challenges enacting decisions outside of sociocultural norms. This study explored how NHS midwives facilitated women’s alternative physiological birthing choices–defined in this study as ‘birth choices that go outside of local/national maternity guidelines or when women decline recommended treatment of care, in the pursuit of a physiological birth’. The study was underpinned by a feminist pragmatist theoretical framework and narrative methodology was used to collect professional stories of practice via self-written narratives and interviews. Through purposive and snowball sampling, a diverse sample in terms of age, years of experience, workplace settings and model of care they operated within, 45 NHS midwives from across the UK were recruited. Data were analysed using narrative thematic that generated four themes that described midwives’ processes of facilitating women’s alternative physiological births: 1. Relationship building, 2. Processes of support and facilitation, 3. Behind the scenes, 4. Birth facilitation. Collectively, the midwives were involved in a wide range of alternative birth choices across all birth settings. Fundamental to their practice was the development of mutually trusting relationships with the women which were strongly asserted a key component of safe care. The participants highlighted a wide range of personal and advanced clinical skills which was framed within an inherent desire to meet the women’s needs. Capturing what has been successfully achieved within institutionalised settings, specifically how, maternity providers may benefit from the findings of this study.

An ethnographic study of the interaction between philosophy of childbirth and place of birth

BackgroundOrganisational culture and place of birth have an impact on the variation in birth outcomes seen in different settings. AimTo explore how childbirth is constructed and influenced by context in three birth settings in Australia. MethodThis ethnographic study included observations of 25 healthy women giving birth in three settings: home (9), two birth centres (10), two obstetric units (9). Individual interviews were undertaken with these women at 6–8 weeks after birth and focus groups were conducted with 37 midwives working in the three settings: homebirth (11), birth centres (10) and obstetric units (16). ResultsAll home birth participants adopted a forward leaning position for birth and no vaginal examinations occurred. In contrast, all women in the obstetric unit gave birth on a bed with at least one vaginal examination. One summary concept emerged, Philosophy of childbirth and place of birth as synergistic mechanisms of effect. This was enacted in practice through ‘running the gauntlet’, based on the following synthesis: For women and midwives, depending on their childbirth philosophy, place of birth is a stimulus for, or a protection from, running the gauntlet of the technocratic approach to birth. The birth centres provided an intermediate space where the complex interplay of factors influencing acceptance of, or resistance to the gauntlet were most evident. ConclusionsA complex interaction exists between prevailing childbirth philosophies of women and midwives and the birth environment. Behaviours that optimise physiological birth were associated with increasing philosophical, and physical, distance from technocratic childbirth norms.

Interdisciplinary Physiological Birth Skills and Drills

We sought to implement an interdisciplinary program to educate and encourage our obstetric providers to apply best practices for supporting vaginal birth in response to the California Maternal Quality Care Collaborative’s (CMQCC) comprehensive and evidence-based Toolkit to Support Vaginal Birth and Reduce Primary Cesareans. Through use of CMQCC’s toolkit and supplementary evidence-based resources, an interdisciplinary team of physicians, certified nurse midwives, and nurses was assembled and created learning objectives and interactive skills stations over several months. We focused on increasing the use of evidence-based practices in support of physiological birth, improving maternal and neonatal outcomes, and increasing patients’ satisfaction with their birth experience. All interdisciplinary staff on the labor and delivery unit and obstetric triage unit was required to attend an inperson interactive skill session that included five physiological birth–related stations. The skill sessions were offered on four occasions. Participants included faculty providers and residents, advanced practice nurses, and clinical nurses. Stations were led by trained providers, including nurses, certified nurse midwives, and physicians. A total of 126 staff attended the four sessions. A survey assessment of those who participated in our skills and drills sessions showed an overall program evaluation of 3.80 of 4.00. Participant comments included, “I consider myself to be generally familiar with physiologic birth, but still I learned so much!” and, “So fun and educational! Especially for MD, we don’t get a lot of this.” As a Magnet hospital with an emphasis on evidence-based practice, nurses and leadership have a responsibility to examine current practices and initiate those that are evidence based and quality driven. Key strategies to support intended vaginal birth will affect maternal and neonatal outcomes and increase patients’ satisfaction with their birth experience.

Birth Outcomes Associated With Induction and Augmentation: A Population Health Perspective

Normal physiological birth occurs when biological and psychological conditions support intended vaginal births and reduce primary cesarean births. Induction and augmentation of labor are hospital interventions associated with disrupting normal physiological birth. The purpose of this study was to examine the association between induction and augmentation of labor with childbirth outcomes in low-risk nulliparous women. A secondary data analysis was conducted using birth registry data from two diverse northeastern states in the United States from 1992 to 2014. Chi-square tests were used to evaluate the relationship between use of induction and augmentation of labor with childbirth outcomes. After evaluating these relationships and adjusting for potential confounders, multivariable logistic regression models were used to estimate the odds ratio of childbirth outcomes with induction and augmentation of labor. Of the 3.5 million births in the two states, 650,237 deliveries met the inclusion criteria of nulliparous, low-risk, singleton pregnancy at term and not breech. After adjusting for potential confounders, induction at 39 weeks gestation in State 1 was associated with a 50% greater likelihood of having a primary cesarean compared with no induction from 39 to 41 weeks gestation (adjusted odds ratio, 1.50 [95% CI 1.40–1.62]). In State 2, induction during gestational week 39 was associated with a 71% greater likelihood of having a primary cesarean birth compared with no induction between 39 to 41 completed weeks gestation (adjusted odds ratio1.71 [95% CI 1.65–1.77]). Augmentation of labor was associated with increased assisted vaginal birth in both states compared with births that were not augmented. Less reliance on induction or augmentation in low-risk nulliparous women could result in better birth outcomes and support women in their endeavor to achieve a normal physiological birth.

Development of a Labor Support Course to Reduce Primary Cesareans and Support Vaginal Births

This podium presentation provides a plan for developing a labor support program for the obstetric staff. Labor support education is an intricate component of the American College of Obstetricians and Gynecologists’ safety bundle, Safe Reduction of Primary Cesarean Births: Supporting Intended Vaginal Births. The Perinatal Quality Collaborative of North Carolina (PQCNC) provides labor support classes across the state as a component of the initiative to reduce primary cesareans. The course offers a didactic component to enhance the understanding of optimal fetal positioning in labor; interactive training for physical and emotional support in labor; review of case scenarios; and hands-on practice stations to support vaginal birth. The enhanced education and skills of the obstetric staff for labor support will optimize the likelihood of a healthy labor and vaginal birth for maternity patients. Developing a labor support course that includes didactic education on the process of labor and a tool kit of equipment that can be used on the maternity unit may result in reducing primary cesarean births. The course is primarily attended by nurses, but it is recommended that all providers on the team can benefit from attending. Information from the course can be included in patient childbirth education as well. Tracking of outcomes for postpartum women and their newborns through reduction in operative births is being evaluated in North Carolina. Patient discharge surveys can be used to qualify the effect on the labor and birth experience. Conducting case reviews to assess improvements to care and for team members’ success can be performed and will contribute to the existing research data on nurse support in labor. The Association of Women's Health, Obstetric and Neonatal Nurses ( AWHONN ) has published a nurse's guide to supporting physiological birth and the American College of Nurse-Midwives published a healthy birth initiative bundle for promoting comfort in labor. Enhanced supportive nursing care of women during labor and birth is supported by their professional organizations and is evidence based. Beyond the labor and birth outcomes, labor support can improve Apgar scores in the newborn and reduce negative childbirth experiences.

Promotion of Safe and Effective Physiological Birth in a Tertiary Care Center Through Use of the American College of Nurse-Midwives’ Intermittent Auscultation Bundle

Promotion of Safe and Effective Physiological Birth in a Tertiary Care Center Through Use of the American College of Nurse-Midwives’ Intermittent Auscultation Bundle

Features of the cytokine profile in the structures of chorion and placenta in premature termination of pregnancy

The placenta is a mirror of pregnancy. The formation of a healthy placenta predetermines embryo-endometrial relationships, which are regulated by cytokines. The study of the role of cytokines in the regulation of the gestation process in miscarriage is relevant.The aim of the work is to establish markers of miscarriage based on the study of features of the cytokine profile in the structures of the chorion and placenta in premature termination of pregnancy.Materials and methods. 22 chorions and 26 placentas from women with a history of reproductive loss and termination of current pregnancy were examined (the main group). The control was the tissue of the chorion, taken after artificial abortion in 20 women, and 20 placentas from uncomplicated pregnancy and physiological births in women with the first pregnancy. The placenta was examined according to the protocol (form No. 013-1/0). Expression of TNF-a, CD31/PECAM-1, CD45/T200/LCA in chorion and placenta structures were determined by immunohistochemistry.Results. The termination of pregnancy in the first trimester is accompanied by a violation of the ratio of cytokines - an increase in the expression of TNF-α and a decrease in the expression of CD31/PECAM-1 in the structures of the endometrium and villous chorion. The results indicate a shift in the immunological balance towards an inflammatory response and a violation of the cytotrophoblastic invasion. Inflammation plays a leading role in the development of preterm birth. Structural and functional changes in the placenta against the background of inflammation make up the morphological substrate of chronic placental dysfunction, which, in a case of decompensation, triggers the process of preterm birth.Conclusions. The cytokine marker of terminating pregnancy in the first trimester is the high expression of TNF-α in the structures of chorion and endometrium in combination with low expression of CD31/PECAM-1 in the endothelium of the spiral arteries, in the intravascular and interstitial cytotrophoblast. The marker of inflammation is a moderate expression of TNF- α in the invasive cytotrophoblast, decidual cells and terminal villi of placenta in combination with high expression of CD45/T200/LCA in the decidual membrane.

How do midwives facilitate women to give birth during physiological second stage of labour? A systematic review.

Both nationally and internationally, midwives' practices during the second stage of labour vary. A midwife's practice can be influenced by education and cultural practices but ultimately it should be informed by up-to-date scientific evidence. We conducted a systematic review of the literature to retrieve evidence that supports high quality intrapartum care during the second stage of labour. A systematic literature search was performed to September 2019 in collaboration with a medical information specialist. Bibliographic databases searched included: PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Maternity and Infant Care Database and The Cochrane Library, resulting in 6,382 references to be screened after duplicates were removed. Articles were then assessed for quality by two independent researchers and data extracted. 17 studies focusing on midwives' practices during physiological second stage of labour were included. Two studies surveyed midwives regarding their practice and one study utilising focus groups explored how midwives facilitate women's birthing positions, while another focus group study explored expert midwives' views of their practice of preserving an intact perineum during physiological birth. The remainder of the included studies were primarily intervention studies, highlighting aspects of midwifery practice during the second stage of labour. The empirical findings were synthesised into four main themes namely: birthing positions, non-pharmacological pain relief, pushing techniques and optimising perineal outcomes; the results were outlined and discussed. By implementing this evidence midwives may enable women during the second stage of labour to optimise physiological processes to give birth. There is, however, a dearth of evidence relating to midwives' practice, which provides a positive experience for women during the second stage of labour. Perhaps this is because not all midwives' practices during the second stage of labour are researched and documented. This systematic review provides a valuable insight of the empirical evidence relating to midwifery practice during the physiological second stage of labour, which can also inform education and future research. The majority of the authors were members of the EU COST Action IS1405: Building Intrapartum Research Through Health (BIRTH). The study protocol is registered in the International Prospective Register of Systematic Reviews (PROSPERO; Registration CRD42018088300) and is published (Verhoeven, Spence, Nyman, Otten, Healy, 2019).

Nursing Support During Latent Phase Labor: A Scoping Review.

The purpose of this scoping review was to synthesize the literature on nursing support during the latent phase of the first stage of labor. In 2014, the definition of the beginning of active labor changed from 4 centimeters (cm) to 6 cm cervical dilation. More women may have an induction of labor based on results of recent research showing no causal increase in risk of cesarean birth with elective induction of labor for low-risk nulliparous women. Therefore, in-hospital latent phase labor may be longer, increasing the need for nursing support. Scoping review of the literature from 2009 to present. We conducted the review using key words in PubMed, CINAHL, and Scopus. Search terms included different combinations of "latent or early labor," "birth," "support," "nursing support," "obstetrics," and "onset of labor." Peer-reviewed research and quality improvement articles from 2009 to present were included if they had specific implications for nursing care during the latent phase of labor. Articles were excluded if they were not specific to nursing, focused exclusively on tool development, or were from the perspective of pregnant women or providers only. Ten articles were included. Results were synthesized into six categories; support of physiologic labor and birth, the nurse's own personal view of labor, birth environment, techniques and tools, decision-making, and importance of latent labor discussion during the prenatal period. Support for physiologic labor and birth is an important consideration for use of nonpharmacological methods during latent labor. The nurse's own personal view on labor support can influence the support that laboring women receive. Nurses may need additional education on labor support methods.

The Contributions of Physiologic Birth and Cesarean Delivery to Attachment and Social Skills of 6-Year-Old Children

The aim of the current study is to investigate the contributions of physiologic birth and cesarean delivery to attachment and social skills of 6-year-old children. A causal-comparative research design was employed. The study was conducted during the Fall of 2017 and Spring of 2018 in 2 low SES state preschools randomly-selected in Bağcılar District, in İstanbul. The sample of the study is made up of a total of 50 children (23 girls and 27 boys). 20 of the children were normally delivered whereas 30 of them were cesarean born. Incomplete Stories with a Doll Family (ISDF) and Social Skills Rating System (SSRS) were used for the data collection. A t-test and One-Way ANOVA were employed for the data analysis. The results showed that that attachment levels and social skills of 5- and 6 year-old children differed significantly by types of child delivery favoring normally born children.

No More ‘Hands off the Breech’

This article explores recent research about physiological breech birth and implications for midwifery practice, challenging whether some ‘common understandings’ for breech births are evidence based. For example, ‘hands off the breech’, has been the golden rule, but how long is it safe to remain hands off? If you have only been taught supine manoeuvres, should you ask the woman to give birth on her back for her baby’s safety? The article ends with a call for developing more local midwife breech specialists, working with one voice alongside their obstetric colleagues.

Seeing birth in a new light: The transformational effect of exposure to homebirth for hospital-based midwives

ObjectiveThe aim of the study was to explore hospital-based midwives' experiences of providing publicly-funded homebirth services in Australia. DesignA qualitative descriptive study using a constructivist grounded theory methodology was undertaken. SettingFive different states or territories of Australia where publicly-funded homebirth services were operating. ParticipantsInterviews were conducted with 21 midwives and midwifery managers from eight different public hospitals who had recent experience of working in, or with, publicly-funded homebirth models. FindingsWitnessing undisturbed birth in the home setting transformed midwives' attitudes towards birth. Following exposure to homebirth, many midwives felt they were seeing undisturbed birth for the first time. This led them to question their current understanding of physiological birth and develop a new awareness of the powerful influence that the environment has on labouring women. This new understanding resulted in changes to their practice. Key ConclusionsFor midwives accustomed to working in hospital settings, exposure to homebirth deepened their understanding of physiological birth, resulting in a perspective transformation and subsequent shift in practice. Implications for practice: Exposure to homebirth may motivate midwives to alter their practice in both home and hospital settings in order to shift the power dynamic between women and caregivers and protect women from unnecessary disturbance during labour.