Childbirth Process Research Articles

Fast soft-tissue deformations coupled with mixed reality toward the next-generation childbirth training simulator.

High-quality gynecologist and midwife training is particularly relevant to limit medical complications and reduce maternal and fetal morbimortalities. Physical and virtual training simulators have been developed. However, physical simulators offer a simplified model and limited visualization of the childbirth process, while virtual simulators still lack a realistic interactive system and are generally limited to imposed predefined gestures. Objective performance assessment based on the simulation numerical outcomes is still not at hand. In the present work, we developeda virtual childbirth simulator based on the Mixed-Reality (MR) technology coupled with HyperMSM (Hyperelastic Mass-Spring Model) formulation for real-time soft-tissue deformations, providing intuitive user interaction with the virtual physicalmodel and a quantitative assessment to enhance the trainee's gestures. Microsoft HoloLens 2 was used and the MR simulator was developed including a complete holographic obstetric model. A maternalpelvis system modelof a pregnant woman (including the pelvis bone, the pelvic floor muscles, the birth canal, the uterus, and the fetus) was generated, and HyperMSM formulation was applied to simulate the soft tissue deformations. To induce realistic reactions to free gestures, the virtual replicas of the user's detected hands were introduced into the physical simulation and were associated with a contact model between the hands and the HyperMSM models. The gesture of pulling any part of the virtual models with two hands was also implemented. Two labor scenarios were implemented within the MR childbirth simulator: physiological labor and forceps-assisted labor. A scoring system for the performance assessment was included based on real-time biofeedback. As results,our developedMR simulation application was developed in real-time with a refresh rate of 30-50 FPS on the HoloLens device. HyperMSM model was validated using FE outcomes: high correlation coefficients of [0.97-0.99] and weighted root mean square relative errors of 9.8% and 8.3% were obtained for the soft tissue displacement and energy density respectively. Experimental tests showed that the implemented free-user interaction system allows to apply the correct maneuvers (in particular the "Viennese" maneuvers) during the labor process, and is capable to induce a truthful reaction of the model. Obtainedresults confirm alsothe possibility of using our simulation's outcomes to objectively evaluate the trainee's performance with a reduction of 39% for the perineal strain energy density and 5.6mm for the vertical vaginal diameter when the "Viennese" technique is applied. This present study provides, for the first time, an interactive childbirth simulator with an MR immersive experience with direct free-hand interaction, real-time soft-tissue deformation feedback, and an objective performance assessment based on numerical outcomes. This offers a new perspective for enhancing next-generation training-based obstetric teaching. The used models of the maternal pelvic system and the fetus will be enhanced, and more delivery scenarios (e.g. instrumental delivery, breech delivery, shoulder dystocia) will be designed and integrated. The third stage of labor will be also investigated to include the delivery of the placenta, and the clamping and cutting of the umbilical cord.

Жіночий досвід у перинатальному періоді

Perinatal experience is an important stage in the life of every mother and her child. The childbirth process can be a source of emotional satisfaction and strengthen the bond between the mother and the newborn baby. However, a negative childbirth experience can create feelings of fear towards future deliveries, the need for cesarean section, the risk of developing post-traumatic stress and postpartum depression, as well as problems with breastfeeding. Purposе - to study the level of women’s satisfaction with childbirth in order to improve perinatal care. Materials and methods. A prospective cohort study was conducted involving 321 mothers who completed the satisfaction scale for childbirth and delivery. Descriptive statistics were utilized for data analysis. It was found that the data distribution deviates from the normal distribution. The median value (Me) and the interquartile range (Q I - Q III) were calculated for the dataset. Results. The satisfaction scale helped identify the advantages and disadvantages of the childbirth experience in four key aspects of vaginal delivery. 1. Own capacity: a) Advantages: 76% of women felt strong; 79.3% - felt confident; 67.4% - felt happy. b) Disadvantages: 54% - felt that their childbirth experience matched their plans; 76.2% - felt tired. 2. Professional support: a) Advantages: 86.8% - felt they received sufficient attention and information from their caregivers; 84.8% - felt a comfortable and warm atmosphere; 84.8% - felt their needs were understood; 89.3% - felt they received proper care and assistance; b) Disadvantages: None, as the majority of women felt satisfied with the professional support. 3. Perceived safety: a) Advantages: 86% - felt safe; 89% - had trust in the professional abilities of the healthcare team; 68% - had many positive memories, while 1% had many negative memories; b) Disadvantages: 31% - experienced a low level of anxiety, while 16% - experienced a high level of anxiety. 4. Participation: a) Advantages: 67% - had the opportunity to choose a pain relief method; 60% - had the opportunity to change positions, while 21% did not; 86% - felt they received sufficient attention and information from the medical team; b) Disadvantages: Some women did not have the opportunity to choose a pain relief method (33%) or change positions during childbirth (21%). Conclusions. The study of women’s satisfaction with childbirth indicated the need for improvement in the aspect of «perceived safety». «Own capability», «professional support», and «participation» demonstrate high satisfaction, indicating the quality of perinatal care. The level of satisfaction can become a key indicator of the quality of perinatal care, contributing to the improvement of hospital efficiency assessment and quality of medical services». The study was conducted in accordance with the principles of the Helsinki Declaration. The research protocol was approved by the Local Ethical Committee of the institution specified in the work. Informed consent for participation in the study was obtained from the women. No conflict of interests was declared by the authors.

Pengaruh Video Edukasi Hypnobirthing untuk Mengatasi Tokophobia pada Wanita Usia Produktif

Pregnancy is a time awaited by many women. Entering pregnancy, there are many changes that occur both biologically due to hormonal changes, but also psychologically. Pregnancy generally occurs at a productive age before entering menopause. Pregnancy is a difficult phase, so many pregnant women experience excessive fear and anxiety during pregnancy and childbirth, due to many factors, both internal and external. Fear and anxiety are usually more felt in pregnant women with their first child, but in subsequent pregnancies there are still many who experience fear and anxiety. This is very bad if not handled properly, because it can endanger the condition of pregnant women and also their womb. Tokophobia is a common condition characterized by fear experienced by women in relation to the processes of pregnancy and childbirth. Various stakeholders, including healthcare professionals, psychologists, media outlets, and specialized teams, have sought solutions to address tokophobia. One popular approach is hypnotherapy, particularly hypnobirthing, which supports the processes of pregnancy and childbirth. Hypnobirthing involves the utilization of positive suggestions to facilitate and ease the process of childbirth while reducing potential fears experienced by the mother. Educational videos are frequently employed within hypnobirthing, combining auditory and visual elements to provide positive benefits to viewers. Based on research and testing conducted on 15 productive age pregnant women with tokophobia in Pekanbaru, the use of educational hypnobirthing videos has proven to have a positive impact in reducing levels of fear throughout the pregnancy process.

Trend and Reasons of Women Towards the Choice for Place of Delivery: Evidence from Mics 2017-18 Punjab, Pakistan

Objective: To assess the attitudes and reasons of women towards the choice for place of delivery as per the data from the Multiple Indicators Cluster Survey (MICS) 2017-18, Punjab, Pakistan. Material and methods: Observational Study conducted at 36 districts of the Punjab, 2017-18A total of 53,840 households were drawn as the sample size from 2,692 sample clusters, out of which 1,893 were rural clusters and 799 were urban clusters. From 53,840 households, 52,765 households occupied and 51,660 were successfully interviewed. Therefore, the response rate was 97.9%. According to survey results, 79,510 women had been eligible for interview of age group 15-49 years. Out of which 74,010 women were interview successfully with the response rate 93.1%. Further, out of these 74,010 women, there were 26,980 women who had ever or currently married, and out of these women 15,656 women gave birth in the last two years. In our study, we considered the place of delivery as an outcome variable and wanted to identify the associated socio-demographic and socioeconomic characteristics that were expected to be responsible for shifting the trend from the public to the private sector for delivery. To check the association and for statistical testing of hypothesis, Chi-square test for association was applied. We also applied multinomial logistic regression to identify the predictors for the place of delivery by using SPSS. P-value ?0.05 was considered as significant. Results: Majority of the women (43.5%) delivered their babies in the private sector while (29.7%) of women delivered their babies in public sector hospitals, and (26.4%) women prefered home delivery. In the comparison of area of residence, urban women compared to rural women were more likely to choose public sector hospitals for their deliveries OR=1.02 (0.94-1.09) 95% CI, p=0.000, for home deliveries OR=1.293 (1.154-1.45) 95% CI, p=0.000 and for other OR=2.341 (1.196-4.582)95% CI, p=0.013. In the comparison of regions of Punjab, the women of South and Central Punjab were more likely to choose private sector hospitals for delivery, OR=1/0.535=1.87 (0.478-0.600)95% CI, p=0.000 and OR=1/0.624=1.61 (0.564-0.690)95% CI, p=0.000, respectively. The women who get antenatal care had 2.84 times more chances, as compared to the women who did not get antenatal care visits, to deliver in the private sector OR=0.353 (0.213-0.538)95% CI, p=0.000. About the model fitting, chi-square value=3527.06, Cox & Snell=0.202 and p=0.000 suggested that the predictors in the model had a significant effect. Conclusion: Overall women prefer to undergo childbirth process in private sector hospital while women of urban area prefer public sector hospital. It may be related to facilities present in private sector hospitals or it may due to the fact that public healthcare facilities are not accessible to everybody especially in rural areas. In modern era, still many women prefer home delivery.

Association of workload and practice of respectful maternity care among the healthcare providers, before and during the early phase of COVID-19 pandemic in South Western Nepal: a cross-sectional study

IntroductionRespectful maternity care is an approach that involves respecting women’s belief, choices, emotions, and dignity during the childbirth process. As the workload among maternity care workforce affects intrapartum quality care, respectful maternity care might have also been affected, particularly during the pandemic. Thus, this study was conducted to examine the association between workload among healthcare providers and their practice of respectful maternity care, before and during the early phase of pandemic.MethodsA cross-sectional study was conducted in South Western Nepal. A total of 267 healthcare providers from 78 birthing centers were included. Data collection was done through telephone interviews. The exposure variable was workload among the healthcare providers, and the outcome variable was respectful maternity care practice before and during the COVID-19 pandemic. Multilevel mixed-effect linear regression was used to examine the association.ResultsThe median client-provider ratio before and during the pandemic was 21.7 and 13.0, respectively. The mean score of respectful maternity care practice was 44.5 (SD 3.8) before the pandemic, which was decreased to 43.6 (SD 4.5) during the pandemic. Client-provider ratio was negatively associated with respectful maternity care practice for both times; before (Coef. -5.16; 95% CI -8.41 to -1.91) and during (Coef. -7.47; 95% CI -12.72 to -2.23) the pandemic.ConclusionsWhile a higher client-provider was associated with a lower respectful maternity care practice score both before and during the COVID-19 pandemic, the coefficient was larger during the pandemic. Therefore, workload among the healthcare providers should be considered before the implementation of respectful maternity care, and more attention should be given during the pandemic.

Mistreatment of women during childbirth and its influencing factors in public maternity hospitals in Tehran, Iran: a multi-stakeholder qualitative study

BackgroundMistreatment during labour and childbirth is a common experience for many women around the world. This study aimed to explore the manifestations of mistreatment and its influencing factors in public maternity hospitals in Tehran.MethodsA formative qualitative study was conducted using a phenomenological approach in five public hospitals between October 2021 and May 2022. Sixty in-depth face-to-face interviews were conducted with a purposive sample of women, maternity healthcare providers, and managers. Data were analyzed with content analysis using MAXQDA 18.ResultsMistreatment of women during labour and childbirth was manifested in four form: (1) physical abuse (fundal pressure); (2) verbal abuse (judgmental comments, harsh and rude language, and threats of poor outcomes); (3) failure to meet professional standards of care (painful vaginal exams, neglect and abandonment, and refusal to provide pain relief); and (4) poor rapport between women and providers (lack of supportive care and denial of mobility). Four themes were also identified as influencing factors: (1) individual-level factors (e.g., providers’ perception about women’s limited knowledge on childbirth process), (2) healthcare provider-level factors (e.g., provider stress and stressful working conditions); (3) hospital-level factors (e.g., staff shortages); and (4) national health system-level factors (e.g., lack of access to pain management during labour and childbirth).ConclusionsOur study showed that women experienced various forms of mistreatment during labour and childbirth. There were also multiple level drivers for mistreatment at individual, healthcare provider, hospital and health system levels. Addressing these factors requires urgent multifaceted interventions.

Women's experiences with implementation of the physiologic birth program in Iran: a qualitative content analysis study.

Increased rate of caesarean section (CS) without medical indication is a global concern. According to the guidelines of the World Health Organization (WHO), the physiologic birth program is one of the strategies for reducing the rate of unnecessary caesarean sections. The aim of this study is to explain women's experiences with the implementation of the physiologic birth program in Iran. This study is a part of a mixed-method study involving 15 targeted semi-structured interviews individually conducted with women attending physiologic birth classes between January 2022 and June 2022. Interviews continued until data saturation was achieved. Data were analyzed using conventional content analysis approach based on the criteria proposed by Graneheim and Lundman, using MAXQDA10 software. Analysis of the findings of the study led to the emergence of 2 themes, 4 categories, and 10 subcategories. The first theme was the positive experiences of the women ("satisfaction with pregnancy" and "making the childbirth process pleasant"), and the second theme was their negative experiences with physiologic birth ("challenges and limitation of physiologic birth program" and "lack of high-quality obstetric services in the public health system"). The results of this study showed that childbirth preparation classes reduced women's fear and stress and enhanced their positive attitude toward vaginal delivery by preparing them for childbirth. Also, effective communication with midwives and their support along with efficient implementation of physiologic birth techniques led to successful pain management and satisfaction with the birth process. Policymakers should implement strategies to remove limitations and make this program accessible to all women.

POISSON REGRESSION MODELING GENERALIZED IN MATERNAL MORTALITY CASES IN ACEH TAMIANG REGENCY

Maternal Mortality Rate (MMR) is the number of maternal deaths due to the process of pregnancy, childbirth, and postpartum which is used as an indicator of women's health degrees. The number of maternal deaths in Aceh Tamiang Regency in 2021 is a discrete random variable distributed by Poisson. The purpose of this study is to find out what poisson regression model is generalized in the case of MMR in Aceh Tamiang Regency in 2021 and what factors affect the AKI in Aceh Tamiang Regency in 2021. The research data was obtained from the Aceh Tamiang District Health Office. This type of research is quantitative by using the Generalized Poisson Regression method. The data used are maternal mortality rates and data on factors affecting MMR in Aceh Tamiang Regency in 2021. Influencing factors are the percentage of visits by pregnant women in K1 , percentage of visits by pregnant women K4 , percentage of maternity assistance by health workers , TT immunization of pregnant women , pregnant women who get Fe tablets , and puerperal ministry . Based on the results of research, the factors that affect the maternal mortality rate in Aceh Tamiang Regency in 2021 are TT immunizations for pregnant women (X4) with a p-value of 0.009 which states that for every additional TT immunization of pregnant women by 1%, the average maternal mortality rate also decreases by . The form of the generalized poisson regression model obtained is .

Pregnant in a Pandemic: Mental Wellbeing and Associated Healthy Behaviors Among Pregnant People in California During COVID-19

IntroductionPregnancy is a time of increased vulnerability to mental health disorders. Additionally, the COVID-19 pandemic has increased the incidence of depression and anxiety. Thus, we aimed to assess mental health and associated healthy behaviors of pregnant people in California during the pandemic in order to contextualize prenatal well-being during the first pandemic of the twenty-first century.MethodsWe conducted an online cross-sectional study of 433 pregnant people from June 6 through July 29, 2020. We explored 3 hypotheses: (1) mental health would be worse during the pandemic than in general pregnant samples to date; (2) first-time pregnant people would have worse mental health; and (3) healthy behaviors would be positively related to mental health.ResultsMany of our participants (22%) reported clinically significant depressive symptoms and 31% reported clinically significant anxiety symptoms. Multiparous pregnant people were more likely to express worries about their own health and wellbeing and the process of childbirth than were primiparous pregnant people. Additionally, as pregnancy advanced, sleep and nutrition worsened, while physical activity increased. Lastly, anxious-depressive symptomology was significantly predictive of participant sleep behaviors, nutrition, and physical activity during the past week.DiscussionPregnant people had worse mental health during the pandemic, and this was associated with worse health-promoting behaviors. Given that the COVID-19 pandemic and associated risks are likely to persist due to low vaccination rates and the emergence of variants with high infection rates, care that promotes mental and physical well-being for the pregnant population should be a public health priority.

A qualitative study of women's experiences with obstetric violence during childbirth in Turkey

Objectivesto examine and explain the feelings, thoughts and experiences of women who reported that they had experienced obstetric violence at any stage of the childbirth process (i.e. pregnancy, delivery and postpartum) in Turkey. Designa phenomenological qualitative study using the theoretical thematic analysis approach in data analysis. Settingdata were collected in individual in-depth interviews via video conferencing between 24 February 2021 and 16 November 2021. Participants27 women who reported that they had experienced obstetric violence during the childbirth process and who met the study inclusion criteria. Resultsparticipants who reported that they had experienced obstetric violence were categorised into the following themes: (1) types of obstetric violence; (2) failure to meet professional standards of care; (3) reactions; and (4) awareness. Women with different sociodemographic and obstetric characteristics were exposed to diverse types of obstetric violence, causing them to feel stress, anxiety, worry, sadness, helplessness, anger and fear. They had certain expectations of health professionals (e.g. midwives, nurses and physicians), and did not have prior awareness of obstetric violence. Key conclusionsobstetric violence against women during the childbirth process is a serious problem in the Turkish care system that has a negative effect on women's health. Implications for practiceawareness of obstetric violence should be increased amongst health professionals and women receiving healthcare services. Further studies should be conducted to determine the prevalence of obstetric violence, and relevant training programmes should be developed to eliminate this type of violence against women in health facilities.

Comparison of the Performance Results of C4.5 and Random Forest Algorithm in Data Mining to Predict Childbirth Process

Technology advancements in the world of information have made it easier for many people to process data. Data mining is a process of mining more valuable information from large data sets. The research aims to determine the difference between the C.45 and random forest algorithms in data mining to predict the childbirth process of pregnant women. It compares the accuracy of the performance results of the C4.5 and random forest algorithms to predict the delivery process for pregnant women. Then, experimental research is conducted to classify the childbirth process in Situbondo, Indonesia, by applying the C.45 and the random forest algorithm in the data mining. The decision tree J48 algorithm is used for the C4.5 algorithm in the research. Both algorithms are compared for their error classification and accuracy level. The research uses 1,000 data for training and 200 data for testing. The results show the accuracy of implementing the C4.5 and random forest algorithms with data mining using 10-fold cross-validation, generating 96% and 95% as correctly classified data. Then, the Relative Absolute Error for both algorithms has the same result. It is 15%. The C4.5 algorithm has a better result than the random forest algorithm by comparing the performance results. Further research can add more data to improve the accuracy of the analysis results by using another algorithm.

Did everyone change their childbirth plans due to the COVID-19 pandemic? A web-based cross-sectional survey of Polish pregnant women.

With the worldwide outbreak of coronavirus, a significant impact has been observed on the functioning of healthcare systems and the process of childbirth. Women probably did not even have a choice to adjust their plans accordingly to the current situation. The aim of the study was to examine how the outbreak of the SARS CoV-2 pandemic state affected the decisions of pregnant women about their childbirth plan. This cross-sectional study was performed using a web-based survey published on social media in Poland. The cross-sectional study was performed using web-based questionnaires. The study group included Polish women who changed their childbirth plans, compared to a group of women not sure about delivery plan change and those whose plans had not changed. The data were collected from 4 March 2020 to 2 May 2020, when the first rising count of new infections was observed in Poland and worldwide. Statistical analysis was performed using STATISTICA Software, Inc., 13.3 (2020). Of 969 women who completed the questionnaire and were enrolled into the study, 57.2% had not changed their childbirth plans (group I), 28.4% had changed their plans (group II), and 14.4% of respondents answered "not sure" to this question (group III). The majority of women changed their birth plans during the pandemic because of the potential absence of their partner during labour (56% of women who had changed their plans and 48% of those whose answer was "I am not sure", p < .001). Another reason was the fear of separation from the child after delivery (33% of women who had changed their plans and 30% of those whose answer was "I am not sure", p < .001). Restrictions due to the COVID-19 outbreak have influenced the childbirth plans of pregnant women. The changes were independent of women's vision of birth before the pandemic. The restriction on births with accompanying person and the risk of separation from their infant after childbirth significantly influenced the decision-making process. As a result, some women were more likely to opt for a home birth with or even without medical assistance. The study participants were women who were pregnant at the time of completing the questionnaire, were over 18 years old and spoke Polish.

THE ROLE OF MELATONIN IN COMPLICATED PREGNANCY

In recent years, there have been signifi cant changes in the understanding of the hormone melatonin (MT). It has been confi rmed that the processes of conception, pregnancy, and childbirth directly depend on the rhythm and level of MT secretion, but there is no general concept that could describe in detail the mechanisms of infl uence on ontogenesis. The aim of the study. To assess MT in the blood of pregnant with retrochorial hematoma (RCH) up to 12 weeks of pregnancy.Material and methods. Two groups were formed: 1st – 40 pregnant women with RCH, 2nd control– 44 healthy pregnant. Obstetric research, enzyme immunoassay to determine MT, and ultrasound were performed. Statistical analysis according to generally accepted methods of variational statistics.The approval of the scientifi c work was obtained from the Bioethical Commission of the Bukovinian State Medical University (Ukraine).Research results. A signifi cant decrease of MT in the 1st group and the dependence of its level on the size of the RCH was revealed: in the case of hematomas up to 1 cm MT (59.31±10.32 pg/ml) (р ˂ 0.001), which is not observed in hematomas more than 1 cm, which are dangerous for pregnancy (93.98±14.52 pg/ml), which may indicate a compensatory increase in MT; and the term of pregnancy (in 10-12 weeks 79.03±9.61 pg/ml (р ˂ 0.05), in 5-6 weeks 93.78±17.44 pg/ml).Conclusions. In cases of RCH up to 1 cm the number of MT decreases with the development of pregnancy, which can be used as a prognostic marker for the diagnosis of pregnancy complications. The increase in the level of MT with RCH more than 1 cm can be considered as a compensatory increase for the preservation of pregnancy and a regulatory infl uence on the further course of pregnancy.

Genjer Extract As An Alternative Preventing Constipation In Pregnancy

Background : Constipation is a problem that is always disturbing in pregnant women, in general trimester pregnant women 3. Constipation is a difficult condition or unable to defecate, hard stool, a sense of defecation is not complete (there is a sense of wanting to defecate but unable to remove it) accompanied by complaints of the stomach feeling full and bloating. If this problem is left alone it will have an impact on the process of childbirth and childbirth. Objectives : The purpose of this study can be seen the effect of giving genjer extract as an alternative to prevent constipation during pregnancy at PMB Rusmiati Karang Tengah Tarumajaya Research Methods : This research design uses the quasi-experimental study method with pretest-posttest with control group design with a total of 32 respondents. The technique used in this study is a saturated sample. Results : The results of the study were found that after consuming the genjer extract of pregnant women who experience constipation into non-constipation it is shown in the occurrence of chapters for 2 weeks in pregnant women to normal. Conclusion : There is an effectiveness of the effect of providing genjer extract consumption as an alternative to prevent constipation during pregnancy.

Comparison Effectiveness Of Ice Pack Therapy And Cinnamin Decil On Reduce Perineal Wound Pain In Padasuka Village Working Area, Kab. Lebak The Year 2022

Background : WHO (2018) states that the Maternal Mortality Rate (MMR), there are approximately 830 women who die every day due to things that can actually be anticipated which are generally related to the process of pregnancy and childbirth. Pain or morbidity that occurs early in the puerperium is generally caused by the influence of mastitis, urinary tract infections, infections of episiotomy and laceration wounds, and other diseases. The puerperium is the period since the birth of the baby, the discharge of the amniotic fluid, the birth of the placenta, and the membranes needed to restore the health condition of the uterine organs back to their pre-pregnancy state.. This period generally occurs around 6 weeks. The general condition in postpartum mothers is feeling of pain and discomfort in the area of ​​ruptured sutures (perineal wounds).Purpose : Knowing the Comparative Effectiveness of Ice Pack Therapy and Cinnamon Decoction on Reducing Perineal Wound Pain in Padauka Village in 2022Method : The method in this research is experiment. The type of research used is Quasi Experimental. The population in this study were all postpartum mothers in the working area of ​​Padasuka Village, Kab. Lebak as many as 87 samples. The sample in this study was 30 postpartum mothers. The sampling technique is Purposive Sampling.Result : There is a comparative effect of ice pack and cinnamon extract therapy on reducing the intensity of perineal wound pain level II, this is in line with the results of the Mann Whitney U test with a significant value of 0.000 &lt;0.05.Conclusion and Suggestion : There is a comparison of the effect of ice pack therapy and cinnamon extract on reducing pain intensity in grade II penrineal wounds. Treatment of perineal tear pain during the postpartum period is an important thing that is needed by postpartum mothers, therefore it is very necessary to have a good treatment and intensive care that is able to overcome the mother's complaints of felt wound pain so that the mother feels comfortable during her postpartum period.

Relationship between Knowledge Level and Anxiety Facing Childbirth in Primiparous Mothers at Panembahan Senopati Hospital Bantul

The 7 “P” factors influencing the child-birth process are “Power”, ”Passage”, “Passenger”, “Psyche”, ”Pain”, “Patience”, and “Position”. Psyche includes anxiety, which for laboring mothers creates tension, vasoconstriction in uterine blood vessels, pain, reduced uterine contraction, and delayed cervical opening so that childbirth takes longer. Long childbirth or partus can increase mothers' and babies' morbidity and mortality rates. This research aimed to identify the correlation between Knowledge Level and Anxiety Facing Childbirth in Primiparous Mothers at Panembahan Senopati Hospital Bantul. This study was quantitative research with a descriptive-analytic design using the cross-sectional approach. The population in this research consisted of 145 primipara mothers, with purposive sampling of 59 respondents. The data were collected with a questionnaire and analyzed with the Spearman Rank Correlation Test. The respondents’ knowledge level belonged to the ‘good’ category, 96.6%, while the anxiety level among the primipara mothers belonged to the ‘moderate’ category, 79.7%. The analysis of the correlation between the knowledge level and the anxiety level among Primipara mothers in Panembahan Senopati Hospital Bantul resulted in a p-value = 0.001 with a Rho-Spearman correlation value of -0,415. There was a moderate correlation between knowledge and anxiety levels among primipara mothers in Panembahan Senopati Hospital Bantul. Healthcare providers can promote the seven essential power education models of childbirth ("Power," "Passage," "Passenger," "Psyche," "Position," "Pain," and "Patience") in maternity nursing practice so that nurses can pay attention to the complexities of care holistically for women who give birth

Дитина і дитинство у німецькому місті XIV-XV ст.

The purpose of the article is to study the characteristic features and typologi- cal regularities of a child’s position and attitude to childhood in the bourgeois environment of German cities of the XIV-XV centuries. Th e methodological basis of the research is based on the principles of historicism and objectivity. Analytical, problem-chronological, comparative, and systemic methods have been used during the research. Th e scientifi c novelty is justifi ed by the comprehensive involvement of sources and historiography that highlight the situation of children and childhood in a German city of the XIV-XV centuries, as well as the need to supp- lement domestic research on this topic. Conclusions. During the late Middle Ages, changes in the perception of a child and childhood took place, particularly in the cities of Germany in the XIV-XV centuries. Such elements of previous centuries as the involvement of children in work before their physical maturity and the opportunity to master the profession of their own parents are still relevant for the German burgher community of the late Middle Ages. At the same time, German cities are beginning to introduce obstetric rules that regulate the acceptance of child- birth and control the process of childbirth. In the second half of the XV century, parents’ attitude towards their off spring changed: children are beginning to be seen as potential guardians of their parents in their old age, as well as helpers in their professional activities. Orphanages begin to appear in Augsburg, Esslingen, Munich, Nuremberg, etc. Conventional traditional division of the stages of childhood, which was widespread in late medieval Germany, in particular in cit- ies, consisted of three periods: the fi rst – from 6 to 7 years, the second – from 7 to 14 years, the third – from 14 years and older. Such terms denoted these stages as “infantia” (“childhood”), “pueritia” (“youth”), and “adolescentia” (“adolescence”), respectively. Illegitimate children had a special status in a late medieval German city: access to craft s was closed to them, as well as the possibility of obtaining a position in the city council. Th e period when a child could already be involved in work depended on general ideas about physical maturation. Usually, children’s capacity for work began at the age of 8, when they could partially engage in the same activities as adults. Th e age at which parents stop caring for their children is directly correlated with their off spring marrying or having their own children.

Promoting the participation of low-risk pregnant women in the child birth process by developing a birth plan: The protocol of an action research study.

The birth plan reflects the preferences and expectations of women in the delivery process and can be designed with the participation of women and her partner and implement as a basis for midwifery care during childbirth. This research was designed to promote the participation of low-risk pregnant women in the child birth process by developing a birth plan. The present study is a participatory action research designed in a single specialized, main maternity hospital in Isfahan, Iran. This study was conducted in four stages proposed by the Kemmis, including planning, action, observation, and reflection with the participation of all midwives, gynecologists, and managers who involved in childbirth. Considering the importance of childbirth as an opportunity for participation and empowerment of women, it seems that designing a birth plan based on the preferences of these women and all people involved in this process can strengthen women's participation in child birth process.

Immigrant women's experience of labor and birth.

To describe the childbirth experience of immigrant women in maternity hospitals in southern Brazil. Descriptive, qualitative study, Hybrid Thematic Oral History method, in two public maternity hospitals in Curitiba-PR; semi-structured interviews collected from March to December 2020. Analysis followed the proposed method. The seven interviewees - collaborators immigrated from Venezuela, Haiti and Tunisia. Relevant themes emerged: 1) Surprises and feelings during the childbirth process, pointing out preferences, unexpected birth outcomes, factors related to the higher incidence of C-section and descriptions of sensations and feelings; 2) The care perceived by women and memories of experiences in the country of origin, with reports of previous childbirth experience, difficulties in the current childbirth and perceptions of the care received. The childbirth process was experienced with expectation, accessing feelings and memories. The positive childbirth experience was favored by team care, participation in decision-making, well-informed prenatal care, bonding with the care team, effective communication and evidence-based obstetric practices. Challenges were perceived regarding cultural sensitivity in care.

Recent Trend and a Glory to Childbirth: Pilates - A Review

Various researches indicates about the effects of Pilates during pre-natal and post-natal period. But few studiesindicates the impact of Pilates to achieve the desired childbirth outcomes. Hence, the purpose of our studyis to review various childbirth outcomes through Pilates Training. Google Scholar, Pub Med, Science DirectDatabases were used to extract the research articles to review. Total 15 full text articles were selected for thisnarrative review. Qualitative analysis was done to extract the studies. The results indicates that Pilates Traininghelps in decreasing the intensity of the labour pain, second stage of labor during pregnancy, decreasing therate of Caesarian sections and obstructed labour, episiotomies, etc. The study concluded that Pilates Trainingassists in childbirth process by strengthening the pelvic floor muscles without causing any complications toboth mother and baby. The implications of this study is that it helps in creating awareness about GynaecologicalPhysiotherapy and Pilates Training which can be used as an assisting tool for the childbirth process.