Women's experiences of the Odon Device to assist vaginal birth and participation in intrapartum research: a qualitative study in a maternity unit in the Southwest of England.

OBJECTIVE: To investigate women's experiences of having a birth assisted by the Odon Device (an innovative device for assisted vaginal birth) and participation in intrapartum research. DESIGN: Qualitative semistructured interviews and observations undertaken in the context of case study work embedded in the ASSIST feasibility study. SETTING: A tertiary referral National Health Service (NHS) maternity unit in the Southwest of England, between 8 October 2018 and 26 January 2019. PARTICIPANTS: Eight women, four operators and 11 midwives participated with eight observations of the assisted vaginal birth, eight interviews with women in the postnatal period, 39 interviews/reflections with operators and 19 interviews with midwives. Women in the case study research were recruited from participants in the main ASSIST Study. INTERVENTION: The Odon Device, an innovative device for assisted vaginal birth. RESULTS: Thirty-nine case studies were undertaken. Triangulation of data sources (participant observation, interviews with women, operators and midwives) enabled the exploration of women's experiences of the Odon Device and recruitment in the intrapartum trial. Experiences were overwhelmingly positive. Women were motivated to take part by a wish for a kinder birth, and because they perceived both the recruitment and research processes (including observation) to be highly acceptable, regardless of whether the Odon-assisted birth was successful or not. CONCLUSIONS: Interviews and observations from multiple stakeholders enabled insight into women's experiences of an innovative device for assisted vaginal birth. Applying these qualitative methods more broadly may illuminate perspectives of key stakeholders in future intrapartum intervention research and beyond. TRIAL REGISTRATION NUMBER: ISRCTN10203171; ASSIST Study registration; https://doi.org/10.1186/ISRCTN10203171.

Measuring and conceptualizing PTSD following childbirth: Validation of the City Birth Trauma Scale.

OBJECTIVE: City Birth Trauma Scale is a recently developed scale specifically designed for evaluation of posttraumatic stress disorder (PTSD) following childbirth based on the DSM-5 criteria (Ayers, Wright, & Thornton, 2018). Previous studies showed a two-factor structure of PTSD symptoms in postpartum women; however, more complex models were not tested. This study aimed to validate the Croatian version of the City Birth Trauma Scale and determine the latent factor structure of postpartum PTSD. METHOD: In a cross-sectional study, 603 women completed online questionnaires comprising the City Birth Trauma Scale, Impact of Event Scale-Revised (IES-R), Edinburgh Postnatal Depression Scale (EPDS), and the anxiety subscale from the Depression, Anxiety, and Stress Scale (DASS-21). RESULTS: Confirmatory factor analysis confirmed the bifactor model of birth-related symptoms and general symptoms had an excellent fit to the data. Both subscales and the total scale showed high internal consistency (α = .92). Convergent and divergent validity testing showed high validity, especially for birth-related symptoms. Discriminant validity was confirmed with primiparous women and women who gave birth by instrumental vaginal delivery and emergency caesarean section having significantly higher scores on birth-related symptoms, but not on general symptoms, suggesting high discriminant validity of the birth-related symptoms subscale. CONCLUSIONS: The City Birth Trauma Scale is a reliable and valid measure. Both total scale score and subscale scores can be calculated. It is highly recommended for use in postpartum population. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Psychosocial factors that mediate the association between mode of birth and maternal postnatal adjustment: findings from a population-based survey.

BACKGROUND: Mode of birth has been found to be associated with maternal postnatal adjustment with women who have Caesarean Sections (CS) thought to be at higher risk of emotional distress. However the relationship is complex and studies have demonstrated mixed findings. The aim of this study is to evaluate a model that explores the direct relationship between mode of birth and postnatal maternal adjustment at 3 months and indirect relationships through psychosocial variables. METHODS: A secondary analysis of a population-based survey conducted in England, UK in 2014. The analysis included primiparous women with singleton babies who provided information about mode of birth (n = 2139). RESULTS: Maternal postnatal adjustment, as measured by Maternal postnatal wellbeing and Satisfaction with care during labour and birth, varied by mode of birth. Women who had an unplanned CS had the poorest postnatal adjustment. Mode of birth was not associated with Maternal/infant sense of belonging. Four out of the five proposed mediation variables (Perceived control, Maternal expectation, Support in labour, How long until the mother held her baby), showed partial mediation of the relationship between mode of birth and both Maternal postnatal wellbeing and Satisfaction with care during labour and birth. The strongest mediator was Perceived control and the only variable not to show a significant mediation effect was Health of the infant at 3 months. CONCLUSIONS: Birth by unplanned, but not planned, caesarean section was associated with poorer maternal adjustment and instrumental birth was associated with lower maternal satisfaction with labour and birth. These relationships were found to be partially mediated by psychosocial variables. Psychosocial interventions in the perinatal period should be considered to optimise maternal postnatal adjustment.

Forceps delivery for non-rotational and rotational operative vaginal delivery.

Forceps are a commonly used instrument for assisting vaginal birth. Accepted indications include prolonged labour, suspected foetal distress and maternal medical conditions that benefit from a shortened second stage of labour. Maternal and offspring outcomes of forceps-assisted birth have been extensively reported in observational studies, but randomised trial evidence is limited. Forceps-assisted delivery has a lower failure rate than vacuum-assisted delivery but is associated with a higher incidence of maternal pelvic floor trauma. Second-stage caesarean section is associated with less foetal-neonatal trauma than forceps-assisted delivery but markedly reduces the chance of a subsequent vaginal birth. This review outlines the existing evidence on prevention, indications and contraindications for forceps-assisted birth (non-rotational and rotational), short- and long-term complications for mother and baby, alternatives to use of forceps and how to manage an abandoned forceps-assisted birth. The essential components of informed consent are also discussed.

A qualitative study showing women's participation and empowerment in instrumental vaginal births.

BACKGROUND: An instrumental birth with a ventouse or forceps is a complicated birth, possibly resulting in fear of childbirth which could influence the entire birth experience negatively. Patients who are actively involved in their care have a stronger sense of satisfaction and a sense of participation can contribute to shorter hospital stays. AIM: To describe the experience of participation for women involved in an instrumental delivery with ventouse or forceps. METHOD: Qualitative semi-structured interviews with 16 women who gave birth aided by a ventouse or forceps. Their answers were analyzed through qualitative content analysis. In addition the women were asked to evaluate their experience during the delivery. Using a numerical scale (NRS) the birth experience was graded by choosing a number between 0 (worst possible experience) and 10 (best conceivable experience). FINDINGS: Two themes were extracted from the data: To be part of a team and To feel empowered. Five categories were identified from the women's descriptions of the experience of involvement during the instrumental delivery: to cooperate; to understand; to have contact; to participate, and to not be involved. Those women who rated their experience as low grade, described a lack of involvement in their childbirth compared to those women who rated their experience as high. CONCLUSION: This study shows how cooperation and empowerment of the woman are two key factors in order for the women to have a positive experience of their instrumental vaginal births. The study also shows that empowerment is created when the woman is actively engaged and participates in the birth process which gives her the feeling of being part of the team, creating an environment based on mutual understanding.

Health related quality of life of women at the sixth week and sixth month postpartum by mode of birth.

BACKGROUND: Health-related quality of life of women in the postpartum period may depend on the mode of birth. However, previous findings are contradictory. AIM: To explore health-related quality of life of women at the sixth week and sixth month postpartum by mode of birth. METHODS: We performed a longitudinal prospective study in Spain that included 546 healthy primiparae aged 18 to 45 years who gave birth to a healthy newborn. At the sixth week and sixth month postpartum, we analysed sociodemographic and clinical characteristics and compared health-related quality of life (measured using the SF-36) by mode of birth (normal vaginal, forceps, vacuum-extraction, elective caesarean section, emergency caesarean section). In addition, we analysed the change in health-related quality of life between the two time points for each mode of birth. FINDINGS: We did not find differences in health-related quality of life by mode of birth at the sixth week or sixth month postpartum. At the sixth week postpartum, regardless of the mode of birth, women with postpartum urinary incontinence reported lower health-related quality of life. Between the sixth week and sixth month postpartum, health-related quality of life improved for all modes of birth. CONCLUSION: While mode of birth is not directly associated with health-related quality of life, it does have an indirect relationship in the short term. Women who reported the lowest health-related quality of life were those with postpartum urinary incontinence. Most women with postpartum urinary incontinence were in the forceps group.

Impact of mode of delivery on the birth experience in first-time mothers: a qualitative study.

BACKGROUND: The birth of a first child is an important event in a woman's life. Delivery psychological impacts vary depending on whether delivery has been positively or negatively experienced. Delivery experience determinants have been identified but the understanding of their expression according to the mode of delivery is poorly documented. The purpose of the study was to determine important elements associated with women's first delivery experience according to the mode of delivery: vaginal or caesarean section. METHODS: Qualitative approach using thematic content analysis of in-depth interviews conducted between 4 and 6 weeks' postpartum, in 24 primiparous women who delivered at Geneva University Hospital in 2012. RESULTS: Perceived control, emotions, and the first moments with the newborn are important elements for the experience of childbirth. Depending on the mode of delivery these are perceived differently, with a negative connotation in the case of caesarean section. Other elements influencing the delivery experience were identified among all participants, irrespective of the mode of delivery. They included representations, as well as the relationship with caregivers and the father in the delivery room, privacy, unexpected sensory experiences, and ownership of the maternal role. Women's and health professionals' representations sometimes led to a hierarchy based on the mode of delivery and use of analgesia. CONCLUSIONS: The mode of delivery directly impacts on certain key delivery experience determinants as perceived control, emotions, and the first moments with the newborn. The ability/inability of the woman to imagine a second pregnancy is a good indicator of the birth experience. Certain health professional gestures or attitudes can promote a positive delivery experience. We recommend to better prepare women during prenatal classes for the eventuality of a caesarean section delivery and to offer all women and, possibly, their partners, the opportunity to talk about the experience of childbirth during the postpartum period. The results of this study suggest that further research is required on the social representations of women and health professionals regarding the existence of a hierarchy associated with the mode of delivery.

Decision-making in operative vaginal delivery: when to intervene, where to deliver and which instrument to use? Qualitative analysis of expert clinical practice.

OBJECTIVE: To identify the decision-making process involved in determining when to intervene, where to deliver and the optimal choice of instrument for operative vaginal deliveries in the second stage of labour. STUDY DESIGN: A qualitative study using interviews and video recordings took place at two university teaching hospitals (St. Michael's Hospital Bristol and Ninewells Hospital, Dundee). Ten obstetricians and eight midwives were identified as experts in conducting or supporting operative vaginal deliveries. Semi-structured interviews were carried out using routine clinical scenarios. The experts were also video recorded conducting low cavity vacuum and mid-cavity rotational forceps deliveries in a simulation setting. The interviews and video recordings were transcribed verbatim and analysed using thematic coding. The anonymised data were independently coded by three researchers and then compared for consistency of interpretation. The experts reviewed the coded interview and video data for respondent validation and clarification. The themes that emerged following the final coding were used to identify the decision-making process when planning and conducting an operative vaginal delivery. Key decision points were reported in selecting when and where to conduct an operative vaginal delivery and which instrument to use. RESULTS: The final decision-making list highlights the various decision points to consider when performing an operative vaginal delivery. We identified clinical factors that experts take into consideration when selecting where the delivery should take place and the preferred choice of instrument. CONCLUSION: This detailed illustration of the decision-making process could aid trainees' understanding of the approach to safe operative vaginal delivery, aiming to minimise morbidity.

Mode of birth and women's psychological and physical wellbeing in the postnatal period.

BACKGROUND: Physical and psychological problems after childbirth are common, and may have a significant negative and long-term impact on women's wellbeing and daily functioning. The method of birth may be a particularly important factor influencing women's health and wellbeing following birth, however, population-wide evidence is limited. This study uses data from 5,332 women who responded to a national survey of women's experiences of maternity care in England. We examined women's postnatal wellbeing in the first three months after birth, and whether these varied by mode of birth. METHODS: This is a secondary analysis of survey data using a random sample of women selected from birth registration. We used multinomial logistic regression models to examine the association between women's self-reported psychological symptoms, health problems and mode of birth. RESULTS: Women who had forceps-assisted vaginal births and unplanned caesarean section births reported the poorest health and wellbeing, while those of women who had unassisted vaginal births and planned caesarean section births were less affected by the birth process. Most women's physical and emotional health appeared to improve with time, however, those who had a forceps-assisted vaginal birth were more likely to report ongoing posttraumatic-type symptoms several months after the birth. CONCLUSIONS: Mode of birth was associated with differences in outcomes at three months. By comparison to women who had unassisted vaginal births, the risk of reduced postnatal health and wellbeing was higher amongst the women who had forceps-assisted vaginal births but not amongst women who had ventouse-assisted vaginal births. This would suggest that it is important to differentiate the different types of instrumental birth in outcome studies. Of concern was the higher rate of posttraumatic-type symptoms among women who had forceps-assisted vaginal births relative to the other modes of birth. Women who have forceps-assisted births should be monitored carefully by health professionals in the postnatal period, and in the months after childbirth, when they could be offered the opportunity to discuss their labour and birth.

Delivery mode and the course of pre- and postpartum depression.

PURPOSE: To compare depressiveness scores, both during and after pregnancy, with the delivery mode (DM). METHODS: In a longitudinal, prospective study, standardized questionnaires for the Edinburgh Postnatal Depression Scale were presented to 1,100 women and used to assess the presence and severity of depressiveness at three time points: prenatal, from the 30th gestational week (Q1); 48-72 h postnatal (Q2); and 6-8 months postnatal (Q3). The patients were divided into four groups relative to DM: spontaneous delivery, primary cesarean section (CS), secondary CS, and assisted vaginal delivery. The final number of participating women with both delivery mode and depression information for all three time points was 753. RESULTS: There was a significant difference of the mean EPDS values between the spontaneous delivery and primary CS groups (P=0.04) at Q1 (5.1 vs. 6.3). None of the other comparisons was significant. Significant differences relative to DM were seen at Q2 (P<0.0001), but there were no significant differences between the patient groups at Q3 (P=0.54). CONCLUSIONS: DM only showed coherence with the extent of depression briefly during the peripartal period. A relationship was found between depressiveness during pregnancy and DM, with higher depressiveness scores in the group of patients undergoing primary CS. This should be taken into account when patients requesting an elective cesarean section are being counseled.

Validity and reliability of a scale to measure genital body image.

UNLABELLED: Women's body image dissatisfaction extends to body parts usually hidden from view--their genitals. Ability to measure genital body image is limited by lack of valid and reliable questionnaires. We subjected a previously developed questionnaire, the Genital Self Image Scale (GSIS) to psychometric testing using a variety of methods. METHODS: Five experts determined the content validity of the scale. Then using four participant groups, factor analysis was performed to determine construct validity and to identify factors. Further construct validity was established using the contrasting groups approach. Internal consistency and test-retest reliability was determined. RESULTS: Twenty one of 29 items were considered content valid. Two items were added based on expert suggestions. Factor analysis was undertaken resulting in four factors, identified as Genital Confidence, Appeal, Function, and Comfort. The revised scale (GSIS-20) included 20 items explaining 59.4% of the variance. Women indicating an interest in genital cosmetic surgery exhibited significantly lower scores on the GSIS-20 than those who did not. The final 20 item scale exhibited internal reliability across all sample groups as well as test-retest reliability. CONCLUSIONS: The GSIS-20 provides a measure of genital body image demonstrating reliability and validity across several populations of women.

Obstetric outcome for women who received individualized treatment for fear of childbirth during pregnancy.

OBJECTIVE: To compare obstetric outcomes for women with fear of childbirth who received counseling during pregnancy with women without fear of childbirth. DESIGN: Descriptive, retrospective case-control study. SETTING: University Hospital, Linköping, Sweden. SAMPLE: 353 women who were referred to a unit for psychosocial obstetrics and gynecology because of fear of childbirth constituted the index group and 579 women without fear of childbirth formed a reference group. METHODS. Data were collected from standardized antenatal and delivery records. MAIN OUTCOME MEASURES: Delivery data. RESULTS: Elective cesarean sections (CS) were more frequent in the index group (p<0.001). Induction of delivery was also more common among the women with fear of childbirth (16.5 compared with 9.6%, p<0.001). Women with fear of childbirth who were scheduled for vaginal delivery were more often delivered by emergency CS (p=0.007). Elective CS was more common among the parous women with fear of childbirth and instrumental delivery was more common among nulliparous women with fear of childbirth. There were no differences in complications during pregnancy, delivery or postpartum between the two groups. CONCLUSION: Fear of childbirth is a predisposing factor for emergency and elective CS even after psychological counseling. Maximal effort is necessary to avoid traumatizing deliveries and negative experiences, especially for nulliparous women.

The delivery mode and seasonal variation are associated with the development of postpartum depression.

INTRODUCTION: Previous studies have indicated that mode of delivery and/or season of delivery might be risk factors for postpartum depression (PD). However, only a few studies have provided support for this supposition. This study aim was to confirm the association between mode of delivery and/or season of delivery and PD. METHODS: We analyzed 2003-2006 Taiwan National Health Insurance Research Database (NHIRD). A group of 2107 mothers who were diagnosed with PD within 6months of delivery in 2005 were selected as the case group and another 8428 mothers without PD during the same timeframe were selected as the control group. Logistic regression was performed after controlling for age, antepartum comorbidities and postpartum complications to confirm the degree of association with the risk of PD. RESULTS: The results of the logistic regression analysis showed that the risk of acquiring PD was lower in mothers with a normal vaginal delivery or an instrumental vaginal delivery compared to mothers with an emergency caesarean section (odds ratio [OR]=0.67, p<0.0001; OR=0.56, p<0.0001). But the women who elected to have a caesarean section was higher risk than an emergency caesarean section (OR=1.48, p=0.0168). In addition, the risk of PD for winter deliveries was higher compared to other seasons. CONCLUSIONS: This study provides a reference for gynecologists, obstetricians and health providers that should help with the prevention of PD among pregnant women and mothers.

A survey of women's experiences following instrumental vaginal delivery.

There is little published data on women's experiences of having had an instrumental vaginal delivery (IVD). We conducted a postal survey of women who had IVD at our centre between November 2007 and January 2008, using a semi-structured questionnaire to ascertain perceptions. The response rate was 63% (58/92). Eleven (19%) felt that the risks and benefits of an IVD were explained to them. Although 46/58 (79%) needed an episiotomy, only 17(37%) recalled an explanation. Increased fear of childbirth following IVD was reported by 16/58 (27.5%); 14 of the 58 women (24%) preferred a caesarean section if they were to need operative delivery, rather than having an IVD in a further pregnancy. Clear information about the risks and benefits of IVD and debriefing following the procedure are desirable to women having IVD. These measures may reduce fear of childbirth and also reduce maternal request for caesarean section in future pregnancies.

Traumatic experience with vacuum extraction--influence of personal preparation, physiology, and treatment during labor.

OBJECTIVE: To assess pre-labor attitudes and post-labor experiences of the use of vacuum extraction during delivery. To seek associations between traumatic labor experience and personal preparation, physiology of labor and treatment during labor. METHODS: A total of 205 women filled in a questionnaire within five days of vacuum extraction delivery. The questionnaire was designed to distinguish the group of women having experienced their labor as traumatic from those not having such an experience. The association between explanatory variables grouped as background factors, physiological factors of labor and treatment-related factors in relation to traumatic experience status was studied by bivariate analysis by the chi-square test or Student's t-test. Logistic regression analysis was carried out to examine simultaneous effects of factors. In the first phase, each of the previously chosen groups was analyzed separately, and in the second, all risk factors thus emerging as significant were entered into the final model. RESULTS: Forty-two women (20%) regarded their childbirth experience as traumatic. Of the background factors, insufficient pre-labor training and a pre-labor desire for extra strong pain relief during the coming labor were significantly more common in the traumatic birth group. Of the physiological factors of labor, unsatisfactory pain relief and a difficult third stage of labor were associated with a traumatic birth experience. The treatment-related factors showed mutual correlation and were strongly associated with birth experience. After logistic regression analysis only four independent risk factors emerged as significant: insufficient support immediately after delivery, the experience of being poorly listened to during labor, insufficient doctor's support during the first stage of labor, and pre-labor training classes considered insufficient. CONCLUSIONS: Treatment-related factors were the most powerful predictors of an adverse birth experience after vacuum extraction delivery, exceeding those related to labor physiology. Thus, the role of treatment and care before, during and after vacuum extraction is emphasized.

The negative birth experience of prolonged labour: a case-referent study.

AIMS: This study aimed to analyse and describe women's different perceptions and experiences of childbirth following prolonged or normal labour. BACKGROUND: In clinical practice prolonged labour, or dystocia, is a common delivery complication often causing a negative birth experience. METHOD: Women giving singleton live birth to their first child with spontaneous labour after more than 37 completed weeks' pregnancy at three hospitals in northern Sweden were recruited to a case-referent study. Cases (n = 84) were women following a prolonged labour with assisted vaginal or abdominal delivery, and referents (n = 171) delivered following a normal labour. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships and childhood experiences. RESULTS: Women with prolonged labour had a negative childbirth experience more often (34%) than did women who had a normal labour (4%) (P < 0.05). Cases agreed significantly more than the referents with the statement, 'Pain relief during the delivery saved me' (OR 4.5, 95% CI: 1.9-11.1) and 'My difficulties during the delivery will mark me for life' (OR 12.4, 95% CI: 4.4-35.9). There were no differences between the cases and referents regarding perceived experience of professional or social support. RELEVANCE TO CLINICAL PRACTICE: To improve care, midwives and doctors can alleviate pain and relieve the negativity and difficulty associated with the experience of prolonged labour from the perspective of the woman giving birth.

Post-traumatic stress disorder due to childbirth: the aftermath.

BACKGROUND: Childbirth qualifies as an extreme traumatic stressor that can result in post-traumatic stress disorder. The reported prevalence of post-traumatic stress disorder after childbirth ranges from 1.5% to 6%. OBJECTIVE: The aim of this phenomenologic study was to describe the essence of mothers' experiences of post-traumatic stress disorder after childbirth. METHODS: The qualitative research design used for this study was descriptive phenomenology. The main recruitment approach was via the Internet through the help of Trauma and Birth Stress, a charitable trust in New Zealand. Purposive sampling was used and resulted in 38 mothers participating from the countries of New Zealand, the United States, Australia, and the United Kingdom. The participants were asked to describe their experiences with post-traumatic stress disorder after childbirth. Their stories were analyzed using Colaizzi's method of data analysis. RESULTS: Mothers with post-traumatic stress disorder attributable to childbirth struggle to survive each day while battling terrifying nightmares and flashbacks of the birth, anger, anxiety, depression, and painful isolation from the world of motherhood. CONCLUSIONS: This glimpse into the lives of mothers with post-traumatic stress disorder attributable to childbirth provides an impetus to increase research efforts in this neglected area.

Does traumatic birth increase the risk of postnatal depression?

The aim of the study was to review if experiencing a traumatic birth, in the form of caesarean section or assisted vaginal births, increases the risk of developing postnatal depression. This issue is significant to health professionals when planning postnatal care. A focused search of databases containing medical and psychiatric research relevant to this question was performed and the selected papers critically appraised and reviewed. The numbers of mothers recording depressive symptoms for each birth method were measured using a validated outcome tool for postnatal depression. Two research papers met the inclusion criteria and were reviewed using a checklist for critically appraising cohort studies. Although the papers met many of the quality markers, both reported limited data relating to obstetric factors in the development of postnatal depression and both sets of published results were incomplete. More studies may be found by searching psychological and psychiatric medicine-oriented databases as just one was included in this evaluation. The conclusion of this review is that there is no evidence on which to base a reappraisal of current clinical practice.