The Experience of Land and Water Birth Within the American Association of Birth Centers Perinatal Data Registry, 2012-2017.

Consumer demand for water birth has grown within an environment of professional controversy. Access to nonpharmacologic pain relief through water immersion is limited within hospital settings across the United States due to concerns over safety. The study is a secondary analysis of prospective observational Perinatal Data Registry (PDR) used by American Association of Birth Center members (AABC PDR). All births occurring between 2012 and 2017 in the community setting (home and birth center) were included in the analysis. Descriptive, correlational, and relative risk statistics were used to compare maternal and neonatal outcomes. Of 26 684 women, those giving birth in water had more favorable outcomes including fewer prolonged first- or second-stage labors, fetal heart rate abnormalities, shoulder dystocias, genital lacerations, episiotomies, hemorrhage, or postpartum transfers. Cord avulsion occurred rarely, but it was more common among water births. Newborns born in water were less likely to require transfer to a higher level of care, be admitted to a neonatal intensive care unit, or experience respiratory complication. Among childbearing women of low medical risk, personal preference should drive utilization of nonpharmacologic care practices including water birth. Both land and water births have similar good outcomes within the community setting.

Overcoming fear of facilitating water birth: student and mentor perspectives.

Water immersion for labour and birth is a powerful, low cost intervention that facilitates physiological birth. However, for some midwives - students or qualified - a lack of exposure to water births can create fearful perceptions and reduce their willingness to support women in water. This article explores the nature of this fear, and how it was overcome from the perspectives of both the mentor and student, perhaps offering useful insights for others.

Web-based education and attitude to delivery by caesarean section in nulliparous women.

OBJECTIVE: To measure the effect of a web-based educational tool on baseline knowledge of the risks and benefits of delivery by Caesarean section in healthy nulliparous women. METHODS: We constructed a web-based educational tool to provide evidence-based information on the potential benefits and risks of CS for healthy nulliparous women in the second trimester. We included women with an uncomplicated singleton pregnancy who were receiving antenatal care at Mount Sinai Hospital. Eligible women logged into the website to undertake a pre-test survey. After completing this survey, they received access to the educational tool, followed by a link to a second survey. The surveys collected baseline demographics and assessed participants' knowledge of the perceived safety and risks of vaginal delivery and CS, their sources of information, and the influence of these sources on their views. RESULTS: Seventy-three participants completed both surveys. Participants had a high baseline preference (84%) for vaginal delivery. The mean score for knowledge about vaginal delivery and CS increased significantly between the surveys, from 47% to 76% (P < 0. 001). There was no significant change in preference for mode of delivery between the two surveys. In both surveys, more participants responded that they were a "little fearful" or "not fearful at all" of vaginal deliveries. In the second survey, significantly more responded that they were "very fearful" or "fearful" of CS (P < 0.05). Increased knowledge about specific risks of vaginal delivery did not deter participants from preferring a vaginal delivery. However, knowledge of risks associated with CS made them more likely to have "very favourable" or "somewhat favourable" views of vaginal delivery. Ethnicity and country of birth were not found to have a significant effect on preferred mode of delivery. CONCLUSIONS: We demonstrated that a web-based educational tool significantly increased knowledge of the risks and benefits of vaginal delivery and CS. However, the educational intervention did not significantly change preferences.

Objectif : Mesurer l'effet d'un outil pédagogique Web traitant des connaissances de base sur les risques et les avantages de la césarienne chez les nullipares en santé. Méthodes : Nous avons créé un outil pédagogique Web visant à fournir des renseignements factuels sur les risques et les avantages possibles de la césarienne chez les nullipares en santé pendant le deuxième trimestre. Nous avons inclus des femmes présentant une grossesse monofœtale sans complications qui recevaient des soins prénatals au Mount Sinai Hospital. Les femmes admissibles ont ouvert une session sur le site Web afin de remplir un sondage prétest. Une fois le sondage rempli, elles ont obtenu accès à l'outil pédagogique et ont reçu un lien menant à un deuxième sondage. Ces sondages ont permis de recueillir des données démographiques de référence et d'évaluer les connaissances des participantes quant à l'innocuité et aux risques perçus de l'accouchement vaginal et de la césarienne, leurs sources d'information et l'influence qu'avaient ces sources sur leurs opinions. Résultats : Soixante-treize participantes ont rempli les deux sondages. Elles présentaient, au départ, une préférence élevée (84 %) pour l'accouchement vaginal. Le score moyen quant aux connaissances sur l'accouchement vaginal et la césarienne a augmenté considérablement entre les sondages, passant de 47 % à 76 % (P < 0,001). Aucun changement appréciable n'a été constaté entre les sondages en ce qui concerne la préférence en matière de mode d'accouchement. Dans les deux sondages, plus de participantes ont dit ne ressentir « aucune crainte ¼ ou ressentir « une légère crainte ¼ relativement à l'accouchement vaginal. Dans le deuxième sondage, par contre, un nombre considérablement plus élevé de participantes ont dit ressentir « de la crainte ¼ ou « beaucoup de crainte ¼ en ce qui concerne la césarienne (P < 0,05). L'amélioration des connaissances à propos des risques propres à l'accouchement vaginal n'a pas empêché les participantes de continuer de privilégier l'accouchement vaginal. Toutefois, le fait d'en connaître plus au sujet des risques associés à la césarienne les rendait plus susceptibles d'avoir une opinion « relativement favorable ¼ ou « très favorable ¼ à l'égard de l'accouchement vaginal. L'ethnicité et le pays d'origine n'ont eu aucun effet appréciable sur la préférence en matière de méthode d'accouchement. Conclusions : Nous avons démontré que l'utilisation d'un outil pédagogique Web améliorait considérablement les connaissances sur les risques et les avantages de l'accouchement vaginal et de la césarienne. Toutefois, l'intervention pédagogique n'a pas modifié les préférences de façon marquée.

A birth education program for expectant fathers in Taiwan: effects on their anxiety.

BACKGROUND: A father who does not know how to assist the mother in relieving labor pains may experience a sense of powerlessness and anxiety. The objective of this study was to evaluate how an education program for expectant fathers who attended their partners' labor and birth affected their anxiety. METHODS: In a randomized controlled trial, 87 expectant fathers who attended their pregnant partners through labor and birth at a hospital in central Taiwan were allocated by block randomization to an experimental (n = 45) and a control (n = 42) group. The men completed their basic personal information, a childbirth expectations questionnaire, and a Trait Anxiety Inventory when they were recruited. Two hours after birth of their child, all the expectant fathers completed a State of Anxiety Inventory. RESULTS: Our results showed no statistically significant differences between the experimental and control groups of fathers in trait anxiety and their prenatal childbirth expectations. After analysis of covariance (ANCOVA) was applied to correct for education level, sources of childbirth information, attendance at Lamaze childbirth classes, and childbirth expectations at baseline, the effect of the childbirth program was significant for the postnatal level of anxiety (F = 3.38, p = 0.001). CONCLUSIONS: The study findings justify the clinical implementation of a birth education program based on the self-efficacy theory as an effective means of reducing anxiety among expectant fathers.

[The effectiveness of the video-based Lamaze method on prenatal mothers' knowledge, attitudes, and practice].

This study was conducted to explore the effectiveness of the video-based Lamaze method on pre-natal mothers' knowledge and attitudes, compared with that of traditional nursing guidelines. Using a quasi-experimental design, women in labor with gestations of 32 weeks or more were divided into four study groups, including two experimental groups (E(1): issued with traditional nursing guidelines and instructed in video-based Lamaze method; and E(2): instructed in video-based Lamaze method), and two control groups (C(1): issued with traditional nursing guidelines and C(2): issued with no guidelines). Before the intervention, E(1) had the highest score for knowledge. Scores for attitude showed no significant difference between the four groups. The experimental groups had higher scores than the control groups in the posttest. With the exception of the scores for attitude (E(1) > E(2)), knowledge (E(1): 13.09 +/- 1.40, E(2): 12.40 +/- 1.17) and management of the labor process (E(1): 119.00 +/- 10.91, E(2): 112.97 +/- 14.33) there were no significant differences between E(1) and E(2) in the posttest. Correlation analysis showed that the higher the scores for prenatal knowledge, the better the performance in prenatal practice, postnatal knowledge, attitude, and management of the labor process. The more positive the prenatal attitude, the better the performance in postnatal knowledge, attitude, and management of the labor process. The higher the scores in prenatal practice, the better the performance in postnatal knowledge, attitude, and management of the labor process. Positive associations were also found between postnatal knowledge, attitude, and management of the labor process. This study showed that the video-based Lamaze method is likely to promote more effectively than traditional guidelines the knowledge, attitudes, and practice of prenatal mothers in relation to giving birth. The use of this method in conjunction with traditional nursing guidelines may be even more effective in relation to maternal attitude.

The American College of Nurse-Midwives' home-based lifesaving skills program: a review of the Ethiopia field test.

The Home-Based Lifesaving Skills program (HBLSS) is a family- and community-focused, competency-based program that aims to reduce maternal and newborn mortality by increasing access to basic lifesaving measures within the home and community and by decreasing delays in reaching referral facilities where obstetric complications, such as postpartum hemorrhage and newborn asphyxia, can be managed. HBLSS was field tested in rural southern Ethiopia where over 90% of births take place at home with unskilled attendants. The program review assessed 1) the performance of HBLSS-trained guides; 2) management of postpartum hemorrhage and newborn infection by women, family, and birth attendants; 3) exposure of women and families to HBLSS training; and 4) community support. There was improved performance in management of postpartum hemorrhage, a leading cause of maternal death. Findings for management of newborn infection were less compelling. None of the communities had established reliable emergency transportation. Exposure to HBLSS training in the community was estimated at 38%, and there was strong community support. Organizations incorporating HBLSS into proposals focusing on maternal and newborn health during birth and the immediate postpartum period are encouraged to conduct research necessary to establish the evidence base for this promising new approach.

[Fetal arterial oxygen saturation (FSpO2) during the second stage of labor after training for childbirth]. / Wysycenie tlenem krwi plodowej (FSpO2) w drugim okresie porodu po przygotowaniu w Szkole Rodzenia.

OBJECTIVE AND DESIGN: The aim of the research was to determine the effects of participating in training program for childbirth in Maternity School in Lódz on the state of the fetus. In the above research, the authors presented the foetal oxygen saturation (FSpO2) during the second stage of labour among the women participating in Maternity School as well as a control group. Our study analysed the neonatal outcome too (umbilical arterial blood pH and 5 min. Apgar score). MATERIAL AND METHODS: The test group consisted of eighty seven (87) healthy primigravidas of whom forty two (42) participated in classes in the Maternity School and forty fifth (45) made up the control group. Validity of the correlation was assessed by means of t-Student's table of N--2 degree of freedom. RESULTS: The medium parameters of FSpO2 values and duration of the second stage of labor in both groups were shown. Statistically significant differences between the groups were found in duration the second stage of labour--in Maternity School group being shorter. Statistically significant differences in FSpO2 values between groups were not observed.