Qualitative exploration of fear of childbirth and preferences for mode of birth among Japanese primiparas.

Antenatal fear of childbirth (FOC) is associated with negative effects, such as postnatal traumatic symptoms. As the birth-related culture of East Asian countries differs from that in Western countries, the aim of the present qualitative, descriptive study was to explore FOC, perceptions for Caesarean section (CS), and obstetric analgesia (OA) among Japanese primiparas. The qualitative, descriptive study included focus group interviews with 11 primiparous women, which were conducted in a birth house and a maternity hospital in a metropolitan area of Japan in 2013. As a result, seven categories emerged from the analysis: Maternal and child risk, pain, losing control, uncertainty, prolonged labor, poor family support and loneliness before hospitalization. All participants denied having a preference for CS birth due to fear. Opposing values of OA were identified in women who chose OA and those who did not. In conclusion, it is necessary to increase clinical awareness that the objects of fear are diverse. Furthermore, diverse values regarding OA should be understood and equally respected by health-care professionals.

[Implementation methodology of practices based on scientific evidence for assistance in natural delivery: a pilot study]. / Metodologia de implementação de práticas baseadas em evidências científicas na assistência ao parto normal: estudo piloto.

OBJECTIVE: Presenting methodology for transferring knowledge to improve maternal outcomes in natural delivery based on scientific evidence. METHOD: An intervention study conducted in the maternity hospital of Itapecerica da Serra, SP, with 50 puerperal women and 102 medical records from July to November 2014. The PACES tool from Joanna Briggs Institute, consisting of pre-clinical audit (phase 1), implementation of best practice (phase 2) and Follow-up Clinical Audit (phase 3) was used. Data were analyzed by comparing results of phases 1 and 3 with Fisher's exact test and a significance level of 5%. RESULTS: The vertical position was adopted by the majority of puerperal women with statistical difference between phases 1 and 3. A significant increase in bathing/showering, walking and massages for pain relief was found from the medical records. No statistical difference was found in other practices and outcomes. Barriers and difficulties in the implementation of evidence-based practices have been identified. Variables were refined, techniques and data collection instruments were verified, and an intervention proposal was made. CONCLUSION: The study found possibilities for implementing a methodology of practices based on scientific evidence for assistance in natural delivery.

Planned home birth in the United States and professionalism: a critical assessment.

Planned home birth has been considered by some to be consistent with professional responsibility in patient care. This article critically assesses the ethical and scientific justification for this view and shows it to be unjustified. We critically assess recent statements by professional associations of obstetricians, one that sanctions and one that endorses planned home birth. We base our critical appraisal on the professional responsibility model of obstetric ethics, which is based on the ethical concept of medicine from the Scottish and English Enlightenments of the 18th century. Our critical assessment supports the following conclusions. Because of its significantly increased, preventable perinatal risks, planned home birth in the United States is not clinically or ethically benign. Attending planned home birth, no matter one's training or experience, is not acting in a professional capacity, because this role preventably results in clinically unnecessary and therefore clinically unacceptable perinatal risk. It is therefore not consistent with the ethical concept of medicine as a profession for any attendant to planned home birth to represent himself or herself as a "professional." Obstetric healthcare associations should neither sanction nor endorse planned home birth. Instead, these associations should recommend against planned home birth. Obstetric healthcare professionals should respond to expressions of interest in planned home birth by pregnant women by informing them that it incurs significantly increased, preventable perinatal risks, by recommending strongly against planned home birth, and by recommending strongly for planned hospital birth. Obstetric healthcare professionals should routinely provide excellent obstetric care to all women transferred to the hospital from a planned home birth.The professional responsibility model of obstetric ethics requires obstetricians to address and remedy legitimate dissatisfaction with some hospital settings and address patients' concerns about excessive interventions. Creating a sustained culture of comprehensive safety, which cannot be achieved in planned home birth, informed by compassionate and respectful treatment of pregnant women, should be a primary focus of professional obstetric responsibility.

"After having a waterbirth, I feel like it's the only way people should deliver babies": The decision making process of women who plan a waterbirth.

OBJECTIVE: To explore the decision making process of women who seek to give birth in water DESIGN: A qualitative design using semi-structured interviews with women who planned a waterbirth was used. Interviews were recorded, transcribed, and coded for emergent themes using a grounded theory approach for analyses SETTING: Twenty-three women (mean age = 33.5 years mean number of children = 2.5) who had planned a waterbirth were recruited from a prenatal care clinic in a mid-sized southeastern city in the United States. Questions explored how they decided to pursue a waterbirth, sources of information, support systems, resistance, and their birth experience FINDINGS: Although all participants used the tub during labor, five did not give birth in the water. Analyses revealed that a belief in their body's ability to give birth along with the desire for limited medical interventions were the primary reasons for choosing waterbirth. Previous positive and negative experiences with birth also shaped their decision. Women actively sought information about waterbirths from the internet and friends. One-third of participants decided to pursue a waterbirth later in pregnancy and changed OB practices in order to have access to a waterbirth. Midwives and doulas were viewed as critical supporters of their waterbirth decision. However, most participants experienced some form of resistance toward their decision from others including family, friends, coworkers, and strangers. The overwhelming majority were positive about their experience and indicated they felt empowered, even if they were unable to give birth in the water, and encouraged other women to consider waterbirth. Most indicated they wanted to have a waterbirth in the future.

Medicalização da assistência ao parto normal: Perfil de gestantes atendidas em uma maternidade de risco habitual / Medicalización de la asistencia del parto natural: Perfil de las mujeres embarazadas atendidas en una maternidad de bajo riesgo / Medicalization of natural childbirth assistance: Profile of pregnancies women in a low-risk maternity hospital

Introdução: O nascimento tem experimentado mudanças na compreensão do parto como processo natural, tornando-o passível de intervenções, como as relacionadas a abreviação do parto através do uso de medicamentos. Objetivo: Descrever o perfil da assistência às gestantes, verificando a prevalência do uso de medicamentos, instrumentos e protocolos, durante o trabalho de parto e parto, em maternidade pública de saúde, destinada à assistência a gestantes de risco habitual. Método: Estudo transversal, descritivo, exploratório e quantitativo, com população por conveniência (n=26 profissionais de saúde). Foram investigadas as características sociodemográficas dos enfermeiros e médicos que prestavam assistência direta ao parto, além daquelas relativas ao uso de medicamentos, instrumentos e protocolos. Os dados foram tabulados no Epiinfo 7.2.2.2, sendo realizada análise estatística descritiva. Resultados: Observou-se que 53,8% são enfermeiros obstetras e 46,2% médicos obstetras. Dentre os entrevistados: 65,4% asseguraram preencher sempre ou quase sempre o partograma, 61,6% aplicam sempre ou quase sempre o índice de Bishop, 57,7% fazem uso de medicamentos para induzir o parto. A prevalência de profissionais que afirmaram não existir protocolos assistenciais ao parto na instituição somou 80,8%. Conclusão: O presente estudo foi relevante para demonstrar que a maioria dos profissionais não usavam medicamentos aceleradores do trabalho de parto; consideravam a integridade das membranas antes da indução medicamentosa, com maior prevalência de uso da ocitocina em relação ao misoprostol nos casos de necessidade de indução com iguais condições do colo uterino. A maior parte dos profissionais afirmou ainda fazer uso de protocolos de assistência ao parto, embora não fossem os institucionais.

Introducción: El nacimiento ha experimentado cambios en la comprensión del parto como un proceso natural, haciéndolo susceptible de intervenciones, como las relacionadas con la abreviación del parto mediante el uso de medicamentos. Objetivo: Describir el perfil de atención de la gestante, para verificar la prevalencia del uso de medicamentos, instrumentos y protocolos durante el trabajo de parto y parto en una maternidad de la red pública de salud, destinada a la asistencia de gestantes de riesgo habitual. Método: Estudio transversal, descriptivo, exploratorio y cuantitativo con población (n=26 profesionales de la salud). Se investigaron las características sociodemográficas de profesionales de enfermería y profesionales médicos que ofrecían asistencia directa durante el parto, además de las relacionadas con el uso de medicamentos, instrumentos y protocolos. Los datos se tabularon en el programa Epiinfo 7.2.2.2 y se realizó el análisis estadístico descriptivo. Resultados: Se observó que el 53.8 % son personal de enfermería obstetricia y el 46.2 % son obstetras. Entre las entrevistadas, el 65.4 % aseguró que siempre o casi siempre completaba el partograma, el 61.6 % siempre o casi siempre aplicaba el índice de Bishop, el 57.7 % utilizaba medicación para inducir el parto. La prevalencia de profesionales que afirmaron que no existían protocolos de atención del parto en la institución fue de 80.8 %. Conclusión: El presente estudio fue relevante para demostrar que la mayoría de los profesionales no utilizaban fármacos para acelerar el trabajo de parto, consideraron la integridad de las membranas antes de la inducción medicamentosa, con mayor prevalencia de uso de oxitocina, en relación al misoprostol en casos de necesidad de inducción con las mismas condiciones del cuello uterino. La mayoría de los profesionales dijeron que todavía hacen uso de los protocolos de atención al parto, aunque no sean institucionales.

Introduction: Birth has experienced changes in the understanding of childbirth as a natural process, making it amenable to interventions, such as those related to shorten the labor time by medication. Objective: To describe the prevalence of the use of drugs, instruments, and protocols in the labor and delivery profile of assistance in a public maternity hospital that nurses low risk pregnancies. Method: This is a cross-sectional, descriptive, exploratory, and quantitative study with population (n=26 health professionals). The sociodemographic characteristics of nurses and doctors who provide direct assistance during childbirth were analyzed in addition to those related to the use of medications, instruments, and protocols. Data were tabulated in the Epiinfo 7.2.2.2 program; then, a descriptive statistical analysis was performed. Results: It was observed that 53.8% are obstetric nurses and 46.2% are obstetricians. Among the interviewees: 65.4% assured that they always or almost always completed the partograph, 61.6% always or almost always applied the Bishop index, 57.7% used medication to induce labor. The prevalence of professionals who stated that there were no childbirth care protocols in the institution totaled 80.8%. Conclusion: The present study was relevant to demonstrate that most professionals did not use drugs for labor induction; they considered the integrity of the membranes before these drugs; and, when induction was needed, there was a higher prevalence of the use of oxytocin in relation to misoprostol in cases with the same conditions of the uterine cervix. Most professionals said that they still use childbirth care protocols although they are not institutional.

Barriers to implementing guideline recommendations to improve childbirth care: a rapid review of evidence / Obstáculos a la aplicación de las recomendaciones para la atención del parto normal: revisión rápida de evidencia / Barreiras à implementação de recomendações para assistência ao parto normal: revisão rápida de evidências

ABSTRACT Objective. To identify potential barriers to the implementation of the National Childbirth Guidelines in Brazil based on the best available global evidence. Method. A rapid review of evidence was performed in six databases in March/April 2019. Secondary studies published in English, Spanish, or Portuguese with a focus on barriers of any nature relating to the implementation of the Guidelines were retrieved. Results. Twenty-three documents (21 reviews and two practice guides) were included in the review. The barriers identified were grouped into 52 meaning categories and then reorganized into nine thematic clusters: delivery and childbirth care model, human resource management, knowledge and beliefs, gender relations, health care service management, attitudes and behaviors, communication, socioeconomic conditions, and political interests. Conclusions. The results show that combined approaches may be required to address different barriers to the implementation of the Guidelines. For successful implementation, it is essential to engage health care leaders, professionals, and users in the effort to change the delivery and childbirth care model. Also necessary is the development of intersectoral initiatives to improve the socioeconomic conditions of women and families and to curtail gender inequalities.

RESUMEN Objetivo. Identificar los posibles obstáculos a la aplicación de las recomendaciones formuladas en las Directrices Nacionales para la Atención del Parto Normal en Brasil a partir de la mejor evidencia disponible a nivel mundial. Métodos. Entre marzo y abril de 2019 se llevó a cabo una revisión rápida de seis bases de datos. Se seleccionaron estudios secundarios publicados en español, inglés o portugués sobre los obstáculos de cualquier tipo que pudieran estar relacionados con la aplicación de las recomendaciones contenidas en las Directrices. Resultados. Se incluyeron 23 documentos (21 revisiones sistemáticas y 2 guías de práctica clínica). Los obs- táculos identificados se agruparon en 52 categorías con base en su semejanza de significado y luego se reorganizaron en nueve grupos temáticos: modelo de atención del parto, gestión de recursos humanos, cre-encias y conocimientos, relaciones de género, gestión de servicios de salud, actitudes y comportamientos, comunicación, condiciones socioeconómicas e intereses políticos. Conclusiones. La aplicación de las Directrices puede requerir enfoques combinados para hacer frente a diferentes obstáculos. La participación de los administradores y los trabajadores de la salud en el proceso de cambio del modelo de atención del parto, así como la participación de los usuarios, son fundamentales para que la aplicación de las Directrices sea satisfactoria. Además, se necesitan medidas intersectoriales para mejorar las condiciones socioeconómicas de las mujeres y las familias y para combatir las desigualdades entre los géneros.

RESUMO Objetivo. Identificar potenciais barreiras à implementação das recomendações das Diretrizes Nacionais de Assistência ao Parto Normal a partir das melhores evidências globais disponíveis. Métodos. Realizou-se uma revisão rápida com consulta a seis bases de dados em março/abril de 2019. Foram selecionados estudos secundários publicados em inglês, espanhol ou português sobre barreiras de qualquer natureza que pudessem ser relacionadas à implementação das recomendações das Diretrizes. Resultados. Foram incluídos 23 documentos (21 revisões sistemáticas e dois guias de prática clínica). As barreiras identificadas foram agrupadas em 52 categorias por semelhança de significado e, em seguida, reorganizadas em nove núcleos temáticos: modelo de atenção ao parto e nascimento, gestão de recursos humanos, crenças e saberes, relações de gênero, gestão de serviços de saúde, atitudes e comportamentos, comunicação, condições socioeconômicas e interesses políticos. Conclusões. Os resultados mostraram que a implementação das Diretrizes pode requerer abordagens combinadas para o enfrentamento de diferentes barreiras. O engajamento de gestores e profissionais de saúde no processo de mudança do modelo de atenção ao parto e nascimento e o envolvimento de usuários são indispensáveis para o sucesso da implementação. São necessárias, ainda, ações intersetoriais para melhorar as condições socioeconômicas de mulheres e famílias e para combater as iniquidades de gênero.

Barreiras à implementação das Diretrizes Nacionais de Assistência ao Parto Normal: uma análise prototípica das representações sociais de atores estratégicos / Barriers to the implementation of the National Guidelines for Assistance to Normal Childbirth: a prototypical analysis of the social representations of strategic actors

Resumo Este estudo tem por objetivo analisar as representações sociais de atores estratégicos envolvidos na assistência ou gestão em saúde, sobre as questões que envolvem a mulher, o parto e o nascimento, buscando identificar e compreender barreiras à implementação das Diretrizes Nacionais de Assistência ao Parto Normal. Realizou-se estudo qualitativo descritivo, de corte transversal, baseado num teste de associação livre de palavras, com 12 atores estratégicos. As palavras - Parto; Enfermeira obstétrica; Nascimento; Médico obstetra; Mãe; Complicação; Mulher - foram selecionadas a partir de uma análise textual das contribuições da sociedade na Consulta Pública das Diretrizes, com o software IRaMuTeQ. A análise do resultado do teste de associação de palavras foi realizada na abordagem estrutural das Representações Sociais, com os softwares OpenEVOC e IRaMuTeQ. Foram identificadas como potenciais barreiras à implementação as representações sobre parto associado a dor, o médico obstetra como obstrutor e os estereótipos que marcam o papel da mulher e da mãe na sociedade. Compreender essas representações é importante para evidenciar as convenções que subjazem nas atitudes e práticas de profissionais e usuárias, possibilitando a definição de estratégias específicas para cada grupo.

Abstract This study aims to analyze the social representations of strategic actors involved in health care or management, on issues involving women, childbirth, and birth, seeking to identify and understand barriers to the implementation of the National Guidelines for Assistance to Normal Childbirth. A qualitative, descriptive, cross-sectional study was conducted, based on a word association test with 12 strategic actors. The words - Childbirth; Midwife; Birth; Obstetrician; Mother; Complication; Woman - were selected from a textual analysis of society's contributions to the Public Consultation of the Guidelines, supported by IRaMuTeQ software. The analysis of the word association test result was carried out in the structural approach of Social Representations, with the OpenEVOC and IRaMuTeQ software. Representations about childbirth associated with pain, the obstetrician as an obstructer and the stereotypes that mark the role of women and mothers in society were identified as potential barriers to implementation. Understanding these representations is important to highlight the conventions that underlie the attitudes and practices of professionals and users of services, enabling the definition of specific strategies for each group.

The association of birth model with resilience variables and birth experience: Home versus hospital birth.

OBJECTIVE: to study home, natural hospital, and medical hospital births, and the association of these birth models to resilience and birth experience. DESIGN: cross-section retrospective design. SETTING: participants were recruited via an online survey system. Invitations to participate were posted in five different Internet forums for women on maternity leave, from September 2014 to August 2015. PARTICIPANTS: the sample comprised 381 post partum healthy women above the age of 20, during their maternity leave. Of the participants: 22% gave birth at home, 32% gave birth naturally in a hospital, and 46% of the participants had a medical birth at the hospital. MEASUREMENTS: life Orientation Test Revised (LOT-R), General Self-Efficacy Scale, Sense of Mastery Scale, Childbirth Experience Questionnaire (CEQ). FINDINGS: women having had natural births, whether at home or at the hospital, significantly differed from women having had medical births in all aspects of the birth experience, even when controlling for age and optimism. Birth types contributed to between 14% and 24% of the explained variance of the various birth experience aspects. KEY CONCLUSIONS: home and natural hospital births were associated with a better childbirth experience. Optimism was identified as a resilience factor, associated both with preference as well as with childbirth experience. IMPLICATIONS FOR PRACTICE: physically healthy and resilient women could be encouraged to explore the prospect of home or natural hospital births as a means to have a more positive birth experience.

Ethics and professional responsibility: Essential dimensions of planned home birth.

Planned home birth is a paradigmatic case study of the importance of ethics and professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the professional responsibility model of obstetric ethics, which is based on the professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist's ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman's rights. We then identify the implications of the professional responsibility model for the perinatologist's role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the professional responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth.

The traditional birth attendant: a reality and a challenge.

The traditional birth attendant (TBA) is an institution as old as the birthing process in the human species. Generally a female, in the absence of a better alternative, continues to deliver two thirds of the world's babies. A number of studies generated international interest in training TBAs. A review of TBA training and utilization programs in more than 70 countries over the past three decades revealed that there are very limited examples of their successful utilization. If unsupervised the TBA tends to slide back into her old ways and if unsupported she is rendered helpless when a killer strikes during child birth. The impact of trained TBAs on maternal mortality ratios is not palpable because of other factors such as accessibility of essential obstetric services. The challenge for the policy makers is to make the best use of this available human resource but simultaneously plan and implement a definite replacement strategy.

The hour of birth: comparisons of circadian pattern between women cared for by midwives and obstetricians.

OBJECTIVE: To examine the difference, if any, between midwives' care and obstetricians' care in the circadian pattern of the hour of birth in spontaneous labour and delivery. DESIGN: A descriptive study comparing the circadian pattern of the hour of birth between women cared for by a midwife or an obstetrician. SETTING: Data were derived from the Perinatal Database of the Netherlands (LVR), comprising 83% of all births under midwives' care and 75% of all births under obstetricians' care. SUBJECTS: 57,871 women receiving midwives' care and 31,999 women receiving obstetricians' care with spontaneous labour and spontaneous delivery. MAIN OUTCOME MEASURES: Differences in the circadian rhythms between women receiving midwives' care and obstetricians' care. FINDINGS: There was a difference in the circadian pattern of the hour of birth between midwives' and obstetricians' care. Peak times differed 5.43 hours (CI 4.23-7.03) for primiparous and 3.34 hours (CI 3.00-4.08) for multiparous women between the midwives' group and the obstetricians' group. CONCLUSION: This study demonstrates a remarkable difference in circadian pattern of the hour of birth between midwives' care and obstetricians' care. In obstetricians' care the duration of normal labour appears to be prolonged, presumably by an increased level of stress. In normal birth the care of midwives is preferable.

Safe motherhood program evaluation: theory and practice.

Debate on the evaluation of safe motherhood programs has mainly focused on the outcome or process measure to be used. Less attention is paid to the application of different approaches to evaluation. This article reviews current theories of evaluation and provides examples of the extent to which these theories have been applied in the actual practice of evaluation. Most evaluations use multiple methods and approaches, but the rationale and intention behind these choices are often not made explicit. Factors are identified that need to be taken into consideration when planning and conducting safe motherhood program evaluations. Safe motherhood programs are complex interventions, requiring evaluation by different theoretical approaches and multiple methods. Awareness of these approaches will allow health professionals to plan for evaluation and to use evaluation findings more effectively. If cognizant of the different approaches to evaluation, evaluation frameworks can be developed to improve assessment of the effectiveness of these programs.

Do birth certificate data accurately reflect the number of CNM-attended births? An exploratory study.

The number of midwife-attended births is increasing as reported on birth certificates in the United States. However, there is some evidence that births attended by certified nurse-midwives (CNMs) may not be accurately recorded. In this exploratory study, data on birth attendants for those clients giving birth during the study period were compared by using four sources: the client's hospital chart, the CNM birth log, hospital birth certificate records, and state vital statistics records. Researchers sought to determine the accuracy of birth attendant data as reflected in these four sources and whether other providers were listed as the birth attendant for actual CNM-attended births. During the study period, the CNM birth log showed that CNMs attended 97 vaginal births, whereas the client hospital charts for these same births noted 92 births as attended by CNMs (the other five were operative vaginal births). Hospital birth certificate and state vital statistics data during the study time period credited 88 and 82 of the client's births, respectively, to the CNMs. Exploration of the inaccurately reported birth attendant data, implications for practice, and recommendations for accurately recording birth certificate data are discussed.

[Aspects of women's satisfaction with childbirth care in a maternity hospital in Rio de Janeiro]. / Aspectos da satisfação das mulheres com a assistência ao parto: contribuição para o debate.

The objective of this study was to evaluate factors associated with women's satisfaction with vaginal delivery at the Leila Diniz Maternity Hospital in Rio de Janeiro, Brazil. A cross-sectional study was conducted from March 1 to 30, 1999, using interviews with women who had undergone vaginal delivery. In order to analyze women's satisfaction, the following were used: (a) a scale to evaluate overall satisfaction with the birthing process; (b) description of the woman's reasons for this evaluation; and (c) analysis of factors associated with the evaluation of childbirth satisfaction. Chi-square for trend with a 5% significance level was used to analyze the results. The results of the study showed high satisfaction with childbirth care (67%), determined mainly by short labor time, good treatment by staff, low level of distress, absence of complications for the mother and baby, and presence of a family companion. The study also verified the association between women's satisfaction with information received during perinatal care and positive perceptions of the professionals responsible for providing care.