Experiences of labour and childbirth among physicians in Canada: a qualitative study.

BACKGROUND: Little is known about physicians' birth experiences and the perceived relation between physicians' professional status and their birth outcomes, particularly in nonsurgical specialties. This study aimed to explore the birth experiences of physicians in Canada and to determine their perception of the relation between their profession, and their birth experiences and obstetric outcomes. METHODS: We undertook a qualitative descriptive study consisting of in-depth interviews with practising physician birthing parents, all members of the Canadian Physician Mothers Group (online Facebook community) who had deliveries between 2016 and 2021. Data were analyzed using conventional content analysis. RESULTS: Fourteen interviews were conducted. Half of the participants worked in primary care specialties. From participants' narratives, we developed 5 themes pertaining to physicians' birth experiences: (negative impact of) professional culture of medicine whereby professional responsibility trumped personal needs; (mixed) impact of medical knowledge whereby participants felt empowered to make decisions and ask questions, but also experienced augmented stress due to knowing what could go wrong; difficulty stepping out of physician role; privileged access to care; and belief in negative impact of physician role on birth outcome. Some participants suggested possible reasons that physicians may have worse birth outcomes than the general public. INTERPRETATION: The professional culture of medicine was largely perceived as a negative, in particular, the pressure to deny one's own needs for the good of patients and colleagues. Physicians' increased access to medical care combined with their higher levels of anticipatory anxiety around childbirth could be exposing them to increased monitoring and surveillance, thus augmenting the likelihood of medical and surgical interventions.

Roundtable discussion: "no one can condemn you to a C-section!".

The stories in this Roundtable Discussion are related by two women whose babies were born recently in Canadian hospitals. Each woman had undergone a cesarean delivery for her first child, and whereas Sophia delivered her second baby by vaginal birth after a cesarean (VBAC), Marie was unable to find a practitioner or hospital that would allow her to have a VBAC for her second birth. The women describe how they feel about their choices and experiences. Their two accounts and the issues that they raise are discussed in commentaries by a family physician, midwife, doula, and obstetrician.

Prevalence, diagnosis, and treatment of ankyloglossia: methodologic review.

OBJECTIVE: To review the diagnostic criteria for, the prevalence of, and the effectiveness of frenotomy for treatment of ankyloglossia. DATA SOURCES: MEDLINE and CINAHL databases were searched for articles suitable for a methodologic review of studies on various aspects of ankyloglossia. STUDY SELECTION: Studies that presented data on patients and addressed ankyloglossia in relation to breastfeeding were selected. Case reports, case series, retrospective studies, prospective controlled studies, and randomized controlled trials were included in the analysis. Opinion pieces, literature reviews, studies without data on patients, studies that did not focus on breastfeeding, position statements, and surveys were excluded. SYNTHESIS: There is no well-validated clinical method for establishing a diagnosis of ankyloglossia. Five studies using different diagnostic criteria found a prevalence of ankyloglossia of between 4% and 10%. The results of 6 non-randomized studies and 1 randomized study assessing the effectiveness of frenotomy for improving nipple pain, sucking, latch, and continuation of breastfeeding all suggested frenotomy was beneficial. No serious adverse events were reported. CONCLUSION: Diagnostic criteria for ankyloglossia are needed to allow for comparative studies of treatment. Frenotomy is likely an effective treatment, but further randomized controlled trials are needed to confirm this. A reliable frenotomy decision rule is also needed.

Ankyloglossia in breastfeeding infants: the effect of frenotomy on maternal nipple pain and latch.

OBJECTIVE: The aim of this study was to measure the effectiveness of frenotomy in ankyloglossic infants, by quantifying the changes in latch and maternal nipple pain using standardized tools. METHODOLOGY: Infants below 12 weeks of age were recruited from the Goldfarb Breastfeeding Program between August 2004 and February 2005. Infants were selected based on the Frenotomy Decision Rule for Breastfeeding Infants (FDRBI), a new clinical tool for future validation. Latch was assessed using the Latch Tool. Maternal nipple pain was assessed using R. Melzack's Short Form McGill Pain Questionnaire, consisting of the Pain Rating Index (PRI) and Present Pain Intensity (PPI). Frenotomy was performed, followed by repeat latch and pain assessments. Mothers also received breastfeeding counseling throughout and after the procedure. A telephone questionnaire was administered 3 months later. RESULTS: Twenty-seven (27) mother-infant dyads participated in the study. No complications were seen with frenotomy. All infants had an equal or higher latch score after frenotomy, with an improvement in mean latch score of 2.5 (p < 0.0001, 95% confidence interval [CI], 2.038, 2.925). Maternal pain scores decreased significantly after frenotomy, with mean improvements of -11.4 points (p < 0.0001, 95% CI, -15.544, -7.345) on the PRI subscale and -1.5 points (p < 0.0001, 95% CI, -1.952, -1.011) on the PPI subscale. Seventy-seven point eight percent (77.8%) of subjects were still breastfeeding after 3 months; 92% were pain free after 3 months; and 88% felt the frenotomy had helped them. CONCLUSION: Timely frenotomy and breastfeeding counseling is an effective intervention, improving latch and decreasing nipple pain.

Giving birth: the voices of Orthodox Jewish women living in Canada.

OBJECTIVE: To describe the meaning of the childbirth experience to Orthodox Jewish women living in Canada. DESIGN: In this phenomenologic study, audiotaped interviews were conducted. Tapes were transcribed verbatim and analyzed for emergent themes. Demographic data also were collected. SETTING AND PARTICIPANTS: Thirty Orthodox Jewish women who had given birth to healthy full-term newborns at a university-affiliated Jewish hospital in Montreal, Canada, participated in the study. Data were collected within 2 weeks after childbirth, either in the mother's postpartum hospital room or in her home. RESULTS: The following themes reflecting spiritual/cultural dimensions of the childbirth experience were identified: (a) birth as a significant life event, (b) birth as a bittersweet paradox, (c) the spiritual dimensions of giving birth, (d) the importance of obedience to rabbinical law, and (e) a sense of support and affirmation. CONCLUSION: This study documents cultural, religious, and spiritual dimensions of the childbirth experience of Orthodox Jewish women living in Canada. Knowledge and appreciation of the multiple dimensions of childbirth reflected by this study's findings can contribute to holistic and culturally competent nursing care of women and newborns.