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Birth (Berkeley, Calif.) Mar 2022The risks and benefits of different birthing positions are commonly studied, but both paternal and maternal preferences and experiences of different birth positions are... (Review)
Review
BACKGROUND
The risks and benefits of different birthing positions are commonly studied, but both paternal and maternal preferences and experiences of different birth positions are not examined. Therefore, this systematic review aims to explore the perceptions of women and their partners on birthing positions during the first and second stage of labor, so that maternity health care practitioners can provide better quality patient-centered care.
METHODS
Six databases were searched from each database's inception through November 2020. Qualitative or mixed-methods studies exploring perceptions of women and/or their partners on birthing positions were included in the review. Key information and findings of the studies were extracted; qualitative data were meta-summarized, then meta-synthesized using thematic analysis.
RESULTS
Seven studies were included, and four themes emerged: (a) Influences on choice and preference; (b) mixed experiences from "pain" to "more in control"; (c) impact on postpartum health; and (d) ways to empower couples in their choice.
CONCLUSIONS
Women's preferences for birthing positions were influenced by a myriad of personal and socio-cultural beliefs and traditions. Findings suggest a need for health care practitioners to build better rapport and provide more culturally relevant informational support to both women and their birthing partners, so they are better able to make informed decisions on their preferred birthing position.
Topics: Family; Female; Humans; Labor, Obstetric; Parturition; Postpartum Period; Pregnancy; Qualitative Research
PubMed: 34245040
DOI: 10.1111/birt.12574 -
BMJ Global Health Jul 2022Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to... (Review)
Review
BACKGROUND
Community-based doulas share the same cultural, linguistic, ethnic backgrounds or social experiences as the women they support. Community-based doulas may be able to bridge gaps for migrant and refugee women in maternity settings in high-income countries (HICs). The aim of this review was to explore key stakeholders' perceptions and experiences of community-based doula programmes for migrant and refugee women during labour and birth in HICs, and identify factors affecting implementation and sustainability of such programmes.
METHODS
We conducted a mixed-method systematic review, searching MEDLINE, CINAHL, Web of Science, Embase and grey literature databases from inception to 20th January 2022. Primary qualitative, quantitative and mixed-methods studies focusing on stakeholders' perspectives and experiences of community-based doula support during labour and birth in any HIC and any type of health facility were eligible for inclusion. We used a narrative synthesis approach to analysis and GRADE-CERQual approach to assess confidence in qualitative findings.
RESULTS
Twelve included studies were from four countries (USA, Sweden, England and Australia). There were 26 findings categorised under three domains: (1) community-based doulas' role in increasing capacity of existing maternity services; (2) impact on migrant and refugee women's experiences and health; and (3) factors associated with implementing and sustaining a community-based doula programme.
CONCLUSION
Community-based doula programmes can provide culturally-responsive care to migrant and refugee women in HICs. These findings can inform community-based doula organisations, maternity healthcare services and policymakers. Further exploration of the factors that impact programme implementation, sustainability, strategic partnership potential and possible wider-reaching benefits is needed.
Topics: Doulas; Female; Humans; Labor, Obstetric; Parturition; Pregnancy; Refugees; Transients and Migrants
PubMed: 35902203
DOI: 10.1136/bmjgh-2022-009098 -
Nursing Open Sep 2021This study aimed to evaluate the effect of prenatal aerobic exercises on maternal and neonatal outcomes. (Meta-Analysis)
Meta-Analysis Review
AIM
This study aimed to evaluate the effect of prenatal aerobic exercises on maternal and neonatal outcomes.
DESIGN
A systematic review and meta-analysis.
METHOD
A search was carried out in databases including PubMed, ProQuest, EMBASE, Cochrane Library, Scopus, Web of Science, Magiran and SID until 30 September 2020. Two reviewers independently assessed the articles for quality and risk of bias using the Cochrane handbook. The statistical heterogeneity was determined using the Cochran's Q test and Higgins' I coefficient.
RESULTS
Of the 2,790 extracted articles, 16 were included in this review. The results of the meta-analysis showed that prenatal exercise can increase the frequency of vaginal delivery significantly (RR: 1.24; 95% CI: 1.08-1.43), but had no statistically significant effect on other maternal and neonatal outcomes, such as first, second and third stages of labour, gestational age at birth, first and fifth-minute Apgar score, umbilical cord pH, neonatal weight, height and head circumference (p > .05).
CONCLUSIONS
The meta-analysis results suggested that prenatal exercise can reduce the frequency of caesarean section.
Topics: Cesarean Section; Delivery, Obstetric; Exercise; Female; Humans; Labor, Obstetric; Parturition; Pregnancy
PubMed: 33683833
DOI: 10.1002/nop2.838 -
American Journal of Obstetrics and... May 2023The past 20 years witnessed an invigoration of research on labor progression and a change of thinking regarding normal labor. New evidence is emerging, and more advanced...
The past 20 years witnessed an invigoration of research on labor progression and a change of thinking regarding normal labor. New evidence is emerging, and more advanced statistical methods are applied to labor progression analyses. Given the wide variations in the onset of active labor and the pattern of labor progression, there is an emerging consensus that the definition of abnormal labor may not be related to an idealized or average labor curve. Alternative approaches to guide labor management have been proposed; for example, using an upper limit of a distribution of labor duration to define abnormally slow labor. Nonetheless, the methods of labor assessment are still primitive and subject to error; more objective measures and more advanced instruments are needed to identify the onset of active labor, monitor labor progression, and define when labor duration is associated with maternal/child risk. Cervical dilation alone may be insufficient to define active labor, and incorporating more physical and biochemical measures may improve accuracy of diagnosing active labor onset and progression. Because the association between duration of labor and perinatal outcomes is rather complex and influenced by various underlying and iatrogenic conditions, future research must carefully explore how to integrate statistical cut-points with clinical outcomes to reach a practical definition of labor abnormalities. Finally, research regarding the complex labor process may benefit from new approaches, such as machine learning technologies and artificial intelligence to improve the predictability of successful vaginal delivery with normal perinatal outcomes.
Topics: Child; Female; Humans; Pregnancy; Artificial Intelligence; Delivery, Obstetric; Dystocia; Labor Stage, First; Labor, Obstetric
PubMed: 37164489
DOI: 10.1016/j.ajog.2022.11.1299 -
Journal of Clinical Nursing Jul 2023To evaluate and quantify the best available evidence regarding risk factors for severe perineal lacerations. (Meta-Analysis)
Meta-Analysis Review
AIMS AND OBJECTIVES
To evaluate and quantify the best available evidence regarding risk factors for severe perineal lacerations.
BACKGROUND
Many studies have evaluated the risk factors for severe perineal lacerations. However, the results of those studies are inconsistent, and meta-analysis which thoroughly evaluates the risk factors for severe perineal lacerations is still lacking.
DESIGN
Systematic review and meta-analysis of cohort studies based on the PRISMA guideline.
METHODS
PubMed, Embase, the Cochrane Library, CINAHL, ClinicalTrials.gov, CNKI, Wanfang Data, VIP and SinoMed were systematically searched for cohort studies reporting at least one risk factor for severe perineal lacerations from 1 January 2000 to 2 June 2021. Two reviewers independently conducted quality appraisal by NOS scale and extracted data. Data synthesis was conducted via RevMan 5.3 using a random-effects or fixed-effects model.
RESULTS
A total of 47 studies with 7,043,218 women were included. The results showed that prior caesarean delivery (OR: 1.46, 95% CI 1.12-1.92) and pre-pregnant underweight (OR: 1.31, 95% CI 1.22-1.41) significantly increased the risk of severe perineal lacerations. The results also demonstrated that episiotomy was protective against severe perineal lacerations in forceps delivery (OR: 0.56, 95% CI 0.42-0.74), but not spontaneous vaginal delivery (OR: 1.30, 95% CI 0.81-2.07) or vacuum delivery (OR: 0.76, 95% CI 0.45-1.28). Nulliparity, foetus in occipitoposterior or occipitotransverse position, and midline episiotomy were also independent risk factors for severe perineal lacerations.
CONCLUSIONS
Severe perineal lacerations are associated with many factors, and evidence-based risk assessment tools are needed to guide the midwives and obstetricians to estimate women's risk of severe perineal lacerations.
RELEVANCE TO CLINICAL PRACTICE
This systematic review and meta-analysis identified some important risk factors for severe perineal lacerations, which provides comprehensive insights to guide the midwives to assess women's risk for severe perineal lacerations and take appropriate preventive measures to decrease the risk.
Topics: Pregnancy; Female; Humans; Lacerations; Perineum; Obstetric Labor Complications; Delivery, Obstetric; Parturition; Episiotomy; Cohort Studies; Risk Factors
PubMed: 35791260
DOI: 10.1111/jocn.16438 -
PloS One 2024Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Stress during pregnancy is detrimental to maternal health, pregnancy and birth outcomes and various preventive relaxation interventions have been developed. This systematic review and meta-analysis aimed to evaluate their effectiveness in terms of maternal mental health, pregnancy and birth outcomes.
METHOD
The protocol for this review is published on PROSPERO with registration number CRD42020187443. A systematic search of major databases was conducted. Primary outcomes were maternal mental health problems (stress, anxiety, depression), and pregnancy (gestational age, labour duration, delivery mode) and birth outcomes (birth weight, Apgar score, preterm birth). Randomized controlled trials or quasi-experimental studies were eligible. Meta-analyses using a random-effects model was conducted for outcomes with sufficient data. For other outcomes a narrative review was undertaken.
RESULT
We reviewed 32 studies comprising 3,979 pregnant women aged 18 to 40 years. Relaxation interventions included yoga, music, Benson relaxation, progressive muscle relaxation (PMR), deep breathing relaxation (BR), guided imagery, mindfulness and hypnosis. Intervention duration ranged from brief experiment (~10 minutes) to 6 months of daily relaxation. Meta-analyses showed relaxation therapy reduced maternal stress (-4.1 points; 95% Confidence Interval (CI): -7.4, -0.9; 9 trials; 1113 participants), anxiety (-5.04 points; 95% CI: -8.2, -1.9; 10 trials; 1965 participants) and depressive symptoms (-2.3 points; 95% CI: -3.4, -1.3; 7 trials; 733 participants). Relaxation has also increased offspring birth weight (80 g, 95% CI: 1, 157; 8 trials; 1239 participants), explained by PMR (165g, 95% CI: 100, 231; 4 trials; 587 participants) in sub-group analysis. In five trials evaluating maternal physiological responses, relaxation therapy optimized blood pressure, heart rate and respiratory rate. Four trials showed relaxation therapy reduced duration of labour. Apgar score only improved significantly in two of six trials. One of three trials showed a significant increase in birth length, and one of three trials showed a significant increase in gestational age. Two of six trials examining delivery mode showed significantly increased spontaneous vaginal delivery and decreased instrumental delivery or cesarean section following a relaxation intervention.
DISCUSSION
We found consistent evidence for beneficial effects of relaxation interventions in reducing maternal stress, improving mental health, and some evidence for improved maternal physiological outcomes. In addition, we found a positive effect of relaxation interventions on birth weight and inconsistent effects on other pregnancy or birth outcomes. High quality adequately powered trials are needed to examine impacts of relaxation interventions on newborns and offspring health outcomes.
CONCLUSION
In addition to benefits for mothers, relaxation interventions provided during pregnancy improved birth weight and hold some promise for improving newborn outcomes; therefore, this approach strongly merits further research.
Topics: Pregnancy; Infant, Newborn; Female; Humans; Cesarean Section; Maternal Health; Mental Health; Birth Weight; Premature Birth; Labor, Obstetric
PubMed: 38271440
DOI: 10.1371/journal.pone.0278432 -
International Journal of Gynaecology... Sep 2023Numerous interventions to reduce perineal trauma during childbirth have been studied in recent years, including perineal massage. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Numerous interventions to reduce perineal trauma during childbirth have been studied in recent years, including perineal massage.
OBJECTIVE
To determine the efficacy of perineal massage during the second stage of labor to prevent perineal damage.
SEARCH STRATEGY
Systematic search in PubMed, Pedro, Scopus, Web of Science, ScienceDirect, BioMed, SpringerLink, EBSCOhost, CINAHL, and MEDLINE with the terms Massage, Second labor stage, Obstetric delivery, and Parturition.
SELECTION CRITERIA
The articles must have been published in the last 10 years; the perineal massage was administered to the study sample; and the experimental design consisted of randomized controlled trial.
DATA COLLECTION AND ANALYSIS
Tables were used to describe both the studies' characteristics and the extracted data. The PEDro and Jadad scales were used to assess the quality of studies.
MAIN RESULTS
Of the 1172 total results identified, nine were selected. Seven studies were included in the meta-analysis and indicated a statistically significant decreased number of episiotomies in perineal massage.
CONCLUSIONS
Massage during the second stage of labor appears to be effective in preventing episiotomies and reducing the duration of the second stage of labor. However, it does not appear to be effective in reducing the incidence and severity of perineal tears.
Topics: Humans; Female; Pregnancy; Lacerations; Labor Stage, Second; Massage; Delivery, Obstetric; Parturition; Perineum; Obstetric Labor Complications
PubMed: 36808391
DOI: 10.1002/ijgo.14723 -
Journal of Nephrology Dec 2022As awareness around infertility is increasing among patients with chronic kidney disease (CKD), ever more of them are seeking Assisted Reproductive Technology (ART). Our... (Review)
Review
BACKGROUND
As awareness around infertility is increasing among patients with chronic kidney disease (CKD), ever more of them are seeking Assisted Reproductive Technology (ART). Our aim was to perform a systematic review to describe obstetric and renal outcomes in women with CKD following ART.
METHODS
The following databases were searched from 1946 to May 2021: (1) Cochrane Central Register of Controlled Trials (CENTRAL), (2) Cumulative Index to Nursing and Allied Health Literature (CINAHL), (3) Embase and (4) MEDLINE.
RESULTS
The database search identified 3520 records, of which 32 publications were suitable. A total of 84 fertility treatment cycles were analysed in 68 women. Median age at time of pregnancy was 32.5 years (IQR 30.0, 33.9 years). There were 60 clinical pregnancies resulting in 70 live births (including 16 multifetal births). Four women developed ovarian hyperstimulation syndrome which were associated with acute kidney injury. Hypertensive disorders complicated 26 pregnancies (38.3%), 24 (35.3%) pregnancies were preterm delivery, and low birth weight was present in 42.6% of pregnancies. Rates of live birth and miscarriage were similar for women with CKD requiring ART or having natural conception. However, more women with ART developed pre-eclampsia (p < 0.05) and had multifetal deliveries (p < 0.001), furthermore the babies were lower gestational ages (p < 0.001) and had lower birth weights (p < 0.001).
CONCLUSION
This systematic review represents the most comprehensive assessment of fertility outcomes in patients with CKD following ART. However, the high reported live birth rate is likely related to reporting bias. Patient selection remains crucial in order to maximise patient safety, screen for adverse events and optimise fertility outcomes.
Topics: Infant; Pregnancy; Infant, Newborn; Humans; Female; Renal Insufficiency, Chronic; Kidney; Reproductive Techniques, Assisted; Acute Kidney Injury; Live Birth
PubMed: 36396849
DOI: 10.1007/s40620-022-01510-x -
Nursing Open Sep 2021This study aimed to determine effectiveness of peanut ball on the duration of the stages of labour and frequency of caesarean section. (Meta-Analysis)
Meta-Analysis Review
AIM
This study aimed to determine effectiveness of peanut ball on the duration of the stages of labour and frequency of caesarean section.
DESIGN
A systematic review and meta-analysis.
METHOD
A comprehensive electronic search was carried out with no time limit until December 2020. Collected data were analysed using software RevMan- version 5.3. Heterogeneity was assessed using I , T , and . GRADE approach was used to assess the certainty of evidence.
RESULTS
The meta-analysis on six clinical trials with 645 participants showed no statistically significant difference between the two groups in caesarean surgery rate (RR = 0.82) and length of the first (MD = -15.64).
CONCLUSIONS
Therefore, further clinical trials with stronger evidence should be carried out to assess the effectiveness of peanut ball on caesarean surgery rate and length of first and second stages of labour.
Topics: Humans; Pregnancy; Arachis; Cesarean Section; Labor, Obstetric; Female
PubMed: 33773071
DOI: 10.1002/nop2.844 -
Frontiers in Psychiatry 2021Temperament involves individual variations in behavioural tendencies of emotional responses and reactions to stimuli after birth. Because 'foetal programming' is a...
Temperament involves individual variations in behavioural tendencies of emotional responses and reactions to stimuli after birth. Because 'foetal programming' is a strong hypothesis in developing temperament, prenatal and intrapartum factors may be significant determinants of infant temperament. This systematic literature review aims to elucidate the evidence of prenatal and intrapartum predictors, including genetic, biological, environmental, socio-demographic, psychological, and obstetric factors of parents and their child. Relevant articles were searched using MEDLINE, PubMed, and SCOPUS. The inclusion criteria were (a) original research article, (b) written in English, (c) assessed the temperament of infants 12 months old or younger as an outcome variable, and (d) investigated prenatal and intrapartum factorial variables of infant temperament. Following the PRISMA guideline, the articles found in the three databases were screened and selected according to the inclusion and exclusion criteria before the final review. Finally, 35 articles were reviewed. This systematic review identified a variety of prenatal and intrapartum factors that were significantly associated with infant temperament: (1) genetic and biological factors: certain genotypes, maternal cortisol and ACTH, and CRHs, (2) environmental factors: substance use such as tobacco, alcohol, and illegal drugs, (3) socio-demographic factor: lower-income, (4) psychological factors: depression or anxiety, eating disorders, personality types of mothers, and domestic violence, and (5) obstetric factors: foetal growth (birth weight), hypertension in mothers, nausea (emesis), and preterm birth. The findings support gene-environment interaction and biological mechanisms for developing infant temperament, suggesting the importance of ensuring a safe and comfortable environment for pregnant mothers, unborn infants, and families during pregnancy and delivery.
PubMed: 33897486
DOI: 10.3389/fpsyt.2021.609020