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Women and Birth : Journal of the... Nov 2021The birth environment can help or hinder physiological birth and influence a woman's level of satisfaction with birth.
BACKGROUND
The birth environment can help or hinder physiological birth and influence a woman's level of satisfaction with birth.
AIM
This paper gives new theoretical insights into how spatial architecture influences birthing women and their birth processes. It builds the architectural awareness of midwives/ designers need by linking design regulations/recommendations and experiential aspects of birth spaces architecture.
METHODS
Two qualitative methods were used: (1) a regulation/policy document critique, and (2) childbearing women's spatial experiences explored in semi-structured interviews with drawing methods (24 mothers in a case study location in the north of England, UK). Themes emerged from semiotic (documents/visual data) and thematic (transcripts) analysis, and their relationships explored.
FINDINGS
The regulatory documents revealed four spatial categorization concepts: (1) medical risk; (2) a tripartite clinical approach; (3) single-function birth space; and (4) a woman-centered approach. In contrast, women experience birth spaces architecture as an amalgam of all the spaces they use and in affective, interpersonal. Two patterns of spatial use emerged from the interviews: (1) 'wait and transfer' (more common in healthcare buildings); and (2) 'curate and prosume' (more common in women's homes). Women gave greater positive descriptions of the 'curate and prosume' pattern.
CONCLUSIONS
The influence of building regulations on hospital settings and women's prior experiences of such spaces through appointments and antenatal education, shape women's spatial experiences of childbirth. This new evidence can act as a catalyst to evolve birth space design towards delivering woman-centered and personalized care in spaces designed for women to 'curate and prosume'.
Topics: Delivery, Obstetric; Female; Humans; Midwifery; Mothers; Parturition; Pregnancy; Qualitative Research
PubMed: 33341363
DOI: 10.1016/j.wombi.2020.11.003 -
Matrix Biology : Journal of the... May 2019Cervical hyaluronan (HA) synthesis is robustly induced in late pregnancy in numerous species including women and mice. Recent evidence highlights the diverse and dynamic... (Review)
Review
Cervical hyaluronan (HA) synthesis is robustly induced in late pregnancy in numerous species including women and mice. Recent evidence highlights the diverse and dynamic functions of HA in cervical biology that stem from its expression in the cervical stroma, epithelia and immune cells, changes in HA molecular weight and cell specific expression of HA binding partners. Mice deficient in HA in the lower reproductive tract confirm a structural role of HA to increase spacing and disorganization of fibrillar collagen, though this function is not critical for pregnancy and parturition. In addition, cervical HA depletion via targeted deletion of HA synthase genes, disrupts cell signaling required for the differentiation of epithelia and their mucosal and junctional barrier, resulting in increased susceptibility to ascending infection-mediated preterm birth. Finally the generation of HA disaccharides by bacterial hyaluronidases as made by Group B streptococcus can ligate toll like receptors TLR2/4 thus preventing appropriate inflammatory responses as needed to fight ascending infection and preterm birth. This review summarizes our current understanding of HA's novel and unique roles in cervical remodeling in the process of birth.
Topics: Animals; Cell Differentiation; Cervix Uteri; Female; Fibrillar Collagens; Humans; Hyaluronan Synthases; Hyaluronic Acid; Mice; Parturition; Pregnancy; Premature Birth
PubMed: 29510230
DOI: 10.1016/j.matbio.2018.03.002 -
Sexual & Reproductive Healthcare :... Dec 2022Following the "call for action to research", various aspects of maternity care should be examined so that perinatal care can be improved based on evidence. Clinical... (Review)
Review
Following the "call for action to research", various aspects of maternity care should be examined so that perinatal care can be improved based on evidence. Clinical midwifery is the most common way of attending births in high-income countries. Midwives are the experts for normal labor and birth and play a central role in caring for women giving birth in a hospital setting. The aim of this scoping review was to explore midwives' action-guiding orientation in their care provision during hospital births in high-income countries. Four databases (CINAHL, PubMed, MEDLINE and PSYNDEX) were searched systematically for studies in English or German on midwives' action-guiding orientation during hospital labor and birth, published between 2000 and February 2022. Only studies from peer-reviewed journals were included. Reporting followed the PRISMA-ScR statement for scoping reviews. From a total of 1572 studies, 26 studies with 4 different research designs were included in the narrative synthesis. The synthesis shows 7 central concepts that emerge in the studies: medicalization of birth versus woman-centered care; midwives' knowledge and experience; midwives' professional identity; midwives' confidence or autonomy in practice; intra-professional and multi-professional relations; continuity of care and relationship with the woman; and working conditions and cultural context. The central concept most reflective of midwives' action-guiding orientation was "medicalization of birth versus woman-centered care." Other elements that affect midwives' action-guiding orientation and represent influencing factors at the micro, meso, and macro levels of obstetric care must be considered if one is to understand the profession and work of midwives.
Topics: Female; Humans; Pregnancy; Hospitals; Labor, Obstetric; Maternal Health Services; Midwifery; Nurse Midwives; Parturition; Qualitative Research
PubMed: 36152453
DOI: 10.1016/j.srhc.2022.100778 -
Birth (Berkeley, Calif.) Mar 2022Much of the emerging research on the effects of SARS-CoV-2 disease (COVID-19) on pregnant people and their infants has been clinical, devoting little attention to how...
BACKGROUND
Much of the emerging research on the effects of SARS-CoV-2 disease (COVID-19) on pregnant people and their infants has been clinical, devoting little attention to how the pandemic has affected families navigating pregnancy and birth. This study examined the perspectives of doulas, or nonclinical labor support professionals, on how pregnancy and birth experiences and maternal health care delivery systems changed in the early weeks of the COVID-19 pandemic.
METHODS
Semi-structured interviews using open-ended questions were conducted over the phone with 15 birth doulas. Doulas were invited to participate because of their close relationships with pregnant and birthing people and the comprehensive support they offer. The interview transcripts were analyzed inductively.
RESULTS
Doulas' clients faced three predominant COVID-19-related pregnancy and birth challenges: (a) fear of exposure; (b) limited access to their expected support systems; and (c) uncertainties surrounding hospital restrictions on labor and birth. Doulas responded creatively to help their clients confront these challenges. Participants expressed various criticisms of how maternal health care systems handled the emerging crisis, argued that COVID-19 exposed preexisting weaknesses in US maternity care, and called for a coordinated care model involving doulas.
DISCUSSION
Doulas' close relationships with pregnant people enabled them to be an important source of support during the COVID-19 pandemic. Added to the larger body of work on the impacts of doula care, this study supports widespread calls for universally integrating doulas into maternity care systems as a targeted strategy to better support pregnant and birthing people in both crisis and noncrisis situations.
Topics: COVID-19; Doulas; Female; Humans; Maternal Health Services; Pandemics; Parturition; Pregnancy; SARS-CoV-2; United States
PubMed: 34296466
DOI: 10.1111/birt.12580 -
Philosophical Transactions of the Royal... Mar 2015The pelvis performs two major functions for terrestrial mammals. It provides somewhat rigid support for muscles engaged in locomotion and, for females, it serves as the... (Comparative Study)
Comparative Study Review
The pelvis performs two major functions for terrestrial mammals. It provides somewhat rigid support for muscles engaged in locomotion and, for females, it serves as the birth canal. The result for many species, and especially for encephalized primates, is an 'obstetric dilemma' whereby the neonate often has to negotiate a tight squeeze in order to be born. On top of what was probably a baseline of challenging birth, locomotor changes in the evolution of bipedalism in the human lineage resulted in an even more complex birth process. Negotiation of the bipedal pelvis requires a series of rotations, the end of which has the infant emerging from the birth canal facing the opposite direction from the mother. This pattern, strikingly different from what is typically seen in monkeys and apes, places a premium on having assistance at delivery. Recently reported observations of births in monkeys and apes are used to compare the process in human and non-human primates, highlighting similarities and differences. These include presentation (face, occiput anterior or posterior), internal and external rotation, use of the hands by mothers and infants, reliance on assistance, and the developmental state of the neonate.
Topics: Adaptation, Biological; Animals; Biological Evolution; Female; History, Ancient; Humans; Labor Presentation; Midwifery; Parturition; Pelvis; Pregnancy; Primates; Species Specificity
PubMed: 25602069
DOI: 10.1098/rstb.2014.0065 -
NCHS Data Brief Sep 2021This report presents selected highlights from 2020 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates...
This report presents selected highlights from 2020 final birth data on key demographic, health care utilization, and infant health indicators. General fertility rates (births per 1,000 women aged 15-44), age-specific birth rates (births per 1,000 women in specified age group), low-risk (nulliparous, term, singleton, cephalic births) cesarean delivery, and preterm (less than 37 weeks of gestation) birth rates are presented. All indicators are compared between 2019 and 2020 and shown for all births. General fertility rates (GFRs), lowrisk cesarean and preterm birth rates are shown for the three largest race and Hispanic-origin groups: non-Hispanic white, non-Hispanic black, and Hispanic. Fertility rates are shown by age of mother.
Topics: Birth Rate; Cesarean Section; Female; Hispanic or Latino; Humans; Infant; Infant, Newborn; Parturition; Pregnancy; Premature Birth; United States
PubMed: 34582330
DOI: No ID Found -
BMC Pregnancy and Childbirth Aug 2017Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices... (Review)
Review
BACKGROUND
Two recent recommendations made by the World Health Organization confirm the benefits of companion of choice at birth on labour outcomes; however institutional practices and policies do not always support its implementation in different settings around the world. We conducted a review to determine factors that affect implementation of this intervention considering the perspectives and experiences of different stakeholders and other institutional, systemic barriers and facilitators.
METHODS
Forty one published studies were included in this review. Thirty one publications were identified from a 2013 Cochrane review on the effectiveness of companion of choice at birth. We also reviewed 10 qualitative studies conducted alongside the trials or other interventions on labour and birth companionship identified through electronic searches. The SURE (Supporting the Use of Research Evidence) framework was used to guide the thematic analysis of implementation factors.
RESULTS
Women and their families expressed appreciation for the continuous presence of a person to provide support during childbirth. Health care providers were concerned about the role of the companion and possible interference with activities in the labour ward. Allocation of resources, organization of care, facility-related constraints and cultural inclinations were identified as implementation barriers.
CONCLUSION
Prior to introducing companion of choice at birth, understanding providers' attitudes and sensitizing them to the evidence is necessary. The commitment of the management of health care facilities is also required to change policies, including allocation of appropriate physical space that respects women's privacy. Implementation research to develop models for different contexts which could be scaled up would be useful, including documentation of factors that affected implementation and how they were addressed. Future research should also focus on documenting the costs related to implementation, and on measuring the impact of companion of choice at birth on care-seeking behavior for subsequent births.
Topics: Attitude of Health Personnel; Choice Behavior; Female; Friends; Health Knowledge, Attitudes, Practice; Health Personnel; Health Plan Implementation; Humans; Labor, Obstetric; Parturition; Pregnancy; Qualitative Research
PubMed: 28854903
DOI: 10.1186/s12884-017-1447-9 -
Obstetrics and Gynecology Jan 2023Preterm birth (any birth at less than 37 weeks of gestation) disproportionally affects Black birthing people and is associated with adverse perinatal and fetal health...
OBJECTIVE
Preterm birth (any birth at less than 37 weeks of gestation) disproportionally affects Black birthing people and is associated with adverse perinatal and fetal health outcomes. Racism increases the risk of preterm birth, but standardized measurement metrics are elusive. This narrative synthesis examines literature on measures of racial discrimination used in preterm birth research.
DATA SOURCES
Six databases (CINAHL, Cochrane, EMBASE, PubMed [MEDLINE], Scopus, Web of Science) and ClinicalTrials.gov were searched. Search terms were categorized into three groups (racism terms, measurement terms, preterm birth terms) to identify original research articles that explored associations between racism and preterm birth. English-language, original research articles with U.S. populations were included.
METHODS OF STUDY SELECTION
Studies were excluded if conducted in only White populations, if only paternal factors were included, or if only racial differences in preterm birth were described. Articles were independently reviewed by two blinded researchers for inclusion at every stage of screening and data extraction; a third reviewer resolved discrepancies.
TABULATION, INTEGRATION, AND RESULTS
Sixty studies were included in the final analysis. Articles primarily included measures examining interpersonal forms of racism (n=17) through the Experiences of Discrimination and Everyday Discrimination scales, neighborhood composition (n=22) with the Neighborhood Deprivation Index and the Index of Concentration at the Extremes, policy-level racism (n=12) through institutions such as residential racial segregation or policy inequities, or multiple forms (n=9).
CONCLUSION
Among studies, assessment methods and application of constructs varied. This heterogeneity poses significant challenges to understanding associations between racial discrimination and preterm birth and to describing potential etiologic pathways of preterm birth, which ultimately hinders development of effective intervention. Strategies to capture multilevel exposures to racism require the development and expansion of metrics that are culturally inclusive, empirically valid, and reliable among Black pregnant populations.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42022327484.
Topics: Female; Humans; Infant, Newborn; Pregnancy; Parturition; Premature Birth; Prenatal Care; Racism; Residence Characteristics
PubMed: 36701611
DOI: 10.1097/AOG.0000000000005023 -
Sexual & Reproductive Healthcare :... Dec 2022Adopting an upright sacrum flexible position may facilitate physiological childbirth, which many pregnant women wish for. A positive association between women's choice...
BACKGROUND
Adopting an upright sacrum flexible position may facilitate physiological childbirth, which many pregnant women wish for. A positive association between women's choice on birthing position and birthing experience has been found.
OBJECTIVE
The aim of this study was to examine women's preferred birth position, self-efficacy at term and their actual birth position at time of birth.
METHODS
A survey of 554 pregnant Danish women at gestational week 38. Data was collected using an online survey and information was retracted from the woman's medical record. Descriptive statistics and non-parametric tests were used and univariate and multivariate logistic regression models were used to analyse the association between self-efficacy and fulfilled wish of birth position.
FINDINGS
The majority of women (>70 %) wished to give birth in a sacrum flexible position but more than 80 % gave birth in a non-flexible position. Less than 50 % had their wish of birth position fulfilled. All women reported overall high self-efficacy. No difference in having wish for birth position fulfilled was found comparing women with high and low self-efficacy.
CONCLUSIONS
Most women wished for a sacrum flexible position but more than 80% gave birth in a sacrum non-flexible position and less than 50% had their wish for birth position fulfilled. Level of self-efficacy did not affect the likelihood of having wish of birth position fulfilled indicating that the culture at the birth setting and skills and attitudes among birth providers may have a considerable impact on women's choice of birth position.
Topics: Female; Pregnancy; Humans; Self Efficacy; Motivation; Parturition; Pregnant Women; Surveys and Questionnaires
PubMed: 36244077
DOI: 10.1016/j.srhc.2022.100783 -
Midwifery Nov 2022Maternity health professionals (MHPs) caring for women may witness or be involved in traumatic births. This can be associated with MHPs experiencing secondary traumatic... (Review)
Review
OBJECTIVES
Maternity health professionals (MHPs) caring for women may witness or be involved in traumatic births. This can be associated with MHPs experiencing secondary traumatic stress (STS) or probable post-traumatic stress disorder (PTSD), which may impact MHPs emotionally and physically. The aims of this review were therefore to determine: (i) the prevalence of STS and PTSD in maternity health professionals; and (ii) the impact of witnessing birth trauma on maternity health professionals.
METHODS
A mixed-methods systematic review was carried out by conducting literature searches on CINAHL, MEDLINE, PsychARTICLES, PsychINFO and PsychTESTS databases. Searches were conducted from the inception of databases up to February 2022 using search terms on MHPs and birth trauma combined. Methodological quality and bias were assessed. Data were synthesised using thematic synthesis.
RESULTS
A total of 18 studies were included in the review. Sample size ranged from 9 to 2,165 (total N = 8,630). Participants included midwives, nurses and obstetricians aged 18-77 years. Many MHPs had witnessed a traumatic birth event (45% - 96.9%) with the prevalence of STS ranging from 12.6%-38.7% and the proportion of participants meeting diagnostic criteria for PTSD ranging from 3.1%-46%. MHPs reported positive and negative effects associated with witnessing traumatic birth events. Synthesis of quantitative and qualitative papers identified five themes: Negative emotions and symptoms; Responsibility and regret; Impact on practice and care; Challenging professional identity; and Team support being essential.
DISCUSSION
Witnessing traumatic birth events is associated with profound emotional and physical impacts on MHPs, signifying the importance of acknowledging and addressing this in the maternity workforce. It is important to raise awareness of the impact of birth trauma on MHPs. Effective education and training guidelines, a supervisory network, ways to change practice and policy, and support and treatment should be provided to assist and improve the outcomes and work-life of MHPs' who witness traumatic births.
Topics: Humans; Female; Pregnancy; Parturition; Midwifery; Nurse Midwives; Stress Disorders, Post-Traumatic; Birth Injuries
PubMed: 36058189
DOI: 10.1016/j.midw.2022.103460