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PloS One 2021Home birth is very common in the Peruvian Amazon. In rural areas of the Loreto region, home to indigenous populations such as the Kukama-Kukamiria, birth takes place at...
Home birth is very common in the Peruvian Amazon. In rural areas of the Loreto region, home to indigenous populations such as the Kukama-Kukamiria, birth takes place at home constantly. This study aims to understand the preference for home births as well as childbirth and newborn care practices among Kukama-Kukamiria women in rural Loreto. Following a case study approach, sixty semi-structured, face-to-face interviews were conducted with recent mothers who experienced childbirth within one year prior to the interview, female relatives of recent mothers who had a role in childbirth, male relatives of recent mothers, community health workers, and traditional healers. We found that for women from these communities, home birth is a courageous act and an intimate (i.e. members of the community and relatives participate in it) and inexpensive practice in comparison with institutional birth. These preferences are also linked to experiences of mistreatment at health facilities, lack of cultural adaptation of birthing services, and access barriers to them. Preparations for home births included handwashing and cleaning delivery surfaces. After birth, waiting for the godparent to arrive to cut the cord can delay drying of the newborn. Discarding of colostrum, lack of skin-to-skin contact as well as a range of responses regarding immediate breastfeeding and immediate drying of the baby were also found. These findings were used to tailor the educational content of the Mamas del Rio program, where community health workers are trained to identify pregnancy early, perform home visits to pregnant women and newborns, and promote essential newborn care practices in case institutional birth is not desired or feasible. We make recommendations to improve Peru's cultural adaptation of birthing services.
Topics: Adult; Female; Health Knowledge, Attitudes, Practice; Home Childbirth; Humans; Infant Care; Infant, Newborn; Parturition; Peru; Pregnancy; Rural Population; Socioeconomic Factors; Young Adult
PubMed: 33945560
DOI: 10.1371/journal.pone.0250702 -
Archives of Women's Mental Health Apr 2022The aim of this study was to investigate the prevalence of depressive symptoms and associated factors in women who underwent treatments for fear of birth; internet-based...
The aim of this study was to investigate the prevalence of depressive symptoms and associated factors in women who underwent treatments for fear of birth; internet-based cognitive therapy, counseling with midwives, continuity with a known midwife or standard care. A secondary analysis was performed using data collected from four samples of women identified with fear of birth and receiving treatment with different methods. A questionnaire was used to collect data in mid-pregnancy and at follow-up 2 months after birth. Depressive symptoms were assessed using the Edinburgh Postnatal Depressive Scale. In mid-pregnancy, 32% of the 422 women with fear of birth also reported a co-morbidity with depressive symptoms. At postpartum follow-up, 19% reported depressive symptoms 2 months after birth, and 12% showed continued or recurrent depressive symptoms identified both during pregnancy and postpartum. A history of mental health problems was the strongest risk factor for presenting with depressive symptoms. None of the treatment options in this study was superior in reducing depressive symptoms. This study showed a significant co-morbidity and overlap between fear of birth and depressive symptoms. Screening for depressive symptoms and fear of birth during pregnancy is important to identify women at risk and offer specific treatment.
Topics: Depression; Depression, Postpartum; Fear; Female; Humans; Parturition; Pregnancy; Risk Factors; Sweden
PubMed: 35190877
DOI: 10.1007/s00737-022-01213-z -
Biology Letters Jan 2022Most primates, including humans, give birth during the inactive phase of the daily cycle. Practical constraints therefore limit our knowledge of the precise timing of...
Most primates, including humans, give birth during the inactive phase of the daily cycle. Practical constraints therefore limit our knowledge of the precise timing of nocturnal birth in wild diurnal primates and so limit our understanding of selective pressures and consequences. We measured maternal core body temperature () across 24 births in a population of wild vervet monkeys using biologgers. We identified distinct perturbations in during the birth period, including declining during labour and the rapid recovery of post-parturition. Vervet monkeys typically gave birth during their inactive phase in synchrony with the nadir of the maternal nychthemeral rhythm but also showed remarkable inter-individual variability in their absolute during birth. Our findings support the view that selection may have favoured a nocturnal timing of primate birth to coincide with lower night-time and environmental temperatures, which improve thermal efficiency during birth.
Topics: Animals; Biological Evolution; Chlorocebus aethiops; Circadian Rhythm; Female; Parturition; Pregnancy; Primates; Reproduction
PubMed: 35078330
DOI: 10.1098/rsbl.2021.0574 -
Women and Birth : Journal of the... Feb 2023Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this... (Review)
Review
BACKGROUND
Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies.
AIM
To investigate the impact of the birth environment for women with complex pregnancies.
METHODS
This was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently.
FINDINGS
30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues.
DISCUSSION
Women and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies.
CONCLUSION
Further research is needed investigating different users' needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.
Topics: Female; Humans; Pregnancy; Health Personnel; Labor, Obstetric; Midwifery; Parturition; Qualitative Research; Quality of Health Care
PubMed: 35431173
DOI: 10.1016/j.wombi.2022.04.008 -
American Journal of Obstetrics and... Apr 2017Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal... (Comparative Study)
Comparative Study
BACKGROUND
Women who seek vaginal birth after cesarean delivery may find limited in-hospital options. Increasing numbers of women in the United States are delivering by vaginal birth after cesarean delivery out-of-hospital. Little is known about neonatal outcomes among those who deliver by vaginal birth after cesarean delivery in- vs out-of-hospital.
OBJECTIVE
The purpose of this study was to compare neonatal outcomes between women who deliver via vaginal birth after cesarean delivery in-hospital vs out-of-hospital (home and freestanding birth center).
STUDY DESIGN
We conducted a retrospective cohort study using 2007-2010 linked United States birth and death records to compare singleton, term, vertex, nonanomolous, and liveborn neonates who delivered by vaginal birth after cesarean delivery in- or out-of-hospital. Descriptive statistics and multivariate regression analyses were conducted to estimate unadjusted, absolute, and relative birth-setting risk differences. Analyses were stratified by parity and history of vaginal birth. Sensitivity analyses that involved 3 transfer status scenarios were conducted.
RESULTS
Of women in the United States with a history of cesarean delivery (n=1,138,813), only a small proportion delivered by vaginal birth after cesarean delivery with the subsequent pregnancy (n=109,970; 9.65%). The proportion of home vaginal birth after cesarean delivery births increased from 1.78-2.45%. A pattern of increased neonatal morbidity was noted in unadjusted analysis (neonatal seizures, Apgar score <7 or <4, neonatal seizures), with higher morbidity noted in the out-of-hospital setting (neonatal seizures, 23 [0.02%] vs 6 [0.19%; P<.001]; Apgar score <7, 2859 [2.68%] vs 139 [4.42%; P<.001; Apgar score <4, 431 [0.4%] vs 23 [0.73; P=.01]). A similar, but nonsignificant, pattern of increased risk was observed for neonatal death and ventilator support among those neonates who were born in the out-of-hospital setting. Multivariate regression estimated that neonates who were born in an out-of-hospital setting had higher odds of poor outcomes (neonatal seizures [adjusted odds ratio, 8.53; 95% confidence interval, 2.87-25.4); Apgar score <7 [adjusted odds ratio, 1.62; 95% confidence interval, 1.35-1.96]; Apgar score <4 [adjusted odds ratio, 1.77; 95% confidence interval, 1.12-2.79]). Although the odds of neonatal death (adjusted odds ratio, 2.1; 95% confidence interval, 0.73-6.05; P=.18) and ventilator support (adjusted odds ratio, 1.36; 95% confidence interval, 0.75-2.46) appeared to be increased in out-of-hospital settings, findings did not reach statistical significance. Women birthing their second child by vaginal birth after cesarean delivery in out-of-hospital settings had higher odds of neonatal morbidity and death compared with women of higher parity. Women who had not birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery had higher odds of neonatal morbidity and mortality compared with women who had birthed vaginally prior to out-of-hospital vaginal birth after cesarean delivery. Sensitivity analyses generated distributions of plausible alternative estimates by outcome.
CONCLUSION
Fewer than 1 in 10 women in the United States with a previous cesarean delivery delivered by vaginal birth after cesarean delivery in any setting, and increasing proportions of these women delivered in an out-of-hospital setting. Adverse outcomes were more frequent for neonates who were born in an out-of-hospital setting, with risk concentrated among women birthing their second child and women without a history of vaginal birth. This information urgently signals the need to increase availability of in-hospital vaginal birth after cesarean delivery and suggests that there may be benefit associated with increasing options that support physiologic birth and may prevent primary cesarean delivery safely. Results may inform evidence-based recommendations for birthplace among women who seek vaginal birth after cesarean delivery.
Topics: Adult; Apgar Score; Birthing Centers; Cohort Studies; Female; Home Childbirth; Hospitalization; Humans; Infant; Infant Mortality; Pregnancy; Respiration, Artificial; Retrospective Studies; Seizures; United States; Vaginal Birth after Cesarean
PubMed: 27956202
DOI: 10.1016/j.ajog.2016.12.001 -
Women and Birth : Journal of the... Jul 2022Labour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors.
BACKGROUND
Labour and birth are sensitive physiological processes substantially influenced by environmental and psychosocial factors.
AIM
To explore the influence and meaning of the birth environment for nulliparous women giving birth in either one of two differently designed birthing rooms at a hospital-based labour ward.
METHODS
Five months of ethnographic fieldwork was conducted at a labour ward in Sweden, consisting of participant observations of 16 nulliparous women giving birth in either a 'Regular' birthing room (n = 8) or a specially designed, 'New room' (n = 8). Data included field notes, informal interviews, reflective notes, and individual interviews with eight women after birth. The data was analysed through an ethnographic iterative hermeneutic analysis process.
FINDINGS
The analysis identified the birth environment as consisting of the physical space, the human interaction within it, and the institutional context. The analytic concept; Birth Manual was conceived as an instrument for managing labour in accordance with institutional authority. Significant to the interpretation of the influence and meaning of the birth environment were two abstract rooms: an Institutional room, where birth was approached as a critical event, designating birthing women as passive; and a Personal room, where birth was approached as a physiological event in which women's agency was facilitated.
CONCLUSION
Institutional authority permeated the atmosphere within the birth environment, irrespective of the design of the room. A power imbalance between institutional demands and birthing women's needs was identified, emphasising the vital role the birth philosophy plays in creating safe birth environments that increase women's sense of agency.
Topics: Anthropology, Cultural; Female; Hospitals; Humans; Labor, Obstetric; Parturition; Pregnancy; Sweden
PubMed: 34321183
DOI: 10.1016/j.wombi.2021.07.005 -
Scientific Reports Jan 2018The Old World non-human primates (NHP) - baboons (Papio spp.) share similarities with humans regarding fetal and placental development and some pregnancy-related...
The Old World non-human primates (NHP) - baboons (Papio spp.) share similarities with humans regarding fetal and placental development and some pregnancy-related complications. Information about the mechanism of birth and complications arising during parturition in these species is relatively sparse. In this manuscript, we add information from a series of pathological and observational cases to highlight insights and selected complications of birth in Papio spp, based on video-recording of the delivery process, X-ray, MRI, and ultrasound evaluations in pregnant baboons. Additionally, we abstracted pathology records obtained from perinatal loss in a large baboon colony during a 17 year period. The presented cases provide important information for the management of pregnancy and delivery in Papio spp.
Topics: Animals; Female; Gestational Age; Labor, Obstetric; Male; Papio; Parturition; Pregnancy; Pregnancy Complications
PubMed: 29352119
DOI: 10.1038/s41598-018-19221-4 -
Midwifery Jun 2022When Europe was hit by the COVID-19 pandemic, changes were made in maternity care to reduce infections. In Norway, hospital maternity wards, postnatal wards, and...
BACKGROUND
When Europe was hit by the COVID-19 pandemic, changes were made in maternity care to reduce infections. In Norway, hospital maternity wards, postnatal wards, and neonatal units' companions and visitors were restricted. We aimed to explore the experiences of being pregnant, giving birth and becoming a parent in Norway during the COVID-19 pandemic.
METHODS
The study is based on the responses from women who provided in-depth qualitative accounts to the ongoing Babies Born Better survey version 3 during the first year of the COVID-19 pandemic. The responses were analysed with inductive thematic analysis.
RESULTS
In all, 806 women were included, regardless of parity and mode of birth. They gave birth in 42 of 45 available birthing units across Norway. The analysis resulted in four themes: 1) Pregnancy as a stressful waiting period; 2) Feeling lonely, isolated, and disempowered without their partner; 3) Sharing experiences and becoming a family; and 4) Busy postnatal care without compassion.
CONCLUSION
The COVID-19 pandemic seems to have affected women's experiences of giving birth and becoming a parent in Norway. The restrictions placed on companionship by the healthcare facilities varied between hospitals. However, the restrictions seem to have affected a range of aspects related to women's experiences of late pregnancy, early labour and birth and the early postpartum period. Postnatal care was already poor, and the pandemic has highlighted the shortcomings, especially where companionship was banned.
Topics: COVID-19; Female; Humans; Infant, Newborn; Male; Maternal Health Services; Pandemics; Parents; Parturition; Pregnancy
PubMed: 35349790
DOI: 10.1016/j.midw.2022.103321 -
Midwifery Sep 2022To evaluate women and partners' experience of birth in a "birth environment room" compared to a standard birth room. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
To evaluate women and partners' experience of birth in a "birth environment room" compared to a standard birth room.
DESIGN
A single centre parallel randomised controlled trial. Women and partners were enrolled during a 3-year period (May 2015 to March 2018).
SETTING
The Department of Obstetrics and Gynaecology at Herning Hospital, Denmark.
PARTICIPANTS AND INTERVENTION
A total of 680 Danish speaking nulliparous women, more than 18 years old, with a singleton pregnancy in cephalic presentation, and a spontaneous onset of labour, and their partners were randomly assigned to give birth in a "birth environment room" (n = 340) or in a standard birth room (n = 340) on arrival at the birth unit.
MEASUREMENTS AND FINDINGS
Outcomes were the overall birth experience and overall satisfaction with care, measured on a Likert scale, obtained in the postpartum questionnaire sent to the women 6 weeks after birth and to their partners 1/2 weeks after birth. Other outcomes were "staff support for partner", "undisturbed contact with new-born", "feeling of being listened to", "level of information", "attention to psychological needs", "suggestions for pain-relief", "participation in decision-making", "midwife present when wanted", "support from midwife", "birth wishes were met", "loss of internal control" (only women), "loss of external control", "support from partner" (partners: "being supportive for partner"), "importance of physical environment for birth" and "importance of physical environment for staff´s ability to involve the women" (only women). All outcomes were prespecified. We applied Mann Whitney U test for comparing the two groups. Data were collected from 326 women and 236 partners in the intervention group and from 315 women and 209 partners in the control group. The intention-to-treat analysis revealed no difference in the overall experience of birth for women or partners (p 0.81 and p 0.17, respectively). Partners in the intervention group reported more overall satisfaction with care compared to partners in the control group (p 0.048). In the intervention group, fewer women and partners responded they had not had the opportunity for undisturbed contact with their new-born in the first hours after birth (RR 0.19 (95% CI 0.04-0.87) and OR 0.00 CI (0.00-0.83), respectively). Otherwise, there were no differences between groups. The thematic analysis revealed that many women and partners felt they were not able to benefit from the features in "the birth environment room" in the most intense hours of birth.
KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE
"The birth environment room" did not improve the overall experience of birth for women and partners. Partners in the intervention group were overall more satisfied with care. These findings are of importance in the developing of physical birth environments that support the mental/emotional process of labour.
Topics: Adolescent; Emotions; Female; Humans; Labor, Obstetric; Midwifery; Parturition; Postpartum Period; Pregnancy
PubMed: 35850078
DOI: 10.1016/j.midw.2022.103424 -
BMC Pregnancy and Childbirth Jul 2023Antenatal preparation is commonly offered to women in pregnancy in the United Kingdom, but the content is highly variable, with some programmes orientated towards...
BACKGROUND
Antenatal preparation is commonly offered to women in pregnancy in the United Kingdom, but the content is highly variable, with some programmes orientated towards 'normal birth', whilst others may incorporate information about complications and procedures (broader focus). However, the impact of this variability on birth experience has not been explored. We examined the relationship between the content of antenatal preparation received and birth experience, taking into account obstetric complications and procedures. As birth experience can have a profound impact on a mother's postnatal well-being, we also investigated associations with mothers' postnatal mood and anxiety.
METHODS
N = 253 first-time mothers completed a cross-sectional survey measuring demographic and clinical factors, antenatal preparation content (categorised as normality-focused or broader-focused), obstetric complications and procedures experienced, birth experience (measured using three separate indices; the Childbirth Experience Questionnaire, emotional experiences, and presence/absence of birth trauma), postnatal depression and anxiety, and qualitative information on how the COVID-19 pandemic had affected birth experience.
RESULTS
Regarding birth experience, receiving more broader-focused preparation was associated with a more positive birth experience irrespective of complications/procedures experienced, while receiving only normality-focused preparation was beneficial in the context of fewer complications/procedures. Regarding birth trauma, receiving more broader-focused preparation was associated with lower likelihood of reporting birth as traumatic only in the context of more complications/procedures. Degree of normality-focused preparation was unrelated to experience of birth trauma. Lastly, while more complications/procedures were associated with greater anxiety and low mood, only greater normality-focused preparation was linked with better postnatal mental health.
CONCLUSIONS
Antenatal preparation including both normality- and broader-focused information is positively related to women's birth experience. While normality-focused preparation seems most beneficial if fewer complications/procedures are experienced, broader-focused preparation may be most beneficial in the context of a greater number of complications/procedures. As complications/procedures are often unpredictable, offering broader-focused preparation routinely is likely to benefit women's birth experience. This antenatal preparation should be freely available and easily accessible.
Topics: Pregnancy; Female; Humans; Mental Health; Cross-Sectional Studies; Pandemics; COVID-19; Parturition
PubMed: 37501081
DOI: 10.1186/s12884-023-05846-5