Women's Satisfaction with Birth Center Care: A Randomized,Controlled Study

This randomized, controlled trial compared women's satisfaction with care at an in-hospital birth center with standard obstetric care in Stockholm. Subjects were 1230 women with an expected date of birth between October 1989 and February 1992, who expressed interest in birth center care, and who were medically low risk. The intervention was the random allocation of maternity care at the birth center or standard obstetric care. Birth center women expressed greater satisfaction with antenatal, intrapartum, and postpartum care, especially psychological aspects of care. Of these women, 63 percent thought that the antenatal care had raised their self-esteem, versus 18 percent of the control group. Eighty-nine percent of the experimental group would prefer birth center care for any future birth, and 46 percent of the control group would prefer standard care. Birth center care successfully meets the needs of women who are interested in natural childbirth and active involvement in their own care, and are concerned about the psychological aspects of birth.     

Swedish Women's Interest in Home Birth and In‐Hospital Birth Center Care

ABSTRACT:Background: In Sweden, few alternatives to a hospital birth are available, and little is known about consumer interest in alternative birth care. The aim of this study was to determine women's interest in home birth and in‐hospital birth center care in Sweden, and to describe the characteristics of these women. Methods: All Swedish‐speaking women booked for antenatal care during 3 weeks during 1 year were invited to participate in the study. Three questionnaires, completed after the first booking visit in early pregnancy, at 2 months, and 1 year after the birth, asked about the women's interest in two alternative birth options and a wide range of possible explanatory variables. Results: Consent to participate in the study was given by 3283 women (71% of all women eligible). The rates of response to the three questionnaires were 94, 88, and 88 percent, respectively. One percent of participants consistently expressed an interest in home birth on all three occasions, and 8 percent expressed an interest in birth center care. A regression analysis showed five factors that were associated with an interest in home birth: a wish to have the baby's siblings (OR 20.2; 95% CI 6.2–66.5) and a female friend (OR 15.2; 95% CI 6.2–37.4) present at the birth, not wanting pharmacological pain relief during labor and birth (OR 4.7; 95% CI 1.4–15.3), low level of education (OR 4.5; 95% CI 1.8–11.4), and dissatisfaction with medical aspects of intrapartum care (OR 3.6; 95% CI 1.4–9.2). An interest in birth center care was associated with experience of being in control during labor and birth (OR 8.3; 95% CI 3.2–21.6), not wanting pharmacological pain relief (OR 2.3; 95% CI 1.3–4.1), and a preference to have a known midwife at the birth (OR 2.2; 95% CI 1.6–2.9). Conclusion: If Swedish women were offered free choice of place of birth, the home birth rate would be 10 times higher, and the 20 largest hospitals would need to have a birth center. Women interested in alternative models of care view childbirth as a social and natural event, and their needs should be considered. (BIRTH 30:1 March 2003)     

The Tyranny of Meta-analysis and the Misuse of Randomized Controlled Trials in Maternity Care

Abstract: Recent meta-analyses of key areas in maternity care have covered home birth and epidural analgesia. In each of these cases serious issues have arisen from the use of subjective inclusion and exclusion criteria, heterogeneity of included studies, and inclusion of studies that were conducted in settings that were not representative of usual maternity care. This latter flaw is especially notable for early epidural analgesia, where study environments with very low cesarean section rates are included. Such study settings lack external validity and have raised concerns about the political uses of meta-analysis. For a meta-analysis to be useful, the included studies must be broadly representative of the way that maternity care is carried out in usual birth environments. (BIRTH 39:1 March 2012)     

The Components of Women's Satisfaction with Maternity Care

Abstract: For a better understanding of how women's satisfaction with maternity care is affected, a representative sample of 1790 women from the Montreal area who had delivered four to seven months earlier were mailed a postal questionnaire; 938 (52.4%) completed and returned it. With factor analysis, we determined five dimensions to women's satisfaction: (a) the delivery itself, (b) medical care, (c) nursing care, (d) information received and participation in the decision-making process, and (e) physical aspects of the labor and delivery rooms. Multiple regression analysis was used to determine explicative factors for each of these dimensions of satisfaction. Items relative to the delivery process such as pain intensity, complications, and length of labor were the most important for the delivery experience itself. Participation in the decision-making process was the first component of satisfaction with medical care. Information received appeared to be the major component of their satisfaction with nursing care. The physical environment did not affect women's satisfaction with obstetric care.     

Bilateral Oophorectomy versus Ovarian Conservation: Effects on Long-term Women's Health

Bilateral oophorectomy at the time of hysterectomy for benign disease is commonly practiced to prevent the subsequent development of ovarian cancer. Currently, bilateral oophorectomy is performed in 55% of all U.S. women having a hysterectomy, with approximately 300 000 prophylactic oophorectomies performed every year. Observational studies show that estrogen deficiency, resulting from premenopausal or postmenopausal oophorectomy, is associated with higher risks of coronary artery disease, stroke, hip fracture, Parkinsonism, dementia, cognitive impairment, depression, and anxiety. These studies suggest that bilateral oophorectomy may do more harm than good. In women not at high risk for development of ovarian or breast cancer, removing the ovaries at the time of hysterectomy should be approached with caution.     

Maternity Care in The Netherlands: The Changing Home Birth Rate

In 1965 two-thirds of all births in The Netherlands occurred at home. In the next 25 years, that situation became reversed with more than two-thirds of births occurring in hospital and fewer than one-third at home. Several factors have influenced that change, including the introduction of short-stay hospital birth, hospital facilities for independent midwives, increased referral rates from primary to secondary care, changes in the share of the different professionals involved in maternity care, medical technology, and demographic changes. After a decline up to 1978 and a period of relative stability between 1978 and 1988, the home birth rate started to decline further, to the extent that it might destabilize the Dutch maternity care system and the role of midwives in it. The Dutch maternity care system depends heavily on primary caregivers, midwives and general practitioners who are responsible for the care of women with low-risk pregnancies, and on obstetricians who provide care for high-risk pregnancies. Its preservation requires a high level of cooperation among the different caregivers, and a functional selection system to ensure that all women receive the type of care that is best suited to their needs. Preserving the home birth option in the Dutch maternity care system necessitates the maintenance of high training and postgraduate standards for midwives, the continued provision of maternity home care assistants, and giving women with uncomplicated pregnancies enough confidence in themselves and the system to feel safe in choosing a home birth. (BIRTH 25:3 September 1998)     

Effects of Pushing Techniques in Birth on Mother and Fetus: A Randomized Study

ABSTRACT: Background: The Valsalva pushing technique is used routinely in the second stage of labor in many countries, and it is accepted as standard obstetric management in Turkey. The purpose of this study was to determine the effects of pushing techniques on mother and fetus in birth in this setting. Methods: This randomized study was conducted between July 2003 and June 2004 in Bakirkoy Maternity and Children’s Teaching Hospital in Istanbul, Turkey. One hundred low‐risk primiparas between 38 and 42 weeks’ gestation, who expected a spontaneous vaginal delivery, were randomized to either a spontaneous pushing group or a Valsalva‐type pushing group. Spontaneous pushing women were informed during the first stage of labor about spontaneous pushing technique (open glottis pushing while breathing out) and were supported in pushing spontaneously in the second stage of labor. Similarly, Valsalva pushing women were informed during the first stage of labor about the Valsalva pushing technique (closed glottis pushing while holding their breath) and were supported in using Valsalva pushing in the second stage of labor. Perineal tears, postpartum hemorrhage, and hemoglobin levels were evaluated in mothers; and umbilical artery pH, Po₂ (mmHg), and Pco₂ (mmHg) levels and Apgar scores at 1 and 5 minutes were evaluated in newborns in both groups. Results: No significant differences were found between the two groups in their demographics, incidence of nonreassuring fetal surveillance patterns, or use of oxytocin. The second stage of labor and duration of the expulsion phase were significantly longer with Valsalva‐type pushing. Differences in the incidence of episiotomy, perineal tears, or postpartum hemorrhage were not significant between the groups. The baby fared better with spontaneous pushing, with higher 1‐ and 5‐minute Apgar scores, and higher umbilical cord pH and Po₂ levels. After the birth, women expressed greater satisfaction with spontaneous pushing. Conclusions: Educating women about the spontaneous pushing technique in the first stage of labor and providing support for spontaneous pushing in the second stage result in a shorter second stage without interventions and in improved newborn outcomes. Women also stated that they pushed more effectively with the spontaneous pushing technique. (BIRTH 35:1 March 2008)     

Impact of Training of Traditional Birth Attendants on Maternal Health Care: A Community-based Study

Objective

To study the impact of Training of Traditional Birth Attendants (TBAs) on maternal health care in a rural area.

Methods

An interventional study in the Primary Health Center area was conducted over 1-year period between March 2006 and February 2007, which included all the 50 Traditional Birth Attendants (30 previously trained and 20 untrained), as study participants. Pretest evaluation regarding knowledge, attitude, and practices about maternal care was done. Post-test evaluation was done at the first month (early) and at the fifth month (late) after the training. Analysis was done by using Mc. Nemer’s test, Chi-square test with Yates’s correction and Fischer’s exact test.

Results

Early and late post-test evaluation showed that there was a progressive improvement in the maternal health care provided by both the groups. Significant reduction in the maternal and perinatal deaths among the deliveries conducted by TBAs after the training was noted.

Conclusion

Training programme for TBAs with regular follow-ups in the resource-poor setting will not only improve the quality of maternal care but also reduce perinatal deaths.     

A Randomized,Controlled Trial of Nurse-Midwifery Care

ABSTRACT: Background : In 1990 a pilot nurse-midwifery program was implemented in a tertiary care hospital in a major western Canadian city. A randomized, controlled trial was conducted to determine if when maternal and newborn patient outcomes were compared, the midwifery program was as effective as traditional, low-risk health care available in the city. Methods : All low-risk women who requested and qualified for nurse-midwifery care were randomly assigned to an experimental or control group. Results : One hundred one women received care from nurse-midwives and 93 received standard care from either an obstetrician or family physician. The rate of cesarean delivery in the nurse-midwife group was 4 percent compared with 15.1 percent in the physician group. The episiotomy rate, excluding cesarean deliveries, for the nurse-midwife group was 15.5percent compared with 32.9 percent in the physician group. The rates of epidural anesthesia for pain relief in labor were 12.9 percent and 23.7 percent, respectively. Statistically significant differences were found for ultrasound examinations, amniotomy, intravenous drug administration during labor; dietary supplements, length of hospital stay, and admission of infants to the neonatal intensive care unit. Conclusions : The results clearly support the effectiveness of the pilot nurse-midwifery program and suggest that more extensive participation of midwives in the Canadian health care system is an appropriate use of health care dollars.     

In‐Hospital Birth Center with the Same Medical Guidelines as Standard Care: A Comparative Study of Obstetric Interventions and Outcomes

Background: A challenge of obstetric care is to optimize maternal and infant health outcomes and the mother’s experience of childbirth with the least possible intervention in the normal process. The aim of this study was to investigate the effects of modified birth center care on obstetric procedures during delivery and on maternal and neonatal outcomes. Methods: In a cohort study 2,555 women who signed in for birth center care during pregnancy were compared with all 9,382 low‐risk women who gave birth in the standard delivery ward in the same hospital from March 2004 to July 2008. Odds ratios (OR) were calculated with 95% confidence interval (CI) and adjusted for maternal background characteristics, elective cesarean section, and gestational age. Results: The modified birth center group included fewer emergency cesarean sections (primiparas: OR: 0.69, 95% CI: 0.58–0.83; multiparas: OR: 0.34, 95% CI: 0.23–0.51), and in multiparas the vacuum extraction rate was reduced (OR: 0.42, 95% CI: 0.26–0.67). In addition, epidural analgesia was used less frequently (primiparas: OR: 0.47, 95% CI: 0.41–0.53; multiparas: OR: 0.25, 95% CI: 0.20–0.32). Fetal distress was less frequently diagnosed in the modified birth center group (primiparas: OR: 0.72, 95% CI: 0.59–0.87; multiparas: OR: 0.45, 95% CI: 0.29–0.69), but no statistically significant differences were found in neonatal hypoxia, low Apgar score less than 7 at 5 minutes, or proportion of perinatal deaths (OR: 0.40, 95% CI: 0.14–1.13). Anal sphincter tears were reduced (primiparas: OR: 0.73, 95% CI: 0.55–0.98; multiparas: OR: 0.41, 95% CI: 0.20–0.83). Conclusion: Midwife‐led comprehensive care with the same medical guidelines as in standard care reduced medical interventions without jeopardizing maternal and infant health. (BIRTH 38:2 June 2011)     

Compare the Effectiveness of PLISSIT and Sexual Health Models on Women's Sexual Problems in Tehran,Iran: A Randomized Controlled Trial

IntroductionSexuality is an important aspect of human life and sexual problems are common, but there is limited evidence for cost‐effective treatments of women's sexual dysfunctions.AimsThe aim of this study was to assess whether group therapy such as Sexual Health Model (SHM) can be as effective as individual therapy like Permission, Limited Information, Specific Suggestions, and Intensive Therapy (PLISSIT) model in women with sexual problems.MethodsA randomized controlled trial was conducted between May 2012 and September 2013 in five Tehran, Iran health clinics. Eighty‐four consecutive married women aged 20–52 years, with sexual problems who were admitted for the first time, were recruited and randomized into two groups. The intervention included two therapeutic models: the SHM, which consisted of two sessions of 3 hours of group education, and the PLISSIT model, which required a total of 6 hours of one‐on‐one consultation at an interval of 1–2 weeks.Main Outcome MeasuresSexual function and sexual distress were assessed, respectively, with the Brief Index of Sexual Function for Women and Female Sexual Distress Scale Revised questionnaires.ResultsSeven months after intervention, the mean (SD) of the sexual distress score decreased and sexual composite score increased significantly in both groups (P < 0.001). The overall analysis of repeated measure manova revealed borderline significance differences for combined outcomes between two groups (P = 0.051).ConclusionsDue to the considerable human resource, time, and cost spent conducting the PLISSIT, it seems that group education based on SHM could be more cost‐efficient and nearly as effective. This conclusion may be more applicable in communities where the treatment of sexual problems is in the beginning stages and where people have not received any sexual education or knowledge during their lifetime. Farnam F, Janghorbani M, Raisi F, and Merghati‐Khoie E. Compare the effectiveness of PLISSIT and Sexual Health Models on women's sexual problems in Tehran, Iran: A randomized controlled trial. J Sex Med 2014;11:2679–2689.