The New Birth Experience

Recently emerging consumer demands and expectations concerning labor and delivery are put into perspective vis-a-vis professional unpreparedness and resistance.     

High Parity and Adverse Birth Outcomes: Exploring the Maze

Abstract: Background : Despite extensive literature on the topic, it is uncertain if grand (para ≥ 5) and great grand (para ≥ 10) multiparity are associated with adverse birth outcomes. We critically evaluate the evidence for and against the existence of adverse maternal and/or fetal outcomes in high parity women. Methods : An electronic search of MEDLINE and other bibliographic databases (Current Contents, EMBASE, and CAB) was conducted, and all relevant articles in English language were retrieved. Results : Findings on the association between high parity and maternal‐fetal birth outcomes are not consistent. Although the older literature tends to suggest that multiparity is a risk factor for negative birth outcomes, more recent reports are not supportive. Comparison across studies was further complicated by confounding factors like maternal age, socioeconomic status, and levels of prenatal care, as well as by variations in study designs and in the definition of parity itself. Furthermore, most studies that examined women of extreme parity (para ≥ 10) were handicapped by inadequate power. Conclusions : After accounting for quality, culture, and degrees of associations, the preponderance of evidence seems to point to possible existence of heightened risk for certain medical complications and placental pathologies among women of extreme parity. The literature also provides reasonable evidence for a higher‐than‐expected likelihood for occurrence of fetal macrosomia with advanced parity.     

Prevalence and Persistence of Health Problems After Childbirth: Associations with Parity and Method of Birth

ABSTRACT: Background: Awareness about the extent of maternal physical and emotional health problems after childbirth is increasing, but few longitudinal studies examining their duration have been published. The aim of this study was to describe changes in the prevalence of maternal health problems in the 6 months after birth and their association with parity and method of birth. Methods: A population‐based, cohort study was conducted in the Australian Capital Territory (ACT), Australia. The study population, comprising women who gave birth to a live baby from March to October 1997, completed 4 questionnaires on the fourth postpartum day, and at 8, 16, and 24 weeks postpartum. Outcome measures were self‐reported health problems during each of the three 8‐week postpartum periods up to 24 weeks. Results: A total of 1295 women participated, and 1193 (92%) completed the study. Health problems showing resolution between 8 and 24 weeks postpartum were exhaustion/extreme tiredness (60–49%), backache (53–45%), bowel problems (37–17%), lack of sleep/baby crying (30–15%), hemorrhoids (30–13%), perineal pain (22–4%), excessive/prolonged bleeding (20–2%), urinary incontinence (19–11%), mastitis (15–3%), and other urinary problems (5–3%). No significant changes occurred in the prevalence of frequent headaches or migraines, sexual problems, or depression over the 6 months. Adjusting for method of birth, primiparas were more likely than multiparas to report perineal pain and sexual problems. Compared with unassisted vaginal births, women who had cesarean sections reported more exhaustion, lack of sleep, and bowel problems; reported less perineal pain and urinary incontinence in the first 8 weeks; and were more likely to be readmitted to hospital within 8 weeks of the birth. Women with forceps or vacuum extraction reported more perineal pain and sexual problems than those with unassisted vaginal births after adjusting for parity, perineal trauma, and length of labor. Conclusions: Health problems commonly occurred after childbirth with some resolution over the 6 months postpartum. Some important differences in prevalence of health problems were evident when parity and method of birth were considered. (BIRTH 29:2 June 2002)     

Expectation and Experience in Alternative and Conventional Birth

A study was conducted to determine if differences exist between the clients of two types of health-care services with regard to the childbirth experience. Nurse-midwife-attended and physician-attended births were compared in terms of the birthing woman's expected and actual participation in her own birthing experience. Questionnaires were completed before and after delivery. The nurse-midwife group both anticipated and experienced significantly more active participation in the birth than the physician group. Also, women attended by nurse-midwives viewed themselves and their partners as the most important individuals for contributing to the satisfaction of the experience while women attended by physicians more often viewed the infant as most important. Differences between the study groups were also found regarding the perceived importance of the birth attendant and the staff nurse.     

Experience of the Birth Regulation Department

Since the establishment of the department at a hospital in Valparais o, Chile, the number of births has declined, as well as the number of abortions (monthly births, from 102 to 70, abortions from 24.7 to 13.8, that is, a decrease of 36.4% and 43.4%, respectively). IUDs, oral contraceptives and, in some cases, condoms have been prescribed. Complications due to IUDs generally concerned expulsion, metrorrhagia (both curable and requiring removal of IUD), infection and intrauterine perforation (few cases) and pelvic pain. The pregnancy rate per 100 years of observations was .80 with the Lippes IUD (more used) and 2.03 with the zipper type. Expulsions amounted to 5.4%. After repositioning, the final expulsion rate was only 1.25%. With respect to oral contraceptives, the findings coincide with those already widely published. The sequential treatment appears to be tolerated considerably better. Since 1970 all patients were subjected to cytological tests, irrespective of age and of apparent good health. This made possible to detect several cases of inflammation and suspected cancer; after treatment, most cases improved, leaving two highly probably cancer cases.     

The Experience of Pregnancy and Birth with Midwives: Results from the Canadian Maternity Experiences Survey

Abstract: Background: In Canada maternity care is publicly funded, and although women may choose their care providers, choices may be limited. The purpose of this study was to compare perceptions of maternity outcomes and experiences of those who received care from midwives with those who received care from other providers. Methods: Based on the 2006 Canadian census, a random sample of women (n = 6,421) who had recently given birth in Canada completed a computer‐assisted telephone interview for the Maternity Experiences Survey. The sample was stratified according to province or territory where birth occurred, age, rural or urban residence, and presence of other children in the home. Those who were 15 years of age and older, gave birth to a singleton baby, and were living with their infant were eligible for inclusion. Results: Women whose primary prenatal providers were midwives had fewer ultrasounds and were more likely to attend prenatal classes and have at least five or more prenatal visits. They were also more likely to rate satisfaction with their maternity experience as “very positive” and be satisfied with information provided on a variety of pregnancy and birth topics if their primary prenatal provider was a midwife. They were almost half as likely to experience induction and 7.33 times more likely to experience a medication‐free delivery. They were more likely to initiate and maintain breastfeeding at 3 and 6 months. Conclusions: Evidence shows that midwifery outcomes and levels of satisfaction meet or exceed Canadian maternity care standards. Facilitation of the continuing integration of midwives as autonomous practitioners throughout Canada is recommended. (BIRTH 38:3 September 2011)     

The Birth of a First Child: Do Women's Reports Change Over Time?

ABSTRACT: Seventy-two women who had been interviewed three weeks postpartum in an earlier study were re-interviewed two years after the birth. There was a significant decrease over time in their ratings of each of the medical and preparation procedures they had had. Those women who had the one child or who were pregnant with a second child showed no change in overall perception of their labor and delivery after the two-year interval, while those who had had a second child were more negative than at the first interview. Women's recall of the events of their first birth was generally accurate and their pain ratings for all but the second stage labor were not significantly different at the two interviews. The results indicate that “time of interview” is an important factor to take into account in childbirth research.     

Birth Technology and Maternal Roles in Birth: Knowledge and Attitudes of Canadian Women Approaching Childbirth for the First Time

ObjectiveTo describe Canadian nulliparous women's attitudes to birth technology and their roles in childbirth.MethodsA large convenience sample of low-risk women expecting their first birth was recruited by posters in laboratories, at the offices of obstetricians, family physicians, and midwives, at prenatal classes, and through web-based advertising and invited to complete a paper or web-based questionnaire.ResultsOf the 1318 women completing the questionnaire, 95% did so via the web-based method; 13. 2% of respondents were in the first trimester, 39. 8% were in the second trimester, and 47. 0% in the third. Overall, 42. 6% were under the care of an obstetrician, 29 3% a family physician, and 28 1% a registered midwife The sample included mainly well-educated, middle-class women The planned place of giving birth ranged from home to hospital, and from rural centres to large city hospitals. Eighteen percent planned to engage a doula. Women attending obstetricians reported attitudes more favourable to the use of birth technology and less supportive of women's roles in their own delivery, regardless of the trimester in which the survey was completed Those women attending midwives reported attitudes less favourable to the use of technology at delivery and more supportive of women's roles Family practice patients' opinions fell between the other two groups. For eight of the questions, “I don't know” (IDK) responses exceeded 15%. These IDK responses were most frequent for questions regarding risks and benefits of epidural analgesia, Caesarean section, and episiotomy Women in the care of midwives consistently used IDK options less frequently than those cared for by physiciansConclusionsRegardless of the type of care provider they attended, many women reported uncertainty about the benefits and risks of common procedures used at childbirth. When grouped by the type of care provider, in all trimesters, women held different views across a range of childbirth issues, suggesting that the three groups of providers were caring for different populations with different attitudes and expectations