Women's perceptions of social support during labour: Development,reliability and validity of the Birth Companion Support Questionnaire

Objective

to develop and test the reliability and validity of a research instrument to measure women's perceptions of social support provided during labour by at least one lay birth companion.

Design

a cross-sectional study was carried out from April 2009 to February 2010.

Setting

non-tertiary hospital in the outer western region of Brisbane, Australia.

Participants

six registered midwives and 10 postnatal women reviewed the instrument. The instrument was then completed by 293 inpatient women who had experienced a vaginal birth.

Measurements and findings

the Birth Companion Support Questionnaire (BCSQ) was developed and its reliability and validity were evaluated in this study. An exploratory factor analysis was performed on the final instrument using principal component analysis with an oblique (Promax) rotation. This process suggested two subscales: emotional support and tangible support. The questionnaire was found to be reliable and valid for use in midwifery research.

Key conclusions

the BCSQ is an appropriate instrument to measure women's perceptions of lay birth companion support during labour.

Implications for practice

this is the first rigorous study to develop and test a measure of social support in labour which is critical at a time when policy makers and health planners need to consider the needs of birthing women and their network of support friends and family.     

Vaginal Birth After Caesarean Section: Review of Antenatal Predictors of Success

Objective: To determine antenatal factors that may predict successful vaginal birth after Caesarean (VBAC).Data Sources: The MEDLINE database was searched for all English-language articles describing the impact of various factors on outcomes when VBAC is attempted. Articles reviewed included published abstracts, retrospective and prospective studies, and meta-analyses.Criteria for Study Selection: Studies were included if they reported both a control group of pregnant women without the factor under evaluation and a study group with this factor, both undergoing a trial of labour (TOL). Other criteria included accountability for all individuals enrolled at study outset, and vaginal delivery rates in both study and control groups stated or easily calculated.Results: A nonrecurrent indication for previous Caesarean section (CS), such as breech presentation or fetal distress, is associated with a much higher successful VBAC rate than recurrent indications, such as cephalopelvic disproportion (CPD). Even with a history of CPD, two-thirds of women will have successful VBAC, though rates decrease with increasing numbers of prior CS. Prior vaginal deliveries are excellent prognostic indicators of successful VBAC, especially if the vaginal delivery follows the prior CS. A low vertical uterine incision does not seem to adversely affect VBAC success rates as compared to a low transverse incision. Maternal obesity and diabetes mellitus adversely affect VBAC outcomes. Fetal macrosomia does not appear to be a contraindication to VBAC, as success rates exceeding 50% are achieved and uterine rupture rates are not increased. Twin gestation does not preclude VBAC. Post-dates pregnancies may deliver successfully by VBAC in greater than two-thirds of cases.Conclusion: There are few absolute contraindications to attempted VBAC. Attempted VBAC will be successful in the majority of attempted cases.     

Improving Nurse Self-Efficacy and Increasing Continuous Labor Support With the Promoting Comfort in Labor Safety Bundle

ObjectiveTo increase nurse self-efficacy and the use of continuous labor support and to reduce the rate of primary cesareans among nulliparous women with low-risk pregnancies by implementing the Promoting Comfort in Labor safety bundle.DesignA quality improvement project with a pre–post practice implementation design. This practice change was part of the Reducing Primary Cesarean Learning Collaborative from the American College of Nurse-Midwives.SettingA Level II regional hospital in Virginia with more than 2,600 births annually. Births are attended by certified nurse-midwives and physicians.ParticipantsNursing staff on the labor and delivery unit in March 2016 (n = 27), September 2017 (n = 20), and June 2019 (n = 24).Intervention/MeasurementsWe updated policies, educated nurses, procured labor support equipment, and modified documentation of care. We measured nurse confidence and skill in labor support techniques with the Self-Efficacy Labor Support Scale over 4 years. We tracked how many women were provided continuous labor support and the primary cesarean birth rate among women who were nulliparous and low risk.ResultsNurses’ mean self-efficacy scores increased from 76.67 in 2016 to 86.96 in 2019 (p < .001). The proportion of women who were provided continuous labor support increased from a baseline of 4.38% (47/1,074) in January 2015 through March 2016 to 18.06% (82/454) in July through December 2019 (p < .001). The primary cesarean birth rate for nulliparous women with low-risk pregnancies remained stable, at approximately 18% from 2015 to 2019.ConclusionImplementation of the Comfort in Labor Safety Bundle improved nurse self-efficacy in labor support techniques and increased the frequency of continuous labor support.     

Birth plans—Impact on mode of delivery,obstetrical interventions,and birth experience satisfaction: A prospective cohort study

Objective

To examine whether the presence of a birth plan was associated with mode of delivery, obstetrical interventions, and patient satisfaction.

Methods

This was a prospective cohort study of singleton pregnancies greater than 34 weeks’ gestation powered to evaluate a difference in mode of delivery. Maternal characteristics, antenatal factors, neonatal characteristics, and patient satisfaction measures were compared between groups. Differences between groups were analyzed using chi‐squared for categorical variables, Fisher exact test for dichotomous variables, and Wilcoxon rank sum test for continuous or ordinal variables.

Results

Three hundred women were recruited: 143 (48%) had a birth plan. There was no significant difference in the risk of cesarean delivery for women with a birth plan compared with those without a birth plan (21% vs 16%, adjusted odds ratio [adjOR] 1.11 [95% confidence interval (CI) 0.61‐2.04]). Women with a birth plan were 28% less likely to receive oxytocin (P < .01), 29% less likely to undergo artificial rupture of membranes (P < .01), and 31% less likely to have an epidural (P < .01). There was no difference in the length of labor (P = .12). Women with a birth plan were less satisfied (P < .01) and felt less in control (P < .01) of their birth experience than those without a birth plan.

Conclusion

Women with and without a birth plan had similar odds of cesarean delivery. Though they had fewer obstetrical interventions, they were less satisfied with their birth experience, compared with women without birth plans. Further research is needed to understand how to improve childbirth‐related patient satisfaction.     

Use of Routine Interventions in Vaginal Labor and Birth: Findings from the Maternity Experiences Survey

ABSTRACT: Background: Intervention rates in maternity practices vary considerably across Canadian provinces and territories. The objective of this study was to describe the use of routine interventions and practices in labor and birth as reported by women in the Maternity Experiences Survey of the Canadian Perinatal Surveillance System. Rates of interventions and practices are considered in the light of current evidence and both Canadian and international recommendations. Methods: A sample of 8,244 estimated eligible women was identified from a randomly selected sample of recently born infants drawn from the May 2006 Canadian Census and stratified primarily by province and territory. Birth mothers living with their infants at the time of interview were invited to participate in a computer‐assisted telephone interview conducted by Statistics Canada on behalf of the Public Health Agency of Canada. Interviews averaged 45 minutes long and were completed when infants were between 5 and 10 months old (9–14 mo in the territories). Completed responses were obtained from 6,421 women (78%). Results: Women frequently reported electronic fetal monitoring, a health care practitioner starting or speeding up their labor (or trying to do so), epidural anesthesia, episiotomy, and a supine position for birth. Some women also reported pubic or perineal shaves, enemas, and pushing on the top of their abdomen. Conclusions: Several practices and interventions were commonly reported in labor and birth in Canada, although evidence and Canadian and international guidelines recommend against their routine use. Practices not recommended for use at all, such as shaving, were also reported. (BIRTH 36:1 March 2009)     

A Qualitative Study of Women's Feelings About Future Childbirth: Dread and Delight

Introduction: There is extensive knowledge about expectations of and thoughts about childbirth among women who have not given birth. When it comes to women who have given birth to at least 1 child, on the other hand, knowledge about their expectations for a future birth is limited. The purpose of this study is thus to describe the emotions of this group concerning future childbirth. Methods: Participants were 908 women in Sweden who had given birth to at least 1 child. This study is based on responses to the following request in the questionnaire sent out to women 4 to 7 years after they had given birth vaginally: “Please describe your feelings when you think about giving birth in the future.” Results: One‐third of the women responded that they were mostly frightened of future childbirth, while the remaining two‐thirds had mostly positive feelings. The qualitative analysis resulted in 3 categories and 8 subcategories and an overall theme: a mixture of dread and delight. Even with negative feelings/fears about future childbirth, many women want to give birth to more children. Discussion: Despite experiences of severe pain or complications during a previous birth, many women nonetheless looked forward to future childbirth, primarily since they were motivated by having another child and encouraged by having been given good support by the midwife.     

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)     

Birth equity on the front lines: Impact of a community-based doula program in Brooklyn,NY

Background

We assessed whether participation in Healthy Start Brooklyn's By My Side Birth Support Program—a maternal-health program providing community-based doula support during pregnancy, labor and delivery, and the early postpartum period—was associated with improved birth outcomes. By My Side takes a strength-based approach that aligns with the doula principles of respecting the client's autonomy, providing culturally appropriate care without judgment or conditions, and promoting informed decision making.

Methods

Using a matched cohort design, birth certificate records for By My Side participants from 2010 through 2017 (n = 603) were each matched to three controls who also lived in the program area (n = 1809). Controls were matched on maternal age, race/ethnicity, education level, and trimester of prenatal-care initiation, using the simple random sampling method. The sample was restricted to singleton births. The odds of preterm birth, low birthweight, and cesarean birth were estimated, using conditional logistic regression.

Results

By My Side participants had lower odds of having a preterm birth (5.6% vs 11.9%, P < .0001) or a low-birthweight baby (5.8% vs 9.7%, P = .0031) than controls. There was no statistically significant difference in the odds of cesarean delivery.

Conclusion

Participation in the By My Side Birth Support Program was associated with lower odds of preterm birth and low birthweight for participants, who were predominantly Black and Hispanic. Investing in doula services is an important way to address birth inequities among higher risk populations such as birthing people of color and those living in poverty. It could also help shape a new vision of the maternal-health system, placing the needs and well-being of birthing people at the center.     

The Language of Birth

Our language both reflects and influences our attitudes and behavior. This Roundtable Discussion explores the language used in obstetrics and in the interactions between caregivers and women or their families: What do practitioners say to mothers and families during labor? At birth? In consultations? To describe what is happening? To encourage a woman's efforts? To lighten the atmosphere? When advising about possible interventions? Medical terminology in perinatal care can often be deceptive or confusing, not only for mothers but for caregivers. The authors of this Roundtable, representing health professionals from different specialties and interests in the field, have examined some examples of such language use, misuse, and abuse in perinatal care. (BIRTH 39:2 June 2012)