Exploring the effect of hospital admission on contraction patterns and labour outcomes using women's perceptions of events

Objective

this study investigated the phenomenon of spontaneous labour contractions becoming less frequent on admission to hospital, which is observed anecdotally but is not evident in the literature. Anxiety in response to hospitalisation has been proposed to be responsible by initiating the biochemical response termed ‘fight or flight’.

Design

A non-experimental prospective design and a combination of quantitative and qualitative analysis. Data were collected using self-report labour diaries, postnatal questionnaires and hospital records of labour. Univariate analysis using t-test and χ²-test was performed to examine relationships between variables, and content analysis was undertaken on qualitative data regarding reactions to hospitalisation.

Setting

hospital and community maternity services provided by a National Health Service hospital in Southern England in 1997.

Participants

about 87 women at least 37-week gestation, uncomplicated singleton pregnancy anticipating spontaneous labour with a live fetus.

Measurements and findings

labour diaries were analysed from 26 births. In three home births and 11 hospital births, labour contractions became more frequent, but in the remaining 12 labours, contractions decreased after admission to hospital. Women whose contractions slowed were not more anxious, but they rarely had cervical dilatation over 5 cm and usually assumed a recumbent position in hospital. Artificial rupture of membranes was performed more frequently in these women, they used more pain relief and had a higher incidence of complicated childbirth; however, these differences were not statistically significant.

Key conclusions

labour contractions can increase or decrease in frequency following admission to hospital, and the change of frequency may be associated with stage of cervical dilatation and posture rather than anxiety.

Implications for practice

routine intervention to speed up labour on the basis of admission observations is called into question, and women should be made aware that slowing of contractions can occur as a normal part of changing the labour environment. Further research is needed to determine the physiological parameters of spontaneous labour and the role of posture in labour progress is needed.     

What do midwives need to know about approaches of women towards labour pain management? A qualitative interview study into expectations of management of labour pain for pregnant women receiving midwife-led care in the Netherlands

Objective

to investigate factors important to women receiving midwife-led care with regard to their expectations for management of labour pain.

Design

semi-structured ante partum interviews and analyses using constant comparison method.

Participants

fifteen pregnant women between 36 and 40 weeks gestation receiving midwife-led care.

Setting

five midwifery practices across the Netherlands between June 2009 and July 2010.

Main outcome

women's expectations regarding management of labour pain.

Results

we found three major themes to be important in women's expectations for management of labour pain: preparation, support and control and decision-making. In regards to all these themes, three distinct approaches towards women's planning for pain management in labour were identified: the ‘pragmatic natural’, the ‘deliberately uninformed’ and the ‘planned pain relief’ approach.

Conclusion

midwives need to recognise that women take different approaches to pain management in labour in order to adapt care to the individual woman.     

Maternal and foetal consequences of dengue fever during pregnancy

Objective

The aim of the study was to assess the maternal and foetal consequences of dengue fever infection during pregnancy.

Study design

A retrospective study was carried out from 1 January 1992 to 10 September 2006 on 53 pregnant women infected with the dengue virus during pregnancy. The women were patients of the obstetrics and gynaecology department of Saint Laurent du Maroni hospital. A dengue infection was confirmed either by the presence of specific IgMs or by isolation of the virus (PCR or culture). The data collected related to obstetric and foetal consequences both during pregnancy and at birth, as well as the effect on the newborn.The risk of maternal–foetal transmission was assessed from 20 samples of blood taken from the umbilical cord at birth.

Results

The principal maternal consequences were: premature labour (41%), premature birth (9.6%), haemorrhage during labour (9.3%: 5 cases) and retroplacental haematoma (1.9%: 1 case).Foetal consequences were: prematurity (20%), foetal death in utero (3.8%: 2 cases), late miscarriage (3.8%: 2 cases), acute foetal distress during labour (7.5%: 4 cases), maternal–foetal transmission (5.6%: 3 cases) and neonatal death (1.9%: 1 case).

Conclusions

Maternal infection with the dengue virus during pregnancy represents a real risk of premature birth.There is also a risk of haemorrhage both for the mother and the baby when infection occurs near term.     

Possibilities for transparency and trust in the communication between midwives and pregnant women: the case of smoking

Objective

to explore barriers to and possibilities for interactive communication between midwives and pregnant women regarding smoking behaviour during pregnancy.

Design

the study was based on a qualitative research design aiming at a Grounded Theory analysis of interviews with pregnant women.

Setting

public sector antenatal clinics in Cape Town, South Africa predominantly providing care to women of mixed ancestry.

Informants

in-depth interviews with 12 pregnant women purposively selected on the basis of smoking behaviour, age and marital status to reach maximum variation.

Findings

the findings indicated low levels of transparency and trust in antenatal visits. Lack of trust was related to categories such as conflicting personal capabilities and socio-cultural and medical expectations, combined with a didactic approach from caregivers. The unworthy woman was identified as the core category of the interviews describing how women feel in their relationship with midwives. A theoretical model illustrates possibilities for change in relation to an ideal situation where a supportive caregiver, congruent expectations and capabilities result in women feeling visible.

Key conclusions and implications for practice

culturally appropriate smoking cessation interventions should be of high priority. Training in patient-centred counselling for midwives is necessary for creating an open dialogue with pregnant mothers about their smoking habits. The time constraint experienced by midwives also suggests that other methods apart from midwife counselling should be investigated for inclusion in the clinical setting.     

The relationship between prenatal control, expectations, experienced control, and birth satisfaction among primiparous women

Objectives

this paper explores the relationship between perceptions of prenatal control, expectations for childbirth, and experienced control in labour and birth and how they individually and collectively affect birth satisfaction.

Design

a repeated measures exploratory study was conducted with 31 primiparous women between 26 and 40 weeks pregnant. Standardised interviews were conducted prior to birth to assess levels of prenatal control and expectations for control during childbirth. Six weeks after the birth, women were interviewed again to assess experiences of control and birth satisfaction.

Setting

prenatal clinic, North Carolina, USA.

Findings

results show experienced control to be a significant predictor of birth satisfaction, with high levels of control correlating with high satisfaction levels. However, no correlations were found between the three aspects of control, and both prenatal control and birth expectations were found to have no significant effect on birth satisfaction. Findings also indicate that women cared for by midwives have significantly higher experienced control and birth satisfaction than women whose care was provided by obstetricians, while incidence of caesarean birth did not affect either measure.

Conclusions

experienced control during labour and birth is an important predictor of birth satisfaction. Health care providers should collaborate with the women they care for to use techniques that maximize the experience of control especially during labour and birth.     

Reliability and validity of the Acceptance Symptom Assessment Scale in assessing labour pain

Objective

to investigate the reliability and validity of the Acceptance Symptom Assessment Scale (ASAS) in assessing labour pain.

Design

a test–retest approach was used to assess reliability and validity.

Setting

labour ward with approximately 2,400 deliveries annually in western part of Sweden.

Participants

forty-seven pregnant women in the latent or active phase of labour.

Methods

a total of five pain assessments with both the ASAS and the VAS were conducted in three sessions.

Main outcome measures

correlation between ASAS and VAS.

Findings

both scales demonstrated high and significant test–retest correlations (r=0.83–0.92; p<0.001). High and significant alternative-form reliability correlations (r=0.76–0.93, p<0.001) were found between ASAS and VAS ratings at all five assessments. Construct validity was established when both the ASAS and the VAS identified a pain reduction (p<0.001) 2 hrs after birth, compared to the previous assessment. Over two-thirds of the women preferred the ASAS to the VAS, mainly (n=30) because the ASAS provided more choices relating to the pain experience, making it possible to label pain acceptable/unacceptable.

Conclusions

the ASAS is interchangeable with the VAS for assessing labour pain. Over two-thirds of the women preferred it to the VAS.     

Maintaining power: women's experiences from labour onset before admittance to maternity ward

Background

in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward.

Method

interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used.

Findings

‘Maintaining power’ was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: ‘to share the experience with another’, ‘to listen to the rhythm of the body’, ‘to distract oneself’ and ‘to be encased in a glass vessel’, explained how the women coped and thereby maintained power.

Conclusions

the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process.     

Induction of labour at term for women over 35 years old: a survey of the views of women and obstetricians

Objectives

To determine the views of UK women and obstetricians relating to induction of labour at term for women over 35 years of age.

Study design

Cross-sectional web-based survey sent to members of the British Maternal and Fetal Medicine Society (BMFMS) and pregnant or recently delivered members of a large social network site for parents (www.mumsnet.com). One hundred and twenty-eight consultant obstetrician members of BMFMS and 663 pregnant or recently delivered women responded.

Results

Two hundred and eighty-eight women (43%) would consider induction of labour for maternal age alone, and 192 women (29%) would consider participating in a randomised trial of induction of labour at term versus expectant management in a future pregnancy. Three percent (n = 4) of consultant obstetricians offer induction of labour at term to women at 35–39 years of age, 37% (n = 47) to women at 40–44 years of age and 55% (n = 70) to those over 45 years. Sixty-one consultants (48%) would participate in a trial to test the effect of a policy of induction for nulliparous women over 35 years old.

Conclusions

The policy of offering induction of labour at term for advanced maternal age is widespread and a significant percentage of women consider it to be a valid indication.     

Maternal obesity and pregnancy: a retrospective study

Objectives

to establish the incidence of obesity in the pregnant population in a large city in the North West of England, identify links between obesity and social deprivation, and compare outcomes of pregnancy in obese and non-obese women.

Design

retrospective cohort study using maternal records.

Setting

largest maternity hospital in Europe.

Participants

8176 women who gave birth at the study hospital in 2006.

Findings

data showed that 17.7% of women were clinically obese. Obesity rates increased with advancing age. The incidence of pre-eclampsia, gestational diabetes, induction of labour, caesarean section and fetal macrosomia was significantly higher amongst the obese population. No relationship was found between obesity and social deprivation.

Conclusions

this study ascertained the exact incidence of maternal obesity in the local area and showed the increased risks associated with obesity and pregnancy.

Implications for practice

this study supports the need for a shared-care approach to antenatal care and that obese women should give birth in consultant-led units. The support of a named midwife should be available to these women throughout the childbearing experience, and preconception care advocated.     

Midwives' beliefs and concerns about telephone conversations with women in early labour

Objective

to explore midwives' concerns, experiences and perceptions of the purpose of telephone contacts with women in early labour.

Design

a qualitative design based on interpretive phenomenology.

Setting

two Maternity Units in the Midlands of England.

Participants

three focus groups of labour ward midwife co-ordinators and labour ward midwives and nine in-depth interviews of midwives, obstetricians and labour ward receptionists.

Findings

the principal finding was that midwives are trying to reconcile gatekeeping of labour wards with individual support for women and these two aspects are often in conflict. Women experiencing prolonged or painful early labour often expect to be admitted to labour wards whereas midwives operate from a belief that women should only be accepted onto labour ward in active labour. They hold this view because labour wards are busy places and being admitted early contributes to unnecessary medical intervention.

Key conclusions

because midwives are trying to reconcile the two conflicting priorities of responding to women's needs and protecting the labour ward from inappropriate admissions, the potential always exists for women's needs to be ‘not heard’ or marginalised.

Implications for practice

the primary recommendation is that early labour telephone triage should be a discrete service, staffed by midwives who have been trained for this service, working independently of labour ward workloads.     

Women's experience with early labour management at home vs. in hospital: A randomised controlled trial

Objective

to compare experiences with early labour assessment and support at home vs. by telephone.

Design

a randomised controlled trial of nurse home visits vs. telephone support for assessment and support of women in early labour.

Setting

hospitals serving obstetrical populations in metropolitan and suburban Vancouver, British Columbia, Canada.

Participants

healthy nulliparous women in labour at term with uncomplicated pregnancies participating in the third and fourth year of the trial.

Intervention

women were randomised to receive early labour assessment and support at home (n=241) and or to receive assessment and support by telephone (n=182).

Measurement

the Early Labour Experience Questionnaire (ELEQ), a 26-item self-administered questionnaire that measures women's experience with early labour care across three domains: emotional well-being, emotional distress and perceptions of nursing care.

Findings

women who received home visits rated their early labour experience more positively overall compared to women who received telephone support (103.14±12.45 vs. 99.67±13.11, p<.01)including perceptions of nursing care that they received (38.64±2.90 vs. 36.82±4.09, p<.001). However, women's affective experiences did not differ.

Key conclusions

early labour nursing care provided at home is associated with a more positive experience of early labour compared to telephone support.     

Swedish women's experiences of seeking care and being admitted during the latent phase of labour: a grounded theory study

Objective

to gain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour.

Design

a qualitative interview study using the grounded theory approach.

Setting

the study was conducted at a hospital in the southwestern part of Sweden with a range of 1600–1700 deliveries per year. The interviews took place in the women's homes two to six weeks after birth.

Participant

eighteen Swedish women, aged 22–36, who were admitted to the labour ward while they were still in the latent phase of labour.

Findings

‘Handing over responsibility’ to professional caregivers emerged as the core category or the central theme in the data. The core category and five additional categories formed a conceptual model explaining what it meant to women being admitted in the early stage of labour and their experiences of the latent phase of labour. The categories, which all related to the core category, were labelled: (1) ‘longing to complete the pregnancy,’ (2) ‘having difficulty managing the uncertainty,’ (3) ‘having difficulty enduring the slow progress,’ (4) ‘suffering from pain to no avail’ and (5) ‘oscillating between powerfulness and powerlessness.’

Conclusions and implications for practice

findings indicate that women being admitted to the labour ward in the latent phase of labour experienced a need for handing over responsibility for the labour, the well-being of the unborn baby, and for themselves. Midwives have an important role in assisting women with coping during the latent phase of labour, and in giving the women opportunity to hand over responsibility. This care should include validation of experienced pain and confirmation of the normality of the slow process, information and support.     

Fears associated with childbirth among nulliparous women in Turkey

Objective

to describe fears associated with childbirth and reasons for the fears.

Design

a qualitative study. Data were gathered through semi-structured interviews and analysed using content-analysis method.

Setting

outpatient maternity clinic of a university hospital in Turkey.

Participants

19 nulliparous pregnant women who stated that they had fear related to childbirth.

Findings

women's fears were related to labour pain, birth-related problems and procedures, attitudes of health-care personnel and sexuality. The reasons for their fears included type and quality of childbirth information, personal characteristics and experiences, maternity ward environment and lack of confidence in health-care personnel. Seven of the women were considering an elective caesarean section. The role of husbands in the childbirth experience was not mentioned by any participants.

Key conclusions and implications for practise

women experience considerable fear related to impending childbirth. Considering the potential for negative findings caused by fear, and the likelihood of requesting a caesarean section, it is important for health professionals who provide antenatal care to explore fears related to childbirth. The development and evaluation of formal childbirth education is also recommended.     

Estudio prospectivo,aleatorizado y controlado para evaluar la utilidad de la radiopelvimetría en la inducción de parto en primigrávidas

Introduction

There are very few studies published in the scientific literature to assess the real value of the x-ray pelvimetry (X-PM). The current recommendations on its use are based on a single meta-analysis that includes only four studies with a very low level of scientific evidence.

Objectives

To evaluate the usefulness of the X-PM in induction in primiparous women for the diagnosis of pelvic-cephalic disproportion and analysing its influence on the duration of pregnancy, neonatal mortality and the rate of caesarean sections.

Materials and methods

The observational, prospective, randomised, double-blind, study, in a population of 264 primigravid pregnant women in whom induction of labour was an indication.

Results

X-ray pelvimetry did not influence the rate of caesarean section or the perinatal results, and has a low predictive value as a prognostic factor in the method of delivery.     

Antenatal taboos among Chinese women in Hong Kong

Objective

to identify the antenatal taboos commonly practised by pregnant Hong Kong Chinese women; to explore the health beliefs behind these taboos; and to examine how pregnant women perceived and reacted to the cultural tradition.

Design

general ethnography and in-depth interviews, followed by a quantitative self-reported survey.

Setting

Antenatal clinic of a university-affiliated hospital in Hong Kong.

Participants

consecutive samples of 60 women for in-depth interviews, and 832 women for the survey.

Measurements

an inventory on the adherence and attitude towards antenatal taboos, and the Beck Depression Inventory that measures severity of depression.

Findings

antenatal taboos were still commonly observed by contemporary Chinese women. Miscarriage, fetus malformation and fetal ill-health were the key cultural fears that drove contemporary Chinese women to observe the traditional taboos. About one-quarter and one-tenth of the women, respectively, felt unhappy and disputed with their families about the taboos. These women had significantly higher levels of depression in late pregnancy and during childbirth.

Implications for practice

health-care practitioners should be aware of the benefits and risks of traditional antenatal taboos on maternal health. Although some taboos can be socio-morally protective, the tension created by the observation of cultural tradition in modernity may impair maternal psychological well-being. Health-care providers in Western countries should be vigilant of the complex cultural tension faced by migrant Chinese mothers.