Hospital Birth

Introduction: A flow experience typically occurs when the challenge of a demanding physical activity aligns with an individual's abilities, resulting in a sense of empowerment and fulfillment. Experiencing flow during physiological childbirth occurs in various birth environments, but quantitative studies comparing home birth and hospital birth in this respect are scarce. Childbirth is a psychological, social, and physiological event; thus, the birthing environment probably crucially affects the mental state of birthing women. We hypothesized that home birth will be positively correlated with a heightened flow state experienced by women during physiological labor, differing significantly from the experience of women birthing in a hospital. Method: Israeli women with physiological childbirth experience were recruited through social media. Participants (n = 421) completed the Flow State Scale (FSS) and a demographic questionnaire. Results: Comparing hospital births and home births, our research reveals a significant correlation between home birth environment and heightened birthing women's flow state. In physiological childbirth, women birthing at home report higher flow states compared to women in hospitals. Discussion: The observed differences indicate a compelling connection between the birthing environment and the women's experience during labor. The heightened flow state during home births is explained in measured flow dimensions: challenge-skill balance, action-awareness merging, clear goals, unambiguous feedback, concentration, and joy. By comparing correlations of birthing environments and birthing women's flow state, this research contributes a novel perspective to the ongoing discourse on optimizing childbirth experience.

Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries. To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma. A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearson's chi-square test was used to measure association between birthing positions and perineal trauma. Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, ...

Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries. To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma. A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearson's chi-square test was used to measure association between birthing positions and perineal trauma. Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, ...

To explore Greek Cypriot women's perceptions of their right to choose the place of childbirth. DESIGN: This study is qualitative and is based on Husserl's phenomenological approach. The field work extended over a 6-month period in 2010-2011. In all cities of the Republic of Cyprus. Purposive sample of 55 women within 1 year after birth. Forty-eight women were recruited for semistructured interviews and six of them took place in first focus group. The second group consisted of seven women that did not participate in interviews. Women's perceptions were categorized into four themes: (a) informed choice for birth place, (b) trusting relationship with health professionals, (c) medicalization of childbirth, and (d) safety of the mother and baby. There is no equity and accessibility in Cyprus maternity care system because it does not provide correct information and accessibility to all birthplace choices. This study demonstrated the need to explore women's views before formulating policy for maternity care. These views will be helpful for the creation of an innovative evidence-based maternity care policy, taking into account women's needs, and will be helpful to raise awareness among health professionals for maternity care improvement. Ensuring the right for birthplace choices is a social and political necessity that enhances the existing health care systems and health professionals to provide quality and holistic maternity care. Conducting more studies on maternity care in Cyprus will reinforce the aim for improving the health of the women, neonates, and society.

In places where hospital birth is the norm, one of the major contemporary challenges to the organization of intrapartum care is posed by women who are not in established labor. In the United Kingdom, these women have been given a special name, "Category X," and they can account for a substantial percentage of admissions (1). These women are not deemed to be in need of hospital care, but the women themselves may feel otherwise as they struggle to understand the sensations they are experiencing. Until relatively recently, little research effort was expended on early and latent phase labor, reflecting, perhaps, the assumption that it is just a gentle and relatively straightforward preamble to the "real thing" that can easily be dealt with by keeping mobile, leaning over furniture, or doing the ironing. Because early labor is not seen as needing a health professional's input, the message is that it is unimportant. However, emerging evidence is challenging that view. Four large randomized controlled trials have recently evaluated interventions related to early labor care (2-5), stimulated by concerns that included repeated visits to the labor ward and the impact of early admission with the potential for a cascade of interventions. These trials, and other research reporting women's own perspectives on labor onset, reflect growing awareness that this stage of labor merits consideration in its own right. An International Early Labor Research Group has formed who will develop the evidence base in this important part of childbearing. The group represents varied disciplines including midwifery, psychology, epidemiology, antenatal education, and service user representatives. Members of this group are among those who have contributed to this Roundtable Discussion. The contributions draw attention to the complexities of early labor and its importance for childbearing women, their caregivers and companions. We might reasonably hypothesize that a woman's experience of early labor sets the scene for what follows, and it is clear that this is an area worthy of considerable further research.

El artículo explora las experiencias maternas ligadas al dolor y el sufrimiento en el marco del parto medicalizado. La información se obtuvo a través de la realización de una serie de entrevistas semiestructuradas realizadas a madres y padres que habían sido atendidos en un centro sanitario de corte intervencionista. El análisis se hizo desde un posicionamiento culturista crítico con las representaciones somaticistas de dolor. Los resultados hablan de unas dinámicas asistenciales que favorecen la transformación del dolor en sufrimiento, realidad que junto con las cosmovisiones culturales de la tecnociencia, que lo catalogan como un sinsentido, llevan a las madres a un tratamiento farmacológico estandarizado. La conclusión es que existe una hegemonía de las representaciones en clave biologicista del dolor en los contextos clínicos, perspectivas desde las que no se contemplan sus dimensiones morales, sociales y funcionales; minusvalorando, así, otros afrontamientos no farmacológicos d...

Objetivo. El estudio analiza el grado de implementación de las nuevas coordenadas asistenciales humanistas dadas para la asistencia de los partos hospitalarios de bajo riesgo en España y su influencia en la generación de nuevas redes clínicas de cuidado. Metodología. Se utilizó un enfoque etnográfico basado en la observación participante en un paritorio de un hospital del sistema sanitario estatal español, y en la realización de una serie de entrevistas semiestructuradas a madres atendidas en dicho centro, se acumularon ochocientas setenta y cuatro horas de observación y veinte entrevistas. Resultados. Los resultados muestran una metamorfosis hacia redes clínicas de asistencia del parto en clave humanista, transformación dibujada sobre el fondo de una dinámica asistencial todavía medicalizada. Conclusiones. Se puede concluir que se están generando nuevas redes asistenciales mixtas a medio camino entre el intervencionismo y la humanización asistencial. Redes sujetas aún a las idiosin...

The belief that hospital birth for low risk pregnancies has better outcomes than planned, attended homebirth is an urban legend. The choice of low-risk women to deliver in hospital is a result of the dominant and irrational human propensities to gossip, to follow the crowd and to cling to irrational hope. Rational analysis shows that planned homebirth with experienced trained attendants has the best outcomes for both mother and newborn for low risk pregnancy.

In places where hospital birth is the norm, one of the major contemporary challenges to the organization of intrapartum care is posed by women who are not in established labor. In the United Kingdom, these women have been given a special name, "Category X," and they can account for a substantial percentage of admissions (1). These women are not deemed to be in need of hospital care, but the women themselves may feel otherwise as they struggle to understand the sensations they are experiencing. Until relatively recently, little research effort was expended on early and latent phase labor, reflecting, perhaps, the assumption that it is just a gentle and relatively straightforward preamble to the "real thing" that can easily be dealt with by keeping mobile, leaning over furniture, or doing the ironing. Because early labor is not seen as needing a health professional's input, the message is that it is unimportant. However, emerging evidence is challenging that view. Four large randomized controlled trials have recently evaluated interventions related to early labor care (2-5), stimulated by concerns that included repeated visits to the labor ward and the impact of early admission with the potential for a cascade of interventions. These trials, and other research reporting women's own perspectives on labor onset, reflect growing awareness that this stage of labor merits consideration in its own right. An International Early Labor Research Group has formed who will develop the evidence base in this important part of childbearing. The group represents varied disciplines including midwifery, psychology, epidemiology, antenatal education, and service user representatives. Members of this group are among those who have contributed to this Roundtable Discussion. The contributions draw attention to the complexities of early labor and its importance for childbearing women, their caregivers and companions. We might reasonably hypothesize that a woman's experience of early labor sets the scene for what follows, and it is clear that this is an area worthy of considerable further research.

Background Home birth is available to women in Canada who meet eligibility requirements for low risk status after assessment by regulated midwives. While UK researchers have reported lower costs associated with planned home birth, there have been no published studies of the costs of home versus hospital birth in Canada.

Increasing numbers of Aboriginal women are using urban hospital settings to give birth. Culturally competent care, including an understanding of cultural, emotional, historical, and spiritual aspects of Aboriginal Peoples’ experience and beliefs about health and healthcare, is important to the provision of quality care. While there is a body of literature on culturally competent care, no models specific to Aboriginal women giving birth in hospital settings exist. This article explores Aboriginal peoples’ historical experience with western health care systems, worldviews and perspectives on health and healing, and beliefs regarding childbirth. Some of the existing models of culturally competent care that emphasize provision of care in a manner that shows awareness of both patients’ cultural backgrounds as well as health care providers’ personal and professional culture are summarized. Recommendations for the development of cultural competency are presented. Acquisition of knowledge, ...

Studies have associated lithotomy position during childbirth with negative consequences and increased risk of perineal injuries. To identify prevalence rates of different birthing position and episiotomy and to explore the differences in perspectives of mothers and midwives about birthing positions and perineal trauma. A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal injuries. Perceptions of mothers and midwives were analysed. Pearson's chi-square test was used to measure association between birthing positions and perineal trauma. Mothers, n=94 (85%) and midwives, n=108 (98%) reported high rates of lithotomy position for birth. N=63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a similar number of midwives perceived lithotomy position as helpful, n=65 (59%). However, a high majority of mothers, ...

Women bring into the birthing unit values which include preferences, concerns and expectations that are involved in decision-making during intrapartum care. When midwives fail to meet the women’s values, they experience such care as being inhumane and degrading, thus affecting the childbirth outcomes. The inhumane and degrading care includes a lack of sympathy and empathy, as well as a lack of attention to privacy and confidentiality. Midwives’ possession of the required personal values and the ability to integrate women’s values are vital to enhance ethical best practice during intrapartum care. The aim of the study was to explore and to describe the midwives’ personal values that are required for ethical best practice during intrapartum care. The birthing unit at a public hospital in the Gauteng province of South Africa formed the context of the study. A qualitative research design that was explorative, descriptive and contextual in nature was used. The following personal values e...

Background: Studies have associated lithotomy position during childbirth with negative consequences
and increased risk of perineal injuries.
Aims: To identify prevalence rates of different birthing position and episiotomy and to explore the
differences in perspectives of mothers and midwives about birthing positions and perineal trauma.
Methods: A survey involving 110 mothers and 110 midwives at two hospitals. Participants were mothers
who had a vaginal birth/perineal injury and midwives who attended births that resulted in perineal
injuries. Perceptions of mothers and midwives were analysed. Pearson’s chi-square test was used to
measure association between birthing positions and perineal trauma.
Findings: Mothers, n = 94 (85%) and midwives, n = 108 (98%) reported high rates of lithotomy position
for birth. N = 63 (57%) of mothers perceived lithotomy position as not being helpful for birth. In contrast, a
similar number of midwives perceived lithotomy position as helpful, n = 65 (59%). However, a high majority
of mothers, n = 106 (96%) and midwives, n = 97 (88%) reported they would be willing to use alternative
positions. Majority of mothers had an episiotomy, n = 80 (73%) and n = 76 (69%) reported they did not give
their consent. N = 59 (53%) reported they were not given local anaesthesia for an episiotomy. n = 30 (27%) of
midwives confirmed they performed an episiotomy without local anaesthesia.
Conclusion: Care isnot based on current evidence and embedded practices, i.e. birthing in lithotomyposition
and routine episiotomies are commonly used. However, this survey did find a willingness to change, adapt
practice and consider different birthing positions and this may lead to fewer episiotomies being performed.

Background. Evidence recommends encouraging expectant mothers to adopt birthing positions that will assist them in having a normal physiological birth. Upright birthing positions have been shown to have good birth outcomes and assist women to give birth normally. However, adopting the lithotomy position with legs flexed and supported with hands has become an entrenched clinical birthing practice in Nigeria and is associated with an increased risk of a routinely performed episiotomy. Hospital protocols have supported this medicalised approach to how women give birth, with little regard to woman-centred care. Nevertheless, Nigerian obstetricians' perceptions and experiences on birthing position and perineal trauma have received minimal recognition and research. Aim. To explore the perceptions and experiences of Nigerian obstetricians' regarding maternal birthing position and perineal trauma following childbirth, and to gain insights as to whether obstetricians clinical decisions and practice were influenced by research evidence. Methods. A descriptive qualitative study was conducted involving a purposive sample of eight obstetricians recruited from two referral hospitals in the Niger Delta region of Nigeria during November 2014. Data were collected using an interview schedule and a thematic analysis was undertaken. Data analysis was guided by Braun and Clarke's (2006) six-stage thematic framework. Interviews were transcribed in full and categorisation of the data achieved with several in-depth readings of the transcripts. Data saturation was reached with the facilitation of the second focus group interview as no more emerging themes were identified. The study obtained ethical approval from the health and social research ethics committee at the University of Chester in the UK, and also from the study hospitals in the Niger Delta region in Nigeria. Results. Six participants were doctors undertaking obstetric specialist training and two were consultant obstetricians. The following core themes emerged: entrenched practice, lack of insight for evidence, embracing woman-centred care and professional dominance. An overall finding demonstrated a willingness to support mothers in their choices of birthing position and involved reflections on the indications for an episiotomy and incidences of perineal injuries. The findings also indicated that the obstetricians were prepared to consider woman-centred care in relation to birthing position and perineal trauma. Conclusions. This study has enabled some Nigerian obstetricians to reflect upon their perceptions and experiences of their clinical decisions and practices concerning birthing position and perineal trauma. Their current practice was frequently not supported by evidence. However, it emerged that there was a willingness to listen to women and adopt clinical birthing practices and perineal care that would respect choices based on contemporary evidence. Adopting a woman-centred approach would also enable Nigerian midwives working in the two study hospitals to support women to give birth in a position of their choosing and reduce the risk of a routinely performed episiotomy.

The belief that hospital birth for low risk pregnancies has better outcomes than planned attended homebirth is an urban legend. The choice of low risk women to deliver in hospital is a result of the dominant and irrational human propensities to gossip, to follow the crowd and to cling to irrational hope. Rational analysis shows that planned homebirth with experienced trained attendants has the best outcomes for both mother and newborn for low risk pregnancy.

Why is it that over 99% of people in every westernized country, except England and Holland, are convinced that attended homebirth for low-risk women is more dangerous and has worse outcomes than hospital birth? There are several answers, and they all involve irrational thinking.

Based on the research from my Master’s thesis, this article looks at the choices and experiences of ten BC queer couples’ births, early in the twenty-first century. It situates their births in a social context of some of the most queer-family-friendly policies in the world, as well as in a place where midwives have been able to practice legally throughout the province since 1998. I give an overview of three different types of births, from totally medical to totally natural, all the while recognizing that most families chose to experience something in between. In the end, it becomes clear that while I am talking about queer couples, there is nothing essentialist or universal about their choices or experiences. Instead, they offer insight into the everyday experiences, challenges, and choices facing most childbearing couples in British Columbia.