Hospital Birth

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.