Swedish women's experiences of doula support during childbirth

Objective

to describe women's experiences of doula support during childbirth.

Design and setting

a qualitative study using a hermeneutic approach. Data were collected via tape-recorded interviews in the women's homes or at a place chosen by the women, one to eight months after the birth.

Participants

nine women, seven primiparous and two multiparous, aged between 15 and 40 years, who had received antenatal care at a special clinic for single mothers in Gothenburg, Sweden between 2006 and 2007.

Key findings

the role of the doula lies between natural care and professional care, veering towards professional care. Professional aspects include being a mediator to the unknown, and a human life line to help the woman to play her part in the birth. Furthermore, the doula is a coach who mediates a belief in the woman's capacity to give birth. The midwives’ supporting role is not clear to the women, which can be the result of doulas having a more professional supporting role than giving natural care. Midwives are unable to offer continuity of care and constant support during the birth.

Implications for practice

the different supporting roles of doulas and midwives in maternity care should be addressed. Furthermore, maternity care should be organised in a way that gives the woman an opportunity to access continuity of care and constant support.     

Dissociative experience during childbirth

Objective: A dissociative experience refers to phenomena such as depersonalization, derealization, amnesia, out of body experience, altered time perception and body image. The aim of this study was to assess dissociative experience during childbirth and the possible related variables. Method: A total of 328 women, up to 72 hours postpartum, completed the peritraumatic dissociative experience questionnaire (PDEQ), the socio-demographic and obstetrical questionnaire, the pain numeric rating scale, the Trauma History Questionnaire and an SCID-I for traumatic events. Results: A total of 11.3% of the sample experienced significant dissociation. In particular, symptoms like a sensation of time changes during the event/things seemed to be happening in slow motion, not being aware of things that happened, and disorientation. A traumatic childbirth, previous trauma, obstetrical complications, forceps, prematurity, complications with the baby, dissatisfaction with the maternity care, unemployment, high score pain during labor and years of schooling were the factors considered. Conclusion: Dissociative experiences can occur during childbirth.     

Fear of childbirth before, during, and after childbirth

BACKGROUND: Only scanty research exists about the relationship between women's expectations during pregnancy and their experiences as reported during the actual process of labor and afterwards. The aims of the present study were: (1) to investigate the associations between fear of childbirth during pregnancy and postpartum and fear and pain during early active labor (phase 1: cervix dilatation 3-5 cm), and (2) to explore possible differences regarding fear of childbirth during pregnancy and postpartum between women who did or did not receive epidural analgesia during labor. Methods. Fear of childbirth was measured in 47 nulliparous women during gestation weeks 37-39 by means of the Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ version A). During early active labor we measured women's fear (Delivery Fear Scale) and their experiences of pain (a pain intensity scale). Finally, fear after childbirth (W-DEQ version B) was measured two hours, two days, and five weeks after delivery. RESULTS: A positive correlation appeared between fear of childbirth during pregnancy, postpartum, and early active labor. There were no differences in fear of childbirth during late pregnancy between women who received epidural analgesia and those who did not. Postpartum fear was higher in the women who had received epidural analgesia. CONCLUSIONS: Pregnant women who fear childbirth are prone to report fear during the actual labor and postpartum. The administration of epidural analgesia is not a sufficient response to women's fear during the process of labor.     

The number and histopathologic type of ovarian tumors operated during cesarean section at the Polish Mother's Health Institute between 1990-2000

OBJECTIVES: The differences exist in concerning the estimation of number and histopathological type of ovarian tumors in pregnancy. MATERIAL AND METHODS: From all 41,661 labours which took place in our Institute between 1990-2000 retrospective analysis of medical documentation of 11,050 caesarean sections (CS) as well as histopathological protocols were performed. RESULTS: The prevalence of ovarian tumors removed during CS performed between 28-41 weeks of gestation was 0.19%. The prevalence of malignancy was low (0.005% of all labours). Unilateral cystectomy was found to be the most frequent kind of surgery and adult teratoma, serous cyst and paraovarian cyst as most common histopathological tumor types. CONCLUSION: We conclude that ovarian tumors, especially of malignant type are rarely the complication of pregnancy. The most are benign, small, unilocular and smooth-wall cystic tumors.     

Maternal goals for childbirth associated with planned vaginal and planned cesarean birth

We describe maternal childbirth goals among women planning either cesarean or vaginal birth. Women in the third trimester planning cesarean or vaginal birth were asked to report up to five childbirth goals. Goal achievement was assessed postpartum. Based on free-text responses, discrete goal categories were identified. Goals and goal achievement were compared between the two groups. Satisfaction was rated on a visual analogue scale and was compared with goal achievement. The sample included 163 women planning vaginal birth and 69 women planning cesarean. Twelve goal categories were identified. Only women planning vaginal birth reported a desire to achieve fulfillment related to childbirth. Women planning cesarean were less likely to express a desire to maintain control over their own responses during childbirth and more likely to report a desire to avoid complications. The 72 women who achieved all stated goals reported significantly higher mean satisfaction scores than the 94 women reporting that at least one goal was not achieved (P = 0.001). Goal achievement was higher among women planning cesarean than among those planning vaginal birth (52.2% versus 23.1%, P < 0.001). This research furthers our understanding of women's attitudes regarding cesarean childbirth and definitions of a successful birth experience.     

Frequency, spacing, and outcome of pregnancies subsequent to primary cesarean childbirth

A prospective study was conducted to determine the frequency, spacing, and outcome of pregnancies that occur subsequent to primary cesarean childbirth. A cohort of 5513 women, pregnant for the first time and with these pregnancies terminating with a live birth via cesarean childbirth, were followed for 5 years with use of the vital records registration system of the New York State Department of Health. Also followed was a group of women whose first pregnancy terminated with a live birth via vaginal delivery. The cesarean childbirth study group was found to have had 11% fewer pregnancies terminating during the follow-up period than did the vaginal delivery group. Subsequent live births among the cesarean delivery study group were, on the average, 1 week shorter in gestation and lower in birth weight than those of the vaginal delivery group. However, there was no excess of very low- or low-birth weight infants among the cesarean delivery study group. There was no difference between study groups in the spacing of subsequent pregnancies.     

Effect of continuous support during labor on duration of labor and rate of cesarean delivery

Objective

To evaluate the effect of continuous support provided by midwives during labor on the duration of the different stages of labor and the rate of cesarean delivery.

Method

A randomized trial of 100 eligible nulliparous women who had not received education classes on childbirth. In the intervention group (n = 50), continuous support during labor was provided; the control group (n = 50) did not receive continuous support.

Results

The two groups did not differ by age, employment, educational level, gestational age, economic status, and neonatal weight. Mean duration of the active phase of labor (167.9 ± 76.3 vs 247.7 ± 101 min, P < 0.001), second stage of labor (34.9 ± 25.4 vs 55.3 ± 33.7 min, P = 0.003), and the number of cesarean deliveries (4 vs 12, P = 0.026) were significantly lower in the intervention group compared with the control group. The rates of oxytocin use and Apgar scores of less than 7 at 5 minutes were similar between the two groups.

Conclusion

Continuous support provided by midwives during labor may reduce the duration of labor and the number of cesarean deliveries; this model of support should be available to all women.     

Myomectomy during cesarean section

The purpose of this prospective study is to assess the possibility of myomectomy during CS as a routine method. The material includes 21 cases of myomectomy during CS. 162 consecutive CS without myomectomy are control group for hemorrhage during the operation. The myomectomy is accomplish according classical technique. Our data show that the myomas and pregnancy is found mainly in women after 30 years of age and is prevalent in nulliparas (70%). Single myomas were found in 85% of cases, 63% located in the corpus uteri and 46% of all myomas are confined to the myometrium. Related to the isthmus uteri are 23% of myomas. Myomectomy as a separate operation during CS increases the hemorrhage by 10%. The analysis of the cases with severe hemorrhage point to the placental disorders (abruptio placentae and placenta praevia) as a main cause of overall increased blood lost. Our limited experience with myomectomy as a protocol during CS irrespective of number and magnitude of myomas shows that this is possible. The postoperative period is without complications.