Optimising Physiology Flashcards
what does evidence say about women who planned birth in a midwifery unit (AMU or FMU)?
- Women who planned birth in a midwifery unit (AMU or FMU) had significantly fewer interventions, including substantially fewer intrapartum caesarean sections, and more ‘normal births’ than women who planned birth in an obstetric unit.
For planned births in freestanding midwifery units and alongside midwifery there were no significant difference in adverse perinatal outcomes compared with planned birth in an obstetric unit.
what does evidence say about multiparous women, birthing in a non-obstetric unit setting?
- For multiparous women, birth in a non-obstetric unit setting significantly and substantially reduced the odds of having an intrapartum caesarean section, instrumental delivery or episiotomy.
what was the comparison for nulliparous women birthing at home in comparison to obstetric units?
For nulliparous women, there were 9.3 adverse perinatal outcome events per 1000 planned home births compared with 5.3 per 1000 births for births planned in obstetric units, and this finding was statistically significant.
what does evidence say about transfer rate for first time mums?
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth
- For nulliparous women, the peri-partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births
what does evidence say about transfer rate for first time mums?
For women having a first baby, there is a fairly high probability of transferring to an obstetric unit during labour or immediately after the birth
- For nulliparous women, the peri-partum transfer rate was 45% for planned home births, 36% for planned FMU births and 40% for planned AMU births
what does evidence say about transfer rate for multiparous women?
For women having a second or subsequent baby, the transfer rate is around 10%
- For women having a second or subsequent baby, the proportion of women transferred to an obstetric unit during labour or immediately after the birth was 12% for planned home births, 9% for planned FMU births and 13% for planned AMU births
what does evidence say about low risk women birthing at home outcomes in comparison to those birthing in hospital?
overall, those who planned to give birth at home were less likely to experience any of the intrapartum interventions studied (caesarean section, operative vaginal birth, epidural analgesia, episiotomy, and oxytocin augmentation). They were also less likely to suffer a 3rd or 4th degree perineal tear, maternal infection or postpartum haemorrhage. No cases of maternal mortality were reported in either study group.
what does water immersion reduce the chance of?
- use of epidural
- injected opioids
- episiotomy
- maternal pain
- postpartum haemorrhage
what does waterbirth increase the chance of?
- maternal satisfaction and
- odds of an intact perineum with water immersion.
Waterbirth was associated with increased odds of cord avulsion (snapping), although the absolute risk remained low (4.3 per 1000 vs 1.3 per 1000). There were no differences in any other identified neonatal outcomes.
what does evidence say about waterbirth impact psychologically?
- women experience warm water immersion during labour and/or birth positively.
- water and pool itself, facilitated women’s physical and psychological needs during labour and/or birth
- versatile tools that provide for a space that women can adapt and influence to best suit their individual needs. The presence of the birth pool created an atmosphere conducive to relaxation; whereas the warm water offered physical comfort during contractions.
- The analgesic properties of the water did not remove pain, instead women appeared to possess a greater ability to cope with the pain. This stimulated a mind-body connection or ‘synergy’ whereby women were enabled to ‘work-with’ their bodies during labour leading to enhanced feelings of control, self-efficacy and self-trust.
- the structure of the pool sides, women reported feelings of safety, privacy, and security.
- ome women reported that water immersion facilitated altered states of consciousness, a transcendent experience that not only took them to another place but also facilitated their ability to thrive as they entered the postnatal period.
what are the key themes of waterbirth/
autonomy and control was a key theme that women reported following their experience of a waterbirth; a finding that aligns with our theme of ‘Liberation and self-emancipation’.
what does waterbirth support?
strongly suggest water immersion is a valued and accepted approach to labour care from the perspectives of women. As a tool for pain management that enhances both psychological coping and which supports the physiological processes of labour and birth,
what do women think about waterbirth and their babies?
Reflecting vivid feelings of empowerment, ‘victory’ women ‘claimed’ their birth’, rather than ‘being delivered’ of their baby. Moreover, the benefits extended into the postnatal period and their transition to motherhood:
For women who did not necessarily receive their baby, the opportunity to watch the birth was highly valued: ‘irreplaceable’ and a ‘perfect’ way to meet their baby. One that was felt to be a ‘natural’ and ‘normal’ way to meet for the first time
what did women feel about the second stage during a waterbirth?
Three studies (Gonçalves et al., 2019; Sprague, 2004; Ulfsdottir et al., 2018) reported that women valued water immersion during the pushing stages of birth. The ‘gentleness’ and ‘warmth’ of the water was experienced as ‘supportive’ and ‘soothing’ on their perineum, that was also attributed to minimal or no tearing:
what were the key findings of the waterbirth study?
Liberation and Self-Emancipation, Synergy, transcendence and demarcation and Transformative birth and beyond. Overall, women experienced warm water immersion during labour and/or birth positively. Both the water and pool itself, facilitated women’s physical and psychological needs during labour and/or birth, including offering effective analgesia. Our findings indicated that birthing pools are versatile tools that provide for a space that women can adapt and influence to best suit their individual needs.
why is support in labour important?
- Women who received continuous labour support may be more likely to give birth ‘spontaneously’
- women may be less likely to use pain medications
- to have a caesarean birth, and may be more likely to be satisfied and have shorter labours.
- Postpartum depression could be lower in women who were supported in labour, but we cannot be sure of this due to the studies being difficult to compare
- women who received continuous support may be less likely to have low five-minute Apgar scores
what does research show about continuous support impact on women?
Research shows that women value and benefit from the presence of a support person during labour and childbirth. This support may include emotional support (continuous presence, reassurance and praise) and information about labour progress. It may also include advice about coping techniques, comfort measures (comforting touch, massage, warm baths/showers, encouraging mobility, promoting adequate fluid intake and output) and speaking up when needed on behalf of the woman. Lack of continuous support during childbirth has led to concerns that the experience of labour and birth may have become dehumanised.
what can support in labour include?
The supportive care may include having someone who is continuously present and who reassures and praises her, assists with measures for physical comfort (e.g. providing comforting touch, massage, warm baths or showers, and promoting adequate fluid intake and output) and undertakes any necessary advocacy on her behalf
what are the WHO recommendation about continuous support in labour?
WHO recommendations for augmentation of labour (2014): “Continuous companionship during labour is recommended for improving labour outcomes” WHO recommendations on health promotion interventions for maternal and newborn health (2015): “Continuous companionship during labour and birth is recommended for improving women’s satisfaction with services”
who can continuous support in labour be given by?
continuous support during labour and childbirth. This may be someone from the woman’s family or social network, such as her spouse/partner, a female friend or relative, a community member (such as a female community leader, health worker or traditional birth attendant) or a doula (i.e. a woman who has specialty training in labour support but is not part of the healthcare facility’s professional staff )
what is relaxin role in labour ?
Relaxin: loosens ligaments helping to make more space for birth.
what is the pelvis role in labour?
Pelvis: sacrum and iliac bones move symphysis pubic widens. Specific positions and movements can increase or decrease pelvic diameters.
what are the advantages to adopting Walking and upright positions in the first stage of labour?
reduces:
- The duration of the first and second stage of labour
- The risk of caesarean birth
- The need for epidural
Interventions - reports less severe pain and increased satisfaction with childbirth experience than woman in a semi-recumbent or lithotomy position.
what are the disadvantages to adopting Walking and upright positions in the first stage of labour?
none
what are the biochemical advantages to walking and upright positions in labour?
Biochemically advantages: flexible sacrum positions such as knelling, standing etc are more beneficial as they allow a higher coccyx movement and lower widening the pubic symphysis.
what percentages of women gave birth on a bed?
82% gave birth on the bed (majority semi recumbent or supine)
what percentage of unassisted vaginal birth are in lithotomy?
24%
what are the advantages of lithotomy and supine positions?
none
what are the disadvantages of lithotomy and supine positions?
- Increased risk of severe perineal trauma
- Comparatively longer labour
- Great pain
- Decreased in satisfaction and control
- More fetal heart rate patterns
what are the restrictions in the birth room, Goer and Romanos 4 P’s?
- Is it possible: is there freedom to move, to eat to drink?
- Physical environment: is there room to move? Pool, beanbags, birth stool, balls
- Practices: “being connected to things” is the main obstacle to mobility, bed as dominant feature, pharmacological analgesia, convenience
People: the impact of the HCP can overrise all of the above either negatively or positively. Midwife’s lack skills, peer pressure, woman become patients.
how can you create more space in the pelvis?
Use hip opening, muscle releasing, fascia stretching techniques and positions like side lying release and shaking the apple tree. Peanut ball. Asymmetrical positions like lunges. Internal rotations of the femur.
what position is best for women with epidurals and benefits?
Left lateral position is better for women with epidural
- Increases pelvic diameters
- Reduced length of labour
- Reduced caesarean section rate
- Aids rotation and descent
Aids asymmetrical positions
