Recent anthropological scholarship on “new midwifery" centers on how professional midwives in various countries are helping women reconnect with “nature," teaching them to trust in their bodies, ...respecting women’s “choices," and fighting for women’s right to birth as naturally as possible. In No Alternative, Rosalynn A. Vega uses ethnographic accounts of natural birth practices in Mexico to complicate these narratives about new midwifery and illuminate larger questions of female empowerment, citizenship, and the commodification of indigenous culture, by showing how alternative birth actually reinscribes traditional racial and gender hierarchies. Vega contrasts the vastly different birthing experiences of upper-class and indigenous Mexican women. Upper-class women often travel to birthing centers to be delivered by professional midwives whose methods are adopted from and represented as indigenous culture, while indigenous women from those same cultures are often forced by lack of resources to use government hospitals regardless of their preferred birthing method. Vega demonstrates that women’s empowerment, having a “choice," is a privilege of those capable of paying for private medical services—albeit a dubious privilege, as it puts the burden of correctly producing future members of society on women’s shoulders. Vega’s research thus also reveals the limits of citizenship in a neoliberal world, as indigeneity becomes an object of consumption within a transnational racialized economy.
Even childbirth is affected by globalization-and in India, as elsewhere, the trend is away from home births, assisted by midwives, toward hospital births with increasing reliance on new technologies. ...And yet, as this work of critical feminist ethnography clearly demonstrates, the global spread of biomedical models of childbirth has not brought forth one monolithic form of "modern birth." Focusing on the birth experiences of lower-class women in the South Indian state of Tamil Nadu,Birth on the Thresholdreveals the complex and unique ways in which modernity emerges in local contexts. Through vivid description and animated dialogue, this book conveys the birth stories of the women of Tamil Nadu in their own voices, emphasizing their critiques of and aspirations for modern births today. In light of these stories, author Cecilia Van Hollen explores larger questions about how the structures of colonialism and postcolonial international and national development have helped to shape the form and meaning of birth for Indian women today. Ultimately, her book poses the question: How is gender-especially maternity-reconfigured as birth is transformed?
Despite today's historically low maternal and infant mortality rates in the United States, labor continues to evoke fear among American women. Rather than embrace the natural childbirth methods ...promoted in the 1970s, most women welcome epidural anesthesia and even Cesarean deliveries. In Deliver Me from Pain, Jacqueline H. Wolf asks how a treatment such as obstetric anesthesia, even when it historically posed serious risk to mothers and newborns, paradoxically came to assuage women's anxiety about birth.
Each chapter begins with the story of a birth, dramatically illustrating the unique practices of the era being examined. Deliver Me from Pain covers the development and use of anesthesia from ether and chloroform in the mid-nineteenth century; to amnesiacs, barbiturates, narcotics, opioids, tranquilizers, saddle blocks, spinals, and gas during the mid-twentieth century; to epidural anesthesia today.
Labor pain is not merely a physiological response, but a phenomenon that mothers and physicians perceive through a historical, social, and cultural lens. Wolf examines these influences and argues that medical and lay views of labor pain and the concomitant acceptance of obstetric anesthesia have had a ripple effect, creating the conditions for acceptance of other, often unnecessary, and sometimes risky obstetric treatments: forceps, the chemical induction and augmentation of labor, episiotomy, electronic fetal monitoring, and Cesarean section.
As American women make decisions about anesthesia today, Deliver Me from Pain offers them insight into how women made this choice in the past and why each generation of mothers has made dramatically different decisions.
In resource-limited settings, childbirth remains a matter of life and death. High levels of childbirth fear in primigravid women are inevitable. To date, few studies have explored interventions to ...reduce childbirth fear in primigravid women. This study aimed to evaluate the efficacy of companion-integrated childbirth preparation (C-ICP) during late pregnancy for reducing childbirth fear and improving childbirth self-efficacy, birth companion support, and other selected pregnancy outcomes in primigravid women.
A quasi-experimental study was carried out using a non-equivalent control group design to recruit a sample of 70 primigravid women in hospital maternity waiting homes in the intervention and control groups, with 35 in each group. The primigravid women and their birth companions in the intervention group received two sessions of companion-integrated childbirth preparation, whereas the control group received routine care. A questionnaire that incorporated the childbirth attitude questionnaire (CAQ), the childbirth self-efficacy inventory (CBSEI), the birth companion support questionnaire (BCSQ), and a review checklist of selected pregnancy outcomes was used to collect data. Pretest and post-test data were analyzed using simple linear regression. Beta coefficients were adjusted at a 95% confidence interval with statistical significance set at a P-value of < 0.05 using Statistical Package for the Social Sciences version 25.
At pretest, mean scores were similar in the intervention and control groups. At post-test, being in the intervention group significantly decreased childbirth fears (β: = - .866, t (68) = - 14.27, p < .001) and significantly increased childbirth self-efficacy (β: = .903, t (68) = 17.30, p < .001). In addition, being in the intervention group significantly increased birth companion support (β: = - 0.781, t (68) = 10.32, p < .001). However, no statistically significant differences regarding pregnancy outcomes were observed between the study groups (Mann-Whiney U test, p > .05).
The findings of our study suggest that C-ICP is a promising intervention to reduce childbirth fear while increasing childbirth self-efficacy and maternal support. We recommend the inclusion of C-ICP for primigravid women during late pregnancy in resource-limited settings.
Background
Out‐of‐hospital births have been increasing in the United States, although past studies have found wide variations between states. Our purpose was to examine trends in out‐of‐hospital ...births, the risk profile of these births, and state differences in women’s access to these births.
Methods
National birth certificate data from 2004 to 2017 were analyzed. Newly available national data on method of payment for the delivery (private insurance, Medicaid, self‐pay) were used to measure access to out‐of‐hospital birth options.
Results
After a gradual decline from 1990 to 2004, the number of out‐of‐hospital births increased from 35 578 in 2004 to 62 228 in 2017. In 2017, 1 of every 62 births in the United States was an out‐of‐hospital birth (1.61%). Home births increased by 77% from 2004 to 2017, whereas birth center births more than doubled. Out‐of‐hospital births were more common in the Pacific Northwest and less common in the southeastern states such as Alabama, Louisiana, and Mississippi. Women with planned home and birth center births were less likely to have a number of population characteristics associated with poor pregnancy outcomes, including teen births, smoking during pregnancy, obesity, and preterm, low birthweight, and multiple births. More than 2/3 of planned home births were self‐paid, compared with 1/3 of birth center and just 3% of hospital births, with large variations by state.
Conclusions
Lack of insurance or Medicaid coverage is an important limiting factor for women desiring out‐of‐hospital birth in most states. Recent increases in out‐of‐hospital births despite important limiting factors highlight the strong motivation of some women to choose out‐of‐hospital birth.
Birthing Fathers Reed, Richard K
2005, 20050119, 2005-01-19, 20050101
eBook
"Treating birth as ritual, Reed makes clever use of his anthropological expertise, qualitative data, and personal experience to bring to life the frustrations and joys men often encounter as they ...navigate the medical model of birthing."-William Marsiglio, author Sex, Men, and Babies: Stories of Awareness and ResponsibilityIn the past two decades, men have gone from being excluded from the delivery room to being admitted, then invited, and, finally, expected to participate actively in the birth of their children. No longer mere observers, fathers attend baby showers, go to birthing classes, and share in the intimate, everyday details of their partners' pregnancies.In this unique study, Richard Reed draws on the feminist critique of professionalized medical birthing to argue that the clinical nature of medical intervention distances fathers from child delivery. He explores men's roles in childbirth and the ways in which birth transforms a man's identity and his relations with his partner, his new baby, and society. In other societies, birth is recognized as an important rite of passage for fathers. Yet, in American culture, despite the fact that fathers are admitted into delivery rooms, little attention is given to their transition to fatherhood.The book concludes with an exploration of what men's roles in childbirth tell us about gender and American society. Reed suggests that it is no coincidence that men's participation in the birthing process developed in parallel to changing definitions of fatherhood more broadly. Over the past twenty years, it has become expected that fathers, in addition to being strong and dependable, will be empathetic and nurturing.Well-researched, candidly written, and enriched with personal accounts of over fifty men from all parts of the world, this book is as much about the birth of fathers as it is about fathers in birth.
Mother-infant separation post birth is common. In standard hospital care, newborn infants are held wrapped or dressed in their mother's arms, placed in open cribs or under radiant warmers. ...Skin-to-skin contact (SSC) begins ideally at birth and should last continually until the end of the first breastfeeding. SSC involves placing the dried, naked baby prone on the mother's bare chest, often covered with a warm blanket. According to mammalian neuroscience, the intimate contact inherent in this place (habitat) evokes neuro-behaviors ensuring fulfillment of basic biological needs. This time frame immediately post birth may represent a 'sensitive period' for programming future physiology and behavior.
To assess the effects of immediate or early SSC for healthy newborn infants compared to standard contact on establishment and maintenance of breastfeeding and infant physiology.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (17 December 2015), made personal contact with trialists, consulted the bibliography on kangaroo mother care (KMC) maintained by Dr Susan Ludington, and reviewed reference lists of retrieved studies.
Randomized controlled trials that compared immediate or early SSC with usual hospital care.
Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. Quality of the evidence was assessed using the GRADE approach.
We included 46 trials with 3850 women and their infants; 38 trials with 3472 women and infants contributed data to our analyses. Trials took place in 21 countries, and most recruited small samples (just 12 trials randomized more than 100 women). Eight trials included women who had SSC after cesarean birth. All infants recruited to trials were healthy, and the majority were full term. Six trials studied late preterm infants (greater than 35 weeks' gestation). No included trial met all criteria for good quality with respect to methodology and reporting; no trial was successfully blinded, and all analyses were imprecise due to small sample size. Many analyses had statistical heterogeneity due to considerable differences between SSC and standard care control groups. Results for womenSSC women were more likely than women with standard contact to be breastfeeding at one to four months post birth, though there was some uncertainty in this estimate due to risks of bias in included trials (average risk ratio (RR) 1.24, 95% confidence interval (CI) 1.07 to 1.43; participants = 887; studies = 14; I² = 41%; GRADE: moderate quality). SSC women also breast fed their infants longer, though data were limited (mean difference (MD) 64 days, 95% CI 37.96 to 89.50; participants = 264; studies = six; GRADE:low quality); this result was from a sensitivity analysis excluding one trial contributing all of the heterogeneity in the primary analysis. SSC women were probably more likely to exclusively breast feed from hospital discharge to one month post birth and from six weeks to six months post birth, though both analyses had substantial heterogeneity (from discharge average RR 1.30, 95% CI 1.12 to 1.49; participants = 711; studies = six; I² = 44%; GRADE: moderate quality; from six weeks average RR 1.50, 95% CI 1.18 to 1.90; participants = 640; studies = seven; I² = 62%; GRADE: moderate quality).Women in the SCC group had higher mean scores for breastfeeding effectiveness, with moderate heterogeneity (IBFAT (Infant Breastfeeding Assessment Tool) score MD 2.28, 95% CI 1.41 to 3.15; participants = 384; studies = four; I² = 41%). SSC infants were more likely to breast feed successfully during their first feed, with high heterogeneity (average RR 1.32, 95% CI 1.04 to 1.67; participants = 575; studies = five; I² = 85%). Results for infantsSSC infants had higher SCRIP (stability of the cardio-respiratory system) scores overall, suggesting better stabilization on three physiological parameters. However, there were few infants, and the clinical significance of the test was unclear because trialists reported averages of multiple time points (standardized mean difference (SMD) 1.24, 95% CI 0.76 to 1.72; participants = 81; studies = two; GRADE low quality). SSC infants had higher blood glucose levels (MD 10.49, 95% CI 8.39 to 12.59; participants = 144; studies = three; GRADE: low quality), but similar temperature to infants in standard care (MD 0.30 degree Celcius (°C) 95% CI 0.13 °C to 0.47 °C; participants = 558; studies = six; I² = 88%; GRADE: low quality). Women and infants after cesarean birthWomen practicing SSC after cesarean birth were probably more likely to breast feed one to four months post birth and to breast feed successfully (IBFAT score), but analyses were based on just two trials and few women. Evidence was insufficient to determine whether SSC could improve breastfeeding at other times after cesarean. Single trials contributed to infant respiratory rate, maternal pain and maternal state anxiety with no power to detect group differences. SubgroupsWe found no differences for any outcome when we compared times of initiation (immediate less than 10 minutes post birth versus early 10 minutes or more post birth) or lengths of contact time (60 minutes or less contact versus more than 60 minutes contact).
Evidence supports the use of SSC to promote breastfeeding. Studies with larger sample sizes are necessary to confirm physiological benefit for infants during transition to extra-uterine life and to establish possible dose-response effects and optimal initiation time. Methodological quality of trials remains problematic, and small trials reporting different outcomes with different scales and limited data limit our confidence in the benefits of SSC for infants. Our review included only healthy infants, which limits the range of physiological parameters observed and makes their interpretation difficult.
Background
Birthing pools are integrated into maternity care in the United Kingdom and are a popular care option for women in midwifery‐led units and at home. The objective of this study was to ...describe and compare maternal characteristics, intrapartum events, interventions, and maternal and neonatal outcomes by planned place of birth for women who used a birthing pool.
Methods
A total of 8,924 women at low risk of childbirth complications were recruited from care settings in England, Scotland, and Northern Ireland. Descriptive analysis was performed.
Results
Overall, 7,915 (88.9%) women had a spontaneous birth (5,192, 58.3% water births), of whom 4,953 (55.5%) were nulliparas. Fewer nulliparas whose planned place of birth was the community (freestanding midwifery unit or home) had labor augmentation by artificial membrane rupture (149, 11.3% 95% CI: 9.6–13.1), compared with an alongside midwifery unit (271, 22.7% 95% CI: 20.3–25.2), or obstetric unit (639, 26.3% 95% CI: 24.5–28.1). Results were similar for epidural analgesia and episiotomy. More community nulliparas had spontaneous birth (1,172, 88.9% 95% CI: 87.1–90.6), compared with birth in an alongside midwifery unit (942, 79% 95% CI: 76.6–81.3) and obstetric unit (1,923, 79.2% 95% CI: 77.5–80.8); and fewer required hospital transfer (265, 20% 95% CI: 17–22.2) compared with those in an alongside midwifery unit (370, 31% 95% CI: 28.3–33.7). Results for multiparas and newborns were similar across care settings. Twenty babies had an umbilical cord snap, 18 (90%) of which occurred during water birth.
Conclusions
Birthing pool use was associated with a high frequency of spontaneous birth, particularly among nulliparas. Findings revealed differences in midwifery practice between obstetric units, alongside midwifery units, and the community, which may affect outcomes, particularly for nulliparas. No evidence was found for a difference across care settings in interventions or outcomes in multiparas or in outcomes for newborns. During water birth, it is important to prevent undue traction on the cord as the baby is guided to the surface. (BIRTH 39:3 September 2012)
Uterine angioleiomyoma is a rare entity. Angioleiomyoma is a benign vascular tumor that originates fromthe blood vessels. Although exceptionally they can be found in the uterus, they are commonly ...reportedin the lower extremity. Preoperative diagnosis is tricky. We are publishing this case to highlight uterinecontractions as a possible cause of the peripartum rupture.
The patient was in her fourth pregnancy, with a history of three vaginal deliveries. She presented to theemergency department in our hospital with labor pain, at 39 weeks of gestation, and was admitted to thelabor unit in active labor. She had an uneventful vaginal delivery with a good neonatal outcome. Afterdelivery, the patient complained of abdominal pain, shoulder tip pain, and abdominal distention.
Examination revealed a tender mass felt on the left side of the uterus up to the left hypochondriac region, contracted uterus, and normal lochia. A CT (computed tomography) scan was carried out and was remarkable for a left-sided, mixed-density, abdominopelvic lesion, measuring 18×12×9 cm, and a moderate amount of hemoperitoneum. Intraoperatively there was 1 liter of free blood, ruptured left-sided, subserous myoma connected to a 20×15 cm hematoma. A myomectomy was carried out. Histopathology reported an angioleiomyoma with symplastic-type cells.
Although infrequent, complicated angioleomyoma should be suspected in the differential diagnosis ofabdominopelvic hematoma in patients with uterine fibroids
Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and ...fewer complications. This is an update of a Cochrane review first published in 1998.
To assess the effects of planned hospital birth compared with planned home birth in selected low-risk women, assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.
We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2012) and contacted editors and authors involved with possible trials.
Randomised controlled trials comparing planned hospital birth with planned home birth in low-risk women as described in the objectives.
The two review authors as independently as possible assessed trial quality and extracted data. We contacted study authors for additional information.
Two trials met the inclusion criteria but only one trial involving 11 women provided some outcome data and was included. The evidence from this trial was of moderate quality and too small to allow conclusions to be drawn.
There is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women. However, the trials show that women living in areas where they are not well informed about home birth may welcome ethically well-designed trials that would ensure an informed choice. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new randomised controlled trials.
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