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Introduction: The type of perineal repair can have significant long-term effects on various functions in a woman's postpartum life. The aim was to compare urinary incontinence (UI), women's satisfaction, pelvic floor muscle strength (PFMS), and sexual function according to the type of perineal repair (surgical glue or suture thread) during the first eight months after normal childbirth. Methods: A controlled randomized clinical trial of 133 primiparous women undergoing perineal repair during birth with surgical glue or sutures, evaluated during labor and monitored up to 8 months postpartum, from March 2017 to September 2018, in the city in São Paulo, Bazil. Descriptive and inferential analyses were carried out. Results: A total of 133 women were included in the study, 111 (83.5%) were assessed between 10 to 20 days postpartum, 121 (91.0%) between 50 to 70 days, and 54 (40.6%) between 6 to 8 months. There were no significant differences for UI concerning the type of repair; however, there was a significant difference concerning the postpartum period (p=0.031), with a higher prevalence at two months. Most women reported satisfaction, with the highest levels reported two months after birth (p=0.019). For PFMS, the mean of the glue and suture groups were 32.4 cmH2O and 27.4 cmH2O, but not significant. Women in the glue group showed higher mean values in all sexual function domains but without significance. Conclusions: Surgical glue showed good aesthetic and functional results in the perineum at eight months postpartum. [ABSTRACT FROM AUTHOR]

Introduction: Fear of natural childbirth is a common problem among pregnant women. The present study was performed with aim to explain fear of natural childbirth and its related factors among primigravid women. Methods: This sequential-explanatory mixed-methods study with participant selection type was conducted in 2014-2015. At quantitative phase, using a multistage cluster sampling method, 400 primigravid women with 18-32 gestation weeks were selected. To collected data, Childbirth Attitude Questionnaire, demographic characteristics, and Northouse Social Support Questionnaire were used. Data analysis was performed using Chi-square, t-test, Mann-Whitney test, and multivariate logistic regression. At qualitative phase, semi-structured individual interviews using open-ended questions was performed on 15 primigravid women who were selected using purposive sampling method. The data were analyzed using conventional content analysis method. Results: Mean score of fear of natural childbirth was 37.86±9.44 and its prevalence (CAQ≥28) was 80.8%. According to the results of multivariate logistic regression analysis, a significant relationship was found between lack of sufficient income (p=0.020), not participating in childbirth preparation classes (p=0.040) and selection of delivery method (vaginal delivery) (p

During the French Revolution, obstetrics underwent substantial transformations in practice, teaching, and the physical spaces where it was conducted. The revolutionary authorities implemented reforms in French medical institutions that promoted an instrument-centred style and the dissemination of novel surgical techniques in obstetrics. The selection of professors for the obstetrics chair at the newly established École de santé and the appointment of chiefs for the new maternity ward in Paris favoured proponents of a mechanistic approach to labour assistance. This essay explores the theoretical principles and societal pressures that guided these transformative reforms and the remarkable changes they introduced in healthcare and in the practise of medicine and surgery. Furthermore, it examines the consolidation of new epistemological, ethical, and professional boundaries within the context of late eighteenth-century French obstetrics. A critical section of this study focuses on the debate ignited by the contemporaries who voiced concerns that the rise of surgical interventions on pregnant women's bodies might result in unwarranted violence, in a diminishing of midwives’ roles, and in a departure from the tradition of natural childbirth. These controversies among obstetricians highlight significant contradictions within the Revolutionary medical reforms. [ABSTRACT FROM AUTHOR]

Objectives: The use of internet-based search engines for health information is very popular and common. The Internet has become an important source of health information and has a considerable impact on patient's decision making process. Knowledge of pregnant women about childbirth comes from health professionals and personal experiences described by friends or family members. There is a growing interest in digital sources used by pregnant women. Analysis of queries related to regarding to natural childbirth and cesarean section in the Google search engine. Material and methods: In this infodemiology, descriptive study tool "AlsoAsked" was used. This is a tool for analyzing data appearing in Google search results. "AlsoAsked" search was conducted on April 19, 2023. Search phrases "natural childbirth" and "cesarean section" in polish language were used. Questions that were typed into the Google search engine, ranked according to popularity (volume) and thematic connections have been discussed. Results: The most frequently asked questions were related to the course and duration of labor as well as the preparation for labor and cesarean section (CS). Comparison between a natural labour and CS in the context of safety and pain received a great deal of attention. Conclusions: The most popular questions regarding CS were related to elective CS and indications for it. Some questions concerned the connection between labor and clinical state of a newborn. Women's healthcare should include education about the possibility of incorrect information provided by the Internet Web sites and information about trustworthy Web sites. [ABSTRACT FROM AUTHOR]

Background Aim Methods Results Discussion Conclusion Diagnoses of labor dystocia, and subsequent labor augmentation, make one of the biggest contributions to childbirth medicalization, which remains a key challenge in contemporary maternity care. However, labor dystocia is poorly defined, and the antithetical concept of physiological plateaus remains insufficiently explored.To generate a definition of physiological plateaus as a basis for further research.This qualitative study applied grounded theory methods and comprised interviews with 20 midwives across Australia, conducted between September 2020 and February 2022. Data were coded in a three‐phase approach, starting with inductive line‐by‐line coding, which generated themes and subthemes, and finally, through axial coding.Physiological plateaus represent a temporary slowing of one or multiple labor processes and appear to be common during childbirth. They are reported throughout the entire continuum of labor, typically lasting between a few minutes to several hours. Their etiology/function appears to be a self‐regulatory mechanism of the mother‐infant dyad. Physiological plateaus typically self‐resolve and are followed by a self‐resumption of labor. Women with physiological plateaus during labor appear to experience positive birth outcomes.Despite appearing to be common, physiological plateaus are insufficiently recognized in contemporary childbirth discourse. Consequently, there seems to be a significant risk of misinterpretation of physiological plateaus as labor dystocia. While findings are limited by the qualitative design and require validation through further quantitative research, the proposed novel definition provides an important starting point for further investigation.A better understanding of physiological plateaus holds the potential for a de‐medicalization of childbirth through preventing unjustified labor augmentation. [ABSTRACT FROM AUTHOR]

Introduction: Fear of natural childbirth is a common problem among pregnant women. The present study was performed with aim to explain fear of natural childbirth and its related factors among primigravid women. Methods: This sequential-explanatory mixed-methods study with participant selection type was conducted in 2014-2015. At quantitative phase, using a multistage cluster sampling method, 400 primigravid women with 18-32 gestation weeks were selected. To collected data, Childbirth Attitude Questionnaire, demographic characteristics, and Northouse Social Support Questionnaire were used. Data analysis was performed using Chi-square, t-test, Mann-Whitney test, and multivariate logistic regression. At qualitative phase, semi-structured individual interviews using open-ended questions was performed on 15 primigravid women who were selected using purposive sampling method. The data were analyzed using conventional content analysis method. Results: Mean score of fear of natural childbirth was 37.86±9.44 and its prevalence (CAQ≥28) was 80.8%. According to the results of multivariate logistic regression analysis, a significant relationship was found between lack of sufficient income (p=0.020), not participating in childbirth preparation classes (p=0.040) and selection of delivery method (vaginal delivery) (p<0.001) with fear of childbirth. Analysis of data at the qualitative stage led to three themes including feeling of inability for natural childbirth, confusion in decision making and concerns about natural childbirth complications. Conclusion: Fear of childbirth was influenced by personal, social and cultural factors. Therefore, it is suggested that health service providers use the results of this study to implement educational programs in order to encourage natural childbirth. [ABSTRACT FROM AUTHOR]

Abstract Objectives: this study describes the occurrence of cesarean sections according to the Robson Classification in a public hospital in southern Brazil. Methods: a cross-sectional and retrospective study was conducted. Women who underwent vaginal delivery or cesarean section at the study location (gestational age >20 weeks and/or fetuses weighing > 500 g) were included. Stillbirths were excluded. Sociodemographic and obstetric data from July to November 2018 were retrospectively collected from medical records. Chi-square and linear trend tests were used for data analysis. The Robson Classification was analyzed according to World Health Organization recommendations, and the reasons for cesarean section were described. Results: the sample consisted of 1,531 women. The cesarean section rate was 39.1% (n=598). A greater incidence of cesarean sections was identified among women with no previous vaginal births, older women, those with higher educational levels, and those with more previous cesarean sections. Groups 1, 2 and 5 of the Robson Classification stood out for presenting cesarean section rates of 16%, 56.9% and 66.2%, respectively, and for totaling 60.3% of births by cesarean section in the studied institution. Conclusions: the percentage of cesarean sections found was greater than that reported in studies conducted in other countries. Groups 1 to 5 of the Robson Classification presented rates lower than values found in national literature. Groups 1, 2 and 5 should be prioritized for management and care interventions aiming to reduce cesarean rates.

Objectives: To determine the prevalence of episiotomy over a 14-year period and to explore its association with maternal, delivery, and neonatal variables using administrative data. Material and methods: This is a cross-sectional study. Women who had a vaginal delivery with a live newborn at a referral hospital for obstetric care in Ecuador were included. Consecutive sampling was employed. ICD-10 records and the perinatal information system (PIS) were utilized. Sociodemographic, gestational, delivery, and neonatal variables were assessed. Descriptive analysis was performed. The overall and yearly prevalence was determined. Exploratory bivariate and multivariate analyses were conducted. The study was approved by the Human Research Ethics Committee of the Universidad Central del Ecuador. Results: A total of 11,862 records were analyzed. The overall prevalence of episiotomy was 36.69 %, with a maximum of 42 % and a minimum of 28 %. There is an implied trend towards a reduction in frequency from 2019 to 2022. A positive association was found between episiotomy and maternal age under 20 years, previous cesarean section, absence of a companion during delivery, term newborns, and large for gestational age newborns. A negative association was found with previous vaginal deliveries. Conclusions: The prevalence of episiotomy exceeds the recommendation of the World Health Organization (WHO). Clinical practice guidelines should consider potentially modifiable maternal and neonatal factors in their recommendations. Prospective studies should be conducted to evaluate the safety of the procedure, confirm these observations, and use robust methodologies to assess if there is a real decrease in its practice. [ABSTRACT FROM AUTHOR]

Introduction: Childbirth is recognized as a physiological process essential to procreation and societal development. Nevertheless, it often lacks adequate discussion on humanized care practices. Therefore, it is necessary to identify women’s experiences during vaginal birth care to create practices that ensure better quality care. Objective: To characterize scientific evidence related to women’s experiences during vaginal birth care. Materials and Methods: An integrative review was conducted following Cooper’s methodology; six databases were reviewed: Cochrane, PubMed, Science Direct, Springer, Scopus, and Cinahl, using the descriptors: Normal Birth; Humanized Birth; Humanization of Care; Obstetric Violence; Qualitative Research, in Spanish, English, and Portuguese, limited to the 2010-2023 period, with the following inclusion/exclusion criteria: Qualitative full-text articles on vaginal births with a score of 8 or higher according to CASPe. Results: Six thematic units emerged: microaggressions and macro-impacts: childbirth: between pain and fear; acting with respect: childbirth as a natural process; silencing, enduring, and bearing; my birth, my choice; making the invisible visible: normalizing violence during childbirth; and the ritual of childbirth: women’s dignity. Conclusions: Women’s childbirth experiences are influenced by the cultural contexts in which they live; the biomedical model and traditional practices clash and impact women’s lives. Women must know their reproductive rights to contribute to a humanized childbirth. [ABSTRACT FROM AUTHOR]

Objective: To investigate the effect of incorporating noise-canceling headphones into the delivery process for natural childbirth puerperae. Methods: We conducted a retrospective analysis of clinical data encompassing natural childbirth puerperae in the People's Hospital of Suzhou New District from January 2021 to February 2023. The implementation of routine noise reduction management was done from January 2021 to January 2022. During this interval, 69 natural childbirth puerperae were selected as subjects, with 7 excluded, resulting in 62 participants constituting the reference group. Subsequently, noise-canceling headphones were distributed to natural childbirth puerperae from February 2022 to February 2023. In this phase, 66 subjects were selected, and 6 were excluded, resulting in 60 participants forming the observation group. Following admission, both groups underwent corresponding nursing management. Emotional states, pain levels, and various indicators were systematically collected and meticulously compared. Results: The observation group exhibited significantly lower Hamilton Anxiety Rating Scale scores than the reference group before delivery and during the first stage of labor (P < 0.05). The observation group demonstrated significantly lower visual analog scale scores and substance P, nitric oxide, and prostaglandin E2 levels than the reference group during the first stage of labor (P < 0.001). During the second stage of labor, the visual analog) scale scores were significantly lower in the observation group than in the reference group (P < 0.05). The durations of first and second labor stages were significantly shorter in the observation group than in the reference group (P<0.05). No significant difference existed in Apgar scores between the two groups (P>0.05). Conclusion: The utilization of noise-canceling headphones emerges as an effective intervention, alleviating anxiety, reducing pain during T1, and abbreviating total labor time in natural childbirth puerperae, suggesting its substantial clinical application value and potential as a beneficial addition to maternity care practices. [ABSTRACT FROM AUTHOR]

The "A Randomized Trial of Induction Versus Expectant Management" trial (ARRIVE trial) published in 2018 suggested that induction of labor can be considered a "reasonable option" for low-risk nulliparous women at ≥39 weeks of gestation. The study results led some professional societies to endorse the option for elective induction of labor at 39 weeks of gestation in low-risk nulliparas, and this has begun to change obstetrical practice. The ARRIVE trial provided valuable information supporting the benefits of induction of labor; however, the trial is insufficient to serve as the primary justification for widespread elective induction of labor at 39 weeks of gestation in low-risk nulliparas because of concerns about external validity. Thus, the French ARRIVE trial was designed to test the hypothesis in a different setting that elective induction of labor at 39 weeks of gestation in low-risk nulliparas leads to a lower cesarean delivery rate than expectant management. This ongoing trial has been criticized as "pseudoscientific" and telling "women where, when, and how to give birth." We reject these allegations and extensively examine the ethical framework that should govern clinical and research interventions, including elective induction of labor at 39 weeks of gestation in low-risk nulliparas. This study aimed to discuss the ethical issues that emerge from randomized trials of elective induction of labor at 39 weeks of gestation in low-risk nulliparas and the ethics of the clinical practice itself. The analysis of existing evidence shows the importance of further research on induction of labor at 39 weeks of gestation in low-risk women. Certain aspects of research ethics in this area, particularly the consent of pregnant women in a context where autonomy remains fragile, call for vigilance. In addition, we emphasize that childbirth is not only a medical object but also a social phenomenon that cannot be regarded only from the perspective of a health risk to be managed by clinical research. Further research on this issue is needed to allow pregnant women to make informed decisions, and the results should be integrated with social issues. The perspective of women is required in constructing, evaluating, and implementing medical interventions in childbirth, such as induction of labor at 39 weeks of gestation. [ABSTRACT FROM AUTHOR]

Background: Midwives can play a pivotal role in promoting natural-birth experiences. However, limited information is available about Jordanian laboring women’s experiences of natural childbirth guided by midwives. Understanding women’s experiences of natural birth can inform healthcare providers and policymakers to improve the care provided for laboring women. Purpose: This study aims to explore women's experiences of natural childbirth in a midwife-led care unit. Methods: A qualitative descriptive approach guided the study protocol. Data was collected through in-depth, semi-structured telephone interviews with 10 Jordanian women who experienced natural childbirth in a midwife-led care unit. Results: Two main themes emerged: “The journey of empowerment “and “being prepared for natural childbirth". The first theme consisted of two sub-themes: Making an informed decision, and being supported. The second theme consisted of three sub-themes: The power of the place, being satisfied with natural-childbirth practices, and feeling relieved. Conclusion: Women had positive childbirth experiences shaped by having autonomy in decision-making, perceived support, and being satisfied with the midwife-led care unit. Women’s positive experiences emphasize the need for social and political change to promote natural childbirth. Implications for Nursing: This paper provides evidence that supports the incorporation of midwife-led units to promote natural childbirth. New data will play a critical role in strengthening the responsibilities of nurses and midwives by raising public awareness and calling for policy changes to promote natural childbirth. [ABSTRACT FROM AUTHOR]

Objective: To explore the effectiveness of diversified teaching modes in Pregnant Women′s Educational School in promoting natural delivery. Methods: A retrospective study was conducted on primiparous pregnant women who were registered for prenatal examination and hospitalized for delivery at Tianjin Central Hospital of Gynecology Obstetrics from June to August 2023. Based on whether they had participated in the courses of Pregnant Women′ s Educational School, the participants were divided into experimental group (309 women) and control group (300 women). A questionnaire survey was conducted upon admission to compare the awareness of natural delivery knowledge and the willingness to undergo natural delivery between two groups. Analyze and compare the cesarean section rate, social factors cesarean section rate, incidence of pregnancy complications, application rate of labor analgesia, incidence rate of macrosomia and proportion of postpartum hemorrhage between two groups. Conduct a satisfaction survey on different teaching modes in the experimental group. Compare the number of learners attending each teaching modes in Pregnant Women′s Educational School. Results: The awareness of natural delivery knowledge and the willingness to undergo natural delivery in the experimental group were higher than those in the control group, the differences were statistically significant (P＜0.05). There was no significant difference in cesarean section rates between the two groups (P=0.051). However, compared to the control group, the experimental group had a lower rates of social factors cesarean section, lower incidence of pregnancy complications, macrosomia and postpartum hemorrhage, as well as a higher application rate of labor analgesia. The differences between two groups were statistically significant (all P＜0.05). There was a statistically significant difference in the average number of learners among the five different teaching modes in the experimental group (χ² =83.455, P＜0.000 1). There were 596 students in each Recorded Course on average, higher than other teaching modes, followed by WeChat Video Account Live Course, 280 students in each course on average. There was a statistically significant difference in patient satisfaction of different teaching modes among the pregnant women who had participated in the courses of Pregnant Women′s Educational School (χ² =104.708, P＜0.000 1), with 100% satisfaction of the WeChat Video Account Live Courses. Conclusions: The diversified teaching modes at Pregnant Women′s Educational School can attract the attention of pregnant women, enhance their awareness of prenatal health care, reduce pregnancy complications and promote natural delivery. The WeChat Video Account Live Course has the characteristics of high satisfaction and wide audience, which is worth promoting. [ABSTRACT FROM AUTHOR]

During childbirth, one of the most common diagnoses of pathology is 'failure to progress', frequently resulting in labour augmentation and intervention cascades. However, failure to progress is poorly defined and evidence suggests that some instances of slowing, stalling and pausing labour patterns may represent physiological plateaus. To explore how midwives conceptualise physiological plateaus and the significance such plateaus may have for women's labour trajectory and birth outcome. Twenty midwives across Australia participated in semi-structured interviews between September 2020 and February 2022. Constructivist grounded theory methodology was applied to analyse data, including multi-phasic coding and application of constant comparative methods, resulting in a novel theory of physiological plateaus that is firmly supported by participant data. This study found that the conceptualisation of plateauing labour depends largely on health professionals' philosophical assumptions around childbirth. While the Medical Dominant Paradigm frames plateaus as invariably pathological, the Holistic Midwifery Paradigm acknowledges plateaus as a common and valuable element of labour that serves a self-regulatory purpose and results in good birth outcomes for mother and baby. Contemporary medicalised approaches in maternity care, which are based on an expectation of continuous labour progress, appear to carry a risk for a misinterpretation of physiological plateaus as pathological. This study challenges the widespread bio-medical conceptualisation of plateauing labour as failure to progress, encourages a renegotiation of what can be considered healthy and normal during childbirth, and provides a stimulus to acknowledge the significance of childbirth philosophy for maternity care practice. [ABSTRACT FROM AUTHOR]

During the 1970s, the National Childbirth Trust (NCT) began to provide information and support to women experiencing postnatal mental illness, building on its promotion of natural childbirth and emphasis on the emotional wellbeing of women around birth, which had occupied the organisation since its establishment in 1956. This article argues that, alongside emotional, social and medical factors, the NCT attributed postnatal depression to the shift to hospital deliveries, involving high levels of intervention and frustrating women's choice and agency. While sharing ambitions to improve care in childbirth and giving women a voice in describing their experiences, it is suggested that the NCT's relationship with the feminist health movement remained ambiguous. The article also explores the NCT's collaboration with a variety of experts and advisors, some of whom emphasised the risk of postnatal depression to the bonding process and infant's development, potentially exacerbating the mental distress of new mothers. [ABSTRACT FROM AUTHOR]

Background: There are insufficient and contradictory reports regarding the effect of delivery method on the rate of umbilical cord Nucleated Red Blood Cell (NRBC). Therefore, the present study aimed to compare the percentages of umbilical cord NRBC in vaginal delivery and emergency cesarean section (C-section) in preterm neonates. Materials and Methods: The present cross-sectional study was performed on mothers with vaginal delivery and C-section, from 2020 to 2021. The samples (n = 221) were preterm neonates selected using the convenience sampling method. The percentages of NRBC in neonates born by natural childbirth and by emergency C-section were measured and compared in this research. A researcher-made checklist, which included maternal and neonatal characteristics and laboratory evaluation, was used as a data collection tool. Results: The statistical population of thisresearch included 93 (42.10%) and 128 (57.90%) neonates born by vaginal delivery and by C-section, respectively.The mean (SD) score of gestational ages at birth was 30.75 (2.81) weeks. The mean (SD) score of umbilical cord NRBC level were estimated at 8.01 (5.93) and 25.64 (22.61) for the neonates born by natural childbirth and by emergency C-section, respectively (t=-8.43, df = 150, p

Introduction: Self-efficacy during pregnancy is a self-assessment of one's ability to manage stress and perform important behaviors, especially in coping with pain. Women who benefit from the support of others during pregnancy feel more self-efficacious. The studiesshow that involving family members in education, support or presence during pregnancy has contradictory consequences. This study was therefore conducted with the aim of determining the effect of an accompanying training programme based on Bandura's theory on the mother's self-efficacy during childbirth. Material & Methods: This RCT was conducted on 60 primiparous mothers between 20 and 23 weeks of gestation who were admitted to Umm al-Banin Hospital in Mashhad and were randomly assigned to two intervention and control groups. The control group received 8 sessions of 90 minutes of oral and practical training. In addition to these sessions, training sessions based on Bandura's theory were held for the intervention group, includingtwo sessions of companions and pregnant mothers together and two sessionsalone. A demographic questionnaire and a Childbirth Self-Efficacy Inventory (CBSEI, Lowe, 1993) were completed by both groups before and immediately after the training. Data were analyzed using independent t-tests, paired t-tests, Mann-Whitney and Wilcoxon in SPSS 16 software. A significance level of less than 0.05 was considered. Findings: The average age of the mothers in the intervention group was 26.7±8.3 years and in the control group 28.3±5.9 years. In most cases, the mother 's companion was her sister (73.3%). Before the training, the mean value of self-efficacy was 82.5±22.3 in the intervention group and 87.5±32.4 in the control group (P = 0.492, independent t-test). After the training, the mean value of self-efficacy was 132.4±18.5 in the intervention group and 115.2±26.4 in the control group (P=0.006, Mann-Whitney test). Self-efficacy after the intervention compared to before increased by 49.9±31.3 in the intervention group and by 27.7±29.5 in the control group (P=0.007, Mann-Whitney test). In intragroup comparison, the difference between the intervention group after and before the training was significant (P

Abstract Background Birth is a significant event in women’s lives. As Mansfield notes (2008) many women aim for a birth that avoids pharmacological pain relief because they are advised it is better for them and their baby. For women having their first baby, this may not be realistic as 3/4 of primiparous women in Australia will use pharmacological pain relief. This study examines the expectations that a group of women had regarding pain relief, how these expectations developed and what happened to requests for pain relief in labour. Methods A longitudinal prospective study design was used to recruit 15 women who were having their first baby. Women having low risk pregnancies, hoping for a ‘natural birth’ (vaginal, no/minimal pharmacological pain relief) were eligible. A semi-structured interview tool was used across all three interviews that asked women about their expectations, then actual labour experience, pain management requests and how these were responded to by carers. Fifteen women were interviewed – at 36 weeks gestation; as soon after delivery of their baby as possible, then six months post-delivery (N = 43 interviews). Interviews were recorded and transcribed and coded by ES using NVivo software with hierarchical thematic analysis used. Results The study found that women appear to experience a mismatch between expectations they had developed pre-birth, versus actual experience. This appears to cause a specific form of dissonance – which we have termed ‘birth dissonance’ leaving them feeling traumatised post birth. This is because what women expected to happen in birth was often not realised. In particular, some women requested pain relief in birth and felt that their request was not responded to as hoped, and also seemed to develop post-birth trauma. We proposed that this may have resulted from dissonance arising from their expectations about being able to birth without significant pain relief. Interventions and technology may also contribute to this sense of mismatch and post-birth trauma. Conclusions Low risk birthing women birthing in a hospital may have to engage with higher levels of technology, intervention and pain relief than that which they expected pre-birth. This could possibly be avoided with four simple changes. Firstly, better pre-birth education for women about how painful labor is likely to be. Secondly, pre-birth education which includes a detailed explanation of the utility of pharmacological and non-pharmacological pain relief. Thirdly, more egalitarian decision-making during labour and finally delivering upon women’s requests for pain relief in labor, at the time that they ask for it. Further research is required to determine the extent of birth dissonance and how women making the transition to motherhood can avoid it.

BACKGROUND: The Safe Childbirth Checklist (SCC) was designed in an effort to support health workers to perform essential tasks and improve the quality of care (QoC) for mothers and babies during childbirth. Given the fact that human experiences in any society can be influenced by cultural, economic, and social differences. Therefore, the present qualitative study aimed to investigate mothers’ perceptions and experiences of natural childbirth and QoC in childbirth management based on SCC. MATERIALS AND METHODS: The current study is a qualitative study that was conducted in 2022–2023 by targeted sampling on women who gave birth based on SCC in two hospitals in Ahvaz. Eighteen women participated in the interview sessions 1 month after giving birth. The conventional content analysis method was used to analyze the data. RESULTS: Overall, 870 codes were extracted from the interviews. The interviewed mothers’ satisfaction with the use of SCC was organized into seven main themes, namely “Satisfaction with the comprehensive support of the companion,” “Satisfaction with the comprehensive support of the midwife,” “Satisfaction with the emotional support of the husband,” “Satisfaction with the mutual interaction between the midwife and the parturient mother,” “ Preparation for the challenges of different stages of childbirth and postpartum through training,” “ Satisfaction with the pain management strategies adopted by the companion,” “Satisfaction with skin-to-skin contact and early breastfeeding” and “ Satisfaction with the strengthened relationship between the couples and acceptance of the father’s role after the husband’s meeting with the parturient mother.” CONCLUSION: Implementation of SCC by providing evidence-based practice and midwifery standards to mothers and neonates can help improve women’s experiences of the birth process. By reminding midwives to encourage women to have a companion during childbirth and by giving the necessary training to them about danger signs in every stage of childbirth from admission to discharge, this checklist can not only lead to positive birth experiences but also improve the interaction of mothers with midwives. Therefore, it is recommended that this checklist be used in maternity wards.

Background: There are insufficient and contradictory reports regarding the effect of delivery method on the rate of umbilical cord Nucleated Red Blood Cell (NRBC). Therefore, the present study aimed to compare the percentages of umbilical cord NRBC in vaginal delivery and emergency cesarean section (C-section) in preterm neonates. Materials and Methods: The present cross-sectional study was performed on mothers with vaginal delivery and C-section, from 2020 to 2021. The samples (n = 221) were preterm neonates selected using the convenience sampling method. The percentages of NRBC in neonates born by natural childbirth and by emergency C-section were measured and compared in this research. A researcher-made checklist, which included maternal and neonatal characteristics and laboratory evaluation, was used as a data collection tool. Results: The statistical population of thisresearch included 93 (42.10%) and 128 (57.90%) neonates born by vaginal delivery and by C-section, respectively.The mean (SD) score of gestational ages at birth was 30.75 (2.81) weeks. The mean (SD) score of umbilical cord NRBC level were estimated at 8.01 (5.93) and 25.64 (22.61) for the neonates born by natural childbirth and by emergency C-section, respectively (t=-8.43, df = 150, p<0.001). Statistically significant differences were observed in the gestational age (t=-3.36, df = 218, p = 0.001), fifth-minute Apgar score (t=-2.32, df = 200, p = 0.021), umbilical cord NRBC (t=-8.43, df = 160, p<0.001), and short-term prognosis (p = 0.032) between the two groups. It was also revealed that the number of NRBCs in the dead neonates was about 1.5 times higher than that in the discharged neonates. Conclusions: Based on the results of the present study, emergency C-section increased the mean of umbilical cord NRBC by three times, compared to that of normal delivery. Since an increase in the NRBC raises the risk of infant death, it is advisable to take steps to maintain the health of children by identifying high-risk neonates through umbilical cord NRBC measurement immediately after delivery and special care. [ABSTRACT FROM AUTHOR]

• COVID-19 infection alone should not be an indication for caesarean section. • Caesarean section was associated with poorer perinatal outcomes. • Mode of delivery should be individualised to prevent negative perinatal outcomes. There is paucity in the literature that provides a comprehensive and evidence-based conclusion regarding this topic. To compare perinatal outcomes of vaginal and caesarean section delivery in women diagnosed with COVID-19 by meta -analysis of literature. The search was conducted on MEDLINE, EMBASE, LILACS, CINAHL, Scopus, Web of Science and Cochrane Database of Systematic Reviews by 25th May 2022. The inclusion criteria involved pregnant women diagnosed with COVID-19 who underwent caesarean section and those who had vaginal deliveries. The included studies were meta -analyzed for various outcomes including: Gestational age, maternal intensive care unit admission, maternal death, prematurity, newborn birth weight, newborn intensive care unit admission, Apgar scores, newborn death, and newborn vertical transmission of COVID-19. The meta -analysis was conducted using Comprehensive Meta-Analysis (CMA) software, version 3.3.070. The meta -analyses included 2,566 deliveries (866 caesarean sections and 1,700 vaginal deliveries) and identified that caesarean section was significantly associated with increased prematurity (OR 2.5 [1.7; 3.6], p < 0.001), lower birth weight (−118 g [−170; −66], p < 0.001), and a higher need for maternal (OR 9.54 [5.22; 17.43], p < 0.01) and neonatal intensive care unit intervention (OR 3.67 [2.71; 4.96], p < 0.01) compared to vaginal delivery. COVID-19 infection alone should not be an indication for caesarean section as there is insufficient evidence that caesarean section reduces mortality, improves birth conditions, or prevents vertical transmission. Additionally, caesarean section is associated with poorer perinatal outcomes compared to vaginal delivery. [ABSTRACT FROM AUTHOR]

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Background: Normal physiologic birth has been shown to result in optimal maternal–infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised. Objective: In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births. Methods: Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home‐based, community‐based, and hospital‐based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically. Results: Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self‐confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person‐centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision‐making. The midwife–client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth. Conclusions: This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth. [ABSTRACT FROM AUTHOR]

Background: Birth is a significant event in women's lives. As Mansfield notes (2008) many women aim for a birth that avoids pharmacological pain relief because they are advised it is better for them and their baby. For women having their first baby, this may not be realistic as 3/4 of primiparous women in Australia will use pharmacological pain relief. This study examines the expectations that a group of women had regarding pain relief, how these expectations developed and what happened to requests for pain relief in labour. Methods: A longitudinal prospective study design was used to recruit 15 women who were having their first baby. Women having low risk pregnancies, hoping for a 'natural birth' (vaginal, no/minimal pharmacological pain relief) were eligible. A semi-structured interview tool was used across all three interviews that asked women about their expectations, then actual labour experience, pain management requests and how these were responded to by carers. Fifteen women were interviewed – at 36 weeks gestation; as soon after delivery of their baby as possible, then six months post-delivery (N = 43 interviews). Interviews were recorded and transcribed and coded by ES using NVivo software with hierarchical thematic analysis used. Results: The study found that women appear to experience a mismatch between expectations they had developed pre-birth, versus actual experience. This appears to cause a specific form of dissonance – which we have termed 'birth dissonance' leaving them feeling traumatised post birth. This is because what women expected to happen in birth was often not realised. In particular, some women requested pain relief in birth and felt that their request was not responded to as hoped, and also seemed to develop post-birth trauma. We proposed that this may have resulted from dissonance arising from their expectations about being able to birth without significant pain relief. Interventions and technology may also contribute to this sense of mismatch and post-birth trauma. Conclusions: Low risk birthing women birthing in a hospital may have to engage with higher levels of technology, intervention and pain relief than that which they expected pre-birth. This could possibly be avoided with four simple changes. Firstly, better pre-birth education for women about how painful labor is likely to be. Secondly, pre-birth education which includes a detailed explanation of the utility of pharmacological and non-pharmacological pain relief. Thirdly, more egalitarian decision-making during labour and finally delivering upon women's requests for pain relief in labor, at the time that they ask for it. Further research is required to determine the extent of birth dissonance and how women making the transition to motherhood can avoid it. [ABSTRACT FROM AUTHOR]

Painless labor refers to using of different methods that can be used during labor including non-pharmacological and pharmacological methods to help women better cope with labor pain. Aim: The present study aimed to assess knowledge and attitudes of pregnant women regarding painless labor. Subjects and method: A descriptive research design was used. The study was conducted at out-patient clinics of obstetrics departments of: Tanta University Hospitals, El-Menshawy General Hospital, El-Mogamaa El-Teby Hospital, Doctor Mohamed Mashally Medical Center at Said, and Medical Center at Segar. A purposive sample of 300 pregnant women were included in the study. Two tools were used for data collection: Tool I: Pregnant women's knowledge regarding painless labor individual questionnaire, consisting of three parts: Part (1): Socio-demographic data of the pregnant women. Part (2): Obstetric history of the pregnant women. Part (3): Pregnant women's knowledge regarding painless labor. Tool (II): Women's attitudes toward painless labor. Results: The vast majority (95.0%) of the studied pregnant women had low level of knowledge regarding painless labor, while more than two-thirds (69.0%) of them had positive attitudes towards it. A significant relationship and positive correlation were found between the total score of women's knowledge and the total score of women's attitudes regarding painless labor. Conclusion: There was a low level of knowledge and positive attitudes regarding painless labor among the pregnant women. Recommendation: Planning and developing of antenatal childbirth preparation classes for all pregnant women to improve their compliance regarding painless labor. [ABSTRACT FROM AUTHOR]

Copyright of Fisioterapia Brasil is the property of Atlantica Editora and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract Objective: To describe the prevalence of perineal laceration, based on the self-reported perception of postpartum women, and to analyze factors associated with its occurrence in Brazil. Methods: This was a cross-sectional study conducted with 23,894 postpartum women, excluding twin pregnancies, cesarean sections, and births with episiotomies, between 2011 and 2012. Prevalence ratios (PR) and 95% confidence intervals (95%CI) of association between the event and maternal, fetus/newborn, obstetric and clinical management characteristics were estimated in hierarchical Poisson regression models. Results: Out of 4,606 postpartum women, 49.5% (95%CI 46.1;42.9) self-reported perineal laceration. Being an adolescent (PR = 1.12; 95%CI 1.02;1.25), primipara (PR = 1.47; 95%CI 1.33;1.63), having had excessive gestational weight gain (PR = 1.17; 95%CI 1.07;1.29) and having undergone the Kristeller maneuver (PR = 1.18; 95%CI 1.08;1.29) increased the proportion of the outcome. Conclusion: The results found call for prenatal care and adjustments to childbirth care so as to be in accordance with current recommendations.

Background: Midwives can play a pivotal role in promoting natural birth experiences. However, limited information is available about Jordanian laboring women’s experiences of natural childbirth guided by midwives. Understanding women’s experiences of natural birth can inform healthcare providers and policymakers to improve the care provided for laboring women. Purpose: This study aims to explore women's experiences of natural childbirth in a midwife-led care unit. Methods: A qualitative descriptive approach guided the study protocol. Data were collected through in-depth, semi-structured telephone interviews with 10 Jordanian women who experienced natural childbirth in a midwife-led care unit. Results: Two main themes emerged: “The journey of empowerment “and “Being prepared for natural childbirth". The first theme consisted of two sub-themes: Making an informed decision and being supported. The second theme consisted of three subthemes: The power of the place, being satisfied with natural childbirth practices, and feeling relieved. Conclusion: Women had positive childbirth experiences shaped by having autonomy in decision-making, perceived support, and being satisfied with the midwife-led care unit. Women’s positive experiences emphasize the need for social and political change to promote natural childbirth. Implications for Nursing: This paper provides evidence that supports the incorporation of midwife-led units to promote natural childbirth. New data will play a critical role in strengthening the responsibilities of nurses and midwives by raising public awareness and calling for policy changes to promote natural childbirth.

Background: Childbirth is a completely natural event; however, when the life of the mother or child is in danger, a cesarean section is performed. Due to the lack of awareness of the complications of cesarean section, we are faced with an exponential increase in cesarean; therefore, this research aims to compare the effect of education based on the theory of planned behavior with the routine method on the intention to choose the method of childbirth in women referred to comprehensive health service centers in Mashhad, Iran. Methods: The present study was a field trial that was conducted on 76 pregnant women in 2022. People were selected by two-stage random cluster sampling method and randomly divided into two groups (intervention and control). Data were collected using a demographic and fertility questionnaire and a valid and reliable questionnaire related to the construct of the theory of planned behavior for both intervention and control groups in three stages, before, immediately, and one month after the intervention. The training program for the intervention group was given to people based on the theory of planned behavior in 6 sessions and the control group received routine training. The data were analyzed using Kolmogorov-Smirnov, Mann-Whitney, chi-square, Fisher's exact, and generalized estimating equations (GEE) model statistical tests. Findings: In this study, the two groups were homogeneous in terms of demographic and fertility variables. The results of the GEE model showed that the average score of the variables of awareness, attitude, perceived behavioral control, subjective norm, and behavioral intention immediately and one month after the intervention was significantly higher in the intervention group than in the control group (P < 0.05). Conclusion: The intervention by the theory of planned behavior has an effect on the choice of natural delivery method; therefore, it is recommended to use these trainings along with pregnancy care in order to reduce caesarean section.

Abstract Background Pregnant women experience several changes in their appearance, body shape and body image. In some studies, there has been a relationship between these changes and the type of delivery. This study aimed to investigate the relationship of the prenatal body image and genital image with the mode of delivery preferred by pregnant women in Gorgan in 2020. Methods In this cross-sectional study, 334 pregnant women were selected by stratified sampling. The Prenatal Body Image Questionnaire (PBIQ), Female Genital Self-Image Scale (FGSIS), pregnant women’s preferences for mode of delivery questionnaire (PPMDQ) and DASS-21 were completed on line. The data was analyzed using Spearman test and linear regression. Results The average score of PBIQ, FGSIS, and PPMDQ was 68.24 (standard deviation = 17.71), 19.25 (standard deviation = 3.3), and 63.12 (standard deviation = 3.3) respectively. Vaginal delivery as a preferred mode of delivery was inversely correlated with dissatisfaction with body image (r=-0.32, P

Abstract Background The increasing demand for childbirth care based on physiological principles has led official bodies to encourage health centers to provide evidence-based care aimed at promoting women’s participation in informed decision-making and avoiding excessive medical intervention during childbirth. One of the goals is to reduce pain and find alternative measures to epidural anesthesia to enhance women’s autonomy and well-being during childbirth. Currently, water immersion is used as a non-pharmacological method for pain relief. This review aimed to identify and synthesize evidence on women’s and midwives’ experiences, values, and preferences regarding water immersion during childbirth. Methods A systematic review and thematic synthesis of qualitative evidence were conducted. Databases were searched and references were checked according to specific criteria. Studies that used qualitative data collection and analysis methods to examine the opinions of women or midwives in the hospital setting were included. Non-qualitative studies, mixed-methods studies that did not separately report qualitative results, and studies in languages other than English or Spanish were excluded. The Critical Appraisal Skills Program Qualitative Research Checklist was used to assess study quality, and results were synthesized using thematic synthesis. Results Thirteen studies met the inclusion criteria and were included in this review. The qualitative studies yielded three key themes: 1) reasons identified by women and midwives for choosing a water birth, 2) benefits experienced in water births, and 3) barriers and facilitators of water immersion during childbirth. Conclusions The evidence from qualitative studies indicates that women report benefits associated with water birth. From the perspective of midwives, ensuring safe water births requires adequate resources, midwives training, and rigorous standardized protocols to ensure that all pregnant women can safely opt for water immersion during childbirth with satisfactory results.

ABSTRACT OBJECTIVE To descriptively analyze Brazilian parturient women who underwent previous cesarean section and point out the factors associated with Vaginal Birth After Cesarean (VBAC) in Brazil. METHODS The study used data from women with one, two, or three or more cesarean sections from the survey Nascer no Brasil (Birth in Brazil). Differences between categories were assessed through the chi-square test (χ2). Variables with significant differences (p < 0.05) were incorporated into logistic regression. FINDINGS Out of the total of 23,894 women, 20.9% had undergone a previous cesarean section. The majority (85.1%) underwent another cesarean section, with 75.5% occurring before the onset of labor. The rate of Vaginal Birth After Cesarean (VBAC) was 14.9%, with a success rate of 60.8%. Women who underwent three or more cesarean sections displayed greater social vulnerability. The chances of VBAC were higher among those who opted for a vaginal birth towards the end of gestation, had a prior vaginal birth, underwent labor induction, were admitted with over 4 centimeters of dilation, and without partner. Receiving care from the private health care system, having two or more prior cesarean sections, obstetric complications, and deciding on cesarean delivery late in gestation reduced the chances of VBAC. Age group, educational background, prenatal care adequacy, and the reason for the previous cesarean section did not result in significant differences. CONCLUSION The majority of women who underwent a previous cesarean section in Brazil are directed towards another surgery, and a higher number of cesarean sections is linked to greater social inequality. Factors associated with VBAC included choosing vaginal birth towards the end of gestation, having had a previous vaginal birth, higher cervical dilation upon admission, induction, assistance from the public health care system, absence of obstetric complications, and without a partner. Efforts to promote VBAC are necessary to reduce overall cesarean rates and their repercussions on maternal and child health.

Lysinuric protein intolerance (LPI) is a rare inborn error of metabolism (IEM), classified as an inherited aminoaciduria, caused by mutations in the SLC7A7 gene, leading to a defective cationic amino acid transport. The metabolic adaptations to the demands of pregnancy and delivery cause significant physiological stress, so those patients affected by IEM are at greater risk of decompensation. A 28-year-old woman with LPI had experienced 3 early miscarriages. While pregnancy was finally achieved, diverse nutritional and medical challenges emerged (food aversion, intrauterine growth restriction, bleeding risk, and preeclampsia suspicion), which put both the mother and the fetus at risk. Moreover, the patient requested a natural childbirth (epidural-free, delayed cord clamping). Although the existence of multiple safety concerns rejected this approach at first, the application of novel strategies made a successful delivery possible. This case reinforces that the woman's wish for a non-medicated, low-intervention natural birth should not be automatically discouraged because of an underlying complex metabolic condition. Achieving a successful pregnancy is conceivable thanks to the cooperation of interdisciplinary teams, but it is still important to consider the risks beforehand in order to be prepared for possible additional complications. [ABSTRACT FROM AUTHOR]

Objective: Nowadays, the presence of husbands during the childbirth process is regarded as an important factor that can contribute to lower rate of the C-section, better success of physiologic delivery and higher satisfaction in childbirth experience. Considering the special sociocultural characteristics of the Iranian society, this method requires accurate assessment to be practical and effective. The aim of this research was finding out how husbands perceive the environmental and physical characteristics of delivery spaces via studying these physical characteristics, exploring them through husbands' perception and finally discovering the mechanism behind formation of this perception. Materials and methods: First, the conceptual model of the study was developed after a review of the physiologic childbirth literature. Then, a research questionnaire was designed and distributed among 120 husbands who recently had the experience of accompanying their wives during physiologic childbirth. Results: The results showed that light, color and temperature play a significant role in husbands' perception of delivery spaces under the special psychological conditions and stress that they experience during the childbirth. Designer should pay due attention to these three factors when designing the structure of childbirth spaces. Conclusion: Promoting the environmental quality of the physiologic delivery room based on husband's perception can help mothers and medical staff better manage childbirth pain which is an integral part of natural childbirths. [ABSTRACT FROM AUTHOR]

Introduction: Self-efficacy during pregnancy is a self-assessment of one's ability to manage stress and perform important behaviors, especially in coping with pain. Women who benefit from the support of others during pregnancy feel more self efficacious. The studies show that involving family members in education, support or presence during pregnancy has contradictory consequences. This study was therefore conducted with the aim of determining the effect of an accompanying training programme based on Bandura's theory on the mother's self-efficacy during childbirth. Material & Methods: This RCT was conducted on 60 primiparous mothers between 20 and 23 weeks of gestation who were admitted to Umm al-Banin Hospital in Mashhad and were randomly assigned to two intervention and control groups. The control group received 8 sessions of 90 minutes of oral and practical training. In addition to these sessions, training sessions based on Bandura's theory were held for the intervention group, including two sessions of companions and pregnant mothers together and two sessions alone. A demographic questionnaire and a Childbirth Self Efficacy Inventory (CBSEI, Lowe, 1993) were completed by both groups before and immediately after the training. Data were analyzed using independent t-tests, paired t tests, Mann-Whitney and Wilcoxon in SPSS 16 software. A significance level of less than 0.05 was considered. Findings: The average age of the mothers in the intervention group was 26.7±8.3 years and in the control group 28.3±5.9 years. In most cases, the mother 's companion was her sister (73.3%). Before the training, the mean value of self-efficacy was 82.5±22.3 in the intervention group and 87.5±32.4 in the control group (P = 0.492, independent t-test). After the training, the mean value of self-efficacy was 132.4±18.5 in the intervention group and 115.2±26.4 in the control group (P=0.006, Mann-Whitney test). Self-efficacy after the intervention compared to before increased by 49.9±31.3 in the intervention group and by 27.7±29.5 in the control group (P=0.007, Mann-Whitney test). In intragroup comparison, the difference between the intervention group after and before the training was significant (P<0.001, Wilcoxon test). The difference between before and after the training was also significant in the control group (P<0.001, paired t-test). Discussion & Conclusion: Companion training based on Bandura's theory has an effect on the self-efficacy of pregnant women during childbirth and is recommended as a training method for childbirth preparation. [ABSTRACT FROM AUTHOR]

Background: Postpartum hemorrhage, anemia, and iron deficiency are important health problems. Using safe, cheap, and available methods to reduce the amount of hemorrhage after childbirth can be effective for the mother's health during this period. Therefore, this study was conducted to determine the effect of date fruit consumption on the amount of hemorrhage after natural childbirth. Methods: This randomized clinical trial was conducted on 98 women referred to the maternity ward of Al-Zahra Hospital in Rasht using the available sampling method. The primary outcome was postpartum hemorrhage, measured using the Pictorial Blood Loss Assessment Chart (PBLAC). Two hours after delivery, 100 g of date fruits were given to the intervention group, and the amount of hemorrhage was recorded during the first 24 h. Comparison between the two groups was done with the Mann–Whitney test with the Hodges–Lehmann estimator and corresponding exact conditional nonparametric confidence interval (CI) as effect estimate. A P < 0.05 was considered significant. Results: The median of postpartum hemorrhage after normal delivery in the date and control groups was 35.0 [interquartile range (IQR): 22.0 to 39.8] and 39.0 [IQR: 27.5 to 64.5], respectively. Using the Hodges–Lehmann estimator, on average, the median postpartum hemorrhage in the date group was 9.0 (95% CI: 2.00–18.0) units lower than the control group (P = 0.009). Conclusion: Consumption of dates effectively reduces the amount of hemorrhage after natural childbirth; thus, consuming this fruit during postpartum period is recommended. Also to confirm the findings, it is recommended to conduct similar studies in this field. Trial registration: This trial was registered with the Iranian Registry of Clinical Trials; https://www.irct.ir/trial/59197 (IRCT20210607051505N2) on 31/10/2021. [ABSTRACT FROM AUTHOR]

Abstract Background To assess the relationship between infant birthweight and pelvic floor muscle (PFM) strength in China. Methods We performed a retrospective, single-center cohort study of 1575 women delivering vaginally between January 2017 and May 2020. All participants completed pelvic floor examinations within 5–10 weeks after delivery and were evaluated for PFM strength, which was estimated by vaginal pressure. Data were collected from electronic records. We evaluated the association between infant birthweight and vaginal pressure through multivariable-adjusted linear regression analysis. We also performed subgroup analyses stratified by potential confounders. Results Vaginal pressure decreased as the quartile of birthweight increased (P for trend

Background: In Iran, the Natural Childbirth Promotion Program (NCPP) has been implemented as acomponent of the Health Transformation Plan (HTP) since 2014 and as an attempt to encourage naturalchildbirth practices and reduce cesarean section rates. The purpose of this qualitative study was toexplore the perceptions of midwives about conditions influencing the implementation of NCPP.Methods: In this qualitative study, data were collected through 21 in-depth semi-structured individualinterviews with expert midwives who were selected using purposive sampling mainly from one medicaluniversity in Eastern Iran from October 2019 to February 2020. Based on the framework method asa thematic analysis approach, the data were analyzed manually. To enhance the rigor of the study, wefollowed Lincoln and Guba’s criteria.Results: Data analysis yielded 546 open codes. After the codes were reviewed and similar codeswere removed, there remained 195 codes. Further analysis led to extraction of 81 sub-sub themes,19 sub-themes, and eight main themes. These themes included: Responsive staff; Characteristicsof the parturient; Recognition of midwifery role; Teamwork; The birthing environment; Effectivemanagement; Institutional and social context; and Social education.Conclusion: Based on the perceptions of the studied midwives, the success of the NCPP is guaranteedby a set of conditions identified in this study. In practice, these conditions are complementary andinterrelated, and they cover a wide range of staff and parturient characteristics to the social context. Itseems that effective implementation of the NCPP also calls for the accountability of all stakeholders,from policymakers to maternity care providers.

Objective·To evaluate the effect of pelvic floor muscle training (Kegel training) on the rehabilitation of pelvic floor function within 1 year after delivery.Methods·From January to April 2020, primiparas with different degrees of urinary incontinence or pelvic organ prolapse were selected and divided into exercise group (147 cases) and control group (194 cases). The exercise group received Kegel training at 6 weeks of the postpartum period, while the control group received general postpartum health education only. At 6 weeks and 1 year after delivery, these postpartum women in the two groups were investigated with the general information questionnaire and International Consultation Incontinence Questionnaire-UI Short Form (ICIQ-SF). The pelvic floor muscle strength was measured (the pelvic floor muscle strength grade>Ⅲ indicates normal muscle strength). The pelvic organ prolapsed quantitation (POP-Q) score was assigned accordingly. The urinary incontinence score, pelvic floor muscle strength and pelvic floor organ prolapse were compared between the two groups, and the effect of pelvic floor muscle training was evaluated.Results·In the exercise group, 20 postpartum women lost contact during follow up sections, and 28 women in the control group were unable to be contacted within 1 year. In the exercise group, the proportion of women with normal pelvic floor muscle strength at 1 year postpartum was significantly higher than that at 6 weeks postpartum (56.0% vs 34.7%, P=0.000), and the incidence of incontinence at 1 year postpartum was significantly lower than that at 6 weeks postpartum (25.2% vs 36.7%, P=0.040). In the control group, the proportion of women with normal pelvic floor muscle strength at 1 year postpartum was significantly higher than that at 6 weeks postpartum (43.4% vs 32.5%, P=0.033), and the incidence of incontinence at 1 year postpartum was significantly lower than that at 6 weeks postpartum (17.5% vs 28.9%, P=0.011). At 1 year postpartum, the proportion of women with normal pelvic floor muscle strength in the exercise group was higher than that in the control group (56.0% vs 43.4%, P=0.033). The improvement rate of muscle strength in the exercise group was higher than that in control group (50.4% vs 35.5%, P=0.011). There was no significant difference in the improvement rate of pelvic organ prolapse and frequency of urinary incontinence between the exercise group and the control group (P>0.05).Conclusion·Postpartum pelvic floor muscle training can improve pelvic floor muscle strength, but has no significant effect on improving pelvic floor dysfunction in the current samples. The urinary incontinence condition and pelvic floor muscle strength of women improve 1 year after delivery, indicating that there is a mechanism for self recovery of pelvic floor muscle, but it may take a long time.

Objectives: To analyze the factors associated with mode of delivery in puerperal women assisted by Primary Health Care in a municipality in the north of Minas Gerais. Methods: This is a cross-sectional study, conducted with 188 puerperal women in the city of Montes Claros, state of Minas Gerais, Brazil. Data were obtained with a structured questionnaire about the sociodemographic profile and obstetric history. Descriptive analysis was performed and, for the analysis of factors associated with the mode of delivery, the Pearson’s chi-square test was used. Results: The prevalence of vaginal deliveries was 56.4% (n=106) and 43.6% (n=82) of cesarean sections. Of the 82 (43.6%) women who were subjected to cesarean section, the main reasons for cesarean section reported by the puerperal women were: cephalopelvic disproportion (40.2%; n=33), elevated blood pressure levels (13.4%; n=11), and previous cesarean section (12.2%; n=10). A significant association was found between choice of cesarean delivery and higher maternal age (p=0.031), skin color (p=0.045), high income (p=0.015), and public financing of delivery (p=0.041). Conclusion: Vaginal route prevailed among puerperal women, but a high prevalence of cesarean sections was observed, which showed that higher maternal age, skin color, high income, and public financing of childbirth influence the mode of delivery. The information obtained in this study can be used to improve the assistance to pregnant women and puerperal women, especially in pregnant women more susceptible to unnecessary cesarean sections.

ABSTRACT Objective: To assess the repercussions of SARS-CoV-2 infection (suspected or confirmed) and the context of the pandemic on the birth route and humanized assistance during childbirth. Method: Cross-sectional epidemiological study, nested within a cohort and comparative with the research “Birth in Belo Horizonte: Survey on Childbirth and Delivery”.The medical records of three reference maternity hospitals in Belo Horizonte were assessed, with a final sample of 1,682 pregnant women, in the months of May, June and July 2020. A descriptive analysis was carried out, with absolute and relative frequency, and a comparative one, with a Pearson’s chi-square test. Results: It was observed that 2.02% of pregnant women were infected with SARS-CoV-2.Before the pandemic, out of a total of 390 pregnant women, 74.10% gave birth vaginally.During a pandemic, among infected women, 51.61% gave birth via cesarean section and 48,39% via vaginal delivery;among uninfected, 26.99% cesarean sections and 73.01% vaginaldeliveries. Conclusion: There was an increase in the percentage of cesarean sections and a possible influence of the pandemic on the rates of indication of cesarean sections at the time of admission to the maternity ward.

Background: Pregnant women experience several changes in their appearance, body shape and body image. In some studies, there has been a relationship between these changes and the type of delivery. This study aimed to investigate the relationship of the prenatal body image and genital image with the mode of delivery preferred by pregnant women in Gorgan in 2020. Methods: In this cross-sectional study, 334 pregnant women were selected by stratified sampling. The Prenatal Body Image Questionnaire (PBIQ), Female Genital Self-Image Scale (FGSIS), pregnant women's preferences for mode of delivery questionnaire (PPMDQ) and DASS-21 were completed on line. The data was analyzed using Spearman test and linear regression. Results: The average score of PBIQ, FGSIS, and PPMDQ was 68.24 (standard deviation = 17.71), 19.25 (standard deviation = 3.3), and 63.12 (standard deviation = 3.3) respectively. Vaginal delivery as a preferred mode of delivery was inversely correlated with dissatisfaction with body image (r=-0.32, P < 0.001), and directly correlated with satisfaction with the genital image (r = 0.19, P < 0.001). There was a significant inverse correlation between prenatal body image dissatisfaction and genital image satisfaction (r=-0.32, P < 0.001). While FGSIS score could not predict PPMDQ, PBIQ score could. Conclusions: Satisfaction with the prenatal body image or genital image is associated with the choice of vaginal delivery. These results can be the basis for prenatal care and childbirth counselling. [ABSTRACT FROM AUTHOR]

Copyright of Revista Ciência & Saúde Coletiva is the property of Associacao Brasileira de Pos-Graduacao em Saude Coletiva and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Introduction: Global reimbursement is a hospital payment method. In some global surgeries, the billing cost of treatment differs from the tariff set by the Supreme Council of Insurance, leading to financial losses for hospitals or insurance companies. This study compares the billing costs of childbirth services with the approved tariffs. Methods: This descriptive-analytical study examined the billing costs of all childbirth cases (natural and cesarean section) covered by health insurance at three specialized maternity hospitals (A, B, C) in Tehran province in 1400. Data were sourced from health insurance company dashboards, compiled in Excel, and analyzed using SPSS software. Results: The study evaluated 3,742 childbirth cases, with 35% being natural births and 65% cesarean sections. The comparison between billing costs and approved tariffs showed that Hospital A's costs for both natural and cesarean childbirths exceeded the set tariffs. However, the billing costs in the other two hospitals were below the approved tariffs. Additionally, the actual hospitalization days for cesarean sections were shorter than those covered by the tariff in all three hospitals. Conclusion: This study highlights variations in childbirth billing costs compared to the approved global tariffs across different hospitals. These findings underline the necessity of cost control in hospitals and suggest a need to revise the approved tariffs to align with the actual hospitalization duration for patients. [ABSTRACT FROM AUTHOR]

Copyright of Revista de Derecho y Genoma Humano is the property of Dykinson SL and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)