Identification of maternal characteristics associated with the use of epidural analgesia
ABSTRACT The present survey aims to identify predictors associated with the use of epidural analgesia (EA). Therefore, from October 2007 to June 2008, a survey was conducted in 193 pregnant women (mean age 31.7 years (SD 4.9); 64.8% primipara) attending a German general hospital with a specialisation in integrative medicine. Questionnaires, including Antonovsky's sense of coherence (SOC) were delivered antepartum. Delivery data were recorded within the hospital quality management programme. The adjusted odds ratio (OR) for EA use was significantly greater than one for women who had previously used EA (adjusted OR =4.1; CI: 1.03-16.31) and for the desire for a delivery without pain (adjusted OR =3.05; CI: 1.36-6.83). The likelihood of EA use decreased in multipara (adjusted OR =0.05; CI: 0.01-0.22). SOC was not found to be an independent predictor for EA use. However, women with high SOC more often preferred a delivery without EA (p for trend =0.037). In conclusion, first time labour, the desire for a delivery without pain and previous use of EA are independent predictors for the use of EA in labour. Further studies should clarify the predictive role of SOC in pregnancy.
- SourceAvailable from: Sally Louise Ferguson
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- "Unlike Borrmann et al. (2002) this study found a pregnant woman's SOC was unrelated to planned place of birth with women with higher SOC scores being no more likely to plan a birth in a primary setting than women with lower SOC scores. Unlike other studies this study did not find that SOC was related to gestation (Sjostrom et al., 2004), parity (Sjostrom et al., 2004) or a desire to avoid epidural anaesthesia in labour (Jeschke et al., 2012). "
ABSTRACT: as concern for increasing rates of caesarean section and interventions in childbirth in Western countries mounts, the utility of the risk approach (inherent in the biomedical model of maternity care) is called into question. The theory of salutogenesis offers an alternative as it focuses on the causes of health rather than the causes of illness. Sense of coherence (SOC), the cornerstone of salutogenic theory, is a predictive indicator of health. We hypothesised that there is a relationship between a woman׳s SOC and the childbirth choices she makes in pregnancy. the study aims to investigate the relationship between SOC and women׳s pregnancy and anticipated labour choices. A cross sectional survey was conducted where eligible women completed a questionnaire that provided information on SOC scores, Edinburgh Postnatal Depression (EPDS) scores, Support Behaviour Inventory (SBI) scores, pregnancy choices and demographics. 1074 pregnant women completed the study. Compared to women with low SOC, women with high SOC were older, were less likely to identify pregnancy conditions, had lower EPDS scores and higher SBI scores. SOC was not associated with women׳s pregnancy choices. this study relates SOC to physical and emotional health in pregnancy as women with high SOC were less likely to identify pregnancy conditions, had less depressive symptoms and perceived higher levels of support compared to women with low SOC. Interestingly, SOC was not associated with pregnancy choices known to increase normal birth rates. More research is required to explore the relationship between SOC and women׳s birthing outcomes. Copyright © 2015 Elsevier Ltd. All rights reserved.Midwifery 07/2015; DOI:10.1016/j.midw.2015.07.012 · 1.57 Impact Factor
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- "There is considerable recent empirical evidence on factors associated with some of the individual elements of normal birth: determinants of type of onset of labour (Humphrey and Tucker, 2009), mode of birth (Coonrod et al., 2008), use of epidural analgesia (Jeschke et al., 2012), and use of episiotomy (Robinson et al., 2000; Allen and Hanson, 2005; Ogunyemi et al., 2006; Gossett and Dunsmoor-Su, 2008). Altogether, these studies provide consistent evidence that the determinants of various individual elements of normal birth are multifactorial and include parity, insurance status, care provider characteristics (e.g., discipline, experience), hospital characteristics (e.g., percentage of publicly-funded births, availability of in-house medical specialists), and the presence of maternal medical conditions such as diabetes and pre-eclampsia (Robinson et al., 2000; Allen and Hanson, 2005; Ogunyemi et al., 2006; Coonrod et al., 2008; Gossett and Dunsmoor-Su, 2008; Humphrey and Tucker, 2009; Jeschke et al., 2012). There is less consistent evidence for maternal age as a determinant of individual elements of normal birth, no evidence for the influence of some suggested care practices (i.e., ensuring mobility) and no research examining determinants of normal birth as a multidimensional construct that can be aligned with population targets for increasing 'normal birth' when evaluating policy initiatives. "
ABSTRACT: Background: currently, care providers and policy-makers internationally are working to promote normal birth. In Australia, such initiatives are being implemented without any evidence of the prevalence or determinants of normal birth as a multidimensional construct. This study aimed to better understand the determinants of normal birth (defined as without induction of labour, epidural/spinal/general anaesthesia, forceps/vacuum, caesarean birth, or episiotomy) using secondary analyses of data from a population survey of women in Queensland, Australia. Methods: women who birthed in Queensland during a two-week period in 2009 were mailed a survey approximately three months after birth. Women (n=772) provided retrospective data on their pregnancy, labour and birth preferences and experiences, socio-demographic characteristics, and reproductive history. A series of logistic regressions were conducted to determine factors associated with having labour, having a vaginal birth, and having a normal birth. Findings: overall, 81.9% of women had labour, 66.4% had a vaginal birth, and 29.6% had a normal birth. After adjusting for other significant factors, women had significantly higher odds of having labour if they birthed in a public hospital and had a pre-existing preference for a vaginal birth. Of women who had labour, 80.8% had a vaginal birth. Women who had labour had significantly higher odds of having a vaginal birth if they attended antenatal classes, did not have continuous fetal monitoring, felt able to 'take their time' in labour, and had a pre-existing preference for a vaginal birth. Of women who had a vaginal birth, 44.7% had a normal birth. Women who had a vaginal birth had significantly higher odds of having a normal birth if they birthed in a public hospital, birthed outside regular business hours, had mobility in labour, did not have continuous fetal monitoring, and were non-supine during birth. Conclusions: these findings provide a strong foundation on which to base resources aimed at increasing informed decision-making for maternity care consumers, providers, and policy-makers alike. Research to evaluate the impact of modifying key clinical practices (e.g., supporting women׳s mobility during labour, facilitating non-supine positioning during birth) on the likelihood of a normal birth is an important next step.Midwifery 04/2015; 31(8). DOI:10.1016/j.midw.2015.04.005 · 1.57 Impact Factor
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- "Research shows that many women consider pain during labour as meaningful and that they get strength and power that brings them closer to the baby (Lundgren and Dahlberg, 1998; Cipolletta and Balasso, 2011). Women with a strong SOC more often prefer childbirth without epidural analgesia (Jeschke et al., 2012). Peterson (1997) explains that a positive birth experience depends on the woman's ability to apply her coping strategies, whereas Cipolletta and Balasso (2011) argue that women's satisfaction with birth is related to the feeling of controlling the pain. "
ABSTRACT: the aim of this study is to gain a deeper understanding of a woman׳s internal factors and factors in her environment that are important for a normal birth and a positive birth experience. a qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Twelve healthy first time Norwegian mothers, aged 22-34, with a normal childbirth and a positive birth experience were interviewed five to six weeks after giving birth. All participants had given birth at a maternity unit, where 4000 births take place per year. The transcribed interviews were analysed through systematic text condensation. the findings included two main themes: safe environment and emotional strength. Stability in everyday life and close relationships provided the women with the safe environment they needed. The women had a positive attitude to childbirth and they had all previously developed coping strategies. They highlighted that these acquired coping strategies contributed to higher emotional strength and a positive birth experience. the women experienced that a safe environment and network contributed to a sense of trust and emotional strength, which were positive factors promoting a normal birth and a positive birth experience. The women had a positive attitude towards the birth and used acquired coping strategies to deal with it, which in turn led to a positive birth experience. The natural vision the women had in connection with childbirth was part of their antenatal preparation, which also contributed to a positive experience of childbirth. Copyright © 2015 Elsevier Ltd. All rights reserved.Midwifery 04/2015; 31(7). DOI:10.1016/j.midw.2015.03.016 · 1.57 Impact Factor