Due 12/2

Author/Date

Seemole Eniffer Matabane, Maurine Rofhiwa Musie, and Mavis Fhumulani Mulaudzi

2024

Theoretical/Conceptual Framework

There is no map, this is appropriate because the study was conducted with questionnaires intended to evaluate the knowledge level of pregnant women. The premise of the study is that theoretically, most pregnant women are unaware of or do not receive complete information about possible interventions during childbirth and throughout different stages of labor.

Research Question/PICOT

P – pregnant women

I – knowledge of using non-pharmacological pain relief

C – lack of knowledge about using non-pharmacological pain relief

O – determine if pregnant women are aware of non-pharmacological pain relief methods

T – no time frame

What percentage of pregnant women are aware of the options regarding non-pharmacological pain relief methods during childbirth?

Methodology

This study was conducted across four hospitals in South Africa and consisted of 384 women. The individuals with history of a caesarean delivery or experienced stillbirth/early neonatal death were excluded. Study participants filled out a questionnaire consisting of yes/no/not sure questions along with questions requiring written responses. Responses were collected and sent to a statistician for analysis. Participants in this study were informed that their participation was voluntary and were invited to participate after receiving informed consent.

Analysis & Results

The study results indicate most women have never been educated on non-pharmacological methods for pain relief (52.1%). Only about 33% of women said they would opt to use these methods and around 32% were unsure if they would utilize them. The methods questioned were hydrotherapy, aromatherapy, music therapy, breathing exercises, acupuncture, application of heat/cold, transcutaneous electrical nerve stimulation, movement, and birthing positions. 60% said they have never heard of or had been educated on any of the above interventions. Overall, pregnant women expect more education during antenatal visits, it is impossible to utilize the methods if participants don’t know they exist.

Conclusions

Many women are uneducated on the option for non-pharmacological pain relief. Some women may use these options, some are unsure, and some know they would not. There should be more effort put into educating women about these methods.

Implications for future research

A big implication this has on future research is to determine if these numbers are true across the world and if so, why these results are true. This study could also lead to determining if there is a correlation between satisfaction during the labor process with more autonomy in controlling pain.

Implication for practice

It is important for nurses, doctors, midwives, and anyone else involved in the care of laboring mothers to inform them of all their options. This study shows that is not currently happening. Moving forward, there should be a stronger push to educate patients on all their options regarding pain management. While it remains probable pharmacologic interventions will be utilized, the use of non-pharmacologic interventions may lower the amounts used and increase satisfaction with labor experience.

Relevance to your PICOT/Capstone Project

This study addresses the lack of teaching about non-pharmacologic pain relief options for those in labor. It was found that 52.1% of the patients in this study had never been informed of non-pharmacologic pain management options. Massage and hydrotherapy were the most recommended options at 35% and 31% respectively.

Author/Date

Parivash Ahmadpour, Sakineh Mohammad-Alizadeh-Charandabi, Rana Doosti, Mojgan Mirghafourvand

2021

Theoretical/Conceptual Framework

Key concepts were adequately defined as utilizing a peanut ball in place of a traditional birth ball for women with epidural analgesia to keep their pelvis open and aid in moving baby down. There was no map, but the lack of use is justified. The theoretical framework for this study is that using a peanut ball will reduce the length of labor and increase vaginal delivery.

Research Question/PICOT

P – laboring mothers

I – use of a peanut ball

C – not using a peanut ball

O – duration of the stages of labor and frequency of caesarean section

T – no time limit

What is the effectiveness of a peanut ball on the duration of the stages of labor and frequency of caesarean section.

Methodology

Electronic research was carried out with no time limit. This study used a GRADE approach to assess statistical confidence of data. [GRADE: grading of recommendations assessment, development and evaluation]. The study pulled information from other studies in English and Persian records with peanut ball use during labor while excluding studies on multiple pregnancies. Two of the authors assessed each study to be included individually and had discussions on whether to include it in this study. If there was a stalemate the authors pulled in another individual to settle the decision.

Analysis & Results

Of 89 possible articles, only 6 studies included in meta-analysis and participants were split into use of peanut ball and no use of peanut ball. It was found that during the first stage of labor, those using a peanut ball had a non-statistically significant reduction in the length of the first stage of labor. Those using a peanut ball had a shorter second stage of labor. There was no significant difference in those who eventually needed a caesarean section versus those who did not. Of the six studies, four had low risk of bias while two had high risk.

Conclusions

This study had no findings regarding statistically significant effect on either the stage of labor or the frequency of caesarean section, also suggests further studies are required.

Implications for future research

This study implies there needs to be more research done on this topic. The sample size was small and pulled information from a multitude of different studies with different objectives. This topic should be further studied to determine if the use of peanut balls in conjunction with other interventions during labor will decrease the duration of labor and overall caesarean section rate.

Implication for practice

The use of peanut balls may be implemented in labor for women who undergo epidural anesthesia. Their use will maintain an open pelvis in a safe and comfortable position without the added risk that a typical birthing ball would include. There are other variables that go into a patient needing a caesarean or not, the main use of peanut balls should be to progress labor.

Relevance to your PICOT/Capstone Project

This article addresses alternative methods of progressing labor without pharmacological interventions. The use of pharmacologic interventions was lower in the group using peanut balls.

Author/Date

Monirolsadte Hosseini Tabaghdehi, Afsaneh Keramat, Sakineh Kolahdozan, Zohreh Shahhosseini, Mahmood Moosazadeh, Zahra Motaghi

2020

Theoretical/Conceptual Framework

There is no map but that is appropriate, there were only 10 participants, and they were interviewed regarding their experience with childbirth. The idea behind this study is increased communication, self-efficacy, self-esteem, and maternal/infant attachment will positively affect the childbirth experience.

Research Question/PICOT

P – postnatal mothers

I – empowerment and control

C – n/a

O – positive childbirth experience

T – from 72 hours to 2 months after birth

Do women with positive birthing experiences have higher levels of self-esteem, self-efficacy, and cooperation within their support circle?

Methodology

This is a smaller qualitative study completed on 10 women with a positive childbirth experience and healthy outcomes. These women were interviewed between 72 hours and 2 months after birth with questions that were guided by interviewees responses to general questions. Ethical approval was granted and the participants were provided informed consent.

Analysis & Results

It was found that the more a mother participated in her labor experience, the more positive her feelings towards birth were. Women also felt more empowered and confident if they were familiarized with the environment prior to birth. Women use different methods to cope with pain and have differing levels of support which influences positive feelings towards birthing experiences. Childbirth empowered these women and made them proud of themselves, making them want to vaginally deliver again in the future.

Conclusions

Women who feel empowered experience more positive factors, however this requires participation form the mother’s support network from family to healthcare.

Implications for future research

This study leaves room for further research on this topic. As it is so small, it is hard to dictate any statistically significant methods. Moving forward, this study should be conducted on a larger scale and a generalized list of questions instead of allowing the conversation to flow naturally. The results would be stronger and more specific research can be conducted.

Implication for practice

This study begins to show how important education is in childbirth. Allowing women to make their own choices and guide their own laboring process after being fully educated leads to more positive outcomes, higher natural birth rates, and an increased likelihood to have a subsequent child/vaginal birth.

Relevance to your PICOT/Capstone Project

This study identifies what makes a woman’s experience during labor more positive. This study explores areas such as empowerment and self-esteem. If pain is controlled well with alternative methods and a woman feels more empowered the two may combine to completely negate the need for pharmaceuticals.

Author/Date

Tommy Carlsson, Hanna Ulfsdottir

2020

Theoretical/Conceptual Framework

Waterbirth is a safe alternative for women because it has been shown there is no difference between neonatal outcomes for waterbirths or out of water births. There is no map. This is a qualitative study regarding education, benefits, and uncertainties about waterbirths. Theoretically, giving birth in water for low-risk pregnancies allows women to guide their own birth and use less pharmaceutical interventions.

Research Question/PICOT

P – laboring women

I – water birth

C – no water birth

O – was it a beneficial or negative experience

T – December 2015 – December 2018

Does giving birth in water provide a beneficial experience for women in labor and what negative aspects are involved in water births?

Methodology

A qualitative web-based, open-ended question survey was emailed to 155 women (111 of which who responded) from two separate birthing units in Sweden.

Analysis & Results

There were many findings from this study. Pain relief was provided due to buoyancy and one mother said after getting in the bathtub she did not require any other pain medication. Water enhanced the process and made labor smoother while also decreasing the risk for perineal tears. Psychologically, many enjoyed the experience and found it to be positive, relaxing, and calming. Mothers also enjoyed that it felt less clinical. There were negative experiences such as an inability to be intimate with their partner, lack of epidural analgesia use, it was embarrassing to sit in the dirty water, and lack of mobility. Not many women were educated about waterbirth even if they contacted the unit to ask clarifying questions.

Conclusions

There are physical and psychological benefits from giving birth in water, and there is room for improvement regarding education about the option to do so. This is a great option for those with low-risk pregnancies. Midwives should discuss this option in an antenatal setting to allow families to prepare and make educated decisions about their healthcare.

Implications for future research

Future research should focus on the availability and education surrounding waterbirths. Many labor suites are not equipped to provide any experience outside of laboring in the hospital bed. Education is lacking and studies should be done to determine why.

Implication for practice

This study indicates more midwives should be educating their patients on the option of giving birth in water. Many women were uninformed or had many questions surrounding the idea. Birthing mothers with low-risk pregnancies should be informed of not only the option, but deeper information such as how the child is caught, birthing positions, temperature, fetal monitoring, and water contamination.

Relevance to your PICOT/Capstone Project

A useful piece of this is Figure 1, it has a breakdown of positive benefits for multiple categories including pain relief, mobility, labor progression, relaxation, less medicated, and heightened control. This study discusses the effects on birthing in water.

Author/Date

Semra Tuncay, Sena Kaplan, Ozlem Moraloglu Tekin

2019

Theoretical/Conceptual Framework

The key concept of this study is that giving birth in water will speed up labor, decrease complications, and increase mother’s positive feelings towards baby quicker than not using water births. As opposed to pharmacological interventions which can increase the risk of adverse effects, waterbirths provide analgesic effects with fewer complication risks. There is a framework map leading us through the three stages of this study starting with eligibility assessment and leading into the experimental group versus the comparison group and finally the third stage where all the data is compared.

Research Question/PICOT

P – Women in labor

I – hydrotherapy during active labor

C – no hydrotherapy during active labor

O – what the effect on the labor process and parenting behavior is

T – November 2015 – June 2016

What is the effect on the labor process and parenting behavior when birthing mothers utilize hydrotherapy during active labor?

Methodology

A study of 80 participants between ages 18 and 35 with a gestational age of 37-42 weeks, low-risk pregnancy, with intact membranes, and no psychiatric health problems was conducted via face-to-face interview. A participant questionnaire, birth follow-up questionnaire, postpartum behavior scale, and labor agentry scale were utilized and the study was conducted in three phases. Ethical approval was obtained along with legal. Permission form hospital management. Informed verbal and written consent were provided.

Analysis & Results

Data was analyzed with statistical package for social sciences version 23.0, where type 1 error levels was less than 5% were deemed significant. Results showed a significant difference in overall blood pressure between participants in hydrotherapy versus those not. There was a difference in the stages of labor, the lower being those utilizing hydrotherapy. Those in the experimental group had a more positive attitude towards the infant and the labor process sooner.

Conclusions

Hydrotherapy can be effective in reducing pain and labor duration while improving mother-baby bond and provides a positive labor experience. It is suggested that hydrotherapy be used in more labor and delivery suites.

Implications for future research

This study is important for future research because it has proven statistically significant differences in hydrotherapy during birth versus not. This should be further researched with a larger and more differentiated population.

Implication for practice

The results of this study show that women should be educated on and provided the option to give birth in water. There are many benefits to mother and baby that should be explored in the hospital setting.

Relevance to your PICOT/Capstone Project

This article completely revolves around hydrotherapy use in labor.