First do no harm - interventions during labor and maternal satisfaction: a descriptive cross-sectional study

Abstract

BackgroundInterventions can be lifesaving when properly implemented but can also put the lives of both mother and child at risk by disrupting normal physiological childbirth when used indiscriminately without indications. Therefore, this study was performed to investigate the effect of frequent interventions during labor on maternal satisfaction and to provide evidence-based recommendations for labor management decisions.MethodsThe study was performed in descriptive design in a state hospital in Kars, Turkey with 351 pregnant women who were recruited from the delivery ward. The data were collected using three questionnaires: a survey form containing sociodemographic and obstetric characteristics, the Scale for Measuring Maternal Satisfaction in Vaginal Birth, and an intervention observation form.ResultsThe average satisfaction scores of the mothers giving birth in our study were found to be low, at 139.59 ± 29.02 (≥150.5 = high satisfaction level, < 150.5 = low satisfaction level). The percentages of the interventions that were carried out were as follows: 80.6%, enema; 22.2%, perineal shaving; 70.7%, induction; 95.4%, continuous EFM; 92.3%, listening to fetal heart sounds; 72.9%, vaginal examination (two-hourly); 31.9%, amniotomy; 31.3%, medication for pain control; 74.9%, intravenous fluids; 80.3%, restricting food/liquid intake; 54.7%, palpation of contractions on the fundus; 35.0%, restriction of movement; 99.1%, vaginal irrigation with chlorhexidine; 85.5%, using a “hands on” method; 68.9%, episiotomy; 74.6%, closed glottis pushing; 43.3%, fundal pressure; 55.3%, delayed umbilical cord clamping; 86.0%, delayed skin-to-skin contact; 60.1%, controlled cord traction; 68.9%, postpartum hemorrhage control; and 27.6%, uterine massage. The satisfaction levels of those who experienced the interventions of induction, EFM, restriction of movement, two-hourly vaginal examinations, intravenous fluid, fundal pressure, episiotomy, palpation of contractions on the fundus, closed glottis pushing, delayed umbilical cord clamping, delayed skin-to-skin contact, fluid/food restriction, and of those who were not provided pharmacological pain control were found to be lower (p < 0.05).ConclusionMedical interventions carried out at high rates had a negative impact on women’s childbirth experience. Therefore, a proper assessment in the light of medical evidence should be made before deciding that it is absolutely necessary to intervene in the birthing process and the interdisciplinary team should ensure that intrapartum caregivers will “first do no harm.”

Cross-cultural adaptation and psychometric evaluation of the Brazilian Portuguese version of the childbirth experience questionnaire

“…Other limitation of this study, referring participants' level of education, as most of them had tertiary education, which may not properly represent the general population of Brazil. According to census data from 2016, 51% of the population aged 25 and over had at most completed primary education and only 15.3% of the population had completed tertiary education [20].…”

“…Some specific cultural factors can influence maternal satisfaction. Çalik et al [20] report that women who had their labor induced and received no pain relief methods or had an episiotomy were less satisfied with their labor. Among the study population, only 39.3 and 16.9% of the participants received pain relief, including pharmacological or nonpharmacological methods, respectively.…”

Comparing Transperineal Ultrasonography and Vaginal Examination for Discomfort in Labor Follow-up

“…Therefore, we avoided enema, urinary catheter, frequent VE, fundal pressure, intravenous fluid, intravenous medicine, perineum shaving, induction, amniotomy, episiotomy, continuous electronic fetal monitoring, and food and beverage restrictions to reduce the rate of CD and health expenses. 16,17 The primary CD ratio of the study is below than Turkey's average primary CD ratio. This may be due to (i) the fact that the study was conducted in a low risk pregnancy group, (ii) a high literacy rate in Tunceli, (iii) active working of Tunceli pregnancy unit, and (iv) following maternal friendly childbirth practices and natural birth methods in our clinic.…”

Violência obstétrica: a abordagem da temática na formação de enfermeiros obstétricos

“…Considera-se que as intervenções podem salvar vidas quando adequadamente implementadas, garantindo o total cuidado e fornecendo satisfação materna. (12) O fortalecimento do modelo assistencial é relevante para a formação de profissionais humanizados. Há a necessidade de preparar a parturiente efetivamente e oferecer uma assistência harmônica nesse ciclo gravídico-puerperal, que se resume em técnica, procedimento e embasamento teórico.…”