Effects of a pushing intervention on pain, fatigue and birthing experiences among Taiwanese women during the second stage of labour.

OBJECTIVES: To evaluate maternal labour pain, fatigue, duration of the second stage of labour, the women's bearing-down experiences and the newborn infant Apgar scores when spontaneous pushing is used in an upright position. DESIGN: Quasi-experimental study. SETTING: Medical centre in Taichung, Taiwan. PARTICIPANTS: 66 Women giving birth at the hospital, with 33 primigravidas assigned to each group. INTERVENTIONS: During the second stage of labour, the women in the experimental group pushed from an upright position and were given support to push spontaneously; the women in the control group pushed from a supine position and were supported via Valsalva pushing. OUTCOME MEASURES: Pain scores were recorded at two evaluation time points: at 10 cm of cervical dilation and one hour after the first pain score evaluation. One to four hours after childbirth, the trained nurses collected the fatigue and pushing experience scores. FINDINGS: The women in the experimental group had a lower pain index (5.67 versus 7.15, p = 0.01), lower feelings of fatigue post birth (53.91 versus 69.39, p < 0.001), a shorter duration of the second stage of labour (91.0 versus 145.97, p = 0.02) and more positive labour experiences (39.88 versus 29.64, p < 0.001) compared with the control group. There was no significant difference in the Apgar score for newborn infants during either the first minute (7.70 versus 7.73, p = 0.72) or the fifth minute (8.91 versus 8.94, p = 0.64). KEY CONCLUSIONS: The pushing intervention during the second stage of labour lessened pain and fatigue, shortened the pushing time and enhanced the pushing experience. IMPLICATIONS FOR PRACTICE: Pushing interventions can yield increased satisfaction levels for women giving birth.

Evaluation of the effects of a birth plan on Taiwanese women's childbirth experiences, control and expectations fulfilment: a randomised controlled trial.

BACKGROUND: In many western countries, pregnant women often prepare birth plans, outlining how they would like their childbirth experiences to proceed. However there have been no experimental studies to evaluate the effect of birth plans. OBJECTIVE: The objective of this research was to evaluate the effects of birth plans on women's fulfilment of their childbirth expectations, their control over the birth process, and overall experiences. DESIGN: A randomised, single-blind controlled trial study design was used. SETTINGS: This study involved seven hospitals and 10 obstetricians in Taiwan. PARTICIPANTS: Participants included primiparous women, each under the care of one of seven Taiwanese medical facilities, and who had been pregnant for at least 32 weeks. They were also at least 18 years old, and had no pregnancy complications. An exclusion criterion was elective caesarean as a mode of delivery. A total of 296 women in hospital clinics who met the study criteria were allocated by block randomisation to experimental (n=155) or control (n=141) groups. METHODS: The women completed their basic personal information and a childbirth expectations questionnaire when they were recruited. One day after delivery, all the participants completed a questionnaire about the childbirth experience, control and fulfilment of their childbirth expectations. RESULTS: The experimental group had a statistically higher degree of positive childbirth experiences than that of the control group (t=2.48, p=0.01). The experimental group also showed a higher degree of childbirth control (t=9.60, p<0.001). There were no noticeable differences in mean values between the experimental and control groups in prenatal birth expectations, but a significant difference (t=2.63, p=0.01) in the degree of fulfilment of their childbirth expectations after delivery. On a subscale measuring the fulfilment of childbirth expectations, there was a statistically higher degree of mastery and participation (t=3.74, p<0.001) in the experimental group than in the control group. CONCLUSIONS: The results justify the clinical implementation of birth plans. Providing birth plans in medical facilities is an effective means of fulfilling pregnant women's childbirth expectations, of affording them a larger degree of control over the birth process, and for their overall positive experiences. Birth plans are acceptable and feasible in maternity care.

[The lived experience of postpartum women receiving rooming-in care].

A phenomenological study was conducted to explore the lived experience of postpartum women receiving rooming-in care. Subjects (n = 21) were recruited from a medical center in Taichung. Data were collected by a demographic questionnaire, open-ended interview guide and a tape recorder. Content analysis by Giorgi's method was used, and identified four themes. Because of early contact women who receive rooming-in care in postpartum can perceive the happiness and suffering of nursing their baby, promote the success of breastfeeding, and increase family cohesion, but in this process women also have some needs and concerns. The results of this study can enable professional staff to understand the lived experience of postpartum woman receiving rooming-in care, so that nurses can provide care that meets their needs and enhance their willingness to participate. In this way, rooming-in care can be extended into family-centered maternity care and create baby-friendly hospitals.