Labor Support during the Early Months of the COVID-19 Pandemic in the United States.

PURPOSE: To describe the experiences of registered nurses and certified nurse midwives who provided labor support and care in the early months of the COVID-19 pandemic. STUDY DESIGN AND METHODS: A descriptive, qualitative approach was used to explore nurses' and midwives' perceptions via in-depth interviews. Data were analyzed via thematic analysis. RESULTS: Thirteen nurses, four of whom were also midwives, participated in semi-structured interviews. All provided care during the first 9 months of the pandemic and represented seven states across the United States. The analysis revealed an overarching theme, A New World but still a Celebration. This overarching theme encompasses participants' accounts of trying to provide the same support, presence, and celebration while dealing with constant policy changes, the impact of limited family presence in labor, and their own fears and risks. Four sub-themes were identified: The Impact of Nursing during COVID-19; Challenges, Changes, and Consequences; Unexpected Benefits; and The Cost. CLINICAL IMPLICATIONS: The first year of the COVID-19 pandemic saw unprecedented challenges for nurses. Practice changes due to these changing policies had negative and positive effects. Negative practices affected family support, decreased interprofessional collaboration, and caused shorter hospital stays for new mothers. Some positive aspects of practice changes included additional time for mother-newborn bonding due to restrictive visitation policies, increased initiation of breastfeeding, and focused patient education. Nurses across the United States are still coping with practice changes from the pandemic. Our study highlights the need to support nurses in adapting care in the midst of practice changes.

'Giving birth on a beach': Women's experiences of using virtual reality in labour.

INTRODUCTION: Birth is a normal physiological process, and many women want a natural birth. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using Virtual Reality as a non-pharmacological method of pain relief in labour. Virtual Reality has been shown to be an effective distraction technique in other acute pain settings which also reduces anxiety. METHODS: This study conducted qualitative in-depth interviews postnatally with women who used Virtual Reality in labour. Thematic analysis was used to analyse the qualitative data. RESULTS: Nineteen women used Virtual Reality in labour. Results from interviews with nineteen women in the postnatal period identified three main themes: impact of virtual reality on experience of labour, managing the pain of labour and challenges of using virtual reality in labour. CONCLUSION: This study identified that Virtual Reality was effective as a relaxation technique and helped in pain management by the use of self-efficacy techniques. Women in this study also identified preferred virtual environments specifically to use during labour and birth. This study provides a unique and original contribution to the field of Virtual Reality in labour and birth. It also identifies Virtual Reality as an acceptable and positive experience in the management of anxiety and labour pain.

Women's experiences of remote video calls with a labour ward midwife during early labour.

BACKGROUND: In an increasingly strained maternity care system with a shortage of midwives and great demands for service, pregnant women in their early labour are at risk of receiving insufficient support. Women make calls and visit the labour ward on multiple occasions before being admitted. A video call with a labour ward midwife during early labour is an unknown practice but could support pregnant women and their partners during this uncertain period. AIM: The study aimed to describe women's experiences of remote video calls with a labour ward midwife during early labour. METHODS: A qualitative study comprising nine semi-structured interviews followed by an inductive thematic analysis was conducted. RESULTS: The results revealed that video calls prepared women and their partners by means of practical support. They received an assessment of early labour and the interaction with labour ward midwives prepared them for the impending birth. The participants reported feeling secure and strengthened by being met at their current stage of labour. Furthermore, they found the service accessible, easy to use and emphasised the need for increased availability and continuity. CONCLUSION: This study highlights the positive impact of video calls in early labour when conducted by competent labour ward midwives. The perceived accessibility and ease of use e-health system underscore a demand for extended availability. These findings indicate the potential benefits of integrating video calls in labour care to enhance support, security, accessibility and overall satisfaction for pregnant women and their partners.

A comparison of childbirth self-efficacy, fear of childbirth, and labor pain intensity between primiparas and multiparas during the latent phase of labor: a cross-sectional study.

BACKGROUND: Childbirth is a long-lasting physiological stress. As one of the main stressors, labor pain exists throughout the whole process. Childbirth self-efficacy is the confidence, or belief that they can manage pain during childbirth. This sense of self-efficacy determines how pregnant women deal with labor pain and enables them to regulate their behavior and actively deal with childbirth. However, the difference in pain sensitivity between single births (primiparas) and multiple births (multiparas) has rarely been investigated. OBJECTIVES: This study is aimed at investigating self-efficacy, fear of childbirth, labor pain of primiparas and multiparas and exploring factors related to the perceived labor pain intensity of pregnant women. DESIGN: Prospective cross-sectional study. SETTING(S): Labour and delivery in a large academic specialized hospital in Guangzhou, China. PARTICIPANTS: A total of 347 women, (182 primiparas and 165 multiparas) were enrolled in the data analysis. Pain was assessed before cervical dilatation (cervical dilatation ≤ 3 cm for the first delivery and ≤ 2 cm for the second delivery). METHOD: The general information of participants was obtained by questionnaire and obstetrical records of the subjects were obtained from the electronic medical records extracted from the electronic medical record system (EMRS). Childbirth self-efficacy, fear of childbirth (FOC) and labor pain were compared between primiparas and multiparas. Paired t-test, chi-square test, Mann-Whitney test, univariate and multivariate regression analysis were used to analyze labor pain between the two groups and investigate factors related perceived labor pain intensity. RESULTS: The total scores related to fear of childbirth, fetal health, self-control, and labor pain injury of multiparas were notably reduced compared with primiparas (all P < 0.05). The perceived labor pain intensity and duration of the first stage of labor was reduced in the multipara group compared with the primipara group. The childbirth control sense of the multipara was better than that of the primipara. The perceived labor pain intensity was negatively correlated with advanced age (age ≥ 35 years), self-efficacy score, family support, and education (all P < 0.05). In contrast, the perceived labor pain intensity was positively correlated with tension, severe fear of childbirth, and anxiety (P < 0.05). Self-efficacy, gravidity, delivery cognition, and fear of childbirth were independent risk factors for the perceived labor pain intensity in the latent period (all P < 0.05). CONCLUSIONS: Fear of childbirth is a predictor of perceived labor pain intensity. The extent of labor pain (minimum and maximum) can be predicted by the level of fear the expectant mother has. During the latent phase of labor, self-efficacy, fear of childbirth and labor pain are different between primiparas and multiparas.

An online survey of women's views of respectful and disrespectful pregnancy and early labour care in the Czech Republic.

OBJECTIVE: To ascertain and explore the views of women and their partners, giving birth in the Czech Republic, of the level of respectful or disrespectful care provided during pregnancy and early labour. DESIGN: Ethical approval was granted for a descriptive, online anonymous survey of 65 questions, with quantitative and qualitative responses. SETTING: The Czech Republic.The survey was completed by 8,767 women and 69 partners in 2018. MEASUREMENTS AND FINDINGS: Descriptive statistics and thematic analysis were used to present results. The majority of women were aged 26-35 years. Most had birthed in one of 93 hospitals, with 1.5% home births. Almost 40% never had an abdominal examination.in pregnancy. Quantitative data analysis revealed that less than half were given information on place of birth, or how to keep labour normal or non-interventionist. Almost 60% did not get information on positions for birth. Most (68%) commenced labour naturally, 25% had labour induced, 40% of them before term, and 7% had an elective caesarean section; 55% stated they had not been given any choice in the decision. Over half of those who had a membrane sweep said permission had not been sought. Half (54%) only had 'checking' visits from the midwife in labour. KEY CONCLUSIONS: Findings reveal a lack of information-giving, discussion and shared decision-making from healthcare professionals during pregnancy and early labour. Some practices were non-evidenced-based, and interventions were sometimes made without consent. IMPLICATIONS FOR PRACTICE: The examples of disrespectful care described in this study caused women distress during childbirth, which may result in an increased fear of childbirth or an increase in free-birthing.

How does the use of continuous electronic fetal monitoring influence women's experiences of labour? A systematic integrative review of the literature from high income countries.

BACKGROUND: A variety of technologies are used to monitor fetal wellbeing in labour. Different types of fetal monitoring devices impact women's experiences of labour and birth. AIM: This review aims to understand how continuous electronic fetal monitoring (CEFM) influences women's experiences, with a focus on sense of control, active decision-making and mobility. METHODS: A systematic search of the literature was conducted. Findings from qualitative, quantitative and mixed methods studies were analysed to provide a review of current evidence. FINDINGS: Eighteen publications were included. The findings were synthesised into three themes: 'Feeling reassured versus anxious about the welfare of their baby', 'Feeling comfortable and free to be mobile versus feeling uncomfortable and restricted', and 'Feeling respected and empowered to make decisions versus feeling depersonalised with minimal control '. Women experienced discomfort and a lack of mobility as a result of some CEFM technologies. They often felt anxious and had mixed feelings about their baby's welfare whilst these were in use. Some women valued the data produced by CEFM technologies about the welfare of their baby. Many women experienced a sense of depersonalisation and lack of control whilst CEFM technologies were used. DISCUSSION: Fetal monitoring technologies influence women's experiences of labour both positively and negatively. Wireless devices were associated with the most positive response as they enabled greater freedom of movement. CONCLUSION: The design of emerging fetal monitoring technologies should incorporate elements which foster freedom of movement, are comfortable and provide women with a sense of choice and control. The implementation of fetal monitoring that enables these elements should be prioritised by health professionals.

"We restrict certain things": a cross-sectional study of health provider adherence to WHO's recommendation for intrapartum oral intake of fluid and food in Greater Accra, Ghana.

BACKGROUND: Since 2018, WHO recommends oral fluid and food intake for low-risk women during labor to enhance positive childbirth experience and respect for women's preferences. This study investigated the current practices related to intrapartum oral intake among maternity care providers and women in public health facilities in Greater Accra, Ghana, and explored barriers and opportunities for adherence to the WHO guidance. METHODS: We used a mixed-method design at five public health facilities in Greater Accra, Ghana, which included structured interviews with 11 facility-level quality improvement staff and 12 maternity care providers; a knowledge, attitudes, and practices survey with the same providers; and a client survey with 56 inpatient postpartum women. We conducted descriptive and inferential statistics, including z-tests to assess independent and dependent variables, and inductive thematic analyses. RESULTS: Provider adherence to the WHO recommendation varied, with many imposing restrictions on oral intake during labor. Concerns included potential complications like Mendelson's syndrome, consequently framing oral intake decisions as clinical and leading providers to limit women's involvement in their care decisions. Within our sample, 54% and 43% women reported their provider counseled them on oral fluid and food intake respectively, while 41% and 34% reported their provider asked them their preference for drinking and eating respectively. Ultimately, 73% drank fluids and 19% ate food during their labor. Counseling significantly correlated with women's intake practices (p < 0.01) and providers' inquiry to women's preferences for drinking and eating (p < 0.001) during labor. CONCLUSION: Adherence to evidence-based practices for intrapartum oral intake among low-risk women was inconsistence. Maternity care providers play a vital role in involving women in their care decisions and respecting women's preferences. Strengthening national-level labor care guidelines and provider quality improvement approaches like in-service training, supportive supervision, and job aides to include the WHO recommendation will help providers adhere to the guidance and contribute to promoting a positive childbirth experience for women.

Maternity healthcare professionals' experiences of supporting women in decision-making for labour and birth: a qualitative study.

OBJECTIVES: To explore and characterise maternity healthcare professionals' (MHCPs) experience and practice of shared decision-making (SDM), to inform policy, research and practice development. DESIGN: Qualitative focus group study. SETTING: Large Maternity Unit in the Southwest of England. PARTICIPANTS: MHCPs who give information relating to clinical procedures and pregnancy care relating to labour and birth and are directly involved in decision-making conversations were purposively sampled to ensure representation across MHCP groups. DATA COLLECTION: A semistructured topic guide was used. DATA ANALYSIS: Reflexive thematic analysis was undertaken. RESULTS: Seven focus groups were conducted, comprising a total of 24 participants (3-5 per group). Two themes were developed: contextualising decision-making and controversies in current decision-making. Contextual factors that influenced decision-making practices included lack of time and challenges faced in intrapartum care. MHCPs reported variation in how they approach decision-making conversations and asked for more training on how to consistently achieve SDM. There were communication challenges with women who did not speak English. Three controversies were explored: the role of prior clinical experience, the validity of informed consent when women were in pain and during life-threatening emergencies and instances where women declined medical advice. CONCLUSIONS: We found that MHCPs are committed to SDM but need better support to deliver it. Structured processes including Core Information Sets, communication skills training and decision support aids may help to consistently deliver SDM in maternity care.

Outcomes of the MAMA Training: A Simulation and Experiential Learning Intervention for Labor and Delivery Providers to Improve Respectful Maternity Care for Women Living with HIV in Tanzania.

Respectful maternity care (RMC) for women living with HIV (WLHIV) improves birth outcomes and may influence women's long-term commitment to HIV care. In this study, we evaluated the MAMA training, a team-based simulation training for labor and delivery (L&D) providers to improve RMC and reduce stigma in caring for WLHIV. The study was conducted in six clinical sites in the Kilimanjaro Region of Tanzania. 60 L&D providers participated in the MAMA training, which included a two-and-a-half-day workshop followed by a half-day on-site refresher. We assessed the impact of the MAMA training using a pre-post quasi-experimental design. To assess provider impacts, participants completed assessments at baseline and post-intervention periods, measuring RMC practices, HIV stigma, and self-efficacy to provide care. To evaluate patient impacts, we enrolled birthing women at the study facilities in the pre- (n = 229) and post- (n = 214) intervention periods and assessed self-reported RMC and perceptions of provider HIV stigma. We also collected facility-level data on the proportion of patients who gave birth by cesarean section, disaggregated by HIV status. The intervention had a positive impact on all provider outcomes; providers reported using more RMC practices, lower levels of HIV stigma, and greater self-efficacy to provide care for WLHIV. We did not observe differences in self-reported patient outcomes. In facility-level data, we observed a trend in reduction in cesarean section rates for WLHIV (33.0% vs. 24.1%, p = 0.14). The findings suggest that the MAMA training may improve providers' attitudes and practices in caring for WLHIV giving birth and should be considered for scale-up.

Women's attitudes, prevalence, related factors, and perceived barriers of birth companionship in Saudi Arabia.

BACKGROUND: The World Health Organization recommends companionship as a critical element of respectful maternity care. However, there is paucity of literature regarding women's attitudes, related factors, and barriers of implementation in Saudi Arabia. OBJECTIVE: This study aimed to assess women's attitudes toward birth companionship during labor and delivery, related factors, and barriers of implementing labor companionship in Saudi Arabia. DESIGN/METHODS: This study was carried out in Al Ahsa, Saudi Arabia, using a cross-sectional design. The data collection took place over a period of approximately 6 months, specifically from 16 August 2021 to 20 February 2022. A total of 418 women who had given birth at three governmental hospitals and three private hospitals in Al Ahsa participated in the survey. The study included women between the ages of 18 and 49 years who had delivered during the study period. RESULTS: The study revealed that while around 82.8% of mothers expressed a desire for companionship during labor, only 43.2% actually had a labor companion present during delivery. The primary obstacle to labor companionship reported by 21.5% of respondents was hospital policies. Other barriers identified included husbands' fear of being present during labor (4.7%) and limited availability of time for companionship (3.8%). CONCLUSION: The study concludes that birth companionship is highly desired by women in the study area. However, various physical, emotional, and institutional barriers, such as hospital policies and regulations, impede its implementation. Addressing these barriers and promoting supportive policies are essential to facilitate the provision of birth companionship and improve the childbirth experience for women in Al Ahsa.

Relationships Among Individual and Hospital Characteristics and Self-Efficacy in Labor Support Among Intrapartum Nurses in Texas.

OBJECTIVE: To explore the relationships among individual and workplace characteristics and self-efficacy in labor support among intrapartum nurses. DESIGN: Cross-sectional survey. SETTING: Online distribution from April to August 2020. PARTICIPANTS: Members of the Texas section of the Association for Women's Health, Obstetric, and Neonatal Nurses (N = 106). METHODS: I conducted descriptive analysis on individual and workplace characteristics, including scores on the Self-Efficacy Labor Support Scale. I conducted backward stepwise multivariate linear regression to assess the factors associated with self-efficacy in providing labor support. RESULTS: Years as an intrapartum nurse had a positive association with self-efficacy in labor support. Experience with open-glottis pushing, the overall cesarean birth rate, and the use of upright positioning during labor and birth were also positively associated with self-efficacy in labor support. Conversely, lack of recognition by providers was negatively associated with self-efficacy in labor support. CONCLUSION: Findings suggest that modifiable factors at the individual and hospital levels are associated with nurses' self-efficacy in labor support. Hospitals must work to engage in obstetric practices that are congruent with providing labor support, including the use of experienced nurses to mentor new nurses and the creation of a unit culture to reinforce the intent of individual nurses to provide labor support.

Community-Based Doulas' Roles Within the Birth Support System: Young Black Mothers' Perspectives.

INTRODUCTION: Doulas have been found to be beneficial to pregnant adolescents during childbirth, but little is known about their role within the larger system of people providing birth support, including family and health care providers. The purpose of this study was to examine, from the perspectives of young mothers, the role of the doula within their broader birth support system. METHODS: One hundred pregnant Black adolescents and young women (aged 13 to 21) who were provided perinatal community-based and racially concordant doula services at no cost to them were interviewed after the birth of their newborn, prior to hospital discharge. Interviews generated birth story narratives and responses to focused questions about their experiences of birth support. Thematic analysis was conducted to examine the role of the doula within the context of the broader system of birth support. RESULTS: Doulas functioned in 2 primary ways within the birth support system by (1) providing tandem support alongside family and health care providers and (2) filling gaps in health care not provided by family and providers. Laboring adolescents sometimes described their family members and doulas working in tandem to provide multiple types of support such as comfort measures, coaching, and help with pushing. They also identified gaps in their care or support filled by the doula, in particular gaps due to family members' physical or emotional unavailability or health care providers' many responsibilities. DISCUSSION: The findings highlight the ways in which doulas support pregnant adolescents during childbirth through their deft navigation of the existing support system. Well-being was enhanced by the inclusion of the doula in the birth support system. The findings align with existing research that underscores the valuable role doulas play in supporting individuals during childbirth, particularly for those most affected by processes of marginalization.

Effect of Acupressure on Anxiety and Pain Levels in Primiparous Women During Normal Labor: A Randomized Controlled Trial.

Background: Normal labor is stressful, and the intense pain and anxiety can have an adverse effect on the mother, the fetus, and the delivery procedure. This study aimed to determine how acupressure applied to multiple acupoints during normal labor affected labor pain and anxiety in primiparous women. Method: This study was a double-blinded randomized controlled trial that involved 43 primiparous women aging 20-30 years who were referred for normal labor. Subjects were randomly allocated to one of two groups: acupressure or control. Acupressure was administered to the Large Intestine 4 (LI4), Heart 7 (He-7), and Spleen 6 (SP6) acupoints in the acupressure group, whereas sham acupressure was administered to the control group. The study assessed the mothers' anxiety levels using the Spielberger Inventory questionnaire and measured their pain levels using the visual analog scale before and after the intervention. In addition, pulse rate and blood pressure were also measured. Result: In the acupressure group, both the anxiety score and pain level showed a substantial improvement (p < 0.001), but in the control group, only the anxiety score showed a significant improvement (p < 0.001). After the intervention, the difference in anxiety and pain scores between the two groups is statistically significant (p < 0.001). Furthermore, neither group's blood pressure nor pulse rate showed any significant changes (p < 0.05). Conclusion: According to the study's findings, acupressure targeting LI4, He-7, and SP6 acupoints was effective in relieving anxiety and pain during labor. Compared with the sham acupressure group, the acupressure group showed a greater decrease in both anxiety and pain levels. As such, acupressure may be recommended as an effective, affordable, and accessible technique for managing pain and anxiety during labor. This study has been registered in the database of clinical trials under the identifier Clinicaltrials.gov NCT05411289.

Talking cervixes: How times materialise during the first stage of labour.

The clock occupies a prominent position in many feminist and midwifery critiques of the medicalisation of labour and birth. Concern has long focused on the production of standardised 'progress' during labour via the expectation that once in 'established' labour, birthing people's cervixes should dilate at a particular rate, measurable in centimetres and clock time. In this article we draw on 37 audio- or video-recordings of women labouring in two UK midwife-led units in NHS hospital settings to develop a more nuanced critique of the way in which times materialise during labour. Mobilising insights from literature that approaches time as relational we suggest that it is helpful to explore the making of times during labour as multiple, uncertain and open-ended. This moves analysis of time during labour and birth beyond concern with particular forms of time (such as the clock or the body) towards understanding how times are constituted through interactions (for example, between midwives, cervixes, clocks, people in labour and their birth partners), and what they do.

Fostering childbirth education on upright positions and mobility during labor in nulliparous women.

BACKGROUND: Upright labor positions and movement during labor have a positive effect on childbirth, yet the predominant labor positions are still horizontal. Therefore, it is important to explore how it is possible to improve childbirth education, particularly its instructional design, to strengthen women's self-efficacy toward the use of upright positions and mobility during labor. The aim of the study was to evaluate the impact of an instructional approach based on a cognitive engagement ICAP (Interactive, Constructive, Active, Passive) framework on the development of knowledge, attitudes, and self-efficacy expectations toward upright positions and mobility during labor. METHODS: A prospective quasi-experimental study was conducted among nulliparous women from the ultra-orthodox Jewish community (n = 74). While the control group (n = 34) participated in routine childbirth education, the intervention group (n = 36) learned with childbirth education that included interactive and constructive cognitive engagement activities. Participants in both groups completed a set of questionnaires regarding knowledge, attitudes, and self-efficacy. RESULTS: The post-test analysis revealed that women in the intervention group compared to the control group gained significantly higher knowledge scores (p < 0.05), more positive attitudes (p < 0.001), and stronger self-efficacy expectations toward upright positions and mobility during labor (p < 0.01). CONCLUSIONS: The findings suggest that by fostering women's cognitive engagement levels during childbirth education toward the interactive and constructive modes of the ICAP framework, women's self-efficacy to move during labor and to use upright positions can be induced. These results can serve as a foundation to improve the overall effectiveness of childbirth instruction. TRIAL REGISTRATION: The study was registered retrospectively.

Implementing a new birthing room design: a qualitative study with a care provider perspective.

BACKGROUND: Research shows that interventions to protect the sensitive physiological process of birth by improving the birthing room design may positively affect perinatal outcomes. It is, however, crucial to understand the mechanisms and contextual elements that influence the outcomes of such complex interventions. Hence, we aimed to explore care providers' experiences of the implementation of a new hospital birthing room designed to be more supportive of women's birth physiology. METHODS: This qualitative study reports on the implementation of the new birthing room, which was evaluated in the Room4Birth randomised controlled trial in Sweden. Individual interviews were undertaken with care providers, including assistant nurses, midwives, obstetricians, and managers (n = 21). A content analysis of interview data was conducted and mapped into the three domains of the Normalisation Process Theory coding manual: implementation context, mechanism, and outcome. RESULTS: The implementation of the new room challenged the prevailing biomedical paradigm within the labour ward context and raised the care providers' awareness about the complex interplay between birth physiology and the environment. This awareness had the potential to encourage care providers to be more emotionally present, rather than to focus on monitoring practices. The new room also evoked a sense of insecurity due to its unfamiliar design, which acted as a barrier to integrating the room as a well-functioning part of everyday care practice. CONCLUSION: Our findings highlight the disparity that existed between what care providers considered valuable for women during childbirth and their own requirements from the built environment based on their professional responsibilities. This identified disparity emphasises the importance of hospital birthing rooms (i) supporting women's emotions and birth physiology and (ii) being standardised to meet care providers' requirements for a functional work environment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03948815, 14/05/2019.

The impact of transfer from an alongside midwifery unit to labor and delivery on birthing women: A qualitative study.

OBJECTIVE: To explore laboring women's thoughts, feelings, and experiences of transferring from an Alongside Midwifery Unit or free-standing birth center to labor and delivery. DESIGN: A qualitative online survey was used for this research. SETTING: An Alongside Midwifery Unit in the southwestern United States. PARTICIPANTS: Eight women over the age of eighteen who had transferred to labor and delivery from either the AMU or free-standing birth center. FINDINGS: Five themes emerging from the women's transfer experiences. It was important for the women to maintain their physiologic birth ideals. The initiation of transfer, even a discussion, altered the atmosphere in the birthing room. Women experienced a range of emotions surrounding the transfer. The stories spoke to mourning the loss of physiologic birth experience. Some women expressed guilt about the potential effects on their infants. Post-birth women had realizations about their mental and physical capabilities and limitations. KEY CONCLUSIONS: This pertinent study addressed the effect on women when a transfer needs to occur from an Alongside Midwifery Unit or free-standing Birth Center to the Labor and Delivery Unit. Regardless of the reason, a transfer affected all participants. The psychological impact can have significant consequences on mother and baby's wellbeing. Women need an opportunity to share their story. The fifth theme of learning about themselves mentally and physically is new and not identified in other studies. IMPLICATIONS FOR PRACTICE: Clinical recommendations are proposed to improve understanding and integrate into one's mindset, care processes, and clinical practice. Post-birth care should continue for these women until they completely process and come to a resolution of their experience of transferring to labor and delivery.

The effect of continuous intrapartum supportive care on maternal mental health: a randomized controlled trial.

Supportive care during labor is the primary role of intrapartum nurses and midwives and provides comfort for women allowing them to have a positive experience. It is argued that supportive care during labor reduces fear and resultant side effects. However, evidence for different parameters of mental health is insufficient. The aim of this study was to evaluate the effect of continuous intrapartum supportive care on the fear of childbirth, perceived control and support at birth, birth trauma and maternal attachment. This is a randomized controlled study with an intervention group and a control group. The intervention group included 40 women receiving continuous intrapartum supportive care and the control group included 40 women receiving routine care. Thirty women in the intervention group and 29 women in the control group completed the study. No significant differences were detected between the two groups at baseline (p > .05). Continuous intrapartum supportive care significantly decreased fear of birth and birth trauma, and significantly increased perceived intrapartum control and support and postpartum maternal attachment (p < .01). Results from this evidence-based study suggest that continuous intrapartum supportive care could protect and maintain perinatal mental health.

Paradoxes in the cultural doula concept for migrant women: Implications for gender-inclusive care versus migrant-friendly maternity care.

OBJECTIVE: Swedish healthcare policies promote gender equality, shared parenting and cultural diversity. In response to the risk of adverse outcomes for migrant women, cultural doulas were introduced as support for migrant women during pregnancy and/or labour. The aim is to investigate potential tensions in the cultural doula concept in relation to policies of gender equality and diversity. DESIGN: An interview study was designed to analyse perceptions of the cultural doula concept among healthcare providers in Swedish sexual and reproductive healthcare. Through the framework of Bacchi's approach 'What Is the Problem Represented to Be?' and Hochschild's concept of 'global care chains', we analyzed whether the introduction of the cultural doula concept is in line with the policies of gender equality and culturally sensitive care by exploring paradoxes, unintended consequences and what was not reflected upon. SETTING AND PARTICIPANTS: Semi-structured interviews (n = 18) with midwives and obstetricians at hospitals in two Swedish counties during 2022. MEASUREMENTS AND FINDINGS: The interviews were analyzed through thematic analysis. Cultural doulas were perceived as multi-tasking resources for facilitating integration and providing healthcare information and psychosocial support. Respondents did not identify doula support as a cultural practice in migrants' origin countries. Despite awareness of cultural differences in gender norms, many respondents stated that doula support included male partners. KEY CONCLUSIONS: The cultural doula concept includes paradoxes in relation to gender equality and diversity. Rather than empowering migrant women, the cultural doula concept is related to gendered patterns of low-educated, underpaid care work. Labour support interventions including migrant women's social network and intensified partner involvement would be more in line with Swedish policies of gender equality, shared parenting and cultural sensitivity when needed. However, doulas may be an imperfect solution for women lacking partners or social networks, for example, newly arrived migrant women, if no support is to be found within the perinatal care system. IMPLICATIONS FOR PRACTICE: Midwives and obstetricians need reflexivity about what the problem is represented to be when it comes to gender equality and cultural sensitivity in their collaboration with cultural doulas, boundaries between roles, how they handle confidentiality, and why cultural doulas are needed in relation to migrant women's integration.

Sense of coherence as facilitated by water immersion during labour and birth: A concept analysis and synthesis.

OBJECTIVE: To explore the concept of sense of coherence as facilitated by water immersion during labour and/or birth. DESIGN: A concept analysis and synthesis. A literature search of CINAHL, Medline, PubMed, PsycINFO and Emcare was undertaken in February 2022. Results were cross-checked with Google Scholar. No timeframe was specified, and results were restricted to research papers written in English. Overall, 2768 papers were retrieved and after removal of duplicates and unrelated papers, abstracts were screened to ensure the paper met the inclusion criteria i.e. women's experiences of water immersion for labour and/or birth. This process yielded a total of 37 articles and two theses, these were used for the concept analysis. Attributes were described and an exemplar case developed after mapping and charting of the data set. FINDINGS: Three attributes were identified; agency, holistic and complete and more than pain relief which align with the three sense of coherence components: comprehensible, meaningfulness and manageability. KEY CONCLUSION: There is a growing evidence base regarding the use of intrapartum water immersion. The literature exploring women's experiences and views of water immersion, appears to consistently report that women experience physiological, physical and psychological benefits and that these benefits complement each other to facilitate greater self-efficacy and a more holistic experience. This combination of benefits afforded by water immersion facilitates a sense of coherence and subsequently, increases the likelihood of the woman experiencing labour and birth as both positive and satisfying. IMPLICATIONS FOR PRACTICE: A greater understanding of women's experiences of water immersion will provide rationale and reason for making the option a real choice while revealing the positive impacts that it can have on all outcomes beyond just the physical.