tag:theconversation.com,2011:/us/topics/giving-birth-66955/articlesgiving birth – The Conversation2023-09-05T02:39:09Ztag:theconversation.com,2011:article/2114352023-09-05T02:39:09Z2023-09-05T02:39:09ZMore than 6,000 women told us what they wanted for their next pregnancy and birth. Here’s what they said<figure><img src="https://images.theconversation.com/files/545717/original/file-20230831-29-n7bhi3.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C1000%2C666&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-newborn-child-birth-maternity-hospital-1938100312">Shutterstock</a></span></figcaption></figure><p>Many women want a different kind of pregnancy and birth the next time around. Many want to see the same one or two midwives throughout, and want to choose where they give birth. And when the time comes, they want a vaginal birth, with less intervention. </p>
<p>This is what thousands of Australian women told us when we asked if they would do anything differently if they had another baby.</p>
<p>We publish our findings today in <a href="http://dx.doi.org/10.1136/bmjopen-2023-071582">British Medical Journal Open</a>. </p>
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<strong>
Read more:
<a href="https://theconversation.com/curious-kids-why-do-babies-cry-when-they-come-out-of-their-mum-205477">Curious Kids: why do babies cry when they come out of their mum?</a>
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<h2>What we did</h2>
<p>In 2021, we undertook Australia’s largest national study of birth experiences. As part of that, we asked women, “Would you do anything different if you were to have another baby?”</p>
<p>A total of 6,101 women left comments. More than 85% of comments were from women who said they’d do things differently the next time around.</p>
<p>Several themes emerged.</p>
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Read more:
<a href="https://theconversation.com/mondays-medical-myth-women-forget-the-pain-of-childbirth-12271">Monday’s medical myth: women forget the pain of childbirth</a>
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<h2>‘Next time I’ll be ready’</h2>
<p>The largest group of comments (39.2%) were from women who wanted to avoid a repeat of their previous pregnancy and birth experience. They wanted to better advocate for themselves, get more informed about their choices, and avoid certain birth interventions. </p>
<p>For example, there were more than 500 comments from women who would try to avoid having their next labour started manually, known as an <a href="https://theconversation.com/too-many-healthy-women-are-having-their-labour-induced-for-no-identified-medical-reason-our-study-shows-161281">induction of labour</a>. </p>
<p>A woman from Western Australia, who ended up having a caesarean, said:</p>
<blockquote>
<p>I would 100% opt for no induction. I believe it’s the reason that led me to a c-section.</p>
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<p>Australia has a high rate of induction, especially for women having their first babies <a href="https://www.aihw.gov.au/reports/mothers-babies/australias-mothers-babies/contents/labour-and-birth/onset-of-labour">(41% induced labour rate for women having their first baby)</a>. Women feel they are <a href="https://pubmed.ncbi.nlm.nih.gov/32146087/">inadequately informed</a> about the process of induction and not given a choice or alternative options.</p>
<p>We have also shown an induction of labour in Australia can lead to <a href="https://bmjopen.bmj.com/content/11/6/e047040">further medical interventions</a>. High rates of medical intervention, such as induction, can lead to <a href="https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31472-6/fulltext">poorer</a> maternal and neonatal outcomes when used excessively. </p>
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Read more:
<a href="https://theconversation.com/too-many-healthy-women-are-having-their-labour-induced-for-no-identified-medical-reason-our-study-shows-161281">Too many healthy women are having their labour induced for no identified medical reason, our study shows</a>
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<h2>‘I want a specific birth experience’</h2>
<p>This was the second largest category (28.5% of comments). Here, most women said they wanted their next birth to be a vaginal birth (1,735 comments) and some would opt for a caesarean (438 comments). </p>
<p>Of the women wanting a vaginal birth, 1,021 comments related to wanting the next birth at home.</p>
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<a href="https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Newborn baby wrapped in towel, with mum holding wrinkly tiny fingers" src="https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545718/original/file-20230831-21-19g87w.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Many women wanted their next birth at home.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/newborn-baby-holds-onto-their-fathers-1519293962">Shutterstock</a></span>
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Read more:
<a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">Explainer: what are women's options for giving birth?</a>
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<h2>‘I want a specific model of care’</h2>
<p>Women also said they wanted to be better prepared by getting better support. This ranged from a more supportive partner, hiring a <a href="https://theconversation.com/what-is-a-doula-and-how-do-they-help-women-giving-birth-113562">doula</a> and choosing their care provider.</p>
<p>Some 17.8% of all comments, the next-largest group, identified a specific <a href="https://theconversation.com/explainer-what-are-womens-options-for-giving-birth-55133">model of maternity care</a>. Women wanted to access a more supportive model that would respect their choices and wishes.</p>
<p>Most women in this group wanted “<a href="https://www.cochrane.org/CD004667/PREG_midwife-led-continuity-models-care-compared-other-models-care-women-during-pregnancy-birth-and-early">midwifery continuity of care</a>”. This is where women are cared for by one or two midwives throughout their pregnancy, labour and birth, and into the post-birth period.</p>
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<a href="https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Midwife or doctor measuring pregnant woman with tape measure" src="https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545862/original/file-20230901-16-laxk62.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Many women prefer to see the same one or two midwives throughout.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kind-obstetrician-examining-pregnant-belly-clinic-538015297">Shutterstock</a></span>
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<p>A woman from Victoria, who told us she wanted continuity of care next time around, said:</p>
<blockquote>
<p>It is very important to me that next time I have a care provider who I fully trust, who has a good understanding of my birth preferences and who I know will be a strong advocate for me and who will encourage, empower, support and believe in me and my ability to birth my baby.</p>
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<p>Midwifery continuity of care is <a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">available</a> now in many public hospitals and is commonly called midwifery group practice or caseload midwifery. Some women access this type of care through private midwives. These charge a fee (there are some Medicare rebates) and can support women to have births at home.</p>
<p>But access to midwifery continuity of care <a href="https://www.aihw.gov.au/reports/mothers-babies/maternity-models-of-care/contents/about">is still limited</a> and booked out early, meaning many women miss out, especially if they live in regional or remote regions.</p>
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<p>
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Read more:
<a href="https://theconversation.com/call-the-midwife-playing-catch-up-with-australias-maternity-care-22544">Call the Midwife: playing catch up with Australia's maternity care </a>
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<h2>‘I want better access’</h2>
<p>This group of comments (2.9%) included ones from women in regional and remote parts of Australia.</p>
<p>They said they wished they had access to more local maternity services and equitable access to models that offer continuity of care and homebirth, such as private midwives. </p>
<p>A woman from a remote town in New South Wales said:</p>
<blockquote>
<p>If I ever fell pregnant again. I would move to a bigger town. Obstetric care in the bush is very much lacking. Rural women like myself are lucky to even be alive after our experiences.</p>
</blockquote>
<p>With many maternity units in rural and remote areas <a href="https://www.abc.net.au/news/2023-02-27/rural-remote-maternity-services-in-crisis-experts-have-solutions/102020056">shutting down</a>, women are forced to travel big distances and have fewer maternity care options than women who give birth in cities.</p>
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<a href="https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant woman driving, holding belly" src="https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/545863/original/file-20230901-28-8sz7ov.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Pregnant women can end up driving long distances to access care.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-driving-car-buttoned-belt-633963140">Shutterstock</a></span>
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<h2>‘I don’t want to change anything’</h2>
<p>Some 10.2% of comments were from women who didn’t want to change anything the next time around.</p>
<p>Of these, just under half (47%) were from women who received midwifery continuity of care.</p>
<p>This is significant as midwifery continuity of care only represent <a href="https://www.aihw.gov.au/reports/mothers-babies/maternity-models-of-care/contents/what-do-maternity-models-of-care-look-like/major-model-category">15%</a> of maternity models in Australia.</p>
<h2>Why are birth experiences important?</h2>
<p>We’ve shown that many women who reflect on their experience of pregnancy and birth wish they had made <a href="https://www.sciencedirect.com/science/article/pii/S1877575622000854">different decisions</a> and wish they had a more positive experience to look back on. </p>
<p>A <a href="https://theconversation.com/1-in-10-women-report-disrespectful-or-abusive-care-in-childbirth-186827">negative birth</a> experience can lead to <a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">birth trauma</a> and post-traumatic stress disorder. </p>
<p>Some of this may be unavoidable, such as when emergency situations arise during the labour. But trauma can also be related to the way women are <a href="https://journals.sagepub.com/doi/10.1177/10778012221140138">respected</a>, informed and cared for.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/so-your-birth-didnt-go-according-to-plan-dont-blame-yourself-89155">So your birth didn't go according to plan? Don't blame yourself</a>
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<h2>What happens next?</h2>
<p>What women are asking for is humanised, evidence-based maternity care. So it’s time to act if we are to avoid the type of experiences highlighted during the current <a href="https://www.parliament.nsw.gov.au/committees/listofcommittees/Pages/committee-details.aspx?pk=318">NSW Select Committee on Birth Trauma</a>.</p>
<p>With evidence from more than 4,000 submissions, this reminds us we often fail women during one of the most vulnerable, yet potentially transforming experiences in their life. We hope women’s voices are finally heard.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/1-in-10-women-report-disrespectful-or-abusive-care-in-childbirth-186827">1 in 10 women report disrespectful or abusive care in childbirth</a>
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<img src="https://counter.theconversation.com/content/211435/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Hazel Keedle is affiliated with the Australian College of Midwives. </span></em></p><p class="fine-print"><em><span>Daniella Susic is affiliated with UNSW Sydney, RANZCOG and MothersBabies. Funding for research has been received via RANZCOG.</span></em></p><p class="fine-print"><em><span>Hannah Dahlen receives funding from NHMRC, ARC and MRFF. She is affiliated with the Australian College of Midwives </span></em></p>Many women want to see the same one or two midwives throughout, and want to chose where they give birth. And when the time comes, they want a vaginal birth, with less intervention.Hazel Keedle, Senior Lecturer of Midwifery, Western Sydney UniversityDaniella Susic, Clinical Academic Obstetrician, UNSW SydneyHannah Dahlen, Professor of Midwifery, Associate Dean Research and HDR, Midwifery Discipline Leader, Western Sydney UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1915822022-11-07T01:55:30Z2022-11-07T01:55:30ZMore and more women in Australia are having their labour induced. Does it matter?<figure><img src="https://images.theconversation.com/files/489707/original/file-20221014-13-z1vhte.jpg?ixlib=rb-1.1.0&rect=0%2C12%2C4009%2C2657&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">anastasiia chepinska/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Induction of labour for women having their first baby has risen in Australia from 26% in 2010 to 46% in 2020, according to the latest data from the Australian Institute of Health and Welfare <a href="https://www.aihw.gov.au/reports/mothers-babies/ncmi-data-visualisations/contents/labour-and-birth-indicators/induction-of-labour">(AIHW)</a>. This compares to a rise from <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2020-21/deliveries---time-series">21% to 34%</a> over roughly the same period in the UK (for all births, not just first-time mothers). </p>
<p>South Australia was the <a href="https://www.aihw.gov.au/reports/mothers-babies/ncmi-data-visualisations/contents/labour-and-birth-indicators/induction-of-labour">highest state</a> with 48.8% induction rates for first time mothers, and Queensland the lowest with 40.5%.</p>
<p>Why are rates so high in Australia, and why are they increasing?</p>
<h2>First, why do we induce labours?</h2>
<p>Doctors or midwives might recommend induction when they believe allowing the pregnancy to continue could pose a risk to the mother or baby. </p>
<p>This can be for multiple reasons, including prolonged pregnancy (being overdue), diabetes, bleeding, medical complications, ruptured membranes, high blood pressure, twin pregnancy, infection, large babies or foetal death.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant woman at hospital wearing hospital gown, leaning on the side of the bed" src="https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489710/original/file-20221014-12-oy88m9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">There are many reasons labour might be induced, including being overdue.</span>
<span class="attribution"><span class="source">jimmy conover/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
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<p>If the woman or birthing parent decides to proceed with induction, this can occur in several ways. A popular method for inducing labour involves the midwife or doctor inserting a small catheter through the woman’s cervix (the neck of the womb) and inflating a balloon on the other side, or sometimes on both sides. </p>
<p>This mechanical pressure can stimulate the production of prostaglandin (a natural hormone that helps prepare for labour) and encourage a slight opening of the woman’s cervix. This allows the doctor or midwife to break the membranes (releasing the amniotic fluid) around the baby with a special plastic hook. At this point, a hormone called oxytocin can be used to stimulate contractions and labour.</p>
<p>Other methods for inducing labour include applying hormones directly to the cervix, or rupturing the membranes of the amniotic sac.</p>
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<p>
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<strong>
Read more:
<a href="https://theconversation.com/weight-gain-during-pregnancy-how-much-is-too-much-89016">Weight gain during pregnancy: how much is too much?</a>
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<h2>Why are induction rates increasing?</h2>
<p>Australian women are giving birth at the average age of 30.8 years, which has been slowly increasing over the <a href="https://www.aihw.gov.au/reports/mothers-babies/health-of-mothers-and-babies#Mothers">past decade</a>. Pregnancy risks and medical complications increase with advanced age or with very young women. Many of these complications can increase the likelihood of a recommendation of induction.</p>
<p>Obesity adds another layer of complexity when considering pregnancy and birth. The <a href="https://www.aihw.gov.au/getmedia/aa54e74a-bda7-4497-93ce-e0010cb66231/aihw-per-108.pdf.aspx?inline=true">AIHW 2018</a> report found 47% of women giving birth in Australia were either obese or overweight at their first antenatal visit. We know women who are overweight or obese have significant increased risks in pregnancy and birth and these risks extend to their babies. </p>
<p>The UK’s <a href="https://obgyn.onlinelibrary.wiley.com/doi/epdf/10.1111/1471-0528.15386">Care of Women with Obesity in Pregnancy Guideline</a> and <a href="https://wpstaging.ranzcog.edu.au/wp-content/uploads/2022/05/Management-of-Obesity-in-Pregnancy.pdf">Best Practice Statement</a> from the Royal College of Australian and New Zealand College of Obstetricians and Gynaecologists highlights the risks for overweight pregnant women and these include hypertension, pre-eclampsia, haemorrhage, depression, diabetes, venous thromboembolism, infection, failed induction and death.</p>
<p>They also highlight additional risks for the baby if the mother is overweight or obese in pregnancy and these can include stillbirth, large baby, shoulder dystocia (where the baby gets stuck during birth), prematurity, admission to the nursery and undiagnosed congenital abnormalities.</p>
<p>Some inductions occur at the request of the woman and in the absence of risks that might necessitate induction. It is these cases where a reduction in rates should be targeted. Women can mistakenly believe induction is a risk-free procedure when we know it is better for mother and child a woman establishes in labour without interventions where possible. This is because each intervention in the birthing process is <a href="https://pubmed.ncbi.nlm.nih.gov/28251626/">more likely to lead to further interventions</a>.</p>
<h2>Does it matter rates are increasing?</h2>
<p>A recent <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004945.pub5/full#CD004945-abs-0002">review of studies</a> found in places where labour is induced once a woman reaches 40 weeks or shortly thereafter, there are fewer stillbirths and perinatal deaths (deaths shortly after birth).</p>
<p>However when labour is induced the baby must be monitored, which involves strapping equipment to the woman’s abdomen or directly to the baby’s head. This can restrict movement for some women, and women frequently use movement to help them manage contractions.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Pregnant woman lying in hospital bed with monitor around her abdomen." src="https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/489711/original/file-20221014-13-clt2ju.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Moving around helps women manage contractions, and foetal monitoring equipment makes that difficult.</span>
<span class="attribution"><span class="source">alexander grey/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Sometimes despite using the methods described above the induction may not be successful. In these cases, a different method may be attempted, or the doctor or midwife may try again in a few days. Sometimes a caesarean may be recommended.</p>
<p>Another potential side effect is from the hormone used to stimulate contractions – occasionally these hormones cause over-stimulation of the uterus, and this can stress the baby. The hormone can be stopped but sometimes because of the impact on the baby’s wellbeing a caesarean might be recommended.</p>
<p>Induction rates are higher in Australia than like countries and without detailed data about all reasons for induction it is difficult to comment on the cause of these increases. The demographics as described above may be one factor.</p>
<p>Ultimately women should talk with their midwife or doctor about any concerns they may have, and make the best decision that is informed by their individual pregnancy.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/dont-blame-and-shame-women-for-unintended-pregnancies-50977">Don't blame and shame women for unintended pregnancies</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/191582/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Angela Brown does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>What are the risks and benefits of having labour induced?Angela Brown, Midwifery Program Director, University of South AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1492642020-12-03T22:06:53Z2020-12-03T22:06:53ZTokophobia is an extreme fear of childbirth. Here’s how to recognise and treat it<figure><img src="https://images.theconversation.com/files/372676/original/file-20201202-15-1rfluvi.jpg?ixlib=rb-1.1.0&rect=15%2C0%2C5144%2C3448&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Many pregnant women worry about birth. Some, however, suffer from a much more serious condition called tokophobia: a severe and unreasoning dread of childbirth, which is sometimes accompanied by a disgust of pregnancy.</p>
<p>At its most extreme, tokophobia can lead to:</p>
<ul>
<li>an obsessive use of contraception to prevent pregnancy</li>
<li>termination of pregnancy</li>
<li>not attending maternity care appointments</li>
<li>post-traumatic stress disorder and/or other mental health disorders and mother-baby bonding difficulties.</li>
</ul>
<p>Tokophobia comes in two forms: primary (in women who have not had a baby before) and secondary (women who have previously had a baby). Women with tokophobia in a previous pregnancy are more likely to have it in a subsequent pregnancy, resulting in a potential cycle of anxiety and depression.</p>
<p>Our new <a href="https://www.tandfonline.com/doi/full/10.1080/02646838.2020.1843908">paper</a>, published in the Journal of Reproductive and Infant Psychology, reflects on a recent meeting of researchers and clinicians about what’s missing from the way we identify and treat tokophobia. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tokophobia-what-its-like-to-have-a-phobia-of-pregnancy-and-childbirth-91271">Tokophobia: what it’s like to have a phobia of pregnancy and childbirth</a>
</strong>
</em>
</p>
<hr>
<h2>Hard to define, hard to screen for</h2>
<p>It’s hard to say how many women are affected by tokophobia; it’s been defined and measured using different questionnaires. One <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/aogs.13138">research paper</a> estimated the prevalence of tokophobia at 14% of pregnant women worldwide.</p>
<p>Screening for tokophobia is not common practice around the world. Screening questionnaires sometimes ask the woman questions about her mood, whether she has fears for herself or her baby, about feeling so afraid of childbirth she’s considered terminating the pregnancy, or feeling fear so overwhelming it interferes with eating, work or sleep.</p>
<p>In other words, tokophobia goes beyond normal childbirth concerns and worries, and becomes an intense and irrational fear of pregnancy and/or labour.</p>
<p>It’s important women with this condition are identified as soon as possible but that often only happens when they seek specialised professional help. This can sometimes (but not always) take the form of a request for a termination of pregnancy or caesarean section.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman holds a packet of contraceptive pills." src="https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372682/original/file-20201202-15-9bnqz1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">An obsessive use of contraception to prevent pregnancy is one possible symptom of tokophobia.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Treatment options</h2>
<p>Treatment for tokophobia remains patchy but should be determined based on factors such as the woman’s level of fear, stage of pregnancy and her individual wishes.</p>
<p>Early conversations about fear of childbirth — and understanding exactly what those fears are — may reduce negative impact and prevent anxiety.</p>
<p>For women with birth trauma (and potential secondary tokophobia), helping them prepare for uncertainty and building trust in themselves and their caregivers can result in a future positive experience.</p>
<p>Approaches that may help include:</p>
<ul>
<li>additional <a href="https://pubmed.ncbi.nlm.nih.gov/29773474/">midwifery support</a> to discuss the birth, with continuity of care, which is where the same midwife and/or midwifery care team sees the woman throughout pregnancy and labour</li>
<li>involvement of the obstetrician in decision-making around birth</li>
<li>extra education about childbirth</li>
<li>the involvement of the birth partner,</li>
<li>supported visits to the delivery suite, and</li>
<li>the development of a <a href="https://www.communitypractitioner.co.uk/features/2020/02/pregnant-fear">supportive birth plan</a>.</li>
</ul>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A woman looks worriedly into the distance." src="https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/372679/original/file-20201202-13-147pju1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Many pregnant women worry about birth. Some, however, suffer from a much more serious condition called tokophobia.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<h2>Pathways of care</h2>
<p>The way childbirth is often depicted in the media may play a role in setting birth up in women’s minds as a negative experience. But it’s important women share birth stories - the good and the bad. <a href="https://www.bmj.com/content/362/bmj.k3933/rr-0">Like-minded peer support mechanisms</a>, including parenting forums, which can be really helpful for some women.</p>
<p>During pregnancy, women should be encouraged to share their fears with their maternity care provider and ask questions.</p>
<p>Our understanding of fear of childbirth has undoubtedly increased, and some pioneering “<a href="https://search.proquest.com/openview/8785069f9dd679cef1540fc8881f6c0f/1?pq-origsite=gscholar&cbl=47216">pathways of care</a>” for women with tokophobia already exist. </p>
<p>But there is much work left to do if we are to understand and identify when standard worries deviate from expected levels to problematic levels.</p>
<p>We owe it to women and babies everywhere to find better ways to support women with tokophobia and maximise their chances of a positive birth experience.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/tokophobia-the-women-with-an-extreme-fear-of-pregnancy-and-childbirth-103886">Tokophobia: the women with an extreme fear of pregnancy and childbirth</a>
</strong>
</em>
</p>
<hr>
<img src="https://counter.theconversation.com/content/149264/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Jomeen received funding for this work from the Society for Reproductive and Infant Psychology development grant scheme </span></em></p><p class="fine-print"><em><span>The consensus statement referred to in the paper co-authored by Catriona Jones was facilitated by a small Society for Reproductive and Infant Psychology (SRIP) development grant, which funded the workshop.</span></em></p><p class="fine-print"><em><span>Claire Marshall is funded by the National Institute for Health Research. Claire Marshall is employed by Humber Teaching NHS Foundation Trust. </span></em></p><p class="fine-print"><em><span>The consensus statement referred to in the paper co-authored by Colin Martin was facilitated by a small Society for Reproductive and Infant Psychology (SRIP) development grant, which funded the workshop.
</span></em></p>Tokophobia goes beyond normal childbirth concerns and worries and becomes an intense and irrational fear of pregnancy and/or labour.Julie Jomeen, Professor of Midwifery and Dean in the Faculty of Health Sciences, Southern Cross UniversityCatriona Jones, Senior Research Fellow in Maternal and Reproductive Health, University of HullClaire Marshall, National Institute for Health Research Fellow, University of HullColin Martin, Adjunct professor, Southern Cross UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1338662020-03-22T12:21:18Z2020-03-22T12:21:18ZDuring coronavirus hospital surge, a midwife recommends home birth<figure><img src="https://images.theconversation.com/files/321067/original/file-20200317-60879-d01hck.jpg?ixlib=rb-1.1.0&rect=77%2C46%2C5078%2C3385&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A woman holds her newborn son right after giving birth; they are still in the birthing pool after labour at home.</span> <span class="attribution"><span class="source">(Shutterstock)</span></span></figcaption></figure><p>For many health-care providers who worked through the 2003 SARS epidemic, especially in epicentres, like Toronto, the COVID-19 pandemic is a reminder of the many lessons health-care providers <a href="https://www.ncbi.nlm.nih.gov/pubmed/12925421">learned at that time.</a> Social distancing measures are the most effective way to “<a href="https://www.nytimes.com/2020/03/11/science/coronavirus-curve-mitigation-infection.html">flatten the curve</a>” and minimize the spread of the epidemic. </p>
<p>However, as a midwife working in Toronto for over 20 years, I can also speak about another important lesson learned during SARS that is often forgotten or overlooked: <a href="http://doi.org/10.1624/105812410X482329">the importance of home birth and the role of midwives during an epidemic</a>. </p>
<p>There is ample evidence from high-income countries like Canada, the United States and the United Kingdom <a href="https://doi.org/10.1016/j.midw.2018.03.024">to demonstrate the safety of home births for healthy people who have a trained midwife</a>. In fact, research shows that <a href="https://doi.org/10.1111/j.1523-536X.2009.00322.x">home birth may even be beneficial in terms of rates of unnecessary interventions, complications and associated cost to the system</a>. </p>
<p>The evidence is so compelling that in 2014, U.K.’s NICE, the National Institute for Health and Care Excellence — the main body responsible for setting guidelines for health care in the U.K. — <a href="https://www.nice.org.uk/guidance/cg190">recommended home births for all low-risk healthy pregnant people</a>. Since the selection criteria for home birth is <a href="https://doi.org/10.1016/j.jogc.2018.08.008">vitally important to safety</a>, being a low-risk pregnant person is an important factor. For people with <a href="https://www.ontariomidwives.ca/sites/default/files/CPG%20supplemental%20resources/Choice%20of%20birthplace.pdf">high blood pressure, diabetes, preterm labour and other health issues</a>, home birth would not be the safest option.</p>
<p>However, despite these recommendations, mainstream perception has not greatly changed regarding hospital as the preferred place of birth for the large majority. The reasons for this are numerous and complicated, and highly related to <a href="https://doi.org/10.17615/4yqp-tc63">social norms, preferences and perceptions of risk</a>.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/321425/original/file-20200318-1982-alqy28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/321425/original/file-20200318-1982-alqy28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/321425/original/file-20200318-1982-alqy28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/321425/original/file-20200318-1982-alqy28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/321425/original/file-20200318-1982-alqy28.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/321425/original/file-20200318-1982-alqy28.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/321425/original/file-20200318-1982-alqy28.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A husband and a midwife both congratulate a new mother, moments after birth, placing their hands on her shoulder and the back of the newborn’s head.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>I have seen many news articles, targeted campaigns, TV shows and even movies supporting home births. But in all my 20 years as a regulated midwife, nothing in my recollection came close to changing people’s minds about place of birth than SARS. </p>
<p>For midwives, this was not necessarily surprising, as we know the safety of a home birth. But it was one of the first times mainstream public perception was greatly altered.</p>
<h2>Home births during a pandemic</h2>
<p>During a pandemic, people quickly remember that hospitals are, and should be, for sick people; that is, those needing medical care. Ironically, however, in Canada and the U.S., health-care systems the <a href="https://www.cihi.ca/en/hospital-stays-in-canada">No. 1 reason people are admitted to hospital is for childbirth</a>. </p>
<p>During a pandemic it soon becomes apparent what a bad idea it is to have healthy women and newborns in the same places and spaces as those who are unwell, and increasingly so as more get infected.</p>
<p>Suddenly — our high tech, bells and whistles “for the normal” starts to seem like a really poor idea. In fact, research shows all those bells and whistles lead to more intervention — more episiotomies, more use of forceps and vacuum, and more severe vaginal tearing — <a href="https://www.ontariomidwives.ca/sites/default/files/CPG%20supplemental%20resources/Choice%20of%20birthplace.pdf">with no better outcomes for either the pregnant woman or newborn</a>.</p>
<p>As soon as that babe is here, it becomes even more apparent what a bad idea it is to have a vulnerable new human in a place with lots of sick people.</p>
<p>Home birth starts looking better every second.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/321426/original/file-20200318-1926-jjyqyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/321426/original/file-20200318-1926-jjyqyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/321426/original/file-20200318-1926-jjyqyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/321426/original/file-20200318-1926-jjyqyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/321426/original/file-20200318-1926-jjyqyk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/321426/original/file-20200318-1926-jjyqyk.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/321426/original/file-20200318-1926-jjyqyk.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A woman being examined at home by her midwife.</span>
<span class="attribution"><span class="source">(Shutterstock)</span></span>
</figcaption>
</figure>
<p>I fully appreciate all the bells and whistles — when they are needed. But, like many of my colleagues, I personally prefer a home birth for low-risk births with a healthy uncomplicated pregnancy and normal labour. Not just because it can be very beautiful — <a href="https://www.ontariomidwives.ca/home-birth">quiet, intimate, family oriented</a> — but also because it is actually safer for healthy people — at least during a pandemic. </p>
<p>Although I could talk about the great benefits of home births in general, I’m specifically advocating for home births, or out-of-hospital births, during a pandemic. So, as our health resources and hospital beds become more scarce, I hope we remember the importance of home birth.</p>
<h2>Lessons from SARS</h2>
<p>SARS was one of the rare times in my career that I had both obstetrical and pediatric colleagues openly supporting the idea of home births and encouraging people to stay out of hospital. At that time, we understood hospital care should be saved for those who were high risk. This was even more clear as the situation worsened during the SARS epidemic.</p>
<p>There were many other important lessons learned during SARS, particularly for Canadian midwifery — although there is almost no academic literature on this subject. However, I do have some anecdotal experience to share as a front-line care provider during that time.</p>
<p>If there is one essential service that we know must continue during a pandemic, it is the business of birthing.</p>
<p>Midwives are an important part of the health force that is often overlooked. Our speciality is low-risk normal birth: this is where we have the most expertise and where we can be most effective. </p>
<p>This is a time when other birth attendants — mainly obstetricians — will be called on for their clinical and surgical speciality skills to manage those pregnant people who have complications, have COVID-19 or are unwell for other reasons.</p>
<p>Midwives can be divided into those who work within the hospital setting and those that work outside within the community. This would help prevent movement in and out of people’s homes and health-care settings. </p>
<p>Midwives have a lot of crossover skills between nurses and physicians. We can stitch and prescribe, like a physician, but also start an IV and take blood, like a nurse. There are many things we can use our skills for beyond birthing.</p>
<p>Some midwives have more advanced skills such as being able to assist during surgery, perform bedside ultrasounds and conduct vacuum deliveries. These skills could be important as the health force declines.</p>
<p>Birth centres, or other out-of-hospital birth locations, should be considered and opened as places for low-risk people to give birth and for healthy newborns to stay.</p>
<p>Finally, the needs of those who are pregnant are often overlooked. Home birth has many potential benefits, but most importantly in a pandemic, we need healthy people to give birth with the best chances of staying healthy — which doesn’t always mean hospital.</p><img src="https://counter.theconversation.com/content/133866/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Manavi Handa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>During a pandemic, a home birth starts looking better every second. Midwives with their specialized skills in low-risk normal birth can be of great service.Manavi Handa, Associate Professor, Midwifery Education Program, Toronto Metropolitan UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1253392019-10-16T10:27:28Z2019-10-16T10:27:28ZPregnant in prison: ‘I told them the baby was coming and ended up giving birth in my cell’<figure><img src="https://images.theconversation.com/files/297291/original/file-20191016-98636-d1b2vk.jpg?ixlib=rb-1.1.0&rect=40%2C34%2C3796%2C2525&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/success?u=http%3A%2F%2Fdownload.shutterstock.com%2Fgatekeeper%2FW3siZSI6MTU3MTI0Mjc4MiwiYyI6Il9waG90b19zZXNzaW9uX2lkIiwiZGMiOiJpZGxfMTM5OTE2MzcxNCIsImsiOiJwaG90by8xMzk5MTYzNzE0L2h1Z2UuanBnIiwibSI6MSwiZCI6InNodXR0ZXJzdG9jay1tZWRpYSJ9LCJrRGRmQ2FkSWRNam1FMy9lSk9oMnZXbVNleWsiXQ%2Fshutterstock_1399163714.jpg&pi=33421636&m=1399163714&src=mPLq3KYa7ZiVsaGmhe2Ltw-2-42">shutterstock/nesquik007</a></span></figcaption></figure><p>A newborn baby recently died in prison after a woman <a href="https://www.theguardian.com/society/2019/oct/04/baby-dies-in-uk-prison-after-inmate-gives-birth-alone-in-cell">gave birth alone in her cell at night</a>. </p>
<p>The newborn’s tragic death, led to the government informing parliament that ten separate investigations are being undertaken into what happened. And that immediate action would include all pregnant women across the prison estate being checked <a href="https://www.theguardian.com/uk-news/2019/oct/08/multiple-inquiries-ordered-into-death-of-baby-in-uk-prison">hourly overnight by prison staff</a>.</p>
<p>Warnings about births in cells have been raised previously. In 2018, <a href="https://www.theguardian.com/society/2018/nov/13/female-prisoners-in-england-left-to-give-birth-alone-in-their-cells-report-reveals">my research into the experiences of pregnant women</a> in prison led to a call from parliament for mandatory guidance for <a href="https://twitter.com/carolynharris24/status/1063021280453160961?s=20">pregnant women and new mothers in prison</a>.</p>
<p>As part of my <a href="https://uhra.herts.ac.uk/handle/2299/20283">research</a>, I carried out interviews with 28 women and ten members of prison staff. And as a result of what I discovered, concerns were raised about the <a href="https://www.herts.ac.uk/about-us/news/2018/november/our-research-finds-pregnant-prisoners-are-giving-birth-without-midwifery-support">risks to women’s safety and well-being</a>.</p>
<p>The number of pregnant women and babies in prison is not currently known or recorded – neither is what happens to them – and this too is something being urgently called for in a <a href="https://publications.parliament.uk/pa/jt201719/jtselect/jtrights/1610/1610.pdf">recent report from the joint human rights committee</a>. </p>
<h2>No midwifery care at night</h2>
<p>Many of the women I spoke to as part of my research expressed their fears of going into labour at night (when they are locked in their cells) and of not being unlocked in time. As one explained:</p>
<blockquote>
<p>I want to be in control, I don’t want to be buzzing people for them to get an ambulance … my biggest fear is being left in that room.</p>
</blockquote>
<p>Indeed, for one woman, Layla*, this became a reality as she gave birth in her prison cell without midwifery care or support. A staff member described what happened:</p>
<blockquote>
<p>She was eight months pregnant and Layla* ended up going into labour. They didn’t listen when she was saying, ‘I think I need to go to hospital, I think the baby’s coming,’ and she ended up giving birth in her cell.</p>
</blockquote>
<p>Although Layla* was the only woman interviewed for this research who had birthed inside prison, several members of staff had experience of women labouring and giving birth in their cells. Prison staff explained how in one instance, “a mobile phone was brought down for [the nurse] to ring [paramedics] to be talked through delivering the baby”. Another said:</p>
<blockquote>
<p>We were like: ‘We’ve got a baby in prison!’ … and we didn’t know what to do. </p>
</blockquote>
<p>Yet, my findings also show that when the system works well for women, they can have a positive experience of timely and compassionate support in labour. As another interviewee explained:</p>
<blockquote>
<p>Within half an hour the ambulance was here, and I was off. When we left the prison, the number one governor was at the gate and she stopped, and she said good luck.</p>
</blockquote>
<h2>At crisis point</h2>
<p>Overall, however, it seems prison staff are being put in an untenable situation when it comes to pregnant women, in a system described as being at “<a href="https://www.theguardian.com/society/2018/sep/25/prisons-crisis-inmates-humans-strikes-uk-us">crisis point</a>”. In my research, I found that staff were often unaware of whose role it was to care for pregnant women, this led to officers believing nursing staff were qualified to make midwifery decisions. In Layla’s case, this led to her birthing in her prison cell and inappropriate decisions being made about her care when in labour.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/297292/original/file-20191016-98640-bd9e8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/297292/original/file-20191016-98640-bd9e8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/297292/original/file-20191016-98640-bd9e8g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/297292/original/file-20191016-98640-bd9e8g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/297292/original/file-20191016-98640-bd9e8g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/297292/original/file-20191016-98640-bd9e8g.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/297292/original/file-20191016-98640-bd9e8g.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Being pregnant in prison can put women in a highly vulnerable position.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/1151410031?src=mPLq3KYa7ZiVsaGmhe2Ltw-1-89&size=huge_jpg">Shutterstock/kittirat roekburi</a></span>
</figcaption>
</figure>
<p>After safety concerns were raised in 2018, the government stated that “specific training on dealing with pregnancy in prison has been made available to all prison officers” and “health care in prisons is provided by trained doctors and nurses”. But it appears the government is missing a fundamental issue here – only registered midwives and doctors are trained to provide care for labouring women – and misrepresenting the midwives’ role <a href="https://www.nmc.org.uk/about-us/governance/our-legal-framework/our-order-and-rules/">is a legal breach</a>.</p>
<p>The expectation placed upon prison staff to carry out “checks” on pregnant women overnight also begs the question as to whether they are trained (or indeed supported) should they come across a woman who may be haemorrhaging or even a newborn baby in need of resuscitation.</p>
<h2>Maternity care needed</h2>
<p>Where midwives are the lead coordinator of care in prisons it works well. “The Perinatal Pathway” at <a href="http://www.justice.gov.uk/contacts/prison-finder/low-newton">HMP Low Newton in County Durham</a>, for example, facilitates continuity of care for all pregnant women and new mothers in prison. This pathway came about after the tragic suicide of Michelle Barnes five days after the <a href="https://www.bbc.co.uk/news/uk-england-37734706">birth of her third child</a>. It ensures a specialist prison midwife, with substantial protected time (30 hours a week), leads the care for all pregnant women and new mothers for up to a year after they have given birth. </p>
<p>It’s clear, then, that what’s needed to urgently rectify this situation, is seamless collaboration between the Prison Service, NHS Trusts and charities like <a href="https://www.birthcompanions.org">Birth Companions</a> which supports pregnant women and new mothers. </p>
<p>Midwives also need to be involved at every step. And attention is especially important with regards to managing pregnancy and childbirth emergencies. This should be the very basic level of expectation for maternity care and must be consistent across the whole female prison estate and not simply a reaction to tragedy.</p>
<p>Ultimately, though, women should not be giving birth in prison cells. And if, on a rare occasion, an unexpected birth occurs, the minimum a female prisoner should expect is to have an appropriately trained professional to support her and her baby. </p>
<p>* <em>names have been changed</em></p><img src="https://counter.theconversation.com/content/125339/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Laura Abbott does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Research offers an insight into the experiences of pregnant women left to give birth in their cells without midwivesLaura Abbott, Senior Lecturer in Midwifery, University of HertfordshireLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1181402019-06-12T11:05:00Z2019-06-12T11:05:00ZNumber of women steered towards repeat caesareans is much higher than necessary<figure><img src="https://images.theconversation.com/files/278287/original/file-20190606-97989-1bijs58.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Pregnant with possibilities. </span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/tEz8JU1j-00">Mustafa Omar</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>As many as one in four women in the UK <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2013.12.013">now give birth</a> by caesarean section, the vast majority of them carried out by choice. The overall number has more than trebled in the last 40 years.</p>
<p>While it is true that birthing outcomes for women and babies have improved over this period, there is no evidence that this is a direct result of the increase in caesareans. While women should be able to choose how they give birth, this is not always clearly presented to them by doctors or midwives. This could undermine the ability of these mothers to choose whichever option is right for them, whether a caesarean or a vaginal birth. </p>
<p>Something like four in five caesareans are planned as opposed to emergency, and many are women who have already given birth the same way in a previous pregnancy. In many hospitals in the UK, this means that the proportion of women who have vaginal births after previously having caesareans is low. </p>
<p>This is despite the fact that vaginal births after caesareans <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/">are successful</a> in as many as 76% of cases – in situations when these births are not working out, normally it simply means that the mother needs to give birth by another caesarean instead. So what’s the problem?</p>
<h2>Reluctant doctors</h2>
<p>The policy and professional guidelines in the UK <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/">say that</a> clinicians should involve women in these birthing decisions. Clinicians’ professional bodies <a href="https://www.rcog.org.uk/en/guidelines-research-services/guidelines/gtg45/">recognise</a> that it is safe for most women to have vaginal births after caesareans, yet the quality of information they receive varies, and there is <a href="https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1016/j.ijgo.2013.12.013">evidence that</a> some clinicians are conservative about supporting women to let nature take its course.</p>
<p>Though many parts of the UK <a href="https://www.nice.org.uk/guidance/cg132?unlid=9290976632016213173944">have established</a> “pathways of care” which aim to improve the access and consistency of the information, pregnant women still don’t always receive full and unbiased advice. It has been <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/1471-2393-12-85">described</a> as a “fog” of conflicting opinions and advice, based on the clinician’s experience or personal preference rather than scientific evidence.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/278289/original/file-20190606-98003-17poll6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">‘Your best option …’</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-doctor-hospital-397630249?src=QNhWlCwzzeSvbzgASYphAA-1-2&studio=1">Africa Studio</a></span>
</figcaption>
</figure>
<p>This may be the result of obstetricians with less experience in giving the relevant counselling – or who lack the confidence to manage the labour of women who opt for a natural birth, which may be more complicated. Part of the problem is that the prospects for a successful vaginal birth in these circumstances varies from woman to woman, and there is no UK model available that accurately predicts which women are likely to be more successful. </p>
<p>While this exists in other countries, such as <a href="https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.12605">the Netherlands</a>, you can’t just cut and paste another national model because women vary from country to country in everything from ethnicity to the state of their health. To ensure that UK women can properly take part in a shared decision-making process, with information that is tailored to them, we therefore need to develop a model based on data collected within the country. </p>
<h2>The UK study</h2>
<p>I have been involved in <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2226-6">a study</a> aimed at identifying predictive characteristics that could inform such a model. We used detailed clinical information for over 1,600 women who had attempted vaginal births after a previous caesarean. This is the largest UK study using consistently detailed data, and also includes about three times more women than any European studies. </p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=899&fit=crop&dpr=1 600w, https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=899&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=899&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1129&fit=crop&dpr=1 754w, https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1129&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/278290/original/file-20190606-98022-1q8icr9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1129&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Counting down.</span>
<span class="attribution"><a class="source" href="https://unsplash.com/photos/6CVObBqPkTY">Mustafa Omar</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>In keeping <a href="https://www.ncbi.nlm.nih.gov/pubmed/23921867">with</a> previous <a href="https://www.ncbi.nlm.nih.gov/pubmed/17466668">studies</a>, we found that factors that made such women more likely to have a successful vaginal birth included: not being overweight; having previously had a caesarean because the baby was in breech position; or having previously had a vaginal birth as well as a caesarean. Importantly, however, we also found that a previous caesarean in the second stage of labour – when the cervix has completely opened and the woman has started pushing – was strongly associated with a successful vaginal birth for a future pregnancy. </p>
<p>It is hoped that these findings will encourage clinicians to take the evidence into account when offering advice. Our next step is to test the same findings on a larger number of women using data from across Scotland – this first study concentrated on Scottish women from one hospital. In time, this should help develop a clinical tool that will support women to make more informed choices about how they give birth – hopefully making more women confident about their ability to give birth vaginally, if that is what they choose to do.</p><img src="https://counter.theconversation.com/content/118140/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Tracy Humphrey receives funding from Chief Scientist Office (Scotland), Burdett Trust, Global Research Challenge Fund, Scottish Government International Development Fund and NHS Education for Scotland.</span></em></p>Professional bodies say that vaginal births after caesareans are safe and usually successful. So why do doctors often recommend that women go back under the knife?Tracy Humphrey, Dean of Health and Social Care, Edinburgh Napier UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1114752019-02-28T15:48:04Z2019-02-28T15:48:04ZEmergency caesareans increase risk of postnatal depression in new mothers, our research suggests<figure><img src="https://images.theconversation.com/files/261077/original/file-20190226-150721-1fk797t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">shutterstock</span></span></figcaption></figure><p>Becoming a mother, especially for the first time, has its challenges – and it starts with giving birth. </p>
<p>From woman to woman, the birth experience can vary tremendously – and one of the most important factors that determines the experiences new mothers have is the delivery method. In the UK about <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2016-17">16% of mothers</a> have a an emergency caesarean section, which is performed when the life of the baby or the mother is at risk. </p>
<p>Research has shown the impact this procedure has on mothers’ bodies – including risk of infections, persistent wound and abdominal discomfort – but less is known about the possible consequences for their mental health. </p>
<p><a href="https://www.sciencedirect.com/science/article/pii/S0167629617308937">My study</a> analyses the effect of having an unplanned caesarean on new mothers’s psychological well-being. We used a representative sample of 5,000 new mothers living in the UK. It found that giving birth through an emergency caesarean increases the risk of developing postnatal depression in the first nine months after childbirth by about 15%.</p>
<h2>Increasing risk</h2>
<p>The number of women giving birth by cesarean section has risen over the years. In England, for example, for every 100 new babies, 26 are born through a caesarean section. Compare this with the 1990s, when only <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2016-17">12-15%</a> of deliveries were cesareans (emergency and elective).</p>
<p>According to <a href="https://digital.nhs.uk/data-and-information/publications/statistical/nhs-maternity-statistics/2013-14">NHS estimates</a>, in 2013-2014 about 42,000 first time mothers delivered their baby through this procedure – and most of these were emergency deliveries (31,500). Similar phenomenons have also been observed in other countries. </p>
<h2>Long-term impact</h2>
<p>Postnatal depression can have a profound and long-term impact on the lives of new mothers. It can lead to a <a href="https://www.sciencedirect.com/science/article/pii/0277953693903385">deterioration of their relationship</a> with their partner and limit their <a href="https://books.google.co.uk/books?hl=en&lr=&id=eam6Sagya_wC&oi=fnd&pg=PP1&ots=rvDy1k_uxs&sig=HDAUdsFrzRPawi8RQjXM-4iEX6w&redir_esc=y#v=onepage&q&f=false">ability to work</a>. </p>
<p>Postnatal depression can also become a chronic condition affecting the way mothers look after their children. Indeed, <a href="https://www.who.int/reproductivehealth/publications/maternal_perinatal_health/cs-statement/en/">previous studies</a> have found <a href="https://pediatrics.aappublications.org/content/115/2/306">lower immunisation rates</a> and higher hospital admissions among children of depressed mothers. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/260706/original/file-20190225-26149-b076x0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Postnatal depression is a type of depression that many parents experience after having a baby.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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<p>Mothers giving birth through an emergency caesarean are different from mothers who give birth naturally in many ways. For example, older or overweight women are more likely to have an emergency caesarean. Complications during labour due to the baby’s health may result in an emergency caesarean. And this can also have an effect on the mother’s psychological well-being, as she may worry for her baby’s health. </p>
<p>In the study, it was important to account for these differences, because what we were interested in was whether emergency caesareans increases the risk of postpartum depression – rather than the effect of these existing factors. </p>
<h2>More support</h2>
<p>We considered all these factors and concluded that women giving birth through an emergency caesarean were 15% more likely to develop postnatal depression. This is a large percentage, when you consider that about one in every three mothers experience some form of postnatal depression after childbirth.</p>
<p>Exactly why this happens, is still unknown. But previous studies have argued that <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/birt.12168">longer and more difficult postpartum recovery</a> for mothers who had a caesarean delivery, as well as the <a href="https://www.sciencedirect.com/science/article/pii/0277953693903385">separation of mothers from their babies</a> directly after the delivery may cause this phenomenon. Another explanation is that because emergency caesareans are unexpected events, <a href="https://www.sciencedirect.com/science/article/pii/S0277953607000779">they may be associated with loss of control</a> and with a birth experience that is very different from what was expected. </p>
<p>Of course, in many cases, emergency deliveries cannot be avoided. But the results of this research highlight the importance of providing additional psychological support to women who have an emergency caesarean. This is important, because supporting mothers who give birth through an emergency caesarean may not only help to reduce the risk of postnatal depression and improve their well-being, but it could also benefit their families, and in particular their children.</p><img src="https://counter.theconversation.com/content/111475/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Valentina Tonei receives funding from the British Academy through a BA Postdoctoral fellowship (Award reference: pf160106). This research was supported by an ESRC PhD scholarship.
</span></em></p>New study finds that giving birth through an emergency caesarean increases the risk of developing postnatal depression in the first nine months after childbirth by about 15%.Valentina Tonei, Research Associate in the Department of Economics, University of YorkLicensed as Creative Commons – attribution, no derivatives.