Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Factors promoting or inhibiting normal birth

Authors: Samantha J. Prosser, Adrian G. Barnett, Yvette D. Miller

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

Login to get access

Abstract

Background

In response to rising rates of medical intervention in birth, there has been increased international interest in promoting normal birth (without induction of labour, epidural/spinal/general anaesthesia, episiotomy, forceps/vacuum, or caesarean section). However, there is limited evidence for how best to achieve increased rates of normal birth. In this study we examined the role of modifiable and non-modifiable factors in experiencing a normal birth using retrospective, self-reported data.

Methods

Women who gave birth over a four-month period in Queensland, Australia, were invited to complete a questionnaire about their preferences for and experiences of pregnancy, labour, birth, and postnatal care. Responses (N = 5840) were analysed using multiple logistic regression models to identify associations with four aspects of normal birth: onset of labour, use of anaesthesia, mode of birth, and use of episiotomy. The probability of normal birth was then estimated by combining these models.

Results

Overall, 28.7% of women experienced a normal birth. Probability of a normal birth was reduced for women who were primiparous, had a history of caesarean, had a multiple pregnancy, were older, had a more advanced gestational age, experienced pregnancy-related health conditions (gestational diabetes, low-lying placenta, high blood pressure), had continuous electronic fetal monitoring during labour, and knew only some of their care providers for labour and birth. Women had a higher probability of normal birth if they lived outside major metropolitan areas, did not receive private obstetric care, had freedom of movement throughout labour, received continuity of care in labour and birth, did not have an augmented labour, or gave birth in a non-supine position.

Conclusions

Our findings highlight several relevant modifiable factors including mobility, monitoring, and care provision during labour and birth, for increasing normal birth opportunity. An important step forward in promoting normal birth is increasing awareness of such relationships through patient involvement in informed decision-making and implementation of this evidence in care guidelines.
Appendix
Available only for authorised users
Literature
1.
2.
Werkmeister G, Jokinen M, Mahmood T, Newborne M. Making normal labour and birth a reality – developing a multi disciplinary consensus. Midwifery. 2008;24:256–9.CrossRef
3.
Declercq E, Young R, Cabral H, Ecker J. Is a rising cesarean delivery rate inevitable? Trends in industrialized countries, 1987 to 2007. Birth. 2011;38:99–104.CrossRef
4.
Anim-Somuah M, Smyth RMD, Jones L. Epidural versus non-epidural or no analgesia in labour. Cochrane Database Syst Rev. 2011;(12) Art. No.: CD000331
5.
Bernitz S, Øian P, Rolland R, Sandvik L, Blix E. Oxytocin and dystocia as risk factors for adverse birth outcomes: a cohort of low-risk nulliparous women. Midwifery. 2014;30:364–70.CrossRef
6.
Grivell RM, Reilly AJ, Oakey H, Chan A, Dodd JM. Maternal and neonatal outcomes following induction of labor: a cohort study. Acta Obstet Gyn Scan. 2011;91:198–203.CrossRef
7.
Knight M, Kurinczuk JJ, Spark P, Brocklehurst P. Cesarean delivery and peripartum hysterectomy. Obstet Gynecol. 2008;111:97–105.CrossRef
8.
Allen VM, Stewart A, O’Connell CM, Baskett TF, Vincer M, Allen AC. The influence of changing post-term induction of labour patterns on severe neonatal morbidity. J Obstet Gynaecol Can. 2012;34:330–40.CrossRef
9.
MacDorman MF, Declercq E, Menacker F, Malloy MH. Neonatal mortality for primary cesarean and vaginal births to low-risk women: application of an “intention-to-treat” model. Birth. 2008;35:3–8.CrossRef
10.
11.
Society of Obstetricians and Gynaecologists of Canada. Association of Women's health obstetric and neonatal nurses of Canada, Canadian Association of Midwives, College of Family Physicians of Canada, Society of Rural Physicians of Canada. Joint policy statement on normal birth. J Obstet Gynaecol Can. 2008;30:1163–5.CrossRef
12.
Australian Health Ministers’ Conference. National Maternity Services Plan. Canberra: ACT: Commonwealth of Australia; 2010. p. 2011.
13.
Queensland Maternity and Neonatal Clinical Guidelines Program. Queensland Maternity and Neonatal Clinical Guideline: Normal birth. Brisbane: Queensland Government; 2012.
14.
New South Wales Health. Maternity – Towards Normal Birth in NSW. Doc No. PD2010_45. Sydney: Department of Health; 2010.
15.
The Birthplace in England Collaborative Group. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the birthplace in England national prospective cohort study. Brit Med J. 2011;343:d7400.CrossRef
16.
Miller YD, Prosser SJ, Thompson R. Back to normal: a retrospective, cross-sectional study of the multi-factorial determinants of normal birth in Queensland, Australia. Midwifery. 2015;31:818–27.CrossRef
17.
Robson SJ, Laws P, Sullivan EA. Adverse outcomes of labour in public and private hospitals in Australia: a population-based descriptive study. Med J Aust. 2009;190:474–7.PubMed
18.
Miller YD, Prosser SJ, Thompson R. Going public: do risk and choice explain differences in caesarean birth rates between public and private places of birth in Australia? Midwifery. 2012;28:627–35.CrossRef
19.
Dahlen HG, Tracy S, Tracy M, Bisits A, Brown C, Thornton C. Rates of obstetric intervention among low risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open. 2012;2:e001723.CrossRef
20.
Einarsdóttir K, Stock S, Haggar F. Neonatal complications in public and private patients: a retrospective cohort study. BMJ Open. 2013;3:e002786.CrossRef
21.
Dahlen HG, Tracy S, Tracy M, Bisits A, Brown C, Thornton C. Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study. BMJ Open. 2014;4:e004551.CrossRef
22.
Howell S, Johnston T, Macleod SL. Trends and determinants of caesarean sections births in Queensland, 1997-2006. Aust N Z J Obstet Gynaecol. 2009;49:606–11.CrossRef
23.
Roberts CL, Tracy S, Peat B. Rates for obstetric intervention among private and public patients in Australia: population based descriptive study. BMJ. 2000;321:137–41.CrossRef
24.
Sandall J, Saltani H, Gates S, Shennan A, Devane D. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2015;(9) Art. No.: CD004667
25.
Gagnon AJ, Meier KM, Waghorn K. Continuity of nursing care and its link to cesarean birth rate. Birth. 2007;34:26–31.CrossRef
26.
Allen RE, Hanson RW. Episiotomy in low risk vaginal deliveries. J Am Board Fam Pract. 2005;18:8–12.CrossRef
27.
Lerchl A. Where are the Sunday babies? III. Caesarean sections, decreased weekend births, and midwife involvement in Germany. Naturwissenschaften. 2008;95:165–70.CrossRef
28.
29.
Cluett ER, Burns E. Immersion in water in labour and birth. Cochrane Database Syst Rev. 2009;(2) Art. No.: CD000111
30.
Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;(8) Art. No.:CD003934
31.
Hodnett ED, Gates S, Hofmeyr G, Sakala C. Continuous support for women during childbirth. Cochrane Database Syst Rev. 2013; Issue 7: Art. No.: CD003766.
32.
Humphrey T, Tucker JS. Rising rates of obstetric interventions: exploring the determinants of induction of labour. J Public Health. 2009;31:88–94.CrossRef
33.
Guidelines Committee of the Royal College of Obstetricians and Gynaecologists. Green–top Guideline No. 27. Placenta Praevia, Placenta Praevia Accreta and Vasa Praevia: Diagnosis and Management. London: Royal College of Obstetricians and Gynaecologists; 2011.
34.
Laughon SK, Zhang J, Grewal J, Sundaram R, Beaver J, Reddy UM. Induction of labor in a contemporary obstetric cohort. Am J Obstet Gynecol. 2012;206:486e1–9.CrossRef
35.
Jeschke E, Ostermann T, Dippong N, Brauer D, Pumpe J, Meißner S, Matthes H. Identification of maternal characteristics associated with the use of epidural analgesia. J Obstet Gynaecol. 2012;32:342–6.CrossRef
36.
Janssens S, Wallace KL, Chang AMZ. Prepartum and intrapartum caesarean section rates at mater mothers’ hospital Brisbane 1997–2005. Aust N Z J Obstet Gynaecol. 2008;48:564–9.CrossRef
37.
Prosser SJ, Miller YD, Thompson R, Redshaw M. Why 'down under' is a cut above: a comparison of rates of and reasons for caesarean section in England and Australia. BMC Pregnancy Childbirth. 2014;14:149.CrossRef
38.
Dzakpasu S, Fahey J, Kirby RS, Tough SC, Chalmers B, Heaman MI, et al. Contribution of prepregnancy body mass index and gestational weight gain to caesarean birth in Canada. BMC Pregnancy Childbirth. 2014;14:106.CrossRef
39.
Poobalan AS, Aucott LS, Gurung T, Smith WCS, Bhattacharya S. Obesity as an independent risk factor for elective and emergency caesarean delivery in nulliparous women – systematic review and meta-analysis of cohort studies. Obes Rev. 2009;10:28–35.CrossRef
40.
41.
Essex H, Green J, Baston H, Pickett K. Which women are at an increased risk of a caesarean section or an instrumental vaginal birth in the UK: an exploration within the millennium cohort study. BJOG. 2013;120:732–43.CrossRef
42.
Prosser SJ, Miller YD, Armanasco A, Hennegan J, Porter J, Thompson R. Findings from the having a baby in Queensland survey, 2012. Brisbane: Queensland Centre for Mothers & Babies, The University of Queensland; 2013.
43.
Li Z, Zeki R, Hilder L, Sullivan EA. Australia’s mothers and babies 2011. Perinatal statistics series no. 28. Cat. no. PER 59. Canberra: AIHW National Perinatal Epidemiology and Statistics Unit; 2013.
44.
Queensland Health. Perinatal statistics: Queensland 2011. Brisbane: Queensland Department of Health; 2014.
45.
Plummer M. Rjags: Bayesian graphical models using MCMC. R package version. 2013:3–11.
46.
R Core Team. R: A Language and Environment for statistical computing. Vienna: R Foundation for Statistical Computing; 2013.
47.
48.
Dodwell M. Normal birth rates in England. NCT Perspective. 2012;16:16–7.
49.
Klein MC, Kaczorowski J, Hall WA, Fraser W, Liston RM, Eftekhary S, et al. The attitudes of Canadian maternity care practitioners towards labour and birth: many differences but important similarities. J Obstet Gynaecol Can. 2009;31:827–40.CrossRef
50.
Stevens G, Thompson R, Kruske S, Watson B, Miller YD. What are pregnant women told about models of maternity care in Australia? A retrospective study of women's reports. Patient Educ Couns. 2014;97:114–21.CrossRef
51.
Gupta JK, Hofmeyr J, Shehmar M. Position in the second stage of labour for women without epidural anaesthesia. Cochrane Database Syst Rev. 2012;(5) Art. No.: CD002006
52.
Queensland Clinical Guidelines. Intrapartum fetal surveillance. Brisbane: Queensland Government; 2015.
53.
Wood SH. Should women be given a choice about fetal assessment in labor? MCN Am J Matern Child Nurs. 2003;28:292–8.CrossRef
54.
Thompson R, Miller YD. Birth control: to what extent do women report being informed and involved in decisions about pregnancy and birth procedures? BMC Pregnancy Childbirth. 2014;14:62.CrossRef
55.
Webb DA, Culhane J. Time of day variation in rates of obstetric intervention to assist in vaginal delivery. J Epidemiol Commun H. 2002;56:577–8.CrossRef
56.
Bat-Erdene U, Metcalfe A, McDonald SW, Tough SC. Validation of Canadian mothers’ recall of events in labour and delivery with electronic health records. BMC Pregnancy Childbirth. 2013;13(Suppl 1):S3.CrossRef
57.
Gartland D, Lansakara N, Flood M, Brown SJ. Assessing obstetric risk factors for maternal morbidity: congruity between medical records and mothers’ reports of obstetric exposures. Am J Obstet Gynecol. 2012;206(152):e1–10.
58.
Rice F, Lewis A, Harold G, van den Bree M, Boivin J, Hay DF. Agreement between maternal report and antenatal records for a range of pre and peri-natal factors: the influence of maternal and child characteristics. Early Hum Dev. 2006;83:497–504.CrossRef
Metadata
Title
Factors promoting or inhibiting normal birth
Authors
Samantha J. Prosser
Adrian G. Barnett
Yvette D. Miller
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1871-5

Other articles of this Issue 1/2018

BMC Pregnancy and Childbirth 1/2018 Go to the issue

Research article

Attitudes of U.S. Hispanic and non-Hispanic women toward congenital CMV prevention behaviors: a cross sectional study

Research article

Stillbirth surveillance and review in rural districts in Bangladesh

Research article

Delivery of the second twin: influence of presentation on neonatal outcome, a case controlled study

Research article

First trimester medication use in pregnancy in Cameroon: a multi-hospital survey

Research article

Multilevel analysis of factors associated with assistance during delivery in rural Nigeria: implications for reducing rural-urban inequity in skilled care at delivery

Research article

Associations with perineal trauma during childbirth at home and in health facilities in indigenous municipalities in southern Mexico: a cross-sectional cluster survey