Midwifery and Childbirth News – Issue 146

Midwifery Today, Issue 146, Summer 2023.
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Perception of Birth Can Affect Outcomes

Childbirth education classes include a focus on the mindset of the mother: teaching her to expect birth to be positive and joyous. She is offered affirmations and encouraged to reframe her perception of birth as empowering and achievable. Two recent studies look at how the perceived fear of birth can affect birth outcomes and beyond. A 2023 study by Hoffmann, Hilger, and Banse focused on the actual birth experience, while Frontiers in Psychiatry measured mother-child bonding during the first postpartum year. In both cases, a positive mental mindset led to better birth outcomes and postpartum period.

  • Hoffmann, L, N Hilger, and R Banse, R. 2023. “The mindset of birth predicts birth outcomes: Evidence from a prospective longitudinal study.” European J Soc Psych 00: 1–15. doi/10.1002/ejsp.2940.
  • Seefeld, Lara, et al. 2022. “Birth Experience Mediates the Association Between Fear of Childbirth and Mother-Child-Bonding Up to 14 Months Postpartum: Findings From the Prospective Cohort Study DREAM.” Frontiers in Psychiatry 12: 776922. doi: 10.3389/fpsyt.2021.776922.

Can Non-Therapeutic Circumcision be Medically Justified?

Although the newborn circumcision rate in the US has declined in the past decades, approximately 55% of newborn males are still subjected to the procedure every year. While there are instances when circumcision is medically indicated, most operations are performed for non-therapeutic or cosmetic reasons. Deacon and Muir gather and analyze studies concerning the medical benefits and risks and conclude that while adult circumcision may confer some health benefits, the non-therapeutic, routine procedure cannot be medically justified.

  • Deacon, M, and G Muir. 2023. “What is the medical evidence on non-therapeutic child circumcision?” Int J Impot Res 35: 256–63 (2023). doi: 10.1038/s41443-021-00502-y.

A Better Understanding of Female Anatomy

A full exploration of the function and anatomy of the clitoris has generally been ignored in medical literature. Margaret Jowitt has done extensive research on this important aspect of female anatomy and how understanding the function of the clitoris during labor helps us understand best practices during birth. She has provided insights into how positions during labor can maximize contact of the baby’s head against the internal clitoral body aiding in the release of oxytocin, increasing blood flow, and minimizing obstructions in baby’s path. Her work is gaining exposure and can inform our understanding of optimal birth.

Health Resources and Services Administration Announces Availability of New Funding to Support Community-Based Doulas

The value doulas bring to families during pregnancy and birth has been recognized by the Biden-Harris Administration as a way to improve birth outcomes, especially for Black and minority communities. The 2023 National Budget includes $4.5 billion to increase the availability of doulas in areas with high rates of maternal and infant mortality and morbidity. The HRSA’s Healthy Start Initiative also funds programs aimed at improving and expanding maternal and infant health, reducing racial and ethnic disparities in the health care system, and providing support for community-based outreach.

Listening to Mothers about Induction

To improve maternity care in the US, the experiences of birthing mothers must be valued and included in shaping policies and health care decision-making. Non-medical inductions are on the increase in America and, with that, so is the cesarean section rate. According to a National Partnership for Women and Families 2020 survey of women who had hospital births, almost half felt pressure from the medical establishment to induce labor and more than a third reported inductions were for non-medical reasons.

  • Declercq, E, C Belanoff, and R Iverson. 2020. “Maternal perceptions of the experience of attempted labor induction and medically elective inductions: analysis of survey results from listening to mothers in California.” BMC Pregnancy Childbirth 20: 458. doi.org/10.1186/s12884-020-03137-x.

Early Detection of Postpartum Hemorrhage

This article details a randomized study that examined the effects of early detection and treatment of postpartum hemorrhage. The study found that compared to the usual care, the test and treatment protocol of early hemorrhage diagnosis, timely management, and subsequent referral for a potential blood transfusion was associated with significantly decreased maternal morbidity, mortality, and need for blood transfusions. These findings suggest that early detection and treatment of postpartum hemorrhage may be beneficial in improving maternal health outcomes.

  • Gallos, I, et al. 2023. “Randomized Trial of Early Detection and Treatment of Postpartum Hemorrhage.” NEJM. doi:10.1056/NEJMoa2303966.

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