2021 № 9 Evaluation of the effectiveness of continuous support by midwives and douls in childbirth.
All the midwives around the word have been struggling in recent decades to reduce the level of unjustified interventions in the birth process. This study was aimed at determining how the continuous support of a private midwife or doula in childbirth will affect the level of caesarean delivery, epidural anesthesia, amniotomy, episiotomy, perineal traumas, labour stimulation with oxytocin and vacuum fetal extraction.
The concept of normal childbirth has changed fundamentally over the past 10 years – from stimulation and acceleration of the birth process to monitoring the normal course of labour. It is of great importance to determine labour satisfaction level, needs of women in labour, which are directly related to the understanding of the birth process by women and the provision of support during childbirth.
The Global Strategy for Women's, Children's and Adolescents' Health (2016–2030) is focused not only on childbirth survival, but also on the opportunity to fully realize the potential of life and health. A positive childbirth experience is very important for women, it is part of their personal and sociocultural expectations. Modern women want to give birth to a healthy baby in a safe and caring environment with continuous support during childbirth and postnatal period. They want to know how their childbirth is proceeding and control this process, making decisions together with healthcare professionals.
The main purpose of the study was to examine how continuous support during childbirth affects the following factors: vaginal delivery, cesarean delivery, amniotomy, epidural anesthesia, oxytocin stimulation, episiotomy, perineal ruptures, vacuum fetal extraction. We present a retrospective cohort observational population study of all the women who gave birth in the Russian Federation in the period from June 2015 to June 2019. All the patients of the main cohort received continuous support in childbirth from a private midwife or doula. The patients from the control group gave birth under standard conditions.
All the patients of the main cohort attended a course of lectures on childbirth and postnatal period. They learned all about labour stages, how it begins, proceeds and ends. The women studied relaxation techniques, including breathing techniques, massage, aromatherapy; various positions for greater comfort during childbirth. 95% of the women attended lectures with their partners. The partners were trained to provide emotional support, to give a massage and to practise breathing techniques.
There were 7,864,496 births in Russia in the period from June 2015 to June 2019. Of these, 30,0% of cesarean sections, 1,1% of vacuum fetal extractions, the perinatal mortality rate was 7,89%.
We have obtained the following results of our study: of 1082 women who received continuous support in childbirth, 165 gave birth by caesarean section (16%, OR0,4). The level of epidural anesthesia in childbirth was 26% (in the control group – 92%, OR0,3), labour stimulation with oxytocin – 12% (in the control group – 78%, OR0,3), episiotomy – 2% (in the control group – 21%, OR0,07), perineal traumas – 28% (in the control group – 74%, OR0,37), amniotomy – 26% (in the control group – 84%, OR0,3), vacuum fetal extraction – 0,5% (in the control group – 1%, OR1,6), perinatal mortality – 0 cases.
Continuous support in childbirth from a private midwife or doula reduces the level of cesarean section, the frequency of synthetic oxytocin use to stimulate labour, amnitomy, episiotomy, perineal traumas and vacuum fetal extraction and increases labour satisfaction level.