The Role of Maternity Care Providers in Promoting Shared Decision Making Regarding Birthing Positions During the Second Stage of Labor

Abstract

Introduction Through the use of a variety of birthing positions during second stage labor, a woman can increase progress, improve outcomes, and have a positive birth experience. The role maternity care providers play in determining which position a woman uses during second stage has not been thoroughly explored. The purpose of this qualitative investigation was to explore how maternity care providers communicate with women during second stage labor regarding birthing position. Methods A literature informed framework was developed to conduct a process of deductive content analysis of communication patterns between nulliparous women and their maternity care providers during second stage. Literature regarding shared decision making, control, and predictors of positive birth experiences were reviewed to develop a coding framework. The framework included the following categories: listening to women, encouragement, information, offering choices and style of support. Forty-one audio tapes of women and their maternity care providers during second stage labor were transcribed verbatim and analyzed. Results Themes identified in the transcripts included all those in the analytic framework plus two added categories of communication: empathy and interaction. Maternity care providers in this study enabled women to select various birthing positions using a dynamic process that moved between open, informative approaches and more closed, directive approaches depending on the woman's needs and clinical condition. Women became more actively involved in shared decision making regarding birthing positions as providers found the right balance between being responsive to the woman's questions or directive as clinical conditions unfolded. Discussion Enabling shared decision making during birth is not a linear process using a single approach; it is dynamic process that requires a variety of approaches. Care providers can support a woman to use different birthing positions during second stage labor by employing a flexible style that incorporates clinical assessment and the woman's responses.

Does maternity care decision‐making conform to shared decision‐ making standards for repeat cesarean and labor induction after suspected macrosomia?

“…Our findings reinforce the perception that decision‐making in maternity care is a complicated, multifaceted experience with potential for improvement . We found that a large majority of mothers reported having a discussion with their maternity care providers about how to give birth after 1 or 2 prior cesareans, and about half reported a discussion about spontaneous vs induced labor after being told their baby might be quite large.…”

Measuring women’s experiences of decision-making and aspects of midwifery support: a confirmatory factor analysis of the revised Childbirth Experience Questionnaire

“…Corresponding items in the participation domain in the original CEQ assessed possibilities to be up and free to move, and to select birthing position and pain relief. Women's choices of mobility and upright positions [43] during labour are beneficial, and should be encouraged [44]. Whilst one newly developed item addressing mobility did not fit in the yielded model, and was thus excluded in the CEQ2, new items relating to receiving information and involvement in decision-making were identified to be of greatest importance and relevance to include [45].…”

Gebärpositionen – Einflussfaktoren auf die Anleitung der Gebärenden

“…Dieser könnte aber laut Autorenteam auch an einer verbesserten Messung des Blutverlustes liegen. Abgesehen von den körperlichen Auswirkungen haben Frauen, die aufrecht gebären oder ihre Position selbst aussuchen, ein stärkeres Kontrollgefühl und ein besseres Geburtserleben [21] [23]. Dieser letzte Punkt kann gerade im Hinblick auf die Prävention traumatisierender Geburtshilfe einen hohen Stellenwert einnehmen.…”

“…Wenn während der Geburt Komplikationen auftreten (z. B. Schulterdystokie oder abnormale fetale Herzfrequenz), wird auch die Position der Gebärenden verändert [21] [10]. Leider wird das nur erwähnt und nicht näher beschrieben, welche Positionen ausgewählt werden.…”

“…Frauen wünschen sich verschiedene Gebärpositionen. Der Wunsch der Frau hat einen Einfluss und Hebammen geben diesem nach [21][10] [9]. Oft wünschen sich Frauen aufrechte Positionen [21] [22], was den aktuellen Evidenzen und Leitlinien entspricht.…”