Midwifery care that encourages pregnant women who choose epidural labor to take autonomy in their childbirth ―Comparison to natural birth―

Abstract

Purpose

This study clarifies the role of midwifery care in achieving childbirth autonomy in pregnant women scheduled to deliver elective epidural labor. By comparing epidural labor with natural birth, it offers suggestions for midwifery care that are necessary to elicit the autonomy of childbirth for pregnant women who wish to have the same.

Methods

A total of 146 midwives who work at facilities in the Tokyo metropolitan area that handle natural birth and epidural labor, are currently involved in antenatal checkups, and have at least three years of experience as a midwife were selected for this study. An anonymous self-administered questionnaire survey was administered. The primary analysis calculated the basic statistics for midwifery care leading to maternal autonomy in childbirth, followed by Mann-Whitney U tests of differences between variables. The study was approved by the Ethical Review Committee of Yokohama City University, which took into account all relevant ethical considerations (approval number: F230800034).

Results

A total of 97 valid responses were obtained from the questionnaire (collection rate: 69.1%; valid response rate: 96.0%). Midwifery care that encourages pregnant women to take the autonomy in childbirth achieves high implementation rates of care elements in both natural birth and epidural labor and includes “giving encouraging words to recognize the pregnant woman's efforts (natural birth 99.0%, epidural labor 96.9%)”, “during the preventive examination, in addition to the essential examination points, listen to the pregnant woman's concerns and questions (natural birth 97.9%, epidural labor 98.9%),” and “acknowledge and respect what the pregnant woman has to say (natural birth 97.9%, epidural labor 96.9%).” In contrast, “encouraging interaction with other pregnant women received low implementation rates (natural birth 28.9%, epidural labor 32.0%)”. Concerning the awareness of midwifery care to take autonomy in childbirth for pregnant women planning to give birth through epidural labor, the highest percentage of respondents chose “the same as natural birth” for most of the items. The implementation rates of midwifery care in epidural labor showed differences in the availability of midwifery care education/training for autonomy in childbirth.

Conclusion

Midwifery care during the gestational period to promote autonomy in childbirth is the same for both natural birth and epidural labor and is based on the same awareness. However, there were differences in the availability of midwifery care education/training in epidural labor, suggesting that improved education/training for midwives could support the autonomy of pregnant women who wanted to have epidural labor.