Click here for the Freedom of Movement

research proposal powerpoint presentation

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Words used to describe movement restricted birth: Powerless Disregarded Demoralizing Angry Mortified Stressed Awful Prison

Words used to describe non restricted labor/birth movement: Free Ease Safe Instinctual Great Beautiful Pleased

(qualitative data received from 57 mothers, November 2013)

DATA TABLES to be posted

Movement Freedom During Labor  to Reduce Adverse

Maternal Outcomes in Low Risk Pregnancies.

  1. Statement of the Project:

Adverse maternal outcomes can be caused by problems arising during labor or birth, such as a fetal malpresentation,  placental issues, or failure to progress.  Emotional and Psychological trauma as a result from birth is caused by feelings of restraint, lack of control, lack of sanction or consent, humiliation, fear and distress as well as physical complications and interventions (Clark SL, Belfort MA, Byrum SL, Meyers JA, Perlin JB,.2008).  This project is an intervention to reduce adverse maternal outcomes.

  1. Contribution to Society:

Close to 30% of women experience complications related to childbirth (Berg, 2009) and 25 and 34 percent of women report traumatic birth experiences (Simkin and Bolding, 2004). Movement physical, psychological and emotional advantages for both mother and baby leading to an easier and faster birth, with less adverse outcomes (Walker, et al, 2012).

  1. Need for change:

In our current maternity system, surgical birth is high as well as inductions, epidurals and other interventions that interfere with a normal, physiologic birth. The need for change is considerable.  (Jolivet,  Sakala, and  Corry, 2009).

  1. Theoretical Foundation:

Movement makes a mother more comfortable physically feeling less pain and restriction and less stressed emotionally and psychologically, allowing for a shorter labor, reducing failure to progress and encouraging cervical dilation, effacement, and baby’s positioning into the correct station for birth, allowing a faster descent  (Simkin and Bolding, 2004).

  1. Investigator Position (Action Researcher’s Role):

In this action research, I plan to be involved by collecting the data from the women by integrating myself into the birth centers and hospitals. I would prefer to collect the questionnaires in person and visit prenatal classes and childbirth education classes to have face-time with the women who are in the intervention cohort. My role will also be directly educating the women on the intervention of movement.  I plan to explain why this intervention was designed, how similar programs and ventures have been successful previously, and the best ways to integrate movement into labor and birth. I will partner with childbirth educators (thorough my collaborating organizations)  to share these labor movements and tools with the women. I will also discuss practice guidelines and policy implementation in birthing facilities with the facility administration.

 

  1. Research Questions or Goals and Objectives of your project:

The question that is posed for this action research proposal is:

  • What is the impact on movement in the 1st and 2nd stages of labor in relation to adverse maternal outcomes?
    • Does this intervention reduce the incidence of these adverse outcomes?
    • Does the intervention of movement have a direct effect on the length of labor?
  1. Action Plan (Action Research Methods):

The aim of this intervention is to teach mothers and maternity care professionals how the use of movement in the 1st and 2nd stages of labor can prevent or significantly reduce adverse birth outcomes including trauma, psychological anxiety, induction and surgical birth.

  1. Dissemination Plan:

The dissemination of the results will be broadcasted through the organizations, “ Improving Birth” and “BirthPower,” the main two collaborators. These organizations have extensive social and educational networks involving the distribution of evidence-based pregnancy and birth materials, support and publishing practice briefs.  The target population of “ Improving Birth” is mainly pregnant women and mothers, but also includes maternal/child health professionals such as midwives, obstetricians, psychologists, nurses and childbirth educators. This organization is an educational, outreach and advocacy group that is committed to bring evidence-based care and humanity to childbirth.  They could include the results of this research on their websites and educational materials.

  1. Action Research Methods:

The recruitment of participants for this study would include an informative flyer to be given to prenatal care facilities, ie. OB offices, pregnancy clinics and midwife offices that serve the two major birthing facilities used in the study (Special Beginnings birth center and Montgomery General Hospital (MedStar) maternity center). This flyer would ask people for interest in participation and give details about the Freedom of Movement initiative for intervention to prevent adverse birth outcomes.

Data Collection

A first set of questionnaires will be distributed to the study participants after being recruited through prenatal care office visit flyers. The first questionnaire asks how they plan to birth, if they are low or high risk, what number pregnancy this is, and if they’re interested in learning more about being involved with the Freedom of Movement Initiative and if so, they will be offered practice guidelines and suggestions for actively choosing their own positions (Freedom of Movement intervention program).

Shortly after birth,  the second questionnaire will be completed by the same participants. This will collect the data regarding use of FMI and adverse outcomes.   Questions include enjoyment or pain sensations in labor and birth, emotional and psychological comfort levels, movement restriction or freedom, ICD-9 code and self reported trauma.  It will also record length of labor and method of delivery.  Their data will be collected via survey monkey and written surveys given to 1 hospital and 1 birth center in the DC metro area (Montgomery General Med Star and Special Beginnings) . Neither provider nor mother will be able to be identified in the data analysis.

In addition to maternal questionnaire,  data from hospital records including the statistics of  number of adverse birth outcomes before intervention and number after intervention implemented at the facility will be collected at 3, 6, and 9 months after the FMI intervention is implemented.  The number of ICD9 trauma codes reported before intervention and number after intervention implemented at the facility will be compared also before implementation and at 3, 6, and 9 months after the FMI intervention is implemented.

References:

Albers L, Anderson D, Cragin L, Moore Daniels S, Hunter C, Sedler K.  (1997). The

relationship  of  ambulation in labor to operative delivery. Journal of Nurse-Midwifery;42(1):4–8.

American Congress of Obstetricians and Gynecologists. (2009). “ACOG Practice Bulletin

No.  106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles.” Obstetrics and gynecology 114(1): 192-202.

Berg, C. (2009). “Overview of Maternal Morbidity During Hospitalization for Labor and

Delivery in the United States 1993–1997 and 2001–2005,” Obstetrics and Gynecology, Vol. 113, No. 5.

Caldeyro-Barcia, R. qtd in O’Mara, P, Facciolo, J, and Ponte, W. (2003). Mothering

Magazine’s Having a Baby, Naturally: The Mothering Magazine Guide to Pregnancy and Childbirth. Simon and Schuster.

Dekker, R. (2012). Evidence Based Birth. Giving Birth Based on Best Evidence. Labor Day

2012: The State of Evidence-Based Maternity Care in the United States. Available: http://evidencebasedbirth.com/labor-day-2012-the-state-of-evidence-based-maternity-care-in-the-united-states/

Gupta JK, Hofmeyr GJ, Smyth R. (2004). Position in the second stage of labour for women

without epidural anaesthesia (Cochrane Review). The Cochrane Database of Systematic Reviews;Issue 1.

Jolivet, R., Sakala, C.,  and  Corry, M. ed (2009). Transforming Maternity Care — 2020 Vision

for a High Quality, High Value Maternity Care System, Blueprint for Action and Proceedings from the Childbirth Connection 90th Anniversary Symposium. Women’s Health Issues .v. 20, i.1, Supplement, January–February 2010, Pages S7–S17.

Koch,T, Mann,S, Kralik, D and van Loon, A. (2005).  Reflection: Look, think and act cycles in

participatory action research. Journal of Research in Nursing. 10; 261

Lavender T and Mlay R. (2006). Position in the second stage of labour for women without

epidural anaesthesia: RHL commentary. The WHO Reproductive Health Library; Geneva: World Health Organization.

Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, & Styles C. (2009). Maternal positions and

mobility during first stage labour. Cochrane Database Syst Rev. 15(

Martin JA, Hamilton BE, Ventura SJ, Osterman MJK, and Mathews TJ. (2013). Births: Final

data for 2011. National vital statistics reports; vol 62no 1. Hyattsville, MD: National Center for Health Statistics.

Online Research Ethics Course (2002). Practical Ethics Center at the University of Montana

and Department of Health and Human Services, Office of Research Integrity (ORI). Available:  http://ori.hhs.gov/education/products/montana_round1/human.html

Oxorn, H., (1986). Human Labor and Birth. University of Ottawa, Ontario, Canada:

McGraw-Hill Professional Publishing.

Shilling, T., Romano, A., and DiFranco, A., (2007). Care Practice #2: Freedom of Movement

Throughout Labor. J Perinat Educ. Summer; 16(3): 21–24.

Simkin P, Bolding A. (2004). Update on nonpharmacologic approaches to relieve labor pain

and prevent suffering. Journal of Midwifery and Women’s Health;49(6):489–504.

Simkin P, O’Hara M. Nonpharmacologic relief of pain during labor: Systematic reviews of

five Methods (2002). American Journal of Obstetrics and Gynecology;186(Suppl. 5):S127–S159.

Stremler R, Hodnett E, Petreshen P, Stevens B, Weston J, Willan A. R. (2005). Randomized

controlled trial of hands-and-knees positioning for occipitoposterior position in labor. Birth;32(4):243–251

Terry, R., Wescott, J., O’Shea, L., Kelly, F. (2006). Postpartum Outcomes in Supine Delivery by

Physicians vs Nonsupine Delivery by Midwives. J Am Osteopath Assoc. 106:199-202.

The National Commission for the Protection of Human Subjects of Biomedical and

Behavioral Research, The Belmont report. (1979, April 18). U.S. Department of Health & Human Services. Available: http://www.hhs.gov/ohrp/humansubjects/guidance/belmont.html

Walker, C, Rodríguez, T,  Herranz , A, Espinosa, J, Sánchez, E, Espuña-Pons, M, (2012).

Alternative model of birth to reduce the risk of assisted vaginal delivery and perineal trauma.  International Urogynecology Journal, v.23, i. 9, pp 1249-1256.

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