This week the Journal of Asian Midwives published our short article ‘Out-of-hospital births: A small but growing phenomenon in high income countries: A viewpoint‘ . OOHBs (out-of-hospital births), is also referred to as freebirth (or freebirthing), unassisted childbirth and/or unassisted pregnancy . OOHB does not refer to giving birth at home before the midwife arrives at a home birth or the birth taking place in an ambulance or along the side of the road on the way to a maternity unit, this is called ‘born before arrival’. OOHB suggests an element of planning of planning a birth without a midwife (or other maternity-care professional).
The paper in the Journal of Asian Midwives highlights that during the COVID-19 pandemic, OOHBs were a way to avoid Public Health regulations and lock-down constraints, and to guarantee the presence of a partner at the birth. The authors argue, however, that the pandemic is not at the origin of the trend, but more of a catalyst. Advocacy groups, maternity-service users’ groups, the media, and midwifery organisations in several high-income countries have in recent years underlined the growing criticism of existing maternity care and midwifery services and a long-term shortage of midwives. This is in addition to a longstanding trend in the United Kingdom of closing community-based hospitals, including small, free-standing midwife-led units.
Prof. Edwin van Teijlingen
Centre for Midwifery & Women’s Health
Miani, C, Batram-Zantvoort, S, Pitchforth, E, Treadgold, B, Johnston, K, Rozée, V, MacDougall, C, Schantz, C, van Teijlingen, E. (2023) Out-of-hospital births: A small but growing phenomenon in high income countries: A viewpoint. Journal of Asian Midwives 10(2):77–78.
After all the physical changes during pregnancy and following childbirth, many women are left wondering how to get active again and where to begin. Of course, activity after childbirth is an individual journey with multiple things to consider – and one of the first considerations may not be what you expect: your pelvic floor.
Your pelvic floor muscles sit at the base of the pelvis. The muscles form a hammock-like structure that supports the bladder, womb and bottom. As many as one in three women experience unwanted bladder leaks or vaginal prolapse in their lifetime and many of these symptoms can start during pregnancy or following childbirth. This is because this small muscle group takes the weight of the baby for nine months and may be stretched during vaginal delivery.
Your pelvic floor supports the bladder and vaginal tissues, helping bladder and bowel control and vaginal position. Recovery of these muscles prevents unwanted leaks, improves internal comfort and allows women to confidently increase activity.
This article is part of Women’s Health Matters, a series about the health and wellbeing of women and girls around the world. From menopause to miscarriage, pleasure to pain the articles in this series will delve into the full spectrum of women’s health issues to provide valuable information, insights and resources for women of all ages.
So focusing on your pelvic floor around pregnancy and postnatally can help you to recover more easily after childbirth and will allow you to get ready to be more active when you feel up to it.
If you’ve just given birth (or are about to) and you’re wondering where to start, here’s what you need to know:
1. Keep your poo soft
Straining on the toilet can overstretch the pelvic floor muscles which makes it harder for them to work properly. To avoid this you can keep your poo soft by drinking lots of water and increasing the fibre in your diet, such as high-fibre cereals, brown pasta and nuts.
Also, consider your position on the toilet. The use of a stool underneath your feet can make it easier to poo without straining as it helps to straighten the end of the bowel.
2. Get your pelvic floor moving
Squeezing and relaxing the pelvic floor muscles daily can improve blood flow to the area and speed up recovery following childbirth. This is because pelvic floor activity can improve the strength and function of the muscles to help bladder control and vaginal support.
The evidence shows that it usually takes a good three months of regular pelvic floor use to change symptoms – and every squeeze can make a difference. After a vaginal delivery and even after a c-section, the recovery time for the pelvic floor continues for up to one year.
One of the biggest problems with pelvic floor training is that women aren’t sure they are doing the exercises correctly and regularly forget to do the exercises.
To engage your pelvic floor muscles imagine you are holding in wind and trying to close the vaginal opening at the same time. You may feel a lifting and tightening inside of you. Try to breathe normally and relax other muscles like your tummy and buttocks.
To check you are doing it correctly, you can use a mirror to look at the area between your front and back passage. This area (the perineum) will move slightly up and inwards with a correct contraction. After each contraction, let your pelvic floor muscles fully relax. Pelvic health physiotherapists recommend squeezing your pelvic floor for ten seconds before relaxing for ten repetitions, followed by ten short squeezes. And to do this three times a day.
3. Let things settle and go gently
The pelvis and abdominal muscles also need time to recover from carrying a baby. Many women have a normal stretch and separation of their tummy muscles, which in a lot of cases improves around eight weeks after delivery, for others it can take six months. The tummy helps to support the pelvis so rushing back to activity too quickly can put unnecessary strain on these areas.
Opt instead for a gentle increase in activity to help the muscles and joints settle such as walking, yoga or pilates rather than starting higher impact activity, like running, too early.
4. Check your mental health
The pressures on women postnatally can feel overwhelming and combined with sleep deprivation things can take a toll mentally. The National Perinatal Mental Health Project Report focuses on improving mental health support for women after they have given birth by providing more support services. These services can be accessed by speaking to your GP, midwife, health visitor or pelvic health physiotherapist.
Although a good level of activity can improve mental health, over-training can have a negative effect on the body, so take it steady and keep checking in with yourself to make sure you’re functioning at a pace that feels comfortable and that you’re not overdoing it. Listen to your body and avoid comparison as everybody and every pregnancy is different.
Above all else, remember to be kind to yourself, your body has just gone through a massive change. Looking after your mental health and concentrating on your pelvic floor are good starting points. Getting more active with the muscles around your pelvis, including your tummy, can all help during the natural recovery time frame. But listen to your body and take things at your own pace.
The scientific journal Nepal Journal of Epidemiology published its fourth and final issue of 2021 on December 31. This issue included our systematic review ‘Epidemiologic characteristics, clinical management and Public Health Implications of Coronavirus Disease 2019 (COVID-19) in Pregnancy: A Systematic Review and meta-analysis’. This review covered the published literature on the epidemiology, clinical management and public health prevention aspects of pregnancy and childbirth and coronavirus (COVID-19) up until December 2020. We worked hard and fast to submit the paper as soon as possible after the end of 2020 to be able to publish up-to-date findings. We managed this and submitted the paper on March 5th, the peer-review took some months and so did the making of the revisions. As a result we resubmitted the manuscript of 29 September and we got the acceptance email within a week. We made it into the next issue of the Nepal Journal of Epidemiology which published exactly one year after the data collection period had ended for our systematic review.
There are two lessons here, first even when submitting to an online journal one will experience a delay in publishing. Secondly, the 36 papers we had appraised and included were published in 2020, meaning these scientific papers were submitted in mid-2020 at the latest in order to make it through the peer-review process, get accepted and formatted for online publication.
In the resubmitted version we had to add as a weakness of this review that: “It is worth noting that this extensive systematic review only cover papers published in 2020, and hence studies conducted in or before 2020. This was before the emergence of variants of COVID-19, especially the delta and omicron variants.”
Prof. Edwin van Teijlingen
CMMPH (Centre for Midwifery, Maternal & Perinatal Health).
Last night I misread a call from BMC Pregnancy & Childbirth. To be fair the email included two different request to contribute to two different kinds of blog posts with different set of instructions. Of course, I managed not to simply to swap these instructions around, but mix them up properly. The result is the text below that does not fit either of the two calls, I think.
The question I tried to address was: “Tell us how your research published in BMC Pregnancy & Childbirth has links to wider issues than health!. The actual call in the email was: “Tell us about your contribution to the SDGs (Sustainable Development Goals) – We invite our Editorial Board Members who have research or personal interests related to the SDGs to contribute a blog post to our BMC Series Blog network discussing your work/interests as these relate to the SDGs”.
My adopted question explains the title ‘Health is not a vacuum’. The short overview of the blog I drafted focused on all the papers I have published in this journal over a fifteen-year period from 2006-2021 [1-11]. Not surprising for a sociologist of health & illness, my argument is that there are nearly always issues wider than SDG 3 ‘Good health and well-being’ in the way health care/service or health policy factors affects maternity care and midwifery. Social, cultural and economic factors affect the way maternity services ares provided, used and perceived. SDG 5 ‘Gender equality’ springs to mind first, but also important is SDG 4 ‘Quality education’, especially of girls, and SDG 1 ‘No poverty’, of course strongly linked with SDG 10 ‘Reduced inequalities’.
Gender is highlighted or at least part of the argument in many of our papers in low- and middle income countries [2,3,5, 7,10,11], but also in a high-income context [1,6]. Education, both health education and education more generally, for example education levels of maternity service users, appears in several papers [1,6,8-11] whilst poverty is a key factors in several papers based on our work in Nepal [2,3,5,6,11]. Several of our papers address issues wider than health that are not strictly speaking SDG, such as paper on cultural differences in postnatal quality of life among German-speaking women living either side of the Swiss-German border , and of course, our paper on media and childbirth .
Last, but not least, all papers published in BMC Pregnancy & Childbirth are Open Access and freely available online!
Prof. Edwin van Teijlingen
CMMPH (Centre for Midwifery, Maternal & Perinatal Health)
Milne, L, van Teijlingen, E, Hundley, V., Simkhada, P, Ireland, J. (2015) Staff perspectives of barriers to women accessing birthing services in Nepal: A qualitative study BMC Pregnancy & Childbirth15:142 biomedcentral.com/1471-2393/15/142 .
Symon, A., Pringle, J, Cheyne, H, Downe, S., Hundley, V, Lee, E, Lynn, F., McFadden, A, McNeill, J., Renfrew, M., Ross-Davie, M., van Teijlingen, E., Whitford, H, Alderdice, F. (2016) Midwifery-led antenatal care models: Mapping a systematic review to evidence-based quality framework to identify key components & characteristics of care, BMC Pregnancy & Childbirth 16:168 http://rdcu.be/uifu
Ladur, AN, van Teijlingen E, Hundley, V. (2018) `Whose Shoes?’ Testing educational board game with men of African descent living in UK, BMC Pregnancy & Childbirth 18:81.http://rdcu.be/JXs0
Arnold, R., van Teijlingen, E., Ryan, K., Holloway, I. (2019) Villains or victims? An ethnography of Afghan maternity staff and the challenge of high quality respectful care, BMC Pregnancy & Childbirth 19 :307 https://rdcu.be/bPqlj
This week Dr. Preeti Mahato in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) appeared in several newspapers and new website in Nepal. The media reported both in Nepali [1-4] and in English, the latter in South Asia Time  on her recently published paper on birthing centres in Nepal. This latest paper from her PhD was published in the scientific journal PLoS ONE. The paper is co-authored by CMMPH’s Dr.Catherene Angell, Prof.Edwin van Teijlingen and Prof. Vanora Hundley as well as BU Visiting Professor Padam Simkhada (Associate Dean International at the School of Human and Health Sciences, University of Huddersfield.
We are very grateful to BU’s Dr. Nirmal Aryal for engaging with all his media contacts in Nepal to achieve this great coverage.
Mahato, P., van Teijlingen, E., Simkhada, P., Angell, C., Hundley, V. (2020), Evaluation of a health promotion intervention associated with birthing centres in rural Nepal PLoS One 15(5): e0233607. https://doi.org/10.1371/journal.pone.0233607
Congratulations to Dr. Preeti Mahato in the Centre for Midwifery, Maternal & Perintal Helath (CMMPH) on the acceptance of the paper ‘ Evaluation of a health promotion intervention associated with birthing centres in rural Nepal’. This paper is part of Dr. Mahato’s PhD work and will appear soon in the international journal PLOS ONE. The journal is Open Access so anyone across the world may copy, distribute, or reuse these articles, as long as the author and original source are properly cited.
The research in this thesis used a longitudinal study design where pre-intervention survey was conducted by Green Tara Nepal a local non-governmental organisation (NGO) in year 2012. The health promotion intervention was conducted by the same NGO in the period 2014 to 2016 and the post-intervention survey was conducted by Dr Mahato in the year 2017.
The intervention was financially supported by a London-based Buddhist charity called Green Tara Trust. The results of the pre- and post-intervention surveys were compared to identify statistically significant changes that might have occurred due to the intervention and also to determine the factors affecting place of birth. This study is co-authored by Professors Edwin van Teijlingen and Vanora Hundley and Dr Catherine Angell from CMMPH and FHSS Visiting Professor Padam Simkhada (based at the University of Huddersfield).
A few months ago Dr. Ann Luce (Faculty of Media & Communication) and I were interviewed by the US-based organisation Catalysta TM on the issue of the portrayal of childbirth in the media. This week Catalysta released the podcast which is available here!
The online interviews with a journalist and podcast producer in the USA was based on our publications around the topic, such as our highly cited BMC Pregnancy& Childbirth paper ‘“Is it realistic?” the portrayal of pregnancy and childbirth in the media ‘  and our 2017 book Midwifery, Childbirth and the Mediapublished by Palgrave Macmillan , as well as papers in UK midwifery journals [3-4].
The paper highlights that despite breastfeeding providing maximum health benefits to mother and baby, many women in the United Kingdom do not breastfeed, or do so briefly. Alison’s study explored in a novel way the everyday experiences of first-time breastfeeding mothers in the early weeks following birth. Five UK mothers were given a camcorder to capture their real-time experiences in a video diary, until they perceived their infant feeding was established. This meant that data were collected at different hours of the day by new mothers without a researcher being present. Using a multidimensional approach to analysis, we examined how five mothers interacted with the camcorder as they shared their emotions, feelings, thoughts and actions in real-time. In total mothers recorded 294 video clips, total recording time exceeded 43 hours.
This paper focuses on one theme, the therapeutic role of the camcorder in qualitative research. Four subthemes are discussed highlighting the therapeutic impact of talking to the camcorder: personifying the camcorder; using the camcorder as a confidante; a sounding board; and a mirror and motivator. The paper concludes that frequent opportunities to relieve tension by talking to “someone” without interruption, judgement or advice can be therapeutic and that more research is needed into how the video diary method can be integrated into standard postnatal care to provide benefits for a wider population.
Alison is Senior Lecturer in Midwifery and a member of the Centre for Midwifery, Maternatal & Perinal Health.
Taylor, A.M., van Teijlingen, E., Alexander, J. & Ryan, K. The therapeutic role of video diaries: A qualitative study involving breastfeeding mothers, Women Birth (2018), (online first) https://doi.org/10.1016/j.wombi.2018.08.160
This morning as Associate Editor I reviewed one academic paper resubmitted to BMC Pregnancy & Childbirth. After this I had to invite three reviewers for another paper newly submitted to BMC Pregnancy & Childbirth.
This afternoon I peer-reviewed a paper submitted to Women & Birth. For readers of our BU Research Blog who are not involved in academia, the volume of requests to review for scientific journals has gone through the roof in the past few years. And these are legitimate requests from high quality journals. There is a whole heap of so-called predatory journals pestering academics for reviews (and papers and editorial board memberships).
All that is left to be done before the Christmas Break is editing six short book chapters, submitting one scientific paper, and answer seventy odd emails.
Birthrights, a national charity for the rights of women during pregnancy and childbirth has today launched the interim report of a study undertaken by staff from Bournemouth University and the University of Liverpool, about the experiences of disabled women during pregnancy, childbirth and early parenting.
The current work arises following their 2013 Dignity in Childbirth survey which highlighted less positive experiences of women who identified themselves as disabled (Birthrights 2013). In response, Birthrights commissioned research to explore the experiences of disabled women throughout pregnancy, childbirth and the first few post-natal weeks (the pregnancy continuum). A multidisciplinary team, comprising of Dr Jenny Hall, Jilly Ireland and Professor Vanora Hundley from CMMPH and Dr Bethan Collins from the University of Liverpool, have just completed the first phase of the study, which has been released by Birthrights as an interim report today. This first phase of the study used an online survey to identify experiences of women in the UK and Ireland with physical or sensory impairment or long term health conditions during the pregnancy continuum.
Although overall satisfaction with services in general was scored highly by most women, challenges were described in women’s experiences. These included lack of continuity of carer, meaning that women needed to repeat their information again and again; women feeling that they were not being listened to, which reduced their feeling of choice and control; feeling they were treated less favourably because of their disability. More than half of the women (56%) felt that maternity care providers did not have appropriate attitudes to disability. Accessibility of services was also highlighted as poor, in some situations.
These findings resonate with recommendations from the recent maternity services review (National Maternity review 2016), which highlights the importance of personalised care, that is woman-centred, with opportunity for choice and control, and continuity of carer for everyone. The current study highlights how imperative this approach is for disabled women.
A follow-up qualitative study is underway to establish in-depth views and experiences of human rights and dignity of disabled women during the pregnancy continuum to develop our understanding of how best to enable this group. This second phase is due to be completed in Spring 2017.
Congratulations to Preeti Mahato in the Centre for Midwifery, Maternal & Perinatal Health (CMMPH) on the publication of a paper based on her Ph.D. research. Her paper ‘Birthing centres in Nepal: Recent developments, obstacles and opportunities’ can be found in the June 2016 edition of the Journal of Asian Midwives (JAM) . All articles in JAM are Open Access to ensure midwives and researchers in the poorest parts of Asia can freely access the scientific articles in the journal.
This literature review was appraised the relevant literature on birthing centres in Nepal, South Asia, and other similar settings. Preeti and her co-authors concluded that birthing centres in Nepal have the potential to improve both (a) the institutional delivery rate; and (b) the proportion of births that benefit from the presence of a skilled birth attendant (SBA). However, accessibility, socio-demographic characteristics, and cultural factors act as barriers to pregnant women attending birthing centres and hospital facilities.
Preeti’s Ph.D. is supervised by Dr. Catherine Angell and Prof. Edwin van Teijlingen in CMMPH and Prof. Padam Simkhada at Liverpool John Moores University. Padam is also Visiting Faculty at the Faculty of Health & Social Sciences (FHSS).
Mahato, P., van Teijlingen, E., Simkhada, P., Angell, C. (2016) Birthing centres in Nepal: Recent developments, obstacles and opportunities, Journal of Asian Midwives3(1): 17-30.
We like to congratulate Ms. Preeti Mahato, Ph.D. student in the Centre for Midwifery, Maternal and Perinal Health (CMMPH) in the Faculty of Health & Social Sciences, has been awarded a Civil Society Scholar Award by the Open Society Foundations for US$ 8,000. The Civil Society Scholar Award offers support for international research activities, such as fieldwork, research visits, or research collaboration at institutions abroad. Preeti has been awarded her scholarship for her Ph.D. fieldwork in Nepal. Her Ph.D. project is a mixed-methods study of birthing centres in Nawalparasi, in southern Nepal. In Nepal, birthing centres act as first contact point for pregnant women seeking maternity services especially basic obstetric care.
Preeti is supervised by Dr. Catherine Angell and Prof. Edwin van Teijlingen, both based in CMMPH and BU Visiting Faculty Prof. Padam Simkhada, who is based at Liverpool John Moores University. This is the third piece of really good news this year for Preeti as last month she gave birth to a lovely baby girl and earlier this year the first article from her Ph.D. research was accepted for publication in the Asian Journal for Midwives.
Yesterday saw the lively debate organised by Prof. Vanora Hundley on the motion: ‘The media is responsible for creating fear in childbirth.’
Elizabeth Duff from the NCT and HSC Prof. Edwin van Teijlingen affiliated with the Centre for Midwifery, Maternal & Perinatal Health and against the motion argued Joanne Dewberry (http://joannedewberry.co.uk/about-joanne/ ), independent blogger, journalist and successful business woman and Dr. Ann Luce from BU’s Journalism and Communication Academic Group.
The debate was part of BU’s Festival of Learning event to explore the role of the mass media in shaping such beliefs and identify whether media portrayals are responsible for rising rates of intervention. The audience voted in favour of the motion, but the media team managed to get some people to reconsider their views on the impact of the mass media on women’s view of childbirth.
Professors Vanora Hundley and Edwin van Teijlingen
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