Physical activity and mode of Delivery - A prospective cohort on Physical Activity among healthy pregnant women and its relationship to childbirth.

Background and Aim: In many parts of the world there is a tendency toward a more sedentary life style. At the same time instrumental delivery (cesarean section, vacuum extraction and forceps) has increased in Norway, as in many parts of the world. The aim of this study was to investigate the relationship between Physical Activity and mode of delivery. Further the level of Physical Activity performed was analyzed according to parity in order to investigate possible differences between women already having children (multipara) with women expecting their first child (primipara). Finally, mode of delivery was investigated according to parity. Theoretical framework: As theoretical framework for this study two theories are used. The first is the paradigm of physical activity, fitness and health. The second is health promotion. Method: A prospective cohort of healthy Scandinavian pregnant women, expecting one child and planning to give birth vaginally at a university hospital in Oslo, Norway. To collect data on the participants’ Physical Activity during pregnancy, a questionnaire was handed out. Information about the delivery was collected via the electronical medical record. Binary logistical regression was performed to investigate the relationship between Physical Activity and mode of delivery. Results: Results did not show a significant relationship between the health determinant Physical Activity and the health outcome mode of delivery in this study. Multiparas were more active than primiparas in total and in the household/care giving domain. Primiparas were more likely to deliver by assisted vaginal delivery than multiparas but there was no significant difference in the rate of cesarean section. Conclusion: Based on the results of this study, there is no reason to alter the recommendations to pregnant women. No link was found between Physical Activity during pregnancy and mode of delivery. Based on previous research, health promotion to pregnant women about Physical Activity is still important for the health outcome of mothers and infants.Bakgrunn og hensikt: I mange deler av verden ses en tendens mot en mer stillesittende livsstil. Samtidig har bruken av instrumentelle fødsler (keisersnitt, vakuum og tang) økt i Norge og i store deler av verden. Hensikten med denne studien var å undersøke om det er en sammenheng mellom fysisk aktivitet og forløsningsmetode. Videre er mengden av fysisk aktivitet analysert i forhold til paritet for å undersøke eventuelle forskjeller mellom de som har barn fra før (multipara) og de som venter sitt første barn (primipara). Til sist er forløsningsmetode undersøkt i forhold til paritet. Teoretisk rammeverk: Som teoretisk rammeverk i denne oppgaven, er to teorier brukt. Den første er paradigmet om fysisk aktivitet, form og helse. Den andre omhandler helsefremmende arbeid. Metode: En prospektiv kohort med friske gravide kvinner med Skandinavisk opprinnelse, som er gravid med ett barn og som planlegger å føde vaginalt på et universitetssykehus i Oslo, Norge. For å samle inn data om deltagernes fysiske aktivitet under graviditeten, ble et spørreskjema delt ut. Informasjon om fødselen ble samlet inn via den elektroniske medisinske journalen. Binær logistisk regresjon ble utført for å undersøke forholdet mellom fysisk aktivitet og forløsningsmetode. Resultat: Resultatene viste ikke en signifikant sammenheng mellom fysisk aktivitet og forløsningsmetode i denne studien. Multipara var mer aktive enn primipara både totalt sett og i husholdning/omsorg domenet. Primipara hadde større sannsynlighet for å bli forløst med assistert vaginal forløsning enn multipara men det var ingen signifikant forskjell i frekvensen av keisersnitt. Konklusjon: Basert på resultatene i denne studien, er det ingen grunn til å endre rekommandasjonene som blir gitt i dag til gravide. Ingen sammenheng ble vist mellom Fysisk Aktivitet og forløsningsmetode. Basert på tidligere forskning er rekommandasjoner om Fysisk Aktivitet fortsatt viktig for gravide, både for kvinnens egen helse og for barnets helse.Master i klinisk sykepleievitenska

Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Introduction and hypothesis: Pudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Methods: We performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit. Results: Of the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h. Conclusions: PNB was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function

Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Introduction and hypothesis: Pudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Methods: We performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit. Results: Of the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h. Conclusions: PNB was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function

Intrapartum pudendal nerve block analgesia and risk of postpartum urinary retention: a cohort study

Introduction and hypothesis: Pudendal nerve block analgesia (PNB) is used as pain relief in the final stage of childbirth. We hypothesized that PNB is associated with higher rates of postpartum urinary retention. Methods: We performed a cohort study among primiparous women with a singleton, cephalic vaginal birth at Oslo University Hospital, Norway. Women receiving PNB were included in the exposed group, while the subsequent woman giving birth without PNB was included in the unexposed group. We compared the likelihood of postpartum urinary retention, defined as catheterization within 3 h after birth. Logistic regression analysis stratified by mode of delivery was performed adjusting for epidural analgesia, episiotomy and birth unit. Results: Of the 1007 included women, 499 were exposed to PNB and 508 were unexposed. In adjusted analyses, women exposed to PNB did not differ in likelihood of postpartum urinary retention compared to women unexposed to PNB in either spontaneous (odds ratio[OR]: 0.82, 95% confidence interval [CI] 0.55–1.22) or instrumental (OR 1.45, 95% CI 0.89–2.39) births. Furthermore, no differences between the groups were observed with excessive residual urine volume or catheterization after > 3 h. Conclusions: PNB was associated with neither risk of postpartum urinary retention nor excessive residual urine volume and is therefore unlikely to hamper future bladder function

The provision of epidural analgesia during labor according to maternal birthplace: a Norwegian register study

Background: The provision of epidural analgesia during labor is ideally a shared decision between the woman and her health care provider. However, immigrant characteristics such as maternal birthplace could affect decisionmaking and thus access to pain relief. We aimed to assess disparities in the provision of epidural analgesia in planned vaginal birth according to maternal region of birth. Methods: We performed a nation-wide register study of 842,496 live-born singleton deliveries in Norway between 2000 and 2015. Maternal birthplace was categorized according to the Global Burden of Disease framework. The provision of epidural analgesia was compared in regression models stratified by parity and mode of delivery. Results: Compared to native-born women, primiparous women from Latin America/Caribbean countries with an instrumental vaginal delivery were most likely to be provided epidural analgesia (OR 2.12, 95%CI 1.69–2.66), whilst multiparous women from Sub-Saharan Africa with a spontaneous vaginal delivery were least likely to be provided epidural analgesia (OR 0.42, 95% C 0.39–0.44). Longer residence time was associated with a higher likelihood of being provided analgesia, whereas effects of maternal education varied by Global Burden of Disease group. Conclusions: Disparities in the likelihood of being provided epidural analgesia were observed by maternal birthplace. Further studies are needed to consider whether the identified disparities represent women’s own preferences or if they are the result of heterogeneous access to analgesia during labor

The provision of epidural analgesia during labor according to maternal birthplace: a Norwegian register study

Background The provision of epidural analgesia during labor is ideally a shared decision between the woman and her health care provider. However, immigrant characteristics such as maternal birthplace could affect decision-making and thus access to pain relief. We aimed to assess disparities in the provision of epidural analgesia in planned vaginal birth according to maternal region of birth. Methods We performed a nation-wide register study of 842,496 live-born singleton deliveries in Norway between 2000 and 2015. Maternal birthplace was categorized according to the Global Burden of Disease framework. The provision of epidural analgesia was compared in regression models stratified by parity and mode of delivery. Results Compared to native-born women, primiparous women from Latin America/Caribbean countries with an instrumental vaginal delivery were most likely to be provided epidural analgesia (OR 2.12, 95%CI 1.69–2.66), whilst multiparous women from Sub-Saharan Africa with a spontaneous vaginal delivery were least likely to be provided epidural analgesia (OR 0.42, 95% C 0.39–0.44). Longer residence time was associated with a higher likelihood of being provided analgesia, whereas effects of maternal education varied by Global Burden of Disease group. Conclusions Disparities in the likelihood of being provided epidural analgesia were observed by maternal birthplace. Further studies are needed to consider whether the identified disparities represent women’s own preferences or if they are the result of heterogeneous access to analgesia during labor