NRS-445 Topic 1: Literature Evaluation Table Student Name: Faculty Name: Background of Nursing Practice Problem (one paragraph; no more than 250 words):

APA Reference

Include the GCU permalink or working link used to access the article

Shmueli, A., Salman, L., Chen, R., Hiersch, L., Wiznitzer, A., & Gabbay-Benziv, R. (2017). 738: 

The duration of the second stage of labor - do we underestimate the impact of epidural analgesia? American Journal of Obstetrics & Gynecology, 216, S429. https://doi-org.lopes.idm.oclc.org/10.1016/j.ajog.2016.11.472

Werner, A., Wu, C., Zachariae, R., Nohr, E. A., Uldbjerg, N., & Hansen, Å. M. (2020). Effects of antenatal hypnosis on maternal salivary cortisol during childbirth and six weeks postpartum—A randomized controlled trial. PLoS ONE, 15(5), 1–18. https://doi-org.lopes.idm.oclc.org/10.1371/journal.pone.0230704

Uludağ, E., & Mete, S. (2021). The effect of nursing care provided based on the philosophy of hypnobirthing on fear, pain, duration, satisfaction and cost of labor: a single-blind randomized controlled study: The effect of nursing care on the labor process and cost. Health Care for Women International, 42(4–6), 678–690. https://doi-org.lopes.idm.oclc.org/10.1080/07399332.2020.1835916

Uludag, E., & Mete, S. (2023). Feelings and Experiences of Turkish Women Using Hypnobirthing in Childbirth: A Non-Traumatic Childbirth Experience. International Journal of Caring Sciences, 16(1), 344–351.

Purpose/Aim of Study

To understand the impact of an epidural as a pain analgesic.

Explore the effect of a brief antenatal training course in self-hypnosis on salivary cortisol during childbirth and 6 weeks postpartum. 

Evaluate hypnobirthing as supportive care during childbirth.  

To examine opinions, emotions and experiences of women who were hypnotized during childbirth.

Research question(s)

The duration of the second stage of labor - do we underestimate the impact of epidural analgesia?

Does hypnosis reduce cortisol levels during childbirth?

Can hypnobirthing be an effective method used in the plan of supportive care for childbirth.  

Did women who were hypnotized during childbirth have a better overall perception and experience during the birthing process?

Design

Is the article qualitative, quantitative, or mixed methods? Explain how you determined the type of research design.

Qualitative and I determined this because this is an observational study.

Quantitative and I determined this because the article is on a randomized controlled trial.

This is a quantitative article as it is a randomized controlled trial.  

This is a qualitative article as explicitly stated in the article and no actual randomized controlled trial was performed.

Setting

Where did the study take place? What type of setting: inpatient, outpatient, etc.?

A university affiliated medical center in an inpatient setting.

Obstetrics Department at Aarhus University Hospital, Denmark

University Hospital between January 2015 and February 2017.

Internet search of blogs between March 14 through Mar 21, 2017.

Sample

Number and characteristics of participants

15,449 live, singleton, vaginal deliveries between 37 to 42 weeks.

139 women in the hypnosis group, 136 women in the active comparison group, and 87 women in the control group

The study was completed with 150 pregnant women, including 75 in the control group and 75 in the intervention group. All women had a vaginal delivery at University Hospital during the specified time.

Eighty-two birthing stories in these blogs were examined using keywords and 13 written by women using hypnobirthing were included into the study.

Methods

Interventions/Instruments

Maternal demographics and labor data including use of epidural, induction of labor or use of oxytocin

The women in the hypnosis group attended three 1-hour classes on self-hypnosis for childbirth held over three consecutive weeks with four supplementary audio recordings, including a 20-minute section especially meant for labor. The women in the relaxation group had three antenatal classes in various relaxation methods, each lasting one hour held over three consecutive weeks. The usual care group received only ordinary antenatal care, which included a nuchal translucency scan about gestational week 12, an anomaly scan about gestational week 19, four to five visits at the midwifery clinic, and a tour of the birth department.

The nurses working in the delivery room provided the pregnant women in the control group with routine care. This routine care consisted of greeting pregnant women, establishing vascular access, performing an enema, providing the required treatment, and performing interventions to teach pushing in the second stage of labor. The supportive nursing care structured according to the Philosophy of HypnoBirthing was provided by the researcher to the pregnant women in the intervention group. Before the intervention, the women completed an introduction form over their demographics and background. Following the intervention, women completed the Visual Analog Scale for pain, the Women’s Perception of Supportive Care During Labor Scale, and the Satisfaction with Labor Experience Sub-Scale.

No intervention was performed. A blog search regarding childbirth was performed and the integrity and quality of the blogs were analyzed before being included.

Analysis

How were the collected data analyzed?

Multivariate linear regression

Participant characteristics are presented as means with standard deviations for continuous variables and as frequencies for categorical variables. Saliva cortisol concentrations, CAR and CDD are presented as means with standard deviations. Additionally, a Spearman rank correlation test was used to examine the correlation between saliva cortisol concentrations and psychological outcomes in the total sample.

To compare the labor fear and pain mean scores of the latent, active, transition phases of the first stage of labor in the intervention and control groups according to group, time and group*time interaction, the "Multi-Way Analysis of Variance for Repeated Measures" was used, for the advanced analysis "One-Way Analysis of Variance in Repeated Measures" was used, and the "Bonferroni Corrected Paired T-Test" was performed to compare the measures with each other.

To determine the effect of labor pain, fear, and duration on the satisfaction with labor and labor cost according to the supportive care, "Multiple Regression Analysis" was used.

A content analysis of the information was used for the coding of data, finding of themes, arrangement of codes and themes, identification and interpretation of findings.

Outcomes/key findings of the study and implications for nursing practice

Summary of study results

Parity, epidural, oxytocin augmentation, birth weight and maternal age were significant confounders for second stage length. Also, Epidural analgesia is associated with higher than one hour difference in second stage duration.

The cortisol concentrations differed between the hypnosis group and the usual care group at wake up and in the evening. Between the hypnosis group and the relaxation group, no differences were found at any time point in pregnancy. 

 A statistically significant difference was found between the labor fear and pain mean scores in terms of group, time and group*time interaction. Additionally, there was a significant difference between the post-intervention, active phase and transition phase labor fear and pain mean scores of the groups in terms of the intervention performed: the fear of labor and labor pain was lower in the intervention group compared to the control group.

The women reported being more prepared for childbirth, they enjoyed being able to move more freely, there muscles were more relaxed, and they had an overall sense of knowing what to do.

Recommendations of the researcher

The researchers recommend a reconsideration of ways to manage second stage labor.

A brief course in antenatal hypnosis training compared to a short course in relaxation and usual care did not have any influence on saliva cortisol concentration 6 weeks postpartum. The intervention may influence the release of cortisol during the extreme labor work and the first hours after childbirth with no long-term consequences. However, further research is needed.

The researchers recommended that nursing care based on the Philosophy of HypnoBirthing should be provided during labor to reduce the fear and pain of labor, shorten the duration of labor, increase the level of satisfaction with labor, and decrease the costs during labor.

Women should make use of hypnobirthing to get prepared for childbirth.

Explain how this article supports your proposed PICO(T) question.

This article describes one of the negative effects of an epidural and in this case, it is prolonged labor.

This article is directly related to my PICOT question as it tests the effects of a hypnosis intervention.

I chose this article because it shows the positive effects on the use of hypnosis to reduce labor pain.

This is a qualitative article that explains the experiences of women that used hypnosis during childbirth and it supports my PICOT.