Logo image
Back
Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review
Journal article   Open access   Peer reviewed

Factors associated with spontaneous vaginal birth in nulliparous women: A descriptive systematic review

Lauren Kearney, Rachael Nugent, Jane Maher, Rebecca Shipstone, John M D Thompson, Rachel Boulton, Kendall George, Anna Robins and Fiona Bogossian
Women and Birth, Vol.37(1), pp.63-78
2024
DOI: https://doi.org/10.1016/j.wombi.2023.08.009
PMID: 37704535
pdf
Factors associated with spontaneous vaginal birth in nulliparous women A descriptive systematic review1.45 MBDownloadView
Published Version Open Access CC BY V4.0
url
https://doi.org/10.1016/j.wombi.2023.08.009View
Published Version

Abstract

Spontaneous vaginal birth Systematic review Caesarean section Nulliparous Vaginal delivery
Problem: Spontaneous vaginal birth (SVB) rates for nulliparous women are declining internationally. Background: There is inadequate understanding of factors affecting this trend overall and limited large-scale responses to improve women's opportunity to birth spontaneously. Aim: To undertake a descriptive systematic review identifying factors associated with spontaneous vaginal birth at term, in nulliparous women with a singleton pregnancy. Methods: Quantitative studies of all designs, of nulliparous women with a singleton pregnancy and cephalic presentation, who experienced a SVB at term were included. Nine databases were searched (inception to October 2022). Two reviewers undertook quality appraisal; Randomised Controlled Trials (RCTs) with high risk of bias (ROB 2.0) and other designs with (QATSDD) scoring ≤ 50% were excluded. Findings: Data were abstracted from 90 studies (32 RCTs, 39 cohort, 9 cross-sectional, 4 prevalence, 5 case control, 1 quasi-experimental). SVB rates varied (13% 99%). Modifiable factors associated with SVB included addressing fear of childbirth, low impact antenatal exercise, maternal positioning during second-stage labour and midwifery led care. Complexities arising during pregnancy and regional analgesia were shown to decrease SVB and other interventions, such as routine induction of labour were equivocal. Discussion: Antenatal preparation (low impact exercise, childbirth education, addressing fear of childbirth) may increase SVB, as does midwifery continuity-of-care. Intrapartum strategies to optimise labour progression emerged as promising areas for further research. Conclusion: Declining SVB rates may be improved through multi-factorial approaches inclusive of maternal, fetal and clinical care domains. However, the variability of SVB rates testifies to the complexity of the issue.

Details

Metrics

11 File views/ downloads
71 Record Views
Logo image