Maternal satisfaction is improved by real-time viewing of the maternal introitus as visual biofeedback during pushing, according to a recent study published in the American Journal of Obstetrics & Gynecology.
Takeaways
- Maternal satisfaction during labor can be improved by real-time viewing of the maternal introitus as visual biofeedback during pushing.
- Prolonged second stage of labor in nulliparous women is associated with increased risks of postpartum hemorrhage, severe perineal laceration, poor Apgar score, and operative deliveries.
- The use of a mirror to witness delivery is a form of biofeedback that stimulates and motivates individuals to push during labor.
- A randomized controlled trial found that real-time viewing of the introitus during pushing led to shorter active second stage labor duration and increased maternal satisfaction compared to viewing the maternal face.
- While 76.5% of the intervention group would recommend the visual biofeedback method to a friend, it was associated with a higher likelihood of minor perineal injuries. Further research is recommended to understand the factors influencing maternal satisfaction with visual biofeedback during labor.
Risks of postpartum hemorrhage, severe perineal laceration, poor Apgar score, and operative deliveries are heightened by prolonged second stage of labor. Among nulliparous women, the duration of pushing during second stage labor is often increased.
The use of a mirror to witness delivery was reported by 88.5% of individuals to stimulate and motivate them to push. This is a method of biofeedback, where patients control and regulate their physiology to improve their physical, mental, and spiritual health.
Through live visualization of the introitus, women are able to observe external dynamic changes directly from their effort. Investigators hypothesized this would, “optimize effectiveness and motivate greater bearing-down effort.”
To test this hypothesis, investigators conducted a randomized controlled trial comparing real-time viewing of the introitus with viewing of the maternal face. Participants were recruited from December 2, 2021, to August 15, 2022.
Eligibility criteria included being aged at least 18 years, having a singleton pregnancy, cephalic presentation, reassuring fetal status, and no contraindication for vaginal delivery.
Exclusion criteria included known gross fetal anatomy, suspected or known COVID-19 infection, maternal severe visual impairment, shortened second stage of labor through planned instrumental delivery, and history of maladaptive maternal response to visual stimuli.
Participants were randomized 1:1 to receive the intervention, real-time viewing of the introitus, or control, viewing of the maternal face. The intervention group had a display screen placed next to their bed, connected through Bluetooth to a live streaming video camera placed at the end of the bed.
The camera in the intervention group provided direct visual of the maternal introitus. The control group had a similar setup to the intervention group, but the camera was placed at the top of the bed and focused on the maternal face.
Women in both groups were instructed to watch the display screen during pushing, with standard provider direction provided to all participants. Prolonged pushing in nulliparous women was reported as pushing lasting for 1 hour or longer.
The duration of the active second stage of labor, measured from the start of biofeedback live viewing to delivery, was one of the 2 primary outcomes in the analysis. The other primary outcome was maternal satisfaction with pushing experienced, measured on an 11-point scale from 0 to 10. A higher score indicated increased satisfaction.
There were 230 women included in the analysis, with 115 randomized into each group. The intervention group had a median active second stage duration and maternal satisfaction score of 16 and 9 respectively. In the control group, these measures were 17 and 7 respectively.
Being likely to recommend the allocated intervention to a friend was reported by 76.5% of the intervention group and 33.9% of the control group. A minor perineal injury was significantly more likely to occur in the intervention group than a nonminor injury. Results did not significantly differ based on epidural analgesia use, which was a potential major cofounder.
These results indicated improved maternal satisfaction from real-time visual biofeedback of the introitus during pushing. Investigators recommended further study to determine the factors influencing maternal satisfaction with visual biofeedback.
Reference
Hamid NA, Hong JGS, Hamdan M, Vallikkannu N, Adlan AS, Tan PC. Real-time imaging as visual biofeedback in active second stage of labor among nulliparas: a randomized controlled trial. Am J Obstet Gynecol 2023;229:443.e1-9. doi:10.1016/j.ajog.2023.04.049
