Birthing outcomes and experience of holistic approach in women undergoing trial of labor after cesarean: a retrospective analysis
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20252902Keywords:
Natural birth, TOLAC, VBAC, Naturopathy, Traditional practice, Childbirth education, DoulaAbstract
Background: A person-centered holistic birth approach (HBA) includes preparation of mind and spirit along with physical body to help mothers attain their ideal birthing experience. There is paucity availability of research done to evaluate the integrity of HBA. The present study aims to evaluate the birthing experience and outcomes of women undergoing a person-centered naturopathic pregnancy care.
Methods: Women with at least one previous cesarean section with no significant comorbidity and spontaneous conception who opted to have holistic approach towards trial of labor after cesarean (TOLAC) (n=44) in a private birthing center with an exclusive birthing team located in Chennai were provided with evidence based holistic interventions under a naturopathic physician from 28 weeks of gestation till delivery. Data collected between November 2022 to September 2023 were analysed retrospectively for maternal and labor outcomes using descriptive statistics.
Results: Out of all eligible pregnant women who had holistic approach (n=44), 1 in 2 (n=27) (61%) had successful vaginal birth (VB), women who came in labor spontaneously were n=32 (73%). Among those who delivered vaginally (n=27), n=17 (63%) had natural birth with no medical interventions, n=25 (93%) had nonmedicated pain management, n=16 (59%) had natural tears ranging from intact perineum to 2nd degree perineal tear and n=17 (46%) chose various birthing positions. Majority of women rated their childbirth experience to be empowering and satisfactory n=35 (88%).
Conclusions: The study demonstrates, that a holistic approach involving a multidisciplinary team in a specialty birthing center delivered by qualified professionals could result in above mentioned birthing experience and outcomes which in turn empowers women through a person-centered care.
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References
Balalau OD, Bacalbașa N, Olaru OG, Pleș L, Stănescu DA. Vaginal birth after cesarean section–literature review and modern guidelines. J Clin Invest Surg. 2020;5(1):13-7. DOI: https://doi.org/10.25083/2559.5555/5.1/13.17
Rezai S, Labine M, Gottimukkala S, Karp S, Sainvil L. Trial of Labor after Cesarean (TOLAC) for Vaginal Birth after Previous Cesarean Section (VBAC) versus repeat cesarean section: a review. Obstet Gynecol Int J. 2016;4(6):00135. DOI: https://doi.org/10.15406/ogij.2016.04.00135
World Health Organization. Monitoring Emergency Obstetric Care: A Handbook. Geneva: World Health Organization. 2009. Available at: https://www.who.int/publications/i/item/9789241547734. Accessed on 3 June 2025.
Haider MR, Rahman MM, Moinuddin M, Rahman AE, Ahmed S, Khan M. Ever-increasing Caesarean section and its economic burden in Bangladesh. PLoS One. 2018;13(12):e0208623. DOI: https://doi.org/10.1371/journal.pone.0208623
Pandey U, Tripathy P. Success of VBAC in a Tertiary Hospital. J Gynaecol Women’s Health. 2017;2(1):1-4. DOI: https://doi.org/10.19080/JGWH.2017.02.555577
De Wolff MG, Ladekarl M, Sparholt L, Lykke JA. Rebozo and External Cephalic Version in breech presentation (RECEIVE): A randomised controlled study. Acta Obstet Gynecol Scand. 2022;129(10):1666-75. DOI: https://doi.org/10.1111/1471-0528.17111
Adler K, Rahkonen L, Kruit H. Maternal childbirth experience in induced and spontaneous labour measured in a visual analog scale and the factors influencing it: a two-year cohort study. BMC Pregnancy Childbirth. 2020;20:415. DOI: https://doi.org/10.1186/s12884-020-03106-4
Cheng YW, Delaney SS, Hopkins LM, Caughey AB. The association between the length of first stage of labor, mode of delivery, and perinatal outcomes in women undergoing induction of labor. Am J Obstet Gynecol. 2009;201(5):477.e1. DOI: https://doi.org/10.1016/j.ajog.2009.05.024
Tanha FD, Ghajarzadeh M, Mohseni M, Shariat M, Ranjbar M. Is ACOG guideline helpful for encouraging pregnant women to do exercise during pregnancy? Taiwan J Obstet Gynecol. 2014;52(6):458-61.
Amis D. Healthy birth practice #1: let labor begin on its own. J Perinat Educ. 2014;23(4):178-87. DOI: https://doi.org/10.1891/1058-1243.23.4.178
Ee C, Levett K, Smith C, Armour M, Dahlen HG, Chopra P, Simas TAM. Complementary medicines and therapies in clinical guidelines on pregnancy care: a systematic review. Women Birth. 2022;35(4):e303-17. DOI: https://doi.org/10.1016/j.wombi.2021.08.003
Okeahialam NA, Sultan AH, Thakar R. The prevention of perineal trauma during vaginal birth. Am J Obstet Gynecol. 2024;230(3S):S991-1004. DOI: https://doi.org/10.1016/j.ajog.2022.06.021
Sichitiu J, Bodenmann P, Robyr D, Lepigeon K, Baud D, Vial Y, Viallon A. Is tachysystole a predictor of unsuccessful labor induction with misoprostol vaginal inserts? BJOG. 2018;125(1):11-2.
Buckley S. The hormonal physiology of childbearing. New York (NY): Childbirth Connection. 2014.
Price BB, Amini SB, Kappeler K. Exercise in pregnancy: effect on fitness and obstetric outcomes-a randomized trial. Med Sci Sports Exerc. 2012;44:2263-9. DOI: https://doi.org/10.1249/MSS.0b013e318267ad67
Barakat R, Pelaez M, Lopez C, Montejo R, Coteron J. Exercise during pregnancy reduces the rate of cesarean and instrumental deliveries: results of a randomized controlled trial. J Matern Fetal Neonatal Med. 2012;25:2372-6. DOI: https://doi.org/10.3109/14767058.2012.696165
Wadhwa Y, Alghadir AH, Iqbal ZA. Effect of antenatal exercises, including yoga, on the course of labor, delivery and pregnancy: a retrospective study. Int J Environ Res Public Health. 2020;17(15):5274. DOI: https://doi.org/10.3390/ijerph17155274
Sun YC, Hung YC, Chang Y, Kuo SC. Effects of a prenatal yoga programme on the discomforts of pregnancy and maternal childbirth self-efficacy in Taiwan. Midwifery. 2010;26:e31-6. DOI: https://doi.org/10.1016/j.midw.2009.01.005
Mahajan A. Role of yoga in hormonal homeostasis. Int J Clin Exp Physiol. 2014;1(3):173. DOI: https://doi.org/10.4103/2348-8093.143474
Sinha A, Kumari S, Ganguly M. Development, validation, and feasibility of a school-based short duration integrated classroom yoga module: a pilot study design. J Educ Health Promot. 2021;10:148. DOI: https://doi.org/10.4103/jehp.jehp_674_20
Deepika S, Seema B. A preexperimental study to evaluate the effectiveness of back massage among pregnant women in first stage of labour pains admitted in labour room of a selected hospital, Ludhiana, Punjab, India. Int J Sci Res. 2017;6(1):76-83. DOI: https://doi.org/10.18203/2320-1770.ijrcog20164636
Xavier R. Facts on reflexology (foot massage). Nurs J India. 2007;98(1):11-2. DOI: https://doi.org/10.48029/NJI.2007.XCVIII103
Poole H, Glenn S, Murphy P. A randomised controlled study of reflexology for the management of chronic low back pain. Eur J Pain. 2007;11(8):878-87. DOI: https://doi.org/10.1016/j.ejpain.2007.01.006
Morey JH. Integrative reflexology: a therapy within a naturopathic nursing practice. Explore (NY). 2005;1(5):400-1. DOI: https://doi.org/10.1016/j.explore.2005.06.020
McCabe P. Complementary therapy in nursing practice: policy development in Australia. Aust J Holist Nurs. 1996;3(1):4-11.
Olza I, Uvnäs-Moberg K, Ekström-Bergström A, Leahy-Warren P, Karlsdottir SI, Nieuwenhuijze M, Kazmierczak M. Birth as a neuro-psycho-social event: an integrative model of maternal experiences and their relation to neurohormonal events during childbirth. PLoS One. 2020;15(7):e0230992. DOI: https://doi.org/10.1371/journal.pone.0230992
Hassed C. Mind-body therapies: use in chronic pain management. Aust Fam Physician. 2013;42(3):112-7.
Lee L, Dy J, Azzam H. Management of spontaneous labour at term in healthy women. J Obstet Gynaecol Can. 2016;38(9):843-65. DOI: https://doi.org/10.1016/j.jogc.2016.04.093
Lawrence A, Lewis L, Hofmeyr GJ, Dowswell T, Styles C. Maternal positions and mobility during first stage labour. Cochrane Database Syst Rev. 2013;2013(10):CD003934. DOI: https://doi.org/10.1002/14651858.CD003934.pub3
Baljon K, Romli MH, Ismail AH, Khuan L, Chew BH. Effectiveness of breathing exercises, foot reflexology and massage (BRM) on maternal and newborn outcomes among primigravidae in Saudi Arabia: a randomized controlled trial. Int J Womens Health. 2022;14:279-95. DOI: https://doi.org/10.2147/IJWH.S347971
Daniyati A, Mawaddah S. Effect of prenatal yoga on duration of the first stage of labor and perineal rupture in primigravida mothers. Res J Life Sci. 2021;8(1):34-9. DOI: https://doi.org/10.21776/ub.rjls.2021.008.01.5
Dieb AS, Shoab AY, Nabil H, Gabr A, Abdallah AA, Shaban MM, Radwan AM. Perineal massage and training reduce perineal trauma in pregnant women older than 35 years: a randomized controlled trial. Int Urogynecol J. 2020;31(3):613-9. DOI: https://doi.org/10.1007/s00192-019-03937-6
Dunn PM. Francois Mauriceau (1637-1709) and maternal posture for parturition. Arch Dis Child. 1991;66(1):78-9. DOI: https://doi.org/10.1136/adc.66.1_Spec_No.78
ACOG Committee on Obstetric Practice. ACOG Committee Opinion No. 766: Approaches to limit intervention during labor and birth. Obstet Gynecol. 2019;133(2):e164-73. DOI: https://doi.org/10.1097/AOG.0000000000003074
Kopas ML. A review of evidence-based practices for management of the second stage of labor. J Midwifery Womens Health. 2014;59(3):264-76. DOI: https://doi.org/10.1111/jmwh.12199
Zaky NH. Effect of pelvic rocking exercise using sitting position on birth ball during the first stage of labor on its progress. IOSR J Nurs Health Sci. 2016;5(4):19-27. DOI: https://doi.org/10.9790/1959-0504031927
National Center for Biotechnology Information. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6511367/#ref14. Accessed on 15 July 2025.
Hemmerich A, Bandrowska T, Dumas GA. The effects of squatting while pregnant on pelvic dimensions: a computational simulation to understand childbirth. J Biomech. 2019;87:64-74. DOI: https://doi.org/10.1016/j.jbiomech.2019.02.017
Desseauve D, Fradet L, Lacouture P, Pierre F, Lempereur M, Pierre F. Is there an impact of feet position on squatting birth position? An innovative biomechanical pilot study. BMC Pregnancy Childbirth. 2019;19(1):251. DOI: https://doi.org/10.1186/s12884-019-2408-2
Ondeck M. Healthy birth practice #2: walk, move around, and change positions throughout labor. J Perinat Educ. 2014;23(4):188-93. DOI: https://doi.org/10.1891/1058-1243.23.4.188