RQ1: Does communication in midwifery play an important role in the hospital birth process?

Communication in midwifery plays a vital role in the birthing process. Due to the way work is organized in Slovenia, a woman usually has no contact with the midwife before labor, which can negatively affect the process of building trust. When a woman is admitted to the delivery room, there is no room for error. The midwife must approach her appropriately, professionally, and with empathy, instilling hope and establishing trust. The first contact is the most important for building that trust. In addition to verbal communication, non-verbal communication is also key. We are always being observed by the partner, who closely monitors our actions, facial expressions, and gestures. To better meet a woman’s wishes, hospital policies must be oriented toward this. Knowledge and experience can help us a great deal. It is important that women receive appropriate information about the birth itself during pregnancy. Their task is to use this information to find out which hospital best aligns with their wishes. We are talking about informed choice. They can communicate their wishes and thoughts regarding the birth to the medical staff orally or through a birth plan. This should be discussed upon admission to the delivery rooms. This gives health professionals an idea of what the woman wants and allows them to encourage her. Nevertheless, based on knowledge, experience, and the woman’s behavior, the midwife can see what could be changed to make the woman more comfortable and at ease. We should also involve the partner or birth companion in the birthing process. We guide the woman through labor; our instructions should be short and clear. If we have followed the first rule—that the first impression is vital—we have done the most important part. We have gained her trust, which means we have prevented excessive adrenaline secretion that could hinder the progress of labor, and at the same time, the woman trusts us enough to tell us what works for her and what doesn’t, making it easier to meet her wishes. Communication between the midwife and the woman/couple is very important in the birthing process.

RQ2: What are the key factors for establishing trust between the midwife and the laboring woman?

In research, patients list the following key factors for establishing trust in the delivery room: a warm greeting, a smile, an introduction, and a warm handshake. The first contact is the most important. It is also important that midwives know how to listen and observe, so they can adapt to the woman and help her through the birthing process.

RQ3: How can we respect the laboring woman’s wishes without disturbing the birthing process?

First, it is important that hospital policies are designed in accordance with best practices, allowing for the use of resources the hospital has available for the woman’s comfort during labor. Prenatal preparation and access to relevant information are also important. Ideally, the midwife would already know the woman. Since our healthcare system doesn’t allow for this, it’s important that the midwife talks to the woman about her wishes, expectations, and fears before she enters the delivery room or the active phase of labor. Then, based on experience and observation, the midwife can adjust the atmosphere to the woman and guide her correctly if things go off track. It is important to gain the woman’s trust upon entering the delivery room, as this is the foundation for good further cooperation with her and her partner/birth companion. We should offer her options and choices.

RQ4: What is the impact of birthing positions on achieving better birth experiences?

Prenatal preparation for birth has a significant impact on the birth experience. This preparation includes getting to know different birthing positions. Of course, a woman cannot know in advance which position will suit her. However, it is important that she is aware of the importance of movement during labor. When changing positions, we must also ensure the baby is doing well. Fetal monitoring should be done in a way that allows the woman free movement and provides a realistic assessment of the fetus’s condition. If we allow the woman to choose the birthing position she finds most comfortable, we will achieve better labor progress and greater satisfaction for the woman. The mother will feel a sense of control, which is often a key factor in a positive or negative assessment of the birth experience. Even for women who have limited mobility or require continuous CTG monitoring due to their own or the baby’s health, it is important to provide as much comfort as possible—through massage, pillow support, and extra encouragement. We will do a lot for Slovenian midwifery practice if we move away from routine births in a semi-sitting position and encourage giving birth on the side or in whatever position suits them.

RQ5: Is restricting eating and drinking during labor justified?

Eating and drinking are considered important factors affecting comfort during labor. A review of studies states that low-risk women should have a free choice regarding food and drink consumption during labor. Poor nutritional balance can be linked to longer and more painful labor. Furthermore, restricting food and drink does not guarantee an empty stomach or lower acidity of the stomach contents. In the review of studies, no disadvantages or advantages of restricting food and drink during labor were proven for low-risk women.

RQ6: What does the undisturbed first/sacred hour after birth mean?

The first/sacred hour after birth means uninterrupted contact between mother and baby for at least one hour after delivery. This is a time when we postpone all unnecessary routine interventions and procedures for at least an hour (weighing, measuring, eye drops, Vitamin K administration, etc.). Nevertheless, during this time, health professionals can still put on identification bracelets, deliver the placenta, cut the umbilical cord on the mother’s belly, treat any birth canal injuries, and monitor postpartum bleeding. We must educate parents about the importance of the first/sacred hour after birth, but also respect it if they do not want it. The first/sacred hour after birth or skin-to-skin contact (kangaroo care) must also be provided for mothers and newborns after a C-section. With an undisturbed first hour after birth, we allow the newborn to go through the 9 instinctive stages, which are also influenced by the course of the birth. Even hospitals that do not have the “Baby-Friendly Hospital” designation should strive to place the newborn on the mother’s chest for skin-to-skin contact immediately after birth for at least one hour and encourage mothers to observe their newborns. If the mother’s condition prevents skin-to-skin contact immediately after birth, the baby is placed on the father’s chest. The baby on the mother or father is covered so that only the head is visible. The baby is naked. We let them rest on the mother’s chest for at least one hour. If contact is not possible immediately after birth for medical reasons concerning the baby, we enable it as soon as possible. After we have allowed the new family an undisturbed first hour after birth, we can proceed with non-urgent interventions, i.e., the first newborn care.

RQ7: What are the benefits of the undisturbed/sacred first hour after birth or skin-to-skin contact?

If we focus on the mother’s wishes and comfort during labor, we must also take care of the newborn after birth. The interventions we must perform should be scheduled to minimize disruption to the bonding process. The first/sacred hour after birth is extremely important for the newborn’s adaptation to extrauterine life. The baby must breathe, and the heart must pump enough blood for pulmonary circulation. Important hormones are released in both mother and baby, which can be disturbed by our interventions. In this short time, such vital processes take place that in a physiological birth, we must not allow them to be disturbed by interventions and procedures that can wait. The baby is warmer during skin-to-skin contact and can hear the mother’s heartbeat, which also normalizes their own heart rate and breathing. Those who remain in skin-to-skin contact with the mother later after birth gain weight faster, their blood sugar levels and blood pressure stabilize, brain development is faster, the baby cries less and experiences fewer stressful stimuli, breastfeeding is more successful, and discharge from the hospital is faster. By providing kangaroo care right in the delivery room, we ensure early bonding; parents gain confidence that they know how to take care of their child and that the child is well cared for. With an undisturbed first hour after birth, we allow the newborn to go through the 9 instinctive stages, which are of course also influenced by the course of the birth. The first/sacred hour after birth is thus very important for the bonding of the new family. We must provide them with as intimate an atmosphere as possible and schedule interventions logically.

RQ8: Is removing vernix in the delivery room in line with good birthing practice?

Removing vernix in the delivery room is not in line with good birthing practice. We do not wash the newborn or remove the vernix in the delivery room, as it serves as immunological protection and helps prevent water loss and regulate temperature. We should follow the recommendation that the baby should not be washed or bathed for at least 24 hours after birth. If this is impossible for cultural reasons, the first wash should be postponed for at least 6 hours after birth.

RQ9: When is the best time to cut the umbilical cord after birth?

For a newborn who does not need immediate care from a pediatrician, it is extremely important to wait at least 90 seconds before cutting the umbilical cord. This allows blood to be pumped from the placenta, giving the baby a good start for a better blood count later in life. With an undisturbed first hour after birth—which includes skin-to-skin contact or kangaroo care—delayed cord clamping, and not removing the vernix immediately after birth, we get the best starting point for a good immune system, health, and well-being for the baby, and consequently for the mother as well.