RQ1: Does communication in midwifery play an important role in the process of giving birth in a maternity hospital?

Communication in midwifery plays an important role in the birth process. Due to how work is organised in Slovenia, a woman usually has no contact with a midwife before labour, which can negatively affect the process of building trust. When a woman is admitted to the delivery room, there is no room for mistakes. The midwife must approach her appropriately, professionally, and with empathy, give her hope, and establish trust. First contact is the most important for building trust. In addition to verbal communication, non-verbal communication is also important. We are always in the partner’s view as well, as they closely observe what we do, our facial expressions, and gestures. For us to meet a woman’s wishes, maternity hospital policies need to be aligned with that. Knowledge and experience can help a lot. It is important that women receive appropriate information about birth already during pregnancy. Their task is to use that information to find out which maternity hospital best matches their wishes. So we are talking about an informed choice. She can communicate her wishes and thoughts about birth to healthcare staff verbally or with a birth plan. This should be discussed already upon admission to the delivery room. That way, healthcare professionals will get a clear idea of what she wants and will encourage her in it. Even so, based on knowledge and experience, and on the woman’s behaviour, the midwife can see what could be changed to make her more comfortable and at ease. We should also include the partner or birth companion in the birth process. We guide the woman through labour; our instructions should be short and clear. If we followed the first rule—that the first impression matters—we have done the most. We have gained her trust, which means we have prevented excessive adrenaline release that could hinder labour progress, and at the same time the woman trusts us enough to tell us what suits her and what doesn’t, so we can more easily align with her wishes. Communication between the midwife and the woman/couple is very important in the birth process.

RQ2: What are the key factors for building trust between a midwife and a woman in labour?

In studies, patients cite the following key factors for building trust in the delivery room: a warm greeting, a smile, an introduction, and a warm handshake. First contact is the most important. It is also important that midwives know how to listen and observe, adapt to the woman in this way, and help her through the birth process.

RQ3: How can we respect the woman’s wishes without disrupting the birth process?

First, it is important that maternity hospital policies are designed in line with good practice, enabling the use of what the hospital has available to support a woman’s comfort during labour. Prenatal preparation for birth and access to relevant information are important. Ideally, the midwife would already know the woman. Since our healthcare system does not allow this, it is important that the midwife talks with the woman about her wishes, expectations, and fears before entering the delivery room or the active phase of labour, and then, based on experience and observation, adapts the atmosphere to the woman and guides her appropriately when she moves away from the usual course. It is important to gain the woman’s trust upon entering the delivery room, as this is the foundation for good ongoing cooperation with her and her partner/birth companion. Offer her options and choice.

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

Prenatal preparation for birth has an important impact on the birth experience. Childbirth preparation also involves familiarizing oneself with birthing positions. Of course, a woman cannot know in advance which position will be most comfortable for her. Nevertheless, it’s important for her to be aware of the importance of movement during labor. When changing positions, we must also ensure the baby is doing well. Fetal monitoring should allow the woman free movement and provide a realistic assessment of the fetal condition. If we allow a woman to choose the birthing position in which she feels most comfortable, we will achieve labor progression and greater satisfaction for the woman. The birthing mother will have a sense of control, which is often a significant factor in the positive/negative evaluation of the birth experience. Even for women who have limited movement due to their own or the baby’s health condition, or continuous cardiotocograph monitoring, it is important to provide them with the greatest possible comfort – through massage, support with pillows, and additional encouragement. We will do a great deal for the practice of Slovenian midwifery if we eliminate routine birthing in a semi-sitting position and encourage birthing on the side or in a position that suits them.

RQ5: Is restricting eating and drinking during labour justified?

Eating and drinking is considered one of the important factors that affect comfort during labour. A review of studies states that low-risk women should have free choice regarding food and drink intake during labour. Poor nutritional balance can be associated with longer and more painful labour. Also, restricting food and drink does not guarantee an empty stomach or lower acidity of stomach contents. The review found no proven disadvantages or advantages of restricting food and drink during labour in low-risk women.

RQ6: What does an uninterrupted/“golden” first hour after birth mean?

The uninterrupted/“golden” first hour after birth means uninterrupted contact between mother and baby for at least 1 hour after birth. This is the time when we postpone all unnecessary routine interventions and procedures for at least one hour (weighing, measuring, administering eye drops, administering vitamin K, and more). Even so, during this time healthcare professionals can still place ID wristbands without interruption, deliver the placenta, clamp and cut the cord on the mother’s abdomen, treat any birth canal injuries, and monitor postpartum bleeding. We must educate parents about the importance of the uninterrupted/“golden” first hour after birth, while also respecting it if they do not want it. The uninterrupted/“golden” first hour after birth, i.e., skin-to-skin contact (kangaroo care), must also be enabled for mothers and newborns after a caesarean section. By enabling an uninterrupted first hour after birth, we allow the newborn to go through the 9 instinctive stages, which are also influenced by how the birth unfolded. Even maternity hospitals without the Baby-friendly Hospital designation should strive to place the newborn on the mother’s chest immediately after birth, skin-to-skin, for at least one hour, and encourage mothers to observe their newborn. When the mother’s condition prevents skin-to-skin contact immediately after birth, we place the baby on the father’s chest. We cover the baby on the mother or father so that the head remains uncovered. The baby is naked. We let the baby rest on the mother’s chest for at least 1 hour. If skin-to-skin contact is not possible immediately after birth for medical reasons related to the baby, we enable it as soon as possible. After we have enabled the new family an uninterrupted first hour after birth, we can continue with non-urgent interventions, i.e., the newborn’s initial care.

RQ7: What are the benefits of an uninterrupted/“golden” first hour after birth, i.e., skin-to-skin contact?

If during labour we focus on the mother’s wishes and comfort, after birth we must also take care of the newborn. We schedule the interventions we need to perform in a way that disrupts bonding as little as possible. The uninterrupted/“golden” first hour after birth is extremely important for the newborn’s adaptation to life outside the womb. The baby needs to start breathing, and the heart needs to pump enough blood for pulmonary circulation. Important hormones are released in the mother and baby, and our interventions can disrupt them. In this short time, such important processes take place that in a physiological birth we must not allow them to be disturbed by interventions, procedures, and steps that can wait. During skin-to-skin contact, the baby is warmer and can hear the mother’s heartbeat, which also helps normalise the baby’s heart rate and breathing. Babies who remain in skin contact with their mother later on gain weight faster, blood sugar levels and blood pressure stabilise, brain development is faster, the baby cries less and experiences fewer stressful stimuli, breastfeeding is more successful, and discharge from the maternity hospital is sooner. By enabling kangaroo care already in the delivery room, we support early bonding; parents gain confidence that they can care for their baby and that the baby is well cared for. With an uninterrupted first hour after birth, we allow the newborn to go through the 9 instinctive stages, which are, of course, influenced by how the birth unfolded. The uninterrupted/“golden” first hour after birth is therefore very important for bonding in the new family. We should provide as intimate an atmosphere as possible and schedule interventions in a sensible way.

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

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

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

For a newborn who does not need immediate care from a paediatrician, it is extremely important to wait at least 90 seconds before clamping and cutting the umbilical cord. This allows blood to be transfused from the placenta, giving the baby a strong start and better blood values for life ahead. With an uninterrupted first hour after birth—which includes skin-to-skin contact or kangaroo care—later cord clamping, and not removing vernix immediately after birth, we create the best foundation for a strong immune system, the baby’s health and wellbeing, and consequently the mother’s as well.