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A Behavior Analytic Approach to Childbirth: A Contingency Analysis and Preliminary Investigation
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The “cascade of interventions” associated with analgesia use during childbirth has contributed to the U.S. having some of the poorest birth outcomes of any developed nation (Clark, Belfort, Byrum, Meyers, & Perlin, 2008; Kuklina, Meikle, & Jamieson, 2009) and one of the highest rates of cesarean section, with 1 in 3 women delivering their babies via surgery (Boyle, Reddy, & Landy, 2013). In a report summarizing the World Health Organization’s principles of perinatal care, appropriate methods for pain relief are suggested to all be behavioral (Chalmers, Mangiaterra, & Porter, 2001) and a meta-analysis of non-pharmacological approaches for pain management demonstrates better outcomes than use of medical pain management (Chaillet et al., 2014). Despite these conclusions, over 80% of women in the U.S. use an epidural during labor and almost 50% of women who do not want epidurals also end up receiving them (Goer & Romano, 2012). The lack of fluency with labor coping strategies and partner support skills has been highlighted as a contributing variable to the over-reliance on heavy narcotics during childbirth. Research has suggested that childbirth education is ineffective at generalizing learned coping strategies and that better methods of prompting non-pharmacological pain management strategies are needed (e.g., Slade, Escott, Spiby, Henderson, & Fraser, 2000). The purpose of this study was to address the common practices within childbirth; outcomes associated with such practices were discussed, contingency analyses of the barriers were identified, and a behavior analytic technology within the current system was proposed and evaluated. Results of this preliminary study conclude that the introduction of a behavior analytic software using in-vivo prompting and video modeling increases the frequency of labor behaviors and variability of labor behaviors during unmedicated labor for women and their support partners.