Abstract
BackgroundLow risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. However, women’s experience and satisfaction of midwife-led maternity care is rarely reported in China. The primary objective of this study is to describe the experience of Chinese women receiving midwife-led maternity care, and to report their satisfaction level of the experience.MethodsThe study is a cross-sectional survey of 4192 women who had natural birth from March–June 2019 in a maternity care center, Shanghai, China. We used a self-administered questionnaire addressing items related to women’s experience during childbirth, as well as their satisfaction with midwife-led maternity care. We also included demographic and perinatal characteristics of each participant. Descriptive statistics and correlations analysis between groups of different experience and satisfaction were used.ResultsIn this sample, 87.7% of women had a Doula and a family member present during childbirth. Epidural anesthesia was used in 75.6% and episiotomy was needed in 23.2%. Free positioning during the first stage of labor and free positioning during the second stage of labor and delivery were adopted in 84.3 and 67.9% of the cases, respectively. Moderate to severe perineal pain and moderate to severe perineal edema were reported in 43.1 and 12.2% of the participants, respectively. High satisfaction level was found when there was midwife-led prenatal counseling and presence of Doula and family member, Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during the first stage of labor, and midwifes’ postpartum guidance. Negative satisfaction was seen with perineal pain and edema.ConclusionWomen in this survey generally had high satisfaction with midwife-led maternity care. This satisfaction is probably felt because of the prenatal counseling by the midwife and allowing a Doula and a family member in the room during childbirth. Other intangible factors to improve the satisfaction level were Lamaze breathing techniques, warm perineal compresses, epidural anesthesia, free positioning during first stage of labor, and early skin to skin contact.
Highlights
Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife
The univariable analysis showed that midwife-led prenatal counseling, presence of doula and family member at delivery, Lamaze breathing techniques, warm perineal compresses with red-bean bags, epidural anesthesia, free position during the first stage of labor, episiotomy, laceration of perineum, midwives’ postpartum guidance, perineum pain two hours after delivery, and perineum edema two hours after delivery were significantly related to women’s satisfaction with childbirth
The mother-infant skin to skin contact is far from optimal, as well as Midwife-led prenatal counseling which is an important component of midwifery care beyond the labor room
Summary
Low risk pregnancy ending in a vaginal birth is best served and guided by a midwife. Utilizing a midwife in such cases offers many emotional and economic advantages and does not increase the risks for mother or neonate. Wang reported that labor pain and lack of social support during childbirth were the major reasons for women to request a C-S [6] These factors may explain the high CS rates in China which remains 41.1–45.6% (nationwide from 2012 to 2016) [7]. All across the World, there is a growing interest for midwife or a team of midwives leading the planning, organization, and delivery of care, with some consultation from obstetricians [10,11,12] This midwifeled team compared to obstetrician-led maternity care was associated with lower maternal and neonatal mortality, lower C-S rate, lower and better postpartum wellbeing [10, 12,13,14]. In the scope of midwifery, according to the framework for quality maternal and newborn care, effective practice for childbearing women and infants includes education, information, health promotion and public health; assessment, screening and care planning; promotion of normal process and prevention of complications; first-line management of complication and so on [12]
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