Birth Preferences Research Articles

The nexus between poverty and maternal healthcare utilization with a focus on antenatal care visits and choice of place of birth in Somaliland.

Poverty poses a significant barrier to accessing healthcare globally, particularly in relation to antenatal care (ANC) visits and the use of childbirth facilities, both of which are crucial for women's health and fetal well-being. In Somaliland, only 47% of pregnant women attend healthcare facilities for ANC, with a mere 33% receiving care from skilled birth attendants. Despite this, no previous studies have examined the relationship between poverty and maternal healthcare utilization in Somaliland. This study aims to investigate the effect of poverty on maternal healthcare utilization with focus on ANC visits and the choice of place of birth in Somaliland. Utilizing data from the 2020 Somaliland Demographic Health Survey, a cross-sectional study design was employed, analyzing a nationally representative sample. The sample size used in this study was 3,183 women of reproductive age. Descriptive analysis, negative binomial regression, and multinomial logistic regression were conducted using Stata version 18.0. Diagnostic tests, including Chi-square - 2log likelihood statistic, Akaike Information Criterion, and Bayesian Information Criterion, were employed to evaluate model fit. Poverty, as indicated by wealth quintile, was associated with reduced ANC visits (adjusted incidence rate ratio (aIRR) = 0.884, 95% CI: 0.791-0.987) among women in poorer households compared to those in richer households. Women in Togdheer, Sool, and Sanaag regions had lower ANC visit rates compared to Maroodi Jeex region (aIRR = 0.803, 95% CI: 0.687-0.939; aIRR = 0.710, 95% CI: 0.601-0.839; aIRR = 0.654, 95% CI: 0.558-0.768, respectively). Women from poorer households had lower probabilities of opting for public health facilities (adjusted relative risk ratio (aRRR) = 0.457, 95% CI: 0.352-0.593) and private health facilities (aRRR = 0.195, 95% CI: 0.111-0.341) over home births compared to women in richer households. Women in Togdheer, Sool, and Sanaag regions had lower probabilities of choosing public (aRRR range: 0.331-0.175) and private (aRRR range: 0.350-0.084) health facilities for delivery over home births compared to women in Maroodi Jeex region. Poverty significantly impedes maternal healthcare utilization, contributing to lower ANC attendance and preference for home births over public or private health facility births. Addressing these disparities requires initiatives to eliminate financial barriers, such as user fees, and enhance equitable access through community-based health insurance and improved healthcare infrastructure.

Knowledge and Attitudes of Pregnant Women towards Bankjo Lamp Technology: Case Study of Choosing a Birth Place

Background: A high-risk pregnancy jeopardizes both maternal and fetal lives. Despite recommendations for hospital births, six out of ten high-risk expectant mothers in Kawedanan opt for PMB or Community Health Center Maternity. To identify high-risk pregnancies, Kawedanan Community Health Center employs the innovative Bankjo lamp. This study investigates how pregnant women's attitudes and knowledge about Bankjo lamps influence their maternity location choice. Methods: This type of research uses quantitative descriptive research. This observational analytical research involved 57 expectant mothers due to maternity in January, February, or March. Using a cross-sectional design, the study treated knowledge and attitudes about Bankjo lamps as independent variables, with maternity location preference as the dependent variable. Data collection methods included knowledge and attitude questionnaires and monthly midwife reports. The data was analyzed using the Chi-Square test and descriptive statistics in the form of frequency distribution with presentation. Results: Findings indicate that pregnant women generally possess adequate knowledge about suitable maternity locations, with some showing insufficient understanding. A significant correlation (p = 0.013) exists between knowledge levels and preferred birthplace. Despite the preference for hospital births among nearly all expectant mothers, a majority hold negative attitudes, strongly correlated (p = 0.000) with their birthplace choices. Interestingly, while most pregnant women understand the Bankjo lamp innovation well, they harbor negative attitudes toward it. Nevertheless, almost all opt for hospital births, prioritizing medical safety despite reservations about new technologies. Conclusions: The study underscores the need for government support in advancing maternal health initiatives, including innovative technologies like Bankjo lamps. Enhancing awareness and promoting positive attitudes among expectant mothers can foster safer childbirth practices. By disseminating knowledge and addressing misconceptions, healthcare providers can better support high-risk pregnancies, ensuring better outcomes for both mothers and babies.

Influence of Antenatal Education on Birth Outcomes: A Systematic Review Focusing on Primiparous Women.

The primary objective of prenatal education programs is to furnish expectant mothers with the necessary knowledge for childbirth and early parenting. Despite the extensive implementation of these programs, the efficacy of these interventions remains unclear. This systematic review endeavored to consolidate the extant evidence pertaining to the effects of prenatal education on birth outcomes and experiences. Fourteen studies, comprising various study designs executed across diverse countries, were incorporated in this review. The outcomes assessed in these studies encompassed fear and anxiety, pain, delivery mode, interventions, postpartum depression, and self-efficacy. Additionally, the risk of bias and study limitations were also summarized. The results manifested that prenatal education was effective in diminishing the fear and anxiety associated with childbirth and enhancing self-efficacy in the majority of the studies. Moreover, several studies found that engaging in prenatal education augmented the preference for unmedicated vaginal birth. However, the effects of prenatal education on postpartum outcomes were less consistent. The primary constraints of the included studies were their minute sample sizes and brief follow-up periods. Nonetheless, the existing evidence proposes that prenatal education is beneficial for first-time mothers in terms of alleviating anxiety and augmenting agency during delivery. Prenatal education can equip pregnant individuals with the necessary knowledge and skills to navigate the perinatal period successfully. Further research is requisite to identify the optimal practices for diverse populations on a global scale.

Women’s experiences of disrespect and abuse in Swiss facilities during the COVID-19 pandemic: a qualitative analysis of an open-ended question in the IMAgiNE EURO study

BackgroundThe COVID-19 pandemic has challenged the provision of maternal care. The IMAgiNE EURO study investigates the Quality of Maternal and Newborn Care during the pandemic in over 20 countries, including Switzerland.AimThis study aims to understand women’s experiences of disrespect and abuse in Swiss health facilities during the COVID-19 pandemic.MethodsData were collected via an anonymous online survey on REDCap®. Women who gave birth between March 2020 and March 2022 and answered an open-ended question in the IMAgiNE EURO questionnaire were included in the study. A qualitative thematic analysis of the women’s comments was conducted using the International Confederation of Midwives’ RESPECT toolkit as a framework for analysis.FindingsThe data source for this study consisted of 199 comments provided by women in response to the open-ended question in the IMAgiNE EURO questionnaire. Analysis of these comments revealed clear patterns of disrespect and abuse in health facilities during the COVID-19 pandemic. These patterns include non-consensual care, with disregard for women’s choices and birth preferences; undignified care, characterised by disrespectful attitudes and a lack of empathy from healthcare professionals; and feelings of abandonment and neglect, including denial of companionship during childbirth and separation from newborns. Insufficient organisational and human resources in health facilities were identified as contributing factors to disrespectful care. Empathic relationships with healthcare professionals were reported to be the cornerstone of positive experiences.DiscussionSwiss healthcare facilities showed shortcomings related to disrespect and abuse in maternal care. The pandemic context may have brought new challenges that compromised certain aspects of respectful care. The COVID-19 crisis also acted as a magnifying glass, potentially revealing and exacerbating pre-existing gaps and structural weaknesses within the healthcare system, including understaffing.ConclusionsThese findings should guide advocacy efforts, urging policy makers and health facilities to allocate adequate resources to ensure respectful and high-quality maternal care during pandemics and beyond.

Digital health's influence on the association between birth preference and vaginal birth.

Women's preferred mode of birth during pregnancy is predictive of their actual mode of birth. Digital prenatal care services are a promising method for educating women on mode of birth to reduce elective cesareans. This study aimed to evaluate the influence of digital health on the association between birth preference and mode of birth. Data come from 5409 pregnant women enrolled in a digital platform for women's and family health. Multi-trajectory modeling identified trajectories of digital health usage throughout pregnancy. Adjusted logistic regression models tested associations between birth preferences and mode of birth. The modifying effect of digital health usage on the association between birth preference and mode of birth was assessed on the multiplicative scale. Four distinct trajectories of digital service usage were identified and labeled as: (1) baseline users (52%): the reference group; (2) just-in timers (16%): high usage during the third trimester; (3) learners (26%): high educational resource usage (e.g., articles and classes) throughout pregnancy; and (4) super users (6%): high usage of both education and care resources throughout pregnancy. Overall, preferred mode of birth at enrollment was predictive of actual mode of birth; however, digital health usage moderated this association, whereby super users and learners who preferred a cesarean at enrollment were more likely to deliver vaginally, compared to baseline users who preferred a cesarean. For the increasing proportion of women considering an elective cesarean, education through a prenatal digital health platform may help to encourage vaginal birth and reduce cesarean births.

Exploring the Drivers of Home Births: Perspectives, Risks, Benefits, and Policy Implications in Zamboanga Sibugay, Philippines

Background: The persistence of home births in the Philippines remains conspicuous, despite the enforcement of policies discouraging this practice and the prevailing concerns about its safety. This research aims to delve into the various perspectives of women concerning home births to describe the underlying motivations behind their choices, their perceptions of the associated risks and benefits, and their stance on the “no home-birthing policy” of the state. Subjects and Method: This was a descriptive, cross-sectional study involving 80 mothers drawn from Malangas, Zamboanga Sibugay, Philippines through a referral-based sampling method. The study examined sociodemographic characteristics as independent variables, while dependent variables included perceived reasons for home birth preference, associated risks and benefits, and respondents' views on the "no home-birthing" policy. Data were described in descriptive statistics. Results: The findings showed that the inclination of women toward giving birth at home without the presence of professional birth attendants emanates from a multitude of factors. These include economic considerations, the sense of a familiar and comfortable environment, deeply rooted cultural beliefs, challenges related to accessibility to health facilities, and geographical impediments. Notwithstanding the inherent health risks, women opt for home births due to cost considerations, improved accessibility, and as a means of expressing their cultural and personal convictions. Consequently, the "no home-birthing policy" implemented in the Philippines is seen to reflect an effort to safeguard maternal and neonatal health by promoting facility-based deliveries. Conclusion: The study underscores the importance of developing a holistic healthcare strategy that harmonizes women's autonomy and cultural practices with the crucial goal of ensuring safe childbirth, especially in marginalized areas.

Pre-University Students’ Attitudes and Beliefs about Childbirth: Implications for Reproductive Health and Maternity Care

Objectives: To determine pre-university students’ attitudes and beliefs about childbirth and identify key sources of information and knowledge.Methods: A survey of 359 Quebec pre-university students (215 female, 144 male) was undertaken to identify sources of beliefs about birth and opinions about types of maternity care providers and place/method of delivery. Results: Prime sources for birth beliefs were family (50.7% female, 39.9% male) and media (21.9% female, 33.6% male). The dominant preferred birth model was hospital vaginal delivery attended by an obstetrician. The students’ birth preferences reflected strong support for professional supervision/intervention and skepticism about the safety of home birth and out-of-hospital birth centres. Although 9.3% of female students and no males would choose elective cesarean section (CS) for themselves or partner, 71.2% of female students and 42.4% of male students agreed that CS is “just another way of having a baby.” Most female students believed “it is a woman’s right to choose CS for herself ” and had a higher preference/acceptance of CS, compared with male students. Students characterized birth as “painful” and “miraculous” and agreed on its relative safety. Female students were more fearful and more stressed about the prospect of birth, compared with male students. Over 75% of female students were aware of the benefits of breastfeeding and planned to breastfeed. Conclusions: Most students supported in-hospital maternity care and perceived CS as normal but did not express a preference for CS for themselves or their partners. Students were unaware of the risks/benefits of CS, epidurals, and out-of-hospital birth. These findings highlight the need for health care professionals to engage young adults and to provide them with evidence-based information about maternity care options.

Midwife-led psycho-education intervention to reduce childbirth fear: a quasi-experimental study.

This quasi-experimental study aimed to assess the impact of a midwife-led psycho-education intervention on reducing fear of childbirth (FOC) and perceived stress (PS) in pregnant women. The present study involved 96 pregnant women. The intervention group received three 30-45 min telephone sessions using 'BELIEF' (Birth Emotion-Looking to Improve Expectant Fear) psycho-education approach. The outcomes were assessed using questionnaires on childbirth attitudes and PS. Data analysis was performed using Stata version 17. In the intervention group, the mean score for FOC decreased from 39.41 ± 7.02 to 29.91 ± 5.60 (9.5; 24.1%). The mean difference (MD) of 28.22% was statistically significant (adjusted MD: -10.51, 95% CI: -11.60, -9.41, P < 0.001). In the intervention group, mean scores for PS decreased from 22.77 ± 6.94 to 18.23 ± 5.69 (4.54; 19.93%). In the control group, scores increased from 22.68 ± 6.76 to 24.82 ± 6.58 (2.14; 9.43%). The 29.36% MD was statistically significant (aMD: -6.95, 95% CI: -8.73, -5.18, P<0.001). The findings of this study indicate that the midwife-led psycho-education intervention, utilizing the 'BELIEF' protocol over the telephone, has a significant effect on reducing FOC and PS, as well as increasing the preference for vaginal birth.

Birth Care Gaps in the Childbirth Options, Information, and Person-Centered Explanation (CHOICEs) Measure.

The objective of this study was to revise and improve the intrapartum items of the shared decision-making (SDM) measure, CH ildbirth O ptions, I nformation and person- C entered E xplanation (CHOICEs). Methodological sequential triangulation was used to select a purposive sample of 29 people who gave birth in the United States between August 2019 and June 2021. A qualitative descriptive approach was used to analyze and interpret the data. We used an interview guide with questions related to the nine intrapartum items in CHOICEs to address the question: How did decision-making occur during your most recent birth? Four major themes were identified: provider told me what to do ; communication about interventions during labor and birth ; preferences overlooked ; multiple team members . Under the theme of provider told me what to do , there was one sub-theme of induction of labor . Participants noted lack of shared decision-making, poor communication, and obstetric violence. We found the need for perinatal providers to improve communication with birthing people on topics such as fetal monitoring, induction of labor, and multiple team members who may participate in their care. Revisions of CHOICEs will include seven new items to further address birth preferences, feeling heard, and multiple team members.

Validation of the Chinese version of the Fear of Birth Scale among pregnant women

Aim: Adapt Fear of Birth Scale (FOBS) for the Chinese context, evaluate psychometric properties and determine optimal cutoff point for pregnant women in 3rd trimester.Design: This is a descriptive cross-sectional study. Cultural guidelines informed the development of the Chinese version of FOBS (FOBS-C) incorporating validation on translation, equivalence index, content validity index, and cognitive debriefing. Thirty pregnant women took a test-retest survey and another 1019 took three cross-sectional surveys. Convergent validation of the FOBS-C involved comparison with Childbirth Attitudes Questionnaire (CAQ), Wijma Delivery Expectancy Questionnaire (WDEQ-A), Edinburgh Postnatal Depression Scale (EPDS), Generalized Anxiety Disorder Scale (GAD-7), and physiological indicators. Cutoff points for FOBS-C were identified using receiver operating characteristic analysis against medical indicators.Findings: FOBS-C demonstrated high translation equivalence (0.833–1), content validity (0.800–0.933), internal consistency (0.897), and test-retest reliability (0.860). Convergent validity was supported by statistically significant correlations between FOBS scores, heart rate, skin conductance changes, as well as scores from WDEQ-A, CAQ, EPDS, and GAD-7. Known-group validity was observed with different medical indicators. FOBS-C cutoff points indicating severe fear of childbirth were identified as 65, 68, 71, and 56, respectively, against WDEQ-A ≥ 85, CAQ ≥ 52, preference for C-section birth, and preference for analgesia, demonstrating known-group validity. A cutoff point of 65 showed the FOBS-C's strongest known-group validity.Conclusion: The FOBS-C exhibits robust psychometric properties, making it a valid screening tool for identifying severe fear of birth. Establishing a cutoff point at 65 facilitates effective screening.

Women’s preference for a vaginal birth in Brazilian private hospitals: effects of a quality improvement project

BackgroundIn 2015, a quality improvement project called “Adequate Childbirth Project” (PPA) was implemented in Brazilian private hospitals in order to reduce cesarean sections without clinical indication. The PPA is structured in four components, one of which is directed at women and families. The objective of this study is to evaluate the effects of PPA on women’s preference for vaginal birth (VB) at the end of pregnancy.MethodsEvaluative research conducted in 12 private hospitals participating in the PPA. Interviews were carried out in the immediate postpartum period and medical record data were collected at hospital discharge. The implementation of PPA activities and women’s preference for type of birth at the beginning and end of pregnancy were compared in women assisted in the PPA model of care and in the standard of care model, using a chi-square statistical test. To estimate the effect of PPA on women’s preference for VB at the end of pregnancy, multiple logistic regression was performed with selection of variables using a causal diagram.ResultsFour thousand seven hundred ninety-eight women were interviewed. The implementation of the planned activities of PPA was less than 50%, but were significantly more frequent among women assisted in the PPA model of care. Women in this group also showed a greater preference for VB at the beginning and end of pregnancy. The PPA showed an association with greater preference for VB at the end of pregnancy in primiparous (OR 2.54 95% CI 1.99–3.24) and multiparous women (OR 1.44 95% CI 0.97–2.12), although in multiparous this association was not significant. The main factor associated with the preference for VB at the end of pregnancy was the preference for this type of birth at the beginning of pregnancy, both in primiparous (OR 18.67 95% CI 14.22–24.50) and in multiparous women (OR 53.11 95% CI 37.31–75.60).ConclusionsThe PPA had a positive effect on women’s preference for VB at the end of pregnancy. It is plausible that more intense effects are observed with the expansion of the implementation of the planned activities. Special attention should be given to information on the benefits of VB in early pregnancy.

Perceptions of Women in Turkey on the Concepts of “Caesarean Section” and “Vaginal Birth After Caesarean Section”: A Metaphor Analysis

Background Determining how women make sense of their birth preferences with metaphor analysis will be an important step in determining perceptions about birth options.&#x0D; Objective The aim of this study is to examine the perceptions of women who had cesarean section regarding the concept of “cesarean birth” and “Vaginal birth after cesarean section” with metaphor analysis.&#x0D; Materials and Methods: This study is a qualitative research based on the philosophy of Husserl’s phenomenology, which was carried out between June and November 2022. Within the scope of the research, 50 women who had a cesarean section were interviewed face to face. The metaphor form prepared in line with the international literature was used to determine women’s perceptions of the concept of “Cesarean section” and “Vaginal birth after cesarean section”.&#x0D; Results 25 metaphors for cesarean birth and 28 metaphors for vaginal birth after caesarean section were identified. Considering the common features and analogy aspects of the metaphors obtained, three themes were determined within the scope of cesarean section and vaginal birth after caesarean section.&#x0D; Conclusions This study took a unique approach to revealing women’s birth experiences and perceptions. Vaginal birth after caesarean section is a very valuable birth method for women who have had a cesarean section and are curious about the feeling of vaginal birth.&#x0D; Bangladesh Journal of Medical Science Vol. 23 No. 02 April’24 Page : 418-428

The Effect of Fear of COVID-19 on the Birth Preferences of Pregnant Women

Deciding on the mode of birth related to the pregnant woman's own body will increase her self-confidence. It will reduce the anxiety caused by the adverse conditions caused by the pandemic process. It was aimed to examine the effect of fear of COVID-19 on the birth preferences of pregnant women.&#x0D; A descriptive cross-sectional study was conducted between January and April 2021 with 631 pregnant women who were followed up in an crowded pandemic hospital in Turkey. The data were obtained through the Google online platform, the Questionnaire Form and the COVID-19 Fear Scale.&#x0D; This study 50.7% of the pregnant women gave vaginal birth before the COVID-19 pandemic, while 75.3% preferred vaginal birth during the pandemic. When the table is examined, the mother's fear of COVID-19 increased her choice of delivery method 96%.&#x0D; According to the findings of this study, fear of COVID-19 affected birth choice.

Effect of Peanut Ball Exercise on Fear of Labour among Primigravida Mother

Background: Fear of giving birth is the primary factor that has reduced the preference for natural birth. Thesudden rise in the percentage of C-sections has harmed women’s pregnancy and new-born health.Purpose: To evaluate the effectiveness of peanut ball exercise on reducing fear among primigravida mothers.Materials and Methods: Thirty participants were randomly assigned to experimental (peanut ball exercise,antenatal exercise, antenatal education) and conventional (Antenatal exercises) groups. The fear of childbirthquestionnaire (FCQ) was used to evaluate the pre-test the same test used to determine post-treatment values after12 weeks of the treatment.Results: A significant difference was observed between the experimental and control groups (P =0.0001). peanutball exercise and antenatal education were effective in mothers with a fear of childbirth.Conclusion: Peanut ball training is effective in mothers with a fear of childbirth.

Fear of Birth and Childbirth Preferences in BIPOC Women Prior to Childbirth Education

The purpose of this project was to examine a free tailored childbirth education (CBE) program’s impact on fear of childbirth and birth preferences in Black, Indigenous, and people of color women. Expectant mothers (N= 8) completed an investigator-designed questionnaire before attending a prenatal community-based CBE program. Post-CBE surveys were not analyzed due to participant data not matching the pre-CBE surveys. Survey results revealed that participants were highly educated and had low levels of fear. Qualitative data revealed common concerns including pain, wishes not being met, desire for a natural birth, and hope for healthy outcomes. Future research is needed to provide evidence that a free culturally matched CBE program is beneficial in high-risk perinatal populations.

Association Between Doula Use on a Digital Health Platform and Birth Outcomes.

To examine the association between the use of virtual doula appointments on a comprehensive digital health platform and users' mode of birth and their birth experiences, among all platform users and Black platform users. Data for this retrospective cohort study were extracted from individuals who enrolled in a comprehensive digital health platform, between January 1, 2020, and April 22, 2023. Multivariable logistic regression models were used to estimate the association between number of virtual doula appointments completed on the digital health platform and odds of cesarean birth and user-reported birth experience outcomes, which included help deciding a birth preference, receiving a high level of support during pregnancy, learning medically accurate information about pregnancy complications and warning signs, and managing mental health during pregnancy, stratified by parity. The interaction of doula utilization by race for each outcome was also tested. Overall 8,989 platform users were included. The completion of at least two appointments with a virtual doula on the digital health platform was associated with a reduction in odds of cesarean birth among all users (adjusted odds ratio [aOR] 0.80, 95% CI, 0.65-0.99) and among Black users (aOR 0.32, 95% CI, 0.14-0.72). Among platform users with a history of cesarean birth, completion of any number of doula visits was associated with a reduction in odds of repeat cesarean birth (one visit: aOR 0.35, 95% CI, 0.17-0.72; two or more visits: aOR 0.37, 95% CI, 0.17-0.83). Analyses among all users indicated dose-response associations between increased virtual doula use and greater odds of users reporting support in deciding a birth preference (one visit: aOR 2.35, 95% CI, 2.02-2.74; two or more visits: aOR 3.67, 95% CI, 3.03-4.44), receiving a high level of emotional support during pregnancy (one visit: aOR 1.99, 95% CI, 1.74-2.28; two or more visits: aOR 3.26, 95% CI, 2.70-3.94), learning medically accurate information about pregnancy complications and warning signs (one visit: aOR 1.26, 95% CI, 1.10-1.44; two or more visits: aOR 1.55, 95% CI, 1.29-1.88), and help managing mental health during pregnancy (one visit: aOR 1.28, 95% CI, 1.05-1.56; two or more visits: aOR 1.78, 95% CI, 1.40-2.26). This analysis demonstrates that virtual doula support on a digital health platform is associated with lower odds of cesarean birth and an improved birth experience. Positive findings among Black users and users with vaginal birth after cesarean suggest that doula support is critical for patient advocacy, and that digital health may play a meaningful role in increasing health equity in birth outcomes.

Systematic review and meta-analysis examining the effects of midwife care on cesarean birth.

The increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births. We searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse-variance random-effects meta-analysis was used to generate overall odds ratios (ORs). We observed a significantly lower likelihood of cesarean birth in midwife-led care, midwife-attended births, among those who received instruction pre-birth from midwives, and within institutions with a midwifery presence. Care from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care.

The impact of maternity service restrictions related to COVID-19 on women's experiences of giving birth in England: A qualitative study

BackgroundThe COVID-19 pandemic led to significant changes in maternity service delivery in England, including: antenatal appointments being cancelled or held by phone; women having to attend antenatal scans alone; partners not being allowed to accompany women during labor; visitor restrictions on postnatal wards; and limited postnatal support. MethodsWe conducted semi-structured interviews with 46 women aged 18–45 who had low-risk pregnancies and gave birth to their babies using NHS services in England between 1st March 2020 and 1st March 2021. ResultsOur thematic analysis of interview data generated key themes: profound negative impacts of birth partners not being allowed to accompany women (including on emotional wellbeing, birth preferences and care-seeking choices); deep frustration about policy variation between trusts and inconsistent implementation of guidance; women being more concerned about the risk of giving birth alone than of COVID-19 infection; and women turning towards private care or delaying seeking NHS care so that they could have the birth experience they desired. The latter two results are, to the best of our knowledge, unique to this paper. ConclusionOur participants reported significant negative affects to their emotional and physical wellbeing because of maternity service restrictions. Going forward, efforts are required by policymakers and health service providers to re-establish trust in NHS maternity care and ensure capacity to provide for potential shifts in birthplace preferences. Health systems strengthening efforts should prioritise protecting the rights of women to access high quality, person-centred care in the event of future health emergencies that strain NHS capacity.

Facilitating positive birth experience when preferences are not met: A qualitative analysis.

High-quality health systems rely on care that centers on patient preferences. Realization of patient preferences can improve the birth experience. However, in the dynamic setting of birth, birth preferences can diverge from what is medically indicated. Through studying women and birthing peoples' experiences of unplanned labor procedures, we aimed to identify ways in which practitioners can support women and birthing people through unexpected or unwanted aspects of their delivery. Specifically, we focused on labor induction. In one large US academic center, women and birthing people participated in prenatal and postpartum surveys regarding their desires, expectations, and experiences of labor induction. From April to November 2021, participants were eligible if they showed discordance between having labor induction and whether it was initially wanted or expected. Interviews focused on attitudes toward birth preferences and outcomes, with attention to discordances. We analyzed interviews through a modified grounded theory approach. Of 22 participants, our sample was predominantly white (91%). Participants in this sample reported discordance between wanting and experiencing (73%) and/or expecting and experiencing (54%) an induction. We identified two themes: "Discordance without mitigation is perceived as a negative experience" and "Practitioner interaction can buffer against negative experience" which includes three ways in which participants prefer support in instances of discordance: preparation, communication, and care and comfort. These methods of support foster patient autonomy and can lead to positive patient experiences. While medical systems should work to support patient preferences, our results suggest that patients can still have positive birth experiences, even when preferences are not fulfilled. Early practitioner preparation, positive communication, and responsive care and comfort may help to improve patient birth experience when challenges arise.

Decision-making experiences and the need for decision aids in women considering vaginal birth after cesarean: A qualitative meta-synthesis.

This study aims to comprehensively explore the decision-making requirements of women contemplating vaginal birth after cesarean (VBAC). A meta-synthesis approach was employed for this study. Using an integrative methodology, we conducted a systematic assessment of women's experiences and needs related to VBAC decision-making. A comprehensive search was conducted across The Cochrane Library, PubMed, EMBASE, Ovid Medline, SCOPUS, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, and Wan Fang databases to identify pertinent studies between 2000 and 2022. Furthermore, the reference lists of the included studies were thoroughly examined. Fifteen studies were incorporated, from which seven themes emerged: emotional changes, preference for vaginal birth, unmet information needs, influences on decision-making, decision-making autonomy, aligning information provision with decision-support needs, and the requirement for support systems. Two primary syntheses were constructed on the decision-making process and the need for decision-making aids, respectively. Women opting for VBAC experienced emotional shifts during their decision-making process in pregnancy. There remains a need for an enhanced decision-making tool to guide them in their choice. Recommendations for implementation in VBAC decision aids include facilitating women's involvement in decision-making, satisfying their information needs, and delivering appropriate emotional support.