Birth Experience Research Articles

Perinatal Loneliness and Isolation Early in the COVID‐19 Pandemic in New York City: A Qualitative Study

IntroductionDuring the COVID‐19 pandemic, birthing parents were identified as a high‐risk group with greater vulnerability to the harms associated with SARS‐CoV‐2. This led to necessary changes in perinatal health policies but also to experiences of maternal isolation and loneliness, both in hospital settings, due to infection mitigation procedures, and once home, due to social distancing.MethodsIn this study, we qualitatively explored birthing and postpartum experiences in New York City during the early days of the pandemic when lockdowns were in effect and policies and practices were rapidly changing. Using thematic analysis, our focus was on experiences of isolation, navigating these experiences, and the potential impacts of isolation and loneliness on maternal health for 55 birthing people.ResultsParticipants described numerous stressors related to isolation during the birthing process, including reconciling their hopes for their birth with the realities of the unknown and separation from partners, family, and friends in the hospital. During the postpartum period, loneliness manifested as having limited or no contact with family and friends, which led to feelings of a need for strengthened social support systems. The impact of these negative experiences shaped mental health. Overall, we found that solitary experiences during birthing and postpartum isolation were major sources of stress for participants in this study.DiscussionTo support impacted families and prepare for future crisis events, clinicians and researchers must prioritize the development of strong clinical and social support structures for perinatal people to ensure both maternal and child health.

Autonomy, Violence, and Consent in the Obstetric Field

Abstract Obstetric violence is a structural form of gender, medical, and sexual violence perpetrated by health providers and institutions during pregnancy, birth, and postpartum. It can produce physical, psychological, and symbolic harm to pregnant/birthing people and their families. Obstetric violence results from structural conditions in the technocratic model of birth and the acceptance of biomedicine as the authoritative knowledge in health care. This phenomenon produces patients’ loss of autonomy and capacity to provide informed consent, which increases their vulnerability to unjustified medical procedures, resulting in negative birth experiences. In this paper, I argue that individual autonomy is necessary but not sufficient for legitimately consenting to obstetric care and preventing violence. The liberal framework of individual autonomy often ignores that childbirth is a social event where multiple individuals and cultural factors influence the consent process. Consequently, I discuss the role of relational autonomy in obstetric decision-making and describe some structural barriers that negatively intervene in this process. Finally, I propose that doulas and midwives can help nurture autonomy and caregiving skills in obstetric patients and health providers. This strategy protects the informed consent process, prevents obstetric violence, and can be effective in recentering childbirth in pregnant people and their families.

The role of childhood trauma and attachment state of mind in mothers’ birth experiences

ABSTRACT Negative birth experiences are common. It is yet unclear which women may be most at risk already before pregnancy. Childhood trauma and non-autonoumous/unresolved attachment state of mind may affect how women experience giving birth. This study used longitudinal data to test childhood trauma and attachment state of mind as predictors of birth experience in at-risk sample of primipara women (N = 193). The Adverse Childhood Experiences questionnaire and the Adult Attachment interview were administered during pregnancy, and women reported about their birth experience three months postpartum. Partial Least Square Structural Equation Modelling was applied to answer the research questions. Childhood physical neglect and parental substance abuse were predictive of a more negative birth experience, while attachment state of mind was not associated with how women experienced giving birth. Cross-validation suggests that these findings may be considered externally valid. Further research using validated measures on birth experience are needed.

Birth expectations, birth experiences and childbirth-related post-traumatic stress symptoms in mothers and birth companions: Dyadic investigation using response surface analysis.

During the perinatal period, women and their birth companions form expectations about childbirth. We aimed to examine whether a mismatch between birth expectations and experiences predict childbirth-related post-traumatic stress symptoms (CB-PTSS) for mothers and birth companions. We also explored the influence of the mismatch between mothers' and birth companions' expectations/experiences on CB-PTSS. Dyadic longitudinal data from the Self-Hypnosis IntraPartumTrial. Participants (n = 469 mothers; n = 358 birth companions) completed questionnaires at 27 and 36 weeks of gestation and 2 and 6 weeks post-partum. We used the measures of birth expectations (36 weeks gestation), birth experiences (2 weeks post-partum) and CB-PTSS (6 weeks post-partum). Correlations revealed that birth expectations were associated with experiences for both mothers and birth companions but were not consistently associated with CB-PTSS. Birth experiences related to CB-PTSS for both mothers and birth companions. The response surface analysis results showed no support for the effect of a mismatch between expectations and experiences on CB-PTSS in mothers or birth companions. Similarly, a mismatch between mothers' and birth companions' expectations or experiences was unrelated to CB-PTSS. Following previous literature, birth expectations were associated with experiences, and experiences were associated with CB-PTSS. By testing the effect of the match between birth experiences and expectations using an advanced statistical method, we found that experiences play a more substantial role than the match between experiences and expectations in CB-PTSS. The impact of birth experiences on CB-PTSS highlights the importance of respectful and supportive maternity care.

How Can Midwives Prevent Birth Trauma?

Recently qualifying as a midwife and having various conversations with colleagues and families has reiterated the common misconception that birth trauma is something we can diagnose from simply reading a delivery summary. The notion that birth trauma exclusively happens when an emergency buzzer is pulled, or when the total blood loss ticks over 500mls disregards the impact that our care has on women’s experience, be it positive or negative. With this in mind, the objective of this article is to unpack what we can do as midwives to prevent women being traumatised by their birth experiences.

Are labor epidural catheters after a combined spinal epidural (CSE) technique more reliable than after a traditional epidural? A retrospective review of 9153 labor epidural catheters.

The combined spinal epidural (CSE) technique may associate with a lower failure rate of epidural catheters compared to traditional epidural catheters. This may be significant for the parturients as failure of neuraxial analgesia has been associated with a negative impact on birth experience. In this one-year retrospective study, the failure rate of epidural catheters was compared between 3201 and 5952 epidural catheters after initiation of neuraxial analgesia by the CSE or traditional epidural technique, respectively. Parturient background information, labor parameters, and neuraxial interventions were collected from 9153 parturients. Failure was defined as replacement of a used epidural catheter by new regional analgesia procedures or general anesthesia during intrapartum cesarean delivery. The primary outcome was the failure rate of epidural catheters. The secondary outcome was the time from the initial analgesia intervention to the epidural catheter replacement and progression of labor during this time. The CSE method was used at an earlier stage of labor, and the parturients were more often primiparous and undergoing induced labor. Earlier onset of analgesia, obesity, induced labor, anesthesiologist experience, and cesarean delivery were found to be significant cofactors for catheter failure. The unadjusted failure rate was 168/3201 (5.2%) and 223/5952 (3.7%) (OR 1.42 [1.16-1.75]) after initiation of analgesia by CSE or traditional epidural method. After controlling for the stage of labor, body mass index, induction of labor, and anesthesiologist's experience level, the adjusted OR for epidural catheter replacement was 1.04 (0.83-1.29) p = .736. The mean (SD) time until epidural catheter failure was 6.3 (4.4) and 4.0 (4.1) hours following initiation of analgesia by CSE or traditional epidural technique, respectively (p < .001). Cervical dilatation progressed from 4.3 (1.4) to 6.4 (2.1) cm and 5.1 (1.5) to 6.7 (1.7) cm between primary neuraxial analgesia and epidural catheter replacement. CSE technique was not associated with a better survival rate of epidural catheters for provision of analgesia or epidural top-up anesthesia for intrapartum CD. In addition, the time to replacement of the catheter was significantly longer when analgesia was initiated with the CSE technique. Maternal satisfaction scores were lower if catheters required replacement.

Satisfaction with maternity care among immigrant women compared to non-immigrant women

Abstract Introduction Migration is a worldwide phenomenon leading to challenges for the health care system. There is conflicting evidence on the effect of migration on the satisfaction with obstetric care. Our hypothesis was that satisfaction with obstetric care was lower in immigrant women with and without self-defined (sd) refugee status than in non-immigrant women. Methods In the Pregnancy and Obstetric Care for Refugees (PROREF)-study between June 2020 and April 2022 in Berlin women were interviewed 1-3 days after giving birth with the Migrant Friendly Maternity Care Questionnaire (MFMCQ). The interview data was linked to the routine perinatal data of the hospital charts. Descriptive analysis and logistic regression analysis were performed to identify factors influencing satisfaction with obstetric care. Results A total of 3420 women (Frauen (247 with sd refugee status, 1356 immigrant women und 1817 non-immigrant women) could be included in the study, with an overall response rate of 77.5%. Satisfaction measured generally high with over 80% of women being satisfied with obstetric care at all three time points: during pregnancy, during labor and birth and after giving birth. We identified two factors associated with an increased chance of being satisfied with obstetric care: sd refugee status (OR 2.57, 95% Cl 1.48 - 4.44, p-value 0.0008) and being multipara (OR 1.40, 95% Ci 1.18 - 1.67, p-value 0.000). Conclusions Efforts on improving birth experience should focus on primipara. Among the reasons for non-immigrant women being less satisfied with care than women with sd refugee status might be different expectations and the timing of data collection. Key messages • Refugee women might have different expectations regarding birth experience than other immigrant women and non-immigrant women. • Satisfaction with obstetric care in Berlin is generally high among immigrant women and non-immigrant women.

Determinants of health and pregnancy and birth outcomes: an overview

Abstract Introduction This study examines the influence of health determinants on pregnancy and birth outcomes. The aim is to provide a clear and updated view of the overall framework characterizing the birth experience, with crucial implications for clinical practice, research, and health policy. Methods Data analysis pertains to the Certificate of Assistance for Birth (CAP) concerning residents in the territory of AUSL South-East Tuscany in the years 2021 and 2022. The number of women of childbearing age in Tuscany in 2022 is 150,959, while the number of births analyzed in the study is 9,053. The study conducts multivariate analysis between factors and pregnancy-related outcomes. Results Controlling for age, citizenship and others factors, the risk of cesarean section is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 2.09), with education levels of lower secondary (OR = 1.21) and upper secondary (OR = 1.23) compared to a degree, not employed (OR = 1.25) and homemakers (OR = 1.45) compared to employed, overweight/obese (OR = 1.41), with gestational diabetes (OR = 1.16), smoking during pregnancy (OR = 1.27), with gestational hypertension (OR = 2.81). Controlling for age, citizenship and others factors, the risk of term low birth weight is significantly higher (p &amp;lt; 0.05) among mothers: over 40 years old (OR = 1.76), not employed (OR = 1.76) and homemakers (OR = 1.34) compared to employed, smoking more than 3 cigarettes daily during pregnancy (OR = 1.31) not significant, with gestational hypertension (OR = 5.57), nulliparous (OR = 1.42). Controlling for age, citizenship and other factors, the risk of premature birth is significantly higher (p &amp;lt; 0.05) among mothers: with gestational hypertension (OR = 5.22), nulliparous (OR = 1.89), smoking during pregnancy (OR = 1.59). Conclusions The results underscore the importance of carefully monitoring and managing these risk factors during pregnancy to improve outcomes for both mother and baby. Key messages • Understanding the determinants that influence birth outcomes plays a fundamental role. • The importance of Early Childhood Development and early interventions can improve children’s health and well-being.

Experience of Labour and Childbirth in a Sample of Portuguese Women: A Cross-Sectional Study

Background/Objectives: Childbirth is a profoundly personal experience that often does not align with expectations. The World Health Organization has established guidelines for best practises; in this sense, it is crucial to understand the childbirth experiences of Portuguese women in comparison with these guidelines. Methods: A quantitative, descriptive, correlational, and cross-sectional study was conducted to achieve this. In total, 615 women completed a sociodemographic questionnaire and the Labour and Childbirth Experience questionnaire, which comprised 39 statements based on the WHO’s recommendations. Additionally, the study utilized the Life Satisfaction Scale and gathered insights into participants’ overall perception of care during this phase. Results: The results were categorized as follows: (1) practises influencing the labour experience; (2) practises influencing the experience of vaginal birth; (3) practises affecting the experience of caesarean birth; and (4) emotional experience during labour and birth. Conclusions: Notably, the study found that practises discouraged by the WHO are still prevalent, potentially enabling obstetric violence. However, a robust and statistically significant correlation was observed between the childbirth experience and the overall perception of care.

“A Wild and Inaccessible Place”: The Lived Experiences of Autistic Pregnancy and Birth

“A Wild and Inaccessible Place”: The Lived Experiences of Autistic Pregnancy and Birth

Connecting with fetus: The use of app-based fetal movement counting and experiences during pregnancy and birth

BackgroundPregnant people are often introduced to fetal movement counting to monitor the health of their fetus. This study aims to examine the impacts of app-based fetal movement counting on experiences during pregnancy and birth. MethodThis study used two types of secondary data including individual user's app use and their end of pregnancy survey data collected on the Count the Kicks (CTK) app. CTK is a free mobile app providing a virtual platform for pregnant people to conduct their daily kick counting. The study sample includes 1,147 pregnant people. Descriptive analyses were used to examine the number of kick counts using CTK and pregnant women's experiences with the app, their pregnancy, and childbirth. Bivariate analyses were used to examine the relationships between the frequency of kick counts and pregnant people's experience with their pregnancy and birth. Logistic regressions were used to model pregnant people's experiences: anxiety level related to their pregnancy and bonding with their baby. FindingsThe study found that there is inadequate compliance with daily fetal movement counting recommendations in third trimester among pregnant people. However, results showed that frequent use of fetal movement counting is associated with lower anxiety level related to their pregnancy, and more bonding with their baby. These positive pregnancy experiences are associated with healthy birth. ConclusionTo benefit from the impacts of fetal movement counting on positive pregnancy and birth experience, the app developers and public health agencies need to develop strategies to increase daily use of fetal movement counting.

Women Friendly: The effectiveness of a woman-centered childbirth intervention in Israel

Women with symptoms of post-trauma are vulnerable during childbirth and often lack trust in the medical staff in the delivery rooms. They are therefore in need of a sensitive intervention to prevent the formation or exacerbation of trauma in the perinatal period. This study evaluated the feasibility and efficacy of a “Woman Friendly” (WF)intervention for women with a history of trauma. During this intervention, the women were informed about childbirth and prepared for the delivery. Fourteen mothers aged 28–41 with symptoms of post-trauma who had participated in the WF intervention were interviewed about their experience within six months after giving birth. Interviews were transcribed and analyzed using thematic analysis. Thematic analysis yielded six themes. One theme was during the pre-delivery period: 1) Preparation of the WF document. Four themes were during the delivery: 1) The WF document as an advocate; 2) security and safety; 3) Controlling the situation; and 4) Respect and kindness from the medical staff. The final theme was limitations of the WF intervention. It seems that a birth preparation intervention adapted to the needs of emotionally vulnerable women can help them to have positive birth experience. Childbirth preparation for these women should focus on their sensitivities rather than trauma-processing. The WF intervention holds promise for women with symptoms of post-trauma and should be further evaluated in future research.

Rebozo and advanced maternal postures: A promising set of intrapartum interventions to reduce persistent occiput posterior position of the fetal head.

Spinning Babies® procedures and the Rebozo technique have been recently implemented as additional interventions in laboring women with a fetus in occiput posterior position (OPP) to favor the rotation to an anterior position, which improve birth experience and health outcomes. Our study aimed to compare the probability of occurrence of persistent OPP (POPP) of the fetal head at the second stage of labor between retrospective and prospective cohorts and to assess associated sociodemographic, obstetric and intrapartum factors. We conducted a combined prospective and retrospective cohort study including 1500 women giving birth in 2017 (retrospective cohort) and 779 between 15 May and 15 December 2023 (prospective cohort). Each cohort was divided into two sub-cohorts depending on presence of OPP. Primary outcomes were compared the probability of occurrence of POPP in the two OPP sub-cohorts by a log binomial regression and logistic regression. A p<0.05 was considered statistically significant. Data analysis was performed using Stata/MP18.0. The proportion of OPP at the onset of labor was similar between the two cohorts (34.9% vs 35.1%). The probability of occurrence of POPP was significantly lower in the prospective OPP sub-cohort (27.7%, n=65/235) compared to the retrospective OPP sub-cohort (35.8%, n=154/430) (risk difference, RD= -0.081; 95% CI: -0.15 - -0.008; p=0.031). In the retrospective OPP sub-cohort, maternal age ≥35 years (RD=0.096; 95% CI: 0.001-0.190, p=0.044) and nulliparity (RD= -0.100; 95% CI: -0.190 - -0.001, p=0.036) were significantly associated with the probability of POPP. Our findings suggest a potential benefit of a set of interventions combining Spinning Babies® and the Rebozo technique in decreasing the probability of POPP.

Do adverse childhood experiences increase the risk of postpartum traumatic stress and depression?

This study was conducted to determine the effect of childhood adverse experiences on the risk of postpartum posttraumatic stress disorder (PP-PTSD) and postpartum depression (PPD). This descriptive study was conducted with 417 mothers between 1 March and 30 April 2022. Data were collected using a demographic and obstetric information form, the Adverse Childhood Experiences Questionnaire (ACE), City Birth Trauma Scale (CityBiTS) and Edinburgh Postpartum Depression Scale (EPDS) through the Google Forms platform. The mothers participating in the study had a mean age of 30.47 ± 4.21 years, 65.9% (n = 275) had at least one ACE, 10.3% (n = 43) met all of the DSM-5 PTSD criteria according to the CityBiTS, and 91.8% (n = 383) had at least one traumatic stress symptom. Correlation analysis revealed weak positive associations between number of ACEs and CityBiTS score (p < 0.001, r = 0.328) and EPDS score (p < 0.001, r = 0.291) and a moderate positive association between CityBiTS and EPDS scores (p < 0.001, r = 0.601). PP-PTSD was found to be a partial mediator variable between ACE and PPD. The presence of ACE in mothers was found to increase the risk of developing PPD, both alone and when combined with traumatic birth experience. Therefore, we believe that screening for a history of ACE during pregnancy, investigating traumatic birth experiences in the postpartum period, closer follow-up of mothers with both ACE and traumatic birth experiences and increasing support systems will be beneficial in the prevention and early diagnosis of PPD.

Disparities in School Connectedness, Unstable Housing, Experiences of Violence, Mental Health, and Suicidal Thoughts and Behaviors Among Transgender and Cisgender High School Students - Youth Risk Behavior Survey, United States, 2023.

Transgender high school students (those whose gender identity differs from their sex assigned at birth) experience disparate health outcomes and challenges in school, including violence and discrimination, compared with cisgender students (those whose gender identity aligns with their sex assigned at birth). Until recently, population-based data describing the experiences of transgender students and students questioning whether they are transgender (questioning) have been limited. In 2023, the national Youth Risk Behavior Survey assessed transgender identity, providing the first nationally representative data about transgender students. This report describes the demographic characteristics of transgender and questioning high school students and examines differences in the prevalence of experiences of violence, poor mental health, suicidal thoughts and behaviors, school connectedness, and unstable housing among transgender, questioning, and cisgender high school students nationwide. In 2023, 3.3% of U.S. high school students identified as transgender, and 2.2% identified as questioning. Transgender and questioning students experienced a higher prevalence of violence, poor mental health, suicidal thoughts and behaviors, and unstable housing, and a lower prevalence of school connectedness than their cisgender peers. Compared with 8.5% of cisgender male students, 25.3% of transgender students and 26.4% of questioning students skipped school because they felt unsafe. An estimated 40% of transgender and questioning students were bullied at school, and 69% of questioning students and 72% of transgender students experienced persistent feelings of sadness or hopelessness, a marker for experiencing depressive symptoms. Approximately 26% of transgender and questioning students attempted suicide in the past year compared with 5% of cisgender male and 11% of cisgender female students. Intervention opportunities for schools to create safer and more supportive environments for transgender and questioning students can help address these disparities. The findings of this report suggest that more effort is necessary to ensure that the health and well-being of youths who are socially marginalized is prioritized.

Satisfaction with perinatal care providers and the childbirth experience: the moderating role of body mass index

BackgroundSatisfaction with birth and healthcare provider experiences have long-term effects for maternal health. Research has shown that mothers who report more trust, respect, and self-efficacy in their relationship with their healthcare providers are more likely to report positive birthing experiences. Further, individuals with obesity, including pregnant mothers, are more likely to experience weight-related stigma from healthcare providers which may negatively impact satisfaction with this relationship. Thus, the current study examines maternal pre-pregnancy body mass index (BMI) as a moderator between birth and provider satisfaction.MethodsA sample of 94 women (ages 16–38) were recruited during pregnancy. Participants completed surveys about their satisfaction with their birth experience, provider satisfaction, height, weight, and demographics including age and education. A moderation analysis was used to examine pre-pregnancy BMI as a moderator between birth and provider satisfaction.ResultsResults show that provider satisfaction is positively associated with birth satisfaction among mothers with moderate (overweight) to high (obese) pre-pregnancy BMI scores in our sample.ConclusionsFindings suggest that strengthening the patient-provider relationship may promote satisfaction with birth experiences.

"I managed to stand on my own. I saved my baby's life.": qualitative analysis of birth experiences from women living with HIV in Cape Town, South Africa.

There is growing recognition of obstetric violence in health facilities across the globe. With nearly one in three pregnant women living with HIV in South Africa, it is important to consider the influence of HIV status on birth experiences, including potential experience of obstetric violence as defined by the Respectful Maternity Care Charter. This qualitative analysis aims to understand the factors that shape birth experiences of women living with HIV, including experiences at the nexus of HIV status and obstetric violence, and how women react to these factors. Data were collected in a Midwife Obstetric Unit in Gugulethu, Cape Town, South Africa, through 26 in-depth interviews with women living with HIV at 6-8weeks postpartum. Interviews included questions about labor and early motherhood, ART adherence, and social contexts. We combined template style thematic analysis and matrix analysis to refine themes and subthemes. Participants described a range of social and structural factors they felt influenced their birth experiences, including lack of resources and institutional policies. While some participants described positive interactions with healthcare providers, several described instances of obstetric violence, including being ignored and denied care. Nearly all participants, even those who described instances of obstetric violence, described themselves as strong and independent during their birth experiences. Participants reacted to birth experiences by shifting their family planning intentions, forming attitudes toward the health facility, and taking responsibility for their own and their babies' safety during birth. Narratives of negative birth experiences among some women living with HIV reveal a constellation of factors that produce obstetric violence, reflective of social hierarchies and networks of power relations. Participant accounts indicate the need for future research explicitly examining how structural vulnerability shapes birth experiences for women living with HIV in South Africa. These birth stories should also guide future intervention and advocacy work, sparking initiatives to advance compassionate maternity care across health facilities in South Africa, with relevance for other comparable settings.

Qualitative and Artificial Intelligence-Based Sentiment Analysis of Formerly Twitter Messages Related to Water Birth

The benefits of water birth are often emphasized in the literature. While there has been an increase in studies examining women’s experiences of water birth, there has been no study examining formerly twitter statements on this subject. The aim of the study is to determine the opinions about water birth by examining tweets about water birth on formerly twitter. This mixed-method, retrospective study included evaluation of descriptive, quantitative, and qualitative data. In the study, sentiment analysis was performed using quantitative and qualitative methods, using tweets with the expression “waterbirth” and shared between May-July 2023. It has been determined that 87.7% of the 510 tweets that constitute the sample of the study contain positive emotions. The most frequently used words in formerly twitter messages are water, birth, home, epidural, want and baby. Six themes emerged because of the qualitative analysis. These themes were “desire,” “painless and comfortable,” “favorable emotions,” “beneficial and natural,” “undecided emotions and statements,” “unfavorable emotions and statements.” People’s opinions about water birth were mostly positive. Water birth is a desired birth method for people. The results of the study can provide insights for future studies as they present the views of people on water birth.

Women and midwives’ experiences of an audio-visual enhanced hospital birth environment: An interview study

ProblemMost hospital birth environments remain clinical in appearance and are not attuned to the neurohormonal processes that orchestrate labour and birth. Hospital environments are therefore not aligned with the innate needs of a woman to feel safe and secure in the place where she gives birth. BackgroundResearch has suggested that audio-visual effects such as nature images and sounds may help promote physiological labour in women at low risk of complications. This study aimed to explore the experiences of women labouring in a hospital birth environment enhanced with audio-visual technology, regardless of pregnancy complexity and use of interventions. Experiences of midwives providing one-to-one midwifery care in this environment were also explored. MethodsTranscripts of semi-structured interviews conducted with thirty-two women and six midwives were analysed thematically. FindingsUniversally, women reported that access to audio-visual imagery and soundtracks in the birth environment positively influenced their experience of labour. Nature images and sounds during labour helped create serenity and calmness within the woman and her surroundings, allowing her to relax and focus inwards. Midwives used this technology to create a calm and psychologically safe environment for women giving birth in the hospital. Projecting nature images and sounds became a medium for midwives to create ambience and instil calmness in the clinical environment. Midwives also reported observing positive impacts on the behaviours of other clinicians entering the room. ConclusionAudio-visual enhancement of the hospital birth environment was found to enhance women’s birth experiences and support midwives providing woman-centred care.

Womenʼs reflections on induction of labour and birthing interventions and what they would do differently next time: A content analysis

BackgroundInduction of labour (IOL) and birth intervention is increasingly conducted in Australia, and rates of maternal dissatisfaction and birth trauma are also on the rise. MethodsThe Birth Experience Study (BESt) national survey was conducted to explore women's experiences of birthing in Australia. This content analysis categorises components pertaining to IOL, and women's responses to the open-ended question: “Would you do anything different if you were to have another baby?” FindingsIn total, 591 responses on IOL resulted in 819 coded comments being coded into multiple categories/subcategories. In the first main category ‘increasing the chance of a spontaneous labour next time by resisting IOL’ (93.3 %), three subcategories were identified: ‘I would resist the pressure or refuse, especially if not a good indication’ (54.8 %, 419); ‘I will await spontaneous onset or delay the IOL until later’ (25.0 %, 191); and ‘I will be better informed next time’ (20.2 %, 154). In the second main category ‘accepting IOL was necessary or desirable’ (6.7 %), two subcategories were identified: ‘my IOL was justified or desired’ (38.2 %, 21) and ‘my IOL was justified or desired, but if there is a next time, I'd want more say in what happens’ (61.8 %, 34). ConclusionOverwhelmingly women expressed a desire to avoid IOL, along with the intention to: resist pressure, allow more time for spontaneous labour onset, and arm themselves with more knowledge to advocate against non-medically indicated justifications. Amongst the minority accepting of their previous IOLs, the majority stated wanting more say regarding when and how IOL was conducted.