Childbearing Women's Experiences Research Articles

Childbearing Women's Experiences of and Interactions With the Health System in Vietnam: A Critical Interpretive Synthesis.

Scholars have long argued that the care experience is shaped by context, and by evolutions in this context. Using Vietnam as a case, we critically interrogate the literature on women's experiences with maternity care to unpack whether and if it engages with the major social, economic, and health system impacts of the Doi Moi reforms in Vietnam and with what consequences for equity. We conducted a critical interpretive synthesis of this literature in light of the social, economic, and health system transformations driven by the Doi Moi reforms. We offer three critiques: (1) an overwhelming focus on public maternity care provision in rural/mountainous regions of Vietnam, (2) a narrow focus on women's ethnic identity, and (3) a misplaced preoccupation with women's limited autonomy and agency. We argue that future research needs to consider the impact of Vietnam's shift towards market-oriented care provision, and the broader societal and health system changes impacting both rural and urban areas, as well as ethnic minority and Kinh majority populations.

Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool

IntroductionIncreasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed. Research aimThe aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth. MethodsA survey tool was created including the following measures: German adaptations of the short and long form of the “Mothers on Respect” (MOR) index (MOR-7 and MOR-G); the “Mothers’ Autonomy in Decision Making” (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale – Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018. FindingsMore than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively). ConclusionsThis study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.

Labouring Together: Women's experiences of “Getting the care that I want and need” in maternity care

ObjectivePoor interprofessional collaboration and lack of decision-making with women have been identified as being detrimental to the quality, safety, and experience of maternity care. The aim of the Labouring Together study was to explore childbearing women's preferences for and experiences of collaboration and control over decision-making in maternity care. DesignA sequential, mixed-method, multi-site case study approach was used to explore the perceptions and experiences of childbearing women regarding collaboration and decision-making. Women's preferred role for decision-making compared to the actual experiences, and the influences upon their preferences and experiences of collaboration were explored using semi-structured interviews. An inductive approach was used for qualitative analysis of interviews, and cross-case analyses were conducted using replication logic. SettingPostnatal wards of 1 private and 3 public maternity services in both metropolitan and regional Victoria, Australia. ParticipantsPostnatal women, over the age of 18 years (n=182). FindingsHalf (48.3%) of the participants indicated a preference for a shared decision-making role and 35% preferred an active role. Only 16.7% participants indicated a preference for a passive role, however 24.4% of women reported experiencing a passive decision-making role during their maternity care. Statistically significant differences were also identified between preferences for and experiences of decision-making among women who chose the private obstetrician model of maternity care compared to the public maternity care system. Negative impacts upon women's autonomy over decision-making included: poor access to midwifery models of care; poor access to relational continuity of care; poor understanding of the rights of the woman; inadequate information for women about the risks and benefits of all proposed interventions; and a bureaucratic style of decision-making based upon a dominant discourse of risk avoidance that could ultimately veto the woman's choice. Key conclusionsDespite evidence of the benefits for women of having autonomy over decision-making in their own care, fundamental barriers were identified that hindered women's participation in collaboration in maternity care. Shared decision-making with childbearing women is not routine practice in maternity care in Victoria, Australia. Implications for practiceRelational continuity of care is imperative to promote the autonomy of childbearing women and an environment conducive to women's active engagement in maternity care and participation in shared decision-making.

Childbearing women’s experiences of the maternity care system in Australia during the first wave of the COVID-19 pandemic

BackgroundSubstantial changes occurred in Australian healthcare provision during the COVID-19 pandemic to reduce the risk of infection transmission. Little is known about the impact of these changes on childbearing women. AimTo explore and describe childbearing women’s experiences of receiving maternity care during the COVID-19 pandemic in Australia. MethodsA qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. Twenty-seven interviews were conducted with women from across Australia. Data was analysed thematically. FindingsThree primary themes and nine sub-themes emerged: ‘navigating a changing health system’ (coping with constant change, altered access to care, dealing with physical distancing restrictions, and missing care), ‘desiring choice and control’ (experiencing poor communication, making hard decisions, and considering alternate models of care), and ‘experiencing infection prevention measures’ (minimising the risk of exposure and changing care plans to minimise infection risk). DiscussionThe substantial changes in care delivery for pregnant and postpartum women during the pandemic appear to have reduced woman-centred care. In most cases, care was perceived as impersonal and incomplete, resulting in a very different experience than expected; consequences included missing care. The presence of a known care provider improved women’s sense of communication, choice, and control. ConclusionThis study provides unique insight into the experiences of childbearing women across Australia. The importance of respectful woman-centred care cannot be forgotten during a pandemic. The findings may inform future service planning during pandemics and disaster situations.

Becoming a mother in the ‘new’ social world in Australia during the first wave of the COVID-19 pandemic

BackgroundSubstantial public health measures occurred in Australian society during the COVID-19 pandemic to reduce the risk of community transmission. Little was known about the impact of these changes on childbearing women. AimTo describe childbearing women's experiences of becoming a mother during the COVID-19 pandemic in Australia. MethodsA qualitative exploratory design using semi-structured interviews was used. Women were recruited through social media and self-nominated to participate in an interview. Maximum variation sampling was used. A total of 27 interviews were conducted with women across Australia. Data were analysed thematically. FindingsThe thematic analysis resulted in four primary themes and ten sub-themes. The themes were ‘going it alone – having a baby was an isolating experience’ (‘receiving maternity care alone’, ‘dealing with government restrictions’, and ‘desiring social support’), ‘advocating for self or others’ (‘seeking reliable information’, ‘valuing peersupport’, and ‘having to be resourceful’), ‘finding a way through’ (‘a changed experience for all’, ‘managing stress and anxiety’, ‘requiring constant adjustments’, and ‘managing fear mongering’), and ‘keeping safe’. ConclusionBecoming a mother during the COVID-19 pandemic in Australia was a profound experience for the women. Following the public health initiatives which resulted in physical distancing restrictions, isolation, and the need to provide and receive social and peer support were common experiences. Whilst public health initiatives are implemented to keep people safe, the social and emotional toll on childbearing women should be considered by healthcare professionals. Childbearing women need to be safe but also require support and reassurance.

The experiences of childbearing women who tested positive to COVID-19 during the pandemic in northern Italy

ProblemThe COVID-19 pandemic has significantly challenged maternity provision internationally. COVID-19 positive women are one of the childbearing groups most impacted by the pandemic due to drastic changes to maternity care pathways put in place. BackgroundSome quantitative research was conducted on clinical characteristics of pregnant women with COVID-19 and pregnant women’s concerns and birth expectations during the COVID-19 pandemic, but no qualitative findings on childbearing women’s experiences during the pandemic were published prior to our study. AimTo explore childbearing experiences of COVID-19 positive mothers who gave birth in the months of March and April 2020 in a Northern Italy maternity hospital. MethodsA qualitative interpretive phenomenological approach was undertaken. Audio-recorded semi-structured interviews were conducted with 22 women. Thematic analysis was completed using NVivo software. Ethical approval was obtained from the research site’s Ethics Committee prior to commencing the study. FindingsThe findings include four main themes: 1) coping with unmet expectations; 2) reacting and adapting to the ‘new ordinary’; 3) ‘pandemic relationships’; 4) sharing a traumatic experience with long-lasting emotional impact. DiscussionThe most traumatic elements of women’s experiences were the sudden family separation, self-isolation, transfer to a referral centre, the partner not allowed to be present at birth and limited physical contact with the newborn. ConclusionKey elements of good practice including provision of compassionate care, presence of birth companions and transfer to referral centers only for the most severe COVID-19 cases should be considered when drafting maternity care pathways guidelines in view of future pandemic waves.

Outcomes and Experiences of Child-Bearing Women with Nasopharyngeal Carcinoma.

PurposeNasopharyngeal carcinoma (NPC) is more common among women in Southeast Asia. An important issue is whether it is safe for them to bear children after treatment and when it is safe to do so. We conducted this study to explore the relation between fertility and prognosis in child-bearing women with NPC.Patients and MethodsChild-bearing women were defined as young women between the ages of 18 and 30. A total of 127 eligible child-bearing NPC patients were identified from December 2003 to December 2014. The patients were divided into two groups, depending on whether or not they had post-therapeutic births. The Kaplan–Meier method was used for survival analyses. The Log rank test was used to compare two survival curves and the independent significances of different prognostic factors were assessed by Cox proportional hazards regression analysis.ResultsThe 5-year overall survival (OS) and disease-free survival (DFS) in the Childbirth group were significantly higher than those in the Non-Childbirth group (100% vs 88.8%, P = 0.026 and 100% vs 77.5%, P = 0.007, respectively). In the Childbirth group, no difference was found in the 5-year DFS between different birth interval times, from 1 to 5 years after treatment. The clinical stage was identified as the risk factor of OS (HR = 101.725, 95% CI: 2.160–4790.910, P = 0.019), and consequent childbirth after treatment was associated with favorable DFS (HR = 0.148, 95% CI: 0.034–0.643, P = 0.011).ConclusionPost-therapeutic birth did not increase the mortality risk of child-bearing women with NPC. There was no significant correlation between the subsequent birth time window after treatment and the prognosis.

Developing a tool for measuring postpartum women's experiences of respectful maternity care at a tertiary hospital in Kumasi, Ghana

The authors of this paper are involved in a 5 years respectful maternity care (RMC) project at a tertiary healthcare facility in Kumasi, Ghana that seeks to change the culture of disrespect and abuse in maternity care practice, with a sub-objective of determining its impact on how midwives provide quality maternity care services in this healthcare facility. To achieve this objective, respectful maternity care must be conceptualized and measured. Our literature search revealed that a Ghanaian version tool that measures women's experiences of respectful maternity care is non-existent. Thus, this study aims to construct a scale that measures childbearing women's experiences of respectful maternity care during childbirth and the immediate postpartum period in the study setting. We surveyed 263 postpartum women with a draft scale we have developed. This scale had 42 questions that sought to measure postpartum women's experiences of respectful maternity care in a tertiary health facility in Kumasi. The scale development went through processes of exploratory factor analyses (EFA) and inter-item reliability tests. The EFA was done using SPSS-21. Through series of EFA, we have created a 23 items RMC scale (23i-RMC) with three main factors labelled as follows: Verbal abuse-free, Discriminatory-free and Dignified care (VADDC), Physical and Psychological Abuse-free care (PPAC), and Compassionate Care (CC). The Cronbach's Alpha of the 23i-RMC is 0.945 and those of the individual domains greater than the 0.70 minimum threshold, suggesting that there is greater reliability among the items in the scale and the subscales. This 23i-RMC scale is useful for assessing postpartum women's experiences of RMC in the study setting. We recommend the use and validation of the newly developed respectful maternity care scale in other healthcare facilities in Ghana.

Vpliv porodnih praks na porodno izkušnjo v institucionalni oskrbi

Uvod: Nosečnost in porod sta naravna dogodka, čeprav ju danes – ob upoštevanju dejstva, da živimo v »družbi tveganja« – opredeljujemo skozi prizmo patologije in potencialnih nevarnosti. Cilj raziskave je bil razumeti izkušnje in doživljanja žensk, povezana z rojevanjem v porodnišnicah skozi prevladujoče porodne prakse, ki so po prepričanju žensk pomembno krojile njihovo porodno izkušnjo.Metode: Uporabljena je bila sekundarna analiza kvalitativnih podatkov. Primarni podatki so bili zbrani leta 2014 v okviru raziskave Medikalizacija nosečnosti in poroda kot družbena konstrukcija z narativno metodo. V vzorec sekundarne analize je bilo vključenih 18 transkriptov intervjujev z ženskami, ki so rodile v porodnišnici. Analiza kvalitativnih podatkov je bila izvedena s pomočjo računalniškega programa NVivo, verzija 12.Rezultati: V analizi so bile identificirane tri teme: (1) pomembnost podpore zdravstvenega osebja in avtonomija odločanja; (2) sprememba fokusa v dojemanju carskega reza kot naravnega načina rojevanja; (3) rutinizacija in tehnifikacija porodnih praks.Diskusija in zaključek: Rojevanje tako danes kot nekoč usmerjajo negativne in pozitivne porodne izkušnje. Poznati je treba oboje. Za ženske je prva porodna izkušnja poučna in obenem določujoča, saj na njeni podlagi presojajo prihodnje porodne izkušnje. Podpora zdravstvenega osebja ter avtonomija odločanja sta ključni za pozitivno porodno izkušnjo. K temu bi lahko v prihodnje pomembno prispevale tudi spremembe nekaterih utečenih porodnih praks, ki bi morale hitreje slediti praksi, utemeljeni z dokazi.

Childbirth on television: a scoping review and recommendations for further research

ABSTRACT Factual and reality television shows that depict childbirth are both commercially successful and controversial. Social debate focuses on the potential implications for women’s experiences of birth and their health. This scoping review critically analyses published literature to assess the state of knowledge about the influence of factual and reality television on the expectations and experiences of childbearing women, and to make recommendations for future research. Recognising the complexity of researching the relationship between the media and lived health experiences, we critically engage with the theoretical and methodological underpinnings of the published literature and its substantive findings. We argue that the field is limited by a disconnect between media studies and health studies. Feminist approaches have both criticised the medicalised view of childbirth seen to dominate mainstream media, and the valorisation of “natural childbirth” as a standard which also disciplines women. Very little research has engaged with pregnant women’s views and experiences. Future research should engage more rigorously with diverse women who are pregnant or have recently become mothers. Recommendations for future research also include transdisciplinary collaboration for methodological innovation, research about television production processes and research that takes social media and the changing nature of television into account.

Childbearing women's experiences of midwives' workplace distress: Patient and public involvement

Background Some midwives experience work-related psychological distress. This can reduce the quality and safety of maternity services, yet there are few interventions to support midwives. Aim To explore and voice the perceptions of new mothers in relation to the barriers to receiving high-quality maternity care, the psychological wellbeing of midwives and the development and evaluation of an online intervention designed to support them. GRIPP2 reporting checklists were also used to demonstrate how patient and public involvement works in research. Methods A co-design approach was used in a discussion group to collect qualitative data from 10 participants. A framework approach was used for analysis. Findings Unique findings included midwives crying, becoming emotional and seeking support from service users. Overall, seven patient and public involvement outcomes relating to intervention development and data collection were identified. Conclusion Maternity service improvement strategies may only be wholly effective once they include the provision of effective midwifery workplace support.

Washington State Childbearing Women's Experiences of Planned Home Births: A Heideggerian Phenomenological Investigation.

The purpose of this interpretive study was to investigate planned home births that occurred in Washington State and to provide meaning. A Heideggerian phenomenological approach was chosen to investigate and interview a purposive sample of 9 childbearing women who experienced at least 1 home birth between 2010 and 2014 in Washington State. The results of this study suggest that childbirth education is an essential and valued aspect of birthing. Childbirth educators can use the findings from this investigation as a means to increase their awareness of birthing in the home. This interpretive investigation can give "voice" to the compelling evidence accumulating that is investigating planned home births as a sanctuary to allow physiological and low-intervention births to transpire.

Washington State Childbearing Women's Experiences of Planned Home Births: A Phenomenological Investigation

Washington State Childbearing Women's Experiences of Planned Home Births: A Phenomenological Investigation

Using video in childbirth research.

Conducting video-research in birth settings raises challenges for ethics review boards to view birthing women and research-midwives as capable, autonomous decision-makers. This study aimed to gain an understanding of how the ethical approval process was experienced and to chronicle the perceived risks and benefits. The Birth Unit Design project was a 2012 Australian ethnographic study that used video recording to investigate the physical design features in the hospital birthing space that might influence both verbal and non-verbal communication and the experiences of childbearing women, midwives and supporters. Participants and research context: Six women, 11 midwives and 11 childbirth supporters were filmed during the women's labours in hospital birth units and interviewed 6 weeks later. Ethical considerations: The study was approved by an Australian Health Research Ethics Committee after a protracted process of negotiation. The ethics committee was influenced by a traditional view of research as based on scientific experiments resulting in a poor understanding of video-ethnographic research, a paradigmatic view of the politics and practicalities of modern childbirth processes, a desire to protect institutions from litigation, and what we perceived as a paternalistic approach towards protecting participants, one that was at odds with our aim to facilitate situations in which women could make flexible, autonomous decisions about how they might engage with the research process. The perceived need for protection was overly burdensome and against the wishes of the participants themselves; ultimately, this limited the capacity of the study to improve care for women and babies. Recommendations are offered for those involved in ethical approval processes for qualitative research in childbirth settings. The complexity of issues within childbirth settings, as in most modern healthcare settings, should be analysed using a variety of research approaches, beyond efficacy-style randomised controlled trials, to expand and improve practice-based results.

Listening to Mothers III: The Evolving Landscape of Childbearing Women's Experiences and Preferences

<i>Listening to Mothers III</i>: The Evolving Landscape of Childbearing Women's Experiences and Preferences

Exploring Dental Care Misconceptions and Barriers in Pregnancy

Poor oral health is increasingly linked to adverse pregnancy outcomes, including preterm birth and low-birthweight infants. Little is known about childbearing women's experiences in obtaining dental care. The objective of this study was to explore Florida women's experience of barriers in obtaining dental care before and during their pregnancies. Study data were derived from a larger data set of a study that examined barriers to prenatal care. One month after giving birth face-to-face interviews were conducted with 253 African American women, 18 to 35 years old, who were residents of one of three Florida counties. Interview questions about women's experiences on obtaining oral health care before and during pregnancy, and recall of guidance about oral health care during prenatal visits were transcribed and analyzed qualitatively. Through subject-level content analysis, key themes were assessed about the participants' perspectives on obtaining oral health care before and during pregnancy. Most participants did not obtain dental care and did not recall receiving dental information during prenatal visits. Barriers to dental care included lack of insurance, difficulty in finding a dentist, low priority given to dental care, misconceptions about the safety and appropriateness of dental care during pregnancy, and sporadic anticipatory guidance during prenatal care. Misconceptions about the appropriateness of oral health care during pregnancy may affect women's access to and use of this care. Given the implications of poor oral health on possible adverse birth outcomes and its larger connection with the general health of mothers and babies, attention to oral health misconceptions and barriers is warranted.

Use of biomedical obstetric care in rural Tanzania: The role of social and material inequalities

Despite over 20 years of efforts to improve maternal health, complications of pregnancy and childbirth continue to threaten women's lives in many countries of sub-Saharan Africa. To reduce maternal mortality levels and achieve Millennium Development Goal Five, institutions working for safe motherhood are committed to making biomedical obstetric care more available to women during childbirth. However, implementation of this strategy is not reaching women at the lower end of the socioeconomic spectrum for reasons that are not well understood. Using data from fieldwork conducted between September 2007 and June 2008, this study examines women's use of biomedical obstetric care in two rural districts of south-central Tanzania where this care was being supplied. Specifically, it seeks to explain how social and material inequalities affect decisions and behaviors related to childbirth. In addressing this aim we employed a mixed-methods study design. Effects of sociodemographic characteristics on obstetric care use were examined with logistic regression analysis (n = 1150), while perspectives and experiences of childbearing women were explored with participant observation and in-depth interviews (n = 48). The results from quantitative and qualitative study components were interpreted in light of each other. Statistically significant social and material factors related to use of care included ethnicity, education, parity, and household assets. Qualitative themes involved physical, economic, and social access to health facilities as well as issues of risk perception and self-identity. The overall findings suggest that use of obstetric care is influenced by a complex interplay of factors closely tied to relative status in family and community. As individual agents differentially positioned by multiple markers of power, women pragmatically negotiate amidst a wide array of deterrents and motivators to secure the best care they can. In order to improve use of biomedical obstetric care, interventions aimed at increasing availability of these services should focus on improving access for women who are disadvantaged.

Childbirth embodiment: problematic aspects of current understandings

The experience of childbirth is one of the most corporeal of the human condition. Against a backdrop of profound change in the milieu of birthing over the past 30 years, especially in the developed world, a number of discourses now compete for the status of the safest, most fulfilling birth experience. Supporters of biomedical and 'natural' approaches make their respective claims to those, with obstetricians broadly aligning their professional interests with the former and midwives with the latter. There is mounting evidence that childbearing women's experiences of birth are often shaped in the uneasy space between the two. Within sociological discourse in health, embodiment is a dominant theme but, to date, research has concentrated mainly on new reproductive technologies, and there is a dearth of recent research and theorising around the act of parturition itself. This paper argues that because of this, there has been a polarising tendency in current discourses which is having a largely negative impact on women, professionals and the maternity services. A call is made for an integration of traditional childbirth embodiment theories, mediated through compassionate, relationally focused maternity care, especially when labour complications develop.

Racism in Health Care: Experiences of Childbearing Women of African Descent

Racism in Health Care: Experiences of Childbearing Women of African Descent

Women's stories of birth: A suitable form of research evidence?

In the past one to two decades, midwifery care has taken a new direction, which encompasses a valuing of women's birth experiences. This move has been contingent upon, and congruent with the adoption of 'woman centred' care and a renewed emphasis on normal birth. In line with these developments, women's stories and anecdotes of birth and midwives stories of experience increasingly form the basis of presentations at midwifery conferences and forums. Overall, this philosophical realignment, which commenced in Australia in the early 1990s, has been applauded by many midwives in terms of a greater valuing of the wishes and experiences of childbearing women and as being consistent with a greater promotion of normal birth. Nonetheless, it also gives rise to several questions, regarding the suitability of this form of research evidence. In a bid to answer some of those questions, this paper aims to evaluate the use of stories and anecdotal evidence within midwifery. First, an overview is presented of the way in which stories of pregnancy and birth appear in the literature. Secondly, the value of stories as evidence is critiqued and, finally, the ratio of story based publications, compared to traditional research methodologies, is reviewed. This review aims to address an area poorly attended in the literature and asks specifically: Are women's birth stories a suitable form of research evidence in midwifery?