Experience Of Intrapartum Care Research Articles

Women’s negative childbirth experiences and socioeconomic factors: Results from the Babies Born Better survey

ObjectiveTo investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care. MethodsWe used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8317 women. First, we performed regression analyses to explore the association between women’s socioeconomic status and labour and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n = 917). ResultsIn total 11.7% reported an overall negative labour and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% CI 1.44–2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: 1) Uncompassionate care: lack of sensitivity and empathy, 2) Impersonal care: feeling objectified, and 3) Critical situations: feeling unsafe and loss of control. ConclusionImportant socioeconomic disparities in women’s childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labour and birth. Tweetable abstractWomen with lower socioeconomic status are more exposed to negative experiences during labour and birth.

Exploring women's decisions of where to give birth in the Peruvian Amazon; why do women continue to give birth at home? A qualitative study.

Despite improvements in maternal mortality globally, hundreds of women continue to die daily. The World Health Organisation therefore advises all women in low-and-middle income countries to give birth in healthcare facilities. Barriers to seeking intrapartum care have been described in Thaddeus and Maine's Three Delays Model, however these decisions are complex and often unique to different settings. Loreto, a rural province in Peru has one of the highest homebirth rates in the country at 31.8%. The aim of this study was to explore facilitators and barriers to facility births and explore women's experiences of intrapartum care in Amazonian Peru. Through purposive sampling, postnatal women were recruited for semi-structured interviews (n = 25). Interviews were transcribed verbatim and thematically analysed. A combination of deductive and inductive coding was used. Analytical triangulation was undertaken, and data saturation was used to determine when no further interviews were necessary. Five themes were generated from the data: 1) Financial barriers; 2) Accessing care; 3) Fear of healthcare facilities; 4) Importance of seeking care and 5) Comfort and traditions of home. Generally, participants realised the importance of seeking skilled care however barriers persisted, across all areas of the Three Delays Model. Barriers identified included fear of healthcare facilities and interventions, direct and indirect costs, continuation of daily activities, distance and availability of transport. Women who delivered in healthcare facilities had mixed experiences, many reporting good attention, however a selection experienced poor treatment including abusive behaviour. Despite free care, women continue to face barriers seeking obstetric care in Amazonian Peru, including fear of hospitals, cost and availability of transport. However, women accessing care do not always receive positive care experiences highlighting implications for changes in accessibility and provision of care. Minimising these barriers is critical to improve maternal and neonatal outcomes in rural Peru.

MATERNAL SATISFACTION WITH INTRAPARTUM CARE IN HEALTHCARE FACILITIES IN KERICHO COUNTY, KENYA

Purpose: The main objective was to determine maternal satisfaction with intrapartum care in healthcare facilities in the Kericho County and specifically to determine the association between mothers’ experience of intrapartum care and satisfaction with quality of nursing, analyze the influence of psychosocial aspects on satisfaction with intrapartum care and evaluate the relationship between hospital factors and maternal satisfaction on intrapartum care among women delivering in healthcare facilities in Kericho County
 Materials and Methods: This was a cross sectional analytical research design and data was collected using mixed method approach. The study targeted women who delivered in the facilities used for study and 441 mothers were sampled. Data was analyzed using (SPSS) version 24. Descriptive statistics was used to describe the findings on socio-demographic characteristics and inferential statistics employed Chi square and logistic regression to determine maternal satisfaction with intrapartum care. Odds ratio was used to test the strength of association, and a p-value of ≤ 0.05 considered as statistically significant.
 Findings: Several factors influence mothers’ satisfaction with intrapartum care. Employment (OR: 3.0; 95% CI: 1.2 – 7.4; p = 0.02) delivery through instrument/Caesarian section were 2.6 more likely to have been satisfied with the care unlike those who delivered through SVD (OR: 2.6; 95% CI: 1.1 – 6.0; p = 0.03). On the other hand, mothers who got encouragement and reassurance by midwives and doctors (OR: 0.2; 95% CI: 0.1 – 0.8; p = 0.02) were more likely to be satisfied with care. Mothers who were shown their babies immediately after delivery to identify sex of the baby (OR: 3.2; 95% CI: 1.5 – 7.0; p = 0.002) were 3 times more satisfied than their counterparts. Mothers who were asked for their opinion about unplanned procedure before it was performed (OR: 3.7; 95% CI: 1.1 – 12.6; p = 0.02) were four times more likely to be satisfied. In conclusion, determinants of intrapartum care satisfaction in public hospitals in the study area are: level of education, employment status and type of delivery, showing the baby to the mother immediately after delivery to identify sex, midwives and doctors asking clients their opinion about unplanned procedure before it is performed. Provision of linen and beds, provision of hot drinks and hot shower after delivery and provision of a locker are all associated with satisfaction.
 Unique Contribution to Theory, Practice and Policy: Therefore, the hospitals should allow mothers to stay with their birth companions and health care providers should be taught on importance of good relation and good communication skills.

Women’s experiences of intrapartum care and recovery in relation to planned caesarean sections: An interview study

Problem and backgroundApproximately one third of women in high-income countries give birth by caesarean section (CS). Better understanding of women’s CS experiences is vital in identifying opportunities to improve women’s experience of care. AimTo identify opportunities for service improvement by investigating Australian women’s experiences of care and recovery when undergoing a planned CS. MethodsQualitative telephone interview study with 33 women who had a planned CS at one of eight Australian hospitals. Semi-structured interviews were conducted to elicit women’s perspectives, experiences and beliefs surrounding their planned CS. Interviews were transcribed verbatim and analysed inductively using NVivo-12. ResultsWomen’s experiences of CS care were mixed. Regarding intrapartum care, many women stated their planned CS was a positive experience compared to a previous emergency CS, but was scarier and more medicalised compared to vaginal birth. CS recovery was viewed more negatively, with women feeling unprepared. They reported disliking how CS recovery restricted their role as a mother, wanting more time in hospital, and greater support and continuity of care. DiscussionWomen reported largely positive intrapartum experiences of planned CS but relatively negative experiences of CS recovery. They wished for time in hospital and support from staff during recovery, and continuity of care. ConclusionBy incorporating shared decision-making antenatally, clinicians can discuss women’s birth expectations with them and better prepare them for their planned CS and recovery.

A known midwife can make a difference for women with fear of childbirth- birth outcome and women’s experiences of intrapartum care

BackgroundThere is evidence that continuity of midwifery care is beneficial to women. Women with fear of childbirth in Sweden are offered counselling, but receiving care from a known midwife during labour is unusual, despite its effects in reducing interventions and increasing birth satisfaction. The aim of this study was to describe and compare birth outcome and experience of intrapartum care among women with fear of childbirth who received intrapartum care from a known midwife, versus those who did not. MethodsAn experimental study of 70 women referred to counselling due to fear of birth during pregnancy wherein the counselling midwife, when possible, also assisted during labour and birth. ResultsHaving a known midwife during labour and birth had a positive impact on fearful women’s birth experience and their perception of pain, but there was no difference in onset of labour or mode of birth. Women who received care from a known midwife experienced better care with regards to information, participation in decision making and perception of control. ConclusionThis study indicates that having access to a known midwife might have an impact on women’s birth experience. This study was limited by its small sample size and further research would need to randomise fearful women to counselling or continuity of care to determine the contribution of each to reducing fear.

Sociodemographic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya

PurposeTo clarify sociodemographic and socioeconomic factors associated with mothers’ experiences of psychosocial care and communication by midwives during childbirth in Nairobi, Kenya. DesignA descriptive cross-sectional study conducted in a government national referral hospital. Respondents were 109 systematically sampled mothers who delivered in the study hospital. Mothers’ experiences of intrapartum care were assessed using three subscales from the Experience of Psychosocial Care and Communication during Childbirth Questionnaire (effective communication; emotional support; and respect, care and dignity). Simple and multivariable logistic regression analyses were used to assess associations between sociodemographic factors, socioeconomic factors and mothers’ experiences of intrapartum care. FindingsThe majority of respondents were aged 20–24 years (45.9%), married (71.6%), had primary school education (48.6%) and were self-employed (45%). The majority reported positive experiences of communication, respect, dignity and emotional support from their midwives. Being an older mother was significantly associated with a positive experience of intrapartum care (adjusted odds ratio [AOR] 7.32; 95% Confidence Interval (CI): 1.17–45.9). The odds of having a positive intrapartum care experience was significantly lower among women with parity of four or more (AOR 0.09; 95% CI: 0.01–0.56) and tertiary education (AOR 0.11; 95% CI: 0.01–0.91). ConclusionAttention to the use of respectful language and adherence to clear communication must be an integral part of quality improvement for midwifery care in Kenya.

Young women′s recent experience of labour and birth care in Queensland

Backgroundyoung parenthood continues to be an issue of concern in terms of clinical and psychosocial outcomes for mothers and their babies, with higher rates of medical complications such as preterm labour and hypertensive disease and a higher risk of depression. The aim of this study was to investigate how young age impacts on women's experience of intrapartum care. Methodssecondary analysis of data collected in a population based survey of women who had recently given birth in Queensland, comparing clinical and interpersonal aspects of the intrapartum maternity care experience for 237 eligible women aged 15–20 years and 6534 aged more than 20 years. Descriptive and multivariate analyses were undertaken. Resultsin the univariate analysis a number of variables were significantly associated with clinical aspects of labour and birth and perceptions of care: young women were more likely to birth in a public facility, to travel for birth and to live in less economically advantaged areas, to have a normal vaginal birth and to have one carer through labour. They were also less likely to report being treated with respect and kindness and talked to in a way they could understand. In logistic regression models, after adjustment for parity, other socio-demographic factors and mode of birth, younger mothers were still more likely to birth in a public facility, to travel for birth, to be more critical about interpersonal and aspects of care and the hospital or birth centre environment. Conclusionthis study shows how experience of care during labour and birth is different for young women. Young women reported poorer quality interpersonal care which may well reflect an inferior care experience and stereotyping by health professionals, indicating a need for more effective staff engagement with young women at this time.

Women's satisfaction with intrapartum care – a pattern approach

This paper is a report of a study to investigate women's satisfaction with intrapartum care along three distinct dimensions simultaneously (interpersonal care, information and involvement in decision-making and physical birth environment) and to describe the characteristics of women with different patterns of satisfaction. Patient satisfaction is an important outcome in the evaluation and development of healthcare services. Studies of satisfaction have often used single global ratings but such ratings may not capture the multidimensionality of care during childbirth. A cluster analytic technique was used to establish a finite set of response patterns. Data were obtained from a longitudinal population-based Swedish survey including 2605 women who completed questionnaires in early pregnancy, and 2 months and 1 year after the birth. Data collection commenced in March 1999 and was completed in April 2002. Nine different clusters, or patterns of satisfaction/dissatisfaction, were found. Nearly half of the women (47%) were in clusters that were satisfied or very satisfied with at least one dimension of care, 20% in clusters that were fairly satisfied (average), and 33% in less than satisfied clusters. Fifteen per cent were mainly dissatisfied with the physical environment, 8% mainly with interpersonal care, 7% only with information and decision-making and 3% with all dimensions. Women in the different clusters differed statistically significantly in psychological health in early pregnancy, emotional reactions during labour and in labour outcomes, but not in background characteristics. Looking at different dimensions of care instead of a single global measure gave a richer, more diverse, and also a more negative picture of women's experiences of intrapartum care.

Why do some women change their opinion about childbirth over time?

The current investigation is a follow-up of a study on women's memory of childbirth, which showed that 60 percent made the same assessment of their overall birth experience at 1 year after delivery as they did at 2 months postpartum, and 24 percent had became more negative and 16 percent more positive. The study purpose was to gain some understanding of what factors make some women change their assessment over time. Data from a longitudinal cohort study of 2,428 women who completed questionnaires in early pregnancy, at 2 months, and at 1 year after birth were analyzed. Two subsamples were studied: 1,451 women who said childbirth was a positive experience at 2 months and 151 who said it was a negative experience. Comparisons were made, within each sample, between those who made the same assessment at 1 year and those who had changed their view, with respect to psychosocial background, labor outcomes, infant health outcomes during first year, and experiences of intrapartum care. Changing the assessment from positive to less positive, mostly to "mixed feelings," was associated with difficult childbirth, such as painful labor and cesarean section; dissatisfaction with intrapartum care; and psychosocial problems, such as single status, depressive symptoms, and worry about the birth in early pregnancy. Changing the assessment from negative to less negative was associated with less worry about the birth in early pregnancy and a more positive experience of support by the birth-attending midwife. This study supported the view that measures of satisfaction with childbirth soon after delivery may be colored by relief that labor is over and the happy birth of a baby. More negative aspects may take longer to integrate. Supportive care may have long-term effects and may protect some women from a long-lasting negative experience.