Subjective Birth Experience Research Articles

Changes in the basic birth beliefs following the first birth experience: Self-fulfilling prophecies?

Women's basic beliefs about birth as a natural and as a medical process are associated with childbirth choices and experience. These beliefs have only recently been quantified and not much is known about their development. In the current study, we assessed the differential effects of the objective and the subjective birth experience on changes in these beliefs. Using self-report questionnaires, we evaluated prenatal to postpartum changes among 342 Israeli first-time mothers. Participants were recruited during pregnancy, between February 2016 and January 2017, mostly in clinical settings, and followed-up two months postpartum. On average, women's beliefs about birth being natural weakened following childbirth and their belief about birth being medical strengthened. In regression models, it was either the objective or the subjective experience that was related to change in the basic birth beliefs: A more medicalized birth was associated with strengthening of the medical belief while greater birth satisfaction was related to strengthening of the natural belief. A mediation effect was observed, which indicated that the beliefs are strengthened when the lived experience fulfilled women's expectation about birth being satisfying, natural or medical. This study adds to the growing body of knowledge regarding the development and evolution of the birth beliefs. It highlights the need to view the beliefs separately and to distinctively assess the objective and subjective birth experience. It supports the need to empower mothers, especially those who had more medicalized births or unsatisfactory ones, which would help conserve their belief in their body and in the normal physiological course of birth.

Adult attachment and birth experience: importance of a secure base and safe haven during childbirth

ABSTRACTObjective: Examine connections between mothers’ adult attachment and subjective birth experience in the context of parity and mode of delivery.Background: Research has established a clear connection between adult attachment and birth experience. This study extended previous research with an in-depth self-report attachment measure examining different dimensions of mothers’ attachment representations and their relation to subjective birth experience. Interactions between mode of delivery and parity were also considered. Method: Participants were 257 mothers who gave birth 4 days to 12 months prior to the study. Mothers’ mean age was 30.5 years, 61% primiparas, and 26% delivered by caesarean. Participants completed an online survey with the Birth Experience Questionnaire, the Reciprocal Attachment Questionnaire, and demographic information.Results: Hierarchical moderated regression analyses showed direct effects from adult attachment dimensions to mothers’ subjective birth experiences, specifically perceived availability, feared loss, separation protest, angry withdrawal, and compulsive careseeking. Interactions emerged for parity and/or mode of delivery for overall subjective birth experience, perceived control, perceived social support, and satisfaction.Conclusion: Adult attachment representations related to subjective birth experience, indicating that attachment figures serve as secure bases and safe havens for mothers during childbirth. These results have implications for practitioners and provide direction for future research.

Antenatal depressive symptoms and subjective birth experience in association with postpartum depressive symptoms and acute stress reaction in mothers and fathers: A longitudinal path analysis

ObjectivesPostpartum depressive symptoms (PDS) and acute stress reactions (ASR) after childbirth are frequently documented in mothers, but research is scarce in fathers. In a longitudinal path analysis, the interplay of depressive symptoms in pregnancy and the subjective childbirth experience of mothers and fathers are examined with regard to the development of PDS and ASR postpartum. Study designOne hundred eighty nine expectant couples were recruited between August 2006 and September 2009. They completed the Edinburgh Postnatal Depression Scale (EPDS) in the last trimester of pregnancy. In the first week postpartum, they answered the Salmon’s Item List (subjective birth experience), and four weeks after birth the EPDS and the Impact of Event Scale − revised (IES-r). The data were evaluated in a longitudinal path analysis. ResultsCompared with fathers, mothers reported more depressive symptoms (pregnancy: p<0.001; postpartum: p<0.001), higher ASR (p<0.001), and lower ‘positive birth experience’ (p<0.001). The association between depressive symptoms in mothers and fathers was not significant during pregnancy (r=0.107, p>0.10), but moderately correlated four weeks after birth (r=0.387, p<0.001). Depressive symptoms during pregnancy and a negative subjective birth experience were independently predictive of PDS and ASR after childbirth in mothers and fathers controlling for age, mode of delivery, parity, epidural anaesthesia, infant gender and birth weight. Antenatal depressive symptoms were related to subjective childbirth experience only in fathers. ConclusionParental prenatal depressive symptoms and subjective birth experience are important predictors of postnatal psychological adjustment in mothers and fathers.

What about me? The loss of self through the experience of traumatic childbirth

Background and objectivebirth trauma has become an increasingly recognised maternal mental health issue and has important implications for both mother and infant. The importance of subjective birth experience in the development of birth trauma has been identified and may mediate the lack of theoretical consistency in this area. The current study aims to explore the subjective experience of birth trauma among first time mothers in Ireland. It aims to separate the potential effects of peripartum depression (PPD) from this in limiting this qualitative investigation to women who reported birth trauma, without PPD. Designmixed methods: Quantitative methods facilitated the recruitment of participants, the selection of a homogenous sample and addressed previous methodological flaws in birth trauma research. Interpretative Phenomenological Analysis (IPA) was used to explore the subjective experience of traumatic childbirth. Participantsseven, first- time mothers who reported a traumatic childbirth, without significant symptoms of PPD participated. Measurement and findingsscreening measures of birth trauma and PPD were completed by participants. A semi-structured interview was then conducted with each participant about their childbirth experience. Interviews were transcribed and analysed using IPA. The primary superordinate theme recounted how the identity and individuality of women is ignored and discounted, throughout the process of childbirth. Identity is challenged and altered as a result of women's incompatibility with the maternity system. Conclusionsthis study supports the existence of birth trauma in an Irish context and highlights the subjective experience of women as central to the development of birth trauma. Implications for practiceacknowledgement and inclusion of the mother as an individual throughout the process of childbirth may be protective in limiting the experience of birth trauma.

Interplay of demographic variables, birth experience, and initial reactions in the prediction of symptoms of posttraumatic stress one year after giving birth

BackgroundThere has been increasing research on posttraumatic stress disorder (PTSD) following childbirth in the last two decades. The literature on predictors of who develops posttraumatic stress symptoms (PSS) suggests that both vulnerability and birth factors have an influence, but many studies measure predictors and outcomes simultaneously.ObjectiveIn this context, we aimed to examine indirect and direct effects of predictors of PSS, which were measured longitudinally.MethodWe assessed women within the first days (n=353), 6 weeks, and 12 months (n=183) after having given birth to a healthy infant. The first assessment included questions on demographics, pregnancy, and birth experience. The second and third assessments contained screenings for postpartum depression, PTSD, and general mental health problems, as well as assessing social support and physical well-being. We analysed our data using structural equation modelling techniques (n=277).ResultsOur final model showed good fit and was consistent with a diathesis-stress model of PSS. Women who had used antidepressant medication in the 10 years before childbirth had higher PSS at 6 weeks, independent of birth experiences. Subjective birth experience was the early predictor with the highest total effect on later PSS. Interestingly, a probable migration background also had a small but significant effect on PSS via more episiotomies. The null results for social support may have been caused by a ceiling effect.ConclusionsGiven that we measured predictors at different time points, our results lend important support to the etiological model, namely, that there is a vulnerability pathway and a stress pathway leading to PSS. PSS and other psychological measures stayed very stable between 6 weeks and 1 year postpartum, indicating that it is possible to identify women developing problems early.Highlights of the articleOur results are consistent with a diathesis-stress model: vulnerability (antidepressant use in the previous 10 years) influenced posttraumatic stress symptoms at 6 weeks and 1 year, independently of stress (birth-related variables).The strongest predictor of posttraumatic stress symptoms 1 year postpartum was posttraumatic stress symptoms 6 weeks postpartum. This means that women who develop problems could be identified during routinely offered postpartum care.Women with a probable migration background experienced more PSS 1 year after the birth, which was an indirect effect through more episiotomies and more PSS after 6 weeks.

Italian women’s childbirth: a prospective longitudinal study of delivery predictors and subjective experience

Background: Previous research has demonstrated that negative childbirth expectations adversely influence perinatal outcomes. The current research builds on this with Italian mothers-to-be. Objective: The present study (1) explored the influence of cognitive and emotional variables on labour and delivery outcomes and (2) examined how individual characteristics, couple adjustment, and medical factors influence the childbirth experience. Method: 121 Italian primiparous women participated in a prospective longitudinal study where participants completed a set of questionnaires between the 32nd and 37th week of pregnancy and again 30–40 days post-delivery. Results: Binary logistic regression analyses revealed that women with negative childbirth expectations were three times more likely to experience an emergency C-section or an instrumental vaginal delivery. Furthermore, childbirth expectations predicted subjective birth experience. This relationship between expectations and delivery type and the subjective childbirth experience was weak while other variables (such as anxiety, depression, couple adjustment) did not significantly influence delivery type or the subjective childbirth experience. Conclusions: The weak relationship between childbirth expectations and perinatal outcomes renders it necessary to question the nature of the relationship found in previous research, especially considering inconsistencies of the literature on the subject. The current research makes it clear that further research is needed to understand better the relationship between expectations and perinatal outcomes in order to better improve the well-being of mothers-to-be during labour and delivery.

The aetiology of post-traumatic stress following childbirth: a meta-analysis and theoretical framework.

There is evidence that 3.17% of women report post-traumatic stress disorder (PTSD) after childbirth. This meta-analysis synthesizes research on vulnerability and risk factors for birth-related PTSD and refines a diathesis-stress model of its aetiology. Systematic searches were carried out on PsycINFO, PubMed, Scopus and Web of Science using PTSD terms crossed with childbirth terms. Studies were included if they reported primary research that examined factors associated with birth-related PTSD measured at least 1 month after birth. In all, 50 studies (n = 21 429) from 15 countries fulfilled inclusion criteria. Pre-birth vulnerability factors most strongly associated with PTSD were depression in pregnancy (r = 0.51), fear of childbirth (r = 0.41), poor health or complications in pregnancy (r = 0.38), and a history of PTSD (r = 0.39) and counselling for pregnancy or birth (r = 0.32). Risk factors in birth most strongly associated with PTSD were negative subjective birth experiences (r = 0.59), having an operative birth (assisted vaginal or caesarean, r = 0.48), lack of support (r = -0.38) and dissociation (r = 0.32). After birth, PTSD was associated with poor coping and stress (r = 0.30), and was highly co-morbid with depression (r = 0.60). Moderator analyses showed that the effect of poor health or complications in pregnancy was more apparent in high-risk samples. The results of this meta-analysis are used to update a diathesis-stress model of the aetiology of postpartum PTSD and can be used to inform screening, prevention and intervention in maternity care.

Inter-relationships between sexual abuse, female sexual function and childbirth

Backgroundthe present quantitative longitudinal study focuses on the inter-relationships between sexual abuse, distressed female sexual function and childbirth. Additional variables studied include depression, mode of delivery, subjective birth experience and traumatic life events other than sexual abuse. Methodsdata collection for the study was extended across three time periods: during the third trimester of pregnancy and approximately one and six months postpartum. Self-reported questionnaire responses of 300 women from two medical centres in Israel, as well as hospital records regarding their mode of childbirth, were included in the data analysis. Measures incorporated in the study included the Female Sexual Distress Scale-Revised, the Beck Depression Inventory and modified versions of the Traumatic Events Questionnaire, the Sexual Experiences Survey, and the Subjective Birth Experience Questionnaire. Resultsfindings demonstrated that women with a lifetime history of sexual abuse compared to women without such history, are at an increased risk for distressed antenatal and postpartum female sexual function (Odds Ratio OR=2.66 and OR=2.26, respectively); and postpartum depression (OR=2.36). Antenatal depression was likewise shown to be significantly associated with antenatal and postpartum distressed female sexual function (OR=4.32 and OR=10.4, respectively), as well as with a more negatively experienced childbirth (T-Ratio, T=1.98, p<0.05). Moreover, distressed antenatal female sexual function was found to increase the risk for a more negatively experienced childbirth (T=2.04, p<0.05), and caesarean childbirth (OR=3.34). Conclusionsthe current study enriches the understanding of the inter-relationships between the antenatal, childbirth and postpartum variables studied herein; and has implications for evidence based practice in both preventative and intervention efforts. Recommendations for future research are presented and discussed.

BIRTH AND MOTHERHOOD: CHILDBIRTH EXPERIENCE AND MOTHERS’ PERCEPTIONS OF THEMSELVES AND THEIR BABIES

Childbirth is a major experience in a woman's life, but the relation between childbirth experiences and later mother-infant outcomes has been understudied. This study examined the relation between mode of delivery and subjective birth experience (e.g., perception of control, social support during labor and delivery), and mothers' descriptions of their babies and their maternal self-esteem, both powerful predictors of maternal caregiving behavior. This study had three questions: (a) Do mode of delivery and subjective birth experience predict mothers' descriptions of their babies and maternal self-esteem? (b) Are the effects of mode of delivery on mothers' descriptions and maternal self-esteem mediated by subjective birth experience? (c) Does infant age moderate any of these pathways? The sample consisted of 269 mothers of full-term, healthy infants who gave birth in the year prior to the study. Mode of delivery showed a direct effect on how mothers describe their babies, but not maternal self-esteem, which was not mediated by subjective birth experience. Subjective birth experience had direct effects on both outcomes. Infant age did not moderate any of these pathways. Results point to the subjective aspects of childbirth as important components of women's experience of labor and delivery. Implications are discussed.

Maternal mental health in the first 3-week postpartum: the impact of caregiver support and the subjective experience of childbirth – a longitudinal path model

Objective: Acute stress reactions (ASR) and postpartum depressive symptoms (PDS) are frequent after childbirth. The present study addresses the change and overlap of ASR and PDS from the 1- to 3-week postpartum and examines the interplay of caregiver support and subjective birth experience with regard to the development of ASR/PDS within a longitudinal path model. Method: A total of 219 mothers completed questionnaires about caregiver support and subjective birth experience (Salmon’s Item List) at 48–6-h postpartum. ASR and PDS were measured for 1- and 3-week postpartum. The Impact of Event Scale (IES) was used to assess ASR, and the Edinburgh Postnatal Depression Scale (EPDS) was used to assess PDS. Results: ASR was frequent 1-week postpartum (44.7%) and declined till week 3 (24.8%, p <.001), while the prevalence of PDS was continuous (14.2% week 1; 12.6% week 3; p = .380). Favorable reports of caregiver support were related to better subjective childbirth experience, which was related to lower ASR and PDS (controlled for age, mode of delivery, parity, EDA and duration of childbirth). Conclusion: High quality of intrapartum care and positive birth experiences facilitate psychological adjustment in the first 3-week postpartum.

The impact of subjective birth experiences on post-traumatic stress symptoms: a longitudinal study

The aim of this prospective study was to examine the etiology of post-traumatic stress symptoms following childbirth within a transactional framework of stress. Participants were women (N = 1,499) from the Akershus Birth Cohort. These women were followed from pregnancy to 8weeks postpartum. We modeled predisposing factors (e.g., fear of childbirth) and precipitating factors (subjective and objective birth experiences) as predictors of post-traumatic stress symptoms. Post-traumatic stress symptoms were measured by means of the Impact of Event Scale, objective birth experiences by means of birth journals, and subjective birth experiences by means of three questions. A structural equation model showed that subjective birth experiences had the highest association with post-traumatic stress symptoms. Moreover, they mediated the effect of predisposing factors and objective birth experiences. The results suggest that women's subjective birth experiences are the most important factor in the development of post-traumatic stress symptoms following childbirth.

3000 Wassergeburten im Vergleich mit 4000 Landgeburten: Prospektive Frauenfelder Geburtenstudie

Objective: We evaluated whether deliveries in water are as safe as conventional deliveries. Methods: Water deliveries were introduced at our teaching hospital in 1991. Data on all water and conventional deliveries were collected prospectively. For this study, we analyzed the maternal and neonatal outcome of 8535 singleton infants after spontaneous vaginal delivery from cephalic presentation between November 1991 and October 1999. Of these infants 3205 (37.6%) were delivered in the water, 1236 (14.5%) on a birth stool, and 3487 (40.9%) in bed. The remaining 607 (7.1 %) deliveries were in other positions. Results: There were no differences in parity or age among women delivered in the water, on a stool or in bed. The rate of neonatal and maternal infections was not increased with water delivery. Episiotomy rates were 8.9% in women delivered in the water, 24.9% in those delivered on a birth stool, and 30.7% in those delivered in bed. Maternal blood loss and analgesic requirements were least with water delivery and these women had the best subjective birth experience. Mean arterial cord blood pH was significantly higher after water birth than after delivery in bed. Conclusion: Delivery in water or on a birth stool are not associated with increased risks for the mother or neonate provided that the same medical criteria for the course of labor are applied.