Women's Birth Experiences Research Articles

Women’s experiences of labour induction - findings from a Swedish regional study

Background: Induction of labour is common in modern obstetrics but its impact on women's birth experiences is inconclusive. Aim: The aim of the present study was to explore the prevalence of induction in a Swedish region and reasons for labour induction. A second aim was to compare the experience of spontaneous labour and birth for women to the experience of induction of labour. A third aim was to explore the difference in labour in relation to the length of pregnancy. Methods: A one-year cohort of 936 women was included in a longitudinal Swedish survey in which data were collected by questionnaires, two months after birth. The main outcome was a set of data recording women's birth experiences. Results: Labour induction was performed in 17% of births and mostly performed for medical reasons. Women who were induced used more epidurals (OR 2.3; 95% CI 1.4-3.8) for pain relief and used bath/shower less frequently for pain relief (OR 0.3; 95% CI 0.2-0.5). Labour induction was associated with a less positive birth experience (OR 1.5; 95% CI 1.0-2.3), and women who were induced were more likely to totally agree that they were frightened that the baby would be damaged during birth (OR 2.1; 95% CI 1.2-3.9), but the assessment of feelings during birth differed with regard to length of pregnancy. Conclusion: Labour induction affects women's experiences of birth and is related to length of pregnancy.

Women and Their Partners’ Perceptions of the Key Roles of the Labor and Delivery Nurse

This descriptive qualitative study examined the perspectives of women and their partners regarding the key roles of the labor and delivery nurse during labor and birth.Ten couples were interviewed separately.The data analysis, conducted through independent and team analysis, was both iterative and interpretive. Participants identified four key roles of the labor and delivery nurse: support person, educator, patient advocate, and provider of continuity. Nurses provided both physical and emotional support.As an educator, they normalized the birth experience and served as a coach for the couple. Nurses advocated on behalf of the woman in labor, particularly when there was an adverse event. The continuity of care provided by the nurses wove the above roles into a cohesive whole. Findings provide important information for nursing educators, supervisors, and hospital administrators to reinforce the meaningful roles nurses serve in the labor and birth experiences of women and their partners.

Does perception of the childbirth experience predict women's early parenting behaviors?

Evidence regarding the predictors of positive parenting behaviors in the early transition to parenting is inconsistent and limited. In this prospective, cohort study, we examined whether women's perceptions of their childbirth experience, as well as selected demographic, obstetrical, and psychosocial variables, predicted positive parenting behaviors at 1 month postpartum in 175 Canadian mothers. Women's birth experience did not predict early parenting behaviors, however being better educated and having a vaginal birth did. Excellent partner support and maternal mental health were also significantly associated with positive parenting at 1 month. Nurses have a responsibility to assess women for possible risks for sub-optimal parenting, based on the predictors found, and intervene to enhance parenting behaviors.

Women's Lived Experience of Their Unexpected Birthing Process

To describe the essence of women's unexpected birthing experiences. Descriptive phenomenology using interviews with 10 women who had birthing experiences that were not what they had expected, including (1) an instrumentally assisted vaginal delivery either by forceps and/or by a vacuum extractor, (2) a third- or fourth-degree tear, (3) birth by an emergency cesarean birth, or (4) women who perceived that their delivery was incongruent with their expectations. Interviews of each woman's birth experience were transcribed using Colaizzi's method of analysis. The findings reflected the absence of three critical elements-caring, connection, and control-that the women believed were missing from their birthing experiences. The lack of caring was demonstrated by the statement: "They were there to take care of your baby and not you and that's the end of it." The lack of connection was demonstrated by the statement "I just didn't have a nurse who was really there." The lack of control was demonstrated by this statement: "You're not in control of the experience." Perinatal nurses have an opportunity to influence a caring environment in which women feel connected to their nurse and in control of their labor and birth. Tailoring nursing care to meet the needs of each mother, especially women who are experiencing things they had not expected in labor or during birth, may be the key ingredient to ensure optimal birthing experiences.

Labor and Delivery Nurses' Perceptions of Caring for Childbearing Women in Nurse-Managed Birthing Units

To identify the perceptions of nurses caring for women giving birth in nurse-managed, highly technological birthing environments. A purposive sample of 18 perinatal nurses employed at four different in-hospital birthing centers utilizing nurse-managed labor models participated in audio-taped interviews. Interviews were transcribed and analyzed for themes. Themes included (1) nurses' aversion to birth plans, (2) barriers to the provision of supportive care for birthing women, (3) differences in caring for women who are medicated versus those who are unmedicated, and (4) the rewards of caring for birthing women. Although practicing in very busy, highly technological birthing units, many study participants seemed to focus on the value of predictability and efficiency guiding the provision of nursing care to birthing women. Women's birth experiences are heavily influenced by perinatal nurses and their care, yet the voices of these nurses have not been represented fully in nursing research. Nurses in this study reported multiple challenges in the provision of supportive care for their patients, and a wider dialogue on this topic within perinatal nursing is warranted. More research is needed on this topic, and intervention studies documenting innovative methods of teaching, orienting, and continually educating these nurses should be undertaken.

Birth planning for midwives and mothers

If women are to be empowered to make choices for childbirth, it is important that midwives explore and discuss their wishes and feelings about the delivery options available. Providing practical and sensible information should facilitate women with constructing a more accurate picture from which realistic hopes, fears and expectations can be formulated about impending labour. To facilitate midwives with this process, a flexible framework for a birth plan has been proposed. This easy to complete template can be used to assist childbearing women with assimilating their ambitions and desires regarding labour. Birth planning is important, since studies that compare women's expectations of childbirth with actual experience present contrasting accounts, with disappointment, guilt and failure compared with delight, pride and success. Since experiences differ it is recommended that midwives audit birth satisfaction against women's birth plans. Results would inform auditors of whether there is satisfaction with a woman's birth experience and the quality of care that she perceived she received. Women's articulated wishes about birth would facilitate understanding of why satisfaction/dissatisfaction occurs.

Perinatal Factors Related to Negative or Positive Recall of Birth Experience in Women 3 Years Postpartum in the Netherlands

Little research has been conducted to date on women's postnatal emotional well-being and satisfaction with the care received in the Netherlands. The aim of this study was to investigate Dutch women's views of their birth experience 3 years after the event. A questionnaire was mailed to all women who had given birth in 2001 and who had at least one prenatal, perinatal, or postnatal visit to the participating midwifery practice. Women who had a subsequent birth after the index birth in 2001 were not excluded. We specifically asked respondents to reflect on the birth that occurred in 2001. Women were asked to say how they felt now looking back on their labor and birth, with five response options from "very happy" to "very unhappy." We received 1,309 postnatal questionnaires (response rate 44%). The sample was fairly representative with respect to the mode of delivery, place of birth, and obstetric interventions compared with the total Dutch population of pregnant women; however, the sample was not representative for ethnicity and initial caregiver. Three years after delivery, most women looked back positively on their birth experience, but more than 16 percent looked back negatively. More than 1 in 5 primiparas looked back negatively compared with 1 in 9 multiparas. Adjusted odds ratios (OR) for looking back negatively 3 years later included having had an assisted vaginal delivery or unplanned cesarean delivery (OR 2.6, 95% CI 1.59-4.14), no home birth (OR 1.4, 95% CI 1.04-1.93), referral during labor (OR 2.4, 95% CI 1.48-3.77), not having had a choice in pain relief (OR 2.9, 95% CI 1.91-4.45), not being satisfied in coping with pain (OR 4.9, 95% CI 2.55-9.40), a negative description of the caregivers (OR 2.9, 95% CI 1.85-4.40), or having had fear for the baby's life or her own life (OR 2.3, 95% CI 1.47-3.48). A substantial proportion of Dutch women looked back negatively on their birth experience 3 years postpartum. Further research needs to be undertaken to understand women's expectations and experiences of birth within the Dutch maternity system and an examination of maternity care changes designed to reduce or modify controllable factors that are associated with negative recall.

Commentary: childbirth education in iran.

With regard to childbirth, the role of every health-care system is to improve maternity care as well as the birth experience of women and their family members. Despite many efforts to improve maternity care in the Islamic Republic of Iran, the nation's childbirth care still faces a tremendous amount of unnecessary intervention and, consequently, a high rate of cesarean births. This article describes the strengths and weaknesses of Iran's maternity-care system and childbirth education in light of evidence-based practice.

Postoperative Pain After Cesarean Birth Affects Breastfeeding and Infant Care

To study women's experience of postoperative pain and pain relief after cesarean birth and factors associated with pain assessment and the birth experience. Descriptive patient survey. Data were collected through a questionnaire. The outcome variables were assessments of pain using a Visual Analog Scale and women's birth experience measured on a seven-point Likert scale. Central Swedish county hospital, maternity unit. The sample consisted of 60 women undergoing cesarean birth. Women reported high levels of experienced pain during the first 24 hours. Seventy-eight percent of the women scored greater than or equal to 4 on the Visual Analog Scale, which can be seen as inadequately treated pain. There was no difference between elective and emergency cesarean births in the levels of pain. In spite of high levels of pain, women were pleased with the pain relief. The risk of a negative birth experience was 80% higher for women undergoing an emergency cesarean birth compared with elective cesarean birth. Postoperative pain negatively affected breastfeeding and infant care. There is a need for individual and adequate pain treatment for women undergoing cesarean birth, as high levels of pain interfere with early infant care and breastfeeding.

Dancing with the Wind: A Methodological Approach to Researching Women's Spirituality around Menstruation and Birth

Research into spirituality is by definition problematic. In an evidence-based culture, how is a concept like spirituality defined and measured? Through her doctoral dissertation, the author seeks to illuminate dimensions of female spirituality connected with the processes of menstruation and birth. In Western industrialized culture, these processes are regarded as medical concerns. Reframing the spiritual significance of menses, the author explores the links between attitudes toward menstruation and spirituality, and women's birth experiences. The lack of research and literature about the spirituality of menstruation, or the spiritual care of the birthing woman denotes a vacuum in both theory and practice. The author presents her methodological approach to resolving the dilemma of how to research the elusive concept of female spirituality—an endeavor akin to attempting to lasso the wind! Through a combination of autoethnography, focus groups, and in-depth interviews, she takes up the challenge of expanding the qualitative research frontier.

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?

A comparison of labour and birth experiences of women delivering in a birthing centre and at home in the Netherlands

to compare the labour and birth experiences of women who delivered at home without complications with the experiences of women who delivered in a birth centre without complications. a descriptive study using postal questionnaires at 1-6 months after birth of a consecutive sample of postpartum women. women were recruited from one birth centre and three midwifery practices in an urban area of the Netherlands between September and December 2003. 193 women; 129 delivered at home and 64 delivered in the birth centre. the home-birth group perceived less pain (mean score home birth 6.291, birth-centre birth 6.977), desired less pain-relieving medication (home birth 7.9%, birth-centre birth 21.9%), believed they knew their midwife better (home birth 36%, birth-centre birth 10% 'knew her well'), and rated their birth setting 'higher' than the birth-centre group (mean score home birth 4.70, birth-centre birth 4.01). Furthermore, the birth-centre group emphasised safety, having medical help available, and convenience, whereas the home-birth group placed more importance on the home being trustworthy and dependable, having their own place and belongings, and feeling comfortable and relaxed. having an understanding of a woman's labour and delivery experience allows health-care providers to continue to improve the quality of maternity care. The environment can have a positive effect on a woman's birth experience; recommendations have been proposed that can be applied to all pregnant and labouring women. identification and understanding of the factors in the environment that make the labour and birth experience more positive should be incorporated into the education and preparation for an upcoming birth.

Webwatch

This month's Webwatch aims to encourage midwives to continue to explore ways to facilitate a positive birth experience for women. The sites reviewed have a common philosophy, which is one of respecting the woman's body and holding a firm belief in her ability to give birth naturally. The sites draw on midwifery expertise across the world.

Continuous Support for Women During Childbirth

ABSTRACTBackground: Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour.Objectives: Primary: to assess the effects, on mothers and their babies, of continuous, one‐to‐one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour.Search strategy: We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003).Selection criteria: All published and unpublished randomized controlled trials comparing continuous support during labour with usual care.Data collection and analysis: Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data.Main results: Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available.Reviewers’ conclusions: All women should have support throughout labour and birth.Citation: Hodnett ED, Gates S, Hofmeyr G J, Sakala C. Continuous support for women during childbirth (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. •••The preceding report is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464‐780X). The Cochrane Library is designed and produced by Update Software Ltd, and published by John Wiley & Sons, Ltd.

Women's experiences and preferences following Caesarean birth

To seek women's views on their planned mode of birth in a subsequent pregnancy when they had a single prior Caesarean birth in the immediately preceding pregnancy. This study was conducted at the Women's and Children's Hospital, Adelaide. Using a hospital maintained database, women were identified based on who had given birth by primary Caesarean section between December 2002 and June 2003 to a live born infant. The women were sent a questionnaire to assess their experiences related to their Caesarean birth and their plans for mode of birth in any subsequent pregnancy. A total of 319 eligible women were identified from the database and sent a questionnaire, with responses obtained from 208 women (65.2%). Most women were satisfied with their birth experience with a mean satisfaction score of 6.3 (+/- 2.8). The most common response when women were asked to indicate the aspects of their birth experience that they liked was those caring for them (153 women; 48%), followed by the reassurance provided about the health of their baby (106 women; 33%) and their own health (88 women; 28%). One fifth of women (63 women; 20%) indicated that they were glad that they had experienced labour. Eighty-five women (41%) indicated that they would in future plan for a vaginal birth, 48 women (23%) would plan for Caesarean section, and 72 women (35%) were unsure. A proportion of women have a strong preference for mode of birth in a subsequent pregnancy, which is established within 6 months of the woman's birth experience.

A negative birth experience: prevalence and risk factors in a national sample.

A woman's dissatisfaction with the experience of labor and birth may affect her emotional well-being and willingness to have another baby. The aim of this study was to investigate the prevalence and risk factors of a negative birth experience in a national sample. A longitudinal cohort study of 2541 women recruited from all antenatal clinics in Sweden during 3 weeks spread over 1 year was conducted. Data were collected by three questionnaires, which measured women's global experience of labor and birth 1 year after the birth, and obtained information on possible risk factors during pregnancy and 2 months after the birth. Seven percent of the women had a negative birth experience. The following risk factors were found: (1) factors related to unexpected medical problems, such as emergency operative delivery, induction, augmentation of labor, and infant transfer to neonatal care; (2) factors related to the woman's social life, such as unwanted pregnancy and lack of support from partner; (3) factors related to the woman's feelings during labor, such as pain and lack of control; and (4) factors that may be easier to influence by the caregivers, such as insufficient time allocated to the woman's own questions at antenatal checkups, lack of support during labor, and administration of obstetric analgesia. Many risk factors were related to unexpected medical problems and participants' social background. Of the established methods to improve women's birth experience, childbirth education and obstetric analgesia seemed to be less effective, whereas support in labor and listening to the woman's own issues may be underestimated.

“The Cut Above” and “the Cut Below”: The Abuse of Caesareans and Episiotomy in São Paulo, Brazil

In the last 50 years, a rapid increase in the use of technology to start, augment, accelerate, regulate and monitor the process of birth has frequently led to the adoption of inadequate, unnecessary and sometimes dangerous interventions. Although research has shown that the least amount of interference compatible with safety is the paradigm to follow, vaginal birth is still being treated as if it carries a high risk to women's health and sexual life in Brazil. This paper describes the impact of the intervention model on women's birth experience, and discusses how the organisation of public and private maternity services in Brazil influences the quality of obstetric care. Brazil is known for high rates of unnecessary caesarean section (“the cut above”), performed in over two-thirds of births in the private sector, where 30% of women give birth. The 94.2% rate of episiotomy (“the cut below”) in women who give birth vaginally, affecting the 70% of poor women using the public sector most, receives less attention. A change in the understanding of women's bodies is required before a change in the procedures themselves can be expected. Since 1993, inspired by campaigns against female genital mutilation, a national movement of providers, feminists and consumer groups has been promoting evidence-based care and humanisation of childbirth in Brazil, to reduce unnecessary surgical procedures.

A report of women's birth experiences in Baku, Azerbaijan

The findings from a survey exploring women's perceptions of their care during pregnancy, birth and the postpartum period in Baku, Azerbaijan, initiated by the Ministry of Health and UNICEF, are reported here.In the former Soviet Union, on which the perinatal health care systems of Azerbaijan are based, care for women during the perinatal period was based on using available technology and on a physician-centred model of care. Women's perceptions of their care were infrequently if ever sought or heeded. As healthcare systems are being strengthened in these countries, there is an increasing interest in providing a woman-centered or family-centered approach to care as well as offering appropriate medical care birthing procedures. This study explores the progress made in Azerbaijan in implementing such changes since the introduction of a perinatal reform process a few years ago.Findings indicate some significant deviations from traditional maternity care practices in Baku since the breakdown of the Soviet Union. A more humanistic and evidence-based approach to care is being introduced. It is evident that maternity houses in Baku are also providing better support for infant feeding than many of their former Soviet Union counterparts indicating the effective implementation of the principles of breastfeeding encouraged through the WHO/UNICEF Baby Friendly Hospital Initiative program in that country.

Feeling in control during labor: concepts, correlates, and consequences.

Many studies have revealed that a sense of control is a major contributing factor to a woman's birth experience and her subsequent well-being. Since not all studies conceptualize "control" in the same way or distinguish between "external" and "internal" control, the purpose of this study is to advance understanding of how these senses of control relate to each other. Questionnaires were sent to women 1 month before birth to assess their preferences and expectations and at 6 weeks after birth to discover their experiences and assess psychological outcomes. Data are presented from 1146 women. Three control outcomes were considered: feeling in control of what staff do to you, feeling in control of your own behavior, and feeling in control during contractions. Women were less likely to report being in control of staff (39.5%) than in control of their own behavior (61.0%). Approximately one-fifth of the sample felt in control in all three ways, and another one-fifth did not feel in control in any of them. Parity was strongly associated with feeling in control, with multiparas feeling more in control than primiparas in all cases. In logistic regression analyses, feeling in control of staff was found to relate primarily to being able to get comfortable, feeling treated with respect and as an individual, and perceiving staff as considerate. Feeling in control of one's behavior and during contractions were primarily related to aspects of pain and pain relief, but also to antenatal expectations of control. Worry about labor pain was also an important antenatal predictor for primiparas. All three control outcomes contributed independently to satisfaction, with control of staff being the most significant; relationships with emotional well-being were also demonstrated. All three types of control were important to women and contributed to psychological outcomes. Internal and external control were predicted by different groups of variables. Caregivers have the potential to make a significant difference to a woman's experience of childbirth. The ways in which women are helped to deal with pain will affect internal control; the extent to which they feel that they are actually cared about, rather than care being something that is done to them, will affect external control. Both contribute to satisfaction and emotional well-being.

Continuous support for women during childbirth.

Historically, women have been attended and supported by other women during labour. However, in recent decades in hospitals worldwide, continuous support during labour has become the exception rather than the routine. Concerns about the consequent dehumanization of women's birth experiences have led to calls for a return to continuous support by women for women during labour. Primary: to assess the effects, on mothers and their babies, of continuous, one-to-one intrapartum support compared with usual care. Secondary: to determine whether the effects of continuous support are influenced by: (1) routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement, and ability to cope with labour; (2) whether the caregiver is a member of the staff of the institution; and (3) whether the continuous support begins early or later in labour. We searched the Cochrane Pregnancy and Childbirth Group trials register (30 January 2003) and the Cochrane Central Register of Controlled Trials (The Cochrane Library, Issue 1, 2003). All published and unpublished randomized controlled trials comparing continuous support during labour with usual care. Standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group were used. All authors participated in evaluation of methodological quality. Data extraction was undertaken independently by one author and a research assistant. Additional information was sought from the trial authors. Results are presented using relative risk for categorical data and weighted mean difference for continuous data. Fifteen trials involving 12,791 women are included. Primary comparison: Women who had continuous intrapartum support were less likely to have intrapartum analgesia, operative birth, or to report dissatisfaction with their childbirth experiences. Subgroup analyses: In general, continuous intrapartum support was associated with greater benefits when the provider was not a member of the hospital staff, when it began early in labour, and in settings in which epidural analgesia was not routinely available. All women should have support throughout labour and birth.