Interventions during labor and birth in the United States: A qualitative analysis of women's experiences

ObjectiveTo explore and describe hospital-birthing women's understandings of and experiences with interventions during labor and birth.MethodsQualitative data was collected as part of a larger ethnographic study of childbirth in the United States. The grounded theory method was employed to analyze interviews with 59 women from three states who had recently given birth in hospitals with physicians or certified nurse-midwives in attendance.ResultsFour themes emerged from the data. The themes safety/risk and provider match, described women's expectations regarding intervention and their interactions with providers. A third theme addressed how women experienced interventions and their perceptions of control over decision-making. A final theme characterized women's satisfaction with maternity care.ConclusionsWomen who received interventions expressed varying levels of comfort or apprehension associated with both expectations of maternity care and provider match. Women whose expectations matched those of the provider reported more positive experiences. Regardless of provider match, women expressed ambivalence about the use of interventions and confusion over their appropriate place. Women's ability to make sense of interventions was related to how well they navigated a complicated and bureaucratic maternity system. Increasing attention needs to be paid to the impact of these factors on women's perceptions of care during pregnancy and childbirth.     

Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women’s motivations and preparations for freebirth

ObjectiveEven in maternity care systems with free midwifery care, some women intentionally choose to birth unattended by any health professional (freebirth). Women who choose freebirth represent an enigma for many, and a provocation to some. However, people who do not conform to dominant medical practices are a source of valuable insights that can reveal shortcomings in the mainstream health care system. Thus, the aim of this study was to explore and understand women's motivations and preparations for freebirth.MethodsThe study was informed by the theoretical lens of the 'undisciplined patient'. Qualitative, in-depth interviews were performed with ten Danish women, who for their most recent birth had planned to freebirth. Data were analysed using reflexive thematic analysis.ResultsFour themes were identified. “The standard system is not for me” describes negative experiences during previous births and the desire for more individualised support. “Re-establishing trust in myself” describes the women's quest for recognizing their own needs and re-building autonomy and inner strength. “I do my research” describes how the women sought new ways of knowing and prioritised experiential knowledge. And finally, “I create my safe space” describes the women's efforts to create the best possible physical and emotional space for themselves and their babies in order to have a safe and autonomous birth experience.ConclusionFreebirth is not undertaken lightly or without preparation by women. Improved continuity of care as well as greater flexibility in hospital guidelines could accommodate some of these women's demand for autonomy in birth.     

Women’s empowerment and use of contraception in India: Macro and micro perspectives emerging from NFHS-4 (2015–16)

Background and objectiveBased on the four-corner stone of population and development programmes recognized by ICPD (1994) this paper envisages the relationship between the recent waves of women's empowerment anduse of contraceptive methods in India.Data and methodsFindings are based on two rounds of NFHS (3 & 4). Liberson’s Diversity Index has been used to assess the inequality in women’s empowerment. Multiple regression analysis is used to portray the relationship and logistic regression is used to access the adjusted effects of various dimensions of women's empowerment on use of contraception.ResultsVarying degrees of equity in women’s empowerment across different states of India builds a combative relationship with uptake of contraceptive methods. Results portray a positive association between inequality in household decision making, engaged in paid work in last 12 months and having 10 years of schooling with use of any modern method. Women who participated in household decision making (OR = 1.17 p < 0.005), using mobile phone (OR = 1.23 p < 0.005) and working and were paid in cash in last 12 months (OR = 1.37 p < 0.005) are significantly more likely to use any method of contraception.ConclusionsStatus of women in India has improved in different dimensions, yet the patriarchal norms influence the decision of using contraception. The current women-centric bottom-top approach in implementation of family planning programme should focus at the women’s right to decision on their own life and health. Such efforts should hinge at strengthening inter personal counseling and capacity building sessions by outreach workers, which may empower women with enhanced knowledge about their health and bodily rights.     

Women’s views of high risk pregnancy under threat of preterm birth

ObjectiveTo gain an understanding of the experiences of pregnant women at risk of having a preterm birth (PTB) who were attending a specialist preterm antenatal clinic and to elicit their views on treatment to prevent PTB.Study designA qualitative interpretive approach was adopted, utilizing focus groups and one-to-one interviews. The semi-structured interview schedule focused on two main areas; risk and treatment for preterm birth. Fourteen pregnant women were recruited from a preterm antenatal clinic at a major tertiary referral centre in the North West of England. All interviews were audio recorded, with consent, and transcribed verbatim before carrying out thematic analysis.ResultsAnalysis revealed 3 main themes. Women struggled with ‘balancing the risks’ associated with the threat of preterm birth, they developed ‘personal coping strategies to survive the pregnancy’ and they watched as the strain made their ‘whole family crumble’.ConclusionWomen’s journey through pregnancy after a previous PTB experience is one of emotional and physical endurance. Women embrace the ‘high risk’ identity as it offers the opportunity for regular assessment and clinical reassurance. However, emotional and psychological needs must also be addressed to reduce stress and anxiety. By setting mutually agreed short term goals, significant milestones can be reached so that women feel they are successfully progressing through a high risk pregnancy through a series of ‘baby steps’.     

Taking the matter into one's own hands – Women's experiences of unassisted homebirths in Sweden

ObjectiveThere are no national guidelines or financial support for planned homebirths in Sweden. Some women choose to give birth at home without the assistance of a midwife. The objective of this study was to describe eight women's experience of unassisted planned homebirth in Sweden.DesignWomen who had the experience of an unassisted planned home birth were interviewed. The material was analysed using a phenomenological approach.ResultsThe essential meaning of the phenomenon giving birth at home without the assistance of a midwife is understood as a conflict between, on one hand, inner responsibility, power and control and on the other hand insecurity in relation to the outside, to other people and to the social system. A wish to be cared for by a midwife is in conflict with the fear of not maintaining integrity and respect in this precious moment of birth.ConclusionSome women may be more sensitive to attitudes and activities that are routinely performed during pregnancy and childbirth and therefore choose not to turn to any representatives of the medical system. The challenge should be to provide safe care to all women so that assistance from a midwife becomes a reality in all settings.     

Syrian women’s experiences of being pregnant and receiving care at antenatal clinics in Sweden for the first time after migration

ObjectiveTo describe Syrian women’s experiences of being pregnant and receiving care at antenatal clinics for the first time after migration.MethodsA phenomenological lifeworld approach was used. Eleven women from Syria enrolled at antenatal clinics, who were experiencing their first pregnancy in Sweden but who may have given birth before in other countries, were interviewed in 2020. The interviews were open and based on one initial question. Data were inductively analysed using a phenomenological method.ResultsThe essence of Syrian women’s experiences of being pregnant and receiving care at antenatal clinics for the first time after migration was the importance of being met with understanding to create trust to build a sense of confidence. The following four constituents capture the essence of the women’s experiences: “It was important to feel welcomed and to be treated like an equal”; “A good relationship with the midwife strengthened self-confidence and trust”; “Good communication despite language difficulties and cultural differences was important”; and “Previous experience of pregnancy and care influenced the experience of the care received”.ConclusionSyrian women's experiences reveal a heterogeneous group with different experiences and background. The study highlights the first visit and emphasises the importance of this visit for future quality of care. It also points out the negative occurrence of the transferring guilt from the midwife to the migrant woman in case of cultural insensitivity and clashing norm systems.     

Experiences of internet-based treatment for vulvodynia: A qualitative study

ObjectiveThe aim of this study was to describe women's experiences before, under, and after a guided internet-based intervention for vulvodynia.MethodsThe design was qualitative, based on content analysis. Participants were women who had undergone guided internet-based treatment for vulvodynia based on acceptance and commitment therapy principles (n = 13). Data were collected through in-depth interviews approximately-one month after participants completed treatment.ResultsThe analysis revealed the women’s experiences of internet-based treatment for vulvodynia. Three themes emerged: “dealing with pain alone,” which was related to experiences of living with vulvodynia before internet-based treatment; “finding new ways,” which described the experiences of undergoing an internet-based treatment for vulvodynia and “feeling empowered to take control,” referring to the experiences of living with vulvodynia after the internet-based treatment. The women described a long search for a diagnosis, revealing a negative experience of healthcare. The internet-based treatment helped them find new ways to manage vulvodynia, but difficulties with the treatment were also experienced. After the intervention, the women reported improvements in wellbeing and having better strategies to manage pain, but also stated that the treatment was insufficient to perceive changes in vulvar pain.ConclusionsThe guided internet-based treatment program for vulvodynia based on acceptance and commitment therapy principles was perceived as credible, helpful to manage vulvodynia, and could serve as a complement to regular care. Questions regarding the need for more support and optimal length of treatment need to be further evaluated.     

“From hell to healed” – A qualitative study on women’s experience of recovery,relationships and sexuality after severe obstetric perineal injury

ObjectiveFew studies have investigated women’s experiences of daily life after childbirth complicated by obstetric anal sphincter injury (OASI). The aim of the present study was to explore experiences related to recovery, sexual function, relationships and coping strategies among women affected by OASI.MethodsIn-depth interviews were conducted using a purposive sample of 11 women affected by OASI. Women were interviewed 1–2 years after their first childbirth. Inductive qualitative content analysis was applied.ResultsThe theme “From hell to healed” illustrates women’s experiences of recovery, relationships and sexual function after OASI. Three categories addressing women’s perceptions emerged: “Challenged to the core”, “At the mercy of the care provider” and “For better or for worse”. Support from partners and family and comprehensive care were important elements for the experiences of coping and healing from OASI. Elements that negatively influenced women’s experiences were the pain and physical symptoms of pelvic floor dysfunction, normalization of symptoms by heath care providers, and unrealistic expectations about how this period in life should be experienced.ConclusionOASI greatly affects women’s experiences of their first years with their newborn child, relationships, social context and sexuality. For some women, OASI negatively affects everyday life for a long period after childbirth. However, others heal and cope quite quickly. Health care professionals need to identify and pay attention to women with persisting problems after OASI so that they can be directed to the right level of care.     

Sense of coherence in pregnant and new mothers – A longitudinal study of a national cohort of Swedish speaking women

BackgroundPrevious research shows inconsistent results about the stability of SOC during the childbearing period, and few studies have focused on longitudinal measures. There are contradictory results regarding the association between SOC and birth outcome. The link between levels of SOC and parental stress needs to be further explored.AimThe aim of this study was to investigate changes in SOC from early pregnancy to one year after birth and associations with background characteristics, birth outcome and parental stress.MethodsA longitudinal survey of a national cohort of Swedish speaking women during 3 weeks in 1999–2000. Data were collected by questionnaires in early pregnancy, 2 months and 1 year after birth.ResultsSOC increased from pregnancy to 2 months after birth but decreased 1 year after birth. SOC was associated with women's background characteristics, emotional wellbeing and attitudes, but not with labour outcome. Women with low SOC reported higher parental stress after one year.ConclusionSense of coherence is not stable during the childbearing period and is associated with women's sociodemographic background, emotional health and attitudes, but not with reproductive history or birth outcome. Parental stress is negatively correlated with SOC, and some important characteristics are similar in women having low SOC and high parental stress. Identifying women with low SOC in early pregnancy could be a means to prevent later parental stress.     

Women’s experiences of abnormal Pap smear results – A qualitative study

ObjectivesTo describe women’s experiences of abnormal Pap smear result.MethodsTen women were recruited from a women’s health clinic. Qualitative interviews based on six open-ended questions were conducted, transcribed verbatim, and analyzed by content analysis.ResultsThe women believed that their abnormal Pap smear result was indicative of having cancer. This created anxiety in the women, which resulted in the need for emotional support and information. Testing positive with human papillomavirus (HPV) also meant consequences for the relatives as well as concerns about the sexually transmitted nature of the virus. Finally, the women had a need to be treated with respect by the healthcare professionals in order to reduce feelings of being abused.ConclusionsIn general, women have a low level of awareness of HPV and its relation to abnormal Pap smear results. Women who receive abnormal Pap smear results need oral information, based on the individual women’s situation, and delivered at the time the women receive the test result. It is also essential that a good emotional contact be established between the women and the healthcare professionals.     

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.     

A Swedish study of midwives’ and nurses’ experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan

ObjectivesThe aim was to describe midwives’ and nurses’ experiences when women are diagnosed with a missed miscarriage during a routine ultrasound scan in pregnancy weeks 18–20.Study designsA qualitative content analysis with an inductive approach and 13 semi-structured interviews were used for data collection from these three domains: midwives at an ultrasound department, midwives at a maternity clinic and nurses at a gynecological ward. Content analysis resulted in six codes, four categories and one primary theme.Main outcome measuresThe four categories identified were: the interviewees’ experiences of women’s reactions, support from the midwife and nurse, the interviewees’ experiences of men’s reactions and communication between care providers and women. The main theme focused on the interviewees’ noting that women had a premonition that something was wrong with their pregnancy. This could for example have been in the form of minor bleeding or the fact that pregnancy symptoms had receded and there were no movements by the fetus. The midwives carried out a follow-up with assessment.ConclusionsWomen need confirmation of their premonitions of a missed miscarriage so that a diagnosis can be made as early as possible in their pregnancy. Women and their partners who have suffered a missed miscarriage need extended support on an individual basis in addition to follow-up assistance as assessed by the midwives.     

Prevalence and predictive factors for fear of childbirth in pregnant Portuguese women: A cross-sectional study

ObjectiveTo measure the prevalence of the fear of childbirth (FOC) and determine which factors predict severe FOC among pregnant Portuguese women.MethodsAn online cross-sectional study among pregnant Portuguese women aged ≥ 20 years who were recorded using a convenience sampling. Self-administered questionnaires were used for data collection: socio-demographic and obstetric questionnaire and European Portuguese version of Wijma Delivery Expectancy Questionnaire-version A (WDEQ-A). Data of 669 participants were collected successfully from June 9 to October 30, 2019. Predictive factors for severe FOC were investigated using a multivariate logistic regression analysis. Odds ratios (OR) and 95% confidence intervals were calculated.ResultsThe prevalence of severe FOC (WDEQ-A ≥ 85) among pregnant Portuguese women was 10%. Severe FOC was significantly associated with lower educational level, single/divorced marital status, and negative previous childbirth experience. Multivariate logistic regression analysis indicated that being single or divorced and having a negative previous childbirth experience were predictive variables for severe FOC.ConclusionPregnant Portuguese women have FOC, although with varying severity. The data suggest that marital status and women's perceptions of previous childbirth experience may be useful variables to predict severe FOC. Further research for extending the predictive factors of FOC should be refined. The results are clinically relevant for midwifery care, as they should be used in the sense of early identification of fearful pregnant women to provide adequate support strategies to reduce FOC.     

Race inequality in epidural use and regional anesthesia failure in labor and birth: An examination of women's experience

ObjectiveA known racial disparity in medical care is that white women receive epidurals more often in labor than do women from other racial and ethnic groups. Medical researchers have framed this disparity as due to some women's lack of access to anesthesia. Further, an unexamined racial disparity in medical care is that anesthesia failure in labor and birth may also have racial disparity. We explore the organizational processes that may lead to racial disparity an epidural use and regional anesthesia failure in labor and birth.MethodsWe draw on semi-structured, in-depth interviews conducted with 83 women in June through December, 2010 the day after they gave birth at a New England tertiary care hospital.ResultsAmong women who did not plan to have an epidural, women of color were more likely to face pressure to accept the epidural by hospital medical staff. Further, among women who received anesthesia (either during vaginal delivery or a C-section), women of color were more likely to experience failure in their pain medication and were less likely to have their pain and anxiety taken seriously by doctors.ConclusionOverall we challenge the contention that access is the primary way women's epidural experiences are influenced by race and suggest an alternative lens through which to understand racial dynamics and epidural use and anesthesia failure in labor and birth.     

Women’s perceptions of fetal movements in full-term pregnancy

BackgroundBesides the frequency of the fetal movements the woman’s perceptions of the movements can give additional information about the unborn baby’s wellbeing.ObjectiveTo explore women’s perceptions of fetal movements in full-term pregnancy.MethodsInterviews with 40 women in gestational weeks 37 + 2 to 41 + 5, all with uncomplicated pregnancies. All women were recruited from one antenatal clinic in the capital of Sweden. With an inductive approach using a content analysis the answers to the question: “Can you describe how your baby has moved this week?” was analysed.ResultsFetal movements were categorized into seven categories: strong and powerful, large, slow, stretching, from side to side, light, and startled.ConclusionsAlmost all the women perceived the fetal movements at the end of pregnancy as strong and powerful, and internal pressure. Including women’s perceptions of fetal movements in the obstetric anamneses, gives valuable information about the fetus.     

Risks of emergency cesarean section and fetal asphyxia after induction of labor in intrahepatic cholestasis of pregnancy: A hospital-based retrospective cohort study

ObjectivesIntrahepatic cholestasis of pregnancy (ICP) is the most common pregnancy liver-specific disease. Induction of labor in gestational weeks 37–39 is commonly performed with the perspective to avoid the complication of stillbirth. We aimed to study whether this practice increases the risks of emergency cesarean section (CS) and fetal asphyxia.Study designWe assessed the risk of emergency CS and fetal asphyxia in ICP among women with spontaneous and induced onset of labor in comparison to women without ICP. We performed a hospital based retrospective cohort study with 25,870 singleton pregnancies, 333 with ICP (1.3%), of which 231 gave birth in weeks 37–39. Obstetric outcome was assessed through linkage of the Swedish Medical Birth Registry and a local obstetrical database based on the patient’s medical files.Main outcome measureRisk for emergency CS; fetal asphyxia and postpartum hemorrhage.ResultsThe risk of emergency CS in ICP with spontaneous onset of labor (12.5%) did not differ from non ICP women with spontaneous onset of labor (9.3%; aOR, 1.33; 95% CI 0.60–2.96). When labor was induced, risk of emergency CS was significantly lower among women with ICP than among without ICP (aOR, 0.47; 95% CI 0.26–0.86). Exclusion of women with preeclampsia, gestational hypertension or diabetes mellitus did not alter the result. The risk for fetal asphyxia was not significantly associated with ICP status.ConclusionInduction of labor in women with ICP gestational weeks 37–39 did not increase the risks of emergency CS or fetal asphyxia.     

Marital violence and sexually transmitted infections among women in post-revolution Egypt

ObjectivesTo explore the relationship between past year physical or sexual partner violence against women and women’s self-report of sexually transmitted infection (STI) symptoms in post-revolution Egypt; and to examine the effects of men’s and women’s risky sexual behavioural characteristics and structural dimensions of poverty and gender inequality on this relationship.Study designThis study uses the nationally representative cross-sectional demographic and health survey data conducted in 2014. Multivariate logistic regression was used to assess the relationship between past year partner violence and self-report of STI symptoms among currently married women.Main outcome measureswomen’s self-report of STI was based on their responses to three questions; whether in the past year they had: got a disease through sexual contact?, a genital sore or ulcer?, or a bad smelling abnormal genital discharge? Women who gave an affirmative response to one or more of these questions were assumed to self-report STI.ResultsAlmost one-third of women self-reported symptoms of STI. Fourteen percent of women reported they had experienced physical or sexual violence by a male partner in the past 12 months. Abused women had a 2.76 times higher odds of self-reported STI symptoms (95% CI 2.25–3.38). The significant relationship between self-reported STI and past year partner violence against women did not alter when adjusting for men’s and women’s behavioural characteristics and factors related to poverty and gender inequality.ConclusionsPublic health interventions that address women’s sexual and reproductive health need to consider violence response and prevention strategies.     

Swedish women's interest in models of midwifery care – Time to consider the system? A prospective longitudinal survey

BackgroundSweden has an international reputation for offering high quality maternity care, although models that provide continuity of care are rare. The aim was to explore women's interest in models of care such as continuity with the same midwife, homebirth and birth center care.MethodsA prospective longitudinal survey where 758 women's interest in models such as having the same midwife throughout antenatal, intrapartum and postpartum care, homebirth with a known midwife, and birth center care were investigated.ResultsApproximately 50% wanted continuity of care with the same midwife throughout pregnancy, birth and the postpartum period. Few participants were interested in birth center care or home birth. Fear of giving birth was associated with a preference for continuity with midwife.ConclusionsContinuity with the same midwife could be of certain importance to women with childbirth fear. Models that offer continuity of care with one or two midwives are safe, cost-effective and enhance the chance of having a normal birth, a positive birth experience and possibly reduce fear of birth. The evidence is now overwhelming that all women should have maternity care delivered in this way.