Kurdish women's preference for mode of birth: A qualitative study

Choosing between a normal delivery and Caesarean section is a matter of critical importance for a pregnant woman. The third trimester is the time for her to think about methods of delivery. The study aims to gain insight into Kurdish pregnant women's birth preference and their perception of factors influencing this choice. In this qualitative study, 22 pregnant Kurdish women were interviewed during the third trimester of their pregnancies. The setting for the study included three public health‐care centres of Kurdistan University of Medical Sciences in Sanandaj, a centre of the Kurdistan province at the western part of Iran. Study participants were recruited from maternity units of health‐care centres. A purposive sample was used initially and then theoretical sampling was used towards the end of the data analysis. Sample size was not predetermined but was determined when interviewing reached saturation, that is, when no new data emerged about categories. The sample size was restricted to 22, as no new data were generated after the 20th interview. The criteria required for inclusion in the study were being Kurdish women, being in the third trimester of pregnancy, no physical disability, no history of Caesarean section and interest in the study. A qualitative design was chosen, as it is particularly suited to studying complex phenomena or processes that are less understood. This study revealed that of the 22 participants, 18 preferred vaginal delivery and only four preferred Caesarean section. The reasons for choosing the vaginal delivery method were grouped into four categories: safety of baby, fear, previous experience and social support. This finding does not support the rate of Caesarean section among Kurdish women in Sanandaj. It might reflect the effect of other factors such as social, institutional, professional and quality of care on women's choice for delivery method.     

Vaginal birth after Caesarean risk decision‐making: Australian findings on the mothers' perspective

McGrath P, Phillips E, Vaughan G. International Journal of Nursing Practice 2010; 16 : 274–281
Vaginal birth after Caesarean risk decision‐making: Australian findings on the mothers' perspective The purpose of this paper is to explore, from the mothers' perspective, the decision‐making experience with regard to subsequent birth choice for women who had previously delivered by Caesarean section. A qualitative methodological approach was taken to the exploration of mothers' knowledge of the risks of vaginal birth after Caesarean (VBAC) or elective Caesarean following a prior birth by Caesarean section. This paper presents the insights provided by the four women who chose VBAC. The health professionals' attitude to birth, and thus the support they offer to mothers, is predominantly pro‐Caesarean. In view of the declining numbers of VBACs and the fact that the clinical literature documents risks for both elective Caesarean and VBAC, it is important for health professionals to be very sensitive and balanced in the information and support offered for the VBAC birth option.     

Experiences of women who have a vaginal birth after requesting a cesarean section due to a fear of birth: a biographical, narrative, interpretative study

A fear of childbirth is a reason for a Cesarean section on request without a medical indication. The law for patients' rights in Norway does not give women the opportunity to choose a Cesarean section, only the potential to participate in the decision-making process. This requires cooperation between health professionals and patients. The present study explores the experience of women who had a vaginal birth after requesting a Cesarean section due to a fear of birth. A biographical, narrative, interpretative method was used. Through five women's stories, it is evident that the practice of decision-making constitutes a challenge for both the women and the health professionals. The importance of a woman's right to be taken seriously, even if she does not want to understand the reason behind her fear of birth, is emphasized. An open mind from midwives and physicians is required, although this seems difficult to achieve.     

Vaginal birth after caesarean section (VBAC): exploring women's perceptions

Aims and objectives. This study was designed to complement local audit data by examining the lived experience of women who elected to attempt a vaginal birth following a previous caesarean delivery. The study sought to determine whether or not women were able to exercise informed choice and to explore how they made decisions about the method of delivery and how they interpreted their experiences following the birth. Background. The rising operative birth rate in the UK concerns both obstetricians and midwives. Although the popular press has characterized birth by caesarean section as the socialites’ choice, in reality, maternal choice is only one factor in determining the method of birth. However, in considering the next delivery following a caesarean section, maternal choice may be a significant indicator. While accepted current UK practice favours vaginal birth after caesarean (VBAC) in line with the research evidence indicating reduced maternal morbidity, lower costs and satisfactory neonatal outcomes, Lavender et al. point out that partnership in choice has emerged as a key factor in the decision‐making process over the past few decades. Chaung and Jenders explored the issue of choice in an earlier study and concluded that the best method of subsequent delivery, following a caesarean birth, is dependent on a woman's preference. Design and methodology. Using a phenomenological approach enabled a holistic exploration of women's lived experiences of vaginal birth after the caesarean section. Results. This was a qualitative study and, as such, the findings are not transferable to women in general. However, the results confirmed the importance of informed choice and raised some interesting issues meriting the further exploration. Conclusions. Informed choice is the key to effective women‐centred care. Women must have access to non‐biased evidence‐based information in order to engage in a collaborative partnership of equals with midwives and obstetricians. Relevance to clinical practice. This study is relevant to clinical practice as it highlights the importance of informed choice and reminds practitioners that, for women, psycho‐social implications may supersede their physical concerns about birth.     

An action research approach to the development of a clinical pathway for women requiring Caesarean sections

An action research framework was utilised to introduce a clinical pathway for women undergoing Caesarean section in the Maternity Unit at Westmead Hospital in 1998-1999. This style of research allowed the development of the clinical pathwayfor women having a Caesarean section to be progressively modified to adapt it to suit the needs of the multidisciplinary team and the clinical environment. The clinical pathway itself became a document that facilitated the education of the women, improving their preparation for discharge, aided the orientation and skill development of new staff and improved the continuity of care by enhancing the multidisciplinary approach to the women's care. It also identified the need for continuing staff education throughout the implementation and evaluation phases.     

The easy option? Australian findings on mothers' perception of elective Caesarean as a birth choice after a prior Caesarean section

As the rate of primary and repeat Caesareans around the world increases, obstetricians, midwives and primary care providers are being expected to provide counsel to women seeking information regarding birth choices for delivery after a prior emergency Caesarean. This article seeks to contribute to the knowledge on this topic by presenting research findings from a qualitative study designed to explore, from the mothers' perspective, the decision-making experience with regards to subsequent birth choice for women who have previously delivered by Caesarean section. Specifically, the findings in this article present the perspective of the mothers who opted for elective Caesarean. Eighty per cent of mothers in this study chose elective Caesarean for reasons of fear and the desire to retain some control over the birthing process. For many, this decision is made prior to or early in pregnancy without any openness to consider other possibilities. Thus, the findings strongly emphasize the importance of understanding and taking into consideration the mothers' psychosocial perspective on birth choices as a key to providing counsel and support.     

Health care providers' influence on HIV-infected women's beliefs and intentions related to AZT therapy

This study examined how women's relationship with their primary health care provider (PHP) and their perceptions about how effective their PHPs believe zidovudine (AZT) to be in decreasing perinatal transmission related to women's AZT beliefs and intentions. It used a cross-sectional design to collect data from 59 HIV-infected African American women. Almost half the women (45%) had given birth since HIV diagnosis. Most of the babies born to HIV-infected mothers (87%) were seronegative. Data analysis with Pearson's r indicated that the quality of the women's relationship with their PHP was positively correlated to how important the PHP would be in decision making related to AZT therapy. Significant positive correlation was observed between women's perceptions about how effective their PHPs believed AZT to be in decreasing perinatal HIV transmission and the women's own beliefs about AZT, their intent to take AZT if pregnant, and intent to give AZT to a newborn.     

Women's perceptions of vaginal and cesarean deliveries

Three groups of women were compared to determine their perceptions of giving birth and the relationships between those perceptions and their degree of participation in decision making, the type of anesthesia for delivery, and the presence of their husbands at the births. Forty women had vaginal deliveries; 39 had emergency cesareans, and 43 had planned cesareans. All the women were interviewed and completed self-administered questionnaires two to four days after delivery. The three groups had significantly different perceptions of the birth experience with the emergency cesarean birth group having the most negative perception. Among women having cesareans, more positive perceptions were associated with regional anesthesia, presence of their husbands at delivery, and greater participation in decision making. Women in the cesarean groups were less likely to breast feed, and those having planned cesareans were least likely to attend childbirth classes. Many of the women were unaware of the options available to them that could influence the birth experiences.     

Women's perceptions of cesarean and vaginal delivery: another look.

Perception of the birth experience was examined in a sample of 106 women who had unplanned cesarean deliveries, 113 who had planned cesarean deliveries, and 254 who had vaginal deliveries. Vaginally delivered women had more positive perceptions than their unplanned cesarean counterparts (p < .001). There were no differences in perceptions between the unplanned and planned cesarean groups, or between the planned cesarean and vaginal groups. General anesthesia for cesarean delivery was associated with more negative perceptions than regional anesthesia, and regional anesthesia for vaginal delivery was associated with more negative perceptions than no or local anesthesia. Pain intensity and physical distress were negatively correlated with perceptions.     

Women's perception of intrapartal care in relation to WHO recommendations

Background. The aim of intrapartal care in normal birth is to achieve a healthy mother and child using the least possible number of interventions that is compatible with safety. Aim. The aims of this study were to elucidate women’s perception of intrapartal care and women’s perceptions of normal birth. Methods. A questionnaire developed from the WHO’s recommendations for care in normal birth was answered by 138 (response rate 66·0% Swedish women. The women were asked to evaluate items in two ways: their perceived reality of care received and the subjective importance of each item. Results. Most women reported receiving care in the category (A) practices that are good and should be encouraged. However, women to a minor degree reported assessment for physical health, enquiring about support needs and pain assessment on admission. Many women received electronic foetal monitoring, repeated vaginal examinations, oxytocin augmentation and suturing after birth which fall under the category (B) practices that are harmful, (C) insufficient evidence exists and (D) practices frequently used inappropriately. The women who reported ‘Yes’ for perceived reality also reported high subjective importance for those items regardless of category A–D. Eighty‐four per cent of the women perceived that they had a normal delivery. Conclusion. The result suggests that women have great trust that the care midwives give them is the best care. Midwives, therefore, have an ethical responsibility to keep themselves informed about the best evidence‐based care and to implement critical reviewing of their practice as part of continuing professional development. The women’s perceptions of a normal birth allows for a wide range of interventions. Relevance for clinical practice. The result emphasises the importance of midwives’ knowledge of evidence‐based care and how to implement this into practice. Further research should include elucidation of the meaning of normal childbirth to childbearing women.     

Experiences and perceptions of birth companions supporting women in labour at a District Hospital in Limpopo,South Africa

BackgroundSouth Africa has included birth companions in its national guidelines for maternity care and the revised Maternity Case Record, in and effort to improve the quality and experience of care. However, reservations amongst healthcare providers remain about the acceptability of birth companions in the labour ward.ObjectivesTo document the experiences and perceptions of birth companions who supported women in labour in a rural hospital in Limpopo Province where a Respectful Maternity Care (RMC) project was piloted.MethodAn institution-based cross-sectional study design was employed. Purposive sampling was employed where all birth companions who supported a woman during labour and birth were included in the study. The experiences and perceptions of birth companions were captured using a birth companion feedback book during the period of 1st April to 30th August 2019. Thematic analysis was used to analyse the data.ResultsSeventy-one (71) of the 73 birth companions only had positive responses about the birthing experience and how both the birth companion and woman in labour were treated. Two birth companions were dissatisfied with the treatment provided by the midwife that supported the birth.ConclusionIt is important for healthcare providers to understand the far reaching emotional and psychological impact of their attitudes and behaviour on, not only women in labour but also on others who witness their (healthcare providers) behaviour. Mechanisms to obtain feedback from birth companions should be integrated into strategies to improve the quality and experience of care for women during childbirth.     

Prenatal care services in the public and private arena

PURPOSE: This exploratory study described the prenatal care experience in the public and private arena from the perceptions of childbearing women using interpretive interactionism. DATA SOURCES: A face-to-face interview comprised of eight open-ended questions was used to obtain pregnant women's perceptions of their prenatal care experience and prenatal care needs. The purposive sample consisted of six women who received private prenatal care and 14 women who received public prenatal care. CONCLUSIONS: Five essential elements of the prenatal care experience were identified. Prenatal care was viewed as a cooperative effort between informal self-care and formal care by health professionals. Issues related to individuality and normality were important considerations in the delivery of prenatal care. IMPLICATIONS FOR PRACTICE: Controversy exists over the effectiveness of prenatal care in preventing poor outcomes, as the definition of what constitutes adequate prenatal care remains unclear. Advanced practice nurses (APNs) continue to play a pivotal role in the provision of prenatal care services. The expanded knowledge and skills possessed by APNs place them in a pivotal position to develop and implement individualized, developmentally appropriate prenatal care that the women in this study so desperately wanted. In addition, they can assist women in continuing the health promoting behaviors initiated prenatally through out their lifespan.     

An evaluation of prostaglandin E2 vaginal gel usein practice

OBJECTIVE: The purpose of this study was to investigate the effectiveness of prostaglandin E2 vaginal gel as used in practice, rather than its efficacy as assessed in randomised, controlled, clinical trials. This product is used to ripen the cervix prior to induction of labour, sometimes making unnecessary the use of the standard treatment for induction, artificial rupture of the membranes (ARM) plus oxytocin. In this study, effectiveness of the gel was assessed in terms of changes in mode of delivery, and in particular the risk of Caesarean section. METHODS: An historical control was used and the risk of Caesarean section for women induced in the 1990/91 (before the introduction of the gel) was compared with that for women induced in 1992/93 (after the introduction of the gel). Maternal characteristics which may have been different in the two groups and factors which might influence the risk of Caesarean section were controlled for statistically using logistic regression, thus reducing any bias towards one group. RESULTS: After adjusting for the factors which had a significant effect on the process of labour from induction to birth, it was found that the risk of Caesarean section was not significantly lower in the 1992/93-time period, when the gel was in regular use, from that in the 2 years prior to its introduction (Odds ratio 1.09, CI95% 0.88, 1.36). CONCLUSION: Following the introduction of PGE2 gel, no difference in effectiveness, as measured in terms of mode of delivery, was detected in this study of practice, which included patients with more complex obstetric problems.     

The negative birth experience of prolonged labour: a case-referent study

Aims. This study aimed to analyse and describe women's different perceptions and experiences of childbirth following prolonged or normal labour. Background. In clinical practice prolonged labour, or dystocia, is a common delivery complication often causing a negative birth experience. Method. Women giving singleton live birth to their first child with spontaneous labour after more than 37 completed weeks’ pregnancy at three hospitals in northern Sweden were recruited to a case–referent study. Cases (n = 84) were women following a prolonged labour with assisted vaginal or abdominal delivery, and referents (n = 171) delivered following a normal labour. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships and childhood experiences. Results. Women with prolonged labour had a negative childbirth experience more often (34%) than did women who had a normal labour (4%) (P < 0.05). Cases agreed significantly more than the referents with the statement, ‘Pain relief during the delivery saved me’ (OR 4.5, 95% CI: 1.9–11.1) and ‘My difficulties during the delivery will mark me for life’ (OR 12.4, 95% CI: 4.4–35.9). There were no differences between the cases and referents regarding perceived experience of professional or social support. Relevance to clinical practice. To improve care, midwives and doctors can alleviate pain and relieve the negativity and difficulty associated with the experience of prolonged labour from the perspective of the woman giving birth.     

Pregnant women's experiences of models of care in some hospitals in Victoria.

During the data analysis of a much larger study on 13 women's experiences of their first pregnancy, their interactions with the health system emerged as significant. Two grounded theory procedures, the making of comparisons and the asking of questions were used to analyse their experiences. Elements of three models of care were identified, medical/technocratic model, midwifery model, and a feminist perspective model. In some instances, there was blurring and overlapping of models. Tape-recorded, individual interviews were held with 13 pregnant women (aged 34-42 years) in their homes at the end of each trimester and with 10 women again 10-14 days post birth. (Three women were unavailable.) All the women delivered their babies in hospital. Eleven women had an epidural anaesthetic and 11 women had an episiotomy. Information received at antenatal education classes had a marked effect on the women's expectations and the reality of their experiences. The future of implementing midwifery models of care into the hospital system will depend on effective change management and an acknowledgment of consumer needs by administrators.     

A Quality Improvement Project Focused on Women's Perceptions of Skin-to-Skin Contact After Cesarean Birth

A quality improvement (QI) project was designed to identify women's perceptions of the benefits of skin-to-skin contact with newborns immediately following cesarean birth. Women reported positive experiences associated with skin-to-skin contact with their newborns. A major theme that emerged was that women who had cesarean birth felt that this QI project resulted in a birthing experience comparable to that of mothers who had vaginal deliveries. Participants also experienced decreased anxiety regarding the health and welfare of their newborns, as compared to a previous cesarean birth experience in which they did not have skin-to-skin contact.