Fathers' Coping Style,Antenatal Preparation,and Experiences of Labor and the Postpartum

Background: In recent years the trend for fathers in Western postindustrial countries to attend childbirth has increased. This study examined the interaction between fathers' information‐seeking coping predispositions and their level of attendance at antenatal classes with respect to their experiences of attending childbirth. Associations between fathers' childbirth experiences, their relationship with their baby, and level of depressive symptomatology at 6 weeks postpartum were also examined. Methods: A quantitative methodology was employed in which 78 fathers completed several questionnaires, some within 6 days of childbirth and others at 6 weeks postpartum. Results: Fathers who were characterized as high blunters (avoiders) of threat information, from antenatal classes reported that experiencing childbirth was less fulfilling than fathers with similar coping styles who did not attend classes. Fathers' reports of fulfillment and delight while attending childbirth were negatively related to their level of depressive symptomatology at 6 weeks postpartum. Levels of distress were associated with subsequent depressive symptoms, but their effect was removed when preexisting depressive symptoms were partialled out. Fathers whose children were born by cesarean delivery used significantly more negative adjectives to describe their baby at 6 weeks postpartum compared with those born by vaginal delivery. More married fathers attended antenatal classes and reported lower levels of depressive symptomatology than unmarried fathers. Conclusions: Although fathers' attendance at antenatal classes may have positive consequences for them and their partner, for some fathers, attendance at classes may be associated with less positive reports of experiencing childbirth. The way in which men experience childbirth may have some influence on their subsequent emotional well‐being.     

“Vanished Twin”: An Exploration of Women's Experiences

ABSTRACT: Background: Evidence suggests that in identified twin pregnancies 30 percent become a “vanished twin,” that is, when two gestation sacs are identified at early ultrasound but subsequently only one fetus is seen. This study explored the thoughts, feelings, and hospital experiences of women who have a vanished twin. Method: The study was conducted in a large teaching hospital in northwest England from April to June 2001. The experiences of 9 women were explored through 4 focus groups and an individual interview. Nulliparous and multiparous groups were separated for homogeneity. The study's philosophical approach was based on constructivism, and the thematic analysis used a feminist interpretation to search for patterns of meanings from the women's words. Results: The women wanted to be cared for in a humanistic manner, and they felt that acknowledgement of the vanished twin by the professional was important. The findings highlighted the need for better information giving to improve communication between caregivers and women. Multiparas were more prepared than nulliparas to ask for the attention that they wanted. Conclusions: Despite the small number of study participants, results suggest that maternity caregivers should be sensitive to the feelings and individual nature of a woman who has experienced a vanished twin. Humanistic approaches to communication and improved methods of information based on the development of an information sheet are advised. (BIRTH 30:1 March 2003)     

Women's Experiences of Prenatal Serum Screening

Background: Maternal serum screening is used to detect pregnancies at risk for Down syndrome and neural tube defects, but most positive test results (6.6% of all) are false positives. This study examined the influence of positive test results on women's experiences of pregnancy. Methods: The study population was all 67 pregnant women who received a positive result on serum screening in two Finnish towns from September 1993 to March 1994. For each case woman a control woman, matched for age, parity, education, and previous miscarriages, was selected. Of those invited, 45 case women and 46 control women (79%) responded to semistructured interviews. Results: Of the 45 case women, 2 underwent termination of pregnancy after the diagnosis of an abnormality and 1 had a miscarriage. Of the remaining 42, 7 decided not to undergo further diagnostic tests, for 2 women the second serum test was normal, and 33 had amniocentesis or chorionic villus sampling. The positive screening result and wait for the final results negatively affected the emotional well-being of most of these 33 women, and 6 were still worried after receiving final reassuring results. Of the 46 control women, 17 felt some worry or fear regarding abnormality in their fetus. Conclusion: The significant negative psychosocial effects of serum screening should be taken into account by caregivers when deciding whether and how to institutionalize these tests as part of antenatal care.     

The Coping With Labor Algorithm: An Alternate Pain Assessment Tool for the Laboring Woman

The documentation of pain in the labor and delivery setting is one of the essential tasks of all health care providers who care for women in labor. The Joint Commission standards mandate regular pain assessments, but compliance with this mandate in the highly unique patient population of laboring woman is problematic when using the standard 0 to 10 Numeric Rating Scale. Labor pain is always unique given the various contributing physiologic, emotional, social, and cultural components. This article describes the work of a process improvement group to create an alternative pain assessment tool named the Coping With Labor Algorithm. The group, consisting of nurses and nurse‐midwives, used the FOCUS format and Deming's “Plan, Do, Check, and Act” cycle to create a formalized assessment tool for use with laboring women. The Coping With Labor Algorithm is currently in use in the labor unit of a large tertiary care facility, which successfully passed a Joint Commission inspection while using the coping algorithm. The value of the coping algorithm is two‐fold: it provides a mechanism for pain documentation, and it provides nursing care suggestions for the laboring woman. This article reports nurses' perceptions of the tool.     

Women's Perceptions of Nursing Support during Labor

Objective : To determine which nursing support behaviors new mothers rate as most helpful in assisting them to cope with labor.
Design : A retrospective study using quantitative and qualitative approaches, including a ranking of means and a content analysis.
Setting : The postpartum unit of a tertiary-care hospital in eastern Canada.
Participants : Eighty postpartum women, most Of whom were married, employed, and 20–33 years of age.
Interventions : Within 72 hours of their labor women rated 25 nursing support behaviors. Main outcome measures : The perceived degree of helpfulness of 25 nursing support behaviors.
Results : All 25 behaviors were perceived as helpful. The most helpful behaviors included making the woman feel cared about as an individual, giving praise, appearing calm and confident, assisting with breathing and relaxing, and treating the woman with respect. Behaviors in the emotional support category were the most helpful.
Conclusions : Nurses can assist women to cope with the stress of labor. They must use a high degree of interpersonal skills in the care of laboring women in addition to being technically competent.     

Women's Experiences of Giving Birth After 35

Background: This research forms part of a longitudinal study comparing experiences of pregnancy, birth, and the first year of motherhood among women aged 35 years and over with women aged 20 to 29 years, in the light of the current trend toward later childbearing. Methods: Data from 107 women were collected from medical records of labor and delivery, and women themselves evaluated control and pain management in labor, satisfaction with support from professionals, labor problems, and postnatal depression. Associations between maternal age and parity and 1) obstetric outcomes, 2) women's perceptions of labor and delivery, and 3) postnatal depression were calculated. Results: Professionals were more likely to place women over 35 years than those aged 20 to 29 years in a “high-risk” category, but medical records of labor and delivery revealed few maternal age effects. Older mothers were more likely than younger mothers to acknowledge that their baby's life might have been at risk during labor, and that they felt happy about the way staff managed labor problems. They were less likely than younger mothers to blame others for making labor pain worse. Conclusions: Older and younger women's experiences of labor differed in ways that were not mirrored by obstetric differences. Women over 35 years, even if healthy, may believe that their age makes their infants particularly vulnerable during labor. Their higher levels of concern do not necessarily have negative consequences for their experience of childbirth or for their postnatal emotional well-being.     

Coping Strategies of Infertile Women

This study was initiated to explore the coping patterns of infertile women. The researchers interviewed 30 women and evaluated data using content analysis. Six ways of coping with infertility were identified: (1) increasing the space or distancing oneself from reminders of infertility, (2) instituting measures for regaining control, (3) acting to increase self-esteem by being the best, (4) looking for hidden meaning in infertility, (5) giving in to feelings, and (6) sharing the burden with others.     

Hidden Behind the Gunfire: Young Women's Experiences of Gang-Related Violence

This article uses data from a 3-year multisite ethnographic research study of gangs within an English city, to explore the different ways that "gang culture" shapes the victimization experiences and everyday lives of (young) women. Victims of lethal gang violence in Research City are almost exclusively young men, rendering invisible the ways in which gangs have an impact on the lives of women living in neighborhoods with a gang presence. The article also discusses how the adoption of a transdisciplinary approach could be useful in developing a holistic picture of the impact of gang-related violence on the lives of women.     

Women's Recognition of the Spontaneous Onset of Labor

Abstract: Background: Despite extensive research on the onset of labor, almost no data are available on women's perception of labor onset. We undertook a study to assess how women experience spontaneous onset of term labor. Methods: A semistructured questionnaire was given to 235 women admitted in spontaneous labor at term. Women noted when labor had started, whether and when membranes had ruptured, and answered an open question about how labor had announced itself. Two investigators independently subdivided women's experiences on how labor had started into 369 sampling units corresponding to 8 predefined categories. Results: Nearly two‐thirds of the sampling units (63.4%) related to recurrent and nonrecurrent pain, and the ratio between the two types was higher for multiparas than for nulliparas. The number of women and sampling units were identical for each of the following categories: watery fluid (n = 47), blood‐stained loss (n = 33), gastrointestinal symptoms (n = 10) and altered sleep patterns (n = 11); 22 sampling units relating to emotional upheaval were mentioned by 16 women. Although 33.6 percent of women experienced rupture of membranes before admission, only 21.6 percent associated it with their onset of labor, either alone (11.5%) or in association with other categories (10.1%). Conclusions: Although women experience onset of labor in a variety of ways, for most it is a concrete event. Studies on duration of labor should take women's perception of onset of labor as a starting point rather than rely on surrogate measures. (BIRTH 30:4 December 2003)     

Women's Evaluations of Their Labor and Delivery Nurses

Objective: To document women's evaluations of their labor and delivery nurses.
Design: An exploratory, qualitative study using open-ended, intensive, tape-recorded interviews.
Setting: Postpartum unit of a 400-bed midwestern hospital, except for two interviews in the women's homes.
Participants: Sixty-one Lamaze-prepared, married, multigravidae, aged 21-37years.
Results: Ninety percent of the women evaluated their nurses favorably, 10% unfavorably. Nurses were evaluated favorably because of their positive participation (80%), acceptance (78%), information giving (75%), encouragement (65%), presence (53%), and competence (7%).
Conclusions: Although technical competence is important, manner, provision of supportive care, and acceptance of each woman as a unique human being may be a nurse's most important characteristics.     

Taiwanese Women's Experiences of Lactation Suppression After Stillbirth

ObjectiveTo explore the experiences of lactation suppression (LS) among Taiwanese women who experienced stillbirth after 20‐weeks gestation.DesignQualitative research combining practitioner ethnography and the observ‐view method (participant observation and unstructured interviews while caring for participants).SettingParticipants were recruited from a medical center in central Taiwan between June 2013 and November 2014.ParticipantsSeven Taiwanese women who had stillbirths.MethodsData were collected by the observ‐view method. Recorded interviews were analyzed by content analysis.ResultsParticipants described three core experiences: deciding to use LS without careful deliberation; psychological pain is substantially stronger than physical pain; and not regretting their choice regarding method of LS.ConclusionPhysical pain often remains unaddressed because of the greater psychological pain following fetal death. Therefore, LS should be an essential component of follow‐up care as part of the discharge plan. Follow‐up should be for at least 14 days. More research is needed on nonpharmacological LS to address cultural differences and personal beliefs about methods of LS.     

Labor Experiences of Childhood Sexual Abuse Survivors

ABSTRACT: This field study used the ethnographic method to describe and analyze the labor experiences of childhood sexual abuse survivors. The sample included seven sexual abuse survivors, five nurse-midwives, and three labor and delivery nurses. Data collection included in-depth interviews, participant observation in labor and delivery over a period of six years, and anecdotal material from the literature. Analysis followed Spradley's Developmental Research Sequence and included domain, taxonomic, componential and theme analysis. Women reported both forgetting and remembering abusive incidents, and described labor sensations reminiscent of sexual abuse. A heuristic for appraising labor styles suggestive of past sexual abuse includes fighting, taking control, surrendering, and retreating. These styles are considered extremes of women's reactions to labor and are directly linked to posttraumatic stress disorder. This study demonstrated that it is important for perinatal caregivers to understand the link between childhood sexual abuse and childbirth so that they can assist women to have a positive birth experience     

COMPANIONSHIP IN THE PERINATAL PERIOD: A Cross-Cultural Survey of Women's Experiences

Recent research indicates that the nature of the companionship available for women during their transition to parenthood is important for psychological adjustment. The specific nature of the best provider and form of support is not yet well defined. Cross-cultural differences in women's preferences for supportive companions in the perinatal period occur. The present study explores what companionship is currently offered and by whom, and women's reactions to this in three different cultural groups.     

Eating and Drinking in Labor: The Influence of Caregiver Advice on Women's Behavior

Background: Although there is much debate about eating and drinking during labor, little scientific data about its influence on the course of labor exist. In The Netherlands, most midwives and obstetricians allow women to eat and drink during normal labor. The objective of this study was to examine whether or not women were actively advised to eat and drink and if this advice affected eating and drinking behavior. Methods: A randomly selected group of midwives and obstetricians from across The Netherlands identified 211 consecutive nulliparous women to participate in the study. In a questionnaire with open‐ended questions, women were asked after their delivery whether or not they were advised about eating and drinking during labor, and if so, about the nature of this advice and what they had consumed. Data were analyzed at the Leyenburg Hospital in The Hague. Results: Sixty‐six percent of the women were not given advice about eating and drinking during labor. Women who were given advice usually followed it. In the total group, 37 percent of the women had intake other than water and of these, 75 percent ate solid food. After adjusting for other prognostic factors, the incidence of an instrumental delivery due to a nonprogressing second stage was lower in women with caloric intake (13% vs 24%, p = 0.04). Conclusion: The study design did not enable us to draw conclusions about the cause and effect between caloric intake and labor progress. Scientific data with respect to the giving of evidence‐based advice about eating and drinking during labor are lacking. Should such advice become available, women are likely to follow it.