Pregnant Women's Perceptions of Their Nurse's Role During Labor and Delivery

Background: Little has been studied about pregnant women's perceptions of their nurse's role during labor and delivery. The objective of this study was to determine nulliparous pregnant women's expectations of their nurse's role during labor and delivery as expressed during the last trimester of pregnancy. Method: Nulliparous women in childbirth classes were asked on a questionnaire, “What do you think your nurse's role will be during labor and delivery? You may list as many things as you wish.” Results: Fifty‐seven completed surveys were collected. The women listed a total of 174 items. Approximately 29 percent of the nursing tasks listed by the nulliparous women were related to providing them with physical comfort and emotional support, 24 percent related to providing informational support, almost 21 percent were related to providing technical nursing care, and 21 percent related to monitoring of the baby, mother, or labor progress; approximately 5 percent related to indirect care (outside the room). Conclusion: The expectations of women in our study were in contrast with findings from two previous work sampling studies, in which nurses provided much less time giving women physical comfort, emotional support, and informational support than would have been expected by women in our study. Fulfilling women's expectations about childbirth can increase women's satisfaction with their birth experiences. Further studies can help maternity caregivers learn more about women's expectations.     

Childbirth Experiences in Australia of Women Born in Turkey,Vietnam, and Australia

ABSTRACT: Background: Migrant women constitute a growing proportion of the childbearing population in many high‐income countries. The aim of this study was to investigate experiences of childbirth, including recollection of pain and use of pain relief, in women born in Vietnam, Turkey, and Australia who gave birth in Victoria, Australia. Methods: One hundred Vietnamese‐born and 100 Turkish‐born women were compared with 100 Australian‐born women who gave birth in the same metropolitan hospital during the same time period. Only women who had a normal vaginal birth and gave birth to a healthy baby were included. They were interviewed between 24 hours after the birth and hospital discharge. Results: Vietnamese women used less pain relief, reported more pain, and described childbirth overall more negatively than Australian women, while also reporting less anxiety, more confidence, and less panic during labor. Turkish women's responses were more similar to those of Australian women, but they were slightly more satisfied with childbirth overall despite recollecting more pain, and were also more likely to perceive time normally. Turkish women used a similar amount of pharmacological pain relief as Australian women, but used more relaxation and breathing techniques. Conclusions: This study showed that women's responses to childbirth are associated with cultural background. Midwives and other caregivers should be particularly sensitive in assessing Vietnamese women's pain during labor. (BIRTH 32:4 December 2005)     

Selected Coping Strategies in Labor: An Investigation of Women's Experiences

Abstract: Background: Antenatal education classes offer women information about labor and birth and ways of coping with pain and emotional distress. The purpose of this paper was to describe women's experiences of using, starting, and discontinuing three coping strategies in labor that were taught in antenatal education classes. Methods: An exploratory research design was used in which 121 women were interviewed within 72 hours of the birth of their first child. Information was obtained on why women initiated and discontinued their use of three coping strategies (breathing technique, postural changes, relaxation technique) and the reported effects of use. Results: The effects of the coping strategies investigated varied widely among participants. Common aspects of care, changes of environment, and use of pharmacological pain relief affected women's discontinuation of coping strategies. Conclusions: The implications of study findings for clinical practice include the need for caregivers to provide women with accurate information about the effects of coping strategies and to be alert to aspects of care that may disrupt women's use of strategies. (BIRTH 30:3 September 2003)     

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.     

Women's Memory of Childbirth at Two Months and One Year after the Birth

Abstract: Background: Studies of women's memory of labor and birth have generally concluded that women's recall is fairly accurate, but the findings are not unanimous. The aim of this study was to compare women's experiences of labor pain and overall experience of the birth at 2 months and 1 year after the delivery. Methods: A longitudinal cohort study of 2,428 women recruited in early pregnancy from all antenatal clinics in Sweden during 3 weeks evenly spread during 1999–2000 was conducted. In addition to a questionnaire in early pregnancy including background data, the women completed a questionnaire at 2 months and 1 year after the birth including the same 7‐point rating scale of pain intensity and the same question about overall experience of labor and birth. Results: Forty‐seven percent of the women made the same assessment of pain intensity, and 60 percent of childbirth overall, at 1 year as they did at 2 months after the birth. One year after the birth, 35 percent recalled pain as less severe, and 18 percent as more severe, and 24 percent said labor and birth overall was more negative, whereas 16 percent said it was more positive. Conclusion: This study showed great variation in women's memories of labor and birth, and conclusions by some other studies, often based on analyses of group data rather than on the responses of the individual participants were, to some extent, challenged. (BIRTH 30:4 December 2003)     

A Negative Birth Experience: Prevalence and Risk Factors in a National Sample

Abstract: Background : 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. Methods : 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. Results : 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. Conclusions : 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. (BIRTH 31:1 March 2004)     

Women's Evaluations of Their Experience in a Multicenter Randomized Controlled Trial of Intrapartum Fetal Pulse Oximetry (The FOREMOST Trial)

Abstract: Background: Fetal pulse oximetry improves the assessment of fetal well‐being during labor. The objective of this study was to evaluate women's satisfaction with their experience with this additional technology. Methods: We surveyed women participating in the FOREMOST trial, a randomized controlled trial comparing the addition of fetal pulse oximetry (FPO) to conventional cardiotocograph (CTG) monitoring (intervention group), versus CTG‐only (control group), in the presence of nonreassuring fetal status during labor. Our survey evaluated 3 aspects of women's experience: labor, fetal monitoring, and participation in the research. The survey was administered within a few days of giving birth and repeated 3 months later. Results: No differences were found between the intervention and control groups for women's evaluations of their labor, fetal monitoring, research, or overall experiences when surveyed on both occasions. Within each study group, a small but statistically significant decline occurred in women's scores for their experience of labor and overall experience from the initial survey close to the time of giving birth, to 3 months later. The magnitude of differences in responses over time was similar for the both groups. Women were more satisfied after a spontaneous or assisted vaginal birth than after cesarean section. Length of time the research midwife was present had a significant positive effect on women's ratings of their experience several days after giving birth (p = 0.006), but no effect at 3 months. Conclusions: The addition of fetal pulse oximetry for the assessment of fetal well‐being during labor did not affect childbearing women's perceptions of fetal monitoring or their labor. Women evaluated their experience in the research process positively overall. Small changes occurred in women's perception of their satisfaction over time. (BIRTH 33:2 June 2006)     

Decision Making in Analyses of Women's Birth Stories

Background: Complex interactions occur among women and caregivers throughout labor. Analyzing women's birth stories provides a rich data source on these interactions. The purpose of this qualitative study was to clarify how decisions were made in labor by analyzing women's birth stories. Methods: A convenience sample of 15 primiparous and multiparous Midwestern women contributed a total of 33 birth stories. Qualitative methods were used, including analyses of the content and themes of stories. Results: The primary types of decision making that were identified ranged on a continuum from unilateral to joint (shared), and were associated with various emotions expressed by the women. Conclusions: A model of decision making was derived from the data that may help caregivers change practices in ways that will benefit women. Caregivers can also benefit by understanding women's critiques of the birth care they received, and can use this knowledge to improve women's experiences of birth and therefore their satisfaction with the process.     

Exploring the associations between intimate partner violence victimization during pregnancy and delayed entry into prenatal care: Evidence from a population-based study in Bangladesh

ObjectiveIntimate partner violence (IPV) during pregnancy can have serious health consequences for mothers and newborns. The aim of the study is to explore: 1) the influence of experiencing IPV during pregnancy on delayed entry into prenatal care; and 2) whether women's decision-making autonomy and the support for traditional gender roles act to mediate or moderate the relationship between IPV and delayed entry into prenatal care.Designcross-sectional survey. Multivariate logistic regression models were estimated that control for various socio-demographic and pregnancy related factors to assess whether women who experienced IPV during pregnancy were more likely to delay entry into prenatal care compared with women who had not experienced IPV. The influence of traditional gender roles acceptance and decision-making autonomy were examined both as independent variables and in interaction with IPV, to assess their role as potential mediators or moderators.SettingChandpur district, Bangladesh.Participantsthe sample comprised of 426 Bangladeshi women, aged 15–49 years. Postpartum mothers who visited vaccinations centres to receive their children's vaccinations constitute the sampling frame.Resultsalmost 70% of the women surveyed reported patterns consistent with delayed entry into prenatal care. Accounting for the influence of other covariates, women who experienced physical IPV during pregnancy were 2.61 times more likely (95% CI [1.33, 5.09]) to have delayed entry into prenatal care than their counterparts who did not report physical IPV. Neither sexual nor psychological IPV victimization during pregnancy was linked with late entry into prenatal care. Both gender role attitudes and levels of autonomy mediate the effect of IPV on prenatal care.Key conclusionsthe results suggest that the high rates of IPV in Bangladesh have effects that can compromise women's health seeking behaviour during pregnancy, putting them and their developing fetus at risk. Specifically, Bangladeshi women who experience physical IPV during pregnancy are more likely to delay or forgo prenatal care, an effect that is further magnified by cultural ideals that emphasize women's traditional roles and limit their autonomy.Implications for practicethis study reinforces the need to detect and assist women suffering IPV, not only to offer them help and support but also to increase entry into prenatal care. Healthcare professionals involved in obstetrics and midwifery need to be aware of the risk factors of IPV during pregnancy and be able to identify women who are at risk for delayed entry into prenatal care.     

Comportamiento materno durante el parto según parámetros clínicos y sociológicos de la gestación

ObjectiveTo analyze several factors that could be related to women's behavior in labourPatients And MethodsOne-hundred pregnant women were selected at random. The variables analyzed were education, dysmenorrhea, unfavorable obstetric antecedents, maternal preparation program, whether the pregnancy was wanted, fear of delivery, pharmacological treatment in delivery, type of delivery, type of cardiotocographic monitoring and fetal weight. Women's behavior during labor was classified as cooperative or uncooperative. The relationship between women's behavior and the 10 variables was analyzed in the first and second stages of labourResultsFear of delivery was the only variable statistically associated with women's behavior in the first and second stages of labor (p = 0.011 and p = 0.002, respectively)ConclusionsWomen who report a fear of delivery can have a negative attitude that may prevent them from correctly performing instructions     

Women's perceptions and experiences of fetal macrosomia

Objective

to explore women's perceptions and experiences of pregnancy and childbirth following birth of a macrosomic infant (birth weight ≥4000 g).

Methods

a qualitative design utilising interviews conducted 13–19 weeks post partum in women's homes. The study was conducted in one Health and Social Care Trust in Northern Ireland between January and September 2010. Participants were identified from a larger cohort of women recruited to a prospective study exploring the impact of physical activity and nutrition on macrosomia. Eleven women who delivered macrosomic infants participated in this phase of the study.

Findings

four overarching themes emerged: preparation for delivery; physical and emotional impact of macrosomia; professional relations and perceptions of macrosomia. Findings highlighted the importance of communication with health professionals in relation to both prediction of macrosomia and decision making about childbirth, and offers further understanding into the physical and emotional impact of having a macrosomic infant on women. Furthermore, there was evidence that beliefs and perceptions relating to macrosomia may influence birth experiences and uptake of health promotion messages.

Key conclusions and implications for practice

this study provides important insight into women's experiences of macrosomia throughout the perinatal period and how they were influenced by previous birth experiences, professional relations and personal perceptions and beliefs about macrosomia. Pregnant women at risk of having a macrosomic infant may require extra support throughout the antenatal period continuing into the postnatal period. Support needs to be tailored to the woman's information needs, with time allocated to explore previous birth experiences, beliefs about macrosomia and options for childbirth.     

Managing Labor Using Partograms with Different Action Lines: A Prospective Study of Women's Views

Background: The precise timing of medical intervention for women in prolonged labor is the subject of considerable debate. The partogram action line is a tool to assist practitioners in the correct diagnosis of prolonged labor. Despite its widespread use, the precise timing of the action line has not been rigorously studied, and women's views have rarely been sought. The aim of this study was to assess the effect on maternal satisfaction of managing labor using partograms with action lines drawn at 2, 3, or 4 hours to the right of the alert line. Methods: As part of a large pilot randomized controlled trial, women's views were explored using a specifically designed questionnaire that was completed by 615 primiparas 2 days after giving birth. The quantifiable data were analyzed by comparing means using ANOVA followed by the Scheffe test. Results: Women in the 2-hour arm were significantly more satisfied than those in the other two arms ( p < 0.001), despite having the most obstetric intervention. Conclusions: For women in prolonged labor, obstetric intervention can be an acceptable or even favorable option. Midwives and obstetricians need to provide labor management that takes into account the preferences of the women to whom they give care.     

Childbirth and the Development of Acute Trauma Symptoms: Incidence and Contributing Factors

Background: Little is known about the relationship between women's birthing experiences and the development of trauma symptoms. This study aimed to determine the incidence of acute trauma symptoms and posttraumatic stress disorder in women as a result of their labor and birth experiences, and to identify factors that contributed to the women's psychological distress. Method: Using a prospective, longitudinal design, women in their last trimester of pregnancy were recruited from four public hospital antenatal clinics. Telephone interviews with 499 participants were conducted at 4 to 6 weeks postpartum to explore the medical and midwifery management of the birth, perceptions of intrapartum care, and the presence of trauma symptoms. Results: One in three women (33%) identified a traumatic birthing event and reported the presence of at least three trauma symptoms. Twenty‐eight women (5.6%) met DSM‐IV criteria for acute posttraumatic stress disorder. Antenatal variables did not contribute to the development of acute or chronic trauma symptoms. The level of obstetric intervention experienced during childbirth (β= 0.351, p < 0.0001)and the perception of inadequate intrapartum care (β= 0.319, p < 0.0001) during labor were consistently associated with the development of acute trauma symptoms. Conclusions: Posttraumatic stress disorder after childbirth is a poorly recognized phenomenon. Women who experienced both a high level of obstetric intervention and dissatisfaction with their intrapartum care were more likely to develop trauma symptoms than women who received a high level of obstetric intervention or women who perceived their care to be inadequate. These findings should prompt a serious review of intrusive obstetric intervention during labor and delivery, and the care provided to birthing women.     

Women's decision-making autonomy in Dutch maternity care

Background

A positive childbirth experience is an important outcome of maternity care. A significant component of a positive birth experience is the ability to exercise autonomy in decision-making. In this study, we explore women's reports of their autonomy during conversations about their care with maternity care practitioners during pregnancy and childbirth.

Method

Data were obtained from a cross-sectional survey of women living in The Netherlands that asked about their experiences during pregnancy and childbirth, including their role in conversations concerning decisions about their care.

Results

A total of 3494 women were included in this study. Most women scored high on autonomy in decision-making conversations. During the latter stage of pregnancy (32+ weeks) and in childbirth, women reported significantly lower levels of autonomy in their care conversations with obstetricians as compared with midwives. Linear regression analyses showed that women's perception of personal treatment increased women's reported autonomy in their conversations with both midwives and obstetricians. Almost half (49.1%) of the women who had at least one intervention during birth reported pressure to accept or submit to that intervention. This was indicated by 48.3% of women with induced labor, 47.3% who had an instrumental vaginal birth, 45.2% whose labor was augmented, and 41.9% of women who had a cesarean birth.

Conclusions

In general, women's sense of autonomy in decision-making conversations during prenatal care and birth is high, but there is room for improvement, and this appeared most notably in conversations with obstetricians. Women's sense of autonomy can be enhanced with personal treatment, including shared decision-making and the avoidance of pressuring women to accept interventions.     

Satisfaction with Childbirth: Theories and Methods of Measurement

Two studies of women's birth experience emphasized the difficulty in evaluating satisfaction with the event. The first study used a quantitative, direct measure of satisfaction in which 91 postpartum women rated their satisfaction with labor and delivery overall and with different aspects of the experience. The second was a qualitative study that examined conceptual issues of women's satisfaction with childbirth using semistructured interviews with nine postpartum women. Content analysis was used to identify themes and categories that contributed to understanding why some women are satisfied and others dissatisfied with the birth experience. Both studies found support for a discrepancy theory of satisfaction. This paper discusses methodologic issues involved in measuring satisfaction with childbirth.     

An Evaluation of Pain and “Fitness” During Labor and Its Acceptability to Women

Abstract: Background : Labor experiences involve many dimensions that change during labor but are rarely measured contemporaneously and longitudinally. We examined pain and “fitness” aspects of women's labor experience and assessed the acceptability to participants. Methods : Thirty nulliparas and 20 multiparas in term labor indicated pain and fitness every 45 minutes in contraction‐free intervals on visual analog scales from 0 to 10. Fitness implied both physical and psychological strength. Data were analyzed cross‐sectionally and longitudinally, with adjustment for analgesia and time dependency. Women received feedback and evaluated their participation on the first day postpartum. Results : Measurements of pain and fitness ranged from 2 to 22 per woman (mean ± SD: 7.4 ± 4.4). Pain scores showed various patterns, mostly increasing from 1.4 (± 1.9) at the first to 6.6 (± 3.8) at the last measurement in nulliparas and from 1.3 (± 2.1) to 6.2 (± 4.0) in multiparas. One half of the women declined steadily in fitness throughout labor, occasionally after a slight increase early on. Multiparas entered labor more fit (5.9 ± 3.0) than nulliparas (3.9 ± 2.7), but showed a sharper decline so that the difference leveled out just before birth. Although fitness at any one time did not reflect pain levels, fitness and pain were inversely related, especially in nulliparas (p = 0.003). Analgesia affected pain scores but affected fitness only a little. Women's responses were mainly positive, especially in appreciating the feedback. Nevertheless, 32 percent of women skipped one or more measurements, often toward the end or when too close to a contraction. Conclusions : Pain and “fitness” are two distinctly different dimensions of labor experience. Repeated longitudinal measurements of elements of well‐being are clearly feasible and acceptable to laboring women. They may be useful to assess how labor events and interventions affect women's well‐being.