Husbands' experiences of supporting their wives during childbirth in Nepal

Background

the husband’s presence at childbirth is universally accepted in industrialised nations, but the concept is still new within the cultural values and norms of Nepalese society. Understanding the cultural context surrounding the feelings and needs of Nepalese husbands will help to initiate realistic maternity education programmes.

Objective

to explore husbands’ experiences of supporting their wives during childbirth.

Method

semi-structured interviews were conducted, and the data were analysed using thematic analysis.

Setting

the Maternity and Neonatal Service Centre, a midwife-run birthing centre within a public maternity hospital in the capital of Nepal.

Participants

twelve first-time expectant Nepalese fathers who had supported their wives during childbirth were interviewed in July 2009, within seven days of the birth.

Findings

six themes were identified to explain the mixed experiences of the husbands in the labour or delivery room: (1) being positive towards attendance; (2) hesitation; (3) poor emotional reactions; (4) being able to support; (5) the need to be mentally prepared and (6) enlightenment. Husbands reflected on their experiences positively, despite profound hesitation and overwhelming emotions.

Conclusions

the husbands’ experiences revealed that Nepalese husbands tend to experience overwhelming emotional feelings in the labour or delivery room if they are allowed to attend the birth without prior preparation.

Implications for practice

counselling for couples and education from the start of the pregnancy may reduce negative emotional experiences and improve satisfaction with the childbirth experience for both husbands and wives.     

Not-patient and not-visitor: a metasynthesis fathers' encounters with pregnancy, birth and maternity care

Introduction

the active engagement of fathers in maternity care is associated with long-term health and social benefits for the mother, baby and family. The maternity care expectations and experiences of expectant and new fathers have received little attention to date.

Aim

to identify and synthesise good quality qualitative research that explores the views and experiences of fathers who have encountered maternity care in high resource settings.

Methods

based on a pre-determined search strategy, relevant databases were searched for papers published between January 1999 and January 2010. Backchaining of the reference lists in included papers was undertaken.

Inclusion criteria

good quality qualitative research studies exploring fathers' involvement in maternity care through pregnancy, birth, and up to 6 months postnatally, that were undertaken in high resource countries. No language restrictions were imposed.

Analytic strategy

the analysis was based on the metaethnographic techniques of Noblit and Hare (1988) as amended by Downe et al. (2007).

Findings

from 856 hits 23 papers were included. The emerging themes were as follows: risk and uncertainty, exclusion, fear and frustration, the ideal and the reality, issues of support and experiencing transition.

Synthesis

fathers feel themselves to be ‘partner and parent’ but their experience of maternity care services is as ‘not-patient and not-visitor’. This situates them in an interstitial and undefined space (both emotionally and physically) with the consequence that many feel excluded and fearful.

Conclusions

fathers cannot support their partner effectively in achieving the ideal of transition to a successful pregnancy, joyful birth and positive parenthood experience unless they are themselves supported, included, and prepared for the reality of risk and uncertainty in pregnancy, labour and parenthood and for their role in this context.     

Taiwanese women's experiences of hospital midwifery care: a phenomenological study

Objective

to explore women's experiences in interaction with their midwives during their antenatal checks and during labour.

Design

a qualitative study using a phenomenological approach. Data were collected via tape-recorded interviews. All interviews were transcribed verbatim. Data were analysed using Colaizzi's method for data analysis.

Setting

the homes of the study participants in the district of a Taipei (Taiwan) teaching hospital.

Participants

a purposive sample of 11 Taiwanese women, one primipara, and 10 multiparae, who were one to three months post-childbirth at the time of interview.

Findings

five major themes revealed the essence of women's experiences of their interaction with a midwife during pregnancy and childbirth: (1) being respected, (2) being accompanied, (3) trust, (4) being satisfied, and (5) professional competence.

Key conclusions

the women recognised the service model of the midwife; they treasured their mutual relationships and the benefits that women derived from midwifery care during childbirth. In Taiwan, the government is mandated to offer midwifery models of care in hospitals, and to allow women to choose different types of care provider.

Implications for practice

an awareness of women's experiences will help identify the caring behaviours as recognised by the women and may help health-care professionals provide better support and care for women during the pregnancy and childbirth periods. These findings can serve as references for future midwifery practice models and improvements in quality of care.     

Women with pre-existing diabetes and their experiences of maternity care services

Aims and objectives

the aims of the study were to explore the experience of maternity care services used by women whose pregnancy is complicated by pre-existing diabetes, to gain a deeper understanding of service use and to identify aspects of services that women with pre-existing diabetes would like improved.

Background

for women with pre-existing diabetes; pregnancy, birth and the transition to motherhood can be complex and even chaotic. The aim of specialist diabetes care given during pregnancy and delivered by a specialist team of health-care professionals is to optimise pregnancy outcome. However, how health-care professionals within maternity services provide care and support women with pre-existing diabetes during pregnancy and early motherhood has received limited attention.

Design

an exploratory study utilising a grounded theory approach was conducted. Data were collected via in-depth interviews with 20 respondents; one-to-one, dyad and group interviews were undertaken to fully explore issues. Analysis was undertaken by sub-groups of the research team with at least two members working on each of them.

Findings

three themes were identified from interviews: empathic care with care more focused on diabetes not pregnancy; feeling judged by health-care professionals (with nearly all respondents reporting negative encounters of consultation with the specialist team); and the notion of expertise (with respondents reporting feeling frustrated when it seemed health-care professionals did not value their expertise).

Conclusions

the study emphasised the importance of the health-care relationship for pregnant women with pre-existing diabetes. For outcomes to be optimised women need to be able to form open and trusting relationships with the health-care team.

Relevance to clinical practice

this study highlights the need for the health-care team not only to provide physical care to optimise outcome but also supportive care to assist women with pregnancies complicated by diabetes to achieve the best possible physical and emotional health and well-being.     

First-time fathers' expectations and experiences of childbirth in relation to age

Objective

to investigate first-time fathers' expectations and experiences of childbirth and satisfaction with care in relation to paternal age.

Design

data from a randomised controlled trial of antenatal education were used for secondary analysis. Data were collected by questionnaires in mid-pregnancy and at three months after the birth. Comparisons by χ²-tests and Student's t-tests were made between men in three age groups: young men aged ≤27 years (n=188), men of average age 28–33 years (n=389) and men of advanced age ≥34 years (n=200).

Setting

the expectant fathers were recruited from 15 antenatal clinics spread over Sweden.

Participants

777 first-time fathers.

Findings

antenatal expectations and postnatal memory of the childbirth experience varied by paternal age. In mid-pregnancy, mixed or negative feelings about the upcoming birth were more prevalent in men of advanced age (29%) compared with men of average (26%) and young (18%) age (p<0.01), and they feared the event more than the youngest (mean on the Wijma Delivery Expectancy Questionnaire: advanced age 43.3; average age 42.9; young 38.7; p<0.01). The older men also assessed their partner's labour and birth as more difficult (advanced age 43%; average age 41%; young 32%; p=0.05) and had a less positive overall birth experience (advanced age 30%; average age 36%; young 43%; p<0.05). However, older fathers were more satisfied with care given during the intrapartum period: 52% were overall satisfied compared with 46% of the men of average age and 39% of young age (p=0.03).

Key conclusions

men of advanced age had more fearful and negative expectations during their partner's pregnancies and postnatally assessed the births as less positive and more difficult than younger men did. Despite this, older men were more satisfied with intrapartum care.

Implications for practice

knowledge about age-related differences in the expectations and experiences of first-time fathers may help midwives and doctors give more individualised information and support, with special attention to older men's expectations and experiences of the birth as such, and to younger men's perception of care.     

Juggling type 1 diabetes and pregnancy in rural Australia

Objective

to explore the experiences of women with type 1 diabetes, living in rural Australia, while preparing for pregnancy and childbirth. Additionally, we aimed to describe the women's engagement with, and expectations of, health-care providers during this period, and subsequently highlight potential service and informational gaps.

Design

qualitative research using a collective case-study design; seven women with type 1 diabetes who had given birth within the previous 12 months participated in in-depth interviews about their experiences of pregnancy and birth. Data were analysed thematically.

Setting

The experience of type 1 diabetes, preconception preparation and pregnancy among rural Australian women was explored, including interactions with health professionals.

Participants

seven women aged between 26 and 35 years agreed to be interviewed. The woman had one or two children and had given birth within the past 12 months.

Findings

rigid narrow control of blood glucose levels before conception and during pregnancy created unfamiliar body responses for women, with hypoglycaemic symptoms disappearing or changing. For example, some women mentioned developing tunnel vision or numbness and tingling around their lips and tongue as different symptoms of hypoglycaemia. Women needed information and support to differentiate between what might be normal or abnormal bodily processes associated with pregnancy, diabetes, or both. The women's preparation for conception and pregnancy was reliant on the level of available expertise and advice. Participants’ experiences were coloured by their limited access and interactions with expert health professionals.

Conclusion

women with type 1 diabetes experienced significant hardship during their pregnancy, including a higher incidence of hypoglycaemic episodes, a loss of hypoglycaemic symptom recognition and weight gain. These difficulties were compounded by a scarcity of available information to support the management of their pregnancy and a lack of availability of experienced health professionals.

Implications for practice

national and international consensus guidelines emphasise the importance of preconception and pregnancy care for women with type 1 diabetes. Close clinical supervision and the development of closer co-operation and partnership between the women and health-care providers before conception and during pregnancy may improve outcomes for these women and their babies. Building confidence in professional care requires increased access to specialist services, increased levels of demonstrated knowledge and expertise and better general community access to information about preparation for pregnancy and birth among women who have type 1 diabetes.     

A study to promote breast feeding in the Helsinki Metropolitan area in Finland

Objective

the aim of this study was to assess the impact of providing intensified support for breast feeding during the perinatal period.

Design

a quasi-experimental design with non-equivalent control group.

Setting

three public maternity hospitals (two study, one control) in the Helsinki Metropolitan area in Finland.

Participants

a convenience sample of 705 mothers (431 in the intervention group, 274 in the control group).

Methods and intervention

in this study, families in the intervention group had access to intensified breast feeding support from midpregnancy, whereas those in the control group had access to normal care. Intensified support included lectures and workshops to health professionals, and families in the intervention group had access to more intensive support and counselling for breast feeding and a breast feeding outpatient clinic. Additionally, an internet-based intervention was only used in the intervention group, but not in the control group. Mothers in the control group received normal care from the midwifery and nursing professionals who were to continue their work normally. The data were analysed statistically.

Findings

altogether 705 women participated in the study. In the intervention group (n=431), 76% of the women breast fed exclusively throughout the hospital stay, compared to 66% of the mothers in the control group (n=274). In multivariate analysis, the likelihood of exclusive breast feeding at the time of responding (at hospital discharge or after that at home) was increased by the mother not being treated for an underlying illness or medical problem during pregnancy, being in the intervention group, having normal vaginal childbirth, high breast feeding confidence, positive attitude towards breast feeding, good coping with breast feeding, and 24-hour presence of the infant's father in the ward.

Key conclusions and implications for practice

the low exclusive breast feeding rates of newborns could be increased by using intensified breast feeding support. Mothers' health problems during pregnancy can decrease exclusive breast feeding.Mothers with health problems or other than normal childbirth should receive extra breast feeding support, and the presence of fathers in the ward should be encouraged.Intensified breast feeding counselling and support helps mothers to breast feed exclusively. This support should be available in a variety of forms, so that mothers can choose the type of support they need. As breast feeding counselling and support is intensified, more mothers succeed with exclusive breast feeding.     

A qualitative approach to social support and breast-feeding decisions

Objective

to explore pregnant women's perceptions and personal experiences of the influence of formal and informal social support on breast-feeding decision-making, in relation to breast-feeding initiation and duration.

Design

qualitative focus groups and interviews.

Setting

four primary-care centres in Valencia, Spain.

Participants

19 primiparous women in their first trimester of pregnancy participated in focus groups and 12 primiparous and multiparous women in their third trimester of pregnancy participated in interviews. Women had different socio-demographic backgrounds and socio-economic status.

Findings and conclusions

women's perceptions and personal experiences of formal and informal social support of breast feeding may be linked to age and socio-cultural status. Women from higher socio-cultural backgrounds took their partner's opinion and support more into account when choosing breast feeding. They also conceded great importance to formal health support, and employed mothers wished to have more institutional support. Among women from lower socio-cultural backgrounds, friends were the closest social network and had the greatest influence on feeding decisions. They perceived some contradictions in health-promotion messages on breast feeding, and most of them preferred to leave work after birth to exclusively care for their baby. Younger women, without previous experience of breast feeding or possibility of receiving tangible support from their mothers, wanted more practical health-care support (e.g. providing skills in breast-feeding technique).

Implications for practice

breast-feeding promotion strategies should take into account women's different characteristics. Health professionals should consider offering postnatal support as a follow-up to practical support (e.g. breast-feeding workshops).     

Childbirth fear in expectant fathers: Findings from a regional Swedish cohort study

Objective

to investigate the prevalence of childbirth related fear in Swedish fathers and associated factors.

Design

a regional cohort study. Data was collected by a questionnaire.

Setting

three hospitals in the middle-north part of Sweden

Participants

1047 expectant fathers recruited in mid-pregnancy during one year (2007) who completed the Fear of Birth Scale (FOBS).

Measurements

prevalence of childbirth fear and associated factors. Crude and adjusted odds ratios were calculated between men who scored 50 and above (childbirth fear) and those that did not (no fear). Logistic regression analysis was used to assess which factors contributed most to childbirth fear in fathers.

Findings

the prevalence of childbirth fear in men was 13.6%. Factors associated with childbirth related fear were as follows: Less positive feelings about the approaching birth (OR 3.4; 2.2–5.2), country of birth other than Sweden (OR 2.8; 1.3–6.1), a preference for a caesarean birth (OR 2.1; 1.7–4.1), childbirth thoughts in mid-pregnancy (OR 1.9; 1.1–2.0) and expecting the first baby (OR 1.8; 1.2–2.6).

Key conclusions

high levels of fear were associated with first time fathers and being a non-native to Sweden. Men with fear were more likely to experience pregnancy and the coming birth as a negative event. These men were also more likely to identify caesarean section as their preferred mode of birth.

Implications for practice

engaging expectant fathers in antenatal conversations about their experiences of pregnancy and feelings about birth provides health-care professionals with an opportunity to address childbirth fear, share relevant information and promote birth as a normal but significant life event.     

Childbirth fear in Swedish fathers is associated with parental stress as well as poor physical and mental health

Objective

to compare self-rated health and perceived difficulties during pregnancy as well as antenatal attendance, birth experience and parental stress in fathers with and without childbirth related fear.

Design

a longitudinal regional survey. Data were collected by three questionnaires.

Setting

three hospitals in the middle-north part of Sweden.

Participants

1047 expectant fathers recruited in mid-pregnancy and followed up at two months and one year after birth.

Measurements

childbirth fear was assessed using the Fear of Birth Scale (FOBS). Self-rated physical and mental health and perceived difficulties were assessed in mid pregnancy. Two months after birth antenatal attendance, mode of birth and the birth experience were investigated. Parental stress was measured using the Swedish Parental Stress Questionnaire (SPSQ). Crude and adjusted odds ratios were calculated between expectant fathers who scored 50 and above (childbirth fear) and those that did not (no fear).

Findings

expectant fathers with childbirth related fear (13.6%) reported poorer physical (OR 1.8; 95% CI 1.2–2.8) and mental (OR 3.0; 1.8–5.1) health than their non-fearful counterparts. The fearful fathers were more likely to perceive difficulties in pregnancy (OR 2.1; 1.4–3.0), and the forthcoming birth (OR 4.3; 2.9–6.3) compared to fathers without childbirth fear. First-time fathers with fear attended fewer antenatal classes. Fathers with high fear reported higher mean scores in four of the five subscales of the SPSQ. Childbirth related fear was not associated with mode of birth or fathers' birth experience.

Key conclusions

expectant fathers with childbirth related fear had poorer health, viewed the pregnancy, birth and the forthcoming parenthood with more difficulties. They were less often present during antenatal classes and had higher parental stress.

Implications for practice

this study provides insight into the health of expectant fathers during pregnancy and highlights the importance of understanding how childbirth fear may affect expectant fathers in both the short and longer term.     

What can qualitative studies tell us about the experiences of women who are pregnant that have an eating disorder?

Objective

pregnancy is a life-stage during which women undergo significant changes to their body and can feel acute responsibility for the development and well-being of the fetus. A synthesis of qualitative studies was conducted to increase our understanding of pregnancy experiences among women with an eating disorder.

Design

a systematic search of eight electronic databases was carried out to identify relevant investigations. Studies were appraised by two authors. Data were combined using framework analysis. From 459 references, seven papers were included in the review.

Findings

an overriding concept of inner turmoil transpired from the synthesis. This personal conflict related to the fear and guilt expressed by interviewees and stemmed from their association of self-worth with their body, concerns about their child's health and worries about others' response to their eating and weight control practices.

Key conclusions

participants reported vacillating between wanting to do the best for their child, being motivated by social pressures and feeling the need to control their body for self-preservation purposes. This created the inner turmoil they experienced while pregnant.

Implications for practice

midwives should be sensitive to the possibility of an eating disorder among pregnant women. In such cases, practitioners could act as a conduit for any assistance required, guiding these mothers towards appropriate nutritional and psychological support. To do this, professionals must have knowledge of such conditions and be aware of services available for women disclosing disordered eating behaviours.     

Fathers and breast feeding very-low-birthweight preterm babies

Objective

to explore fathers’ experiences of the breast feeding of their very-low-birthweight preterm babies from birth to 12 months of age.

Design

a qualitative study using interpretive phenomenology. Data were collected via longitudinal in-depth individual interviews.

Setting

publicly funded tertiary level hospital, Australia.

Participants

a purposive sample of 17 Australian parents took part in the broader study. This paper reports on data from the seven participant fathers.

Findings

this paper explores the discursive changes in fathers’ accounts of their perspectives on and support of the breast feeding of their preterm baby. The fathers’ accounts highlight their marked influence on breast feeding, their ambivalent experiences related to breast feeding and their struggle in negotiating a parenting role related to baby feeding.

Key conclusions

this study highlights the role and influence that fathers of preterm babies have on breast feeding, and explores the tensions and paradoxes inherent in promoting the ideology of breast feeding while valuing the practice of bottle feeding.

Implications for practice

this study highlights the need to encourage and involve fathers in breast-feeding education including the impact of bottle feeding on breast-feeding outcomes. The active and positive contribution that fathers make towards preterm breast feeding should be acknowledged and encouraged.     

'This is just what you do when you are pregnant': a qualitative study of prospective parents in Iceland who accept nuchal translucency screening

Background

nuchal translucency (NT) screening, mainly for Down's syndrome, in the first trimester of pregnancy is becoming an established practice in many countries. However, very little is known about parents’ knowledge and beliefs prior to undergoing screening. Such information is essential to form guidelines regarding informed decision-making.

Objectives

to explore the influences on prospective parents’ decision-making in relation to NT screening in early pregnancy, and to gain insight into how the views of prospective mothers and fathers towards the benefits and implications of screening may differ.

Design

a qualitative study using framework analysis based on a grounded theory approach.

Participants

10 couples, who had decided to have NT screening, were recruited from four community health centres in Iceland. All pregnancies were defined as ‘low risk’ for fetal anomaly.

Data collection

semi-structured interviews were conducted separately with each prospective mother and father at 7–11 weeks and again at 20–24 weeks of gestation. In total, 40 interviews were conducted.

Findings

the majority of prospective mothers in this study had already decided to accept NT screening before they entered the public antenatal care system. The decision to accept screening seemed to lie with the prospective mother and had hardly been discussed by the couple. Differences between prospective mothers and fathers were observed in relation to the expression of expectations towards the benefits of screening and the perception of disability, which is of interest in the context of information provided to prospective parents.

Conclusions and implications

the findings from this study are of interest to clinicians and policy makers forming future guidelines for antenatal care both in Iceland and further afield. It highlights the need for information for prospective parents to be in the public domain prior to their contact with maternity services. Additionally, findings add to knowledge of prospective fathers in early pregnancy regarding how their perceptions of disability may contribute to the couple's decision to accept screening.     

Fathers' functional status during pregnancy and the early postnatal period

Objective

to determine the functional status of fathers whose wives were pregnant or in the early postnatal period.

Sample and setting

the research population comprised 3750 fathers whose wives were pregnant or in the early postnatal period, and who were registered at a primary health clinic in the province centre. The research sample comprised 275 husbands of women who were registered at these clinics and who were in at least their 28th week of a normal (not at-risk) pregnancy with a single fetus, or who were in the early postnatal period (6–8 weeks postnatal) following birth of a single baby between the 38th and 42nd week without complications. Due to fathers declining to participate in the study or unable to participate because of busy work schedules, the research was completed with 155 fathers-to-be and 93 fathers; in total, 90% of the target sample was reached. A sociodemographic survey and the Inventory of Functional Status—Fathers were used for data collection and to describe the functional abilities of fathers-to-be and fathers.

Findings

no statistically significant differences were found in functional status between the husbands of pregnant women and the husbands of women in the early postnatal period. Number of pregnancies was not significantly related to any of the seven subscales of fathers’ functional status; age of husband, length of marriage and occupation of wife were significantly related to one subscale; occupation of husband and health insurance were significantly related to two subscales; income status of husband and educational level of wife were significantly related to three subscales; and educational level of husband was significantly related to four subscales.

Conclusion

although there was no significant difference in functional status for the husbands of pregnant women and the husbands of postnatal women, sociodemographic factors were found to have an effect.