Women’s experiences of routine care during labour and childbirth and the influence of medicalisation: A qualitative study from Iran

Objectiveto understand women’s experiences of routine care during labor and childbirth in a medicalised context.Designtwenty-six in-depth interviews were conducted during the late postpartum period and thematic analysis was applied.Settingfour public hospitals in Tehran with a high rate of births, providing services to low and middle income families.Participantswomen who had a low risk pregnancies and gave a birth to a healthy infant by normal vaginal delivery.Findingstwo main themes emerged: ‘An ethos of medicalisation’ which indicates that women’s perception of childbirth was influenced by the medicalised context of childbirth. And ‘The reality of fostered medicalisation’ which illustrates the process by which interventions during labor affected women’s pathway through childbirth, and how the medicalisation resulted in a birth experience which often included a preference for Caesarean Section rather than vaginal birth with multiple interventions.Implications for practicecontextual factors such as legal issues, state’s regulations and the organisational framework of maternity services foster medicalised childbirth in Tehran public hospitals. These factors influence the quality of care and should be considered in any intervention for change. The aim should be a high quality birth experience with minimal interventions during normal vaginal delivery. A midwifery model of care combining scientific evidence with empathy may address this need for change.     

Is a midwife's continuous presence during childbirth a matter of course? Midwives' experiences and thoughts about factors that may influence their continuous support of women during labour

Objective

to gain an understanding about midwives' experiences of providing a continuous supportive presence in the delivery room during childbirth, and to learn about factors that may affect this continuous support.

Design/setting

qualitative study at a maternity unit in Norway, where about 4000 births take place each year. In-depth interviews were conducted with ten midwives working in two different maternity wards. The qualitative data were analysed using systematic text condensation.

Findings

the analysis generated three main themes: relational competence, the midwife's ideology, the culture and philosophy of the maternity unit. The midwives identified being mentally present and actively developing mutual trust with the woman in labour as two very important factors for building a relationship with her. They suggested that the midwife's first encounter with the woman is a key opportunity for establishing rapport during labour. Successfully providing a continuous presence during labour fostered the midwives' perception of themselves as a ‘good midwife’; this was considered a feature of holistic care and health promotion. The workload in the unit sometimes made it difficult for them to provide a continuous presence in the delivery room. The midwives experienced feelings of inadequacy when they felt that they had too little time available for the woman in labour.

Key conclusions

midwives' skill in building a relationship with the woman in labour combined with their values and understanding of the midwifery profession are important factors influencing their decision to provide a continuous presence during childbirth. If it is policy that maternity units should provide continuous support to women in labour, managers should ensure that it is actually provided.     

Emotions in labour: Italian obstetricians’ experiences of presence during childbirth

Objective: The present study represents a qualitative research aimed to explore the obstetricians’ psychological experiences of birth.

Background: During labour the role of obstetricians assumes a fundamental importance in hospitalised childbirth. However, literature analysis has shown that the psychological side of birth has been investigated only considering the woman’s and midwife’s points of view. The obstetricians’ psychological experiences have not been considered enough and only a few studies at a quantitative level have been performed.

Methods: Seven focus groups for a total of 72 obstetricians were conducted in hospital contexts in Italy. The qualitative methodology of grounded theory was adopted.

Findings: The results were divided into three different core themes: obstetricians’ approaches to delivery, critical aspects about relationships in the delivery room, and obstetricians’ feelings and emotions in the delivery room. Each theme was subdivided into different subthemes.

Conclusion: The results highlight different ways obstetricians approach their profession, the complex and multifaceted relationship with the woman and the extraordinary variety of feelings and emotions, which enrich, but also may complicate, life in the delivery room. Further studies could provide more details to help researchers to develop new and more effective strategies to support obstetricians’ training and work.     

Mothers’ experiences of the NICU and a NICU support group programme

Objective: to understand both the maternal experience of the NICU and mothers’ views of a NICU Parent Support Group. Background: mothers of babies who are born prematurely have their first experiences of parenting while their infant is in the neonatal intensive care unit (NICU). This presents multiple challenges and a range of stresses related to their role as a mother and concerns about their baby’s survival and growth. Thus, various supportive interventions have been trialled with this NICU parent population. However, the focus of this support and how it should be delivered lacks research as an evidence base for practice. Mothers’ experiences of the NICU and a professionally facilitated NICU support group at a city hospital were explored in this qualitative research study. Method: nine mothers were interviewed in 2010 while their babies were NICU inpatients. Interviews were recorded, transcribed and analysed thematically. Results: the NICU admission resulted in participant mothers facing challenges in getting to know their baby, forming their parenting role while in the NICU, and a reliance upon, but resentment toward, nursing staff. Positive feelings about their baby’s strengths were also apparent. The parent support group was an important part of managing the experience of the NICU and was reported to meet the emotional support needs of these NICU parents. Conclusion: the implications and recommendations for NICU-based emotional support are discussed. In particular, modifications to support group structures to ensure professional staff involvement and a balance between education and emotional care are reviewed.     

First-time mothers’ experiences of preparing for childbirth at advanced maternal age

ObjectiveTo explore the lived experiences of preparing for childbirth for nulliparous women aged 35–44 and determine how mature first-time mothers’ can be better supported regarding childbirth preparation.DesignThe research study comprised a cross-sectional qualitative design utilising Interpretative Phenomenological Analysis to provide a deep exploration into the experience of mature age women.SettingParticipants resided in South Australia and Victoria, Australia, in regional, suburban and inner-city locations.ParticipantsFourteen nulliparous women aged 35–44 were recruited in their third trimester of pregnancy using purposeful sampling.MethodData were collected by conducting in-depth semi-structured interviews during 28–36 weeks of pregnancy. Data were transcribed and analysed using Interpretative Phenomenological Analysis to identify themes of mature first-time mothers’ preparations for childbirth.FindingsThe super ordinate theme “Building confidence for childbirth” describes mature first-time mothers’ experience of preparing for childbirth. This process appears to influence women's information seeking behaviour, expectations of healthcare providers, and reflections on birth planning.ConclusionsParticipants sought various support and interactions with healthcare providers, both helpful and unhelpful, with nulliparous women of advanced maternal age undertaking various preparations with the intention of a positive childbirth experience. Participants were seeking support from friends, along with conducting their own independent research and activities.Implications for practiceIt is evident that more and more women in developed countries are delaying having children into their late thirties and over, and these women report various levels of support from health practitioners. Healthcare professionals have the potential to foster more trustful relationships and empowering interactions with women, provide various resources regarding childbirth preparation, and sensitive birth planning assistance that supports women's agency along with managing risk. Guidelines based on this and other research in managing the antenatal care of women of advanced maternal age would ensure consistency, particularly in terms of risk management and childbirth.     

How do women feel about being weighed during pregnancy? A qualitative exploration of the opinions and experiences of postnatal women

Objectiveto explore routine weighing in antenatal care and weight management in pregnancy with women who have been weighed during pregnancy.Designa qualitative study utilising semi-structured telephone interviews, and thematic analysis.Settingparticipants resided in Dublin, Ireland and had been weighed during pregnancy.Participantsindividual telephone interviews conducted with ten postpartum women (nine months postpartum).Findingsexperiences of routine weighing were positive, and participants believed it should be part of standard antenatal care. Several benefits to routine weighing were cited, including providing reassurance and minimising postpartum weight retention. It was felt that there was a lack of information provided on gestational weight gain and healthy lifestyle in pregnancy, and that healthcare professionals are ideally placed to provide this advice. Increased information provision was seen as a method to improve healthy lifestyle behaviours in pregnancy.Key conclusions and implications for practicethese findings contribute to the current debate about the re-introduction of routine weighing throughout pregnancy (Allen-Walker et al., 2016). Women stated that they expected to be weighed during pregnancy and, contrary to previous claims, there was no evidence that routine weighing during antenatal care caused anxiety. From discussions it was clear that women desired more information on gestational weight gain and a healthy lifestyle, and felt that health professionals should provide this.     

Does fear of childbirth during pregnancy predict emergency caesarean section?

Objective Caesarean section rates are rising dramatically in the UK. It has been estimated that they have increased from 10% to 22% of all births over 15 years. A Swedish study has suggested that fear of childbirth during pregnancy may increase the risk of emergency caesarean section. The aim of this study is to identify whether fear of childbirth can predict the occurrence of emergency caesarean section in a UK sample.
Design A prospective design using between-group comparisons.
Setting Sheffield, S. Yorkshire, UK.
Sample Four hundred and forty-three pregnant women, recruited at 32 weeks of gestation, over 16 years of age.
Methods Participants completed self-assessment, postal questionnaires assessing fear of labour and anxiety using the Wijma Delivery Expectancy Scale (W-DEQ) and the Speilberger State Trait Anxiety Scale (STAI), together with their expectations about their mode of delivery. Delivery information was gathered via birth summary sheets.
Main outcome measure Mode of delivery.
Results Emergency caesarean section was associated with previous caesarean section, parity, age and a score reflecting medical risk, but not fear of childbirth or anxiety measures. There were no differences in fear between women experiencing spontaneous-vertex, forceps/ventouse, emergency or elective caesarean deliveries. The W-DEQ was factor analysed and was found to measure four distinct domains: fear, lack of positive anticipation and the degree to which women anticipate isolation and riskiness in childbirth. However, these individual factors also failed to contribute to the prediction of mode of delivery. Primiparous women in the UK sample showed highly elevated fear scores when compared with a Swedish sample. Such discrepancies were not found for the multiparous sample.
Conclusions Fear of childbirth during the third trimester is not associated with mode of delivery in a UK sample. Possible cross-cultural differences are discussed.     

Midwives’ personal experiences of pregnancy and childbirth: Exploring issues of autonomy and agency in relation to the use of professional knowledge

Abstract

This paper seeks to explore midwives’ experiences of pregnancy and childbirth. It draws on interviews with nine midwives who completed their midwifery training prior to becoming mothers, to discuss how midwives use their professional knowledge to exercise agency (the choices made about their own care), and assume autonomy (the control and responsibility in relation to their own care), in pregnancy and childbirth. It illustrates that a reliance on professional knowledge may create opportunities for choice and increased autonomy in some situations, although the need for intervention during childbirth, for example, may challenge the degree of autonomy exercised by midwives and the choices available to them. As knowledgeable experts, midwives demonstrate a very different understanding of risk and safety in relation to their own experiences of childbirth. Professional knowledge may increase their anxieties which may not be addressed appropriately by caregivers due to their professional status. The use of knowledge in this way highlights potential conflict between their position as midwives and their experience as mothers, illustrating that midwives’ ability to exercise agency and autonomy in relation to their pregnancy and childbirth experiences is potentially problematic.     

How much does the levator hiatus have to stretch during childbirth?

Objective  This study was designed to define the degree of stretch/strain required of the levator hiatus in childbirth. There have been attempts at defining the distension required for vaginal childbirth with the help of individual data sets, but from previous work it is clear that hiatal dimensions and distensibility are likely to vary greatly between individuals.
Design  Retrospective observational study.
Setting  Nepean Hospital, University of Sydney.
Population  Nulliparous women at 36–38 week's gestation.
Methods  The ultrasound data sets of 227 nulliparous women examined at 36–38 week's gestation were investigated using post-processing software. Minimal hiatal diameters, subpubic arch, circumference and area were measured at rest, on Valsalva and pelvic floor muscle contraction. To estimate required hiatal distension at vaginal birth we used neonatal biometric data obtained in a Caucasian population. The muscle 'strain' or 'stretch ratio' required to allow delivery of a Caucasian baby of average size was calculated from dimensions at rest and on maximal Valsalva.
Main outcome measures  Degree of stretch/strain required of the levator hiatus in childbirth.
Results  The mean strain (stretch ratio) required for vaginal delivery was calculated as 1.47 (range 0.62–2.76; SD 0.39) from resting length, and 1.07 (range 0.25–2.45; SD 0.44) when calculated from dimensions at maximal Valsalva. This implies that, from dimensions at maximal Valsalva, some women will have to distend only 25%, others by 245%
Conclusions  We have obtained normative data for the required distension of the levator hiatus in a largely Caucasian population.     

First-time fathers’ experiences of parenting during the first year

Objective: The objective of this study was to explore the experiences of fathers during their first year as parents to fully capture their experiences and transition to parenthood. Background: Becoming a parent for the first time has a life-changing impact for both the mother and the father, yet the factors implicated in the transition to fatherhood have been under-researched. Methods: In this qualitative study using an interpretative phenomenological approach (IPA), 10 first-time fathers were interviewed 7–12 months after the birth of their baby. Results: Two super-ordinate themes were uncovered: experiences during pregnancy and fatherhood – the early days, which are supported by six sub-ordinate themes. Fathers’ narratives can be understood within the theoretical framework of Draper’s Transition Theory; early fatherhood represents the continuation of a man’s transitory journey, which starts during pregnancy. Conclusion: Despite increasing public awareness and socio-political changes affecting paternal parenting culture, fathers still seem to feel undervalued and unsupported when it comes to antenatal support. The antenatal period is a critical time in which to engage with and support motivated expectant fathers; antenatal psycho-education classes can be adapted to accommodate the needs of men. The mental health of the man has an impact on the woman in the antenatal and post-natal periods; addressing the needs of men during pregnancy can function as an early intervention for his family system and could reduce the financial cost to health services in the long term.     

How helpful is the presence of the husband at childbirth?

Abstract

It is now common for husbands to be present at the birth of their children. There is a general impression that this presence is of help to the woman giving birth. However, the results of research into the relationship between his presence and the parturant's experience of labour pain have been inconclusive. The results of this study carried out on 98 British subjects giving birth in hospital, show that the presence of the husband, or chosen birth companion, was not significantly associated with any difference in the perceived intensity of the subjects' labour pain. 78 subjects were accompanied in labour, 60 of whom reported that they found their husband's presence at the birth helpful. These subjects had significantly lower levels of pain when compared with all other subjects, ie subjects whose husbands were present at the birth, but who were not reported as being of help, and subjects whose husbands were absent.     

Is there a place for auricular therapy in the realm of nursing?

Several theories, such as the 'homuncular reflex theory' 'delta reflex theory', and 'meridian theory' point to the fact that the ear is related to all parts of the human body and internal organs. Being one of the approaches in traditional Chinese medicine, auricular therapy is a therapeutic method by which specific points on the auricle are punctured or pressed. Auricular therapy can activate meridians and collaterals, regulate the Qi and blood, help to achieve the balance between Yin and Yang status of internal organs, and is therefore suitable for treating many disorders of the body. Successful examples of previous studies using this therapy including insomnia, weight reduction, hypertension, treatment of addiction, and pain reduction. However, inconsistency in the treatment protocol among studies, or the use of combined therapies, makes it impossible to draw a strong causal relationship between this therapy and the treatment effect. More appropriate clinical trials are therefore necessary to understand in depth the therapeutic effect of auricular therapy. Ideally, these trials can take place in the context of nursing practice so as to explore the application of this therapy in the realm of nursing, and to enable nurses to make a more effective contribution to primary health care.