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

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

The relationship between first-time mothers and care providers in the early postnatal phase: an ethnographic study in a Swiss postnatal unit

Objective

to consider the relationship between first-time mothers and care providers in an organisational context.

Design

an ethnographic approach was used to study the views and behaviours of providers and recipients of postnatal care. Fieldwork involved mainly conversations or qualitative interviews and observation.

Setting

a postnatal unit in a tertiary referral hospital in Switzerland.

Participants

10 child-bearing women and the care providers assigned to them.

Analysis

analysis of the data was organised using the women’s expectations of care and the maternity unit’s mission statement. Thematic analysis centred around two main themes: the experience of ‘being on a postnatal journey’ and ‘caring relationships’.

Findings

the findings presented fall within the framework of the second theme. A caring relationship was established through ‘weaving the net’. This relationship was then maintained through ‘keeping the thread’. The relationship was eventually ended through ‘finishing off’.

Key conclusions

the quality of the caring relationship between a woman and a care provider influences satisfaction with received care. It determines the extent to which women feel in control of their situation at discharge. Organisational and professional factors influence this relationship, which in turn can influence a nurse's level of job satisfaction.

Implications for practice

changes in the provision of postnatal care may involve organisational as well as clinical interventions to ensure continuous and consistent care.     

Birth after caesarean section: changes over a nine-year period in one Australian state

Objectives

to describe the outcomes related to birth after a caesarean section (CS) in one Australian state, New South Wales (NSW), over a nine-year period. The objectives were to determine whether changes had occurred in the rates of attempted and successful vaginal birth after caesarean section (VBAC), induction of labour, place of birth, admission to special care or neonatal intensive care nursery and perinatal mortality.

Design and setting

cross-sectional analytic study of hospital births in New South Wales using population-based data from 1998-2006.

Participants

women experiencing the next birth after a CS where: the total number of previous CS was 1; the presentation at birth was vertex; it was a singleton pregnancy; and, the estimated gestational age was greater than or equal to 37 weeks. A total of 53,455 women met these criteria.

Measurements

data were obtained from NSW Health Department's Midwives Data Collection (MDC). The MDC includes all live births and stillbirths of at least 20 weeks gestation or 400 g birth weight in the state.

Findings

over the nine-year period, the rate of vaginal birth after caesarean section declined significantly (31-19%). The proportion of women who ‘attempted a vaginal birth’ also declined (49-35%). Of those women who laboured, the vaginal birth rate declined from 64% to 53%. Babies whose mothers ‘attempted’ a VBAC were significantly less likely to require admission to a special care nursery (SCN) or neonatal intensive care (NICU). The perinatal mortality rate in babies whose mothers ‘attempted’ a VBAC was higher than those babies born after an elective caesarean section although the absolute numbers are very small.

Key conclusions

rates of VBAC have declined over this nine-year period. Rates of neonatal mortality and proxy measures of morbidity (admission to a nursery) are generally in the low range for similar settings.

Implications for practice

decisions around the next birth after CS are complex. Efforts to keep the first birth normal and support women who have had a CS to have a normal birth need to be made. More research to predict which women are likely to achieve a successful VBAC and the most effective ways to facilitate a VBAC is essential. Midwives have a critical role to play in these endeavours.