The birth experience and subsequent maternal caregiving attitudes and behavior: a birth cohort study

The relationship between maternal functioning and birth memory and trauma

AIM

This study aimed to determine the relationship between birth memory and trauma and maternal functioning in the postpartum period.

METHODS

This cross-sectional study included 584 mothers in the postpartum period between 1 January 2022 and 1 April 2022. Data were collected using a personal information form, the Barkin Index of Maternal Functioning (BIMF), the Birth Memories and Recall Questionnaire (BirthMARQ) and the City Birth Trauma Scale (CityBiTS).

RESULTS

The participants' mean scores for the overall BIMF, BirthMARQ and CityBiTS were 81.41 ± 9.28, 80.30 ± 21.21 and 15.85 ± 11.30, respectively. Their sociodemographic characteristics did not affect their maternal functioning; however, maternal functioning improved with the number of pregnancies. While emotional memory (BirthMARQ subscale) negatively affected maternal functioning (p < 0.001), the centrality of memory (BirthMARQ subscale) positively affected maternal functioning (p < 0.001). The hyperarousal (CityBiTS subscale) score significantly and negatively affected the total maternal functioning score, explaining 6 % of its variance (F = 9.176, p = 0.001).

CONCLUSION

This study demonstrated that birth memory and trauma affected maternal functioning. The mother's functional status in the postpartum period reflects the physical and psychosocial changes associated with pregnancy and birth. Therefore, for women to have positive birth memories and emotions when recalling the birth, their emotional health and physical care should be supported during labour and the postpartum period.

Maternal performance after childbirth and its predictors: a cross sectional study

BACKGROUND AND OBJECTIVES

Birthing parents need to use specialized skills as the first caregiver of the newborn. Several factors may affect performance. Yet there is a paucity of research in this area, and evidence remains inconsistent. Consequently, this study aimed to determine maternal performance after childbirth and its predictors.

METHODS

This cross-sectional study was conducted with those (n = 450) who had given birth (< two months) and been referred for the vaccination of their newborn. The multi-stage sampling method was carried out from April 2022 to February 2023. Participants who met the inclusion criteria completed a demographic and obstetric information questionnaire, along with the childbirth experience 2 (CEQ2), Barkin maternal performance and maternal self-efficacy scales. Multiple linear regression was used to investigate the predictive effect of the independent variables of childbirth experience, maternal self-efficacy, demographic and obstetric variables on the dependent variable of maternal performance.

RESULTS

The mean age of the participants was 26.78 and the mean total score of maternal performance was 91.04 (0-120). The highest and lowest scores related to the 'maternal competence' and the 'maternal needs' domains, with mean score calculated at 77.51 and 72.81 respectively. 'Childbirth experience' and 'maternal self-efficacy' domains had a statistically significant relationship with maternal performance (P < 0.05). Among the predictive factors of maternal performance, the results of our linear regression demonstrated the variables of birth experience (B = 0.63), maternal self-efficacy (B = 1.53), spouse's employment status (B = 5.78 for worker level, B = 3.99 for employee level), the number of previous childbirth experiences (B = -8.46), frequency of receiving antenatal care (B = -6.68), length of stay in the birth suite (B = -2.22) and length of stay in the hospital (B = 2.84) remained in the model. 53.2% of changes in maternal performance can be explained by these independent variables.

CONCLUSION

The promotion of evidence-based, person-centered, and respectful perinatal care during pregnancy and childbirth are of paramount importance. Strategies to improve the experience of childbirth and self-efficacy are especially required to improve maternal performance in the postpartum period. Prenatal care aimed at improving maternal function after childbirth will be important in achieving this overall.

Transferring an extremely premature infant to an extra-uterine life support system: a prospective view on the obstetric procedure

To improve care for extremely premature infants, the development of an extrauterine environment for newborn development is being researched, known as Artificial Placenta and Artificial Womb (APAW) technology. APAW facilitates extended development in a liquid-filled incubator with oxygen and nutrient supply through an oxygenator connected to the umbilical vessels. This setup is intended to provide the optimal environment for further development, allowing further lung maturation by delaying gas exposure to oxygen. This innovative treatment necessitates interventions in obstetric procedures to transfer an infant from the native to an artificial womb, while preventing fetal-to-neonatal transition. In this narrative review we analyze relevant fetal physiology literature, provide an overview of insights from APAW studies, and identify considerations for the obstetric procedure from the native uterus to an APAW system. Lastly, this review provides suggestions to improve sterility, fetal and maternal well-being, and the prevention of neonatal transition.

Seeking a connection: Women's lived experience of the woman-midwife relationship in mainstream maternity services in Japan

PROBLEM

In Japan, women continue to suffer from mental health and other postpartum issues despite good clinical outcomes of maternity care.

BACKGROUND

As key care providers, midwives potentially affect women's overall birth experience. Most women in Japan give birth in hospitals or obstetric clinics where different midwives and nurses provide one woman with fragmented care. Women's lived experiences of the woman-midwife in these birth facilities are not well known in Japan.

AIM

To understand women's birth experience and relationship with midwives in the mainstream maternity care system in Japan to improve maternity care and women's birth experience.

METHODS

Face-to-face individual interviews with 14 mothers were conducted. The data were analysed using van Manen's hermeneutic phenomenological approach, which reveals the meaning of human experience in the everyday world.

FINDINGS

Four themes were derived from the hermeneutic phenomenological analysis; 1) Closed hearts and bodies in insecure relationships, 2) Alienation, 3) Hopelessness and helplessness, and 4) Women's vulnerability and desire for positive relationships.

DISCUSSION

In institutionalised and fragmented maternity care settings, it is difficult for women and midwives to develop a relationship. In such a care environment, women's birth experience with midwives is negative or even traumatic; yet, women still need and seek the midwife relationship. Respectful care-necessary for women's positive birth experience-requires positive relationship between women and midwives.

CONCLUSION

Women's negative birth experience may affect their mental health and parenting. Maternity and midwifery care in Japan needs to develop relationship-based care to improve women's birth experience.

Psychological issues in breast cancer survivors confronted with motherhood: Literature review and a call to action

Breast cancer is currently the most common cancer among women worldwide; in 15-25% of cases, patients are premenopausal at the time of diagnosis, and 50% of women desire pregnancy after cancer diagnosis. Motherhood after breast cancer involves complex psychological challenges with long-term consequences, though it is safely pursuable with adequate support. The purpose of this mini-review is to analyze the psychological implications surrounding pregnancy and motherhood after breast cancer and promote action in addressing the challenges that might affect women facing these life events.

Exploring Western Australian Women's experiences of sharing positive birth stories

BACKGROUND

Fear can impact childbirth experiences, yet most birth stories women hear portray birth as unfavourable, and women must actively seek out positive birth stories.

AIMS AND OBJECTIVES

We aim to explore how women feel when sharing positive birth stories and the socially constructed motivations for or against sharing.

RESEARCH QUESTION

What are the experiences of women who share positive birth stories?

METHODS

A qualitative descriptive approach was adopted, adhering to Standards of Reporting Qualitative Research (SRQR) guidelines, and underpinned by an interpretivist research philosophy. Participants were recruited via Facebook using a non-probability, voluntary-response, purposive sampling method. Twelve English-speaking Western Australian women aged 24-38 years identified as having had a positive vaginal birth experience within the past 5 years. Semi-structured interviews were transcribed verbatim and analysed using thematic analysis.

FINDINGS

The theme Not Safe to Share and sub-themes The Perils of Sharing and Changing the Narrative explores how participants repeatedly felt unable to share their birth stories because society's dominant view of childbirth was negative. It describes the experienced or anticipated reactions that contributed to feeling unsafe and how participants withheld or altered their stories to feel accepted. The theme Safe Spaces and sub-theme The Joys of Sharing, explored participants' love of sharing their birth stories in safe spaces, allowing re-access to feelings of elation, validation of their stories, and opportunity to empower others.

CONCLUSIONS

Women often feel reluctant to share their positive birth stories. Findings may help understand the lack of availability of positive birth stories in our society. Normalising the positive birth experience may improve the experience of sharing positive birth stories, potentially improving society's view of childbirth.

Epidural Oxycodone for Acute Pain

Epidural analgesia is commonly used in labour analgesia and in postoperative pain after major surgery. It is highly effective in severe acute pain, has minimal effects on foetus and newborn, may reduce postoperative complications, and enhance patient satisfaction. In epidural analgesia, low concentrations of local anaesthetics are combined with opioids. Two opioids, morphine and sufentanil, have been approved for epidural use, but there is an interest in evaluating other opioids as well. Oxycodone is one of the most commonly used opioids in acute pain management. However, data on its use in epidural analgesia are sparse. In this narrative review, we describe the preclinical and clinical data on epidural oxycodone. Early data from the 1990s suggested that the epidural administration of oxycodone may not offer any meaningful benefits over intravenous administration, but more recent clinical data show that oxycodone has advantageous pharmacokinetics after epidural administration and that epidural administration is more efficacious than intravenous administration. Further studies are needed on the safety and efficacy of continuous epidural oxycodone administration and its use in epidural admixture.

Can Maternal Prenatal Self-Reported and Physiological Distress Predict Postnatal Caregiving Practices?

Maternal prenatal distress is associated with child outcomes, including health, neurocognitive, and socio-emotional development. Knowledge on underlying mechanisms is limited, yet relevant for prevention and intervention. This study investigated whether maternal prenatal distress predicts specific caregiving practices that are known for their effects on child outcomes. Caregiving practices studied were maternal caregiving quality and the initiation and course of breastfeeding and room-sharing. We hypothesized that more maternal prenatal distress would be associated with altered caregiving practices. Participants were 174 healthy mother-child dyads. During the 37^th week of pregnancy maternal self-reported distress was assessed using questionnaires, and physiological stress by collecting saliva cortisol. Maternal caregiving quality was observed in postnatal week 5 during infant bathing. Weekly diaries on breastfeeding and daily diaries on room-sharing were completed during the first 6 postnatal months. In a regression analysis, no associations between maternal prenatal distress and caregiving quality were found. Multilevel analyses indicated that maternal prenatal evening cortisol was positively related to the initiation of breastfeeding and room-sharing. Replications are warranted, but these results suggest that breastfeeding and room-sharing initiation may be part of a mechanism underlying links between maternal prenatal physiological stress and child outcomes. As other prenatal cortisol markers and self-reported distress were not found to be related to the caregiving practices, it is likely that alternative mechanisms (co-)exist in explaining links between maternal prenatal distress and child outcomes. Future replication research including child outcomes and (other) potential mechanisms will inform prevention and intervention programs fostering healthy pregnancies and child development.

Methods of induction of labor and women's experience: a population-based cohort study with mediation analyses

BACKGROUND

Negative childbirth experience may affect mother wellbeing and health. However, it is rarely evaluated in studies comparing methods of induction of labor (IoL).

AIM

To compare women's experience of IoL according to the method, considering the mediating role of interventions and complications of delivery.

METHODS

We used data from the MEDIP prospective population-based cohort, including all women with IoL during one month in seven French perinatal networks. The experience of IoL, assessed at 2 months postpartum, was first compared between cervical ripening and oxytocin, and secondarily between different cervical ripening methods. Mediation analyses were used to measure the direct and indirect effects of cervical ripening on maternal experience, through delivery with interventions or complications.

FINDINGS

The response rate was 47.8% (n = 1453/3042). Compared with oxytocin (n = 541), cervical ripening (n = 910) was associated less often with feelings that labor went 'as expected' (adjusted risk ratio for the direct effect 0.78, 95%CI [0.70-0.88]), length of labor was 'acceptable' (0.76[0.71-0.82]), 'vaginal discomfort' was absent (0.77[0.69-0.85]) and with lower global satisfaction (0.90[0.84-0.96]). Interventions and complications mediated between 6 and 35% of the total effect of cervical ripening on maternal experience. Compared to the dinoprostone insert, maternal experience was not significantly different with the other prostaglandins. The balloon catheter was associated with less pain.

DISCUSSION

Cervical ripening was associated with a less positive experience of childbirth, whatever the method, only partly explained by interventions and complications of delivery.

CONCLUSION

Counselling and support of women requiring cervical ripening might be enhanced to improve the experience of IoL.

Coping With the Unexpected in Childbirth: A Thematic Analysis

This article reports original research that describes new mothers' experiences of birth and maternity care. Qualitative data were collected through a survey on birth satisfaction, which included space for women to provide comments about their birth and experience of care. Thirty-nine women provided comments that were analyzed using the thematic analysis method. Two themes emerged from the women's experiences: "Unexpected birth processes: expectations and reality" and "Coping with birth: the role of health-care staff." Participants described unexpected birthing processes, their experiences of care, and maternity care staff's contributions to coping with birth. Implications for practice for childbirth professionals include promotion of physiologic birth, respectful person-centered care during all phases of perinatal care, and the value of childbirth preparation.

Childbirth experience, maternal functioning and mental health: how are they related?

Introduction: Childbirth experience is shaped by the labor and delivery process. The aim of this study was to investigate the relationship between childbirth experience, subsequent postpartum maternal functioning and mental health.Methods: A total of 483 mothers in the first 4-16 weeks postpartum participated in this cross-sectional study. The cluster random sampling method was used to select the participants. The Questionnaire for Assessing the Childbirth Experience, Mental Health Inventory, and the Barkin Index of Maternal Functioning were completed through interviews.Results: The mean childbirth experience, mental health, and maternal functioning scores were 1.6 (0.4), 79.1 (15.0), and 97.4 (13.0), respectively. There was a significant correlation between the total mental health and maternal functioning scores and all its subscales with childbirth experience scores (P<0.001). Results from the general linear model pointed to a significant correlation between maternal functioning and childbirth experience (P<0.001), as well as between receiving support for infant care (P<0.001) and family income adequacy (P=0.006). Mental health was also significantly correlated with childbirth experience (P<0.001), complete life satisfaction (P<0.001), and receiving support for infant care (P=0.025).Conclusion: Supportive care provision services may improve mothers' birth experiences, which leads to enhanced postpartum maternal functioning and mental health.

Childbirth Experience Associated With Maternal and Paternal Stress During the First Year, but Not Child Attachment

Women, as well as their partners, can experience childbirth in many different ways. A negative childbirth experience may have adverse effects on the entire family, resulting, for instance, in parental stress symptoms and a weakened parent-child relationship. Parental stress, without sufficient resources to compensate for it, may also in and of itself negatively influence the parent-child relationship. This study contributes to the current knowledge of the psychological effects of childbirth experience by using longitudinal data collected with both self-reports and observational measures, as well as multiple informants (i.e., mothers and partners). The aim of this study was to investigate whether 1) women's retrospective birth experiences were related to maternal and paternal parenting stress, 2) birth experience was indirectly associated with child attachment via maternal stress, and 3) birth experience was directly related to child attachment. Data were collected from a mixed sample of community and at-risk primipara women (N = 1,364), as well as from their partners and children. Retrospective childbirth experience was measured 3 months postpartum with a latent factor consisting of five items asking about the feelings that women have about their childbirth. Parental stress was measured at 3 months postpartum for partners and 3 and 12 months postpartum for mothers using the adult domain of the parental stress index (PSI). Finally, parent-child attachment is observed in a subsample of 223 women and children at 12 months postpartum with the Strange Situation Procedure (SSP). Results show that women's birth experience was significantly related to both mothers' and their partners' parenting stress. However, birth experience was not related to child attachment, neither directly nor indirectly via maternal stress. These findings emphasize the long-lasting impact that childbirth may have on both parents. Future research is still needed to further investigate which protective factors may weaken the association between birth experience and parental stress.

The influence of migration on women's satisfaction during pregnancy and birth: results of a comparative prospective study with the Migrant Friendly Maternity Care Questionnaire (MFMCQ)

INTRODUCTION

Approximately 21% of Germany's inhabitants have been born abroad or are of direct descent of immigrants. A positive birth experience has an effect on a woman's mental health and her future family planning choices. While international studies showed that immigrant women are less satisfied with their birth experience, no such study has been conducted in Germany until now.

METHODS

At our center of tertiary care in Berlin, with approximately 50% immigrants among patients, pregnant women of at least 18 years of age were offered participation in this study. A modified version of the Migrant Friendly Maternity Care Questionnaire (MFMCQ) designed by Gagnon et al. in German, English, French, Spanish, Arabic and Turkish was used. We compared non-immigrant women to immigrant women and women with direct descent of immigrants. For certain analysis, the latter two groups were included together under the category "migration background".

RESULTS

During the study period, 184 non-immigrant, 214 immigrant women and 62 direct descendants of immigrants were included. The most frequent countries of origin were Syria (19%), Turkey (17%), and Lebanon (9%). We found a slight difference between groups regarding age (non-immigrants: mean 33 years versus women with any migration background: mean 31) as well as parity with more non-immigrants delivering their first child. No difference in the satisfaction with care was observed between immigrant and any migration background groups (p ≥ 0.093 in the two-sided Fisher's exact test). At least 75.8% of all participating women reported complete satisfaction with care during labor, birth and after birth. Interestingly, the level of German language proficiency did not influence the immigrant patient's satisfaction with care.

CONCLUSION

The study results show no difference regarding overall satisfaction with care during labor and birth despite a relevant language barrier. We are for the first time providing the MFMCQ in German and Turkish. Further future analyses on the impact of patient expectations on satisfaction with care will be conducted.