‘Off everyone's radar’: Australian women's experiences of medically necessary elective caesarean section

"Where's my baby?" A feminist phenomenological study of women experiencing preventable separation from their baby at caesarean birth

PROBLEM

Separating women and babies immediately after birth contributes to poor birth experience and reduced satisfaction.

BACKGROUND

A negative birth experience can impact a woman's transition to motherhood and emotional well-being beyond the newborn period. Separating women from their baby at birth is known to reduce birth satisfaction and is more likely to happen at caesarean section births.

QUESTION

What is the experience of women who are separated from their baby after caesarean section birth without medical necessity?

METHODS

Unstructured, in-depth phenomenological interviews were conducted with fifteen women who had been separated from their well-baby at caesarean section birth. Data was analysed using a Modified van Kaam approach. A novel feminist phenomenological framework with two birthing theories was used to explore the experience of the participants.

FINDINGS

Four major themes emerged - Disconnection, Emotional Turmoil, Influence, and Insight. These demonstrated significant trauma that both the separation and perinatal care created.

DISCUSSION

The participants recognised their vulnerability and the lack of power and control they had over themselves and their baby, which was seemingly not acknowledged. Provider and hospital needs were valued above those of the women.

CONCLUSION

Woman-centred care was not evident in the treatment of these women despite the attendance of a midwife at each birth. This research challenges midwives and other health care providers to support and advocate for those birthing by caesarean section to return power and control and support them to remain in close physical contact with their baby immediately after birth.

Using a scheduled caesarean birth plan: A cross-sectional exploration of women's perspectives

PROBLEM

There is minimal evidence regarding the role or impact of birth plans from the perspective of women experiencing scheduled caesarean birth.

BACKGROUND

Quality maternity care requires respect for women's preferences. Evidence suggests birth plans enable communication of women's preferences and may enhance agency when vaginal birth is intended, however there is limited evidence of how this translates in the perioperative environment where caesarean birth is the intended outcome.

AIM

Explore the experiences and perspectives of women who had utilised a scheduled caesarean birth plan at an Australian tertiary maternity hospital.

METHODS

A cross-sectional design was used; 294 participants completed the survey within two weeks post-birth. Descriptive statistics were used to analyse quantitative data, qualitative responses were analysed using content analysis.

FINDINGS

Over half of the women requested lowering of the surgical-screen at birth, most requested immediate skin-to-skin with their babies; around two-thirds of these preferences were met. Use of a birth plan for scheduled caesarean section supported women's ability to communicate their desires and choices, enhancing agency and reinforcing the significance of the caesarean birth experience. Qualitative data revealed two main categories: Perceptions and experiences; and Recommendations for improvement, with corresponding sub-categories.

DISCUSSION

Findings provide unique opportunities to consider the provision of woman-centred care within the highly technocratic perioperative environment.

CONCLUSION

All women, regardless of birth mode, have a right to respectful maternity care that prioritises their wishes and agency. This study provides evidence for the positive utility of birth plans in caesarean birth, local adaptation is encouraged.

A scoping review of mother-child separation in clinical paediatric settings

There is increasing evidence to suggest that autonomic regulation of hospitalised infants is affected by separation from their mother. This review explored the extent of the evidence relating to the impact of separation on infants and children and aimed to identify suitable measures of the impact of mother-child separation. We conducted a scoping review of seven databases using the main search terms 'physiological', 'psychological', 'infant/child', 'maternal separation' and 'hospital'. Thirty-four articles containing data relevant to the effects of mother-child separation on either member of the pair were included. Findings highlight the central importance of the mother's presence in mediating the stressful effects of hospitalisation on her child. The majority of articles reported on psychological effects of separation on mothers of infants or on younger children. We identified no articles reporting on physiological effects on the older child or mothers of older children or psychological effects on mothers of older children. Only nine articles used validated tools to measure the effects of separation. There is a need for more evidence, based on validated measurement, about the psychological effects of separation on the child, particularly the older child, and on the physiological effects of separation on the mother-child pair during hospitalisation.

Caesarean section delivery from maternal perspective: An exploratory study in Jordan

AIMS OF THE STUDY

This study aims to determine females' views, experiences and attitudes regarding the caesarean section (CS) and to explore the factors that increase the prevalence of CS in Jordan.

DESIGN

This is a cross-sectional study using a questionnaire that was distributed electronically through social media websites. Study participants included 1005 females with a history of at least one CS. Awareness, experiences about CS, complications and reasons for performing CS were investigated.

SETTINGS

The participants were recruited from all Jordan cities by social media and emails.

FINDINGS

Most of the respondents stated that the source of their knowledge about CS was from the internet (36.2%) followed by family and friends (31.6%). The majority of respondents were satisfied with their CS experience (72.8%). More than half of the participants (56.9%) reported that CS carries no risk for infants. About 53% of respondents stated that the most common reason leading women to choose to give birth via CS is the fear of labour pain. However, the majority of the respondents disagree with performing CS under maternal request (59.2%).

CONCLUSIONS AND IMPLICATIONS

This study indicated that Jordanian females do not have reliable sources of information about CS. This leads to lower awareness of CS and its complications, and, as expected, CS is more likely to be performed by privately insured women.

What are women's experiences of immediate skin-to-skin contact at caesarean section birth? An integrative literature review

BACKGROUND

Skin-to-skin is a well-established practice at vaginal births promoting the health of women and babies. Facilitation of skin-to-skin at caesarean section birth is growing despite environmental and historical challenges. This is led by the expectancy of women and of health professionals increasingly understanding its importance.

OBJECTIVE

To synthesise original research that explores the experience of women having immediate and uninterrupted skin-to-skin contact at caesarean section when woman and baby are well.

DESIGN

Integrative literature review.

DATA SOURCES

The databases of SCOPUS, PubMed, CINAHL plus, Wiley Online, Cochrane Library, Web of Science and MIDIRS were used to identify studies from 2010-2020. Hand searching of library journals, reference and citation lists were also used.

METHODS

The framework of Whittemore and Knafl (2005) was used to guide the literature search, thematic analysis, and synthesis of original research. Initial screening against inclusion criteria was utilised for English-published papers of full-term, well, woman and baby dyads who experienced skin-to-skin at caesarean section birth. Papers were not limited by methodology. The validated Mixed Methods Appraisal Tool (MMAT) was used for critical quality appraisal (Bartlett et al., 2018).

FINDINGS

In total, 750 results were returned in the initial search and a final 13 papers were included in this review including quantitative (6), qualitative (5) and mixed method (2) designs. Immediate and uninterrupted skin-to-skin at caesarean section birth, when mother and baby are well, is safe, appropriate and desired by women, improving birth experience and satisfaction. Three main themes were identified with sub-themes - Positive birth experience (satisfaction; breastfeeding goals); Sense of control (empowered; birth, not a procedure); Natural (wanting to hold their baby; becoming a mother).

CONCLUSIONS

The findings of this review show that skin-to-skin improves the experience for women, and particularly empowers women having a caesarean section giving them a sense of a more natural birth. Women see skin-to-skin as an opportunity to maintain control and not be separated from their baby. Many studies have focused on the benefits of skin-to-skin but less so on the wants and choices of women. Women want to see, hold and feed their babies but are unable to achieve this of their own volition during a surgical birth. Understanding how women value this close physical contact can seek to inform further research on the impact of separation. This can inform policy and practice development in maternity care services to ensure best outcomes for both women and infants.

IMPLICATIONS FOR PRACTICE

The practice of skin-to-skin and keeping mother and baby together is valued by women and justified by research as best-practice for health and well-being. The findings of this paper highlight the importance of maternity settings facilitating both skin-to-skin and non-separation for all women and their newborns, even more so at caesarean section births.

Women's experiences of intrapartum care and recovery in relation to planned caesarean sections: An interview study

PROBLEM AND BACKGROUND

Approximately one third of women in high-income countries give birth by caesarean section (CS). Better understanding of women's CS experiences is vital in identifying opportunities to improve women's experience of care.

AIM

To identify opportunities for service improvement by investigating Australian women's experiences of care and recovery when undergoing a planned CS.

METHODS

Qualitative telephone interview study with 33 women who had a planned CS at one of eight Australian hospitals. Semi-structured interviews were conducted to elicit women's perspectives, experiences and beliefs surrounding their planned CS. Interviews were transcribed verbatim and analysed inductively using NVivo-12.

RESULTS

Women's experiences of CS care were mixed. Regarding intrapartum care, many women stated their planned CS was a positive experience compared to a previous emergency CS, but was scarier and more medicalised compared to vaginal birth. CS recovery was viewed more negatively, with women feeling unprepared. They reported disliking how CS recovery restricted their role as a mother, wanting more time in hospital, and greater support and continuity of care.

DISCUSSION

Women reported largely positive intrapartum experiences of planned CS but relatively negative experiences of CS recovery. They wished for time in hospital and support from staff during recovery, and continuity of care.

CONCLUSION

By incorporating shared decision-making antenatally, clinicians can discuss women's birth expectations with them and better prepare them for their planned CS and recovery.

Women's experiences and satisfaction with having a cesarean birth: An integrative review

BACKGROUND

With around one third of woman having a cesarean birth, better understanding of women's experiences of having a cesarean is vital to improve women's experiences of care. The aim of this review was to gain insight into women's experiences of and satisfaction with cesarean and to identify factors that contribute to women's poor experiences of care.

METHODS

Using an integrative methodology, evidence was systematically considered in relation to women's experiences of cesarean birth and whether they were satisfied with their experience of care. To identify studies, PubMed, Maternity and Infant Care, MEDLINE, and Web of Science were searched for the period from 2008 to 2018, and reference lists of included studies were examined.

RESULTS

Twenty-six studies were included. Although the majority of women were satisfied with their cesarean, a large minority of women were dissatisfied and reported a negative experience. In particular, women who had an emergency cesarean were less satisfied than women who had a vaginal birth. Nonmedical factors or experiences that appear associated with dissatisfaction include (a) feeling ignored and disempowered; (b) experiencing a loss of control; (c) not being informed; and (d) birth values that favor vaginal birth.

CONCLUSIONS

Women's experiences of cesarean birth appear influenced by the circumstances (emergency vs planned), the extent to which they felt involved in decision-making and in control of their experience, and their birth values and beliefs. Increasing antenatal, intrapartum, and postpartum communication and shared decision-making may help engage women as an active participant in their own birth.

Professional strategies that address the whole family's physical and emotional needs after a caesarean section

Objectives: The purpose of the study was to contribute to knowledge about how midwives manage the separation between mother and child after a caesarean section and how they try to manage the difficulties they encounter.Methods: Data were collected from 12 interviews and subjected to inductive qualitative content analysis.Results: The findings showed the importance of enabling midwives to reflect on their daily work and indicated that the partner's role and participation after a caesarean section should receive greater focus and be part of routine care. Collaboration between the surgical and maternity wards could be improved by drawing up written guidelines to establish local routines. Together with national guidelines on minimising separation after a caesarean section, these suggestions could lead to more equal delivery of care for families.

Skin-to-skin contact and what women want in the first hours after a caesarean section

OBJECTIVE

To explore women's experience of skin-to-skin contact and what women want in the first two hours after a caesarean.

DESIGN

Audio recorded interviews were conducted with women as a part of a larger video ethnographic research study where video recordings, observations, field notes, focus groups and further in-depth interviews were conducted.

SETTING

A metropolitan hospital in Sydney, Australia.

PARTICIPANTS

Twenty-one women who had a caesarean section were involved in interviews around six weeks postpartum.

ANALYSIS

The transcribed interviews were thematically analysed.

FINDINGS

Women wanted their baby to stay with them and have skin-to-skin contact, even if they felt apprehensive about providing this care. An overarching theme was, 'I want our baby'. Several subthemes also emerged: 'I felt disconnected when I was separated from my baby', 'I want to explore my naked baby', 'I want my partner involved', and 'It felt right'.

KEY CONCLUSIONS

Despite the challenges of providing skin-to-skin contact in the operating theatre and recovery, health professionals and institutions should recognise the importance of advocating for what women want including keeping women, their partners and babies together and encouraging continuous maternal and infant contact and skin-to-skin contact.

When childbirth becomes a tragedy: What is the role of hospital organization?

In this autoethnographic study, I analyse my birthing event, in order to point out some relevant cultural aspects of the experience. I explore the role of expectations, childbirth place, medicalization and relationships with healthcare professionals and partner. My experience and the analysis of the context where childbirth takes place leads to the conclusion that hospital organization is central to women’s experiences of giving birth, but the hospital culture is still too centred on the security that medical interventions guarantee, relegating people to a passive position. Health services should address personal agency, in order to guarantee more respectful childbirth care.

Iranian obstetricians' views about the factors that influence pregnant women's choice of delivery method: a qualitative study

BACKGROUND

Caesarean section is a commonly performed childbirth procedure. While caesarean section is undeniably a lifesaving procedure for some mothers and babies, it can also be an unnecessary procedure for others. Different factors may be involved in the rate of birth by caesarean section.

QUESTION

This qualitative study was conducted in Kashan city, Iran, to explore obstetrician's views of what might influence pregnant women's choice of delivery method.

METHODS

Obstetricians' views and experiences were collected using semi-structured interviews. Interviews were conducted in a clinic or hospital, based on the preference of the 18 physicians who agreed to participate in the study. All interviews were recorded and transcribed. Participants were asked key questions, including: "Why do some women prefer caesarean section?"; "What kind of delivery did you have and why?"; "What kind of delivery would you recommend to pregnant women and why?" Inductive qualitative content analysis was undertaken using the method described by Morreti with 120 initial codes categorized into six categories.

FINDINGS

The six categories developed from the initial codes were: factors relating to women, obstetricians, delivery conditions, complications, society's beliefs and the health system.

CONCLUSION

A qualitative study conducted in Iran showed that most of the factors identified by participants facilitated the choice of caesarean section. Vaginal birth was anticipated as a painful and lengthy process, with low cultural acceptance and resulting in less income for obstetricians.