Factors related to a negative birth experience – A mixed methods study

Informed consent to midwifery practices and interventions during the second stage of labor-An observational study within the Oneplus trial

OBJECTIVES

To study informed consent to midwifery practices and interventions during the second stage of labor and to investigate the association between informed consent and experiences of these practices and interventions and women's experiences of the second stage of labor.

METHODS

This study uses an observational design with data from a follow-up questionnaire sent to women one month after giving birth spontaneously in the Oneplus trial, a study aimed at evaluating collegial midwifery assistance to reduce severe perineal trauma. The trial was conducted between 2018-2020 at five Swedish maternity wards and trial registered at clinicaltrials.gov, no NCT03770962. The follow-up questionnaire contained questions about experiences of the second stage of labor, practices and interventions used and whether the women had provided informed consent. Evaluated practices and interventions were the use of warm compresses held at the perineum, manual perineal protection, vaginal examinations, perineal massage, levator pressure, intermittent catheterization of the bladder, fundal pressure, and episiotomy. Associations between informed consent and women's experiences were assessed by univariate and multivariable logistic regression.

FINDINGS

Of the 3049 women participating in the trial, 2849 consented to receive the questionnaire. Informed consent was reported by less than one in five women and was associated with feelings of being safe, strong, and in control. Informed consent was further associated with more positive experiences of clinical practices and interventions, and with less discomfort and pain from interventions involving physical penetration of the genital area.

CONCLUSION

The findings indicate that informed consent during the second stage is associated with feelings of safety and of being in control. With less than one in five women reporting informed consent to all practices and interventions performed by midwives, the results emphasize the need for further action to enhance midwives' knowledge and motivation in obtaining informed consent prior to performance of interventions.

Childbirth experiences in women with polycystic ovary syndrome: A cohort study

INTRODUCTION

Women with polycystic ovary syndrome (PCOS) have more pregnancy complications like gestational diabetes, hypertension, and preterm labor than other women. Metformin has been used in an attempt to improve pregnancy outcomes. Our study aims to explore childbirth experiences in women with PCOS compared with a reference population. It also explores the potential influence of metformin, obesity, pregnancy complications, and the duration and mode of birth on childbirth experiences.

MATERIAL AND METHODS

This study is a cohort study combining data from two randomized trials conducted in Norway, Sweden and Iceland. The PregMet2 study (ClinicalTrials.gov, NCT01587378) investigated the use of metformin vs. placebo in pregnant women with PCOS. The Labour Progression Study (ClinicalTrials.gov, NCT02221427) compared the WHO partograph to Zhang's guidelines for progression of labor and were used as the reference population. A total of 365 women with PCOS and 3604 reference women were included. Both studies used the Childbirth Experience Questionnaire (CEQ). Main outcome measures were total CEQ score and four domain scores. The CEQ scores were compared using Mann-Whitney U test for women in Robson group 1 with PCOS (n = 131) and reference women (n = 3604). CEQ scores were also compared between metformin-treated (n = 180) and placebo-treated (n = 185) women with PCOS, and for different subgroups of women with PCOS.

RESULTS

There was no difference in total CEQ score between women with PCOS and reference women-Wilcoxon-Mann-Whitney (WMW)-odds 0.96 (95% confidence interval [CI] 0.78-1.17). We detected no difference in CEQ scores between the metformin- and placebo-treated women with PCOS (WMW-odds 1.13, 95% CI 0.89-1.43). Complications in pregnancy did not affect CEQ (WMW-odds 1, 95% CI 0.76-1.31). Higher body mass index (WMW-odds 0.75, 95% CI 0.58-0.96), longer duration of labor (WMW-odds 0.69, 95% CI 0.49-0.96), and cesarean section (WMW-odds 0.29, 95% CI 0.2-0.42) were associated with lower CEQ scores in women with PCOS.

CONCLUSIONS

Women with PCOS experience childbirth similarly to the reference women. Metformin did not influence childbirth experience in women with PCOS, neither did pregnancy complications. Obesity, long duration of labor or cesarean section had a negative impact on childbirth experience.

Basic psychological needs: A framework for understanding childbirth satisfaction

Women often report being dissatisfied with their childbirth experience, which in turn predicts negative outcomes for themselves and their children. Currently, there is no consensus as to what constitutes a satisfying or positive birth experience. We posit that a useful framework for addressing this question already exists in the form of Basic Psychological Needs Theory, a subtheory of Self-Determination Theory (Deci & Ryan, Can. Psychol., 49, 2008, 182). Specifically, we argue that the degree to which maternity care practitioners support or frustrate women's needs for relatedness, competence, and autonomy predicts their childbirth satisfaction. Using this framework provides a potentially powerful lens to better understand and improve the well-being of new mothers and their infants.

The Consequences of A History of Violence on Women's Pregnancy and Childbirth in the Nordic Countries: A Scoping Review

Violence against women (VAW) is a global challenge also in the childbearing period. Despite high gender equality, there is a high prevalence of VAW in the Nordic countries. This scoping review aims to explore predictors for and consequences of a history of violence on women's pregnancy and childbirth in the Nordic countries, including women's experience of the impact of violence and the interventions used to detect, address consequences, and prevent further violence. The framework by Arksey and O'Malley was followed, and English, Finnish, Icelandic, Norwegian, Danish, and Swedish literature was included. The population was women aged ≥18 residing in the Nordic countries during the perinatal period. Eight databases were searched: MEDLINE, CINAHL, PubMed, PsycINFO, Web of Science, ASSIA, Social Services-, and Sociological abstracts. There was no limitation of the search time frame. The initial screening resulted in 1,104 records, and after removing duplicates, 452 remained. Finally, 61 papers met the inclusion criteria. The results covering the past 32 years indicated that childbearing women with a history of violence are at greater risk of common complaints and hospitalization during pregnancy, fear of childbirth, Cesarean section, breastfeeding difficulties, and physical and mental health problems. While extensive research was found on the associations between a history of and current violence and outcomes related to pregnancy, there was a lack of intervention studies and studies from Finland. Efforts must be made to scientifically test the methods used to reduce and treat the adverse effects of a history of violence and prevent further violence.

Preferences of support and barriers and facilitators to help-seeking in pregnant women with severe fear of childbirth in Sweden: a mixed-method study

BACKGROUND

There are few support interventions for women with fear of childbirth tailored towards type of fears and parity. To inform the future development of an acceptable and relevant intervention for women with severe fear of childbirth, primary objectives were to examine: (1) pregnant women's experiences of and preferences for support and (2) barriers and facilitators to help-seeking. Secondary objectives were to examine if there are any differences based on pregnant women's parity.

METHODS

Pregnant women with a severe fear of childbirth in Sweden completed an online cross-sectional survey between February and September 2022. Severe fear of childbirth was measured using the fear of childbirth scale. Quantitative data were analysed using descriptive and inferential statistics and free answers were analysed using manifest content analysis. A contiguous approach to integration was adopted with qualitative and quantitative findings reported separately.

RESULTS

In total, 609 participants, 364 nulliparous and 245 parous women, had severe fear of childbirth. The main category "A twisting road to walk towards receiving support for fear of childbirth" was explored and described by the generic categories: Longing for support, Struggling to ask for support, and Facilitating aspects of seeking support. Over half (63.5%), of pregnant women without planned or ongoing treatment, wanted support for fear of childbirth. Most (60.2%) pregnant women with ongoing or completed fear of childbirth treatment regarded the treatment as less helpful or not at all helpful. If fear of childbirth treatment was not planned, 35.8% of women would have liked to have received treatment. Barriers to help seeking included stigma surrounding fear of childbirth, previous negative experiences with healthcare contacts, fear of not being believed, fear of not being listened to, and discomfort of having to face their fears. Facilitators to help seeking included receiving respectful professional support that was easily available, flexible, and close to home.

CONCLUSIONS

Most pregnant women with severe fear of childbirth felt unsupported during pregnancy. Findings emphasise the need to develop individual and easily accessible psychological support for women with severe fear of childbirth, delivered by trained professionals with an empathetic and respectful attitude.

Nulliparous women's lived experiences of the prolonged passive stage of labour: A thematic analysis based on descriptive phenomenology

INTRODUCTION

Prolonged progress can occur in the first and second stages of labour and may contribute to a negative birth experience. However, previous studies have mainly focused on quantitative aspects or overall birth experience, and little is known about women's experiences of a prolonged passive second stage.

OBJECTIVE

To describe the lived experiences of a prolonged passive second stage of labour in nulliparous women.

METHODS

A qualitative study was conducted with 15 nulliparous women with a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology.

RESULTS

The analysis resulted in four themes: "An unknown phase" that entailed remaining in a phase that the women lacked an awareness of. "Trust and mistrust in the body's ability" represents the mindset for vaginal birth as well as feelings of powerlessness and self-guilt. The theme "Loss of control" included experiences of frustration, fatigue, and having to deny bodily instincts. "Support through presence and involvement" signifies support through the midwife's presence in the birthing room, although there were also descriptions of emotional or physical absence.

CONCLUSIONS

The findings contribute to the understanding of prolonged labour based on women's lived experiences and add to the body of knowledge about the prolonged passive second stage. This study highlights that women need support through information, presence, and encouragement to remain in control. It can be beneficial during birth preparation to include knowledge about the passive second stage together with unexpected or complicated situations during birth, such as prolonged labour.

Factors influencing midwives' intentions to facilitate normal physiological birth: A qualitative study

BACKGROUND

Whilst most women desire to birth vaginally, research highlights reducing rates of normal physiological birth worldwide. Previous studies have focussed largely on clinical practices associated with vaginal birth however health care professionals' intentions are also known to effect behaviour; a factor not well understood within the context of midwifery and normal physiological birth.

QUESTION/AIM

To explore factors influencing midwives' intentions to facilitate normal physiological birth.

METHODS

A qualitative study using individual interviews was conducted. The Theory of Planned Behaviour was used to develop a semi-structured interview guide to gather perceptions, thoughts, knowledge, and experience of normal physiological birth from participants. Data were analysed thematically within the theoretical constructs: attitudes, subjective norms, and perceived behavioural control.

FINDINGS

Fourteen midwives from various practice settings, models, and locations in Australia were interviewed. Major factors influencing midwives' intentions to facilitate normal physiological birth were influenced by workplace culture, values and influence of leaders, the need to prioritise collaborative interdisciplinary relationships and support autonomy in midwifery.

DISCUSSION

Factors influencing the midwives' intentions of facilitating normal physiological birth were multifaceted. Some influences are more obvious and observable through practice, while others were rooted in underlying beliefs and attitudes that were hidden in the subconscious of those involved. However, all contributing influences ultimately shape midwives' intentions and the way in which they facilitate normal physiological birth.

CONCLUSIONS

Midwives intend to support normal physiological birth; however multiple factors influence their intentions over time. Prioritising collaborative interdisciplinary relationships and supporting autonomy in midwifery could address known barriers.

The effects of flavonoid supplementation on the mental health of postpartum parents

Introduction

During the postpartum period, parents face psychological challenges and consequently, changes in mood and associated mood disorders have become increasingly prevalent in the 6-months following birth. Dietary flavonoids have been found to benefit mood and are therefore an appealing non-pharmacological option for potentially treating mood disorders in the postpartum. The aim of this study was to investigate whether a two-week dietary flavonoid intervention would improve mothers' and fathers' mental health in the immediate 6-month postpartum period.

Method

The study employed a randomised, parallel groups, controlled design to explore the effects of a flavonoid intervention vs. control group on several outcomes, including mood (PANAS), postpartum depression (EPDS), postpartum anxiety (PSAS-RSF-C) and quality of life (WHOQOL). Sixty participants (mothers n = 40, fathers n = 20) in the 6-month post-partum period were randomised to either a "flavonoid" or "control" condition. The flavonoid group were asked to add two flavonoid-rich foods (approximate flavonoid intake 218 mg/day) into their daily diet whilst controls (n = 23) were asked to continue with their usual diet for two-weeks (ClinicalTrials.gov (NCT04990622).

Results

Significant effects were found in the flavonoid group where mothers reported higher positive affect and lower postpartum depression after the two-week intervention relative to baseline. This finding is especially relevant as a clinical reduction in postpartum depression scores in the flavonoid group by an average 2.6 scoring points was observed, which equated to a reduction from "possible depression" at baseline to "little or no depression" at 2-weeks, which was not observed in the control group. Fathers' data was not analysed due to non-compliance with the intervention.

Discussion

This study provides evidence for the benefits of a dietary flavonoid intervention for mood and mental health in new mothers, supporting the utility of non-pharmacological, self-administrable changes to the diet for improving positive mood outcomes and reducing symptoms of postpartum depression in mothers during an especially challenging time. Further research for the effect of dietary interventions on paternal mental health is needed.

Clinical Trial Registration

ClinicalTrials.gov, identifier NCT04990622.

Facilitating childbirth choice for positive postnatal mental health well-being among women: a Namibian case study

Childbirth affects women in a myriad of ways including feelings of tiredness, being overwhelmed, stressed, and having baby blues, and if not attended to, this can lead to postpartum depression, which is a mental condition that can have disastrous effects. Childbirth can affect the mental and physical status of a woman and having supportive midwives who guide women by giving adequate information is an issue of critical concern for a positive birth experience. The World Health Organisation (WHO) has emphasised the need to facilitate childbirth choices for women as a means of having a safe and memorable experience as the experience in childbirth affects the psychological status of a woman. Some women may experience worry and anxiety during labour and childbirth, which may be exacerbated by bias and a lack of childbirth choice facilitation during pregnancy. A negative childbirth experience may lead to negative psychological distress and postpartum depression, which will interfere with the bond between the mother, baby, and family. Midwives, thus, need to understand the emotional aspects that are attached to childbirth and be able to facilitate and support the emotional as well as the psychosocial needs of women under their care. However, there is a dearth of empirical evidence within the Namibian context that can provide direction and context-specific solutions to the present challenge. The current study followed a qualitative research design with an exploratory approach with one-on-one interviews with 10 midwives who were purposively selected. The midwives' experiences in this study depicted their zeal towards the issue at hand; however, what stood out were some barriers in the facilitation of childbirth choices (theme 1) as they expressed the shortages of staff, the timing of information, information sharing, and cultural influences as some of their experiences in facilitating childbirth. Furthermore, midwives shared a lack of provision for childbirth choice (theme 2) as the rights of women were not observed, and a lack of women-centred care despite protocols and guidelines being there, and yet they are not adhered to. In conclusion, midwives as primary caregivers actively need to provide unbiased childbirth information to achieve positive postpartum health. Initiating childbirth choices early in pregnancy gives women the time to weigh options and clearing of any misconceptions relating to childbirth types as well as reducing anxiety and fear of birth, which could lead to postpartum depression and by extension, the mental well-being of the women. Facilitating childbirth choices is critical in positive birth experiences and the management of childbirth as well as crafting guidelines and policy formulation that ensure a mentally healthy woman and society.

Kaleidoscope of emotions in hospital childbirth: A phenomenological study

The childbirth process represents a moment of transition in the life of each woman, and is a source of complex and dynamic emotions. The aim of this study was to describe the emotions women experience during hospital childbirth and to determine the conditioning factors. A qualitative prospective study with a phenomenological approach was conducted using semi-structured interviews with 42 women. The negative emotions the women highlighted were fear, anguish, suffering, concern and nervousness, and they were related to factors such as: the evolution of childbirth, the appearance of complications, pain, the doubt about the ability to give birth and poor communication. The positive emotions highlighted were joy, satisfaction, security, confidence and tranquillity, and they were related to the first skin-to-skin contact, effective communication, partner support and participation in decisions. The findings may contribute to the development of policies aimed at achieving the women and newborns' maximum health and life potential.

Experienced disrespect & abuse during childbirth and associated birth characteristics: a cross-sectional survey in the Netherlands

BACKGROUND

Experiencing upsetting disrespect and abuse (D&A) during labour and birth negatively affects women's birth experiences. Knowing in what circumstances of birth women experience upsetting situations of D&A can create general awareness and help healthcare providers judge the need for extra attention in their care to help reduce these experiences. However, little is known about how different birth characteristics relate to the experience of D&A. Previous studies showed differences in birth experiences and experienced D&A between primiparous and multiparous women. This study explores, stratified for parity, (1) how often D&A are experienced in the Netherlands and are considered upsetting, and (2) which birth characteristics are associated with these upsetting experiences of D&A.

METHODS

For this cross-sectional study, an online questionnaire was set up and disseminated among women over 16 years of age who gave birth in the Netherlands between 2015 and 2020. D&A was divided into seven categories: emotional pressure, unfriendly behaviour/verbal abuse, use of force/physical violence, communication issues, lack of support, lack of consent and discrimination. Stratified for parity, univariable and multivariable logistic regression analyses were performed to examine which birth characteristics were associated with the upsetting experiences of different categories of D&A.

RESULTS

Of all 11,520 women included in this study, 45.1% of primiparous and 27.0% of multiparous women reported at least one upsetting experience of D&A. Lack of consent was reported most frequently, followed by communication issues. For both primiparous and multiparous women, especially transfer from midwife-led to obstetrician-led care, giving birth in a hospital, assisted vaginal birth, and unplanned cesarean section were important factors that increased the odds of experiencing upsetting situations of D&A. Among primiparous women, the use of medical pain relief was also associated with upsetting experiences of D&A.

CONCLUSION

A significant number of women experience upsetting disrespectful and abusive care during birth, particularly when medical interventions are needed after the onset of labour, when care is transferred during birth, and when birth takes place in a hospital. This study emphasizes the need for improving quality of verbal and non-verbal communication, support and adequate decision-making and consent procedures, especially before, during, and after the situations of birth that are associated with D&A.

The prevalence and associated factors of fear of childbirth among Turkish pregnant women

OBJECTIVE

This study was conducted to determine the prevalence of fear of childbirth and affecting factors in pregnant women in Turkey.

MATERIALS AND METHODS

This was a cross-sectional study and included a total of 2025.    Pregnant Women Assessment, some variables related to previous and current perinatal processes and Wijma Delivery Expectancy/Experience Questionnaire (version A) were used for data collection.

FINDINGS

In this sample, 42.4% of the women reported fear of childbirth. What the women were afraid of most was the development of unwanted conditions at childbirth, obscurity/uncertainty, and negative attitudes of health professionals. The factors causing fear of childbirth were the low education level, unemployment status, low financial status, stillbirth, unplanned pregnancy, indecisiveness about the type of delivery, not attending prenatal education programs, negative effects of other people, insufficient social support, confiding in the healthcare centre and health professional, negative, and indecisive birth perceptions, prior negative birth experiences and not feeling ready for childbirth (p < 0.001).

CONCLUSIONS

The prevalence of fear of childbirth in this Turkish sample, especially in the multipara is higher than in Western countries. Causes of fear of childbirth can vary with countries and even with each region of a country.

L'expérience de l'accouchement en milieu surveillé dans la province d'Essaouira au Maroc: Quelle réalité?

RésuméUne expérience positive de l'accouchement (EPA) est fondamentale pour des soins maternels de qualité. Toutefois, de nombreuses femmes subissent des comportements non respectueux lors de ce moment crucial. Au Maroc, peu d'études ont mesuré cette expérience, et les éléments l'influençant demeurent insuffisamment documentés. Nous avons conduit une recherche mixte dans la province d'Essaouira entre avril et décembre 2021. Notre enquête, basée sur un questionnaire, a sollicité l'avis de 240 femmes issues de huit centres de santé choisis au hasard. Par ailleurs, des entretiens semi-directifs ont été conduits avec 20 femmes, 47 professionnels de santé et quatre responsables administratifs. Les données quantitatives ont été soumises à des analyses descriptives, bi- et multivariées, tandis que les entretiens ont été analysés selon une approche de contenu thématique. Les données révèlent que 59.2% des participantes ont eu une expérience défavorable lors de leur dernier accouchement. Parmi elles, la majorité a déploré des soins non consentis (86.7%), un manque de respect de leur intimité (45.4%) et des abus verbaux (25%). L'EPA était principalement associée à la qualité de l'environnement de l'accouchement, au soutien pour l'allaitement, à la propreté des installations, au type d'établissement (privé) et à l'absence de complications médicales pendant le travail. Les entretiens ont révélé que le manque de motivation des professionnels de santé, l'absence de formation continue appropriée et des lacunes organisationnelles et managériales ont affecté l'EPA. Notre étude souligne le besoin crucial de formation continue axée sur le respect des patients, l'éthique et la déontologie, et met en lumière l'importance d'une politique motivante pour les professionnels de santé, notamment dans le secteur public.

Labour agentry and subsequent adverse mental health outcomes: A follow-up study of the ARRIVE Trial

OBJECTIVE

Labour can be traumatic for women who perceive they are not involved in decisions affecting their care during labour. Our objective was to assess the relation between labour agentry and subsequent mental health.

DESIGN

Follow-up cohort study.

SETTING

U.S. Tertiary care center.

POPULATION

Participants from Utah who participated in the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial.

METHODS

During the ARRIVE trial, participants completed the Labor Agentry Scale twice, a validated questionnaire measuring perceived control of patients during childbirth. ARRIVE participants from Utah subsequently were asked to complete questions about mental health history and stressful events occurring since the trial, as well as surveys including the Primary Care Posttraumatic Stress Disorder (PC-PTSD) screen, Edinburgh Postnatal Depression Scale (EPDS) and Generalised Anxiety Disorder-7 (GAD-7) screen. The lower quartile of both agentry measurements defined a person's ordinal agentry category, used for assessing cohort characteristics by exposure category. Continuous minimum agentry was included in adjusted modelling.

MAIN OUTCOME MEASURES

The primary outcome was a mental health composite including a positive screen for depression, anxiety, or PTSD or self-report of a diagnosis or exacerbation since their delivery.

RESULTS

In all, 766 of 1042 (74%) people responded to the survey (median 4.4, range 2.5-6.4 years after delivery) and 753 had complete data for analysis. In unadjusted comparisons across ordinal agentry category, lower agentry was significantly associated with the primary composite endpoint, and depressive symptoms (test of trend p = 0.003 primary, p = 0.004 depression). Lower labour agentry scores were associated with incremental odds of the primary endpoint (1 SD [24 units], adjusted odds ratio [aOR] 1.21, 95% CI 1.41-1.03), driven by depressive symptoms or self-reported diagnosis (aOR 1.25, 95% CI 1.47-1.05).

CONCLUSIONS

Lower labour agentry at the time of birth was associated with a greater risk for mental health conditions years after delivery, indicating a potential opportunity for primary prevention of subsequent depression.

What influences women's experiences of childbirth in Flanders? - A quantitative cross-sectional analysis of the Babies Born Better survey

OBJECTIVE

Labour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium.

DESIGN

A cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders.

PARTICIPANTS

1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018.

FINDINGS

The majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362-0.817) and post term birth (OR 0.664, 95% CI 0.462-0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 - 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 - 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218-0.463), an instrumental birth (OR 0.318, 95% CI 0.218-0.463) or a planned- (OR 0.349, 95% CI 0.205-0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109-0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth.

KEY CONCLUSIONS

The majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences.

IMPLICATIONS FOR PRACTICE

Women's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.

A systematic review and meta-synthesis of qualitative studies on childbirth perineal trauma for the development of a Core Outcome Set

OBJECTIVES

Perineal injury occurs in 85% of cases during vaginal childbirth. This study aimed to synthesize qualitative data on women's perceptions of perineal trauma during vaginal childbirth.

STUDY DESIGN

Thematic synthesis was applied utilizing a structured three-step framework. First, line-by-line coding strategy was applied to the included studies. Secondly, related codes were grouped together to develop descriptive themes to emphasize what matters most for women suffering from childbirth perineal trauma. Thirdly, analytical themes were developed. The quality of the included studies was high based on the assessment using the Critical Appraisal Skills Programme tool.

RESULTS

Ten eligible studies were included in the meta-synthesis. Twenty-three codes encompassing multiple aspects of childbirth trauma from women's perspective were organised into a set of eight descriptive themes: psychosocial effects, communication, recovery, pain, support, knowledge of childbirth perineal trauma, sexuality, and prioritization.

CONCLUSIONS

Among the descriptive themes, psychosocial effects, communication, and recovery exhibited the highest prevalence. The findings of this meta-synthesis may serve as a reporting guideline for future studies investigating the consequences of childbirth perineal trauma, ensuring that women's priorities are accurately reflected in reported outcomes.

Development and evaluation of the psychometric properties of a digital questionnaire for the evaluation of perinatal psychosocial needs

BACKGROUND

If the purpose of maternal education is for women to take control of their own health and that of their family in the process, it is essential to have a simple instrument that allows them to self-assess, globally, how prepared they are to face future childbirth and maternity. As there is nothing similar in our area, the objective of this study was to design a complete, specific measurement questionnaire, with good metric quality and in digital format, for the assessment of perinatal psychosocial needs.

METHODS

A cross-sectional study was carried out, to evaluate the psychometric properties of a digital measurement questionnaire. The questionnaire was developed in 4 steps following the recommendations of the International Test Commission. The participants were 263 pregnant women who were recruited in primary health care appointments in the Basque Healthcare Service (Osakidetza); they completed the newly created questionnaire and all the test selected as gold standard. Their mean age was 33.55 (SD = 4.73). The analysis of the psychometric characteristics was based on mixed expert judgment procedures (focus group of healthcare professionals, item assessment questionnaire and interviews with users) and quantitative procedures (EFA, CFA, association with the gold standard and classification agreement index, ordinal alpha and McDonald's omega).

RESULTS

The final version of the questionnaire was made up of 55 items that evaluate 8 aspects related to perinatal psychosocial well-being (anxious-depressive symptoms, pregnancy acceptance, partner support, coping, internal locus of control, childbirth self-efficacy, perception of childbirth as a medicalized event, and fear of childbirth). Various tests were made of the validity and reliability of the scores, providing metric guarantees for their use in our context.

CONCLUSIONS

The use of this complete, quick-to-use tool with good psychometric properties will allow pregnant women to take stock of their situation, assess whether they have the necessary resources in the psychological and social sphere, and work together with midwives and other health professionals in the areas that are lacking.

The Emotional Landscape of Pregnancy and Postpartum during the COVID-19 Pandemic in Italy: A Mixed-Method Analysis Using Artificial Intelligence

The COVID-19 pandemic affected the perinatal emotional landscape in Italy, a country that had high mortality and implemented a strict lockdown during the pandemic. This study explores the emotions and challenges of pregnant and postpartum women during the pandemic, using AI-based mixed methods. The study analyzed 1774 women from the national survey COVID-ASSESS: 1136 pregnant and 638 postpartum women. The survey had qualitative questions on emotions and feelings related to birth, communication with healthcare professionals, media, and peers and family. We used natural language processing and machine learning to classify emotions, identify themes, and extract citations from the data. Fear and anxiety replaced joy as dominant emotions during the pandemic: trust and joy decreased by 49.3% and 36.4%, respectively, while sadness and fear increased by 52.3% and 49.3%, respectively. The pandemic also induced loneliness, isolation, frustration, and anger. Women faced challenges related to birth, communication with HCPs, media, and peers and family. They also used coping strategies such as self-care, news limitation, and trying to cultivate gratitude and hope. This study provides a comprehensive exploration of the perinatal emotional landscape of Italian women during the pandemic. The findings underscore the significant psychological impact of the pandemic and also highlight women's resilience and coping strategies.

Family centered nursing practices towards women and their families in the birthing context: A qualitative systematic review

AIM

Synthesize qualitative evidence examining how nurses' attitudes, beliefs, and sense of efficacy and the context surrounding birth facilitate or hinder family-centered nursing practice.

DESIGN

Thematic synthesis of qualitative studies.

METHODS

A literature search was conducted in CINAHL, MEDLINE, PsycINFO, SCOPUS, SCIENCE DIRECT, REPÈRES, CAIRN, and ÉRUDIT from October 2020 to June 2021. The PRISMA guidelines were followed, and studies were critically appraised using the Critical Appraisal Skills Programme checklist. Data were extracted by two independent reviewers, and Thomas and Harden's qualitative thematic synthesis method was performed for data analysis.

RESULTS

Thirteen studies were included. Three analytical themes were generated: (1) sharing power: opposing beliefs, (2) feeling a sense of efficacy in fulfilling one's role, and (3) managing a challenging work environment.

PATIENT OR PUBLIC CONTRIBUTION

Synthesizing nurses' experience is essential to promote implementation of favourable changes for care that is more focused on the needs of families.

Approaches and geographical locations of respectful maternity care research: A scoping review

BACKGROUND

Peripartum mistreatment of women contributes to maternal mortality across the globe and disproportionately affects vulnerable populations. While traditionally recognized in low/low-middle-income countries, the extent of research on respectful maternity care and the types of mistreatment occurring in high-income countries is not well understood. We conducted a scoping review to 1) map existing respectful maternity care research by location, country income level, and approach, 2) determine if high-income countries have been studied equally when compared to low/low-middle-income countries, and 3) analyze the types of disrespectful care found in high-income countries.

METHODS

A systematic search for published literature up to April 2021 using PubMed/MEDLINE, EMBASE, CINAHL Complete, and the Maternity & Infant Care Database was performed. Studies were included if they were full-length journal articles, published in any language, reporting original data on disrespectful maternal care received from healthcare providers during childbirth. Study location, country income level, types of mistreatment reported, and treatment interventions were extracted. This study was registered on PROSPERO, number CRD42021255337.

RESULTS

A total of 346 included studies were categorized by research approach, including direct labor observation, surveys, interviews, and focus groups. Interviews and surveys were the most common research approaches utilized (47% and 29% of all articles, respectively). Only 61 (17.6%) of these studies were conducted in high-income countries. The most common forms of mistreatment reported in high-income countries were lack of informed consent, emotional mistreatment, and stigma/discrimination.

CONCLUSIONS

Mapping existing research on respectful maternity care by location and country income level reveals limited research in high-income countries and identifies a need for a more global approach. Furthermore, studies of respectful maternity care in high-income countries identify the occurrence of all forms of mistreatment, clashing with biases that suggest respectful maternity care is only an issue in low-income countries and calling for additional research to identify interventions that embrace an equitable, patient-centric empowerment model of maternity care.

Persian version of the support and control in birth questionnaire among Iranian women

BACKGROUND

Lack of perceived support and control during labor and childbirth is known as an important predictor of post-traumatic stress disorder following childbirth. However, there is no standard scale to measure perceived support and control for Iranian women. This study determined the validity and reliability of the support and control in birth questionnaire for Iranian women.

MATERIALS AND METHODS

Support and control in the birth questionnaire were translated into Persian by the forward and backward translation method in 2019. Among a total of 102 healthcare centers in Tabriz, 50 urban and 10 rural centers were selected randomly. Then, 660 women with vaginal childbirth during the postpartum period were extracted by each center and selected randomly. The validity of the Persian version was evaluated in terms of face, content, and construct validity. Internal consistency and reliability were assessed by Cronbach's alpha coefficient and intraclass correlation coefficient, respectively. Exploratory and confirmatory factor analyses were used for evaluating the construct validity of the tool.

RESULTS

Cronbach's alpha coefficient (0.95) and intraclass correlation coefficient (0.99) were acceptable. In an exploratory analysis, three factors were extracted and these three factors explained 63.1% of the total variance. Items 14 and 17 were removed from the Persian version due to low factor loading and impact factor values. Confirmatory factor analysis supported the three factors extracted in the exploratory analysis. Confirmatory factor analysis showed suitable indexes of fitness for 31 items.

CONCLUSION

Persian version of the support and control in the birth questionnaire is a valid and reliable tool for the Iranian women population.

The Experience of Pregnancy and Childbirth Overshadowed by Obstetric Violence and Structural Barriers of the Israeli Health System from the Perspective of Arab and Jewish Women

The aim of this study was to give a voice to Arab and Jewish women in Israel who had suffered obstetric violence during various stages of fertility treatments, pregnancy, and childbirth and also to learn from the women about their experiences of obstetric violence subject to the barriers of the Israeli health system, and their recommendations of possible solutions. The study underlines the unique gender, social, and cultural context in Israel concerning pregnancy and childbirth, and was based on the feminist approach that strives to promote human rights, and eradicate phenomena of gender-related, patriarchal, and social structures. The study used a qualitative-constructivist methodology. Twenty semi-structured interviews with ten Arab women and ten Jewish women were thematically analyzed, and five main themes emerged: first, the women's experience of becoming pregnant and pregnancy overshadowed by physical and emotional barriers from caregivers and the close environment; second, the women's awareness of their bodies and needs during pregnancy dominated by the challenges of the health services; third, the women's awareness of their bodies and needs during childbirth alongside incompatible expectations and nonattentive medical staff; fourth, the women's descriptions of experiences and types of obstetric violence; and fifth, the women's recommendations to eradicate obstetric violence.

Labouring women perspectives on mistreatment during childbirth: a qualitative study

BACKGROUND

Respectful care during labour and childbirth, which has recently received a great deal of attention around the world, is vital for providing high-quality maternity care. However, this area has been underexplored in developing countries including Iran.

RESEARCH AIM

This study aimed to assess postpartum women's views regarding disrespect and abuse during labour and childbirth in Iran.

METHODS

A qualitative study that involved a purposive sample of 21 postpartum women was conducted in Tehran, Iran, between 2019 and 2020. Following the semi-structured individual interviews, a conventional content analysis was performed.

ETHICAL CONSIDERATIONS

This research approved by Shahid Beheshti University of Medical Sciences in Tehran, Iran, with the ethical approval number 1396.810. Following explanation of the study's objectives, eligible women consented to participate in the study. The confidentiality of the participants' information and the anonymity of the analysis were maintained at all stage of the study. All data was stored on the password protected file in the researcher computer The findings were only disseminated in summary form, with no identifying of individual participants.

RESULTS

Analysis of the data resulted in two main themes: 'inappropriate interaction' and 'inadequate quality care'. The 'inappropriate interaction' theme includes 'lack of empathy' and 'verbal abuse'. The second theme includes five sub-themes 'lack of participation in decision-making', 'lack of privacy', 'ignorance of women's pain and medical needs', 'rushed labour and painful procedures', and "unsatisfying facilities'.

CONCLUSION

Providing supportive care, respectful communication, adequate participation in decision-making, maintaining privacy, attending to women's labour pain and medical needs, and improving the quality of the physical birth environment are all examples of what labouring women consider to be respectful maternity care. To minimise disrespect and maltreatment of women during childbirth, an all-inclusive strategy engaging women, communities, healthcare professionals, managers, and educators is required.

Consent and refusal of procedures during labour and birth: a survey among 11 418 women in the Netherlands

BACKGROUND

Informed consent for medical interventions is ethically and legally required; an important aspect of quality and safety in healthcare; and essential to person-centred care. During labour and birth, respecting consent requirements, including respecting refusal, can contribute to a higher sense of choice and control for labouring women. This study examines (1) to what extent and for which procedures during labour and birth women report that consent requirements were not met and/or inadequate information was provided, (2) how frequently women consider consent requirements not being met upsetting and (3) which personal characteristics are associated with the latter.

METHODS

A national cross-sectional survey was conducted in the Netherlands among women who gave birth up to 5 years previously. Respondents were recruited through social media with the help of influencers and organisations. The survey focused on 10 common procedures during labour and birth, investigating for each procedure if respondents were offered the procedure, if they consented or refused, if the information provision was sufficient and if they underwent unconsented procedures, whether they found this upsetting.

RESULTS

13 359 women started the survey and 11 418 met the inclusion and exclusion criteria. Consent not asked was most often reported by respondents who underwent postpartum oxytocin (47.5%) and episiotomy (41.7%). Refusal was most often over-ruled when performing augmentation of labour (2.2%) and episiotomy (1.9%). Information provision was reported inadequate more often when consent requirements were not met compared with when they were met. Multiparous women had decreased odds of reporting unmet consent requirements compared with primiparous (adjusted ORs 0.54-0.85). There was considerable variation across procedures in how frequently not meeting consent requirements was considered upsetting.

CONCLUSIONS

Consent for performing a procedure is frequently absent in Dutch maternity care. In some instances, procedures were performed in spite of the woman's refusal. More awareness is needed on meeting necessary consent requirements in order to achieve person-centred and high-quality care during labour and birth.

Women's subjective perceptions and background factors associated with poor maternal childbirth experience among induced and spontaneous onset of labour: a two-year tertiary hospital cohort study

BACKGROUND

Women undergoing induction of labour (IOL) more often have poor childbirth experience compared to women with spontaneous onset of labour (SOL). For understanding and optimizing childbirth experience in IOL, we investigated the subjective maternal reasons and perceptions leading to poor childbirth experience in IOL compared to SOL, as well as the background factors and delivery outcomes associated with the poor experience.

METHODS

Two-year retrospective cohort study included 836/19442 deliveries (4.3%) with poor childbirth experience in induced or spontaneous onset at term in Helsinki University Hospital. Poor childbirth experience occurred in 389/5290 (7.4%) cases of IOL and in 447/14152 (3.2%) of SOL. Childbirth experience was measured after delivery using Visual Analog Scale (VAS) score, with poor experience defined as VAS < 5. The primary outcome of the study were the maternal reasons for poor childbirth experience. The parameters were collected in the hospital database and statistical analyses were performed by using Mann-Whitney U-test and t-test.

RESULTS

The subjective maternal reasons for poor childbirth experience were pain (n = 529, 63.3%), long labour (n = 209, 25.0%), lack of support by care givers (n = 108, 12.9%), and unplanned caesarean section (CS) (n = 104, 12.4%). The methods of labour analgesia were similar among the women who expressed pain as the main reason compared with those who didn't. When comparing the reasons according to the onset of labour, IOL group more often reported unplanned CS (17.2% vs. 8.3%; p < 0.001) and lack of support by the care givers (15.4% vs. 10.7%; p = 0.04), while SOL group more often named pain (68.7% vs. 57.1%; p = 0.001) and rapid labour (6.9% vs. 2.8%; p = 0.007). In multivariable logistic regression model, IOL was associated with lower risk for pain compared to SOL (adjusted OR 0.6, 95%CI 0.5-0.8; p < 0.01). Primiparas more often reported long labour (29.3% vs. 14.3%; p < 0.001) and concern over own or baby's wellbeing (5.7% vs. 2.1%; p = 0.03) compared to multiparas. Women who feared childbirth more often reported lack of support compared to women with no fear (22.6% vs. 10.7%; p < 0.001).

CONCLUSION

The main reasons for poor childbirth experience were pain, long labour, unplanned CS and the lack of support by care givers. The childbirth experience is complex and could be optimized by information, support and presence of care givers especially in induced labour.

Women's negative childbirth experiences and socioeconomic factors: Results from the Babies Born better survey

OBJECTIVE

To investigate the association between women's socioeconomic status and overall childbirth experience and to explore how women reporting an overall negative birth experience describe their experiences of intrapartum care.

METHODS

We used both quantitative and qualitative data from the Babies Born Better (B3) survey version 2, including a total of 8317 women. First, we performed regression analyses to explore the association between women's socioeconomic status and labour and birth experience, and then a thematic analysis of three open-ended questions from women reporting a negative childbirth experience (n = 917).

RESULTS

In total 11.7% reported an overall negative labour and birth experience. The adjusted odds ratio (OR) of a negative childbirth experience was elevated for women with non-tertiary education, for unemployed, students and not married or cohabiting. Women with lower subjective living standard had an adjusted OR of 1.70 (95% CI 1.44-2.00) for a negative birth experience, compared with those with average subjective living standard. The qualitative analysis generated three themes: 1) Uncompassionate care: lack of sensitivity and empathy, 2) Impersonal care: feeling objectified, and 3) Critical situations: feeling unsafe and loss of control.

CONCLUSION

Important socioeconomic disparities in women's childbirth experiences exist even in the Norwegian setting. Women reporting a negative childbirth experience described disrespect and mistreatment as well as experiences of insufficient attention and lack of awareness of individual and emotional needs during childbirth. The study shows that women with lower socioeconomic status are more exposed to these types of experiences during labour and birth.

TWEETABLE ABSTRACT

Women with lower socioeconomic status are more exposed to negative experiences during labour and birth.

The relationship of childbirth experience with postpartum depression and anxiety: a cross-sectional study

BACKGROUND

The childbirth experience is a personal life event that is influenced by physiologic and mental-psychological processes. Due to the prevalence of psychiatric problems after childbirth, it is important to recognize the factors affecting women's emotional reactions. This study was conducted to define the relationship of childbirth experience with postpartum anxiety and depression.

METHODS

This cross-sectional study was conducted on 399 women from 1 to 4 months after their childbirth who were referred to health centers in Tabriz-Iran from January 2021 to September 2021. Socio-demographic and obstetric characteristics questionnaire, Childbirth Experience Questionnaire (CEQ 2.0), Edinburgh Postpartum Depression Scale (EPDS), and Postpartum Specific Anxiety Scale (PSAS) were used to collect the data. The general linear modeling was used along with adjustment of socio-demographic characteristics to determine the relationship between the childbirth experience with depression and anxiety.

RESULTS

The mean (SD) of the overall score for childbirth experience, anxiety, and depression were 2.9 (0.2) (score range: 1 to 4), 91.6 (4.8) (score range: 0 to153), and 9.4 (0.7) (score range: 0 to 30), respectively. There was a significant inverse correlation between the overall score of childbirth experiences, the depression score (r= -0.36, p < 0.001), and the anxiety score (r= -0.12, p = 0.028) based on the Pearson correlation test. According to the general linear modeling and with adjustment of socio-demographic characteristics, with the increasing score of the childbirth experience, the depression score decreased (B= -0.2; 95%CI: -0.3 to -0.1). Moreover, the variable of control during pregnancy was a predictor for postpartum depression and anxiety, so in women with the control during pregnancy, the mean score of postpartum depression (B= -1.8; CI 95%: -3.0 to -0.5; P = 0.004) and anxiety (B=-6.0; CI 95%: -10.1 to -1.6; P = 0.007) was less.

CONCLUSION

Based on the study results, postpartum depression and anxiety are related to childbirth experiences, therefore considering the effects of mothers' mental health on other aspects of a woman and her family's life, the core role of health care providers and policymakers in creating positive childbirth experiences is determined.

Obstetric Violence among Pregnant Jordanian Women: An Observational Study between the Private and Public Hospitals in Jordan

BACKGROUND

Obstetric Violence (OV) is a public health matter that affects women and their children with an incidence rate between 18.3-75.1% globally. The delivery institution of public and private sectors represents a potential factor contributing to OV. This study aimed to assess OV existence among sample of pregnant Jordanian women and its risk factors domains between public and private hospitals.

METHODOLOGY

This is a case-control study including 259 recently delivered mothers from Al-Karak Public and Educational Hospital and The Islamic Private Hospital. A designated questionnaire including demographic variables and OV domains was used for data collection.

RESULTS

A significant difference was seen between patients delivering in the public sector compared to patients delivering the private sector in education level, occupation, monthly income, delivery supervision and overall satisfaction. Patients delivering in the private sector showed a significantly less physical abuse by the medical staff compared to patients delivering in the public sector, and patients delivering in a private room also showed a significantly less OV and risk of physical abuse compared to patients delivering in shared room. In public settings, medications information was lesser versus the private ones, additionally, there is significant association between performing episiotomy, physical abuse by staff and the delivery in shared rooms in private settings.

CONCLUSION

This study showed that OV was less susceptible during childbirth in private settings compared to public settings. Educational status, low monthly income, occupation are risk factors for OV; also, features of disrespect and abuse like obtaining consent for episiotomy performance, delivery provision updates, care perception based on payment ability and medication information were reported.

Relationship between birth memories and recall and perception of traumatic birth in women in the postpartum one-year period and affecting factors

This study examines the relationship between birth memory and recall and the perception of traumatic birth in women who were a postpartum one-year period and the affecting factors. This descriptive and correlational study was conducted with 285 participants in the pediatric department of a state university medical school. Data were collected using a participant information form, Birth Memories and Recall Questionnaire, and Perception of Traumatic Childbirth Scale. In the study, it was determined that the women had a moderate level of birth memories and recall, and the rate of those with a "high" and "very high" perception of traumatic childbirth was 45.9%. According to path analysis, Birth Memories and Recall Questionnaire score and educational status (primary secondary school) have a positive and significant effect on the perception of traumatic birth. The perception of traumatic birth was a predictor that explained 17.3% of birth memories and recall. Nearly half of the study participants perceived the experience of giving birth as traumatic, and birth memories and recall were at a moderate level. Improving women's perception of education and traumatic birth will contribute to positive birth memories and to create positive emotions when they remember their birth.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-023-04336-3.

Factors that Promote a Positive Childbearing Experience: A Qualitative Study

INTRODUCTION

Experiences of pregnancy and birth are important and have long-term impacts on the well-being of women and their families. Perinatal services should aim for care that promotes a positive childbearing experience, as well as optimizing health outcomes for the woman and newborn. This study aimed to understand the health system factors that promote a positive childbearing experience.

METHODS

Women who had a positive experience and had given birth in Australia in the previous 12 months were recruited for individual semistructured interviews. The interview guide focused on health system factors that participants credited with contributing to their positive experience of perinatal care. Interviews were conducted until data saturation was reached. Qualitative data were transcribed verbatim and analyzed using inductive thematic analysis.

RESULTS

Data from 36 interviews were thematically analyzed, and 4 major themes were generated: health care provider attributes, health system attributes, communication and decision-making, and experience of care. The salient factors that promoted positive experiences included care that was respectful and individualized with effective communication, access to midwifery continuity of care models, and good integration between services. Competent and professional health care providers who facilitated shared decision-making were also essential.

DISCUSSION

Although women often sought out care that promoted physiologic birth, they emphasized that the way they were cared for was more important than fulfilling specific birth aspirations. Quality maternity care has the capacity to support a woman's confidence in her own abilities and promote a positive, and sometimes transformative, childbearing experience.

The voice of memory in hospital birth: A phenomenological study

OBJECTIVE

To examine the perception of the hospital birth experience in women at 8 weeks and 8 months after the birth and to determine if there have been any changes in that perception.

DESIGN

This was a prospective qualitative study with a phenomenological approach based on semi-structured, individual and in-depth interviews at 8 weeks and 8 months after childbirth as well as participant's observations. The data were transcribed and analysed thematically using ATLAS.ti 8 software.

PARTICIPANTS

43 women participated in the first interview, and 33 of those participated in the second interview.

SETTING

Donostia University Hospital, Gipuzkoa, Spain, 2016-2017.

FINDINGS

Two main topics emerged from the data analysis which summarize the women's perception of childbirth: (1) memory allows us to recall the experience of hospital birth in time and space; (2) some moments are specially remembered. In the second topic, three subtopics were distinguished: fondest memory: meeting the newborn for the first time; highlighted positive memories: support from partners and professionals; and the worst memories were marked by feelings of worry and fear.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

In the perception of the birth experience, positive and negative memories remain in intensity and continuity for at least up to 8 months. Their creation and evocation are highly influenced by the emotional experience and the initial visual impact of meeting the newborn for the first time, which constitutes a milestone in women's lives. The emotions experienced in childbirth and during the postpartum period shape the awareness, memory and new identity of being a mother.

Adaption and validation of the childbirth experience questionnaire (CEQ-SK) in Slovakia

INTRODUCTION

Using validated and reliable instruments to examine women's birth experiences is important to ensure respectful care. There is a lack of validated instruments for evaluating childbirth care in the Slovak context. In this study, we aimed to adapt and validate the childbirth experience questionnaire (CEQ) in Slovakia (CEQ-SK).

METHOD

The CEQ-SK was developed and modified from the English version of the CEQ/CEQ2. Face validity was tested in two pre-tests. A convenience sample, recruited through social media, included 286 women who had given birth within the last six months. Reliability was assessed using Cronbach's alpha. Construct and discriminant validity was assessed by exploratory factor analysis and known-group comparison.

RESULTS

The exploratory factor analysis revealed a three-dimensional structure, explaining 63.3% of the total variance. The factors were labelled 'Own capacity', 'Professional support' and 'Decision making'. No items were excluded. Internal consistency was demonstrated with an overall Cronbach's alpha of 0.94 for the total scale. Primiparous women, women who had an emergency cesarean section, and women who had been exposed to the Kristeller manoeuvre had a lower overall score on the CEQ-SK compared to parous women, women having a vaginal birth and women not exposed to the Kristeller manoeuvre.

CONCLUSION

The CEQ-SK was found to be a valid and reliable tool for evaluating childbirth experience in Slovakia. The original CEQ is a four-dimensional questionnaire; however, factor analysis showed a three-dimensional structure in the Slovak sample. This needs to be taken into consideration when comparing the results from the CEQ-SK with studies that use the four-dimensional structure.

Challenging norms: Making non-normative choices in childbearing. Results of a meta ethnographic review of the literature

OBJECTIVE

Women have the right to make choices during pregnancy and birth that sit outside clinical guidelines, medical recommendations, or normative expectations. Declining recommended place or mode of birth, routine intervention or screening can be considered 'non-normative' within western cultural and social expectations around pregnancy and childbirth. The aim of this review is to establish what is known about the experiences, views, and perceptions of women who make non-normative choices during pregnancy and childbirth to uncover new understandings, conceptualisations, and theories within existing literature.

METHODS

Using the meta-ethnographic method, and following its seven canonical stages, a systematic search of databases was performed, informed by eMERGe guidelines.

FINDINGS

Thirty-three studies met the inclusion criteria. Reciprocal translation resulted in three third order constructs - 'influences and motivators', 'barriers and conflict and 'knowledge as empowerment'. Refutational translation resulted in one third order construct - 'the middle ground', which informed the line of argument synthesis and theoretical insights.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The findings of this review suggest that whilst existing literature from a range of high-income countries with similar healthcare systems to the UK have begun to explore non-normative decision-making for discrete episodes of care and choices, knowledge based, theoretical and population gaps exist in relation to understanding the experiences of, and wider social processes involved in, making non-normative choices across the UK maternity care continuum.

“I shut it out”: expectant mothers’ fear of childbirth after a traumatic birth—a phenomenological study

Purpose

To describe expectant mothers’ experiences of fear of childbirth after a previous traumatic birth.

Method

Qualitative, individual, in-depth interviews were conducted with eight expectant mothers between September and November 2020. Data were analysed using a descriptive phenomenological approach.

Results

We identified four interconnected constituents: Suboptimal midwifery care, loss of control and agency; insufficient time and capacity to process a traumatic birth experience; “The baby has to be delivered!”, and finally, the path to a new childbirth with the hope of mastering fears.

Conclusion

Findings reveal an association between a previous history of traumatic birth and a fear of childbirth in expectant mothers. The trauma they experienced whilst giving birth strongly impacted their subsequent pregnancy, making it difficult for them to deal with the new pregnancy and impending birth. Women who have experienced a traumatic birth need to have the opportunity to process the trauma. Routines must therefore be developed that identify, support and follow up with the women. If these women are identified and given the help they need, this may help prevent and/or alleviate fear of childbirth in their subsequent pregnancy.

The impacts of the COVID-19 pandemic on birth satisfaction and birth experiences in Russian women

Background

Women's satisfaction with their childbirth experiences has significant impacts on their health and the health of their children. Recently, childbirth and maternity care systems have been disrupted by the COVID-19 pandemic. This study aimed to investigate the association of birth satisfaction with mode of birth, medical interventions, support during labour, type of childbirth healthcare plan and antenatal education in the context of the COVID-19 pandemic in Russia.

Methods

1,645 Russian women who gave birth during the first year of the COVID-19 pandemic and 611 matched controls who gave birth in the previous year participated in an anonymous Internet survey about their childbirth experience. The survey included questions regarding women's demographic and obstetric characteristics as well as their childbirth experiences. Birth satisfaction was measured using the Birth Satisfaction Scale Revised Indicator (BSS-RI).

Results

Birth satisfaction scores did not show notable changes before and during the pandemic (Pearson Chi-square = 19.7, p = 0.22). Women had lower BSS-RI scores if they tested positive for COVID-19 during labour (F = 9.18, p = 0.002), but not during pregnancy or postpartum (p > 0.32). In both cohorts women who had vaginal births rated birth satisfaction higher than those who had caesarean births. The more medical interventions there were, the lower were the BSS-RI scores (B = -0.234, 95% CI: -0.760; -0.506, p < 0.001), but only during the pandemic. Birth satisfaction was higher if women had a support person present during labour (F > 7.44, p < 0.001), which was not possible for over 70% of participants during the pandemic. In both cohorts birth satisfaction was associated with the childbirth healthcare plan (F > 5.27, p < 0.001), but not with antenatal education (F < 0.15, p > 0.43).

Conclusions

Our study highlights the significant impacts of the COVID-19 pandemic on the birth experiences of Russian women. Sustaining the rights of women to informed decisions during labour, respect for their preferred childbirth healthcare plan, presence of the birth team of choice and professional support for home birth are essential for higher birth satisfaction and better health outcomes for mothers and their infants.

Developing a woman-centered, inclusive definition of traumatic childbirth experiences: A discussion paper

INTRODUCTION

Many women experience giving birth as traumatic. Although women's subjective experiences of trauma are considered the most important, currently there is no clear inclusive definition of a traumatic birth to help guide practice, education, and research.

AIM

To formulate a woman-centered, inclusive definition of a traumatic childbirth experience.

METHODS

After a rapid literature review, a five-step process was undertaken. First, a draft definition was created based on interdisciplinary experts' views. The definition was then discussed and reformulated with input from over 60 multidisciplinary clinicians and researchers during a perinatal mental health and birth trauma research meeting in Europe. A revised definition was then shared with consumer groups in eight countries to confirm its face validity and adjusted based on their feedback.

RESULTS

The stepwise process confirmed that a woman-centered and inclusive definition was important. The final definition was: "A traumatic childbirth experience refers to a woman's experience of interactions and/or events directly related to childbirth that caused overwhelming distressing emotions and reactions; leading to short and/ or long-term negative impacts on a woman's health and wellbeing."

CONCLUSIONS

This definition of a traumatic childbirth experience was developed through consultations with experts and consumer groups. The definition acknowledges that low-quality provider interactions and obstetric violence can traumatize individuals during childbirth. The women-centered and inclusive focus could help women to identify and validate their experiences of traumatic birth, offering benefits for practice, education, and research, as well as for policymaking and activism in the fields of perinatal mental health and respectful maternity care.

Fear of childbirth: validation of the Kiswahili version of Wijma delivery expectancy/experience questionnaire versions A and B in Tanzania

BACKGROUND

Fear of childbirth is common both before and after childbirth, often leading to complications in mother and new-born. The Wijma Delivery Expectancy/Experience Questionnaires (W-DEQ) are commonly used to measure fear of childbirth among women before (version A) and after childbirth (version B). The tools are not yet validated in the Tanzanian context. This study aimed to validate the reliability, validity, and factorial structure of their Kiswahili translations.

METHODS

A longitudinal study was conducted in six public health facilities in the Pwani region, Tanzania. In all, 694 pregnant and 625 postnatal women were concurrently selected and responded to W-DEQ-A and W-DEQ-B. Validation involved: translating the English questionnaires into Kiswahili; expert rating of the relevancy of the Kiswahili versions' items; computing content validity ratio; piloting the tools; data collection; statistical analysis with reliability evaluated using Cronbach's alpha and the intraclass correlation coefficient. Tool validity was assessed using factor analysis, convergent and discriminant validity. Exploratory factor analysis and confirmatory factor analysis were conducted on data collected using W-DEQ-A and W-DEQ-B, respectively.

RESULTS

Exploratory factor analysis revealed seven factors contributing to 50% of the total variation. Four items did not load to any factor and were deleted. The factors identified were: fear; lack of self-efficacy; lack of positive anticipation; isolation; concerns for the baby; negative emotions; lack of positive behaviour. The factors correlated differently with each other and with the total scores. Both Kiswahili versions with 33 items had good internal consistency, with Cronbach's alphas of .83 and .85, respectively. The concerns for the baby factor showed both convergent and discriminant validity. The other six factors showed some problems with convergent validity. The final model from the confirmatory factor analysis yielded 29 items with good psychometric properties (χ²/df = 2.26, p =  < .001, RMSEA = .045, CFI = .90 and TLI = .81).

CONCLUSIONS

The Kiswahili W-DEQ-A-Revised and W-DEQ-B-Revised are reliable tools and measure fear of childbirth with a multifactorial structure, encompassing seven factors with 29 items. They are recommended for measuring fear of childbirth among pregnant and postnatal Tanzanian women. Further studies are needed to address the inconsistent convergent validity in the revised versions and assess the psychometric properties of W-DEQ-A among pregnant women across gestational ages.

Becoming a mother during the COVID-19 pandemic: The lived experience as told by birthing mothers: A qualitative study

AIMS AND OBJECTIVES

The aim of this study is to explore the lived experience of women who gave birth during the COVID-19 pandemic.

BACKGROUND

Experiencing pregnancy during the Covid-19 pandemic exacerbates the risk of the onset of psychological problems.

DESIGN

This is a descriptive, single-centre, qualitative study.

METHODS

The enrolment for data collection included childbearing mothers aged 18 years and over between November 2021 and April 2022. The researchers invited them to write about their personal experiences during the isolation period of the first pandemic wave. The descriptive phenomenological analysis of the data was carried out using the method described by Mortari.

RESULTS

A total of 50 mothers were recruited, of whom 28 were primiparous (56.0%) and 22 multiparous (44.0%). From the analysis of the interviews, five main themes emerged that enclose the experience of both primiparous and multiparous mothers: 'The negative feeling: between loneliness, sadness and fear'; 'The comfort of being cared for: between humanity and competence'; 'Family proximity: between comfort and stress'; 'Symbiotic intimacy: bonding; Managing physical pain and consciousness of being resilient women'.

CONCLUSIONS

The study showed that the discomfort associated with the absence of family support in the phase of labour and childbirth was compensated by the professionalism of the health staff and allowed new mothers to experience moments of great intimacy with the child.

IMPLICATIONS FOR NURSING MANAGEMENT

Such data could help create recommendations based on the assisted person's experiences to ensure that care is increasingly attentive and tailored to the needs of mothers and, thus, of children.

A stigmatizing dilemma in the labour room: Irrationality or selfishness?

Nowadays, a considerable number of women have a negative or outright traumatic birth experience. Literature shows that being involved in decision-making and exercising autonomy are important factors in having a positive birth experience. In this article, I explore the hypothesis that some views characteristic of the biomedical model of childbirth may hinder women's involvement in decision-making, leading them to what I have dubbed as a 'stigmatizing dilemma'; that is, to be perceived and treated as either irrational or selfish when trying to exercise their autonomy in the labour room. I suggest that such a stigmatizing dilemma arises when the following views are uncritically and unqualifiedly endorsed: (1) childbirth is a process fraught with risk, particularly to babies; (2) labouring women's reports are unreliable and their subjective perspective does not constitute a valuable source of information; (3) medical knowledge and procedures are the safest means to give birth. In a scenario where (1)-(3) are strongly endorsed, if birthing women act according to instrumental rationality and want the best for their babies, they will be expected to just leave decisions to medical experts. Thus, not following expert directions might lead women to fall under the stigma of either irrationality or selfishness: they could be perceived and treated as either irrational, since they may not seem to seek the best means to accomplish their goal; or selfish, since they may seem to pursue goals other than the baby's health. I examine these stigmas in relation to two ideals: that of disembodied rationality and that of selfless motherhood. I also explore different ways in which the views and prejudices underlying this stigmatizing dilemma could be challenged.

Twin birth: The maternal experience

OBJECTIVE

Twin birth is a special setting for women giving birth, and the experience of childbirth can be different from singleton birth. The objective of this study was to evaluate and compare the childbirth experiences of twin mothers and singleton mothers. We also aimed to identify the risk factors of a negative childbirth experience in the whole study population.

METHODS

All live diamniotic twin deliveries in the study hospital of at least 35⁺⁰ weeks of gestation with a plan of vaginal birth were included in this matched groups study from August 2015 to August 2019. For every twin birth, two singleton birth controls were selected and matched with parity, the actual mode of birth, and gestational weeks at birth. Six weeks after birth, a Childbirth Experience Questionnaire (CEQ) was sent to mothers, and 72 twin mothers and 126 singleton mothers returned the questionnaire.

RESULTS

The twin mothers' overall childbirth experience was positive. They reported a significantly lower opportunity to choose the birthing position (p < 0.001). Otherwise, there were no differences in the CEQ mean total scores between the study groups. Intrapartum cesarean section raised the risk of a negative childbirth experience and there was a high level of satisfaction with midwifery care among the whole study population.

CONCLUSION

The overall maternal experience in planned vaginal twin birth was positive. Twin mothers felt less often able to choose their birthing position, otherwise the childbirth experience did not differ from that of singleton mothers.

Maternal childbirth experience and time in labor: a population-based cohort study

A negative childbirth experience may have long term negative effects on maternal health. New international guidelines allow a slower progress of labor in the early active phase. However, a longer time in labor may influence the childbirth experience. In this population-based cohort study including 26,429 women, who gave birth from January 2016 to March 2020, the association between duration of different phases of active labor and childbirth experience was studied. The women assessed their childbirth experience by visual analogue scale (VAS) score. Data was obtained from electronic medical records. The prevalence of negative childbirth experience (VAS 1–3) was 4.9%. A significant association between longer duration of all labor phases and a negative childbirth experience was found for primi- and multipara. The adjusted odds ratio (aOR (95%CI)) of negative childbirth experience and longer time in active labor (above the 90th percentile) in primipara was 2.39 (1.98–2.90) and in multipara 2.23 (1.78–2.79). In primi-and multipara with duration of labor ≥ 12 h or ≥ 6 h the aOR (95%CI) of negative childbirth experience were 2.22 (1.91–2.58) and 1.91 (1.59–2.26) respectively. It is of great importance to identify and optimize the clinical care of women with longer time in labor to reduce the risk of negative childbirth experience and associated adverse long-term effects.

Disrespect and abuse during labour and birth amongst 12,239 women in the Netherlands: a national survey

Background

Women experience disrespect and abuse during labour and birth all over the world. While the gravity of many forms of disrespect and abuse is evident, some of its more subtle forms may not always be experienced as upsetting by women. This study examines (1) how often women experience disrespect and abuse during labour and birth in the Netherlands and (2) how frequently they consider such experiences upsetting. We also examine (3) which respondent characteristics (age, ethnicity, educational level and parity) are associated with those experiences of disrespect and abuse that are upsetting, and (4) the associations between upsetting experiences of disrespect and abuse, and women’s labour and birth experiences.

Methods

Women who gave birth up to five years ago were recruited through social media platforms to participate in an online survey. The survey consisted of 37 questions about experiences of disrespect and abuse divided into seven categories, dichotomised in (1) not experienced, or experienced but not considered upsetting (2) experienced and considered upsetting. A multivariable logistic regression analysis was performed to examine associated characteristics with upsetting experiences of disrespect and abuse. A Chi-square test was used to investigate the association between upsetting experiences of disrespect and abuse and overall birth experience.

Results

13,359 respondents started the questionnaire, of whom 12,239 met the inclusion and exclusion criteria. Disrespect and abuse in terms of ‘lack of choices’ (39.8%) was reported most, followed by ‘lack of communication’ (29.9%), ‘lack of support’ (21.3%) and ‘harsh or rough treatment/physical violence’ (21.1%). Large variation was found in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. Primiparity and a migrant background were risk factors for experiencing upsetting disrespect and abuse in all categories. Experiencing more categories of upsetting disrespect and abuse was found to be associated with a more negative birth experience.

Conclusions

Disrespectful and abusive experiences during labour and birth are reported regularly in the Netherlands, and are often (but not always) experienced as upsetting. This emphasizes an urgent need to implement respectful maternity care, even in high income countries.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12978-022-01460-4.

Disrespect and abuse during labour and birth is a globally recognized phenomenon and has been linked to traumatic birth experiences and PTSD. In our study, we investigated how often women experience disrespect and abuse during labour and birth in the Netherlands and what proportion of these experiences was found to be upsetting. We also looked at risk factors for experiencing upsetting disrespect and abuse and to what extent upsetting disrespect and abuse influences the overall labour and birth experience.

We conducted an online survey, with 12,239 respondents included in the analysis. We found a large variation in how frequently certain types of disrespect and abuse were considered upsetting, with 36.3% of women experiencing at least one situation of disrespect and abuse as upsetting. More subtle forms of disrespect and abuse, such as lack of choice, communication or support, were most prevalent and often considered upsetting. Giving birth for the first time and having a migrant background were risk factors for experiencing upsetting disrespect and abuse. Upsetting disrespect and abuse was found to have a strong impact on the overall labour and birth experience; with every additional experienced category of upsetting disrespect and abuse, the number of (very) positive labour and birth experiences decreases and the number of very negative ones increases.

Although disrespect and abuse is a complex issue and its measurement subjective, this study shows that there is still a long way to go before achieving optimal respectful maternity care for all women, even in high income countries.

The experience of giving birth: a prospective cohort in a French perinatal network

Background

To assess women's positive and negative perceptions after giving birth. The secondary objectives were to identify the women who had a negative perception of their delivery, define the risk factors, and propose actions that maternity units can take to improve their management.

Methods/design

This study was a multicenter, prospective cohort, conducted in 23 French maternity units constituting one perinatal network, in 2019. All adult women who understood French and gave birth between February 1 and September 27, 2019, were eligible. The exclusion criterion was the woman's objection to participation. Validated self-administered questionnaire (QACE) was sent by email 6 weeks after the child's birth. The main outcome was the experience of childbirth, assessed on a scale of 0 to 10. A good experience was defined by a score ≥ 8/10, and a poor experience by a score < 5. A multinomial logistic regression model, expressed by cumulative proportional odds ratios, were used to determine the factors that might have affected women's experiences during childbirth.

Results

Two thousand one hundred and thirty-fifth women completed the questionnaire, for a participation rate of 49.6%. Overall, 70.7% (n = 1501/2121) of the women reported a good experience, including 38% (n = 807/2121) who graded their experience with the maximum score of 10. On the other hand, 7.3% (n = 156) of the women reported a poor experience. Vaginal delivery (aOR 3.93, 95%CI, 3.04–5.08) and satisfactory management (aOR 11.35 (7.69–16.75)) were the principal determining factors of a positive experience. Epidural analgesia increased the feeling of failure (aOR 5.64, 95%CI, 2.75–13.66). Receiving information and being asked for and agreeing to consent improved the global experience (P = 0.03).

Conclusion

The Identikit picture of the woman associated with a poor experience of childbirth shows a nullipara who had a complication during her pregnancy, gave birth after induction of labor, or by cesarean or operative vaginal delivery, with the newborn transferred for pediatric care, and medical management considered unsatisfactory.

Obstetric gaslighting and the denial of mothers' realities

Gaslighting is a type of abuse aimed at making victims question their sanity as well as the veracity and legitimacy of their own perspectives and feelings. In this article, we show how gaslighting can operate as a key, yet underexamined strategy of obstetric violence, or the institutional and interpersonal violation of women's rights during pregnancy, childbirth, and postpartum. We draw on forty-six in-depth, semi-structured interviews with mothers who experienced a traumatic childbirth to examine how obstetric providers gaslight mothers before, during and after childbirth when they deny - and thereby destabilize - mothers' realities. We identify and examine four core types of denials: denials of 1) mothers' humanity, 2) mothers' knowledge as valid, 3) mothers' judgements as rational and 4) mothers' feelings as legitimate. All four denials work to render mothers noncredible and their claims illegible within clinical encounters. In explicitly naming, theorizing, and examining obstetric gaslighting, our aims are threefold: 1) to uncover and theorize an underexamined mechanism of obstetric violence through a sociological lens, 2) to offer a typology of obstetric gaslighting's manifestations to aid scholars and practitioners in recognizing when obstetric gaslighting is occurring and 3) to advance a growing research program on gaslighting in medicine.

Women's Experiences of Physical Features in a Specially Designed Birthing Room: A Mixed-Methods Study in Sweden

Aim:

To explore women’s experiences of physical features in a birthing room designed to be adaptable to personal wishes and needs during labor and birth.

Background:

Childbirth is a central life event influenced by numerous factors, including the healthcare environment; however, there is insufficient knowledge on how the physical design affects women during birth.

Methods:

This study was part of a randomized controlled trial in the Room4Birth research project, including women randomized to receive care in a new birthing room designed with physical features changeable according to personal wishes. Data consisted of responses to two questions analyzed with descriptive statistics (n = 202) and semi-structured interviews analyzed for content (n = 19).

Results:

A total of 93.6% (n = 189) assessed the physical features in the birthing room as meaningful to a very high or high extent. The overall impression of the room was positive and exceeded women’s expectations. They felt welcomed and strengthened by the room, which shifted the focus to a more positive emotional state. The room differed from traditional hospital birthing rooms, contained familiar features that maintained integrity, and had space for companions. The variety of physical features was appreciated. Of nine listed physical features, the bathtub was ranked most important, followed by the projection of nature scenery, and dimmable lighting, but the room as a whole appeared most important.

Conclusions:

When planning and designing hospital-based birthing rooms, it is crucial to offer possibilities to adapt the room and physical features according to personal wishes.

An Investigation of the Relationship between Health Literacy Levels of Pregnant Women and Their Perceptions of Traumatic Childbirth

The researchers aimed to investigate the relationship between the health literacy levels of pregnant women and their perceptions of traumatic childbirth. The sample consisted of 384 pregnant women. The data were collected using the 'Pregnancy Information Form", the "Health Literacy-32 Scale," and the "Traumatic Birth Perception Scale." Health literacy levels of pregnant women were found to be inadequate (44%) and limited (43.5%). 56.8% of pregnant women had moderate, and 27.1% had a high perception of traumatic birth. A negative correlation was determined between the total score and sub-dimensions of the Health Literacy Scale of pregnant women (i.e. access to health information, understanding health information, protection from diseases, and health promotion) and their perceptions of traumatic birth (p < .001).

Female Relatives as Lay Doulas and Birth Outcomes: A Systematic Review

Continuous labor support provided by professional doulas is associated with improved birth outcomes for pregnant women and their infants. However, there is limited data on the impact of using female relatives as lay doulas. This systematic review included nine published studies that examined the association between use of female relatives as lay doulas with childbirth outcomes. In some study populations, there was a decrease in the number of cesarean births and length of labor, and in all studies, there was improved maternal birth satisfaction. However, the woman’s chosen female relative often did not receive education regarding labor support skills before providing continuous support. Educational programs designed to teach labor support skills to female relatives are needed.