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Hawker LA, Mundle S, Tripathy JP, Deshmukh P, Winikoff B, Weeks AD, Kingdon C, Lightly K. Preferences for induction of labor methods in India: a qualitative study of views and experiences of women, clinicians, and researchers. AJOG GLOBAL REPORTS 2024; 4:100389. [PMID: 39309608 PMCID: PMC11415567 DOI: 10.1016/j.xagr.2024.100389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/25/2024] Open
Abstract
Background Induction of labor (IOL) is an increasingly common intervention, but experiences and preferences of induction methods are under-researched particularly in low -and middle-income countries. Understanding these perspectives is important to improve the childbirth experience. Objective To explore the experiences and preferences of IOL methods for women, clinicians, and researchers in the "Misoprostol or Oxytocin for Labour Induction" (MOLI) study. Study Design This qualitative study was based in two government hospitals in the city of Nagpur, India-one tertiary referral hospital and one women's hospital. Fifty-three semi-structured interviews with women before and after induction (between days 1 and 5 postnatal), with women recruited to the "Misoprostol or Oxytocin for Labour Induction (MOLI)" randomized controlled trial (NCT03749902). Eight focus group discussions with doctors, nurses, and trial research assistants before and during trial delivery were conducted. Thematic analysis was conducted using the Framework approach. Results Four themes emerged: (1) IOL methods, (2) impact of the study, (3) IOL and childbirth as one small part of the wider experiences in life, and (4) key moments in the childbirth experience. For women, the safety of their baby was more important than any IOL method. Clinicians had apprehensions over misoprostol use which could affect protocol implementation; they reported that changing perception is difficult as usual practice feels "comfortable." Women wanted to share their experiences and reported key moments during childbirth including vaginal examinations, "trying for normal," bearing the pain, waiting, and relationships with staff. Conclusion Women did not have a strong preference for the IOL method and viewed childbirth positively when maternal and neonatal outcomes were good. Labor pain, vaginal examinations, a normal birth, and interactions with staff impacted women's experiences.
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Affiliation(s)
- Lydia A. Hawker
- Department of Women and Children's Health, University of Liverpool, Liverpool, UK (Hawker)
| | - Shuchita Mundle
- NagpurAll India Institute of Medical Sciences, Nagpur, India (Mundle)
| | - Jaya P. Tripathy
- All India Institute of Medical Sciences, Nagpur, India (Tripathy and Deshmukh)
| | - Pradeep Deshmukh
- All India Institute of Medical Sciences, Nagpur, India (Tripathy and Deshmukh)
| | | | - Andrew D. Weeks
- University of Central Lancashire (UCLan), Lancaster, UK (Weeks, Kingdon, Lightly)
| | - Carol Kingdon
- University of Central Lancashire (UCLan), Lancaster, UK (Weeks, Kingdon, Lightly)
| | - Kate Lightly
- University of Central Lancashire (UCLan), Lancaster, UK (Weeks, Kingdon, Lightly)
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Doering K, McAra-Couper J, Gilkison A. Attuning to the World of Peace of Mind and Trust: Women's Lived Experience of the Woman-Midwife Relationship in Japan. QUALITATIVE HEALTH RESEARCH 2024; 34:964-976. [PMID: 38365201 DOI: 10.1177/10497323241226568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
In Japan, many pregnant women and mothers suffer from anxiety, depression, and other postnatal issues that can be exacerbated by their birth experiences. While benefiting from advanced medical care, these women's mental and psychological health may be disregarded in their maternity care. Midwives have the potential to play a significant role in improving women's birth experiences. Hence, this study aimed to explore the meaning of the woman-midwife relationship, with a specific focus on sensing peace of mind and trust to improve women's birth experiences. Using a hermeneutic phenomenological approach, 14 Japanese women were interviewed. Sensing peace of mind and trust was one of the significant meanings of the woman-midwife relationship and is articulated across five themes: (1) attuning to the world, (2) different kinds of safety and trust, (3) relying on and entrusting midwives, (4) making a mother, and (5) an emotional bridge. The positive relationship with midwives enhanced the women's mental well-being through allowing the women to attune to the peaceful mind which directed their future perspectives and sustained them in motherhood. They became confident mothers by trusting their midwives. The maternity care system in Japan needs to shift to more relationship-based care to ensure continuity of midwifery care that will improve women's birth experiences and their long-term well-being.
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Affiliation(s)
- Keiko Doering
- Human Health Sciences, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Judith McAra-Couper
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
| | - Andrea Gilkison
- School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
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Jamshidimanesh M, Mohammadkhani N. Translation and adaptation of the person-centered maternity care scale to a Persian-speaking population: a confirmatory factor analysis. BMC Public Health 2024; 24:1619. [PMID: 38886704 PMCID: PMC11184814 DOI: 10.1186/s12889-024-19117-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Accepted: 06/12/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Recognized as the most exhaustive multidimensional evaluation of women's person-centered experiences during childbirth, the Person-Centered Maternity Care (PCMC) Scale offers domain-specific insights into facets of care. This instrument has yet to be translated into Persian. Hence, this study purposed to translate and ascertain the reliability and validity of a Persian version of the PCMC scale for postpartum women in Iran. METHODS A cross-sectional study was facilitated at multiple comprehensive health centers within Tehran, Iran, from February 2022 until July 2022. Postpartum women within seven days after childbirth who were referred to selected comprehensive health centers for newborn thyroid screening were conveniently sampled. The validation process for the questionnaire utilized confirmatory factor analysis (CFA), while it gauged convergent validity via factor loads, average variance extracted (AVE), along with composite reliability (CR). Discriminant credibility was evaluated utilizing HTMT alongside the Fornell-Larcker Criteria. Data analysis procedures were conducted through IBM SPSS Statistics for Windows Version 16 and SMART PLS Statistics for Windows Version 4.0.9.9. RESULTS All the items were within the acceptable range of factor loading, except for questions 3 of the facility and 6 of dignity, which were removed from the model. The AVE values for all the variables were above 0.50, and the CR values were above 0.78, indicating convergent validity. On the horizontal loading table, all of the indicators met the conditions. Additionally, the findings validate that the HTMT indicator associated with all constructs remained below 0.9, which confirms divergent relevance about the survey tool under consideration. The composite reliability values also indicated good overall reliability for all the constructs, ranging from 0.78 to 0.91. CONCLUSIONS The results of the present study indicate that the Persian version of the PCMC is a reliable and valid tool for measuring person-centered maternity care in Persian-speaking populations.
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Affiliation(s)
- Mansoureh Jamshidimanesh
- Department of Midwifery, School of Nursing and Midwifery, Iran University Medical and Sciences, Tehran, Iran
| | - Nafiseh Mohammadkhani
- Department of Midwifery, School of Nursing and Midwifery, Iran University Medical and Sciences, Tehran, Iran.
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Jafari E, Asghari-Jafarabadi M, Mirghafourvand M, Mohammad-Alizadeh-Charandabi S. Psychometric properties of the experiences of maternity care scale among Iranian women. BMC Health Serv Res 2024; 24:619. [PMID: 38734592 PMCID: PMC11088168 DOI: 10.1186/s12913-024-11065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 04/30/2024] [Indexed: 05/13/2024] Open
Abstract
BACKGROUND Assessing women's perceptions of the care they receive is crucial for evaluating the quality of maternity care. Women's perceptions are influenced by the care received during pregnancy, labour and birth, and the postpartum period, each of which with unique conditions, expectations, and requirements. In England, three Experience of Maternity Care (EMC) scales - Pregnancy, Labour and Birth, and Postnatal - have been developed to assess women's experiences from pregnancy through the postpartum period. This study aimed to validate these scales within the Iranian context. METHODS A methodological cross-sectional study was conducted from December 2022 to August 2023 at selected health centers in Tabriz, Iran. A panel of 16 experts assessed the qualitative and quantitative content validity of the scales and 10 women assessed the face validity. A total of 540 eligible women, 1-6 months postpartum, participated in the study, with data from 216 women being used for exploratory factor analysis (EFA) and 324 women for confirmatory factor analysis (CFA) and other analyses. The Childbirth Experience Questionnaire-2 was employed to assess the convergent validity of the Labour and Birth Scale, whereas women's age was used to assess the divergent validity of the scales. Test-retest reliability and internal consistency were also examined. RESULTS All items obtained an impact score above 1.5, with Content Validity Ratio and Content Validity Index exceeding 0.8. EFA demonstrated an excellent fit with the data (all Kaiser-Meyer-Olkin measures > 0.80, and all Bartlett's p < 0.001). The Pregnancy Scale exhibited a five-factor structure, the Labour and Birth Scale a two-factor structure, and the Postnatal Scale a three-factor structure, explaining 66%, 57%, and 62% of the cumulative variance, respectively, for each scale. CFA indicated an acceptable fit with RMSEA ≤ 0.08, CFI ≥ 0.92, and NNFI ≥ 0.90. A significant correlation was observed between the Labour and Birth scale and the Childbirth Experience Questionnaire-2 (r = 0.82, P < 0.001). No significant correlation was found between the scales and women's age. All three scales demonstrated good internal consistency (all Cronbach's alpha values > 0.9) and test-retest reliability (all interclass correlation coefficient values > 0.8). CONCLUSIONS The Persian versions of all three EMC scales exhibit robust psychometric properties for evaluating maternity care experiences among urban Iranian women. These scales can be utilized to assess the quality of current care, investigate the impact of different care models in various studies, and contribute to maternal health promotion programs and policies.
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Affiliation(s)
- Elham Jafari
- Student Research Comittee, Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad Asghari-Jafarabadi
- Cabrini Research, Cabrini Health, Malvern, VIC, 3144, Australia.
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia.
- Department of Psychiatry, School of Clinical Sciences, Monash University, Clayton, VIC, 3168, Australia.
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati Ave, P.O. Box: 51745- 347, Tabriz, 513897977, Iran
| | - Sakineh Mohammad-Alizadeh-Charandabi
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Shariati Ave, P.O. Box: 51745- 347, Tabriz, 513897977, Iran.
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Unutkan A, Elem E. "Normal in all the rush": A phenomenological study analyzing midwifery students' views on obstetric violence. NURSE EDUCATION TODAY 2024; 132:106014. [PMID: 37948973 DOI: 10.1016/j.nedt.2023.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION In recent years, obstetric violence, which undermines women's dignity and autonomy, has received increased attention worldwide. Considering the importance of midwives in combating violence in the obstetric field and the significance of the discussed issue, the following question arises: How do future midwives view obstetric violence? OBJECTIVE This study aimed to investigate midwifery students' thoughts about obstetric violence. DESIGN AND METHOD This study was conducted using a phenomenological qualitative research design. This study, which adopted a descriptive approach and used typical case sampling, was conducted in the midwifery department of the Kutahya Health Sciences University. Sixteen midwifery students studying fourth-year in the 2018-2019 academic year, who had participated in childbirth during their studies, and who agreed to participate in the study were included. All students had the experience of repeated monitoring and presence in labor. They had witnessed births in different institutions. Focus group interviews were conducted using an unstructured interview guide to obtain data for the study. Data were collected through four focus group interviews with groups of four students in the classroom environment. The data were evaluated separately by two researchers using the content analysis method in MAXQDA Analytics Pro 2020. The Consolidated Criteria for Reporting Qualitative Studies guidelines were used as a guide in reporting. RESULTS As a result of the analysis, four main themes emerged: defining violence, causes of violence, effects of witnessing violence, and whether can violence be prevented? CONCLUSIONS Midwifery students have an awareness of all visible forms of obstetric violence. However, they were less aware of the invisible structural and policy drivers of obstetric violence. It is invaluable to raise awareness of obstetric violence among midwifery students, who will be the most important defenders of women in childbirth. Studies focused on education and policy will contribute to women receiving quality care at birth.
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Affiliation(s)
- Aysegul Unutkan
- Department of Midwifery, Kutahya Health Sciences University Health Sciences Faculty, PO Box 43700, Kutahya, Turkiye.
| | - Emel Elem
- Department of Midwifery, Kutahya Health Sciences University Health Sciences Faculty, PO Box 43700, Kutahya, Turkiye.
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Aşci Ö, Bal MD. The prevalence of obstetric violence experienced by women during childbirth care and its associated factors in Türkiye: A cross-sectional study. Midwifery 2023; 124:103766. [PMID: 37406467 DOI: 10.1016/j.midw.2023.103766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Revised: 06/20/2023] [Accepted: 06/21/2023] [Indexed: 07/07/2023]
Abstract
Objective This study determined the prevalence of obstetric violence experienced by women during childbirth and related factors in Türkiye. Design Cross-sectional study Setting This study was conducted in the mother-child health and gynecology outpatient clinics of the training and research hospital in Türkiye. Participants The study was completed with 513 women who gave birth in the last two years between January and May 2022. Methods Data were collected using a questionnaire prepared by the researchers. Bivariate and multivariate logistic regression analyzed the relationship between obstetric violence and socio-demographic and obstetric characteristics. Findings Obstetric violence was reported by 76.4% of the women: 44.4% physical abuse, 44.4% abandonment of care, 26.5% non-consented care, 25.1% non-dignified care, 3.3% non-confidential care, and 0.4% discrimination. Low income (OR=1.98), physician-attended birth (OR=2.91), vaginal birth (OR=6.04), and newborn admission to the neonatal care unit (OR=2.99) were associated with higher reporting of obstetric violence. Primiparous women (OR=0.51), whose pain was controlled by non-pharmacological methods (OR=0.34) and who received companion support (OR=0.24) were less likely to report experiencing obstetric violence (p < 0.05). Key conclusions Approximately three out of four Turkish women report that they have been exposed to obstetric violence during childbirth. In Türkiye, vaginal birth is the type of childbirth with the highest rate of obstetric violence reporting. Women who are low-income and multiparous, who are deprived of midwife, companion, and pain control support during childbirth, are more likely to experience obstetric violence. Implications for practice Supporting low-income women, protecting women from traumatic acts and unnecessary interventions in a vaginal birth, increasing births under the attendance of midwives, and providing pain control with non-pharmacological methods, and companion support during labor may be protective factors against obstetric violence.
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Affiliation(s)
- Özlem Aşci
- Zübeyde Hanım Faculty of Health Sciences, Division of Midwifery, Niğde Ömer Halisdemir University, Niğde, Turkey.
| | - Meltem Demirgoz Bal
- Faculty of Health Sciences, Division of Midwifery, Marmara University, Istanbul, Turkey
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Mirzaee F, Hasanpoor-Azghady SB, Amiri-Farahani L. Investigating and comparing the dimensions of worry of Iranian primiparous women in each trimester of pregnancy. Eur J Med Res 2023; 28:285. [PMID: 37587539 PMCID: PMC10428520 DOI: 10.1186/s40001-023-01258-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 08/01/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Pregnancy and childbirth are considered natural events in the life cycle of women. However, it is also a stressful experience along with physiological and psychological changes. Therefore, it is important to study the dimensions that cause more worry in each of the pregnant trimesters. This study aimed to determine and compare the dimensions of worry of Iranian primiparous women in each trimester of pregnancy. METHODS This cross-sectional study was conducted on 300 primiparous women (n = 100 in each trimester) referred to seven health centers affiliated with the Iran University of Medical Sciences, Tehran, Iran. The sampling was multistage. We collected data from a demographic and fertility questionnaire and the Cambridge Worry Scale (CWS). RESULTS The mean score of worry during the entire pregnancy was 28.16. The mean and standard deviation of the worry score in the first trimester was (27.35 ± 12.22). The second trimester was (27.80 ± 12.53) and the third trimester was (29.34 ± 11.11). The highest mean score of worry in the first and third trimmers was the dimension of own health. The second trimester was the dimension of socio-medical. The lowest mean score of worry in all trimmers was the dimension of relationships. Among CWS-related items, the highest mean score of worry in the first trimester was giving birth (3.34) and the possibility of miscarriage (3.22). In the second trimester was the possibility of going into labour too early (3.3) and the possibility of miscarriage (3.12), and in the third trimester was the possibility of going into labour too early (3.33) and giving birth (3.27). The lowest mean score of worry in all three trimesters was related to problems with the law. CONCLUSION pregnancy worry in the third trimester was more than the other two trimesters, and worrying about own health was the most important dimension of worry for pregnant women. Paying attention to the dimensions of worry of pregnant women helps design appropriate interventions to increase the mental and physical health of pregnant women.
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Affiliation(s)
- Foruzan Mirzaee
- Department of Midwifery and Reproductive, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, 1996713883, Iran
| | - Seyedeh Batool Hasanpoor-Azghady
- Department of Midwifery and Reproductive, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, 1996713883, Iran.
| | - Leila Amiri-Farahani
- Department of Midwifery and Reproductive, Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Rashid Yasemi St., Valiasr St., Tehran, 1996713883, Iran
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Hadjigeorgiou E, Andreaki M, Koliandri I, Spyridou A, Balaam MC, Christoforou A. Exploring mothers' experiences of perinatal care in Cyprus: Babies Born Better survey. BMC Pregnancy Childbirth 2023; 23:487. [PMID: 37393248 PMCID: PMC10314612 DOI: 10.1186/s12884-023-05800-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 06/19/2023] [Indexed: 07/03/2023] Open
Abstract
INTRODUCTION A positive perinatal experience facilitates a smooth transition to motherhood and enhances the development of a strong bond between mother and newborn, contributing to maternal and societal wellbeing. Given the medicalization of childbirth in Cyprus, the examination of mothers' experiences of perinatal care becomes imperative. AIM To investigate mothers' experiences of care during the perinatal period and to identify factors related to the provision of maternal care that contribute to the interpretation of these experiences. METHODS The study draws on data from the European survey "Babies Born Better", an online survey utilizing a mixed-methods approach to explore women's experiences of maternity care across Europe. The study population were women who had given birth in Cyprus over a 5-year period (2013-2018). Quantitative data were analyzed using SPSS v22, while qualitative data were analyzed through inductive content analysis. FINDINGS A total of 360 mothers participated in the study. In rating their overall experience, 24.2% stated that they had a "bad experience", 11.1% a "good experience",13.9% a "very good experience", and 13,3% a "very bad experience". The top three sub-factors of the overall experience which received positive evaluation were "Relationship with health care professionals" (33.6%), "Birth environment and care" (11.4%), and "Breastfeeding guidance" (10.8%). The qualitative analysis yielded five themes: "Relationship with health care professionals", "Breastfeeding establishment", "Childbirth rights", "Birth environment and services" and "Choice of mode of birth". CONCLUSION Mothers in Cyprus wish to have respectful maternity care. They need maternity health care professionals to respect their dignity and ask for evidence-based information with shared decision making. Mothers in Cyprus expect to have their childbirth rights safeguarded, to have better support from HCP, and to receive humanized care. The perinatal care provided in Cyprus needs significant improvements based on mothers' needs and expectations.
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Affiliation(s)
- E Hadjigeorgiou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus.
| | - M Andreaki
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - I Koliandri
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - A Spyridou
- Department of Nursing, School of Health Sciences, Cyprus University of Technology, Limassol, Cyprus
| | - M C Balaam
- School of Community Health and Midwifery, University of Central Lancashire, Preston, UK
| | - A Christoforou
- Department of Social & Behavioral Sciences and Health Science, European University Cyprus, Nicosia, Cyprus
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Vogels-Broeke M, Daemers D, Budé L, de Vries R, Nieuwenhuijze M. Women's Birth Beliefs During Pregnancy and Postpartum in the Netherlands: A Quantitative Cross-Sectional Study. J Midwifery Womens Health 2023; 68:210-220. [PMID: 36938758 DOI: 10.1111/jmwh.13473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 11/30/2022] [Accepted: 12/29/2022] [Indexed: 03/21/2023]
Abstract
INTRODUCTION Women and care providers increasingly regard childbirth as a medical process, resulting in high use of medical interventions, which could negatively affect a woman's childbirth experience. Women's birth beliefs may be key to understanding the decisions they make and the acceptance of medical interventions in childbirth. In this study we explore women's beliefs about birth as a natural and medical process and the factors that are associated with women's birth beliefs. METHODS Data were obtained from a cross-sectional survey of women living in the Netherlands asking them about their experiences during pregnancy and childbirth, including their beliefs about birth as a natural and medical process. RESULTS A total of 3494 women were included in this study. Mean scores of natural birth beliefs ranged between 3.73 and 4.01 points, and medical birth belief scores ranged between 2.92 and 3.12 points. There were significant but very small changes between prenatal and postnatal birth beliefs. Regression analyses showed that (previous) childbirth experiences were the most consistent predictor of women's birth beliefs. DISCUSSION Women's high scores on natural birth beliefs and lower scores on medical birth beliefs correspond with the philosophy of Dutch perinatal care that considers pregnancy and childbirth to be natural processes. Perinatal care providers must be aware of women's birth beliefs and recognize that they as professionals influence women's birth beliefs. They make an important contribution to women's perinatal experiences, which affects both women's natural and medical birth beliefs.
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Affiliation(s)
- Maaike Vogels-Broeke
- Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Darie Daemers
- Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands
| | - Luc Budé
- Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands
| | - Raymond de Vries
- Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, Michigan
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Zuyd University, Maastricht, The Netherlands.,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
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Valizadeh F, Heshmat F, Motaghi Z. The Parturient Women's Privacy Preservation in the Delivery Rooms: A Qualitative Study. J Caring Sci 2023; 12:33-41. [PMID: 37124412 PMCID: PMC10131163 DOI: 10.34172/jcs.2023.30401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 06/28/2021] [Indexed: 05/02/2023] Open
Abstract
Introduction: Parturient women's privacy preservation and respectful maternity care (RMC) in delivery room is an important principle in the high quality of midwifery care to achieve maternal satisfaction and positive childbirth experience. Hence, it is essential to make natural vaginal delivery (NVD) a positive experience and increase the mothers' satisfaction. This study aimed to investigate the privacy preservation of parturient women's in the delivery room. Methods: Using conventional content analysis, this qualitative study was conducted from June 2018 to December 2020 at two hospitals and three health centers in Shahroud, Iran. Purposeful sampling was employed and it was continued till data saturation through in-depth interviews with 37 participants. Results: The results of interviews with 21 women with NVD experience and 16 maternity health service providers resulted in the extraction of four themes including physical, spiritual-mental, informational, and social privacy. Conclusion: Various mechanisms were found to promote the privacy and satisfaction of parturient women in the delivery room. They included the necessity continuous education, monitoring about mother's privacy preservation and intervention to improve effective communication skills among staff in delivery rooms.
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Affiliation(s)
| | - Farahnaz Heshmat
- Student Research Committee, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Zahra Motaghi
- Department of Reproductive Health, School of Nursing and Midwifery, Shahroud University of Medical Sciences, Shahroud, Iran
- *Corresponding Author: Zahra Motaghi,
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Moridi M, Pazandeh F, Potrata B. Midwives' knowledge and practice of Respectful Maternity Care: a survey from Iran. BMC Pregnancy Childbirth 2022; 22:752. [PMID: 36199103 PMCID: PMC9535863 DOI: 10.1186/s12884-022-05065-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In the past decade, countries worldwide aimed to evaluate the quality of childbirth care and reduce the high rates of disrespect and abuse during childbirth. Few studies have attempted to identify providers' characteristics associated with respectful maternity care quantitatively. This study aims to evaluate midwives' knowledge and practice of respectful maternity care (RMC). METHODS A cross-sectional study was carried out in 15 teaching and non-teaching hospitals in Tehran, Iran. The hospitals were selected by using a cluster sampling design. Midwives' Knowledge and Practice of Respectful Maternity Care scale (MKP-RMC) was administered to 250 midwives working in maternity units at study hospitals. The data were analysed by statistics package for social science (SPSS, version 21.0, Chicago, IL). RESULTS Findings demonstrated that the mean score for knowledge and practice of midwives were 20.96 ± 3.54 and 101.64 ± 11.49, respectively. Also, in both knowledge and practice scales, midwives had the highest score in "providing safe care' domain and the lowest score in "preventing mistreatment" domain. CONCLUSION Our findings showed that for Iranian midwives, providing care to preserve mothers' and their babies' wellbeing is more critical than preventing maternal mistreatment, resulting from the importance of the care provision in the Iranian healthcare system. Promoting midwives' knowledge and practice through developing a tailored educational program to prevent mistreatment and providing emotional support alongside physical care is recommended.
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Affiliation(s)
- Maryam Moridi
- Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- School of Health Sciences, University of Nottingham, Nottingham, UK.
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Khalil M, Carasso KB, Kabakian-Khasholian T. Exposing Obstetric Violence in the Eastern Mediterranean Region: A Review of Women's Narratives of Disrespect and Abuse in Childbirth. Front Glob Womens Health 2022; 3:850796. [PMID: 35547827 PMCID: PMC9082810 DOI: 10.3389/fgwh.2022.850796] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Background Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region. Aim This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC. Methods A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR. Findings and Discussion This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV. Conclusion In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
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Affiliation(s)
- Merette Khalil
- Your Egyptian Doula, Cairo, Egypt
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
- *Correspondence: Merette Khalil
| | - Kashi Barbara Carasso
- International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands
| | - Tamar Kabakian-Khasholian
- Department of Health Promotion and Community Health, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
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Haghdoost S, Abdi F, Amirian A. Iranian midwives' awareness and performance of respectful maternity care during labor and childbirth. Eur J Midwifery 2021; 5:59. [PMID: 35083427 PMCID: PMC8711250 DOI: 10.18332/ejm/143873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 10/29/2021] [Accepted: 11/10/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Midwives' perceptions of Respectful Maternity Care (RMC) play an important role in promoting quality of care. This study aimed to explore the awareness and performance of Iranian midwives of RMC during childbirth. METHODS A cross-sectional study was carried out from November to December 2020 to evaluate 130 midwives' awareness and performance of RMC during childbirth at four public hospitals in Urmia province, Iran. Participants were midwives who were working in the labor unit and had at least one year of work experience. The Midwives' Knowledge and Practice Scale on Respectful Maternity Care was used to assess midwives' awareness and performance. The quality assessment of questionnaires was based on the mean for each item. A multivariate linear regression approach was developed to evaluate the relationship between midwives' age, academic education level plus occupational information and their awareness and performance of RMC. RESULTS This study revealed that Iranian midwives had good awareness but fair performance of RMC. The mean scores of the overall awareness and performance of RMC were 36.07±10.13 and 75.47±35.4, respectively. Midwives' performance on two domains was fair including 'Giving emotional support' and 'Providing safe care'. The results of multivariate linear regression analysis showed a significant negative relationship between job satisfaction and midwives' performance on RMC. Also work experience plus a Master's degree in midwifery had positive significant effects on midwives' awareness along with performance on RMC (p<0.05). CONCLUSIONS Promoting respectful maternity care requires essential interpersonal and communication skills and supportive attitudes from midwives.
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Affiliation(s)
- Simin Haghdoost
- Department of Midwifery and Reproductive Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abdi
- School of Nursing and Midwifery, Alborz University of Medical Sciences, Karaj, Iran
| | - Azam Amirian
- Department of Midwifery, School of Nursing and Midwifery, Jiroft University of Medical Sciences, Jiroft, Iran
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Gardiner E, Lai JF, Khanna D, Meza G, de Wildt G, Taylor B. Exploring women's decisions of where to give birth in the Peruvian Amazon; why do women continue to give birth at home? A qualitative study. PLoS One 2021; 16:e0257135. [PMID: 34506573 PMCID: PMC8432815 DOI: 10.1371/journal.pone.0257135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2020] [Accepted: 08/24/2021] [Indexed: 11/18/2022] Open
Abstract
Background Despite improvements in maternal mortality globally, hundreds of women continue to die daily. The World Health Organisation therefore advises all women in low-and-middle income countries to give birth in healthcare facilities. Barriers to seeking intrapartum care have been described in Thaddeus and Maine’s Three Delays Model, however these decisions are complex and often unique to different settings. Loreto, a rural province in Peru has one of the highest homebirth rates in the country at 31.8%. The aim of this study was to explore facilitators and barriers to facility births and explore women’s experiences of intrapartum care in Amazonian Peru. Methods Through purposive sampling, postnatal women were recruited for semi-structured interviews (n = 25). Interviews were transcribed verbatim and thematically analysed. A combination of deductive and inductive coding was used. Analytical triangulation was undertaken, and data saturation was used to determine when no further interviews were necessary. Results Five themes were generated from the data: 1) Financial barriers; 2) Accessing care; 3) Fear of healthcare facilities; 4) Importance of seeking care and 5) Comfort and traditions of home. Generally, participants realised the importance of seeking skilled care however barriers persisted, across all areas of the Three Delays Model. Barriers identified included fear of healthcare facilities and interventions, direct and indirect costs, continuation of daily activities, distance and availability of transport. Women who delivered in healthcare facilities had mixed experiences, many reporting good attention, however a selection experienced poor treatment including abusive behaviour. Conclusion Despite free care, women continue to face barriers seeking obstetric care in Amazonian Peru, including fear of hospitals, cost and availability of transport. However, women accessing care do not always receive positive care experiences highlighting implications for changes in accessibility and provision of care. Minimising these barriers is critical to improve maternal and neonatal outcomes in rural Peru.
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Affiliation(s)
- Esme Gardiner
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
- * E-mail:
| | - Jo Freda Lai
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Divya Khanna
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Graciella Meza
- Facultad de Medicina Human, Universidad Nacional de la Amazonía Peruana, Iquitos, Peru
| | - Gilles de Wildt
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Beck Taylor
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
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Conceptual Framework for Implementing the Saudi Childbirth Initiative. INTERNATIONAL JOURNAL OF CHILDBIRTH 2021. [DOI: 10.1891/ijcbirth-d-20-00045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
There are many efforts internationally to achieve safe and respectful Mother-Baby–Family maternity care. This article is the first to provide a conceptual framework for implementing the Saudi Childbirth Initiative (SCI) in all health institutions in Saudi Arabia. It introduces the 10 Steps of the SCI to strategically achieve a safe and respectful Mother-Baby–Family maternity care in order to improve maternal and infant outcome and implement evidence-based maternity care in Saudi Arabia. The SCI is developed upon previous initiatives and integrates and supports much of the current work being carried out by many organizations. The aim of the SCI's 10 Steps is to improve care throughout the childbearing continuum, to save lives, prevent illness and harm from the overuse of obstetric technologies, and promote health for mothers and babies and to provide clear guidelines for providing optimal maternity care. Safe and respectful Mother-Baby–Family Maternity Care is measurable and for each of the 10 Steps, there is an associated assessment tool to ensure these guidelines are being established by health institutions. SCI envisions that successful implementation of the 10 Steps can be measured and monitored using the a combination of statistical information and key performance indicators (KPIs) to measure maternal mortality and morbidity outcomes (currently in development) using local assessors.
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Khalife‐Ghaderi F, Amiri‐Farahani L, Haghani S, Hasanpoor‐Azghady SB. Examining the experience of childbirth and its predictors among women who have recently given birth. Nurs Open 2021; 8:63-71. [PMID: 33318813 PMCID: PMC7729799 DOI: 10.1002/nop2.603] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 07/03/2020] [Accepted: 07/23/2020] [Indexed: 11/25/2022] Open
Abstract
Aims The aim of this study is to examine the experience of childbirth and its predictors among women who have recently given birth. Design This is a cross-sectional study. Methods This study was conducted on 225 women at 22 Bahman Hospital in Khaf City, Iran. The samples were selected by the continuous sampling method from August to November 2018. Data were collected by demographic questionnaire, fertility information, pregnancy experience scale, satisfaction from birth environment inventory and the childbirth experience questionnaire. Results The mean score of childbirth experience was 55.73. According to the regression model, the husband's education, receiving regular care during pregnancy, the person giving birth, presence of a companion, receiving spinal anaesthesia, perineal conditions, being uplifted and hassled about the pregnancy and satisfaction with the birth environment were the predictors of childbirth experience. The regression model showed 39.8% of the change in outcome variable was predicted by independent variables.
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Affiliation(s)
- Faeze Khalife‐Ghaderi
- Department of Reproductive Health and MidwiferySchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Leila Amiri‐Farahani
- Department of Reproductive Health and MidwiferyNursing Care Research CenterSchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
| | - Shima Haghani
- Department of BiostatisticsNursing Care Research CenterIran University of Medical SciencesTehranIran
| | - Syedeh Batool Hasanpoor‐Azghady
- Department of Reproductive Health and MidwiferyNursing Care Research CenterSchool of Nursing and MidwiferyIran University of Medical SciencesTehranIran
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Psychometric Evaluation of the Persian Version of the Childbirth Experience Questionnaire (CEQ). BIOMED RESEARCH INTERNATIONAL 2020; 2020:6879283. [PMID: 33376731 PMCID: PMC7746439 DOI: 10.1155/2020/6879283] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 11/07/2020] [Accepted: 11/30/2020] [Indexed: 12/17/2022]
Abstract
Women's childbirth experience is an outcome indicator for evaluating maternity care. This study evaluated the psychometric properties of the Persian version of the Childbirth Experience Questionnaire (P-CEQ). The study recruited two hundred and fifty primiparous postpartum women in the 1-3 months following birth from one private and three public hospitals in Mazandaran province, Iran. First, face validity and content validity were evaluated. Moreover, confirmatory factor analysis (CFA) was conducted, and discriminant validity was assessed by applying the known-groups method. Intraclass correlation coefficient (ICC) was measured to confirm the stability and Cronbach's alpha to confirm the internal consistency. CFA also confirmed the values of fit indices (RMSEA = 0.05, SRMSR = 0.06, CFI >0.93, χ2/df = 1.80). ICC was 0.88 and Cronbach's alpha for all items was 0.85. Furthermore, discriminant validity of the P-CEQ was approved given that it effectively differentiated women whose stay in the labor unit exceeded twelve hours from those with a shorter stay. The P-CEQ questionnaire is a valid and reliable tool for assessing childbirth experiences. It is an easy-to-use questionnaire that can be used for evaluating quality of care in terms of women's childbirth experience. It can be used in maternity services that aim to improve quality of care during labor and childbirth.
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Anderson G, Zega M, D'Agostino F, Rega ML, Colaceci S, Damiani G, Alvaro R, Cocchieri A. Meta-Synthesis of the Needs of Women Cared for by Midwives During Childbirth in Hospitals. J Obstet Gynecol Neonatal Nurs 2020; 50:6-19. [PMID: 33217368 DOI: 10.1016/j.jogn.2020.10.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE To identify and meta-synthesize results of qualitative studies on the needs of women cared for by midwives during childbirth in hospitals. DATA SOURCES MEDLINE, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, and the Cochrane Library. STUDY SELECTION We restricted the bibliographic search to articles published in English to July 31, 2020. The initial search yielded 6,407 articles, and after 2,504 duplicates were removed, we screened the titles and abstracts of 3,903 articles. We conducted a full-text review of 89 articles and included 13 qualitative studies about the needs of women who were hospitalized during childbirth and had midwives as their primary maternity care providers. DATA EXTRACTION We extracted data (e.g., authors, publication date, type of study, sample size, results, and quotes) from the full text of each article into a standardized table. Two authors reviewed all articles using the Critical Appraisal Skills Programme tool to assess study quality and to independently score each study. DATA SYNTHESIS We analyzed the findings of each study and synthesized them to develop themes. We found 14 major themes that reflected the needs of women during hospitalization for childbirth: Nutrition, Hygiene, Privacy, Information, Bodily Respect, Respect for Social Role, Family Intimacy, Shelter, Pain Management, Partnership, Movement, Reassurance, Support, and Empowerment. We categorized these themes in Maslow's hierarchy of needs to better understand the phenomenon. CONCLUSION We identified 14 needs that midwives and nurses can meet when they care for women in hospitals during childbirth. Standardized methods to assess these needs and to link them to specific interventions can be used by midwives and nurses, which will likely affect women's satisfaction with their experience and overall quality of care.
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Darling F, McCourt PC, Cartwright DM. Facilitators and barriers to the implementation of a physiological approach during labour and birth: A systematic review and thematic synthesis. Midwifery 2020; 92:102861. [PMID: 33137546 DOI: 10.1016/j.midw.2020.102861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 08/24/2020] [Accepted: 10/14/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To explore facilitators and barriers to the implementation of a physiological approach to care during labour and birth in obstetric settings. To explore how facilitators and barriers located at three levels: organisation, professional groups (midwives and obstetricians) and women, interact to influence the implementation of a physiological approach. METHOD A systematic review of the literature, identified 32 eligible studies from four databases reporting relevant qualitative data. Findings from these studies were thematically synthesised in three phases: line by line coding of findings from primary studies, development of descriptive themes and analytical themes. This review is reported in line with PRISMA guidelines. FINDINGS At an organisational level, centralisation of care in obstetric units limited time for labouring and professional care to support a physiological labour and birth. Risk management strategies ostensibly designed to promote safety sustained a risk-based approach. At a professional level, important barriers include hierarchical decision-making led by obstetricians, midwifery acquiescence, obstetric and midwifery risk preoccupation, rationalisation of the routine use of clinical intervention and an erosion of midwifery skills and knowledge. At the level of the woman, barriers include a lack of knowledge and reliance on professional decision-making. Facilitators include collaborative working by midwives and obstetricians, a valuing of midwifery autonomy and women's questioning of inappropriate intervention use. KEY CONCLUSIONS Contrary to evidence-based guidelines that recommend a physiological approach, a risk-based approach informs practices in obstetric units. Primary research has mainly identified barriers to implementing a physiological approach at a professional level, and this has been studied largely from a midwifery perspective. To aid comprehensive investigations of facilitators and barriers and their interactive influences, this review identifies important research gaps for study across all levels: organisation, professionals (midwives and obstetricians) and women. IMPLICATIONS FOR PRACTICE Risk preoccupations and rationalisation, with negative influences on knowledge and skills in the use of a physiological approach, must prompt reflection and action amongst professional groups. Power imbalances between midwives and obstetricians need to be addressed, drawing on experiences in units where collaborative working and midwifery autonomy is fostered.
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Affiliation(s)
- Florence Darling
- Midwife, 3(rd) year PhD Student, City University of London, School of Health Sciences, Myddelton Street Building, City, University of London, Myddelton Street, EC1R 1UW, London, United Kingdom.
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Gu C, Wang X, Zhang Z, Schwank S, Zhu C, Zhang Z, Qian X. Pregnant women's clinical characteristics, intrapartum interventions, and duration of labour in urban China: a multi-center cross-sectional study. BMC Pregnancy Childbirth 2020; 20:386. [PMID: 32616073 PMCID: PMC7330978 DOI: 10.1186/s12884-020-03072-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 06/19/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND There is an increasing global trend towards the widespread over-medicalisation of labour and childbirth. The present study aimed to investigate pregnant women's clinical characteristics, intrapartum interventions, duration of labour and its associated factors; and to compare the differences of these variables between nulliparas and multiparas in China. METHODS A multi-center cross-sectional study was carried out in three tertiary hospitals of Fudan University in Shanghai, China. A total of 1523 participants were approched and assessed for eligibility. Data on women's sociodemographic characteristics, intrapartum interventions, and duration of labour were measured and collected. Kaplan-Meier survival analysis was performed to present the curves of total duration of labour by parity. After z-transformation of labour duration, multivariable linear regression was used to control for confounding and to identify independent associations between potential associated factors and the primary outcome of labour duration. RESULTS Overall, 1209 eligible women agreed to participate and were investigated. Rates of different intrapartum interventions were 27.4% in use of amniotomy, 37.9% in use of oxytocin, 53.0% in continuous electronic fetal monitoring, and 52.9% in epidural use, respectively. The curve of total duration of labour was significantly different between nulliparas and multiparas (P < .001). Of the 1209 participants, 983 (81.3%) women eventually achieved successful vaginal birth while 226 (18.7%) women ended in intrapartum caesarean section. The median duration of total stage of labour was significantly longer in the nulliparous group [9.38 (6.33,14.10) hours] than that in the multiparous group [5.08 (3.00,7.83) hours] (P < .001). The following factors were independently associated with longer duration of total stage of labour: epidural analgesia (P < .001), primiparity (P < .001), continuous electronic fetal monitoring (P = .035), and increased birth weight (P = .005). CONCLUSIONS Intrapartum medical interventions become common obstetric practices in urban China. Multifactorial variables independently associated with longer duration of labour were identified, including epidural analgesia, primiparity, continuous electronic fetal monitoring, and increased birth weight. Further research is required to validate these variables and to determine the modifiable factors for labour management. And models of care with lower intervention rates such as midwife-led models of care should be developed and implemented in China.
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Affiliation(s)
- Chunyi Gu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xiaojiao Wang
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Zhijie Zhang
- Department of Epidemiology, School of Public Health, Fudan University, Shanghai, China
| | - Simone Schwank
- Department of Women and Children's Health, Reproductive Health, Karolinska Institutet, Stockholm, Sweden
| | - Chunxiang Zhu
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Zheng Zhang
- Department of Nursing, Obstetrics & Gynaecology Hospital of Fudan University, Shanghai, China
| | - Xu Qian
- Department of Maternal, Child and Adolescent Health, School of Public Health, Fudan University, Shanghai, China.
- Global Health Institute, Fudan University, Shanghai, China.
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Jordanian women's experiences and constructions of labour and birth in different settings, over time and across generations: a qualitative study. BMC Pregnancy Childbirth 2020; 20:357. [PMID: 32522158 PMCID: PMC7288400 DOI: 10.1186/s12884-020-03034-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 05/25/2020] [Indexed: 11/18/2022] Open
Abstract
Background Overwhelmingly, women in Middle Eastern countries experience birth as dehumanising and disrespectful. Women’s stories can be a very powerful way of informing health services about the impact of the care they receive and can promote practice change. The aim of this study is to examine Jordanian women’s experiences and constructions of labour and birth in different settings (home, public and private hospitals in Jordan, and Australian public hospitals), over time and across generations. Method A qualitative interpretive design was used. Data were collected by face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan (12 had given birth in the last five years and eight had birthed over 15 years ago) while seven were living in Australia (with birthing experience in both Jordan and Australia). Interview data were transcribed verbatim and analysed thematically. Results Women’s birth experiences differed across settings and generations and were represented in the four themes: ‘Birth at home: a place of comfort and control’; ‘Public Hospital: you should not have to suffer’; ‘Private Hospital: buying control’ and ‘Australian maternity care: a mixed experience’. In each theme, the concepts: Pain, Privacy, the Personal and to a lesser extent, Purity (cleanliness), were present but experienced in different ways depending on the setting (home, public or private hospital) and the country. Conclusions The findings demonstrate how meanings attributed to labour and birth, particularly the experience of pain, are produced in different settings, providing insights into the institutional management and social context of birth in Jordan and other Middle Eastern countries. In the public hospital environment in Jordan, women had no support and were treated disrespectfully. This was in stark contrast to women birthing at home only one generation before. Change is urgently needed to offer humanised birth in the Jordanian maternity system,
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Hajiesmaello M, Kariman N, Sharif Nia H, Ozgoli G, Hajian S, Bazzazian S, Mokhtarian-Gilani T. The translation and psychometric assessment of the perception of empowerment in midwifery scale: the Persian version. BMC Health Serv Res 2020; 20:466. [PMID: 32456630 PMCID: PMC7249298 DOI: 10.1186/s12913-020-05326-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 05/14/2020] [Indexed: 11/10/2022] Open
Abstract
Background A major part of midwifery care involves the empowerment of women and their families for the control of factors affecting their health. To this end, midwives should experience their own empowerment first. The present study was conducted to translate and determine the psychometric properties of the Perception of Empowerment in Midwifery Scale among Iranian midwives. Methods A total of 380 people participated in this cross-sectional study. A demographic questionnaire and the 22-item Perception of Empowerment in Midwifery Scale were sent to the participants online. The validity of the scale and the analysis of its main components were carried out through exploratory factor analysis with Varimax rotation and confirmatory factor analysis. The reliability of the scale was assessed using the internal consistency method with Cronbach’s alpha coefficient, average inter-item correlation (AIC) and McDonald’s omega. Results Seventeen scale items were retained after the exploratory factor analysis, and five factors were extracted, including “effective management”, “professional practice”, “authority”, “advocacy”, and “professional informant”, with factor loadings ranging from 0.489 to 0.899. The five latent factors explained 53.07% of the overall variance of the scale. The confirmatory factor analysis showed an acceptable goodness of fit. The internal consistency of the scale was confirmed with a Cronbach’s alpha above 0.7. Conclusion The Persian version of the Perception of Empowerment in Midwifery Scale with 17 items has adequate reliability for midwives working in Iran. Given its appropriate psychometric properties, this scale is fit to be used among midwives in future studies.
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Affiliation(s)
- Maryam Hajiesmaello
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nourossadat Kariman
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-e Asr Ave., Niayesh Intersection, Niayesh Complex, Tehran, Postal Code: 1985717443, Iran.
| | - Hamid Sharif Nia
- School of Nursing and Midwifery Amol, Mazandaran University of Medical Sciences, Sari, Iran
| | - Giti Ozgoli
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-e Asr Ave., Niayesh Intersection, Niayesh Complex, Tehran, Postal Code: 1985717443, Iran
| | - Sepideh Hajian
- Midwifery and Reproductive Health Research Center, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Vali-e Asr Ave., Niayesh Intersection, Niayesh Complex, Tehran, Postal Code: 1985717443, Iran
| | - Shahin Bazzazian
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Tahereh Mokhtarian-Gilani
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Khamehchian M, Adib-Hajbaghery M, HeydariKhayat N, Rezaei M, Sabery M. Primiparous women's experiences of normal vaginal delivery in Iran: a qualitative study. BMC Pregnancy Childbirth 2020; 20:259. [PMID: 32349704 PMCID: PMC7191821 DOI: 10.1186/s12884-020-02954-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 04/16/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Childbirth is considered as the most challenging psychological event in a woman's life. It has a major effect on women's lives with long-term positive or negative impacts. Cultural, religious, and socioeconomic differences can affect women's perception about normal vaginal delivery (NVD) experience. Therefore, it is necessary to explore the primiparous women's perception about it. METHODS This qualitative study, with a descriptive content analysis approach, was conducted in Kashan, a city in the center of Iran. Purposive sampling was used to recruit the participants of the current study. Data was gathered by semi-structured interviews during 24 h after normal vaginal birth among primiparous women. The sampling started from June to October in 2016. Interviews continued until data saturation which was achieved in the 14th interview but for assurance, it continued until the 17th one. RESULTS The following three main themes were extracted "immersion in stress", "pain, the essence of NVD" and "strategies for situation management". Furthermore, seven subthemes were obtained including 'loss threat', 'stressful context', temporary impairment in physiologic harmony, paradoxical emotions, self-management, emotional support, and spiritual support. CONCLUSIONS This study showed that stress and pain were two highlighted issues in NVD process. Increasing women's awareness about NVD process, familiarizing the primiparous women with the simulated delivery room, accompanying these women for emotional support, and providing spiritual support can be effective in situation management to make the child delivery a pleasant and satisfying experience.
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Affiliation(s)
- Marzieh Khamehchian
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | | | - Mahboubeh Rezaei
- Autoimmune Disease Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - Mahdieh Sabery
- Trauma Nursing Research Center, Kashan University of Medical Sciences, Kashan, Iran.
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24
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Moridi M, Pazandeh F, Hajian S, Potrata B. Midwives' perspectives of respectful maternity care during childbirth: A qualitative study. PLoS One 2020; 15:e0229941. [PMID: 32150593 PMCID: PMC7062245 DOI: 10.1371/journal.pone.0229941] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2019] [Accepted: 02/17/2020] [Indexed: 11/28/2022] Open
Abstract
The adoption of respectful maternity care during labor and birth is a complex process which needs both scientific and interpersonal skills of providers. In this regard, identifying the potential barriers and applying effective strategies for implementing respectful maternity care are essential. This study aimed to explore the perceptions of Iranian midwives regarding respectful maternity care during labor and childbirth. This was a qualitative study which was conducted from September-December 2018 in two non-teaching public hospitals in Tehran, Iran. Twenty-four semi-structured interviews were conducted with midwives, who had more than one year work experience in labor and childbirth units, through a purposive sampling method. A content analysis approach was used to analyze the data and identify themes. Three themes were extracted including “showing empathy”, “women-centered care” and “protecting rights”. Showing empathy reflects that “establishing a friendly relationship” and “being with women”. Women-centered care encompassed “keeping women safe” and “participating in decision making”. Protecting rights reflected a need for “safeguarding dignity” as well as “giving equal care” and “preparing appropriate environment”. Iranian midwives considered respectful maternity care a broader concept than just preventing mistreatment. Providing supportive care through friendly interaction with women was the first step for providing respectful maternity care. Respectful care is also promoted by providing safe care, implementing evidence-based care and involving women in their care as well as by providing an appropriate environment for women, families and caregivers.
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Affiliation(s)
- Maryam Moridi
- Student Research Committee, Department of Midwifery and Reproductive Health, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzaneh Pazandeh
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- * E-mail:
| | - Sepideh Hajian
- Midwifery and Reproductive Health Research Center, School of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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25
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Altaweli R, McCourt C, Scamell M, Curtis Tyler K. Ethnographic study of the use of interventions during the second stage of labor in Jeddah, Saudi Arabia. Birth 2019; 46:500-508. [PMID: 30198111 PMCID: PMC6767456 DOI: 10.1111/birt.12395] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 08/20/2018] [Accepted: 08/20/2018] [Indexed: 12/04/2022]
Abstract
BACKGROUND Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence-based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision-making and practices. METHODS This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi-structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically. RESULTS Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision-making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision-making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described. CONCLUSIONS Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence.
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Affiliation(s)
| | - Christine McCourt
- Department of Maternal and Child Health, School of Health SciencesCity, University of LondonLondonUK
| | - Mandie Scamell
- School of Health SciencesCity, University of LondonLondonUK
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26
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Ghanbari-Homayi S, Fardiazar Z, Meedya S, Mohammad-Alizadeh-Charandabi S, Asghari-Jafarabadi M, Mohammadi E, Mirghafourvand M. Predictors of traumatic birth experience among a group of Iranian primipara women: a cross sectional study. BMC Pregnancy Childbirth 2019; 19:182. [PMID: 31117987 PMCID: PMC6532129 DOI: 10.1186/s12884-019-2333-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic birth experience has undesirable effects on the life of the mother, child, family, and society. The identification of predictive factors can be useful in improving birth experiences among women. This study aimed to assess the prevalence of a traumatic birth experience and identify its predictors among a group primiparous women. METHODS A cross-sectional study was conducted among 64 health centres in Tabriz, the second largest city in Iran. Cluster sampling was used to recruit 800 eligible women at one to 4 months postpartum. The Persian version of the Childbirth Experience Questionnaire was used to measure the womens' birth experiences. Data were collected through face to face interviews and analysed mainly by multivariable logistic regression. RESULTS The prevalence of traumatic birth experience was 37% in the study group. The independent predictors of the traumatic birth experience were related to antenatal and intrapartum factors. The antenatal predictor was the lack of exercise during pregnancy (OR = 2.81, CI 1.40-5.63, P = .003) and the intrapartum predictors were the absence of pain relief during labour and birth (OR = 4.24, CI 2.12-8.50, P < .001), and the fear of childbirth (OR = 3.47, CI 1.68-7.19, P < .001). CONCLUSIONS The findings revealed the high rate of traumatic birth experience among the primimarous women and identified the importance of a woman-centered care where a woman can actively make decision about the care she receives receive during labour and birth.
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Affiliation(s)
| | - Zahra Fardiazar
- Women Reproductive Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Shahla Meedya
- Member of South Asia Infant Feeding Research Network (SAIFRN), School of Nursing, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong, Australia
| | | | | | - Eesa Mohammadi
- Department of Nursing, School of Medicine, Tarbiat Modares University, Tehran, Iran
| | - Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran.
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27
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Ghobadi M, Ziaee T, Mirhaghjo N, Pazandeh F, Kazemnejad lili E. Evaluation of Satisfaction with Natural Delivery Experience and its Related Factors in Rasht Women. ACTA ACUST UNITED AC 2018. [DOI: 10.29252/jhc.20.3.215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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28
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Clesse C, Lighezzolo-Alnot J, de Lavergne S, Hamlin S, Scheffler M. The evolution of birth medicalisation: A systematic review. Midwifery 2018; 66:161-167. [PMID: 30176390 DOI: 10.1016/j.midw.2018.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 07/01/2018] [Accepted: 08/12/2018] [Indexed: 02/04/2023]
Abstract
First described at the beginning of the 1970s, the concept of birth medicalisation has experienced a theoretical and ideological evolution influenced by the lines of research that have been associated with it. This evolution has given rise to different schools of thought concerning medicalisation, but also various methodologies used in different scientific fields. It seems relevant to propose a global synthesis of the various lines of thought related to birth medicalisation. To do this, the authors conducted a systematic literature review based on the PRISMA method. With a total of 38 occurrences in French and English, the authors scrutinised 17 databases with a publication period between 1995 and 2018. A total of 112 documents (107 articles, 3 book chapters, 2 books) has been identified, grouped and categorised into five main themes in the results section (1) the theoretical evolution of the concept of medicalisation, (2) factors related to the birth medicalisation, (3) the impact of the birth medicalisation, (4) the humanisation of birth and (5) experiences related to childbirth. A reasoned synthesis of the literature is therefore carried out in each part and then discussed according to the selected lines of research that require development in order to guarantee the best possible accompaniment to women who give birth.
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Affiliation(s)
- Christophe Clesse
- Interpsy Laboratory (EA4432) Université de Lorraine - Nancy 2. 3 Place Godeffroy de Bouillon, 54000 Nancy, France; Hospital Centre of Jury-les-Metz - Route d'Ars Laquenexy BP75088, 57073, JURY-LESMETZ Cedex 03, France; Polyclinic Majorelle. 1240 avenue Raymond Pinchard 54100 Nancy, France.
| | - Joëlle Lighezzolo-Alnot
- Interpsy Laboratory (EA4432) Université de Lorraine - Nancy 2. 3 Place Godeffroy de Bouillon, 54000 Nancy, France.
| | | | - Sandrine Hamlin
- Polyclinic Majorelle. 1240 avenue Raymond Pinchard 54100 Nancy, France.
| | - Michèle Scheffler
- Polyclinic Majorelle. 1240 avenue Raymond Pinchard 54100 Nancy, France; Cabinet de Gynécologie Médicale et Obstétrique. 21 avenue Foch 54000 Nancy, France.
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