First-time mothers' satisfaction with their birth experience - a cross-sectional study

The invisible wounds of women: Ethical aspects of obstetric violence

Background: The quality of care in maternity facilities significantly influences women's autonomy and their right to make decisions about their bodies. Obstetric violence, a form of gender-based violence during childbirth, poses serious threats to women's rights and health worldwide. Aim: The research aimed to examine women's experiences and perceptions of obstetric violence using the micro-level constructivist grounded theory strategies of Mena-Tudela et al. (2023). Research design and methods: This study used a phenomenological qualitative research design. Data were collected from 17 eligible women using a Participant Information Form and a Semi-Structured Interview Form, applying maximum variation sampling to ensure a wide range of sociodemographic characteristics and diverse views and experiences. The data were analyzed using the seven-step phenomenological analysis method. Participants and research context: A total of 17 women who had vaginal labor at least 6 months ago were interviewed. Ethical considerations: The study was approved by the University Ethics Board for Non-Interventional Clinical Studies. Ethical considerations were closely aligned with the principles of respecting women's rights, ensuring that participants' autonomy and consent were central throughout the research process. Results: Five themes and 13 subthemes were extracted from the data analysis, including "Ignoring women in care," "The commodification of women," "Are the healthcare professionals the only authority?", "Ineffective childbirth management and its effects on women's health-seeking behavior," and "Types of obstetric violence." Conclusions: This study underscores the urgent need to address obstetric violence, recognizing its detrimental impact on women's rights, and well-being during childbirth. Protecting women's rights by prioritizing individual-centered care, informed consent, and respectful treatment is essential to uphold ethical standards and ensure dignified childbirth experiences for all women.

Women's experience of adopting lateral positions during the second stage of labour compared with conventional lithotomy positions: A cross-sectional study

AIMS

Maternal positions during childbirth play an important role in safe vaginal births and might also influence women's childbirth experiences greatly. Lateral positions, as a potential position to reduce negative maternal and neonatal outcomes, have become popular in recent years, especially in China where the adoption of conventional lithotomy positions is still common. However, the childbirth experience of those who gave birth in lateral positions has been rarely studied. This study aimed to describe and compare women's childbirth experiences of adopting the newly introduced lateral positions and the conventional lithotomy positions during the second stage of labour.

STUDY DESIGN

A cross-sectional study was conducted in two tertiary hospitals in China involving a total of 658 primiparous and parous women who adopted lateral and lithotomy positions during the second stage of labour from July to November 2020. Sociodemographic characteristics, maternal and neonatal outcomes as well as childbirth experience assessed by the Childbirth Experience Questionnaire (CEQ) were collected. This study followed the STROBE guidelines.

RESULTS

Women who once adopted lateral positions during the second stage of labour had better positive childbirth experiences compared with those in the lithotomy positions group, as demonstrated by their overall higher CEQ scores. Women in the lateral position group also reported better participation and perceived safety, and a greater sense of control during childbirth. Lateral positions remained an influential factor in CEQ scores after controlling for potential confounders. In this study, adverse maternal and neonatal outcomes were rare. Women in lateral positions had comparatively better perineal outcomes.

CONCLUSION

This study described and compared women's childbirth experiences of adopting conventional lithotomy positions and lateral positions during the second stage of labour using a valid instrument. Women who adopted lateral positions during the second stage of labour reported better childbirth experiences than those giving birth in the conventional lithotomy positions. Thus, assisting women in giving birth in lateral positions might be a promising way to improve women's childbirth experience.

A cross-sectional study of low birth satisfaction during the COVID-19 epidemics' fifth wave

AIM

To investigate predictors of low birth satisfaction in a sample of Iranian postpartum women during the COVID-19 epidemics' fifth wave.

DESIGN

A cross-sectional study.

METHODS

This study was conducted on 676 postpartum women admitted to postpartum wards of Mobini maternity hospital using a convenience sampling method between 2 Aug and 18 September 2021 in Iran. We used the general linear model and multiple linear regression analyses to determine predictors of birth satisfaction.

RESULTS

The mean and standard deviation values of age and education were 28.7 ± 6.6 and 11.1 ± 4.1 (years), respectively. The mean scores of the three scales were as follows: FVC-19S (14.7 ± 7.5), WHO-5 (67.5 ± 13.0) and BSS-R (28.6 ± 7.3). Sixty-five point nine percent (65.9%) of the participants were multiparous. Overall predictors of low birth satisfaction were emergency caesarean, instrumental birth, episiotomy, Entonox analgesia, low level of well-being score < 50, fear of COVID-19, low satisfaction with pregnancy and low satisfaction with spouse's support. The overall proportion of the variance in birth satisfaction explained by all variables is 17.4%. Labor and birth variables explained 12.2% of the variance in birth satisfaction.

PATIENT OR PUBLIC CONTRIBUTION

None.

Is Oxytocin Administration During Childbirth Associated With Increased Risk for Postpartum Posttraumatic Stress Symptoms?: A Preliminary Investigation

INTRODUCTION

Synthetic oxytocin is one of the most regularly administered medications to facilitate labor induction and augmentation. The present study examined the associations between oxytocin administration during childbirth and postpartum posttraumatic stress symptoms (PTSS).

MATERIALS AND METHODS

In a multicenter longitudinal study, women completed questionnaires during pregnancy and at 2 months postpartum ( N = 386). PTSS were assessed with the Impact of Event Scale. Logistic regression was used to examine the difference in PTSS at Time 2 between women who received oxytocin and women who did not.

RESULTS

In comparison with women who did not receive oxytocin, women who received oxytocin induction were 3.20 times as likely to report substantial PTSS ( P = .036, 95% confidence interval: 1.08-9.52), and women who received oxytocin augmentation were 3.29 times as likely to report substantial PTSS ( P = .036, 95% confidence interval: 1.08-10.03), after controlling for being primiparous, preeclampsia, prior mental health diagnosis, mode of birth, postpartum hemorrhage, and satisfaction with staff.

DISCUSSION

Oxytocin administration was associated with a 3-fold increased risk of PTSS. The findings may reflect biological and psychological mechanisms related to postpartum mental health and call for future research to establish the causation of this relationship.

Perinatal Outcomes and Level of Labour Difficulty in Deliveries with Right and Left Foetal Position-A Preliminary Study

BACKGROUND

Many studies have shown the negative influence of the foetus's occiput posterior position during birth on the final perinatal outcome. This study aims to add to the discussion on the impact of foetus positioning on the course of labour and subjective assessment of the level of labour difficulty.

METHODS

The cross-sectional study took place from February 2020 to September 2021, and consisted of filling out observation forms and the assessment by the midwives and women of the level of labour difficulty. This study is based on the observation of 152 labours in low-risk women.

FINDINGS

When compared to left foetal positioning, labours in which the foetus was in the right position were longer and more frequently failed to progress (in 11.3% vs. 37.5%), and epidural was more frequently administrated (in 30.4% vs. 52.7%). Both women and midwives subjectively evaluated deliveries with a foetus in the right position as more difficult.

CONCLUSIONS

The right positioning of the foetus was related to greater labour difficulty and worse perinatal outcomes. The position of the foetus' head in relation to the pelvis should be considered as an indicator of the difficulty of labour and a support plan for the woman should be offered accordingly.

Cumulative oxytocin dose in spontaneous labour - Adverse postpartum outcomes, childbirth experience, and breastfeeding

OBJECTIVES

This study aimed to determine the association between the total cumulative oxytocin dose during labour and adverse postpartum outcomes, childbirth experience and breastfeeding in term primiparous women with spontaneous onset of labour.

STUDY DESIGN

A prospective observational multicentre study, including 1395 women with spontaneous labour, in seven hospitals in Southeast Sweden. Multivariable logistic regression (Crude Odds Ratios (OR) and adjusted OR (aOR) for relevant confounders) was used to analyze the association between oxytocin dose and postpartum outcomes. The exposure was the cumulative oxytocin dose during labour, classified in percentiles (<25th, 25-75th, >75th). The outcomes were occurrence of obstetric anal sphincter injury, postpartum haemorrhage (blood loss > 1000 ml), Apgar score < 7 at five minutes, umbilical cord arterial pH, postpartum bladder overdistension, exclusive breastfeeding at one week and three months, and the woman's perceived birth experience.

RESULTS

Women receiving high amounts (>75th percentile, >4370 mU) of oxytocin infusion during labour had an increased risk of postpartum haemorrhage (OR 2.73 (1.78-4.19)), an overdistended bladder (OR 2.19 (1.11-4.31)), an infant with an Apgar score < 7 at five minutes (OR 2.89 (1.27-6.57)), a negative birth experience (OR 1.83 (1.25-2.69)), and a decreased chance of exclusive breastfeeding at one week (OR 0.63 (0.41-0.96)). After adjusting for confounders, all outcomes remained statistically significant except risk of low Apgar score and chance of exclusive breastfeeding.

CONCLUSION

In women with high cumulative oxytocin dose during labour prompt, and prophylactic administration of uterotonics after delivery of the placenta should be considered to reduce the risk of postpartum haemorrhage. The risk for bladder overdistension can be reduced by implementing routines for observation for signs of bladder filling in the early postpartum period, as well as routine use of bladder scans post micturition to assess for successful bladder emptying. As women's birth experience have a major impact on their future mental health, should be routinely assessed postpartum, and support should be offered to women with negative experiences.

Risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised

OBJECTIVE

To evaluate the risk factors for a negative birth experience using the Birth Satisfaction Scale-Revised (BSS-R) questionnaire.

METHODS

A cross-sectional study including women who gave birth at a single tertiary hospital between February 2021 and January 1, 2022. Birth satisfaction was measured using the BSS-R questionnaire. Maternal, pregnancy, and delivery characteristics were collected. Negative birth experience was defined as a BSS-R score lower than the median. Multivariable regression analysis was used to examine the association between birth characteristics and negative birth experience.

RESULTS

A total of 1495 women answered the questionnaire and were included in the analysis; 779 women comprised the positive birth experience group and 716 women comprised the negative birth experience group. Prior deliveries, prior abortions, and smoking (adjusted odds ratio [aOR], 0.52 [95% confidence interval (CI), 0.41-0.66]; aOR, 0.78 [95% CI, 0.62-0.99]; aOR, 0.52 [95% CI, 0.27-0.99], respectively) were independently associated with lower risk of negative birth experience. Immigration, answering the questionnaires in person, and cesarean delivery were independently associated with increased negative birth experience risk (aOR, 1.39 [95% CI, 1.01-1.86]; aOR 1.37 [95% CI, 1.04-1.79]; aOR, 1.92 [95% CI, 1.52-2.41], respectively).

CONCLUSION

Parity, prior abortions, and smoking were associated with a lower risk of negative birth experience, while immigration, answering questionnaires in person, and cesarean delivery were associated with a higher risk of negative birth experience.

The importance of communication and involvement in decision-making: A study in Ireland exploring birth satisfaction using the Birth Satisfaction Scale-Revised (BSS-R)

INTRODUCTION

Evaluation in healthcare services has become a priority, globally¹. The Government of Ireland has highlighted the importance of stakeholder engagement to identify the needs of women in the design and delivery of high-quality health services, driven by necessity rather than financial ability². The Birth Satisfaction Scale-Revised (BSS-R), an internationally validated tool, and recommended for measuring childbirth satisfaction by the International Consortium for Health Outcomes Measurement (ICHOM)³; however, it has yet to be considered in the Irish context. The aim of the study was to explore birth satisfaction with a sample of new mothers in Ireland.

METHODS

A mixed-methods study was conducted including a survey that involved collection of data from the BSS-R 10-item questionnaire from 307 mothers over an 8-week period in 2019, in one urban maternity hospital in Ireland. Quantitative and qualitative data were collected. Qualitative data from the free-text comments of the survey questions were analyzed using content analysis.

RESULTS

Overall, women reported positive relationships with their care providers and were satisfied with the communication and support they received, as well as high levels of control and choice. Postnatal care, however, was highlighted as being less satisfactory with staffing levels described as inadequate.

CONCLUSIONS

Understanding women's birth experiences and what is important to them could facilitate midwives and other health professionals to improve the quality of their care and develop guidelines and policies that focus on women and their families' needs. The vast majority of women rated their birthing experience as extremely positive. The main elements of care that contributed to a positive birthing experience for women were quality relationships with clinicians, choice and control, and emotional safety.

Overall childbirth experience: what does it mean? A comparison between an overall childbirth experience rating and the Childbirth Experience Questionnaire 2

BACKGROUND

In clinical settings and research studies, childbirth experience is often measured using a single-item question about overall experience. Little is known about what women include in this rating, which complicates the design of adequate follow-up, as well as the interpretation of research findings based on ratings of overall childbirth experience. The aim of this study was to examine which known dimensions of childbirth experience women include in the rating on a single-item measure.

METHODS

Ratings of overall childbirth experience on a 10-point numeric rating scale (NRS) from 2953 women with spontaneous or induced onset of labour at two Swedish hospitals were evaluated against the validated Childbirth Experience Questionnaire 2 (CEQ2), completed on one of the first days postpartum. The CEQ2 measures four childbirth experience domains: own capacity, perceived safety, professional support and participation. Internal consistency for CEQ2 was evaluated by calculating Cronbach's alpha. NRS ratings were explored in relation to CEQ2 using empirical cumulative distribution function graphs, where childbirth experience was defined as negative (NRS ratings 1-4), mixed (NRS ratings 5-6) or positive (NRS ratings 7-10). A multiple linear regression analysis, presented as beta coefficients (B) and 95% confidence intervals (CI), was also performed to explore the relationship between the four domains of the CEQ2 and overall childbirth experience.

RESULTS

The prevalence of negative childbirth experience was 6.3%. All CEQ2-subscales reached high or acceptable reliability (Cronbach's alpha = 0.78; 0.81; 0.69 and 0.66, respectively). Regardless of overall childbirth experience, the majority of respondents scored high on the CEQ2 subscale representing professional support. Overall childbirth experience was mainly explained by perceived safety (B = 1.60, CI 1.48-1.73), followed by own capacity (B = 0.65, CI 0.53-0.77) and participation (B = 0.43, CI 0.29-0.56).

CONCLUSIONS

In conclusion, overall childbirth experience rated by a single-item measurement appears to mainly capture experiences of perceived safety, and to a lesser extent own capacity and participation, but appears not to reflect professional support. CEQ2 shows good psychometric properties for use shortly after childbirth, and among women with induced onset of labour, which increases the usability of the instrument.

Women's views and experiences of augmentation of labour with synthetic oxytocin infusion: A qualitative evidence synthesis

OBJECTIVE

To explore and synthesise women's views and experiences of augmentation of labour with synthetic oxytocin infusion.

DESIGN

A qualitative evidence synthesis was conducted. The SPIDER acronym was used to develop the search terms and determine the inclusion criteria. Six bibliographic databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection were searched in October 2021. Grey literature sources, EThOS, DART-Europe, and the World Health Organization's Clinical Trials Registry were searched, and reference lists of included studies were reviewed. Methodological quality of included studies was assessed using the Evidence for Policy and Practice Information and Co-ordinating (EPPI) Centre assessment tool. Data were synthesised thematically. The confidence of each review finding was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Research ethical approval was not required.

SETTING AND PARTICIPANTS

Women of any age, parity, and cultural background who underwent augmentation of labour with synthetic oxytocin infusion were included.

FINDINGS

A total of 9306 citations were retrieved. Twenty-five studies conducted across 14 countries met the inclusion criteria and contributed data. Three principal analytical themes emerged: feeling stuck; past and present shaping the future; and cause and effect of augmentation of labour. The decision to augment women's labour was often performed without their informed consent. Women's views and experiences of augmentation of labour were shaped according to their knowledge, beliefs and support received during labour. Irrespective of the context, women consistently associated augmentation of labour with pain.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Clinical guidelines on augmentation of labour need to be informed by research that includes women's views and experiences as a main outcome. Future research exploring the experience of augmentation of labour rather than the experience of labour dystocia would be beneficial. Increasing women's awareness and knowledge of augmentation of labour may help to ensure that their informed consent is obtained. Healthcare providers should discuss the effects, side effects and implications of augmentation of labour with women, ideally before labour.

Effect of internet-based cognitive behaviour therapy among women with negative birth experiences on mental health and quality of life - a randomized controlled trial

Background

Giving birth is often a positive experience, but 7–44% have negative experiences and about 4% develop posttraumatic stress disorder following childbirth (PTSD FC). This randomized controlled trial (RCT) investigated the effect of internet-based cognitive behaviour therapy (iCBT) for women with negative birth experiences and/or at risk for PTSD FC.

Methods

This was a superiority nonblinded multicentre RCT comparing iCBT combined with treatment as usual (TAU) with TAU only. Data were collected through questionnaires at baseline, at 6 weeks, 14 weeks and 1 year after randomization. The RCT was conducted at four delivery clinics in Sweden and participants were recruited from September 2013 until March 2018. Women who rated their childbirth experience as negative on a Likert scale, and/or had an immediate caesarean section or a haemorrhage of > 2000 ml were eligible. Primary outcomes were symptoms of posttraumatic stress (Traumatic Event Scale, TES) and symptoms of depression (Edinburgh Postnatal Depression Scale, EPDS). Secondary outcomes were satisfaction with life (Satisfaction With Life Scale, SWLS) and coping (Ways of Coping Questionnaire, WCQ).

Results

Out of 1810 eligible women, 266 women were randomised to iCBT+TAU (n = 132) or to TAU (n = 134). In the iCBT+TAU group 59 (45%) completed the treatment. ICBT+TAU did not reduce PTSD FC at 6 weeks, at 14 weeks, or at 1 year follow-up compared with TAU, according to the TES. Both the ITT and completer analyses showed significant time and quadratic time effects due to reduction of symptoms in both groups on the TES (re-experience subscale) and on the EPDS, and significant time effect on the self-controlling subscale of the WCQ (which increased over time). There was also a significant main effect of group on the SWLS where the TAU group showed higher initial satisfaction with life. Exploratory subgroup analyses (negative birth experience, immediate caesarean section, or severe haemorrhage) showed significant time effects among participants with negative birth experience on re-experience, arousal symptoms and depressive symptoms.

Conclusions

The ICBT intervention did not show superiority as both groups showed similar beneficial trajectories on several outcomes up to 1 year follow-up. This intervention for women with negative birth experiences and/or at risk for PTSD FC was feasible; however, the study suffered from significant drop out rate. Future studies with more narrow inclusion criteria and possibly a modified intervention are warranted.

Trial registration

ISRCTN39318241. Date for registration 12/01/2017.

Umbilical cord clamping time and maternal satisfaction

OBJECTIVE

Clamping of the umbilical cord is part of the third stage of delivery. Delayed cord clamping (DCC) is recommended due to its contribution to prevention of anaemia. There is no evidence on the effect of DCC on maternal satisfaction. The aim of this study is to evaluate the effect of different sociodemographic and obstetric factors, including the timing of cord clamping, on maternal satisfaction with the birth experience in our healthcare system.

DESIGN

Pragmatic non-drug intervention study with simple random assignment of participating mothers (Clinical Trials N°: NCT03624335).

SETTING

A public, university-level hospital in Villarreal city, eastern Spain.

PARTICIPANTS

Childbearing woman, gestation week between 35 and 42 weeks, with regular medical pregnancy checks, single pregnancy and vaginal delivery (N = 198, 80% of the women recruited).

INTERVENTIONS

umbilical cord clamping within 60 seconds of the birth (Early cord clamping, ECC) versus umbilical cord clamping after pulsation had been ceased (Delayed cord clamping, DCC).

MEASUREMENTS

Birth satisfaction was measured using the Mackey Childbirth Satisfaction Rating Scale (MCSRS). Additionally, sociodemographic data, degree of knowledge about the moment of clamping and type of breastfeeding data were recorded. The Mann-Whitney and Kruskal-Wallis tests for comparison of the mean of two, three, or more groups, respectively, and Chi-square and Spearman for comparison of two qualitative and quantitative variables, respectively, were used. To determine the weight of each factor of MCSRS, an exploratory factor analysis was carried out using the maximum likelihood method for factor extraction and the varimax method for factor rotation. The adequacy of the factor analysis was checked by mean of Kaiser-Meyer-Olkin test and Bartlett sphericity test. The level of significance was set at a p-value of < 0.05.

FINDINGS

The average degree of satisfaction was 4.55/5 (SD: 0.37). No statistically significant difference was observed between mothers' satisfaction according to mother level of study or mother's place of birth, while it changed significantly with age (p = 0.0398). Within the obstetric variables, satisfaction was significantly associated with spontaneous amniorrhexis, the duration of the second stage of delivery, and the Apgar value of the newborn at the first minute of life, and was independent of the number of previous pregnancies and deliveries, use of intrapartum oxytocin, epidural analgesia, episiotomy, the weight of the child at birth and type of breastfeeding. Furthermore, there was no relationship between the time of clamping and satisfaction (p = 0.5178).

KEY CONCLUSIONS

Maternal satisfaction with the birth experience varies with the age of the childbearing woman, and some intrapartum factors and the result is not influenced by the time of clamping of the umbilical cord. Therefore, this component of the physiological management of childbirth provides additional benefits for the health of the neonate, without negative consequences on the final perception of the maternal health care received.

IMPLICATIONS FOR PRACTICE

If there are no reasons that justify an early umbilical cord clamping, delaying it brings benefits to the neonate, without negatively affecting the maternal assessment of the experience of childbirth.

Predictors of Women’s Childbirth Experience: A Prospective Longitudinal Study on Italian New Mothers

BACKGROUND

Women’s memories of their childbirth experience tend to remain unchanged over time. This experience can be influenced by obstetric factors as well as by sociodemographic and psychological variables.

OBJECTIVE

To examine whether women’s perceived childbirth experience changes over time; to identify the predictors (obstetric, sociodemographic, and psychological variables) of this experience immediately after delivery and after 3 months.

METHODS

This prospective longitudinal study comprised two hundred and twenty-one Italian women who completed a self-report questionnaire at two assessment points: immediately (1–3 days) after birth (Time 1) and 3 months postpartum (Time 2). At Time 1, the questionnaire included some questions on sociodemographic, psychological, and obstetric information, and the Wijma Delivery Experience Questionnaire (WDEQ(B); at Time 2 women compiled again the WDEQ(B).

RESULTS

Repeated measures ANOVA revealed that the childbirth experience did not change from Time 1 to Time 2. However, predictors of this experience were different between Time 1 and Time 2: at Time 1, the childbirth experience (WDEQ(B)_t1) was significantly predicted nly by type of cesarean section; at Time 2, the childbirth experience (WDEQ(B)_t2) was significantly predicted by WDEQ(B)_t1, history of psychological disorders, and type of conception.

DISCUSSIONS

Our findings enhance the understanding of the main predictors of a woman’s childbirth experience. Identifying areas of vulnerability is important for clinical practice, as well as for developing maternal health policies to improve women’s birth experiences, postpartum well-being, and the baby’s development.

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.

Labor dystocia and oxytocin augmentation before or after six centimeters cervical dilatation, in nulliparous women with spontaneous labor, in relation to mode of birth

BACKGROUND

The effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to examine whether cervical dilatation at diagnosis of dystocia and initiation of oxytocin infusion at different stages of cervical dilatation were associated with mode of birth, obstetric complications and women's birthing experience.

METHODS

A retrospective cohort study, including 588 nulliparous term women with spontaneous onset of labor and dystocia requiring oxytocin augmentation. The study population was divided into three groups according to cervical dilatation at diagnosis of dystocia and initiation of oxytocin-infusion (≤ 5 cm, 6-10 cm, fully dilated) with mode of birth as the primary outcome. Secondary outcomes were obstetrical and neonatal complications and women´s experience of childbirth. Statistical comparison between groups using Chi-square and ANOVA was performed. The risk of operative birth (cesarean section and instrumental birth) was assessed using binary logistic regression with suitable adjustments (maternal age, body mass index and risk assessment on admission to the labor ward).

RESULTS

The cesarean section rate differed between the groups (p < 0.001); 12% in the ≤ 5 cm group, 6% in the 6-10 cm group and 0% in the fully dilated group. There was no increased risk for operative birth in the ≤ 5 cm group compared to the 6-10 cm group, adjusted OR 1.28 95%CI (0.78-2.08). The fully dilated group had a decreased risk of operative birth (adjusted OR 0.48 95%CI (0.27-0.85). The rate of a negative birthing experience was high in all groups (28.5%, 19% and 18%) but was only increased among women in the ≤ 5 cm group compared with the 6-10 cm group, adjusted OR 1.76 95%CI (1.05-2.95).

CONCLUSIONS

Although no difference in the risk of operative birth was found between the ≤ 5 cm and 6-10 cm cervical dilatation-groups, the cesarean section rate was highest in women with dystocia requiring oxytocin augmentation at ≤ 5 cm cervical dilatation. This might indicate that oxytocin augmentation before 6 cm cervical dilatation could be contra-productive in preventing cesarean sections. Further, the increased risk of negative birth experience in the ≤ 5 cm group should be kept in mind to improve labor care.

Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion. A protocol for a qualitative evidence synthesis

Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions.  Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited.

Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research.

Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers.

PROSPERO registration: CRD42021285252 (14/11/2021)

Women’s views and experiences of augmentation of labour with synthetic oxytocin infusion: a protocol for a qualitative evidence synthesis

Background: Augmentation of labour (AOL) is the most common intervention to treat labour dystocia. Previous research reported extensive disparities in AOL rates across countries and institutions.  Despite its widespread use, women’s views on and experiences of intrapartum augmentation with infused synthetic oxytocin are limited. Methods: A qualitative evidence synthesis on women’s views and experiences of AOL with synthetic oxytocin after spontaneous onset of labour will be conducted. Qualitative studies and studies employing a mixed methods design, where qualitative data can be extracted separately, will be included, as will surveys with open-ended questions that provide qualitative data. A systematic search will be performed of the databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection from the date of inception. The methodological quality of included studies will be assessed using the Evidence for Policy and Practice Information and Co-ordinating Centre’s appraisal tool. A three-stage approach, coding of data from primary studies, development of descriptive themes and generation of analytical themes, will be used to synthesise findings. Confidence in findings will be established by the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research. Discussion: This qualitative evidence synthesis may provide valuable information on women’s experiences of AOL and contribute to a review of clinical practice guidelines for maternity care providers. PROSPERO registration: CRD42021285252 (14/11/2021)

Obstetric violence a qualitative interview study

OBJECTIVE

To investigate the meaning of the concept of 'obstetric violence' to women in Sweden, who reported a negative birth experience.

DESIGN

An inductive qualitative approach with individual narratives. A thematic qualitative content analysis was used.

SETTING

Three midwifery clinics in southwest Scania.

PARTICIPANTS

Twelve women who had given birth less than three years previously and reported a negative/traumatic birth experience.

FINDINGS

The key findings showed that the women had experienced psychological and physical abuse during childbirth which may be interpreted as 'obstetric violence'. Four categories emerged from the analyses describing the women's experiences: Lack of information and consent including poor information and no right to participate in decisions concerning the process of labour, Insufficient pain relief, which encompassed unbearable pain without pain relief, Lack of trust and security where the women experienced staff with bad attitudes and jargon, and The experience of abuse including threats of violence from midwives and where the birth experience was compared to rape.

KEY CONCLUSIONS

The study shows that physical and psychological abuse during childbirth exists in Sweden and that women experience this as being subjected to 'obstetric violence' during childbirth. The phenomenon of obstetric violence is very complex. The abuse of women during childbirth might be a significant problem and quality assurance is required to secure the rights of women giving birth.

IMPLICATIONS FOR PRACTICE

In order to secure the rights of birthing women and to promote respectful and supportive care for new mothers, quality development programs are required.

Which elements were significant in reducing obstetric anal sphincter injury? A prospective follow-up study

Background

To examine which elements of an obstetric anal sphincter injury (OASI) care bundle were protective for OASI. Several interventional trials showed that application of a care bundle involving a hands-on approach to perineal protection may reduce the risk of OASI. Previously, we found that only the element “hand on the fetal head” in itself was protective, although the risk of a type 2 error was calculated to be 50%.

Methods

A prospective follow-up study in an obstetric department in Denmark with 3200 deliveries per year. We included a cohort of 10,383 women giving birth vaginally from gestational week 22 + 0 from 2016 through 2019. We documented on a person-level the five elements of the care bundle together with maternal and obstetrical characteristics. The elements were 1) communication, 2) visible perineum, 3) hand on fetal head, 4) perineal support and 5) certification. Regression analysis was used for analysis of associations. The primary outcome measure was OASI.

Results

The total rate of OASI in vaginally delivering women was 1.9%. The incidence was 3.2% in nulliparous women giving birth vaginally. The rate of cesarean section was 16.5% and for episiotomy 2.4%. The reduction in the incidence of OASI was sustained since 2013. Hand on the fetal head and perineal support both were protective factors for OASI. In case of a nulliparous woman with a neonate weighing 3500 g giving birth spontaneously, the relative risk (RR) for OASI was 0.50 (95% CI 0.49- 0.51) with use of hand on the fetal head together with perineal support against no use. Similarly, with a nulliparous woman giving birth to a neonate of 3500 g by vacuum extraction, the RR for OASI was 0.65 (95% CI 0.62-0.68) against no use.

Conclusions

Both hand on the fetal head and perineal support were associated with a reduced risk of OASI.

Postpartum women's psychological experiences during the COVID-19 pandemic: a modified recurrent cross-sectional thematic analysis

BACKGROUND

COVID-19 has placed additional stressors on mothers during an already vulnerable lifecourse transition. Initial social distancing restrictions (Timepoint 1; T1) and initial changes to those social distancing restrictions (Timepoint 2; T2) have disrupted postpartum access to practical and emotional support. This qualitative study explores the postpartum psychological experiences of UK women during different phases of the COVID-19 pandemic and associated 'lockdowns'.

METHODS

Semi-structured interviews were conducted with 12 women, approximately 30 days after initial social distancing guidelines were imposed in the UK (22 April 2020). A separate 12 women were interviewed approximately 30 days after the initial easing of social distancing restrictions (10 June 2020). Data were transcribed verbatim, uploaded into NVivo for management and analysis, which followed a recurrent cross-sectional approach to thematic analysis.

RESULTS

Two main themes were identified for T1: 'Motherhood is Much Like Lockdown' and 'A Self-Contained Family Unit'. Each main T1 theme contained two sub-themes. Two main themes were also identified for T2: 'Incongruously Held Views of COVID-19' and 'Mothering Amidst the Pandemic'. Each main T2 theme contained three sub-themes. Comparisons between data gathered at each timepoint identified increased emotional distress over time. Current findings call for the improvement of postpartum care by improving accessibility to social support, and prioritising the re-opening of schools, and face-to-face healthcare appointments and visitation.

CONCLUSION

Social distancing restrictions associated with COVID-19 have had a cumulative, negative effect on postpartum mental health. Recommendations such as: Allowing mothers to 'bubble' with a primary support provider even at their healthcare appointments; allowing one support partner to attend all necessary healthcare appointments; and providing tailored informational resources, may help to support postpartum emotional wellbeing during this, and similar health crises in the future.

Reproducing normative femininity: Women's evaluations of their birth experiences analysed by means of word frequency and thematic analysis

BACKGROUND

Given the significance of the birth experience on women's and babies' well-being, assessing and understanding maternal satisfaction is important for providing optimal care. While previous research has thoroughly reviewed women's levels of satisfaction with the childbirth experience from a multitude of different angles, there is a dearth of papers that use a gender lens in this area. The aim of this study is to explore through a gender perspective the circumstances attributed to both women's assessment of a positive birth experience and those which contribute to a lack of satisfaction with their birth experience.

METHODS

Through the use of a local birth evaluation form at a Swedish labour ward, 190 women gave written evaluations of their birth experiences. The evaluations were divided into groups of positive, ambiguous, and negative evaluations. By means of a latent and constructionist thematic analysis based on word count, women's evaluations are discussed as reflections of the underlying sociocultural ideas, assumptions, and ideologies that shape women's realities.

RESULTS

Three themes were identified: Grateful women and nurturing midwives doing gender together demonstrates how a gender-normative behaviour may influence a positive birth experience when based on a reciprocal relationship. Managing ambiguous feelings by sympathising with the midwife shows how women's internalised sense of gender can make women belittle their negative experiences and refrain from delivering criticism. The midwifery model of relational care impeded by the labour care organisation describes how the care women receive during labour and birth is regulated by an organisation not always adapted to the benefit of birthing women.

CONCLUSIONS

Most women were very satisfied, predominantly with emotional support they received from the midwives. The latent constructionist thematic analysis also elicited women's mixed feelings towards the birth experience, with the majority of negative experiences directed towards the labour care organisation. Recognising the impact of institutional and medical discourses on childbirth, women's birth evaluations demonstrate the benefits and challenges of gender-normative behaviour, where women's internalised sense of gender was found to affect their experiences. A gender perspective may provide a useful tool in unveiling gender-normative complexities surrounding the childbirth experience.