How can midwives promote a normal birth and a positive birth experience? The experience of first-time Norwegian mothers

Maternal experiences of women who had received salutary childbirth education: A descriptive qualitative study

BACKGROUND

Childbirth education, underpinned by Salutogenesis, presents a paradigm shift in maternal care. There was no present information about the maternal experiences of women who had received Salutary childbirth education.

OBJECTIVE

The present study aimed to deeply explore women's pregnancy, birth and postnatal experiences who attended the 'Salutary Childbirth Education Program' and shed light on the mechanisms of Salutogenesis on maternal health promotion.

METHODS

A descriptive qualitative study was conducted with 15 mothers. The study was conducted during April-October 2023. Data were obtained through semi-structured, in-depth individual longitudinal interviews to cover all maternal periods. A thematic analysis was performed.

RESULTS

Women stated that they 'acquired normality oriented perspective' which provides 'attribution of positive meanings to the period' and 'freedom from their risk focus concerns'. Women experienced the naturality of the process and were in the flow. They described that they became 'aware of their internal resources', and gained 'skills for the construction of resources' and 'ability to manage the period'. The 'emotional strength' and 'Investment ability for themselves' in addition to obtained autonomy provided them a feeling of strength to actively engage in their experience.

PRACTICE IMPLICATIONS

This study explores the experiences of women who participated in the Salutary Childbirth Education Program and describes the mechanisms of the program's components on their experiences. By doing so, it aims to enhance understanding of how healthcare professionals can present effective childbirth education through the use of the Salutogenesis Model.

PATIENT OR PUBLIC CONTRIBUTION

The authors would like to acknowledge and thank the women who attended the education program and were willing to interview.

Attuning to the World of Peace of Mind and Trust: Women's Lived Experience of the Woman-Midwife Relationship in Japan

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.

Interplay of Dyadic Consensus, Reflective Functioning, and Perinatal Affective Difficulties in Modulating Fear of COVID-19 among First-Time Mothers: A Mediation Analysis

BACKGROUND

The COVID-19 pandemic has exacerbated fears and anxieties, potentially influencing maternal perinatal mental health. This study addresses a gap in the literature on fear of COVID-19 in pregnant women, aiming to identify contributing factors.

METHOD

Participants were 401 primiparous women with an average age of 34 years (SD = 4.56) who were recruited through the National Health System during birth support courses. They completed a series of self-reported instruments via an online survey, providing information on their levels of reflective functioning, dyadic consensus, perinatal maternal affectivity, and fear of COVID-19. Pearson's correlation and mediation analysis via a generalized linear model were implemented to analyze the collected data.

RESULTS

The relationship between dyadic consensus and fear of COVID-19 was significant and negative. Furthermore, a significant parallel mediation involving perinatal maternal affectivity and reflective functioning was found to the extent that, when these factors were inserted into the model, the direct association between dyadic consensus and fear of COVID-19 became non-significant (total mediation).

CONCLUSIONS

The results highlight the importance of dyadic adjustment in alleviating maternal COVID-19 fear, emphasizing interventions promoting couple functioning, mentalization, and addressing affective difficulties. Such approaches are vital for supporting expecting mothers during challenging times like the COVID-19 pandemic.

Insights of healthcare professionals regarding waterbirths and water immersion during labour: A mixed studies review

AIM

To consolidate healthcare professionals' insights about waterbirths and water immersion during labour.

DESIGN

Mixed studies review.

DATA SOURCES

Seven electronic databases were searched from their inception dates till June 2023: PubMed, Embase, CINAHL, PsycINFO, Web of Science, Scopus, ProQuest Dissertations and Theses Global.

METHODS

The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and Pluye and Hong's mixed studies review framework guided this review. The quality of included studies was evaluated using the Mixed Methods Appraisal Tool. Findings were synthesized using the convergent qualitative synthesis method, and results were thematically analysed using Braun and Clarke's framework.

RESULTS

Three main themes were identified from the 22 included studies: (1) believing in waterbirths, (2) opposing forces and (3) plotting the course ahead.

CONCLUSION

Healthcare professionals reported different views about waterbirths and water immersion practices; midwives were most likely to support these practices, followed by nurses and lastly, few physicians supported them. Reasons for opposing waterbirths include insufficient training and support from colleagues as well as concerns about work efficiency, waterbirth safety and litigation issues.

IMPACT

The available evidence suggests the need to provide waterbirth training for healthcare professionals, equip healthcare facilities with necessary waterbirth-related infrastructure and develop appropriate waterbirth policies/guidelines. Healthcare professionals could also consider providing antenatal waterbirth education to women and obtain women's feedback to improve current policies/guidelines. Future research should explore the views of different types of healthcare professionals from more diverse cultures.

REPORTING METHOD

The PRISMA guidelines.

NO PATIENT OR PUBLIC CONTRIBUTION

Systematic review.

Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies

BACKGROUND

The World Health Organization 2018 intrapartum guideline for a positive birth experience emphasized the importance of maternal emotional and psychological well-being during pregnancy and the need for safe childbirth. Today, in many countries birth is safe, yet many women report negative and traumatic birth experiences, with adverse effects on their and their families' well-being. Many reviews have attempted to understand the complexity of women's and their partners' birth experience; however, it remains unclear what the key dimensions of the birth experience are.

OBJECTIVE

To synthesize the information from reviews of qualitative studies on the experience of childbirth in order to identify key dimensions of women's and their partners' childbirth experience.

METHODS

Systematic database searches yielded 40 reviews, focusing either on general samples or on specific modes of birth or populations, altogether covering primary studies from over 35,000 women (and >1000 partners) in 81 countries. We appraised the reviews' quality, extracted data and analysed it using thematic analysis.

FINDINGS

Four key dimensions of women's and partners' birth experience (covering ten subthemes), were identified: 1) Perceptions, including attitudes and beliefs; 2) Physical aspects, including birth environment and pain; 3) Emotional challenges; and 4) Relationships, with birth companions and interactions with healthcare professionals. In contrast with the comprehensive picture that arises from our synthesis, most reviews attended to only one or two of these dimensions.

CONCLUSIONS

The identified key dimensions bring to light the complexity and multidimensionality of the birth experience. Within each dimension, pathways leading towards negative and traumatic birth experiences as well as pathways leading to positive experiences become tangible. Identifying key dimensions of the birth experience may help inform education and research in the field of birth experiences and gives guidance to practitioners and policy makers on how to promote positive birth experiences for women and their partners.

Effect of childbirth experience on the psychological well-being of postpartum women in Accra, Ghana

BACKGROUND

Women's experience of childbirth can affect their mental health outcomes, many years after the delivery. Consequently, the World Health Organisation has provided recommendations to ensure women receive positive birth experiences during intrapartum care. Yet, negative childbirth experience is widespread in Ghana. This study examined the association between women's childbirth experience (i.e. own capacity, professional support, perceived safety, and participation) and their psychological well-being, and whether or not perceived social support and resilience moderate the childbirth experience - psychological well-being relationship.

METHODS

Mothers (N = 117) who had given birth in the past month and were receiving postnatal care at two health facilities in the Greater Accra Region of Ghana provided the data for the current analysis. Data were collected using the Childbirth Experience Questionnaire, WHO-5 Well-Being Index, Multidimensional Scale of Perceived Social Support, and Brief Resilience Scale. Hierarchical Linear Regression was used to analyse the data.

RESULTS

Results showed that childbirth experience domains of own capacity and perceived safety were significantly, and positively associated with psychological well-being. The domains of professional support and participation were not associated with psychological well-being in this sample. Perceived social support and resilience did not moderate the association between childbirth experience and psychological well-being.

CONCLUSION

The results suggest that efforts by birth practitioners (i.e. midwives, obstetricians, and gynaecologists) to give Ghanaian women positive childbirth experiences through the encouragement of personal control over the birthing process as well as ensuring the safety of the birthing procedure and environment would provide women with optimal mental health outcomes.

Women's experiences with planned singleton upright breech birth - A phenomenological study

OBJECTIVE

To explore the experience of primi- and multiparous women with planned singleton upright breech births.

METHOD

We conducted face-to-face, in-depth interviews with five primiparous and five multiparous women who underwent a physiological breech birth at one hospital in Norway and analyzed the data using Giorgi's descriptive phenomenological method.

RESULTS

The phenomenon of women's experiences with physiological breech birth yielded four main constituents: "Mental preparedness and control", "The importance of shared decision-making and sufficient information", "Trust and the many 'faces' of birthing staff", and "'I actually did it!': Coping and control in the upright breech position". The significance of readiness, the influence of previous experiences and information, and the establishment of trust in midwives and gynecologists emerge as dominant themes. The sense of co-determination, control, and mastery is also highlighted.

CONCLUSIONS

Our findings underscore the pivotal role of personal attributes in fostering mental preparedness when confronted with unforeseen aspects of childbirth. Notably, women's experiences with upright breech birth vary; while some perceive it as an ideal birth, others find it more challenging. Factors such as unpreparedness, lack of information, diminished co-determination, and loss of control negatively impact birth experiences. This study's findings underscore the significance of tailoring maternity care to individual needs and improving information sharing. These measures are paramount for optimizing women's experience during upright breech births.

Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health

BACKGROUND

Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far.

METHODS

Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively.

RESULTS

Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers.

LIMITATIONS

Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small.

CONCLUSIONS

Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.

Midwives' perceptions of and experiences with normal physiologic birth: A qualitative systematic review

BACKGROUND

Normal physiologic birth has been shown to result in optimal maternal-infant outcomes, but the concept of physiologic birth is continually evolving. Midwives play an important role in advocating for normal physiologic birth; however, their perceptions of what this approach entails have not been systematically appraised.

OBJECTIVE

In this qualitative review, we aimed to examine midwives' perceived meanings of "normal physiologic birth" and to describe their experiences facilitating such births.

METHODS

Five electronic databases were searched, and 26 qualitative papers were included, representing a total of 433 midwives from different backgrounds (i.e., independent, home-based, community-based, and hospital-based). Eligible papers were assessed for quality, and then data were coded and synthesized thematically.

RESULTS

Four highly connected themes were generated: (1) the midwife: fundamental beliefs; (2) the woman: empowerment and advocacy; (3) the environment: ambience and culture; and (4) the team: need for institutional support and recognition. The fundamental beliefs of midwives, such as their perceived role and definition of normal physiologic birth and their self-confidence, influence practice styles and contribute to personal and professional development. Midwives often advocate for a person-centered approach that encouraged women's and other birthing person's autonomy and involvement in shared decision-making. The midwife-client relationship is also central. Most importantly, a conducive birthing environment and an inclusive workplace culture that encourages interprofessional support, collaboration, and recognizes midwifery practices were identified as crucial in providing optimal conditions for the facilitation of physiologic birth.

CONCLUSIONS

This review provides healthcare policymakers and institutions fresh impetus to evaluate and revise as needed current workplace policies to be more inclusive and supportive of midwifery practices and physiologic birth.

Norwegian midwiveś experiences of encounter and support women with fear of childbirth during birth

OBJECTIVE

To describe midwiveś experiences of encountering and supporting women with fear of childbirth (FOC) during the birth.

METHOD

Qualitative study with a phenomenological approach, using 10 individual semi-structured interviews with midwives who had cared for women with FOC during the birth. All midwives worked in birth clinics or maternity wards. The data was analysed using Malterud́s systematic text condensation (STC).

RESULTS

The findings present in three main themes: taking on a professional role as a midwife to take care of women; time matters for safety and trust; and to encounter and see women without prejudices. Themes to describe a 'professional midwife' included self-confidence, control, competence/experience, independence, promoting normal birth, and motivation. Time played a crucial role in enabling a calm approach and a relationship built on trust, as well as in creating a sense of continuity and being present. Individual care and equality among the women was of importance to prevent prejudices, as was having control of the term FOC. Self-awareness was also important for evaluating the quality of the relationship, and the midwives' wanted clear guidelines for handling women with FOC.

CONCLUSION

Aspects related to professional midwifery skills, organisational factors such as time to establish safety and trust, and use of the concept of FOC, are all important for midwives when encountering and supporting women with FOC at birth. All these aspects need to be improved in the care of women with FOC, and clearly defined guidelines for handling such cases need to be developed.

Women’s experiences with unexpected induction of labor: A qualitative study

INTRODUCTION

Induction of labor is the most common intervention in modern obstetrics and is a growing phenomenon worldwide. Research on women’s experiences with the induction of labor is scarce, especially on being unexpectedly induced. The purpose of this study is to explore women’s experiences with unexpected induction of labor.

METHODS

We conducted a qualitative study including 11 women who had undergone an unexpected induction of labor within the last three years. Semi-structured interviews were conducted in the period February–March 2022. Data were analyzed using systematic text condensation (STC).

RESULTS

The analysis led to four result categories. The decision to induce labor came as a surprise to the women, both for better and for worse. Information was not automatically provided and was often obtained through the women’s own efforts. Consent to the induction mainly took the form of a decision by healthcare personnel, and the birth was a positive experience during which the woman felt looked after and reassured.

CONCLUSIONS

The women were very surprised when told they had to be induced and were unprepared for the situation. They received insufficient information, and several experienced stress from the time of induction up until they gave birth. Despite this, the women were satisfied with the positive birth experience, and they emphasized the importance of being looked after by empathetic midwives during childbirth.

Women's experiences of continuity of care from student midwives - A qualitative study from Norway

OBJECTIVE

The study aimed to gain a deeper understanding of women's experience of continuity of care by student midwives during the childbearing process.

METHOD

A qualitative approach was the design used in this study. In-depth interviews were conducted with nine women who had received continuity of care during their childbearing process by student midwives. The interviews were analysed with the help of systematic text condensation. The study was approved by the Norwegian Centre for Research Data (ref. 905085) and the Regional Research Ethics Committee (ref. 2019/608).

FINDINGS

Continuity of care enabled a deep relationship between the woman and the student midwife and made the care provided more individualised, giving the woman emotional support and preparing her for birth. The presence of a student midwife during labour and birth who knew the woman's story made the woman able to focus on the birth process. Even when unexpected events occurred, the woman had a positive birth experience due to the relationship between her and the student midwife. Continuity of care made the women feel safe and taken care of and was the preferred model of care.

CONCLUSION

Continuity of care contributes to individualised and personalised care, enabling all aspects of the woman's needs to be considered throughout the childbearing process. Due to the positive impact on the women in the present study, it is appropriate to implement a continuity of care model in midwifery education programmes. Further research should be conducted to examine how doing so would influence both student midwives and women.

Development of the short form Iranian women childbirth experience questionnaire: a confirmatory factor analysis approach item reduction

INTRODUCTION

Considering that childbirth experience has short- and long-term effects on women's lives, it is necessary to examine their delivery experiences. This study aimed to prepare the short form of a 52-item Iranian women's childbirth experience questionnaire with seven factors: professional support, preparation, control, positive perception, baby, family support, and fear.

METHODS

This methodological research was conducted on women aged 15 to 49 years (n = 770) with uncomplicated vaginal delivery. The short form of the Iranian women's childbirth experience questionnaire was prepared in four stages. The first stage was exploratory factor analysis, conducted on 250 samples, the second stage was confirmatory factor analysis which was performed on 260 samples, independent of the first stage, to report goodness and fit indices, and the third stage employed items from modification indices, expected parameter change, and standardized residual covariance, leading to the short form of Iranian women childbirth experience questionnaire. Finally, confirmatory factor analysis was run on 260 samples, independent of the previous two stages, to confirm the short form and compare it with the original questionnaire for psychometric analysis.

RESULTS

In the exploratory factor analysis stage, nine items with a factor load of less than 0.4 were removed, and the number of domains was reduced to five. The second stage showed that the questionnaire had a goodness of fit index. However, the third stage resulted in removing 11 overlapping items and making a short questionnaire with 33 items. Finally, the confirmatory factor analysis in the last stage showed appropriate goodness of fit for the short form of the Iranian women's childbirth experiences questionnaire (𝛘²/df = 2.352, CFI = 0.881, PCFI = 0.750, RMSEA = 0.072, SRMR = 0.0862).

CONCLUSION

The short form of the Iranian women's childbirth experiences questionnaire enjoyed from an appropriate psychometric evaluation. It is recommended when applying the original questionnaire is not feasible due to lack of time.

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

Purpose

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

Method

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

Results

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

Conclusion

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

Iranian midwives' lived experiences of providing continuous midwife-led intrapartum care: a qualitative study

Background & Objective

Continuity of midwifery-led care during labour and birth is considered optimal. To ensure its sustainability in practice where limited evidence is available, the aim of the present study was to explore midwives’ lived experiences of delivering continuous midwife-led intrapartum care.

Methods

This study took a qualitative approach in meeting its aim. Participants were midwives working in the labour wards of private and public hospitals in Iran. The data were purposefully collected in 2019 through in-depth, semi-structured, and face-to-face interviews with midwives (n = 10) aged between 26 and 55 years. A thematic analysis based on descriptive phenomenology was undertaken to make sense of the data collected.

Results

“Wanting to lead continuous woman-centered care but being unable to” was identified as an overarching theme. Three other themes “emphasis on the non-interventional care”, “midwifery-specific focus” and “barriers and challenges of midwifery care” were also identified. Ultimately, midwives described knowing how to and wanting to lead continuous ‘woman’-centered care but being unable to. Perceived barriers included lack of familiarity with and knowledge in relation to childbirth, the insignificant role of midwives in decision making, obstetrician utilitarianism, high workloads along with work-related stress argument-driven communication between midwives and obstetricians and an absence of a ‘triangle of trust’ in care.

Conclusion

Future research strategies could usefully include obstetricians and focus on the upscaling of midwifery in Iran using continuity of care models, highlight the value of midwives, identify why uptake of antenatal education in Iran is poor and develop user friendly, evidence based, midwife-led programs. Initiatives aiming to promote mutual professional respect, trust and collegiality and increased remuneration for midwifery work would be also welcomed in pursuit of reducing maternal and infant mortality in Iran.

The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study

Background

There is insufficient scientific evidence on the effect of communication skills of childbirth care providers on maternal childbirth experience and satisfaction. The present study aimed to determine the effect of communication-based care on the childbirth experience and satisfaction among primiparous women.

Methods

A total of 80 primiparous women participated in this experimental study who were randomly assigned into the intervention and control groups. According to the World Health Organization (WHO) care model, the intervention group received effective communication-based care, and the control group received the routine care. Data were collected using demographic and obstetric questionnaires, Labor Agentry Scale (LAS) and Birth Satisfaction Scale-Revised (BSS-R), and Support and Control in Birth (SCIB) scale applied 12 to 24 h after the intervention.

Results

After controlling the effect of confounding variables, the mean scores of childbirth experience (51.23(1.54) and satisfaction (26.03(0.81) in the intervention group were significantly higher than that in the control group (45.33 (1.54) and 22.66 (0.81) respectively; [adjusted mean difference (AMD) = 5.90, CI = 95%: 1.17 to 10.62, P = 0.01] versus AMD =3.37, CI: 95%: 0.87 to 5.87, P = 0.001].

Conclusion

Eeffective communication-based care improved childbirth experience and satisfaction of primiparous women. Therefore, it is recommended that health-care providers should be trained on the communication skills in the delivery room especially during a vital threatened crises such as the Covid pandemic.

Do women's perceptions of their childbirth experiences change over time? A six-week follow-up study in a Danish population

OBJECTIVE

To evaluate how women's perception of the childbirth experience developed during the postpartum period. The secondary aim was to explore how selected birth interventions were subjectively perceived as part of the birth experience.

DESIGN

A prospective cohort study comparing childbirth experience, assessed at one and six weeks postpartum, using the Childbirth Experience Questionnaire (CEQ).

SETTING

A regional hospital in the northern part of Denmark, with 1,400 childbirths annually.

PARTICIPANTS

A total of 201 women with low-risk births who gave birth at North Denmark Regional Hospital were included in this study. We included both nulliparous and multiparous women.

MEASUREMENTS AND FINDINGS

More than 50% of the women changed their perceptions about their childbirth experience after six weeks. After six weeks the overall CEQ score and the domains 'Participation' and 'Professional support' had a lower CEQ score compared to scores obtained one week postpartum, although differences were small. Induction of labor, augmentation of labor, emergency caesarean section, epidural analgesia, and use of nitrous oxide were associated with a lower CEQ score.

KEY CONCLUSIONS

Women assessed their overall birth experience more negatively at six weeks postpartum compared to one week postpartum. Some interventions in the labor process influenced the women's assessment of their experiences negatively.

IMPLICATIONS FOR PRACTICE

Paying attention to preventive initiatives to ensure the women a spontaneous birth, if possible, may be essential to create positive perceptions of the childbirth experience.

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

INTRODUCTION

A positive childbirth experience promotes women's health, both during and beyond the perinatal period. Understanding what constitutes a positive childbirth experience is thus critical to providing high-quality maternity care. Currently, there is no clear, inclusive, woman-centered definition of a positive childbirth experience to guide practice, education, and research.

AIM

To formulate an inclusive woman-centered definition of a positive childbirth experience.

METHODS

A six-step process was undertaken: (a) Key concepts associated with a positive childbirth were derived from a rapid literature review; (b) The key concepts were used by interdisciplinary experts in the author group to create a draft definition; (c) The draft definition was presented to clinicians and researchers during a European research meeting on perinatal mental health; (d) The authors integrated the expert feedback to refine the working definition; (e) A revised definition was shared with women from consumer groups in six countries to confirm its face validity; and (f) A final definition was formulated based on the women's feedback (n = 42).

RESULTS

The following definition was formulated: "A positive childbirth experience refers to a woman's experience of interactions and events directly related to childbirth that made her feel supported, in control, safe, and respected; a positive childbirth can make women feel joy, confident, and/or accomplished and may have short and/or long-term positive impacts on a woman's psychosocial well-being."

CONCLUSIONS

This inclusive, woman-centered definition highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets. This definition could help to identify and validate positive childbirth experience(s), and to inform practice, education, research, advocacy, and policy-making.

The un-silencing of Japanese women's voices in maternity care: A hermeneutic phenomenological study of the woman-midwife relationship

OBJECTIVE

The purpose of this article is to understand the meaning of the woman-midwife relationship, with the overall aim to improve maternity care and women's birth experiences in Japan. To better understand the meaning of the woman-midwife relationship, this article presents women's and midwives' experiences of having or not having a voice in maternity care.

RESEARCH DESIGN

Hermeneutic phenomenology, as described by Max van Manen, helped to uncover the meaning of the phenomenon-the woman-midwife relationship-through participants' lived experience. Individual interviews were conducted with 14 women and 10 midwives living in Japan. The interview data were interpreted and thematically analysed to reveal the meaning of the woman-midwife relationship.

FINDINGS

'Having a voice' emerged as a central theme underpinning the meaning of the woman-midwife relationship; aspects of which included, 1) being unheard, 2) losing a voice, 3) having a voice, and 4) midwives speaking for women. Although having a voice should be a legitimate right for women in maternity care, some women's voices were unheard or lost in the experience with midwives. Conversely, some women gained a voice, especially when they positively and continuously developed their relationship with their midwife. How the woman and the midwife related to each other clearly affected their experience of having a voice in maternity care.

KEY CONCLUSION

Having a voice, which portrays dimensions of choice, control, and autonomy, in their own maternity care is vital for women's positive birth experience. The woman-midwife relationship is critical in enabling women to have a voice and midwives to speak for women. Women and midwives need to develop their relationship. Moreover, the maternity care system needs to allow sufficient time and space, for instance, by ensuring midwife continuity of care to develop a positive woman-midwife relationship.

Does midwifery-led care demonstrate care ethics: A template analysis

BACKGROUND

Ethical care in maternity is fundamental to providing care that both prevents harm and does good, and yet, there is growing acknowledgement that disrespect and abuse routinely occur in this context, which indicates that current ethical frameworks are not adequate. Care ethics offers an alternative to the traditional biomedical ethical principles.

RESEARCH AIM

The aim of the study was to determine whether a correlation exists between midwifery-led care and care ethics as an important first step in an action research project.

RESEARCH DESIGN

Template analysis was chosen for this part of the action research. Template analysis is a design that tests theory against empirical data, which requires pre-set codes.

PARTICIPANTS AND CONTEXT

A priori codes that represent midwifery-led care were generated by a stakeholder consultative group of nine childbearing women using nominal group technique, collected in Perth, Western Australia. The a priori codes were applied to a predesigned template with four domains of care ethics.

ETHICAL CONSIDERATIONS

Ethics approval was granted by the Edith Cowan University research ethics committee REMS no. 2019-00296-Buchanan.

FINDINGS

The participants generated eight a priori codes representing ethical midwifery care, such as: 1.1 Relationship with Midwife; 1.2 Woman-centred care; 2.1 Trust women's bodies and abilities; 2.2. Protect normal physiological birth; 3.1. Information provision; 3.2. Respect autonomy; 4.1. Birth culture of fear (midwifery-led care counter-cultural) and 4.2. Recognition of rite of passage. The a priori codes were mapped to the care ethics template. The template analysis found that midwifery-led care does indeed demonstrate care ethics.

DISCUSSION

Care ethics takes into consideration what principle-based bioethics have previously overlooked: relationship, context and power.

CONCLUSION

Midwifery-led care has been determined in this study to demonstrate care ethics, which suggest that further research is defensible with the view that it could be incorporated into the ethical codes and conduct for the midwifery profession.

Turkish midwives' experiences and opinions in promoting normal births: A grounded theory study

INTRODUCTION

Worldwide, the biomedical model of maternity care has been dominant, with the overuse of interventions.

AIM

This study aimed to gain a deeper understanding of the experiences and opinions of Turkish midwives regarding the promotion of normal births.

METHODS

In-depth interviews were conducted with 12 midwives; data were analysed using grounded theory. The data were analysed according to the constant comparative method.

FINDINGS

The study generated a core category (We want to promote normal births, but have no power to do it), which means all participants wanted to promote normal births. However, they have been disempowered by the medicalised systems of care. There were also three main categories (different ideologies in the labour ward, the midwives have no power, unempowered women). The participants reported that different ideologies in the labour ward were a challenge to promoting normal births. Their working conditions and education level were not enough to support normal birth. The pregnant women were described as unempowered due to a lack of antenatal education and having a fear of childbirth.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

Normal birth could be promoted by enhancing the power and responsibilities of midwives. The women need antenatal education to have a normal birth. The normal birth may promote the enhanced readiness of women and midwives.

Women's perception of continuity of team midwifery care in Iran: a qualitative content analysis

Background

Understanding the pregnant women’s perception of continuity of team midwifery care is necessary for introducing and implementing this model of midwife-led care in the Iranian maternity services. This qualitative study aims to explore women’s perception of continuity of team midwifery care in Iran.

Methods

This research is a qualitative study conducted in Iran to explore women’s perception of continuity of team midwifery care during pregnancy, birth and postpartum from October 2019 to August 2020. Fifteen semi-structured interviews were conducted with women individually in private midwifery clinic through a purposive sampling method. Interviews were digitally recorded and transcribed verbatim in Persian and analyzed using conventional content analysis.

Results

From the data analysis, two themes, four main categories, and nine subcategories emerged. The themes were “Maternal empowerment” and “Mother’s satisfaction during the transition from pregnancy to motherhood”. The first theme included two categories of improving self-efficacy during antenatal education classes and the effective midwife-mother interaction. The second theme composed of two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood.

Conclusion

Findings of this qualitative study highlight the effectiveness of continuity of team midwifery model of care for promoting empowerment and satisfaction in women during pregnancy, birth and postpartum. The results of this study could pave the way for developing, introducing and implementing the midwife-led continuity models of care in Iran.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03666-z.

Development and psychometric properties of Iranian women childbirth experience questionnaire

Aim

This study aimed to develop and psychometrics a questionnaire for assessing childbirth experience in Iranian women.

Design

Cross‐sectional study.

Methods

This cross‐sectional study was done in women who experienced childbirth within the last 12 hr to 2 months from May to December 2018. Questionnaire items were extracted from a comprehensive review of the available studies and questionnaires on childbirth experiences and definitions implied by qualitative interviews. The designed questionnaire was validated in three stages: face, content and construct. Cronbach's alpha was used to determine the reliability of the instrument.

Result

Iranian women childbirth experience questionnaire contained seven factors with 52 items which were called professional support, husband's and other important support, baby, preparation, fear, positive perception and control were extracted. The Cronbach's alpha coefficient after factor analysis was 0.62–0.92 and for the whole instrument was 0.91. The findings showed that Iranian women childbirth experience questionnaire was valid and reliable.

Place and space in relation to childbirth: a critical interpretive synthesis

Background: In nursing and midwifery, the concept of environment is considered a meta-concept. Research findings suggest that the location is not the only important factor, as both place and space influence the practices of midwives. Moreover, research on the geography of health suggests a connection between place and health that could be extended to reproductive health. Therefore, to move beyond and expand traditional research expressions, it is beneficial to illuminate the concepts of place and space in relation to childbirth. Purpose: This study was undertaken to produce a synthesis of previous qualitative research of issues in childbirth in relation to the concepts of place and space. Method: In this Critical Interpretive Synthesis (CIS), four electronic databases; CINAHL, Medline, PsycINFO and Sociological abstracts, were used for the literature search. In total 734 papers were screened, and 27 papers met the final inclusion criteria after assessment. Results: The synthesis reveals a need to create a space for childbirth underpinned by four aspects; a homely space, a spiritual space, a safe space, and a territorial space. Conclusion: Findings from this review will provide a basis for useful dialogue in midwifery education and in clinical settings.

Women's experience of receiving team-midwifery care in Japan: A qualitative descriptive study

BACKGROUND

Team-midwifery care remains limited in Japan. To introduce changes to the midwifery system, an in-depth understanding of women's perception of receiving team-midwifery care is crucial.

AIM

This study aimed to describe women's experience of receiving team-midwifery care in Japan and to understand the central essence of this form of care.

METHODS

This study used a descriptive research design and involved focus group interviews in a birth clinic in central Tokyo. This birth clinic provided continuous team-midwifery care involving five to six midwives in one team from pregnancy to the postpartum period. Interview data were analysed by content analysis. The ethical review board of St. Luke's International Hospital, Tokyo approved this study (12-R178).

FINDINGS

Thirteen women who gave birth within 19 months were included. The women's experience of receiving team-midwifery care was described as "feelings of becoming closer and connected through a warm mutual relationship" with the midwives. The women felt that the midwives genuinely focused on their care and noticed their desire for their family to be involved. A trusting relationship was built through regular meetings. The women also described their experience as "a lasting feeling of ease and security". The midwives' continuity of care empowered the women even after their discharge.

CONCLUSION

The underlying assumption for the women's empowerment was the continuity of woman-centred care built through a trusting relationship between the women and the midwives. These important elements constitute the central essence of team-midwifery care which can be adopted regardless of the care system.

Women's experiences of birth trauma: A scoping review

BACKGROUND

A high number of Australian women report experiencing traumatic birth events. Despite high incidence and potential wide spread and long-lasting effects, birth trauma is poorly recognised and insufficiently treated. Birth trauma can trigger ongoing psychosocial symptoms for women, including anxiety, tokophobia, bonding difficulties, relationship issues and PTSD. Additionally, women's future fertility choices can be inhibited by birth trauma.

AIM

To summarize the existing literature to provide insight into women's experiences of birth trauma unrelated to a specific pre-existing obstetric or contextual factor.

METHODS

The review follows 5 stages of Arksey and O'Malley's framework. 7 databases were searched using indexed terms and boolen operators. Data searching identified 1354 records, 5 studies met inclusion criteria.

FINDINGS

Three key themes emerged; (1) health care providers and the maternity care system. (2) Women's sense of knowing and control. (3) Support.

DISCUSSION

Continuity of carer creates the foundations for facilitative interactions between care provider and woman which increases the likelihood of a positive birth experience. Women are able to gain a sense of feeling informed and being in control when empowering and individualized care is offered. Functional social supports and forms of debriefing promotes psychological processing and can enable post traumatic growth.

CONCLUSION

Existing literature highlights how birth trauma is strongly influenced by negative health care provider interactions and dysfunctional operation of the maternity care system. A lack of education and support limited informed decision-making, resulting in feelings of losing control and powerlessness which contributes to women's trauma. Insufficient support further compounds women's experiences.

The relationship between fear of childbirth and sense of coherence in women expecting their first child

OBJECTIVE

The aim was to investigate fear of childbirth (FOC) and sense of coherence (SOC), and their components in women expecting their first child.

METHODS

A cross-sectional study where 414 women answered the Wijma Delivery Expectancy Questionnaire Version A and the Sense of Coherence Scale. Statistical analyses were performed.

RESULTS

The main results show that women with severe FOC reported lower SOC, and all three components of SOC were lower in women with severe FOC. Comprehensibility turned out to have a significant correlation with FOC. Psychological problems before pregnancy were more common in women with severe FOC and low SOC.

CONCLUSIONS

Women with severe FOC reported lower SOC and lower levels of each of the following components: comprehensibility, manageability and meaningfulness.

Positive childbirth experience: A qualitative study

Aim

This study aimed to explore the meaning of a positive childbirth experience expressed by women who had given birth in Iran.

Design

Qualitative exploratory study.

Methods

This is a qualitative study conducted on 10 women aged 20-38 years with positive childbirth experience. Data were collected using semi-structured interviews from 72 hr-2 months after childbirth.

Results

Data analysis led to into two themes and five subthemes. The themes include control and empowerment. Control theme consisted of three subthemes of preparation, coping and support; and empowerment theme consisted of two subthemes of self-efficacy and self-esteem. Women's sense of empowerment to childbirth can be the result of a positive childbirth experience. Therefore, it seems that providing positive experience factors of childbirth plays an important role in women's self-efficacy and self-esteem, which requires cooperation and effort at the level of the individual, family, education system and healthcare system.

A meta-ethnographic synthesis of qualitative research on women's experience of midwifery care

Labor and birth constitute a significant emotional event for a childbearing woman. The aim was to explore women's reflections on their experiences of labor and birth and how these were influenced by the midwifery care they received. A modified version of Noblit and Hare's meta-ethnographic approach was used to develop an inductive and interpretive synthesis of nine qualitative articles. Relevant databases were searched and qualitative articles appraised by means of the Critical Appraisal Skills Program. Two metaphors were identified: The guide-Please share your knowledge and The motherly midwife as an anchor. The comprehensive understanding of the images evoked by the metaphors resulted in an overall metaphoric representation of the women's experiences: The midwife as a birth pilot, that is, a positive labor and birth experience is dependent on the relationship with the midwife. This finding confirms previous knowledge that a trusting relationship results in confidence, while feeling secure leads to a positive birth experience. The metaphors facilitate understanding of the significance of the midwife for women's labor and birth experiences. Knowledge of labor and birth experiences helps to broaden understanding of the necessity of midwives being willing to engage, act, be aware of errors that may affect women's birth experience, and employ tools to predict unexpected adverse events.

The childbirth experience: obstetric and psychological predictors in Italian primiparous women

BACKGROUND

The experience of childbirth crucially impacts a mother's psychological well-being and the mother-infant relationship. It is recognised that negative births can be linked to different forms of discomfort, both for the mother as well as for the infant. This prospective longitudinal study aimed to study the effect of obstetric and psychological variables on women's subjective experience of childbirth.

METHODS

111 primiparous Italian women completed a set of questionnaires at 38-40 weeks of pregnancy (Time 1) and 1-5 days after childbirth (Time 2). Sociodemographic and obstetric information were collected. Data about the childbirth were obtained from the mother's ward birth records. Women completed the Wijma Delivery Expectancy/Experience Questionnaire both before and after childbirth.

RESULTS

The subjective experience of birth was significantly predicted by the duration of the expulsive phase (β = .26; p < .05), the use of epidural analgesia (β = .21;  p< .05) and by fear of birth (β = .21; p < .05). The effect of mode of birth and duration of the dilatation phase on women's birth experience was not found.

CONCLUSIONS

In our study, neither instrumental childbirth nor caesarean section have a significant effect on women's birth experience. Instead, both a longer expulsion phase and epidural analgesia contribute to the negative experience. Moreover, the higher the fear of birth, the worse the women's emotional experience. These findings confirmed the role of obstetric and psychological variables on birth experience. More investigation about this topic could be useful to develop specific interventions to prepare women for birth.

Application of the salutogenic theory in the perinatal period: A systematic mixed studies review

BACKGROUND

The pregnancy process has always been medicalized with a focus on the prevention of adverse pregnancy outcomes and a lesser emphasis on enhancing women's wellbeing during the perinatal period. This trend urges healthcare professionals to consider the use of a salutogenic approach throughout the perinatal period.

OBJECTIVE

To consolidate and appraise evidence on the use of the salutogenic theory across the perinatal period.

DESIGN

A systematic mixed studies review.

METHODS

Four electronic databases (CINAHL, ScienceDirect, PsycINFO, and PubMed) were searched for English studies from each database's inception to November 2018. Thirty-four studies met the inclusion criteria and were appraised for quality by two researchers independently. A narrative synthesis was conducted to consolidate and synthesize results from mixed methodology studies.

RESULTS

Four themes emerged from the synthesis: (1) factors affecting sense of coherence (generalized resistance resources), (2) influences of sense of coherence, (3) ways to promote sense of coherence among mothers, and (4) use of salutogenic framework across perinatal healthcare. Sociodemographic background, psychological and birth-related factors, and availability of social support affect sense of coherence among parents, which are positively correlated to quality of relationship, satisfaction of perceived support, psychological wellbeing, and overall birth experience. Sense of coherence also determines mothering orientation and choice of delivery method. Ways to enhance maternal sense of coherence include ensuring continuity of care in the postpartum period, increasing parental involvement, focusing on wellness topics, and having balanced relationships between parents and healthcare providers.

CONCLUSION

Despite consolidating evidence on positive relationships of generalized resistance resources, sense of coherence, and parental outcomes during the perinatal period, the scarcity of literature highlights a need for more in-depth research on the underlying mechanisms of salutogenesis and its components as these insights may underpin future maternal health promotion efforts.

Able to choose? Women's thoughts and experiences regarding informed choices during birth

OBJECTIVE

To gain a deeper understanding of women's thoughts and experiences regarding informed choices during childbirth.

DESIGN/SETTING

A qualitative approach with individual in-depth interviews was chosen for data collection. Ten women were interviewed three to four weeks after the birth of their first child. The transcribed interviews were analysed using systematic text condensation.

FINDINGS

Two main themes emerged based on the analysis: "women's resources and coping abilities" and "women's abilities to make informed choices during birth". Women's resources and coping abilities influenced how they retrieved information and made their own choices. Their abilities to make informed choices during birth were influenced by the course of the birth process and the fact that they were patients and submitted to the hospitals' routines.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Instead of using the term "informed choice", women in this study discussed involvement, participation and being heard and seen as individuals. How receptive women are to information during birth varies, and midwives play an important role during pregnancy in informing and encouraging them. The relationship between women and midwives influences women's abilities to make informed choices during birth. Women need individual care and should be encouraged to have realistic expectations and to gain knowledge and confidence in their ability to give birth. A model of care in which women experience greater continuity will have an impact on their expectations, decision-making and experience of birth.

Prevalence and factors affecting the negative childbirth experiences: a systematic review

Background: Childbirth and its related experiences have the potential physical and psychological effects on women's lives in the short and long term. Many factors play an effective role in the positive and negative childbirth experiences of the mother. This study aimed to examine the prevalence and factors affecting negative labor experiences.Methods: The current research reviewed articles related to "childbirth experiences" in international databases (Pub Med - Scopus - Web of Science - Ovid - clinical key - ProQuest - ScienceDirect - the Cochrane Library), and national databases (SID, Magiran, Iranmedex, and Irandoc). A total number of 3654 articles were found after the elimination of repetitive and unrelated articles, 18 articles were evaluated.Result: In this study, 18 studies entered this systematic review, 8 studies examined the prevalence of childbirth experience. The prevalence of negative childbirth experience was 6.8-44%. The factors related to the childbirth experience includes: individual, such as age, parity, fear, self-efficacy, participation, control, expectations, preparation, and interpersonal, such as husband support, care provider support, unexpected medical problems, such as prolonged labor, stimulation and induction, forceps delivery, emergency cesarean section, and the use of analgesics in the mother, low Apgar score and transfer to the NICU in the child.Conclusions: This review showed the varies factors related to childbirth experience, these findings suggest future research through qualitative studies that why they influence the birth experience.

Pregnant Women in Turkey Experience Severe Fear of Childbirth: A Systematic Review and Meta-Analysis

Background: Culture is an important factor to determine fear of childbirth which is shaped by social learning processes. The purpose of this study is to determine the level of fear of childbirth among Turkish healthy pregnant women. Method: The researchers reviewed the eight databases considering inclusion criteria and 14 studies were included. The data analysis was conducted using meta-analysis. Results: Pregnant women experienced severe levels of fear, 67.26 ± 4.08, 95% confidence interval [59.26, 75.26], and 21 out of every 100 women experienced clinical level of fear. Between study variance was significant for parity (Qb = 6.40, p = .04) and region (Qb = 19.14, p = .00) moderators. Conclusions: The high level of FOC, particularly in the Eastern region, suggests that some of the cultural factors in the Eastern region in Turkey negatively affect the birth expectations. In a country like Turkey with a multicultural population, the health care professional should provide culturally sensitive care.

Midwifery care based on a precautionary approach: Promoting normal births in maternity wards: The thoughts and experiences of midwives

OBJECTIVE

The aim of this study was to gain a deeper understanding of the thoughts and experiences of midwives in the attempt to promote normal births in Norwegian maternity wards.

METHODS

A qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Nine midwives at three different maternity wards in Norway participated in the study. The qualitative data were analysed with the help of systematic text condensation.

RESULTS

The findings included two main themes: (1) "Individualized maternity care" (2) "A woman-centred and a biomedical perspective - a dilemma. Working in a small maternity ward increased the possibility for continuous support during labour and continuity of care throughout pregnancy, birth and the postnatal period. The midwives had a great desire to promote normal births with a minimum of interventions. Still, they adhered to an ideology based on both a woman-centred and a biomedical view of birth. Their work was often based on a precautionary approach in which problem-solving strategies were related to potential risks.

CONCLUSION

The midwives experienced challenges, as they worked in an environment where different ideologies prevailed. They utilized the positive aspects of small maternity wards, like the opportunity for continuous support during labour and continuity of care during the childbearing process. Midwives should encourage discussions about their precautionary approach and the use of technology for low-risk women, while reflecting on their own views on normal births.

Working fulltime throughout pregnancy - The Norwegian women's perspectives. A qualitative approach

OBJECTIVE

the purpose of this study was to gain a deeper understanding of aspects that influence healthy women's ability to work fulltime throughout the pregnancy, considering women's experiences and individual perspectives, as well as understanding health resources available to them.

DESIGN/SETTING

a qualitative approach was selected for the data collection, and the data presented is derived from in-depth interviews. Ten pregnant Norwegian women with uncomplicated pregnancies, aged 24-40, working fulltime throughout their pregnancies with no sick leave, were interviewed during pregnancy week 37-39. All participants had their regular check-ups at six local public health clinics. The transcribed interviews were analysed through systematic text condensation.

FINDINGS

the findings included two main themes: Supporting environment and having a positive mindset. Feeling good about oneself and feeling appreciated at work provided these women with the supporting environment they needed. All the respondents had coped with different challenges that they found important when working throughout their pregnancies while facing the difficulties of a pregnancy. They emphasised that their positive attitude and coping skills contributed to normalising the pregnancy and motivated them to go to work.

CONCLUSIONS

having a positive mindset and a balanced perspective on the pregnancy and bodily changes are important factors in being able to work throughout pregnancy. Support, in various arenas, might positively influence pregnant women´s positive mindset, having a favourable effect on their health resources and ability to continue working when bearing children.

Violência obstétrica: revisão integrativa de pesquisas qualitativas

Objetivo: Describir cómo los factores que afectan las prácticas de atención del parto interfieren en la experiencia del parto y en el nacimiento.Síntesis de contenido: Se trata de una revisión integradora de investigaciones cualitativas. A partir de las búsquedas en las bases de datos seleccionadas, se encontraron 17 051 artículos,de los cuales, según los criterios preestablecidos, se eligieron 54. De acuerdo con el análisis de los estudios elegidos, emergieron cuatro categorías, a saber: Preconcepciones contemporáneas sobre el parto normal y la cesárea, Elementos desfavorables para la vivencia satisfactoria del parto, Banalización de la violencia obstétrica y Presupuestos sobre la asistencia humanizada del parto. Los resultados revelaron que las prácticas de asistencia al parto estaban desactualizadas, eran inapropiadas, se consideraban“normales” y estaban marcadas por el autoritarismo y por la falta de respeto hacia las mujeres, lo cual caracteriza la violencia obstétrica. Por su parte, el modelo humanizado, al valorar elprotagonismo femenino, hace que la experiencia del parto sea más gratificante. Conclusión: Las prácticas de asistencia al parto en Brasil no respetan los derechos sexuales y reproductivos, lo que se refleja en los altos índices de cesáreas innecesarias y en los maltratos que las mujeres sufren en los hospitales materno-infantilesbrasileños.