Childbirth as healing: three women's experience of independent midwife care

The social conception of space of birth narrated by women with negative and traumatic birth experiences

BACKGROUND

Many women experience giving birth as a negative or even as a traumatic event. Birth space and its occupants are fundamentally interconnected with negative and traumatic experiences, highlighting the importance of the social space of birth.

AIM

To explore experiences of women who have had a negative or traumatic birth to identify the value, sense and meaning they assign to the social space of birth.

METHODS

A feminist standpoint theory guided the research. Secondary discourse analysis of 51 qualitative data sets/transcripts from Dutch and Czech Republic postpartum women and 551 free-text responses of the Babies Born Better survey from women in the United Kingdom, Netherlands, Belgium, Germany, Austria, Spain, and the Czech Republic.

FINDINGS

Three themes and associated sub-themes emerged: 1. The institutional dimension of social space related to staff-imposed boundaries, rules and regulations surrounding childbirth, and a clinical atmosphere. 2. The relational dimension of social space related to negative women-healthcare provider interactions and relationships, including notions of dominance, power, authority, and control. 3. The personal dimension of social space related to how women internalised and were affected by the negative social dimensions including feelings of faith misplaced, feeling disconnected and disembodied, and scenes of horror.

DISCUSSION/CONCLUSION

The findings suggest that improving the quality of the social space of birth may promote better birth experiences for women. The institutional, relational, and personal dimensions of the social space of birth are key in the planning, organisation, and provision of maternity care.

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

INTRODUCTION

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

AIM

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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.

Experiences and wishes of women regarding systemic aspects of midwifery care in Germany: a qualitative study with focus groups

BACKGROUND

Knowledge of pregnant women's and mothers' viewpoints on midwifery care is crucial for its appropriate delivery and research. In Germany, comprehensive research to more fully understand women's needs in pregnancy, labour, birth and the postpartum period until weaning is lacking. International studies provide some knowledge of women's expectations, their choices, and subjective criteria indicating good midwifery care.

METHODS

This study explores pregnant women's and mothers' experiences, needs and wishes regarding systemic aspects of midwifery care (access, availability, choices, model of midwifery care; maternity care in the healthcare system). 50 women participated in 10 focus groups in 5 states of Germany. The groups were heterogeneous with regard to age, parity, model of maternity care used, and rating of satisfaction. Women with limited educational years (n = 9) were personally contacted by midwives and reached by social media. Also, mothers living in a mother-child home (n = 6) or attending a peer group for grieving parents (n = 5) were included. The digitally documented focus groups were systematically analysed in an itinerary hermeneutic manner.

RESULTS

Three themes were identified: (a) Knowledge or lack of awareness of midwifery care, (b) availability of and access to midwives, and (c) midwifery care in the healthcare system. Theme (a) entails the scope of midwifery care and the midwife's competence, but also a lack of information, inconsistent counselling, and difficulty identifying midwives. Theme (b) encompasses aspects such as the availability, accessibility and selection of a midwife, the effort involved in looking for a midwife, the challenge of transition points, and family midwives. Theme (c) relates interprofessional cooperation, gaps/inadequacies of care during latency phase, alternative models of care, and the importance of family and peer groups for women.

CONCLUSIONS

Midwifery care and research in Germany must address the issue of imparting relevant information about midwifery services. Interprofessional cooperation and management of transition points ought to be improved in the interests of the women concerned. Moreover, the quality of antenatal classes, support during latency phase, and intrapartum care in hospitals need to be addressed. Lastly, the special needs of vulnerable women in midwifery care must become a major focus in Germany.

Women's experiences of giving birth and making decisions whether to give birth at home when professional care at home is not an option in public health care

OBJECTIVE

To describe women's experiences of giving birth and making decisions whether to give birth at home when professional care at home is not an option in public health care.

METHOD

A phenomenological study. Interviews with seven women; four of them gave birth at home without professional assistant and three at hospital.

RESULTS

The essential structure shows that women live with huge contrasts between an inner and outer image of birth. They express trust towards themselves and giving birth, as well as to their own decision whether hospital care is needed or not. Birth can be empowering and strengthening, and is of importance for bonding with the child. In contrast, an outer image coming from the public and healthcare is characterized by risk, danger and fear of childbirth. Birth is viewed as something draining. The women waited with their decision where to give birth, in some cases until the contractions have started. The women felt left alone and punished. They also met supportive midwives and physicians who represented a personal perspective. In contrast, as a group, they were experienced as insecure and representative for the healthcare system.

CONCLUSION

The implication is to meet, and give a secure care to women with contrasting views of childbirth and not only to the large majority. Midwives and physicians should establish a trustful relationship with the women and know that they can be experienced as trustful even if they do not express a positive attitude towards giving birth at home.

Prevalence of negative birth perception, disaffirmation, perinatal trauma symptoms, and depression among postpartum women

PURPOSE

This study documented new case and estimated annual case prevalence, and relationships among women's negative birth perceptions, provider disaffirmation, perinatal trauma symptoms, and depression at 6-7 months postpartum.

DESIGN AND METHODS

An exploratory investigation of 71 White women (20.8% of the total population) was conducted. CONCLUSIONS. New case prevalence of negative birth perceptions (9.6:100), perinatal trauma symptoms (10.2:100), disaffirmation (8.6:100), and depression (15.7:100) are greater than other prominent high burden diseases. Variables were significantly correlated.

PRACTICE IMPLICATIONS

Findings reinforce the need for psychiatric liaison advanced practice nurses caring for childbearing women, including roles for detection/screening, educating professionals in communication, legislative/advocacy for funding, and further research.