Effect of birth plans on childbirth experience: A systematic review

The contribution of birth plans to shared decision-making from the perspectives of women, their partners and their healthcare providers

BACKGROUND

The birth plan is a document expressing a pregnant woman's childbirth preferences, enabling communication of expectations and facilitating discussions among women, their partners, and healthcare providers for key birthing decisions. There has been limited research on the role of birth plans in shared decision-making (SDM). Our study aims to explore how the use of birth plans can contribute to SDM from women's, partners, and healthcare providers' perspectives.

METHODS

We conducted in-depth interviews with women, their partners, and their healthcare providers. We used a thematic analysis to identify themes and subthemes. Furthermore, we created a grounded theory about the role of birth plans as a tool in SDM.

RESULTS

Three main themes were created: ''Creating a birth plan", ''Getting all on board" and ''Birth plans in the daily practice of decision-making". Most women, partners, and healthcare providers agreed that birth plans can facilitate communication and SDM. Women and their partners viewed the birth plan as a tool to prepare for birth. Most healthcare providers mentioned the birth plan as a tool to get to know the women, their partners, and their preferences. Barriers are the attitude of healthcare providers toward birth plans, such as their evident resistance to the birth plan itself or to certain preferences. Another barrier is the assumption women and their partners may have that these plans can accurately predict the childbirth experience, enhancing the chance of a disappointing, negative experience. Some healthcare providers view birth plans as barriers to SDM.

CONCLUSION

The use of a birth plan seems to promote women's, partners', and healthcare providers' involvement in the birth process, and seems suitable to facilitate SDM. Further research is required to explore strategies for overcoming barriers, including healthcare providers' attitudes toward birth plans and the expectations of women and their partners regarding their role.

Birth plan and fathers: A scoping review

BACKGROUND

With increasing paternal involvement in maternal and infant care, expectant fathers, who are often present during the labour process have been seen to use birth plans to express their wishes during childbirth. Despite their involvement, existing literature mainly focuses on maternal outcomes, highlighting the need to explore paternal involvement with birth plans.

AIMS

To explore and consolidate the available literature on the involvement of fathers in the birth plan process, their perspectives toward birth plans, and how it has influenced their overall childbirth experience.

METHODS

This scoping review was conducted based on Arksey and O'Malley's five-stage framework. Seven databases were searched from 1980 till March 2024: PubMed, Cochrane Library, Embase, Scopus, Web of Science, CINAHL, and Google Scholar. Data were screened, extracted, and cross-checked between two independent reviewers. A thematic analysis was conducted to summarise the data.

RESULTS

BASED ON THE FINDINGS FROM THE 33 INCLUDED STUDIES, ONE OVERARCHING THEME WAS IDENTIFIED: : 'Factors promoting and restricting fathers' participation in birth plan'; supported by two main themes 1) Motivations behind paternal engagement in the birth plan process and 2) Roadblocks to paternal involvement in the birth plan.

CONCLUSION

The findings of this review provided insights to guide future practice to engage fathers during childbirth by enhancing their involvement in birth plans. The findings on the motivating factors for fathers to be involved in the birth plan process and barriers affecting their participation also provided directions for future research by highlighting the gaps in the current evidence.

Impact of shared decision-making on women's childbirth preferences: A cluster randomised controlled trial

BACKGROUND

Midwives provide counselling for birth plans (BPs) to women during prenatal care; however, the impact of individualised BP counselling interventions based on shared decision-making (SDM) regarding women's preferences is unknown.

METHODS

This randomised cluster trial included four primary healthcare units. Midwives provided BP counselling based on SDM to women in the intervention group (IG) during prenatal care along with a handout about evidence-based recommendations. Women in the control group (CG) received standard BP counselling from midwives. The main outcome was preference changes concerning BPs.

RESULTS

A total of 461 (95.5 %) pregnant women received BP counselling (IG, n = 247; CG, n = 214). Women in the IG changed their BP preferences for 13 items compared with those in the CG. These items were: using an unique space during birth (81.1 % vs 51.6 %; p < 0.001), option for light graduation (63 % vs 44.7 %; p < 0.001), listening to music (57.3 % vs 43.6 %; p = 0.006), drinking fluids during labour (84.6 % vs 93.6 %; p = 0.005), continuous monitoring (59 % vs 37.8 %; p < 0.001); desire for natural childbirth (36.6 % vs 25 %; p = 0.014), epidural analgesia (55.1 % vs 43.6 %; p = 0.023); breathing techniques (65.2 % vs 50.5 %; p = 0.003), massage (74.9 % vs 55.3 %; p < 0.001); birthing ball use (81.9 % vs 56.9 %; p < 0.001), spontaneous pushing (49.3 % vs 28.7 %; p < 0.001), choosing birth position (69.6 % vs 41.5 %) and delayed umbilical cord clamping (67.8 % vs 44.1 %; p = 0.001).

CONCLUSION

SDM counselling, together with a handout about evidence-based recommendations on childbirth and newborn care, produced more changes in women's preferences expressed in the BP than standard counselling.

The ethics of induction of labor at 39 weeks in low-risk nulliparas in research and clinical practice

The "A Randomized Trial of Induction Versus Expectant Management" trial (ARRIVE trial) published in 2018 suggested that induction of labor can be considered a "reasonable option" for low-risk nulliparous women at ≥39 weeks of gestation. The study results led some professional societies to endorse the option for elective induction of labor at 39 weeks of gestation in low-risk nulliparas, and this has begun to change obstetrical practice. The ARRIVE trial provided valuable information supporting the benefits of induction of labor; however, the trial is insufficient to serve as the primary justification for widespread elective induction of labor at 39 weeks of gestation in low-risk nulliparas because of concerns about external validity. Thus, the French ARRIVE trial was designed to test the hypothesis in a different setting that elective induction of labor at 39 weeks of gestation in low-risk nulliparas leads to a lower cesarean delivery rate than expectant management. This ongoing trial has been criticized as "pseudoscientific" and telling "women where, when, and how to give birth." We reject these allegations and extensively examine the ethical framework that should govern clinical and research interventions, including elective induction of labor at 39 weeks of gestation in low-risk nulliparas. This study aimed to discuss the ethical issues that emerge from randomized trials of elective induction of labor at 39 weeks of gestation in low-risk nulliparas and the ethics of the clinical practice itself. The analysis of existing evidence shows the importance of further research on induction of labor at 39 weeks of gestation in low-risk women. Certain aspects of research ethics in this area, particularly the consent of pregnant women in a context where autonomy remains fragile, call for vigilance. In addition, we emphasize that childbirth is not only a medical object but also a social phenomenon that cannot be regarded only from the perspective of a health risk to be managed by clinical research. Further research on this issue is needed to allow pregnant women to make informed decisions, and the results should be integrated with social issues. The perspective of women is required in constructing, evaluating, and implementing medical interventions in childbirth, such as induction of labor at 39 weeks of gestation.

Does the birth plan match what is relevant to women? Preferences of Spanish women when giving birth

BACKGROUND

To support women in making shared decisions, it is important to know what is relevant to them. The aim is to explore which of the options included in birth plans (BP) are of most interest to women, and which are more controversial. In addition, the possible association of this variability with personal characteristics.

METHODS

The data are part of a cross-sectional descriptive study, carried out in xxx, on the clinimetric characteristics of two instruments to measure women's needs in labour and postpartum. Women were recruited consecutively by their midwives during pregnancy check-ups, receive a link to a digital questionnaire and were allowed to provide links to the questionnaires to other pregnant women. Women were asked to determine their level of agreement with statements about the birth environment, accompaniment, pain relief, medical intervention and neonatal care. The relationship between agreement with each statement, socio-demographic variables and fear of childbirth (W-DEQ-A) was analysed using a combination of descriptive statistics to analyse frequencies, and regression models to test the effect of socio-demographic variables and fear of childbirth on those items with the greatest variability.

RESULTS

Two hundred forty-seven women responded. More than 90% preferred a hospital delivery, with information about and control over medical intervention, accompanied by their partner and continuous skin-to-skin contact with the newborn. There are other questions to which women attach less importance or which show greater variability, related to more clinical aspects, like foetal monitoring, placenta delivery, or cord clamping… Various factors are related to this variability; parity, nationality, educational level, risk factor or fear of childbirth are the most important.

CONCLUSIONS

Some items referring to the need for information and participation are practically unanimous among women, while other items on technical interventions generate greater variability. That should make us think about which ones require a decision after information and which ones should be included directly. The choice of more interventional deliveries is strongly associated with fear of childbirth.

Standardized Cesarean Risk Counseling with Induction: Impact on Racial Disparities in Birth Satisfaction

OBJECTIVE

Our prior work demonstrated decreased birth satisfaction for Black women undergoing labor induction. We aimed to determine if implementation of standardized counseling around calculated cesarean risk during labor induction could reduce racial disparities in birth satisfaction.

STUDY DESIGN

We implemented use of a validated calculator that provides an individual cesarean risk score for women undergoing induction into routine care. This prospective cohort study compared satisfaction surveys for 6 months prior to implementation (preperiod: January 2018-June 2018) to 1 year after (postperiod: July 2018-June 2019). Women with full-term (≥37 weeks) singleton gestations with intact membranes and an unfavorable cervix undergoing induction were included. In the postperiod, providers counseled patients on individual cesarean risk at the beginning of induction using standardized scripts. This information was incorporated into care at patient-provider discretion. The validated 10-question Birth Satisfaction Scale-Revised (BSS-R) subdivided into three domains was administered throughout the study. Patients were determined to be "satisfied" or "unsatisfied" if total BSS-R score was above or below the median, respectively. In multivariable analysis, interaction terms evaluated the differential impact of the calculator on birth satisfaction by race (Black vs. non-Black women).

RESULTS

A total of 1,008 of 1,236 (81.6%) eligible women completed the BSS-R (preperiod: 330 [79.7%] versus postperiod: 678 [82.5%], p = 0.23), 63.8% of whom self-identified as Black. In the preperiod, Black women were 50% less likely to be satisfied than non-Black women, even when controlling for differences in parity (Black: 39.0% satisfied vs. non-Black: 53.9%, adjusted odds ratio [aOR] = 0.49, 95% confidence interval [CI]: 0.30-0.79). In the postperiod, there was no difference in satisfaction by race (Black: 43.7% satisfied vs. non-Black: 44.0%, aOR = 0.97. 95% CI: 0.71-1.33). Therefore, disparities in birth satisfaction were no longer present at postimplementation (interaction p = 0.03).

CONCLUSION

Implementation of standardized counseling with a validated calculator to predict cesarean risk after labor induction is associated with a decrease in racial disparities in birth satisfaction.

KEY POINTS

· Preintervention, Black women were less likely to have above-median birth satisfaction.. · We implemented standardized counseling around cesarean risk with labor induction.. · Implementation was associated with reduced racial disparities in birth satisfaction scores..

Cultural Adaptation, Validation and Evaluation of the Psychometric Properties of an Obstetric Violence Scale in the Spanish Context

Obstetric violence refers to dehumanized or derogative treatment of women in their pregnancy, childbirth or postpartum periods and may be manifested in different ways. Currently, there is no tool validated in Spain to measure women's perception of obstetric violence. The objective of this study was to carry out the cultural adaptation and validation of an existing 14-item obstetric violence scale in the Spanish context and to evaluate its psychometric properties. The research was conducted in two phases: first, a methodological study designed to evaluate content validity, through assessments by eight experts (calculating the Aiken V coefficient) and face validity in a sample of 20 women; second, a cross-sectional study to evaluate construct validity (through confirmatory factor analysis and Rasch analysis), divergent validity against a scale of birth satisfaction, known-groups validity and, finally, reliability. In Phase 1, Aiken V values higher than 0.71 were obtained for all items. Phase 2 was conducted on a sample of 256 women and the fit values for the unidimensional model were RMSEA: 0.070 (95% CI: 0.059-0.105) and GFI: 0.982 (95% CI: 0.823-0.990). The Rasch analysis indicated poor performance of item 2, which was removed. The Omega and Cronbach's Alpha coefficients were 0.863 and 0.860, respectively. A final 13-item version of the Obstetric Violence Scale was produced, with a total score ranging from 0 (no obstetric violence perception) to 52 (maximum obstetric violence perception). The Obstetric Violence Scale is a reliable and useful tool to measure women's perception of obstetric violence. This study was not registered.

Maternal-infant outcomes of birth planning: A review study

The birth and delivery plan is the center of clinical communication between the pregnant woman and the midwife, which is in the scope of health care services and is designed and provided to specialists with the participation of the woman and her husband during pregnancy. This document reflects the preferences, expectations, and fears of pregnant women regarding the birth process. This study was conducted with the aim of determining the maternal and neonatal outcomes of the birth plan: a review study. In this review study, Persian databases Magiran, SID, and English databases Pubmed, Scopus, SID Elsevier, Web of Sciences, and Google Scholar search engine using English keywords including Maternal outcome, neonatal outcome, birth schedule, delivery plan, birth plan, and their Persian equivalents were searched from 2000 to 2022. Numerous studies were selected and analyzed in a quantitative and qualitative manner that was related to the purpose of the present study in terms of content. Among 948 articles, 13 of the most relevant ones were selected and analyzed for this study. The results of the review of the studies showed that the birth plan has an effect on women's empowerment, satisfaction with childbirth, positive experience of childbirth, cesarean section rate, epidural use rate, episiotomy rate, Apgar, and umbilical cord pH of the newborn. The maternal and neonatal consequences of the birth plan prevail over its negative consequences, and the use of the birth plan can increase women's empowerment, satisfaction with childbirth, positive experience of childbirth, and reduce the rate of cesarean section and negative maternal-neonatal consequences.

"Women Friendly": A Childbirth Preparation Intervention in Israel for Women with Symptoms of Post-Traumatic Stress Disorder

Pregnant women with symptoms of post-traumatic stress disorder (PTSD), who have experienced traumatic events such as sexual abuse and traumatic births, are particularly vulnerable to experiencing extreme fear of childbirth complications during labor and traumatic deliveries. In this commentary, we review the literature on this group of women and their specific needs during pregnancy and childbirth. We present a childbirth preparation intervention for pregnant women with PTSD symptoms, "Women Friendly", designed in Israel and gradually becoming available in the community and Israeli hospitals. This intervention is intended for women with high levels of fear of childbirth who are unmotivated or unable to undergo traditional psychotherapy that focuses on exposure to and processing of past traumatic event(s). It is based on birth-oriented thinking, principles of positive psychology, and trauma-informed care. In addition to the five sessions offered to pregnant women, medical staff are provided with 19 training sessions on the "Women Friendly" approach. Qualitative and quantitative research should examine the effectiveness of this intervention. Should results be encouraging, this intervention could be more widely implemented in Israel and abroad and applied in broader contexts, such as gynecological check-ups and medical examinations, interventions, and surgery.

A realist review of health passports for Autistic adults

BACKGROUND

Autism is a normal part of cognitive diversity, resulting in communication and sensory processing differences, which can become disabling in a neurotypical world. Autistic people have an increased likelihood of physical and mental co-occurring conditions and die earlier than neurotypical peers. Inaccessible healthcare may contribute to this. Autism Health Passports (AHPs) are paper-based or digital tools which can be used to describe healthcare accessibility needs; they are recommended in UK clinical guidance. However, questions remained as to the theoretical underpinnings and effectiveness of AHPs.

METHODS

We undertook a systematic literature search identifying studies focused on AHPs for adults (aged over 16 years) from five databases. Included literature was subjected to realist evaluation. Data were extracted using a standardised form, developed by the research team, which considered research design, study quality for realist review and the Context, Mechanisms and Outcomes (CMOs) associated with each AHP tool.

FINDINGS

162 unique records were identified, and 13 items were included in the review. Only one item was considered high quality. Contextual factors focused on the inaccessibility of healthcare to Autistic patients and staff lack of confidence and training in supporting Autistic needs. Interventions were heterogeneous, with most sources reporting few details as to how they had been developed. The most frequently included contents were communication preferences. Mechanisms were often not stated or were inferred by the reviewers and lacked specificity. Outcomes were included in four studies and were primarily focused on AHP uptake, rather than Outcomes which measured impact.

CONCLUSION

There is insufficient evidence to conclude that AHPs reduce the health inequalities experienced by Autistic people. Using an AHP tool alone in a healthcare Context that does not meet Autistic needs, without the inclusion of the local Autistic community developing the tool, and a wider intervention to reduce known barriers to health inequality, may mean that AHPs do not trigger any Mechanisms, and thus cannot affect Outcomes.

Alternate Birth Strategies

Community birth is defined as birth that occurs outside the hospital setting. Birthing in a birth center can be safe for certain patient populations. Home birth can also be safe in well-selected patient with a well-established transfer infrastructure should an emergency occur. Unfortunately, many areas of the United States and the world do not have this infrastructure, limiting access to safe community birth. Immersion during labor has been associated with decreased need for epidural and pain medication. Delivery should not occur in water due to concerns for infection and cord avulsion. Umbilical cord non-severance (also called lotus birth) and placentophagy should be counseled against due to well-documented risks without clear benefit. Birth plans and options should be regularly discussed during pregnancy visits.

COVID-19 Impact on Group Prenatal Education: A Comparison of Virtual and In-Person Formats

This retrospective study compared knowledge, intention, and satisfaction outcomes between pregnant women who attended prenatal education in person (n = 202; 55%) prior to the COVID-19 pandemic or virtually (n = 166; 45%) during the pandemic. Results identified increases in knowledge and intention for a healthy pregnancy and safe infant care for both groups. Virtual participants were less likely to endorse developing a birth plan (p = 0.035), knowledge of breastfeeding resources (p = 0.006), confidence in the ability to breastfeed (p = 0.033), and plans to use only a safe infant sleep location (p = 0.045). Important education was provided by continuing Baby Talk during the pandemic. However, topics with activities/demonstrations during in-person learning that were discontinued for virtual learning had significantly lower increases for virtual participants. Virtual education should incorporate more demonstrations/activities.

Experiences of health providers regarding implementation of the physiologic birth program in Iran: A qualitative content analysis

INTRODUCTION

The rate of cesarean section is on the rise in both developed and developing countries, and Iran is no exception. According to the WHO, physiologic labor is one of the main strategies for reducing cesarean section and improving the health of mothers and newborns. The aim of this qualitative study was to explain the experiences of health providers regarding implementation of the physiologic birth program in Iran.

METHODS

This study is a part of a mixed-methods study, in which 22 health providers were interviewed from January 2022 to June 2022. Data analysis was performed using Graneheim and Lundman's conventional content analysis approach and using MAXQDA10 software.

RESULTS

Two main categories and nine subcategories emerged from the results of this study. The main categories included "the obstacles to the implementation of the physiologic birth program" and "strategies for improving implementation of the program". The subcategories of the first category included: lack of continuous midwifery care in the healthcare system, lack of free accompanying midwives, lack of integrated healthcare and hospitals in service provision, low quality of childbirth preparation and implementation of physiologic birth classes, and lack of requirements for the implementation of physiologic birth in the maternity ward. The second category included the following subcategories: Supervising the implementation of childbirth preparation classes and physiologic childbirth, support of midwives by insurance companies, holding training courses on physiologic birth, and evaluation of program implementation.

CONCLUSIONS

The experiences of the health providers with the physiologic birth program revealed that policymakers should provide the ground for the implementation of this type of labor by removing the obstacles and providing the particular operational strategies needed in Iran. Important measures that can contribute to the implementation of the physiologic labor program in Iran include the following: Setting the stage for physiologic birth in the healthcare system, creating low- and high-risk wards in maternity hospitals, providing professional autonomy for midwifery, training childbirth providers on physiologic birth, monitoring the quality of program implementation, and providing insurance support for midwifery services.

Birth plans: definitions, content, effects, and best practices

The first written guide for birth plans was introduced in 1980 as a means for birthing people to document their choices in the child birthing experience. The birth plan offers an opportunity for the patient and the provider to discuss the birthing process and determine how to safely accommodate patient preferences. Patient satisfaction with birthing plans is variable and may depend on how many requests they have, how many of their plans are accomplished, route of delivery, and whether complications arise during or after delivery. Unmet expectations may lead to posttraumatic stress disorder, but following a birth plan may also be protective against it. Birthing people who use a birth plan may be less likely to use epidural anesthesia, have early amniotomy, or use oxytocin. The first stage of labor may be longer when a birth plan is used; however, there does not seem to be a decrease in the length of the second stage of labor among patients with a birth plan. Some providers believe that a disadvantage of birth plans is disappointment when birth plans are not able to be followed, and others consider that birth plans interfere with professional autonomy.

Experience of professionals and residents working in the obstetric center on birth plan use

Abstract Objective to know the experience of professionals and residents working at an obstetric center about birth plan use. Method qualitative research, developed with seven professionals and five residents working at an obstetric center of a teaching hospital located in southern Brazil. Data were collected using a semi-structured questionnaire, from November to December 2020. The data obtained were submitted to thematic content analysis. Results the lack of knowledge or updating emerged as one of the reasons for not using the birth plan, in addition to inadequate sizing to meet the service demands. Among the possibilities for birth plan use, there is the elaboration during prenatal consultations and the performance of a multidisciplinary team. Conclusion and Implications for practice The search for knowledge is the main key to increase feasibility and, consequently, the use of this document during prenatal and labor. Knowledge about birth plan use promotes conditions for women to exercise autonomy and role during labor, childbirth and birth.

Effect of implementing a birth plan on maternal and neonatal outcomes: a randomized controlled trial

BACKGROUND

The birth plan is an approach for pregnant women to offering their expectations of labor and birth. The purpose of this study was to investigate the effect of birth plan on maternal and neonatal outcomes.

METHODS

This study was a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city-Iran. Participants were randomly assigned to the two groups of birth plan and control using a randomized block method. Participants in the birth plan group received the interventions based on the mother's requested birth plan. The birth plan included items of the mother's preferences in labor, mobility, eating and drinking, monitoring, pain relief, drug options, labor augmentation, pushing, amniotomy, episiotomy, infant care, and caesarean section. The control group received routine hospital care. The primary outcomes were childbirth experience and duration of the active phase of labor and the secondary outcomes were support and control in labor, fear of labor, post-traumatic stress disorder (PTSD), postpartum depression, duration of the second and third phases of labor, frequency of vaginal delivery, frequency of admission of newborn in NICU (Neonatal Intensive Care Unit), the mean first and fifth minute Apgar scores. The socio-demographic and obstetrics characteristics questionnaire, Wijma Delivery Expectancy/Experience Questionnaire (W-DEQ-versions A), and Edinburgh Postnatal Depression Scale (EPDS) were completed at the beginning of the study (at the gestational age of 32-36 weeks). The questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) was completed during and after the delivery. Also, a partogram was completed for all participants by the researcher. The participants in both groups followed up until 4-6 weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire 2.0 (CEQ2.0), Support and Control In Birth (SCIB) scale, EPDS, and PTSD Symptom Scale 1 (PSS-I) were completed by the researcher through an interview. The independent t-test, the chi-square test, and ANCOVA was used to analyze.

RESULTS

The mean (SD) of CEQ score was singificnalty higher in in the birth plan group (3.2 ± 0.2) compared to the control (2.1 ± 0.2) (MD = 1.0; 95% CI: 1.1 to 0.9; P˂0.001). Also, the mean (SD) SCIB score in the birth plan group was significantly higher than that of those in the control group (P˂0.001). The mean scores of DFS (P = 0.015), EPDS (P˂0.001), and PTSD (P˂0.001) as well as the frequency of emergency caesarean section (P = 0.007) in the birth plan group were significantly lower than those in the control group.

CONCLUSION

This was the first study to assess the implementation of a birth plan in Iran. Based on the findings, a birth plan improves childbirth experiences; increases perceived support and control in labor; reduces fear of delivery; suppresses psychological symptoms of depression and PTSD, and increases the frequency of vaginal delivery.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: 07/07/2020; URL: https://en.irct.ir/trial/47007 ; Date of first registration: 19/07/2020.

Reliability and Validity of a Perinatal Shared Decision-Making Measure: The Childbirth Options, Information, and Person-Centered Explanation

OBJECTIVE

To develop and test the psychometric properties of a shared decision-making tool: Childbirth Options, Information, and Person-Centered Explanation (CHOICEs).

DESIGN

Multiphase instrument development study beginning with item development through a cross-sectional postpartum survey.

SETTING

The cross-sectional postpartum survey was distributed online through convenience and snowball sampling methods.

METHODS

We developed instrument items through an iterative process with key stakeholders. We evaluated reliability based on internal consistency and differential item functioning analysis. We evaluated validity on evidence of construct validity. We used criterion-related item mapping to evaluate whether the measure addressed the full spectrum of shared decision making related to maternity care.

RESULTS

Surveys were completed by 1,171 participants. A Cronbach's αcoefficient of .99 supported internal consistency reliability. Infit and outfit statistics that ranged from 0.92 to 1.55 supported item fit. Differential item functioning analysis showed that CHOICEs scores were invariant between different demographic groups. Significant positive correlations between scores on CHOICEs and the Mothers on Respect index (r = 0.75, p = .01) and the Mothers Autonomy in Decision-Making scale (r = 0.75, p = .01) supported criterion-related validity. Item mapping suggested more items were needed to capture the full spectrum of shared decision making.

CONCLUSION

We recommend using CHOICEs to evaluate shared decision making in maternity care for research and quality improvement projects.

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.

The experience of giving birth in a hospital in Spain: Humanization versus technification

AIM

To explore and describe the experiences of women giving birth in a tertiary public hospital, with special focus on experiences related to humanized care and women's participation in decision making.

METHOD

This is a qualitative phenomenological study through semi-structured interviews to postpartum women giving birth in a tertiary hospital between January and May 2017. Data were analysed through content analysis.

RESULTS

The two overarching themes emerged were the professional-information dyad and privacy. Subthemes of the first main theme were the therapeutic relationship, decision-making, feeding the baby, procedures, and the time factor. Subthemes of the second topic were the feelings generated by the hospital environment, the delivery room, and the maternity ward.

CONCLUSIONS

If the therapeutic relationship is good, technology is not seen as dehumanising but rather as necessary to ensure continuing safety. "Humanising" material resources are not a priority for women in the birth process and are little used. Privacy was experienced as being a particularly intense need, which women called for throughout the healthcare process.

Experiência de gestantes na consulta de Enfermagem com a construção do plano de parto

RESUMO Objetivo Descrever a experiência das gestantes atendidas na Consulta de Enfermagem a partir de 37 semanas e que elaboraram seu plano de parto. Método Pesquisa exploratória qualitativa, com 19 gestantes a partir de 37 semanas vinculadas à maternidade de risco habitual em Curitiba, Paraná, e que passaram pela consulta de enfermagem entre novembro de 2019 e março de 2020. Os dados foram coletados mediante entrevista e submetidos a análise de conteúdo temática. Resultados As gestantes apresentaram desconhecimento sobre assuntos relacionados ao parto, o que contribui para o surgimento de dúvidas, medos e inseguranças. Também não conheciam, ou conheciam de forma superficial, o plano de parto. A consulta de enfermagem e o plano de parto na maternidade contribuíram para o esclarecimento de dúvidas, redução da ansiedade, possibilidade de fortalecimento e empoderamento da gestante e do acompanhante diante da oferta de informações para o parto vaginal e o estabelecimento de vínculo com a maternidade. Conclusões e implicações para a prática Adequados à realidade e focados na individualidade da gestante, a consulta de enfermagem e o plano de parto foram respectivamente evidenciados como espaço para educação em saúde e ferramenta educativa, mostrando-se eficientes para a atuação do enfermeiro e melhora da assistência pré-natal.

Women's satisfaction with childbirth and postpartum care and associated variables

OBJECTIVE

To determine the level of satisfaction with childbirth and the postpartum period.

METHOD

This is a longitudinal, observational study. Clinical variables of the patients and delivery were collected, and a descriptive and inferential analysis was performed. The validated state-trait anxiety inventory (STAI) and the satisfaction survey Care in Obstetrics Measure For Testing Satisfaction Scale (COMFORTS) in Spanish were used.

RESULTS

A total of 381 women was included in the study and grouped into satisfied vs. dissatisfied (94.54% vs. 5.46%). Women having given birth by eutocic delivery (p = 0.005), as well as those who had skin-to-skin time with their newborn (p = 0.012) after delivery, report more satisfaction. Mothers who were separated from their babies reported being less satisfied (p = 0.004), as did those who did not meet the expectations raised in the birth plan (p = 0.013). All the women with minimal anxiety are satisfied (p = 0.004), the same happening for those showing postpartum anxiety (p <0.001).

CONCLUSION

The percentage of satisfied women is high; it is necessary to monitor childbirth and postpartum care, promoting good practices in childbirth care, as well as in women's emotional well-being.

[Questionnaires for the Assessment of Birth Expectancy and Birth Experience (Part 2 of a series on psychological assessment during the peripartum period)]

Giving birth is an intense experience and typically accompanied by severe pain. In addition to medical complications, subjective factors are likely to affect the birth experience. These include previous experiences with pregnancy and birth, previous traumatic experiences as well as birth expectations. Various questionnaires allow a standardized assessment of birth expectations and the birth experience. However, to date there is no questionnaire available in the German language that is based on diagnostic symptoms of birth-related posttraumatic stress disorder. Furthermore, current screening-tools were developed for women while men's perspectives have been neglected in research on the parental birth experience. Nonetheless, questionnaires seem to be well suited for the assessment of the birth experience of both mothers and fathers. In this way, support services could be expanded, since parents sometimes report a negative birth experience even in medically uncomplicated births. Along with the goal of enabling parents to have a positive birth experience, the prevention of the development of subclinical or even full-blown posttraumatic stress disorder after birth also plays an important role.

Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial

BACKGROUND

In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable.

OBJECTIVE

This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic.

METHODS

A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included.

RESULTS

The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020.

CONCLUSIONS

This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic.

TRIAL REGISTRATION

The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/25016.

Childbirth experience, maternal functioning and mental health: how are they related?

Introduction: Childbirth experience is shaped by the labor and delivery process. The aim of this study was to investigate the relationship between childbirth experience, subsequent postpartum maternal functioning and mental health.Methods: A total of 483 mothers in the first 4-16 weeks postpartum participated in this cross-sectional study. The cluster random sampling method was used to select the participants. The Questionnaire for Assessing the Childbirth Experience, Mental Health Inventory, and the Barkin Index of Maternal Functioning were completed through interviews.Results: The mean childbirth experience, mental health, and maternal functioning scores were 1.6 (0.4), 79.1 (15.0), and 97.4 (13.0), respectively. There was a significant correlation between the total mental health and maternal functioning scores and all its subscales with childbirth experience scores (P<0.001). Results from the general linear model pointed to a significant correlation between maternal functioning and childbirth experience (P<0.001), as well as between receiving support for infant care (P<0.001) and family income adequacy (P=0.006). Mental health was also significantly correlated with childbirth experience (P<0.001), complete life satisfaction (P<0.001), and receiving support for infant care (P=0.025).Conclusion: Supportive care provision services may improve mothers' birth experiences, which leads to enhanced postpartum maternal functioning and mental health.

Tokophobia and fear of birth: a workshop consensus statement on current issues and recommendations for future research

Objective: To discuss and develop a statement on the current state of the evidence and opinion in Fear of Childbirth (FoC) and Tokophobia (Tocophobia), and to provide recommendations. Background: A group met in 2019 to discuss the state of clinical and academic knowledge relating to FoC/Tokophobia. Five key areas were agreed as the focus of the meeting. Methods: 12 internationally acknowledged experts, in this or a closely related area (e.g. PTSD) met to discuss their understanding of the evidence for FoC/ Tokophobia and current practice. The consensus described in this paper constitutes the expression of the general opinion of the participants and does not necessarily imply unanimity. Keys points: Work focussed on tokophobia is recent and there remains a wide range of issues, which were addressed in the workshop including complexity in defining prevalence, a theoretical lack of understanding, which creates challenge for robust assessment and the identification of risk factors. An improved aetiological and developmental understanding of the tokophobia is required to underpin appropriate, effective and evidence-based interventions. Evaluation of pathways of care and relevant interventions, should be a focus of future research. Conclusion: Significant gaps remain within the FoC/tokophobia knowledge base. Further research is necessary.

Women's experience of psychological birth trauma in China: a qualitative study

BACKGROUND

The psychological birth trauma is a universal phenomenon in childbearing women. The influences could extend in a wide range, which includes the mothers' health, mother-infant relationship, partner relationship. The medical staff could even choose to quit playing their part in the birthing process. The phenomenon has gradually garnered attention around the world. However, it has rarely been discussed under Chinese special conditions. The study was to explore Chinese women's lived experiences of psychological birth trauma during labor and birth.

METHODS

A descriptive phenomenological approach was adopted in this study. Twenty-four women were recruited, who reported having experienced psychological birth trauma. In-depth interviews were conducted within 1 week after birth. Colaizzi's method was used to analyze the data.

RESULTS

Twenty-four women participated in the study. Four themes emerged to describe the women's experience of psychological birth trauma: "How am I supposed to relieve the endless pain?" " Can't I be weak?" "Am I not important?" "What uncertainties are waiting for me?"

CONCLUSIONS

The findings provide deep insight into Chinese women's unique experience of psychological birth trauma. The social and health system could prevent psychological harm during birth and promote maternal health by measures of pain management, thoughtful attention, adequate caring, and prenatal preparation.

Nonpharmacological approaches to improve women's childbirth experiences: a systematic review and meta-analysis

Background: Childbirth is considered a significant experience in women's life. Different models of care and interventions without pharmacological approaches have been used to enhance women's positive childbirth experiences, but the most effective interventions have not been clearly identified.Objective: To assess the effectiveness of nonpharmacological approaches in improving women's childbirth experiences.Methods: We searched Cochrane Library, Medline, Web of Science, Embase, Scopus, ProQuest, Google Scholar, and Persian databases (Magiran, Scientific Information Database, and Barakat) from inception until December 2017. Randomized controlled trials and quasi-randomized controlled trials comparing interventions designed to improve women's childbirth experiences with standard cares were included in this review. Pharmacological interventions were excluded from the study. The outcome measure was women's childbirth experience. Heterogeneity was determined using the Cochrane's test and I² index. The standardized mean differences were pooled based on random effect models.Results: We included 19 studies (10,141 women) in the review. Results of the meta-analysis of 18 studies (8487 women) demonstrated that all the interventions with nonpharmacological approaches improved childbirth experiences (standardized mean difference: 0.49; 95% confidence interval: 0.33-0.66). But, subgroup meta-analysis showed that different models of midwifery care, support during labor and natural therapies were the most effective interventions in improving women's childbirth experience.Conclusions: Nonpharmacological interventions that enable women to feel supported, safe and respected can lead to improved childbirth experiences. However, there is a need for further studies with larger sample sizes and standardized tool to better assess the effectiveness of specific interventions on women's childbirth experiences.