Processing the first birth: journeying into 'motherland'

How do new mothers describe their postpartum sexual quality of life? a qualitative study

BACKGROUND

Sexuality plays a critical role in a woman's postpartum quality of life and also has a strong impact on the quality of her relationship. Given the sparse body of published literature on the subject, we aimed to explore how new mothers explain their postpartum sexual quality of life.

METHOD

A qualitative study was carried out in Iran and Switzerland from December 2018 to March 2019. Focus groups and semi-structured in-depth interviews (IDIs) were conducted with mothers in the first four months after parturition. Mothers who were older than 18 years, were married or in a stable relationship, and experienced a low-risk vaginal birth or cesarean section participated in the study. We used Graneheim and Lundman's approach for analyzing the data. Multiple data collection methods, maximum variation sampling, and peer checks were applied to enhance the rigor of the data.

RESULTS

We achieved data saturation after two focus group discussions (FGDs), 15 IDIs in Iran, and 13 IDIs in Switzerland. We extracted three themes for postpartum sexual quality of life: (a) sexual worldview, (b) interpersonal relationship, and (c) postpartum sex storm. The participants described sexual worldview as "sexual beliefs", "sexual perceptions", and "sexual behaviors". The interpersonal relationship consists of "changes in postpartum interpersonal relationships" and "supportive role of the husbands/partners". The last one, postpartum sex storm, has three categories including "direct changes in sexual life", "indirect changes in sexual life", and "resumption of sexual intercourse". Differences between the two cultures were identified in some subcategories such as "sexual interests", "comparable to the first intercourse in life", "negative sexual behaviors of husbands/partners", "positive sexual behavior of mothers", "helping with child care and housework", and "emotional support".

CONCLUSION

New mothers explained postpartum sexual quality of life as a three-theme phenomenon. Although most results were similar in both cultures, there were some differences. Our study's results suggest that sexual quality of life is a topic that encompasses international as well as cultural aspects.

Exploring Western Australian Women's experiences of sharing positive birth stories

BACKGROUND

Fear can impact childbirth experiences, yet most birth stories women hear portray birth as unfavourable, and women must actively seek out positive birth stories.

AIMS AND OBJECTIVES

We aim to explore how women feel when sharing positive birth stories and the socially constructed motivations for or against sharing.

RESEARCH QUESTION

What are the experiences of women who share positive birth stories?

METHODS

A qualitative descriptive approach was adopted, adhering to Standards of Reporting Qualitative Research (SRQR) guidelines, and underpinned by an interpretivist research philosophy. Participants were recruited via Facebook using a non-probability, voluntary-response, purposive sampling method. Twelve English-speaking Western Australian women aged 24-38 years identified as having had a positive vaginal birth experience within the past 5 years. Semi-structured interviews were transcribed verbatim and analysed using thematic analysis.

FINDINGS

The theme Not Safe to Share and sub-themes The Perils of Sharing and Changing the Narrative explores how participants repeatedly felt unable to share their birth stories because society's dominant view of childbirth was negative. It describes the experienced or anticipated reactions that contributed to feeling unsafe and how participants withheld or altered their stories to feel accepted. The theme Safe Spaces and sub-theme The Joys of Sharing, explored participants' love of sharing their birth stories in safe spaces, allowing re-access to feelings of elation, validation of their stories, and opportunity to empower others.

CONCLUSIONS

Women often feel reluctant to share their positive birth stories. Findings may help understand the lack of availability of positive birth stories in our society. Normalising the positive birth experience may improve the experience of sharing positive birth stories, potentially improving society's view of childbirth.

How Giving Birth Makes Sense: A Questionnaire Study on Existential Meaning-Making Among Mothers Giving Birth Preterm or at Term

BACKGROUND

Women's reflections on existential meaning-making in relation to giving birth may seem indistinct in maternity services and have not been thoroughly explored in secular contexts. However, research suggests that childbirth accentuates spiritual and existential considerations and needs even in secular contexts highlighting the importance of care for such needs in maternity care practices. The objectives of this study were two-fold: Firstly, to explore how first-time mothers, living in a secular context, experience their first birth in relation to existential meaning-making. Secondly, to describe the relationship between existential meaning-making reflections and gestational week at birth.

METHODS

A nationwide cross-sectional study in Denmark based on the questionnaire "Faith, existence and motherhood" was conducted in 2011. Eight core items related to birth experience informed this study. The cohort was sampled from the Danish Medical Birth Registry and consisted of 913 mothers having given birth 6-18 months previously. Twenty-eight per cent had given birth preterm (PT) and 72% had given birth at full-term (FT). A total of 517 mothers responded.

RESULTS

In relation to the birth of their first child, both FT and PT mothers answered, that they had existential meaning-making reflections. The consent to the 8 items ranged from 17 to 73% among FT mothers and from 19 to 58% among PT mothers. Mothers who gave birth preterm mainly identified the negative aspects of birth, whereas mothers, who gave birth at full-term, to a higher degree identified positive aspects.

CONCLUSIONS

Findings suggest that not only traumatic birth events accentuate existential reflections, but that even normal childbirth to most mothers is an existential event. However, the quality of existential reflections differs when comparing normal and traumatic birth. The study points towards change in education and organization of maternity care to better care for existential needs and reflections specific to every new mother and birthing woman.

What women value in the midwifery continuity of care model: A systematic review with meta-synthesis

INTRODUCTION

There are a number of qualitative studies indicating women are more satisfied with a continuity model of midwifery care however, their experiences have not been understood to gain an overall picture of what it is they value, appreciate and want in such a model. A metasynthesis was undertaken in order to examine the current qualitative literature to gain a deeper understanding of the woman's perspective as a consumer of maternity care in a continuity model.

AIM

To identify and synthesise research findings presenting childbearing women's perspectives on continuity of midwifery care.

METHODS

A search using key words was undertaken using the following databases: CINAHL, Cochrane Library, Ovid, Medline, Nursing Reference Centre and Joanna Briggs Institute. Papers were included if they were published since 2006, in English and included qualitative data from the woman's perspective. The selection process followed was the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Quality appraisal was conducted by all authors using the Critical Appraisal Skills Programme (CASP) tool as a screening tool. This allowed for each paper to be appraised to determine risk of bias.

FINDINGS

Thirteen quality appraised papers published between 2006 and 2016 were found which included qualitative data and were related to the woman's experience in a continuity model. Six papers were from Australia, three in the United Kingdom, two in New Zealand and one in the United States of America and Denmark. Themes identified included an overarching concept of the relationship which was underpinned by themes of personalised care, trust and empowerment.

CONCLUSIONS

The midwife-woman relationship is the vehicle through which personalised care, trust and empowerment are achieved in the continuity of midwifery model of care.

"Engaging with birth stories in pregnancy: a hermeneutic phenomenological study of women's experiences across two generations"

Background

The birth story has been widely understood as a crucial source of knowledge about childbirth. What has not been reported is the effect that birth stories may have on primigravid women’s understandings of birth. Findings are presented from a qualitative study exploring how two generations of women came to understand birth in the milieu of other’s stories. The prior assumption was that birth stories must surely have a positive or negative influence on listeners, steering them towards either medical or midwifery-led models of care.

Methods

A Heideggerian hermeneutic phenomenological approach was used. Twenty UK participants were purposively selected and interviewed. Findings from the initial sample of 10 women who were pregnant in 2012 indicated that virtual media was a primary source of birth stories. This led to recruitment of a second sample of 10 women who gave birth in the 1970s-1980s, to determine whether they were more able to translate information into knowledge via stories told through personal contact and not through virtual technologies.

Results

Findings revealed the experience of ‘being-in-the-world’ of birth and of stories in that world. From a Heideggerian perspective, the birth story was constructed through ‘idle talk’ (the taken for granted assumptions of things, which come into being through language). Both oral stories and those told through technology were described as the ‘modern birth story’. The first theme ‘Stories are difficult like that’, examines the birth story as problematic and considers how stories shape meaning. The second ‘It’s a generational thing’, considers how women from two generations came to understand what their experience might be. The third ‘Birth in the twilight of certainty,’ examines women’s experience of Being in a system of birth as constructed, portrayed and sustained in the stories being shared.

Conclusions

The women pregnant in 2012 framed their expectations in the language of choice, whilst the women who birthed in the 1970s-1980s framed their experience in the language of safety. For both, however, the world of birth was the same; saturated with, and only legitimised by the birth of a healthy baby. Rather than creating meaningful understanding, the ‘idle talk’ of birth made both cohorts fearful of leaving the relative comfort of the ‘system’, and of claiming an alternative birth.

Working together for women’s empowerment: Strategies for interdisciplinary collaboration in perinatal care

Women’s experiences of pregnancy, birth, and postpartum adjustment are often characterized by feelings of disempowerment, trauma, and emotional pain. Psychosocial perinatal care has not kept up with medical advances in perinatal care. Access to psychosocial care appears to be inadequate because of the following: (a) perinatal health care providers are insufficiently prepared to address emotional aspects of maternal care and (b) traditional, compartmentalized psychological services benefit only a subsection of perinatal women, often in an untimely manner. Practical and innovative psychosocial services, integrated into routine perinatal care, can provide widespread access to psychosocial resources for mothers and supports providers in delivering optimal care.

Finding Meaning in Life Following Emergency Postpartum Hysterectomy: What Doesn't Kill Us Makes Us Stronger

INTRODUCTION

Childbirth is generally perceived to be a triumphant and joyous moment in a woman's life. However, current research indicates that it can also be a time of fear, dread, and apprehension, particularly when the birth experience is traumatic. Some women attempt to seek the positives of their traumatic or unexpected childbirth experience to be able to cope with their experience. However, little attention is directed toward how women rebuild their lives and grow following traumatic birth experiences such as severe postpartum hemorrhage and emergency hysterectomy.

METHODS

Twenty-one Australian women, aged 24 to 57 years, who had experienced severe postpartum hemorrhage and emergency hysterectomy were interviewed in an in-depth qualitative study about their experiences.

RESULTS

Thematic analysis revealed the major theme of moving forward and 4 subthemes: appreciating life and what you have; what really counts: learning and growing; accepting it: it's just the way it is; and reframing the experience: seeking the positives All of the women found meaning following their hysterectomy, which produced a positive perspective on their lives.

DISCUSSION

The way that women find meaning and cope with the trauma of having a severe postpartum hemorrhage and emergency hysterectomy is significant to their ability to move forward and live life to the fullest. Midwives and other health care providers may be in a position to provide support for women in the aftermath of severe postpartum hemorrhage and emergency hysterectomy.

Prayer and meditation among Danish first time mothers-a questionnaire study

Background

Mothers’ existential dimensions in the transition to motherhood have not been described thoroughly. They might experience disruption and new perspectives in existential ways and this may especially be the case in preterm birth. The aim of this study was twofold. First we investigated the existential dimension of motherhood transition in a secularized context, through practices of prayer and meditation. Second we described the relationship between time of birth (term/preterm) and the prayer/meditation practices of the mothers.

Methods

Data were gathered from a nationwide questionnaire survey among first time mothers conducted during the summer 2011. All Danish women who gave birth before the 32^nd pregnancy week (n = 255), and double the number of mothers who gave birth at full term (n = 658) in 2010 were included (total n = 913). The questionnaire consisted of 46 overall items categorized in seven sections, which independently cover important aspects of existential meaning-making related to becoming a mother. The respondent rate was 57 % (n = 517).

Results

Moments of praying or meditation 6–18 months post partum were reported by 65 %, and mothers who responded affirmatively, practiced prayer (n = 286) more than meditation (n = 89), p < 0,001. We did not observe differences in affirmative responses to prayer or meditation between mothers of full term or preterm born children, not even after controlling for perinatal or post partum loss, mode of birth, age, status of cohabiting or education.

Conclusions

In this explorative study we found specific practices of existential meaning-making through prayer and/or meditation among first time mothers, living in a very secularized context. Yet we know only little about character or importance of these practices among mothers, and hardly anything about existential meaning-making among new fathers. Hence the implications of meaning-making practices related to other dimensions of health are difficult to address in a qualified way in care for new mothers and families.

Existential meaning among first-time full-term and preterm mothers: a questionnaire study

Research indicates that childbirth is a time when a woman might experience existential disruptions and gain new perspectives on life. The 2-fold aim of this study was to investigate whether attitudes related to existential meaning among first-time mothers intensify and whether they differ between mothers who gave birth at full term and those who gave birth preterm. All first-time mothers who gave birth in Denmark in 2010 before the 32nd week of pregnancy and twice that number of full-term mothers (randomly sampled) were invited to participate in a national cross-sectional survey. Five core items concerning meaning in life, vulnerability of life, responsibility, thoughts about life and death, and "something bigger than oneself" were analyzed to compare mothers' attitudes on existential meaning. The overall response rate was 57% (517/913). Contrary to the hypothesis, attitudes related to existential meaning intensified to the same degree among mothers of full-term and preterm infants, with no statistically significant differences in terms of age, marital status, educational level, or birth method. Danish first-time mothers' attitudes related to existential meaning measured in 5 core items were intensified and almost similar, regardless of whether they gave birth full-term or preterm.

Development and Validation of Women's Satisfaction With Hospital-Based Intrapartum Care Scale in Jordan

BACKGROUND

Measuring satisfaction with care during labor is an important way to improve maternity services for women. This study was undertaken to develop an instrument to measure women's satisfaction with intrapartum hospital-based care.

METHOD

A multidimensional instrument was initially developed, using three core aspects identified from the literature. An expert panel was convened to further modify the instrument. Finally, a total of 300 low-risk women who gave birth in the past 2 months were asked to complete the instrument to assess validity and reliability.

FINDINGS

The 14-item instrument was found to have content and construct validity as well as a high level of reliability (α = .88).

CONCLUSIONS

This new instrument is a valid and reliable measure of satisfaction with intrapartum care in a Jordanian setting. The instrument can provide valuable information on the quality of services and on future planning for maternity services.

Experiences of Women Planning a Home Birth Who Require Intrapartum Transfer to Hospital: A Metasynthesis of the Qualitative Literature

Recent evidence supports the safety of planned home birth for low-risk women when professional midwifery care and adequate collaborative arrangements for referral and transfer are in place. The purpose of this article is to synthesize the qualitative literature on the experiences of women planning a home birth, who are subsequently transferred from home to hospital. A metasynthesis approach was selected because it aims to create a rich understanding of women’s experiences of transfer by synthesizing and interpreting qualitative data. Three categories were synthesized: “communication, connection, and continuity,” “making the transition,” and “making sense of events.” Quality and clarity of communication, feeling connected to the backup hospital, and continuity of midwifery carer helps make the transfer process as seamless as possible for women. Arriving at the hospital is a time of vulnerability and fear, and retaining the care of a known midwife is reassuring. New caregivers must also be sensitive to women’s need to be reassured and accepted. The reasons for transfer need to be clearly communicated both at the time of transfer and in more detail during the postpartum period. Women need to talk through their experience and to acknowledge their feelings of disappointment in order to move forward in the next phase of their lives. Continuity of carer enables this to be done by a known caregiver in a sensitive and individualized manner. Further qualitative research to examine home birth transfer issues, specifically in the Australian context, is currently being planned as part of the Birthplace in Australia project.

Childbirth traditions and cultural perceptions of safety in Nepal: critical spaces to ensure the survival of mothers and newborns in remote mountain villages

OBJECTIVE

to uncover local beliefs regarding pregnancy and birth in remote mountainous villages of Nepal in order to understand the factors which impact on women's experiences of pregnancy and childbirth and the related interplay of tradition, spiritual beliefs, risk and safety which impact on those experiences.

DESIGN

this study used a qualitative methodological approach with in-depth interviews framework within social constructionist and feminist critical theories.

SETTING

the setting comprised two remote Nepalese mountain villages where women have high rates of illiteracy, poverty, disadvantage, maternal and newborn mortality, and low life expectancy. Interviews were conducted between February and June, 2010.

PARTICIPANTS

twenty five pregnant/postnatal women, five husbands, five mothers-in-law, one father-in-law, five service providers and five community stakeholders from the local communities were involved.

FINDINGS

Nepalese women, their families and most of their community strongly value their childbirth traditions and associated spiritual beliefs and they profoundly shape women's views of safety and risk during pregnancy and childbirth, influencing how birth and new motherhood fit into daily life. These intense culturally-based views of childbirth safety and risk conflict starkly with the medical view of childbirth safety and risk.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

if maternity services are to improve maternal and neonatal survival rates in Nepal, maternity care providers must genuinely partner with local women inclusive of their cultural beliefs, and provide locally based primary maternity care. Women will then be more likely to attend maternity care services, and benefit from feeling culturally safe and culturally respected within their spiritual traditions of birth supported by the reduction of risk provided by informed and reverent medicalised care.

Talking with others about stigmatized health conditions: implications for managing symptoms

We investigated the influence of social ties on symptom management and help seeking, using urinary symptoms as a case study. Talking with others about these symptoms was common and both facilitated and hindered symptom management and help seeking. In some cases, talking with others resulted in gaining a sense of identification with others suffering the same symptoms, receiving assistance to ease the burden of symptoms, obtaining suggestions to help manage symptoms, and learning information about available treatments. In other cases, talking with others served to normalize symptoms to such an extent that individuals saw no need to manage their symptoms differently.

'Motherbirth or childbirth'? A prospective analysis of vaginal birth after caesarean blogs

OBJECTIVE

vaginal birth after caesarean (VBAC) is a controversial issue with strong opinions for and against. The means in which women work through the different opinions and options using the internet should be of interest to midwives, obstetricians and policy makers. The aim of this study was to examine how women use English language internet blog sites to discuss the option of VBAC and what factors influence these women's decision to have a VBAC or repeat caesarean section.

DESIGN

a qualitative study using internet blog sites as the source of data was undertaken. Google alerts were created to search for the term VBAC in internet blogs. These alerts were sent to the first author's email account daily for a one-year period (November 2007 to October 2008) and downloaded. The content was analysed using thematic analysis.

FINDINGS

there were 311 blogs mentioning the word VBAC in the one-year period. Most of the blog sites and discussion originated from the USA. There were more blogs written during the Northern Hemisphere winter months than during other seasons. The main theme identified was a dichotomy in philosophical framework women held about birth; that is a 'motherbirth' or 'childbirth' framework. Whether women eventually wrote that they chose a VBAC or repeat caesarean or the extent to which they pursued their birth choice depended on whether they came from a perspective that a 'good parent sacrifices themselves for their baby (prioritises the baby) and takes no risks' (childbirth) or that 'giving birth matters to the woman and a happy, healthy mother is a happy healthy baby (mother and baby have equal priority)' (motherbirth). Several themes were identified including: surviving the damage; inadequate bodies; choice and control; fearing and trusting birth; negotiating the system; and minimising or overestimating risk.

KEY CONCLUSION

women filtered their decision making regarding VBAC through a belief system that prioritises according to their personal approaches.

IMPLICATIONS FOR CLINICAL PRACTICE

blogging may be providing a valuable insight into factors that inform decision making and may provide a forum of information and support for women who have experienced a caesarean section.

Home Birth: A Story of “Infinite Love and Enormous Rejection”

This article calls for a new way of looking at the home birth debate by challenging the underlying assumptions and beliefs that lead to the polarized discourse. The debate around home birth is about more than place of birth or perinatal mortality. It raises deeper and more complex issues that need to be explored. This article moves the debate about home birth from one about death to one about human nature, from one about statistics, to one about why the statistics will not end the debate. It explores less familiar discourses such as confirmation bias, group polarization, fear, risk, scientific paradigms, and power using insights from disciplines such as philosophy and psychology for guidance as to why “infinite love and enormous rejection” have come to fill the discourse about home birth. If we do not try and understand why the home birth debate is so polarized and develop new strategies to overcome the great divide, we will never make progress with important decisions as how home birth should safely be made available to women.