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Hildingsson I, Johansson M. A cluster analysis of reasons behind fear of birth among women in Sweden. J Psychosom Obstet Gynaecol 2024; 45:2319291. [PMID: 38376114 DOI: 10.1080/0167482x.2024.2319291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/11/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Fear of birth is common and complex, caused by a variety of reasons. The aim was to investigate the prevalence of pre-established reasons in relation to fear, and to identify profiles of women based on their reported reasons behind fear of birth. METHODS A cross-sectional Swedish study of women with self-reported fear of birth who completed an online survey. Descriptive statistics, chi-square test, crude and adjusted odds ratios with 95% confidence intervals were used in the analysis of pre-established reasons in relation to self-reported severe fear. A Kappa-means cluster analysis was performed in order to group reasons, that were further investigated in relation to women's background variables. RESULTS A total of 1419 women completed the survey. The strongest reason behind fear of birth was to be forced to give birth vaginally. Four clusters were identified and labeled: minor complexity (reference group), relative minor complexity, relative major complexity, and major complexity. Cesarean section preference, previous mental health problems, being younger, primiparity, and exposure to domestic violence were factors related to cluster grouping. CONCLUSIONS Women with fear of birth have various reasons and diverse complexities behind their fear. Health care providers need to investigate these reasons and support pregnant women with childbirth fear, based on their needs.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
- Department of Nursing, Mid Sweden University, Sundsvall, Sweden
| | - Margareta Johansson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Hildingsson I, Nordin-Remberger C, Wells MB, Johansson M. Cluster Analysis of Fear of Childbirth, Anxiety, Depression, and Childbirth Self-Efficacy. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00071-6. [PMID: 38782047 DOI: 10.1016/j.jogn.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 04/12/2024] [Accepted: 04/22/2024] [Indexed: 05/25/2024] Open
Abstract
OBJECTIVE To identify clusters of women based on anxiety, depression, fear of birth, and childbirth self-efficacy and factors associated with the clusters. DESIGN Cross-sectional survey. SETTING Online in Sweden. PARTICIPANTS Pregnant women (N = 1,419). METHODS We collected data through online questionnaires. We included scales to measure anxiety, depression, worries about and fear of birth, and self-efficacy in a kappa-means cluster analysis. We calculated odds ratios with 95% confidence intervals between clusters and background variables. RESULTS We identified 4 clusters based on severity: Resourceful-Robust, Resourceful-Fearful, Vulnerable-Fearful, and Fragile-Fearful. Participants in the Resourceful-Fearful and Vulnerable-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Vulnerable-Fearful and Fragile-Fearful clusters were more likely to report mental health problems than those in the Resourceful-Robust cluster. Participants in the Fragile-Fearful cluster were more likely to be multiparous, report that their pregnancy was not normal, and prefer cesarean birth than those in the Resourceful-Robust cluster. CONCLUSIONS Women with childbirth fear may be vulnerable to anxiety and depression during the perinatal period, although the severity might vary. Self-efficacy might be a mediator against mental health problems. Findings demonstrated levels of severity, and the one-size-fits-all approach in Swedish health care may benefit from a more targeted approach for women with fear of childbirth.
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Benyamini Y, Delicate A, Ayers S, Dikmen-Yildiz P, Gouni O, Jonsdottir SS, Karlsdottir SI, Kömürcü Akik B, Leinweber J, Murphy-Tighe S, Pajalic Z, Riklikiene O, Limmer CM. Key dimensions of women's and their partners' experiences of childbirth: A systematic review of reviews of qualitative studies. PLoS One 2024; 19:e0299151. [PMID: 38551936 PMCID: PMC10980232 DOI: 10.1371/journal.pone.0299151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 02/06/2024] [Indexed: 04/01/2024] Open
Abstract
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.
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Affiliation(s)
- Yael Benyamini
- Bob Shapell School of Social Work, Tel Aviv University, Tel Aviv, Israel
| | - Amy Delicate
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Susan Ayers
- Centre for Maternal and Child Health Research, City, University of London, London United Kingdom
| | - Pelin Dikmen-Yildiz
- Department of Psychology, Fen—Edebiyat Fakültesi, Cumhuriyet Mahallesi, Kirklareli University, Kırklareli, Turkey
| | - Olga Gouni
- Cosmoanelixis, Prenatal & Life Sciences Educational Organization, Nea Ionia, Athens, Greece
| | | | | | - Burcu Kömürcü Akik
- Department of Psychology, Faculty of Languages and History-Geography, Ankara University, Ankara, Turkey
| | - Julia Leinweber
- Institute of Midwifery, Charité University of Medicine, Berlin, Germany
| | - Sylvia Murphy-Tighe
- Department of Nursing & Midwifery, Health Sciences Building, University of Limerick, Ireland
| | | | - Olga Riklikiene
- Faculty of Nursing, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Claudia Maria Limmer
- Department of Nursing and Management, Faculty of Business and Social Sciences, Hamburg University of Applied Sciences, Hamburg, Germany
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Kajjoune I, de Brouwere V, Manoussi A, Elomrani S, Assarag B. L'expérience de l'accouchement en milieu surveillé dans la province d'Essaouira au Maroc: Quelle réalité? Sex Reprod Health Matters 2023; 31:2272712. [PMID: 38088854 PMCID: PMC11078118 DOI: 10.1080/26410397.2023.2272712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2023] Open
Abstract
RésuméUne expérience positive de l'accouchement (EPA) est fondamentale pour des soins maternels de qualité. Toutefois, de nombreuses femmes subissent des comportements non respectueux lors de ce moment crucial. Au Maroc, peu d'études ont mesuré cette expérience, et les éléments l'influençant demeurent insuffisamment documentés. Nous avons conduit une recherche mixte dans la province d'Essaouira entre avril et décembre 2021. Notre enquête, basée sur un questionnaire, a sollicité l'avis de 240 femmes issues de huit centres de santé choisis au hasard. Par ailleurs, des entretiens semi-directifs ont été conduits avec 20 femmes, 47 professionnels de santé et quatre responsables administratifs. Les données quantitatives ont été soumises à des analyses descriptives, bi- et multivariées, tandis que les entretiens ont été analysés selon une approche de contenu thématique. Les données révèlent que 59.2% des participantes ont eu une expérience défavorable lors de leur dernier accouchement. Parmi elles, la majorité a déploré des soins non consentis (86.7%), un manque de respect de leur intimité (45.4%) et des abus verbaux (25%). L'EPA était principalement associée à la qualité de l'environnement de l'accouchement, au soutien pour l'allaitement, à la propreté des installations, au type d'établissement (privé) et à l'absence de complications médicales pendant le travail. Les entretiens ont révélé que le manque de motivation des professionnels de santé, l'absence de formation continue appropriée et des lacunes organisationnelles et managériales ont affecté l'EPA. Notre étude souligne le besoin crucial de formation continue axée sur le respect des patients, l'éthique et la déontologie, et met en lumière l'importance d'une politique motivante pour les professionnels de santé, notamment dans le secteur public.
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Affiliation(s)
- Imane Kajjoune
- Lauréate, École Nationale de Santé Publique, Rabat, Maroc. Correspondence:
- Chef du Service du réseau des Etablissements de Santé à la Délégation Provinciale de Rhamna, Ministère de la Santé et de la Protection Sociale, Rabat, Morocco
| | - Vincent de Brouwere
- Professeur émérite, Institute of Tropical Medicine, Antwerp, Belgium
- Professeur associé, École Internationale de Santé Publique, Université Mohamed VI des Sciences de la Santé, Casablanca, Maroc
- Visitng Professor, School of Tropical Medicine & Global Health, University of Nagasaki, Nagasaki, Japon
| | - Abdelmounaim Manoussi
- Doctorant, Université Cadi Ayyad, Faculté des sciences Semlalia, Département de biologie, Marrakech, Maroc
| | - Sanae Elomrani
- Doctorante, École Nationale de Santé Publique, Rabat, Maroc
| | - Bouchra Assarag
- Chercheure en DSSR, Directrice Adjoint chargée des études, École Nationale de Santé Publique, Rabat, Maroc
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Weidner K, Bartmann C, Leinweber J. [Traumatic childbirth and trauma-sensitive obstetric support]. DER NERVENARZT 2023; 94:811-820. [PMID: 37351670 DOI: 10.1007/s00115-023-01510-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/14/2023] [Indexed: 06/24/2023]
Abstract
Childbirth can be a very happy and empowering experience for women but also one of suffering and despair. Biographical traumatic experiences, especially sexual, physical and emotional violence, are risk factors for a traumatic childbirth experience with the danger of subsequent trauma sequelae and impaired mother-child bonding; however, obstetrically indicated interventions or poor communication in the delivery room can also primarily be experienced as traumatic.In recent years, policies affecting traumatic childbirth experience have been controversially and sometimes emotionally discussed. In the clinical obstetric routine there is often a fine line between medically necessary rapid interventions and emotionally supportive trauma-sensitive and preventive obstetric care. The following article addresses the causes and prevention strategies of traumatic childbirth experiences from obstetric, midwifery and psychotherapeutic perspectives.
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Affiliation(s)
- Kerstin Weidner
- Klinik und Poliklinik für Psychotherapie und Psychosomatik, Medizinische Fakultät, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland.
| | - Catharina Bartmann
- Frauenklinik und Poliklinik, Universitätsklinikum Würzburg, Josef-Schneider-Str. 4, 97080, Würzburg, Deutschland
| | - Julia Leinweber
- Institut für Hebammenwissenschaft, Charité Universitätsmedizin Berlin, Virchowweg 23, 10117, Berlin, Deutschland
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Gregory S, Caffrey L, Daly D. "It could not have been more different." Comparing experiences of hospital-based birth and homebirth in Ireland: A mixed-methods survey. Women Birth 2023:S1871-5192(23)00035-5. [PMID: 36804152 DOI: 10.1016/j.wombi.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 02/03/2023] [Accepted: 02/12/2023] [Indexed: 02/18/2023]
Abstract
PROBLEM Internationally, little is known about the experiences of the minority who have birthed both in hospital and at home. This group are in a unique position to provide experiential evidence regarding perceptions of care under each approach. BACKGROUND Obstetric care within the hospital setting is the hegemonic approach to birth in western cultures. Homebirth is at least as safe as hospital birth for those with low-risk pregnancies, yet access is strictly regulated. AIM To explore how those who have experienced both hospital and homebirth maternity care in Ireland perceived the care received, and experienced birth in each setting. METHODS 141 participants who birthed both in hospital and at home between 2011 and 2021 completed an online survey. FINDINGS Participants' overall experience scores were significantly higher for homebirth (9.7/10) than hospital birth (5.5/10). In hospital, midwifery-led care scored significantly higher (6.4/10) than consultant-led care (4.9/10). Qualitative data revealed four explanatory themes: 1) Regulation of birth; 2) Continuity of care and/or carer and establishing relationships; 3) Bodily integrity and informed consent; and 4) Lived experiences of labour and birth at home and in hospital. DISCUSSION Homebirth was perceived far more positively than hospital birth experiences across all aspects of care surveyed. Findings suggest that those who have experienced both models of care have unique perspectives and aspirations about childbirth. CONCLUSION This study provides evidence regarding the need for genuine choices for maternity care and reveals the importance of care which is respectful and responsive to divergent ideologies about birth.
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Affiliation(s)
- Soma Gregory
- School of Social Work and Social Policy, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland.
| | - Louise Caffrey
- School of Social Work and Social Policy, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
| | - Deirdre Daly
- School of Nursing and Midwifery, Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland; Trinity Centre for Maternity Care Research (TCMCR), Trinity College Dublin, 24 D'Olier Street, Dublin D02 T283, Ireland
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Mirghafourvand M, Meedya S, Mohammadi E, Mohammad-Alizadeh-Charandabi S, Jafarabadi MA, Ghanbari-Homaie S. Iranian women's perception on the determinants of birth experience: a qualitative study. BMC Pregnancy Childbirth 2022; 22:751. [PMID: 36199065 PMCID: PMC9535943 DOI: 10.1186/s12884-022-05078-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/19/2022] [Accepted: 09/26/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The prevalence of cesarean birth in Iran is very high. Having a negative childbirth experience is one of the reasons that primiparous women provide to prefer caesarean birth over a vaginal birth. This study is aimed to understand women's perspective on what determines a positive or negative birth experience for them. METHODS This qualitative study is a part a mixed method study that was conducted among primiparous women with a previous vaginal birth experience. The purpose of the main study was to develop a guideline based on Iranian primiparous women's birth experiences. The quantitative phase of the study was a cross-sectional study where women's childbirth experiences was measured in a survey via the Childbirth Experience Questionnaire-2. In the qualitative part of the study, women were invited for an in-depth interview via a random stratified sampling method based on their childbirth mean score (women with 10% of the upper bound score which indicated a positive birth experience and 10% of the lower bound indicating negative birth experience, n = 17). Conventional content analysis was used for data analysis. RESULTS We extracted three main themes: (a) "Internal control", (b) "External control", and (c) "Support". Possessing internal control, having a balanced external control to feel cared and feeling supported were the main reasons for women to feel positive about their birth experiences. Whereas, loss of internal control, imbalanced external control and unsupportive environment were related to their negative childbirth experiences. CONCLUSION Considering that women's sense of control, the care and support that they receive can influence their childbirth experiences, there is a need for changing maternity policies and practices to highlight the importance of a woman-centred care to create a pleasant, respectful and positive memory for primirparous women who experience normal vaginal births.
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Affiliation(s)
- Mojgan Mirghafourvand
- Social determinants of Health Research Center, Tabriz University of Medical sciences, Tabriz, Iran
| | - Shahla Meedya
- School of Nursing and Midwifery, Faculty of Health Sciences, Australian Catholic University, Sydney, Australia
| | - Eesa Mohammadi
- Department of Nursing, School of Medicine, Tarbiat Modares University, Tehran, Iran
| | | | - Mohammad Asghari Jafarabadi
- Cabrini Research, Cabrini Health, 3144, Melbourne, VIC, Australia.,School of Public Health and Preventative Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, 3800, Melbourne, VIC, Australia.,Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Solmaz Ghanbari-Homaie
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran.
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