Comparative study analysing women's childbirth satisfaction and obstetric outcomes across two different models of maternity care

Basic psychological needs: A framework for understanding childbirth satisfaction

Women often report being dissatisfied with their childbirth experience, which in turn predicts negative outcomes for themselves and their children. Currently, there is no consensus as to what constitutes a satisfying or positive birth experience. We posit that a useful framework for addressing this question already exists in the form of Basic Psychological Needs Theory, a subtheory of Self-Determination Theory (Deci & Ryan, Can. Psychol., 49, 2008, 182). Specifically, we argue that the degree to which maternity care practitioners support or frustrate women's needs for relatedness, competence, and autonomy predicts their childbirth satisfaction. Using this framework provides a potentially powerful lens to better understand and improve the well-being of new mothers and their infants.

Need of integrated care model for positive childbirth experience in Indian maternity care services

BACKGROUND

Integrated care (IC) models are an emerging trend in healthcare reforms worldwide, especially in the maternal healthcare system. This research focuses on the scope of an integrated model for intrapartum care of women and explores the experience of birth under two intrapartum care models-biomedical and midwifery models, respectively. The term positive childbirth experience (PCE) is a concept defined by the World Health Organization (WHO) in the recommendations on intrapartum care for a PCE.

MATERIALS AND METHOD

This study is convinced to employ a qualitative approach to explore how birth is experienced by women under maternity healthcare services in Kerala. A semi-structured interview was conducted to tap into the lived reality of birthing of sixteen first-time mothers (primipara) aged between 20 and 30 years under these two models. Furthermore, five participants have been specifically interviewed after their vaginal birth after a C-section (VBAC) experience. To achieve a systematic cross-case thematic analysis, systematic text condensation (STC) has been employed as a data analysis method.

RESULTS

Four main categories were identified through the analysis as follows: (1) information and knowledge, (2) confidence, (3) quality of care, and (4) health-promoting perspective. These central themes evolved from 11 subthemes.

CONCLUSION

The data analysis reveals both negative and positive experiences under two care models. It emphasizes the urgent need to reframe the biomedical-focused care model and adopt an integrated approach that aligns with the global intrapartum care model proposed by the World Health Organization (WHO) in 2018 and the definition of IC mentioned in the paper.

Experiences of childbirth care in Lithuania and Romania: Insights from the European Babies Born Better survey

BACKGROUND

Data on experience and satisfaction of users are essential for improvement of health care, especially in the field of childbirth. The aim of this study was to compare childbirth care experiences in Lithuania and Romania.

METHODS

Data derived from the EU Babies Born Better online survey were analyzed. Parturients from Lithuania (N = 373) and Romania (N = 359) who had given birth within the last 5 years were included. Participants were asked to (1) describe the best things in childbirth care and (2) suggest changes in the care received at their birthplace. Qualitative data were analyzed using a previously developed deductive coding framework.

RESULTS

In agreement with previous findings from Austria, positive experiences mainly addressed care experienced at an individual level (in particular healthcare practitioners' competence and personality traits) and suggested changes mainly addressed services at birthplace (issues related to infrastructure, information and counseling, and empowerment). Responses not initially included in the coding framework addressed aspects such as informal payment (in both countries), desire for home birth (particularly in Lithuania), or mistreatment of parturients (particularly in Romania).

CONCLUSIONS

We conclude that similar trends in childbirth care exist in Lithuania and Romania with regard to parturients' personal experiences and psychosocial needs and that addressing the needs of parturients is important for improving service provision.

Exploring Jordanian mothers' experiences of childbirth

AIM

To explore the experiences of Jordanian mothers who gave birth in three public hospitals.

DESIGN

A descriptive qualitative research design was used.

METHODS

Purposive sampling was used to choose the study participants. Semi-structured one-to-one in-depth interviews were conducted with twenty postpartum mothers who had recently given birth at three public hospitals and agreed to participate in the study. Thematic content analysis (TCA) was used to analyze the data and to identify the main themes.

FINDINGS

Three major themes were generated from the data collected: (1) Mothers' experiences of dehumanization and lack of dignity during childbirth; (2) Mothers' experiences of lack of privacy during childbirth; (3) Childbirth practices.

CONCLUSION AND IMPLICATIONS

This study explored the childbirth experiences of Jordanian mothers. This study found that the childbirth experience of mothers under study was not satisfactory. Many outdated childbirth practices are still widely used by healthcare providers. The results of this study should be an alarm to review on the quality of the maternal care services in Jordan hospitals.

Unveiling contextual influences of maternal satisfaction with labour care services in Nigeria: A qualitative inquiry

BACKGROUND

In light of the rising global effort to lower maternal mortality rates, it is crucial for low- and middle-income countries with poor maternal indices to investigate the problem of maternal satisfaction and the key elements that affect it. To this effect, this study explored the experiences of postnatal women in relation to labour services and investigated the factors that contribute to their overall satisfaction.

AIM

The study set out to explore factors influencing maternal satisfaction with labour care services in Ogbomoso, Oyo State, Nigeria. This study ultimately seeks to advance our understanding of this phenomenon to impact labour care and policy.

SETTING

The study was conducted among multiparous women who had their antenatal care and delivery in Ogbomoso, Oyo State, Nigeria.

METHODS

A qualitative study was performed using in-depth interviews among postnatal women.

RESULTS

The results revealed a number of variables that could affect the women's satisfaction with labour care, including the choice of health facility, healthcare providers, environment of the facility, assurance of privacy, treating patients with dignity, provision of needed amenities and having a well-planned postnatal care assessment.

CONCLUSION

The study revealed that the costs of care, the skill of the caregiver, the provision of confidential and dignified care, and the availability of supplies all have an impact on maternal satisfaction. Hospital administration should address these issues to enhance the experience of women and labour care services.Contribution: The study's findings provide insights that will inform strategies to improve the quality of care being provided to parturients in Nigeria.

Midwives', obstetricians', and nurses' perspectives of humanised care during pregnancy and childbirth for women classified as high risk in high income countries: A mixed methods systematic review

Women classified as 'high risk' or 'complicated' in pregnancy and childbirth have increased difficulty in accessing humanised care/humanisation in childbirth due to perceptions that this approach rejects the use of intervention and/or technology. Humanised care recognises the psychological and physical needs of women in pregnancy and birth. A mixed methods systematic review using a convergent segregated approach was undertaken using the Joanne Briggs Institute (JBI) methodology. The objective of the review was to identify the presence of humanisation for women with high risk pregnancy and/or childbirth in high income countries. Studies were included if they measured humanisation and/or explored the perspectives of midwives, obstetricians, or nurses on humanisation for women classified as having a high-risk or complicated pregnancy or childbirth in a high income country. Qualitative data were analysed using a meta-aggregative approach and a narrative synthesis was completed for the quantitative data. All studies were assessed for their methodological quality using the MMAT tool. Four databases were searched, and nineteen studies met the inclusion criteria. A total of 1617 participants from nine countries were included. Three qualitative findings were synthesised, and a narrative synthesis of quantitative data was completed. The integration of qualitative and quantitative data identified complimentary findings on: (i) the importance of developing a harmonised relationship with women; (ii) increased time counselling women on their choices; and (iii) fear of professional reputational damage if caring outside of protocols. Negotiating with women outside of protocols may have a wider impact on the professional than first thought. Understanding how healthcare professionals individualise care for women at risk in labour requires further investigation.

A critical review: developing a birth integrity framework for epidemiological studies through meta-ethnography

Over the past decade, there has been growing evidence that women worldwide experience sub-standard care during facility-based childbirth. With this critical review, we synthesize concepts and measurement approaches used to assess maternity care conditions and provision, birth experiences and perceptions in epidemiological, quantitative research studies (e.g., obstetric violence, maternal satisfaction, disrespect or mistreatment during childbirth, person-centered care), aiming to propose an umbrella concept and framework under which the existing and future research strands can be situated. On the 82 studies included, we conduct a meta-ethnography (ME) using reciprocal translation, in-line argumentation, and higher-level synthesis to propose the birth integrity multilevel framework. We perform ME steps for the conceptual level and the measurement level. At the conceptual level, we organize the studies according to the similarity of approaches into clusters and derive key concepts (definitions). Then, we 'translate' the clusters into one another by elaborating each approach's specific angle and pointing out the affinities and differences between the clusters. Finally, we present an in-line argumentation that prepares ground for the synthesis. At the measurement level, we identify themes from items through content analysis, then organize themes into 14 categories and subthemes. Finally, we synthesize our result to the six-field, macro-to-micro level birth integrity framework that helps to analytically distinguish between the interwoven contributing factors that influence the birth situation as such and the integrity of those giving birth. The framework can guide survey development, interviews, or interventional studies.

The effect of mindfulness-based counseling on the childbirth experience of primiparous women: a randomized controlled clinical trial

INTRODUCTION

Unpleasant childbirth experience is considered as one of the important factors for cesarean preference. Limited studies have been investigated the impact of psycho-based interventions on the childbirth experience and the most effective counseling approach to promote a pleasant childbirth experience has not been clearly identified.

OBJECTIVE

The present study aimed to evaluate the impact of mindfulness-based counseling on the childbirth experience of primiparous women.

METHODS AND MATERIALS

This randomized controlled clinical trial was conducted on 64 primiparous with gestational age of 32 to 34 weeks referred to the perinatology clinic of Al-Zahra and Taleghani educational-treatment hospital, affiliated to Tabriz University of Medical sciences, Iran. Participants were randomly assigned into the intervention and control groups. The intervention group received eight mindfulness-based counseling sessions. The intensity of childbirth pain with VAS (Visual Analog Scale) in the active phase of labor at 8 cm dilatation and the childbirth experience questionnaire were completed by interview after childbirth. Independent t-test and ANCOVA were used to compare the outcomes between the two groups.

RESULTS

After controlling the effect of confounding variables, the mean score of childbirth experience in the intervention group was significantly higher than that in control group [Mean Difference (MD): 1.79, 95% CI: 2.52 to 1.07, P < 0.01]. The mean score of labor pain in the intervention group was significantly lower than that in the control group after controlling the effect of baseline score and confounding variables [MD: -2.21, 95% CL: -3.35 to -1.10, P < 0.001].

CONCLUSION

The findings indicated that providing mindfulness-based counseling improves the childbirth experience and reduces labor pain during childbirth. However, further randomized clinical trials are needed before making a definitive conclusion.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20171007036615N9. Date of registration: 16/03/2022, 25/12/1400.

Trends and motivations for freebirth: A scoping review

BACKGROUND

Even when maternity care facilities are available, some women will choose to give birth unassisted by a professional (freebirth). This became more apparent during the pandemic of coronavirus disease 2019 (COVID-19), as women were increasingly concerned they would contract the virus in health care facilities. Several studies have identified the factors that influence women to seek alternative places of birth to hospitals, but research focusing specifically on freebirth is limited.

METHODS

Eight databases were searched from their respective inception dates to April 2022 for studies related to freebirth. Data from the studies were charted and a thematic analysis was subsequently conducted.

RESULTS

Four themes were identified based on findings from the 25 included studies: (1) Geographical and socio-demographic determinants influencing freebirth, (2) Reasons for choosing freebirth, (3) Factors hindering freebirth, and (4) Preparation for and varied experiences of freebirth.

DISCUSSION

More women chose to give birth unassisted in low- and middle-income countries (LMICs) compared with high-income countries (HICs). Overall, motivation for freebirth included previous negative birth experiences with health care professionals, a desire to adhere to their birth-related beliefs, and fear of contracting the COVID-19 virus. Included studies reported that study participants were often met with negative responses when they revealed that they were planning to freebirth. Most women in the included studies had positive freebirth experiences. Future research should explore the different motivators of freebirth present in LMICs or HICs to help inform effective policies that may improve birth experiences while maintaining safety.

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.

[The impact of a humanized childbirth intervention on women's experience of care in Senegal]

INTRODUCTION

Violence against women during institutional childbirth is recognized as a major barrier to the quality of care. In recent years, several countries have implemented interventions aimed at improving the childbirth experience of women through humanized care. However, the literature on the effectiveness of these interventions remains weak.

PURPOSE OF RESEARCH

The aim of this study is therefore to analyze the experience of care of women regarding the intervention of humanized childbirth in Senegal. Qualitative research based on a multiple case study was done. Three collection methods were used: observation, individual interview, and document analysis. Individual interview were carried out with 20&#160;women.

RESULTS

In general, women who gave birth following the intervention appreciated their experience due to changes such as the opportunity to eat and drink, to be accompanied by a trusted person and to choose their position during childbirth. However, it&#160;was the way in which women were received at the health facility and the attitude of health professionals that were decisive in their level of satisfaction with care. Few women benefited from all the components of the intervention. The difficulties encountered in the&#160;implementation such as non-functional delivery rooms, the lack of qualified human resources and the lack of awareness of the&#160;intervention explain this.

CONCLUSIONS

Our results therefore suggest that improving the quality of care at birth, for a &#8220;humanized&#8221; (or natural, respectful) birth, is only possible when certain materials and medical conditions are met and prepared in advance, during the prenatal period.

Analgesic Effects of Epidural Labor Analgesia at Different Periods and Its Effects on Maternal and Infant Outcomes and MiRNA-146b Level

This paper aimed to analyze the analgesic effects of continuous epidural labor analgesia (ELA) at different periods and its effects on postpartum depression, maternal and infant outcomes, and maternal blood pressure. Giving birth in our hospital from September 2017 to August 2019, 119 primiparas with spontaneous delivery were enrolled and divided into an observation group (65 cases) and a control group (54 cases). Patients in the observation group received epidural block analgesia in advance, whereas those in the control group received epidural block analgesia routinely. At 25 days after delivery, breast milk samples were collected, in which miRNA-146b level was detected by PCR. The patients were compared between the two groups with respect to progress of labor, analgesic effects during 3 stages of labor, labor outcomes, adverse reactions, and levels of NO, ANP, and ET-1 in the parturients' umbilical artery blood. Compared with those in the control group, patients in the observation group had a remarkably higher miRNA-146b level in the breast milk (P < 0.05), remarkably lower average Visual Analogue Scale (VAS) scores during the active phase and the second stage of labor (P < 0.05), and remarkably higher levels of NO, ANP, and ET-1 (P < 0.05). There were no statistically significant differences in adverse reactions and modes of delivery between the two groups (P < 0.05). ELA starting from the latent phase can improve the miRNA-146b level in maternal breast milk, alleviate labor pain of parturients, and shorten stages of labor. Therefore, our study is worthy of clinical promotion. We still need to do more experiments and use more data to conclude more scientific results in future research work.

The Association between Birth Satisfaction and the Risk of Postpartum Depression

Negative experiences with childbirth might have a negative impact on a woman’s overall health, including a higher risk of postpartum depression. The aim of the study was to examine the association between birth satisfaction and the risk of postpartum depression (PPD). A 30-item version of the Birth Satisfaction Scale (BSS) and the Edinburgh Postnatal Depression Scale (EPDS) were used, as well as the Perceived Stress Scale (PSS). The study included 584 women (mean age 30.6 ± 4.9), 2 to 4 days postpartum. In the regression model, the negative effect of birth satisfaction on the risk of postpartum depression was shown: a lower level of satisfaction with childbirth was a significant predictor of a higher risk of PPD (β = −0.18, 95% CI = −0.08; −0.03). The regression model was controlled for the effect of the sociodemographic factors (such as education or marital status) and clinical variables (such as parity, type of delivery, psychiatric history, levels of prenatal stress). Levels of prenatal stress (β = 0.43, 95% CI = 0.27; 0.39), psychiatric history (β = 0.08, 95% CI = 0.01; 3.09), parity (β = −0.12, 95% CI = −1.82; −0.32) and type of delivery (β = 0.11, 95% CI = 0.20; 1.94) were also significantly associated with the levels of postnatal depression. The current study confirmed the association between the level of birth satisfaction and the risk of developing PPD, i.e., a lower satisfaction with childbirth may increase the risk of developing PPD.

Operationalizing respectful maternity care at the healthcare provider level: a systematic scoping review

BACKGROUND

Ensuring the right to respectful care for maternal and newborn health, a critical dimension of quality and acceptability, requires meeting standards for Respectful Maternity Care (RMC). Absence of mistreatment does not constitute RMC. Evidence generation to inform definitional standards for RMC is in an early stage. The aim of this systematic review is clear provider-level operationalization of key RMC principles, to facilitate their consistent implementation.

METHODS

Two rights-based frameworks define the underlying principles of RMC. A qualitative synthesis of both frameworks resulted in seven fundamental rights during childbirth that form the foundation of RMC. To codify operational definitions for these key elements of RMC at the healthcare provider level, we systematically reviewed peer-reviewed literature, grey literature, white papers, and seminal documents on RMC. We focused on literature describing RMC in the affirmative rather than mistreatment experienced by women during childbirth, and operationalized RMC by describing objective provider-level behaviors.

RESULTS

Through a systematic review, 514 records (peer-reviewed articles, reports, and guidelines) were assessed to identify operational definitions of RMC grounded in those rights. After screening and review, 54 records were included in the qualitative synthesis and mapped to the seven RMC rights. The majority of articles provided guidance on operationalization of rights to freedom from harm and ill treatment; dignity and respect; information and informed consent; privacy and confidentiality; and timely healthcare. Only a quarter of articles mentioned concrete or affirmative actions to operationalize the right to non-discrimination, equality and equitable care; less than 15%, the right to liberty and freedom from coercion. Provider behaviors mentioned in the literature aligned overall with seven RMC principles; yet the smaller number of available research studies that included operationalized definitions for some key elements of RMC illustrates the nascent stage of evidence-generation in this area.

CONCLUSIONS

Lack of systematic codification, grounded in empirical evidence, of operational definitions for RMC at the provider level has limited the study, design, implementation, and comparative assessment of respectful care. This qualitative systematic review provides a foundation for maternity healthcare professional policy, training, programming, research, and program evaluation aimed at studying and improving RMC at the provider level.

Perineal protection methods: knowledge and use

OBJECTIVE

To analyse the knowledge and use of perineal protection methods during the expulsive stage by health professionals involved in childbirth and whether they correspond to the World Health Organization's recommendations.

METHOD

This was a cross-sectional descriptive study aimed at health workers involved in births in Spain.

RESULTS

Fifty-seven professionals participated in the study: midwives (47%), gynaecologists (25%), nurse residents (14%) and resident physicians (14%) in obstetrics and gynaecology. The degree of knowledge and use of perineal protection methods differed according to the position held and was very limited among gynaecologists and resident physicians. The only method recognized by all positions was "hands on" (p = 0.05). "Hands off " (p = 0.002), "delayed pushing" (p = 0.0001) and "maternal posture" (p = 0.03) were only known to midwives and nurse residents. "Flexion technique" (p = 0.035) and "delayed pushing" (p = 0.011) were used effectively by midwives and nurse residents. "Episiotomy" was erroneously identified as a method to protect the perineum by gynaecologists and resident physicians (p = 0.003).

CONCLUSION

The degree of knowledge and use of perineal protection methods by health care professionals does not correspond to the recommendations of the World Health Organization.

Satisfaction with maternity care among recent migrants: an interview questionnaire-based study

OBJECTIVE

To examine factors associated with recently migrated women's satisfaction with maternity care in urban Oslo, Norway.

DESIGN

An interview-based cross-sectional study, using a modified version of Migrant Friendly Maternity Care Questionnaire.

SETTING

Face-to-face interview after birth in two maternity wards in urban Oslo, Norway, from January 2019 to February 2020.

PARTICIPANTS

International migrant women, ≤5 years length of residency in Norway, giving birth in urban Oslo, excluding women born in high-income countries.

PRIMARY OUTCOME

Dissatisfaction of care during pregnancy and birth, measured using a Likert scale, grouped into satisfied and dissatisfied, in relation to socio-demographic/clinical characteristics and healthcare experiences.

SECONDARY OUTCOME

Negative healthcare experiences and their association with reason for migration.

RESULTS

A total of 401 women answered the questionnaire (87.6% response rate). Overall satisfaction with maternal healthcare was high. However, having a Norwegian partner, higher education and high Norwegian language comprehension were associated with greater odds of being dissatisfied with care. One-third of all women did not understand the information provided by the healthcare personnel during maternity care. More women with refugee background felt treated differently because of factors such as religion, language and skin colour, than women who migrated due to family reunification.

CONCLUSIONS

Although the overall satisfaction was high, for certain healthcare experiences such as understanding information, we found more negative responses. The negative healthcare experiences and factors associated with satisfaction identified in this study have implications for health system planning, education of healthcare personnel and strategies for quality improvement.

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.

The relationship between women's perception of support and control during childbirth on fear of birth and mother's satisfaction

The study was conducted in order to determine the relationship between women's perception of support and control during childbirth on fear of birth and mother's satisfaction. This descriptive study was carried out at the postpartum clinics of a state hospital. Seven hundred and twenty-five puerperal women were included in the sample. T test in independent groups and Pearson's correlation test were used in the evaluation of the data. Seventy-six percent of the puerperal women had vaginal birth, 24% had caesarean section. The mother's perception of control and support at birth was moderate (99.04 ± 17.30), the fear of birth was at clinical level in most of them (92.8%), and the satisfaction at vaginal and caesarean births was low. Puerperal women who had a planned pregnancy, non-invasive birth, birth without perineal tear had higher support and control perception at birth and lower fear of birth than who had unplanned pregnancy, invasive birth, or birth with a perineal tear (p<.05). Puerperal women who did not have any health problems during pregnancy and postpartum period had higher satisfaction levels compared to those who did (p<.05). The high level of perception of support and control at birth decreases the fear of childbirth and increases the satisfaction levels of puerperal women in vaginal and caesarean births. All health professionals, especially perinatal nurses and midwives, should strive to implement care initiatives that are appropriate to the needs of women.Impact StatementWhat is already known on this subject? The mode of delivery, insufficient supportive care during delivery, or perception of supportive care received are among the causes of trauma among women. Birth trauma may cause women to experience stress, anxiety, fear and loss of control, and maternal and foetal/neonatal health is adversely influenced during the delivery and postpartum period. A literature review revealed no study examining the effect of maternal perception of support and control during delivery on fear of childbirth and maternal satisfaction.What the results of this study add? Stronger perception of support and control during delivery reduces fear of childbirth, and also increases puerperal women's levels of satisfaction from care during vaginal and caesarean deliveries.What the implications are of these findings for clinical practice and/or further research? Facilitating women's achievement of personal control and expectations during childbirth should be the focus of care interventions. In line with these results, it may be recommended that all healthcare professionals, especially perinatal nurses and midwives, strive to implement care initiatives that comply with the needs of women.

Satisfaction of patients in pain management delivering in Reunion Island with or without neuraxial analgesia

BACKGROUND

Neuraxial analgesia (NA) rate during labour in Reunion Island is below the average rate in continental France. Our study objective was to know if the patients that deliver with or without NA were satisfied. We also wanted to identify the reasons of this lower rate.

METHOD

This was a multicentre prospective observational study led in the seven Reunion Island maternity hospitals including all patients who delivered after 24 weeks of gestation onwards during two weeks in 2019 and excluding scheduled caesarean sections. Included patients received a satisfaction questionnaire the day after delivery and returned it before leaving.

RESULTS

Of the 497 patients who met the inclusion criteria, 303 questionnaires were analysable. 216 patients had NA (71.3 %) and 87 patients (28.7 %) delivered without. A total of 88.0 % of patients with NA were satisfied with pain management compared to 83.9 % without. There was no significant difference between the groups (p=0.68). Among patients who delivered without NA, it was their choice in 55.2 % of cases. They wanted the most natural birth possible in 87.5 % of cases. Birth without NA in opposition to their wish was related to too rapid dilation in 90.0 % of lowerecases.

DISCUSSION

No significant difference in satisfaction between women who delivered with or without NA was found. The lower regional NA rate seems to be linked to a choice to give birth as naturally as possible and to too fast dilation at the time of requesting NA.

Necesidades de información de los padres para su participación en el proceso de parto

Introducción: la participación del padre en el trabajo de parto le abarca una serie de decisiones para actuar libremente según su experiencia durante el nacimiento. Así, la presencia y preparación de los padres durante el evento se hace necesaria para el bienestar de la diada; por tal motivo, la investigación tiene el objetivo de ampliar conceptualmente las necesidades de información que requieren los padres para su participación en el proceso de parto. Materiales y Métodos: estudio cualitativo descriptivo interpretativo bajo la técnica de análisis de contenido dirigido. Se realizaron entrevistas de profundidad a 30 participantes. En el proceso de análisis, codificación y categorización de la información realizaron con apoyo de Atlas Ti. Versión 6.2. Resultados y Conclusiones: los resultados ampliaron conceptualmente las necesidades de información de los padres, los cuales se describieron y agruparon en tres categorías establecidas previamente por la literatura: Información como necesidad de acompañamiento, información como necesidad de expresar sentimientos, entrenador “entrenado” para el parto. Los padres manifiestan varios sentimientos que generalmente se intensifican con el progreso del trabajo de parto, este estudio evidencia que entre ellos la incertidumbre y el temor, son eventualmente ocasionados por la falta de información y el desconocimiento. El significado a la información se relaciona directamente con el papel que pueden desempeñar dentro de la sala de parto, la cual les permite interpretar y comprender el proceso que atraviesa la mujer, por consiguiente, desenvolverse con confianza mientras se da el nacimiento.

Antenatal education for childbirth: Labour and birth

INTRODUCTION

This study aimed to identify the way information is described and presented by childbirth educators during antenatal classes for expectant parents, and analyse the language structures used when discussing labour and birth.

METHODS

This cross-sectional study of antenatal education was conducted at a single tertiary referral centre for Maternity Care in Western Sydney, Australia. All childbirth educators (n=3) were recorded whilst providing information to parents during antenatal classes. Audio data were subsequently transcribed and then analysed by two researchers, independently categorising the various language structures and types of information provided. This is the second study in a series of antenatal education topics.

RESULTS

During the labour and birth class, information statements were the predominant language structure that was spoken with 241 of 655 statements; negative statements were the next most frequent at 119 while there were 79 positive statements. The second stage of labour had a greater proportion of negative statements for two educators, followed by information and positive statements combined. Misinformation statements were minimal for this topic however, and there was an absence of any statements discussing the rest period between contractions.

CONCLUSIONS

The findings further emphasise the need to examine the language used by health professionals when educating parents. Negative statements during antenatal education are still common despite research in other contexts suggesting that these are potentially unhelpful. Further research into the language and suggestions used during antenatal education is required to determine whether improved outcomes seen in other contexts are confirmed in the childbirth setting.

Association between maternal satisfaction and other indicators of quality of care at childbirth: a cross-sectional study based on the WHO standards

OBJECTIVES

This study aimed to explore the association between maternal satisfaction and other indicators of quality of care (QoC) at childbirth, as defined by WHO standards.

DESIGN

Cross-sectional study.

SETTING

Referral hospital in Northeast Italy.

PARTICIPANTS

1244 consecutive mothers giving birth in the hospital participated in a survey.

DATA COLLECTION AND ANALYSIS

Univariate analyses were performed to evaluate the association between maternal satisfaction and 61 variables, including measures of 'provision of care', 'experience of care', 'availability of resources' and other maternal characteristics. Exploratory factor analysis was performed to create groups of correlated variables, which were used in multivariate analysis.

RESULTS

Overall, 509 (40.9%) of women were >35 years of age, about half (52.7%) were highly educated, most (95.2%) were married/living with partner and employed (79.3%) and about half (52.9%) were primiparous. Overall, 189 (15.2%) were not born in Italy and 111 (8.9%) did not have Italian citizenship. Most women (84.2%) were highly satisfied (score ≥7/10) with the care received. Among the 61 variables explored, 46 (75.4%) were significantly associated with women's satisfaction, 33 with higher satisfaction and 13 with lower satisfaction. Multivariate analysis largely confirmed univariate findings, with six out of eight groups of correlated variables being statistically significantly associated with women's satisfaction. Factors most strongly associated with women's satisfaction were 'effective communication, involvement, listening to women's needs, respectful and timely care' (OR 16.84, 95% CI 9.90 to 28.61, p<0.001) and 'physical structure' (OR 6.51, 95% CI 4.08 to 10.40, p<0.001). Additionally, 'victim of abuse, discrimination, aggressiveness' was inversely associated with the wish to return to the facility or to recommend it to a friend (OR 0.35, 95% CI 0.17 to 0.70, p<0.003).

CONCLUSION

This study suggested that many variables are strongly associated with women's satisfaction with care during childbirth and support the use of multiple measures to monitor the QoC at childbirth.

Associated factors of labor satisfaction and predictor of postnatal satisfaction in the north-east of Peninsular Malaysia

INTRODUCTION

Identifying the factors contributing to maternal satisfaction is a proxy measure to improve the quality of care. It evaluates the health service provision by understanding maternal perceptions and expectations and promoting adherence to health services. This study aimed to identify the sociodemographic, obstetric, and medical factors contributing to labor satisfaction among postpartum women and examine the association between labor and postnatal satisfaction.

METHODOLOGY

A cross-sectional study using systematic random sampling in a ratio of 1:5 based on the delivery list in a labor room in a tertiary hospital was applied. Information was obtained from medical records for sociodemographic characteristics and obstetric and medical histories. Face-to-face interviews were performed to obtain responses for Malay versions of the Women's Views of Birth Labour Satisfaction Questionnaire and the Women's Views of Birth Postnatal Satisfaction Questionnaire. Simple and general linear regression analyses were performed.

RESULTS

A total of 110 participants responded, accounting for a response rate of 100%. High-risk color codes, the period of gestation, household income, and were significantly associated with maternal satisfaction during labor. The association between labor and postnatal satisfaction was significant.

CONCLUSION

Identifying these associated factors and differences may lead to understanding and contributing to specific and targeted strategies for tackling issues related to maternal satisfaction.

Women's experiences of outpatient induction of labour with double balloon catheter or prostaglandin pessary: A qualitative study

BACKGROUND

One quarter to one third of women experience induction of labour. Outpatient induction of labour may be safe and effective but women's views of this setting and of different methods of induction are sparse.

AIM

To explore women's experiences of outpatient induction of labour with either prostaglandin pessary or double balloon catheter.

METHODS

Qualitative study using semi-structured, audio-recorded interviews with twenty-one women recruited to a feasibility trial of outpatient induction of labour. Transcripts were coded and analysed using a thematic framework approach.

FINDINGS

Two key themes were identified. 'Ownership of induction of labour' concerned how women understood and experienced the induction of labour process and tried to maintain control of a procedure managed by medical professionals. Women felt unprepared for the steps in the process and for the time it would take. The balloon method was preferred as it was considered a gentler start to the process, although some women reported it was painful on insertion. 'Importance of place' reflected women's associations of the home with comfort, ease of support and distraction, and the hospital with safety yet also with discomfort and delays.

DISCUSSION

This sample of women were keen to start induction without hormones. The randomised controlled trial design may have biased the sample towards women who wanted to experience the balloon method and outpatient setting where these were not usually offered, thus further cohort studies would be beneficial.

CONCLUSIONS

Women were positive about experiencing the early stages of induction of labour at home with the balloon catheter.

Health Care Experience Among Women Who Completed Group Prenatal Care (CenteringPregnancy) Compared to Individual Prenatal Care Within Military Treatment Facilities

This study compared TRICARE, the health care program of the United States Department of Defense Military Health System, beneficiaries in CenteringPregnancy, an enhanced prenatal care model, to women in individual prenatal care within the same military treatment facility. Maternity patient experience ratings from May 2014 to February 2016 were compiled from the TRICARE Outpatient Satisfaction Survey. Centering patients had 1.91 higher odds of being satisfied with access to care (p < .01, 95% CI = 1.2-3.1) than women in individual care. Specifically, the saw provider within 15 minutes of appointment measure found Centering patients to have 2.00 higher odds of being satisfied than women in individual care (p < .01, 95% CI = 1.2-3.3). There were no other statistically significant differences between cohorts. Qualitative responses indicate most Centering patients surveyed had good experiences, appreciated the structure and communication with others, and would recommend the program. Providers identified command/leadership support, dedicated space, and buy-in from all staff as important factors for successful implementation. Enhanced prenatal care models may improve access to and experiences with care. Program evaluation will be important as the military health system continues to implement such programs.

Maternal satisfaction towards childbirth Service in Public Health Facilities at Adama town, Ethiopia

BACKGROUND

Maternal satisfaction towards childbirth service is related to the quality of care. Promotion of patient satisfaction is essential for preventing patient anxiety, promoting treatment adherence, preventing disease, and health promotion. This study was aimed at assessing the satisfaction and associated factors among mothers who visit public health facilities in Adama town for childbirth service.

METHODS

An institution based cross-sectional study design was conducted at public health facilities in Adama town from June 01 to June 30, 2018. Four hundred seventy-seven mothers were selected using a systematic random sampling method. Bivariate and multivariate logistic regressions were conducted to identify predictors of maternal satisfaction towards childbirth service by considering p-value less than 0.05.

RESULTS

The study revealed that 357 (74.8%) were satisfied with the services. Factors which showed a significant association with satisfaction were 25-34 age group (AOR; 2.026, 95%CI:1.056,3.887), no formal education (AOR;2.810, 95%CI;1.085,7.278), planned childbirth (AOR; 1.823,95%CI;1.024,3.246), wait time of less than 1 h (AOR;11.620,95%CI;3.619,37.309) and wait time of one to 2 h (AOR;19.620, 95%CI;2.349,68.500).

CONCLUSION

Three-quarters of the mothers were satisfied with childbirth services. Age, educational status, reason for visit and wait time were found to have a significant association with maternal satisfaction of childbirth services.

Preparedness and support, not personality, predict satisfaction in unplanned caesarean births

We evaluated what predicts satisfaction following an unplanned caesarean first-time birth. Two hundred and twenty-seven primiparous women who delivered by unplanned caesarean were surveyed on individual difference variables (the 10-Item Big Five Personality Domains scale, the Desirability for Control Scale), interactional variables (the CollaboRATE scale, and measures of emotional support and decisional inclusion during labour and delivery), perceptions of preparedness, and the Birth Satisfaction Scale-Revised Indicator. A multilinear regression was run using birth satisfaction as the dependent variable. Three variables predicted birth satisfaction: emotional support, being included in the decision-making, and present perception of preparedness (R²=.54, p<.001). Participants reported feeling more prepared before the birth experience than they actually were, as viewed in hindsight (p<.001). How prepared a woman perceives she was for the experience she actually had, together with her perceptions of emotional support and decisional inclusion during birth, predict birth satisfaction when birth deviates from her original expectations.Impact statementWhat is already known on this subject? An unplanned caesarean often leads to dissatisfaction with the birth experience and is emotionally challenging for women, increasing the risk of postpartum depression and acute stress disorder. Some recent work indicates personality may influence the birth experience, and other work suggests the quality of interaction between healthcare provider and the woman may predict satisfaction.What the results of this study add? In this study, we sought to identify predictors of satisfaction in women whose first and only birth experience resulted in an unplanned caesarean delivery. Our research demonstrated that over half of the variation in birth satisfaction can be predicted by how prepared women feel they actually were for their experience, by women's perceptions of healthcare providers' efforts made to emotionally support them and to include them in the decision-making process. Personality and a woman's desire for control did not predict satisfaction. These results indicate that birth satisfaction is heavily influenced by what happens before and during the experience and can be amenable by support from a healthcare provider.What the implications are of these findings for clinical practice and/or further research? Preparing women for the possibility of an unplanned caesarean, emotional support, and inclusion in the decision-making process, may reduce dissatisfaction, and potentially distress, after an unplanned caesarean.

Dimensions of childbirth care associated with maternal satisfaction among low-risk Chilean women

The authors of this study aimed to describe the level of maternal satisfaction during labor reported by a national sample of low-risk childbearing women in Chile by identifying the dimensions of intrapartum care most determinant for overall satisfaction. Maternal satisfaction was measured in the postpartum period with an instrument previously validated in Chile. Almost half of the participants (49.4%) reported having optimal satisfaction, 29% adequate, and 22% worse. Treatment of women by professionals and the physical environment were the most important dimension predicting of maternal satisfaction, consistent with findings from developing countries emphasizing patient-provider interaction during labor as a key component of birth care quality.

Evaluation of the psychometric properties of Hindi-translated Scale for Measuring Maternal Satisfaction among postnatal women in Chhattisgarh, India

Satisfaction with childbirth services is a multi-dimensional phenomenon, providing relevant insights into women's opinion on quality of services received. Research studies report a dearth of standardised scales that quantify this phenomenon; and none have been tested in India to the best of authors' knowledge. The current study was undertaken to evaluate psychometric properties of Hindi version of the Turkish Scale for Measuring Maternal Satisfaction: Normal and Caesarean Births versions in order to fill this gap. A cross-sectional survey was conducted in selected public health facilities in Chhattisgarh, India. Healthy women (n = 1004) who gave birth to a single, live neonate, vaginally or via Caesarean section participated. Psychometric assessment was carried out in four steps: 1) scales translated from Turkish to Hindi; 2) Content Validity Index scores calculated for Hindi scales; 3) data collection; 4) statistical analyses for Hindi scales (Normal and Caesarean Birth). A 10-factor model with 36 items emerged for both scales. The Hindi- translated Normal Birth and Caesarean Birth scales had good internal reliability (Cronbach's α coefficients of 0.85 and 0.80, respectively). The Hindi Scales for Measuring Maternal Satisfaction (Normal and Caesarean Birth) are valid and reliable tools for utilization in Indian health facilities. Their multi-dimensional nature presents an opportunity for the care providers and health administrators to incorporate women's opinions in intervention to improve quality of childbirth services. Having an international tool validated within India also provides a platform for comparing cross-country findings.

Healthcare Providers' Perceptions of Single-Room Versus Traditional Maternity Models: A Concurrent Mixed-Methods Study

While many hospitals have transitioned from traditional maternity care to a single-room maternity model, little is known about how healthcare providers' practice differs between the models. This mixed-methods study compared healthcare providers' job satisfaction and team collaboration between traditional and single-room maternity care and explored how each model shaped providers' practice. Data were collected via questionnaires and interviews with healthcare providers from 2 hospitals. Independent t tests, Mann-Whitney U tests, and thematic analysis were used in analysis; findings were then triangulated. No difference was found in team collaboration and job satisfaction scores between single-room (n = 84) and traditional (n = 42) maternity care; however, providers described different means toward satisfaction and collaboration in the interviews (n = 18). Single-room maternity care providers valued interprofessional teamwork, patient/family involvement, and continuity of care. Traditional maternity care providers enjoyed specialization but described teamwork as uniprofessional and disconnected across professions; transfers between units weakened communication and fragmented care. While single-room maternity care providers described less tension and a more holistic patient-family journey, further research must be undertaken to examine whether and how interprofessional collaboration and communication impact patient and health system outcomes.

How Women Evaluate Birth Challenges: Analysis of Web-Based Birth Stories

BACKGROUND

Birth stories provide an intimate glimpse into women's birth experiences in their own words. Understanding the emotions elicited in women by certain types of behaviors during labor and delivery could help those in the health care community provide better emotional care for women in labor.

OBJECTIVE

The aim of this study was to understand which supportive reactions and behaviors contributed to negative or positive emotions among women with regard to their labor and delivery experience.

METHODS

We sampled 10 women's stories from a popular blog that described births that strayed from the plan. Overall, 90 challenging events that occurred during labor and delivery were identified. Each challenge had an emotionally positive, negative, or neutral evaluation by the woman. We classified supportive and unsupportive behaviors in response to these challenges and examined their association with the woman's emotional appraisal of the challenges.

RESULTS

Overall, 4 types of behaviors were identified: informational inclusion, decisional inclusion (mostly by health care providers), practical support, and emotional support (mostly by partners). Supportive reactions were not associated with emotional appraisal; however, unsupportive reactions were associated with women appraising the challenge negatively (Fisher exact test, P=.02).

CONCLUSIONS

Although supportive behaviors did not elicit any particular emotion, unsupportive behaviors did cause women to view challenges negatively. It is worthwhile conducting a larger scale investigation to observe what happens when patients express their needs, particularly when challenges present themselves during labor, and health care professionals strive to cater to them.

Women's satisfaction with the childbirth experience: a descriptive research

Introduction: Satisfaction is a complex concept, which we often come across when evaluating the childbirth experience. The purpose of the research was to find out the childbirth experiences of women in Slovenia with regard to their level of satisfaction with the provided perinatal care. Methods: The Slovenian version of the Birth Satisfaction Scale – Revised was used in a non-experimental quantitative descriptive research (Cronbach α = 0.81). The data were collected through an online questionnaire in February 2017. Convenience sampling was used and 301 women, who gave birth in 2016 in Slovenia, participated. Data were analysed with descriptive statistics, the Mann-Whitney U test and Spearman's correlation coefficient. Results: The results of the study have shown that the number of births (U = 6802, p = 0.150), education (U = 7493, p = 0.317), age (U = 5142, p = 0.061) and presence of birth partner (U = 2841, p = 0.730) are not statistically significantly correlated with the assessment of childbirth satisfaction. A lower level of satisfaction was also found in cases of caesarean sections of primiparous, in comparison with multiparous, women (U = 430, p = 0.001). A statistically significant difference was established in the correlation between satisfaction and respondents' residential environment (U = 7029, p = 0.039), professional communication, and level of anxiousness of birthing mothers (rs = 0.397, p = 0,000). Discussion and conclusion: The results have shown that healthcare professionals who are present in childbirth are the key factor in contributing to a positive birth experience. The obtained results open up an opportunity for further research on the communication and attitude of health professionals towards birthing mothers.

An Assessment of the Effects of Hydrotherapy During the Active Phase of Labor on the Labor Process and Parenting Behavior

This study was conducted to assess the effect on labor process and parenting behavior of hydrotherapy applied during the active phase of labor. This quasi-experimental study was conducted by using an equivalent comparison group ( n = 40). The participants in the experimental group whose cervical dilation was 5 cm were taken to the hydrotherapy tub. This application continued until cervical dilation reached 10 cm. The Participants Questionnaire, The Birth Follow-up Questionnaire, The Postpartum ]collection tools. The duration of the active phase and second stage of labor was extremely short in the experimental group in comparison with the equivalent comparison group ( p = .001). The Visual Analogue Scale (VAS) scores of the experimental group were lower than those of the equivalent comparison group when cervical dilation was 6 cm and 10 cm ( p = .001). The experimental group also displayed more positive parenting behavior and positive labor feeling ( p = .001).