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Zahroh RI, Sutcliffe K, Kneale D, Vazquez Corona M, Betrán AP, Opiyo N, Homer CSE, Bohren MA. Educational interventions targeting pregnant women to optimise the use of caesarean section: What are the essential elements? A qualitative comparative analysis. BMC Public Health 2023; 23:1851. [PMID: 37741979 PMCID: PMC10517530 DOI: 10.1186/s12889-023-16718-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Accepted: 09/07/2023] [Indexed: 09/25/2023] Open
Abstract
BACKGROUND Caesarean section (CS) rates are increasing globally, posing risks to women and babies. To reduce CS, educational interventions targeting pregnant women have been implemented globally, however, their effectiveness is varied. To optimise benefits of these interventions, it is important to understand which intervention components influence success. In this study, we aimed to identify essential intervention components that lead to successful implementation of interventions focusing on pregnant women to optimise CS use. METHODS We re-analysed existing systematic reviews that were used to develop and update WHO guidelines on non-clinical interventions to optimise CS. To identify if certain combinations of intervention components (e.g., how the intervention was delivered, and contextual characteristics) are associated with successful implementation, we conducted a Qualitative Comparative Analysis (QCA). We defined successful interventions as interventions that were able to reduce CS rates. We included 36 papers, comprising 17 CS intervention studies and an additional 19 sibling studies (e.g., secondary analyses, process evaluations) reporting on these interventions to identify intervention components. We conducted QCA in six stages: 1) Identifying conditions and calibrating the data; 2) Constructing truth tables, 3) Checking quality of truth tables; 4) Identifying parsimonious configurations through Boolean minimization; 5) Checking quality of the solution; 6) Interpretation of solutions. We used existing published qualitative evidence synthesis to develop potential theories driving intervention success. RESULTS We found successful interventions were those that leveraged social or peer support through group-based intervention delivery, provided communication materials to women, encouraged emotional support by partner or family participation, and gave women opportunities to interact with health providers. Unsuccessful interventions were characterised by the absence of at least two of these components. CONCLUSION We identified four key essential intervention components which can lead to successful interventions targeting women to reduce CS. These four components are 1) group-based delivery, 2) provision of IEC materials, 3) partner or family member involvement, and 4) opportunity for women to interact with health providers. Maternal health services and hospitals aiming to better prepare women for vaginal birth and reduce CS can consider including the identified components to optimise health and well-being benefits for the woman and baby.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.
| | - Katy Sutcliffe
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Dylan Kneale
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Martha Vazquez Corona
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Ana Pilar Betrán
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Newton Opiyo
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Caroline S E Homer
- Maternal, Child, and Adolescent Health Programme, Burnet Institute, Melbourne, VIC, Australia
| | - Meghan A Bohren
- Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Zahroh RI, Kneale D, Sutcliffe K, Vazquez Corona M, Opiyo N, Homer CSE, Betrán AP, Bohren MA. Interventions targeting healthcare providers to optimise use of caesarean section: a qualitative comparative analysis to identify important intervention features. BMC Health Serv Res 2022; 22:1526. [PMID: 36517885 PMCID: PMC9753390 DOI: 10.1186/s12913-022-08783-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 11/02/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rapid increases in caesarean section (CS) rates have been observed globally; however, CS rates exceeding 15% at a population-level have limited benefits for women and babies. Many interventions targeting healthcare providers have been developed to optimise use of CS, typically aiming to improve and monitor clinical decision-making. However, interventions are often complex, and effectiveness is varied. Understanding intervention and implementation features that likely lead to optimised CS use is important to optimise benefits. The aim of this study was to identify important components that lead to successful interventions to optimise CS, focusing on interventions targeting healthcare providers. METHODS: We used Qualitative Comparative Analysis (QCA) to identify if certain combination of important intervention features (e.g. type of intervention, contextual characteristics, and how the intervention was delivered) are associated with a successful intervention as reflected in a reduction of CS. We included 21 intervention studies targeting healthcare providers to reduce CS, comprising of 34 papers reporting on these interventions. To develop potential theories driving intervention success, we used existing published qualitative evidence syntheses on healthcare providers' perspectives and experiences of interventions targeted at them to reduce CS. RESULTS We identified five important components that trigger successful interventions targeting healthcare providers: 1) training to improve providers' knowledge and skills, 2) active dissemination of CS indications, 3) actionable recommendations, 4) multidisciplinary collaboration, and 5) providers' willingness to change. Importantly, when one or more of these components are absent, dictated nature of intervention, where providers are enforced to adhere to the intervention, is needed to prompt successful interventions. Unsuccessful interventions were characterised by the absence of these components. CONCLUSION We identified five important intervention components and combinations of intervention components which can lead to successful interventions targeting healthcare providers to optimise CS use. Health facility managers, researchers, and policy-makers aiming to improve providers' clinical decision making and reduce CS may consider including the identified components to optimise benefits.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.
| | - Dylan Kneale
- grid.83440.3b0000000121901201EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Katy Sutcliffe
- grid.83440.3b0000000121901201EPPI-Centre, UCL Social Research Institute, University College London, London, UK
| | - Martha Vazquez Corona
- grid.1008.90000 0001 2179 088XGender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Newton Opiyo
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Caroline S. E. Homer
- grid.1056.20000 0001 2224 8486Maternal, Child, and Adolescent Health Program, Burnet Institute, Melbourne, VIC Australia
| | - Ana Pilar Betrán
- grid.3575.40000000121633745UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A. Bohren
- grid.1008.90000 0001 2179 088XGender and Women’s Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
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Mavuso JMJJ, Chadwick R. Reproductive governance and the affective economy. FEMINISM & PSYCHOLOGY 2022. [DOI: 10.1177/09593535221106644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The governance of reproductive practices, processes, decision-making, experiences, desires, subjectivities, and bodies has received and continues to receive significant attention in feminist efforts to name and resist reproductive oppression. And over the last 30 years, articles published in Feminism & Psychology have made significant contributions to the visibilisation and critique of this form of oppression. In this Virtual Special Issue on Reproductive Governance and the Affective Economy, we apply repronormativity and affect to our reading of 20 articles published in Feminism & Psychology. Collectively, these articles provide a glimpse of the wide-ranging scope of reproductive regulation (including that which is re-produced by/within feminism itself), and the various work that repronormativity and affect do in this governance. The challenging of reproductive governance notwithstanding, we conclude by arguing that the centring and circulation of certain reproductive subjects and their experiences within feminist knowledge production is itself a part of and upholds repronormativity and forecloses the possibility of reproductive freedom for all.
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Gaining insight from future mothers: A survey of attitudes and perspectives of childbirth. Midwifery 2022; 115:103499. [DOI: 10.1016/j.midw.2022.103499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 07/02/2022] [Accepted: 09/25/2022] [Indexed: 11/24/2022]
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Mayra K, Sandall J, Matthews Z, Padmadas SS. Breaking the silence about obstetric violence: Body mapping women’s narratives of respect, disrespect and abuse during childbirth in Bihar, India. BMC Pregnancy Childbirth 2022; 22:318. [PMID: 35421943 PMCID: PMC9009281 DOI: 10.1186/s12884-022-04503-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals. Objective 1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women’s expectations of respectful care. Methods ‘Body mapping’, an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis. Findings Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt ‘good’ and ‘bad’. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy. Discussion The body maps capturing birth experiences, created through a participatory method, accurately portray women’s respectful and disrespectful births and are useful to understand women’s experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women’s choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04503-7.
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Zahroh RI, Disney G, Betrán AP, Bohren MA. Trends and sociodemographic inequalities in the use of caesarean section in Indonesia, 1987-2017. BMJ Glob Health 2021; 5:bmjgh-2020-003844. [PMID: 33380412 PMCID: PMC7780721 DOI: 10.1136/bmjgh-2020-003844] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Caesarean section (CS) rates are increasing globally. CS can be a live-saving procedure when medically indicated, but it comes with higher risks for women and newborns when done without medical indication. Crucially, inequalities in who receives CS exist, both within and across countries. Understanding factors driving increasing rates and inequalities of CS is imperative to optimise the use of this life-saving intervention. This study aimed to investigate trends of CS use and inequalities across sociodemographic characteristics in Indonesia over a 30-year period. METHODS Seven waves of the Indonesia Demographic and Health Survey were used to estimate trends and inequalities in CS from 1987 to 2017. Relative and absolute inequalities across a range of sociodemographic characteristics were estimated and trends in inequalities were assessed through changes in rate ratio and rate difference. RESULTS The proportion of facility-based births in Indonesia has increased in the past 30 years, coinciding with an increase in CS rate (CSR) (1991 CSR: 1.6% (95% CI 1.3 to 1.9); 2017 CSR: 17.6% (95% CI 16.7 to 18.5)). Higher rates of CS are observed mostly in Western Indonesia, while lower CSRs are observed in Eastern Indonesia. Inequalities of CSRs in Indonesia are observed across type of health facility (public/private), regions, places of residence, wealth quintiles and maternal education, with the highest CSRs in more affluent and educated groups. Widening absolute inequalities of CS are observed across all sociodemographic characteristics, except facility type, where CSR gaps between public and private facilities have closed on both relative and absolute scales. CONCLUSION This study provides evidence of increasing trends in CSRs and widening absolute inequalities in CSRs across different sociodemographic groups of women in Indonesia. The context of increasing CSRs across society, however, may have resulted in more stable relative inequalities. Improving understanding of the drivers of these trends in Indonesia and, particularly, of women's and providers' perspectives and preferences for childbirth, should be prioritised to optimise the use of CS.
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Affiliation(s)
- Rana Islamiah Zahroh
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - George Disney
- Disability and Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
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Volpato F, Costa R, Brüggemann OM, Monguilhott JJDC, Gomes IEM, Colossi L. Information that (de)motivate women's decision making on Planned Home Birth. Rev Bras Enferm 2021; 74:e20200404. [PMID: 34105640 DOI: 10.1590/0034-7167-2020-0404] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/13/2020] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To understand how information about Planned Home Birth motivates or discourages women's decisions on this location of birth. METHOD Descriptive exploratory study, qualitative approach. Data collection carried out from February to April 2019, through semi-structured interviews with 14 women and documentary sources. The data were analyzed using Bardin's content analysis process, with the help of ATLAS.ti 8.0. RESULTS The motivations for choosing Planned Home Birth are: respect for the autonomy and natural process of childbirth and delivery, support from a partner and trust in professionals. Aspects that discourage this choice are fear of complications, the need for a hospital medical structure, opinions that value risk. CONCLUSION Women's choices are based not only on information, but also on how that information is processed. This study demonstrated that the perception pertaining to the safety of Planned Home Birth is essential for making this decision.
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Affiliation(s)
- Franciele Volpato
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | - Roberta Costa
- Universidade Federal de Santa Catarina. Florianópolis, Santa Catarina, Brazil
| | | | | | | | - Leticia Colossi
- Waterford Birth Centre, Hamilton Birth and Post Natal Care. Hamilton, Waikato, New Zealand
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Dong D, Ahmed S, Nichini E, Yi H, Jafri H, Rashid Y, Ahmed M, Zhu J. Decision making on antenatal screening results: A comparative Q-method study of women from two Chinese cities. Health Expect 2020; 24:363-376. [PMID: 33316122 PMCID: PMC8077134 DOI: 10.1111/hex.13178] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 11/27/2022] Open
Abstract
Background Although an integral part of ethical and quality health care, little is known about the informed decision making of Chinese women with different socioeconomic backgrounds within the context of antenatal testing. Methods To explore women's viewpoints on informed decision making regarding antenatal screening, a Q‐methodology study that combines both quantitative factor analysis and interviews was conducted between June 2016 and February 2017 in Shanghai and Duyun. A total of 169 women (84 Shanghai and 85 Duyun) participated in the study of 41 ranked statements along a Q‐sorting grid. Results Using by‐person factor analysis, five distinct viewpoints are identified: (a) choice is shared with the partner/husband, but the mother has the right to make the final decision; (b) having antenatal tests is not about choice but about a mother's responsibility; (c) choice is a shared decision led primarily by the partner/husband and secondarily by the doctors; (d) choice should be made using the advice of doctors, but the decision should be made with the partner/husband; and (e) choice is a responsibility shared with the partner, family and doctors. Conclusions The study reveals that women with better education and higher incomes demonstrate more autonomy than those with less education. The nuclear family clearly emerges as the main decision makers in health‐care services in China. Patient and Public Contribution The 169 participants shared their views and stories for at least an hour. They were debriefed after the interviews and contributed their thoughts on our study design and interpretation of the data.
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Affiliation(s)
- Dong Dong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.,Centre for Health Systems and Policy Research, The Chinese University of Hong Kong, Hong Kong SAR, China.,Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen, China
| | - Shenaz Ahmed
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Elena Nichini
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Huso Yi
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | | | | | - Mushtaq Ahmed
- Yorkshire Regional Genetics Service, Leeds NHS Teaching Hospitals Trust, Leeds, UK
| | - Jianfeng Zhu
- Anthropological and Ethnological Research Institute, Fudan-Harvard Medical Anthropology Collaborative Research Center, School of Social Development and Public Policy, Fudan University, Shanghai, China
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Begum T, Saif-Ur-Rahman KM, Yaqoot F, Stekelenburg J, Anuradha S, Biswas T, Doi SA, Mamun AA. Global incidence of caesarean deliveries on maternal request: a systematic review and meta-regression. BJOG 2020; 128:798-806. [PMID: 32929868 DOI: 10.1111/1471-0528.16491] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Caesarean delivery on maternal request (CDMR) is considered a significant contributor to the unprecedented increase in caesarean deliveries (CDs) for nonclinical reasons. Current literature lacks a reliable assessment of the rate of CDMR, which hinders the planning and delivery of appropriate interventions for reducing CDMR rates. OBJECTIVES To conduct a systematic review of the literature and meta-regression to explore the global incidence of CDMR. SEARCH STRATEGY PubMed, Embase, CINAHL, Medline, Google scholar and grey literature were searched from January 1985 to May 2019. SELECTION CRITERIA Observational studies that report CDMR data were included. We excluded non-English articles, case notes, editorial reviews and articles reporting elective CDs from pregnancy risk factors. DATA COLLECTION AND ANALYSIS Two reviewers independently conducted the screening and quality appraisal using a validated tool. The weighted average of CDMR over total deliveries (absolute proportion) and by total CDs (relative proportion) were generated. Quality-effects meta-regression was used to explain the variability of the CDMR estimates by moderators, including study methodology and demography of study participants. MAIN RESULTS We identified 31 articles from 14 countries that include 5 million total births. The absolute proportion of CDMR varies between 0.2 and 42.0%, with significant variations across studies and subgroups. The economic status of the country and study year together explained 84% of the absolute and 76% of the relative proportion of CDMR variation. CONCLUSIONS An appropriate reporting of CDMR should be a key priority in maternal health policies and practices. TWEETABLE ABSTRACT Globally, the proportion of maternal requested caesarean delivery has mostly been influenced by the economic status of the country.
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Affiliation(s)
- T Begum
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course Centre, The University of Queensland, Indooroopilly, Queensland, Australia.,Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh
| | - K M Saif-Ur-Rahman
- Health Systems and Population Studies Division, icddr,b, Dhaka, Bangladesh.,Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - F Yaqoot
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Centre for Rural and Remote Health, James Cook University, Mount Isa, Queensland, Australia
| | - J Stekelenburg
- Department of Health Sciences, Global Health Unit, University Medical Center Groningen, Groningen, the Netherlands.,Department Obstetrics & Gynaecology, Leeuwarden Medical Centre, Leeuwarden, the Netherlands
| | - S Anuradha
- School of Public Health, The University of Queensland, Indooroopilly, Queensland, Australia
| | - T Biswas
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course Centre, The University of Queensland, Indooroopilly, Queensland, Australia
| | - S A Doi
- Department of Population Medicine, College of Medicine, QU Health, Qatar University, Doha, Qatar
| | - A A Mamun
- Institute for Social Science Research, The University of Queensland, Indooroopilly, Queensland, Australia.,Australian Research Council (ARC), Centre of Excellence for Children and Families over the Life Course Centre, The University of Queensland, Indooroopilly, Queensland, Australia
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Sub-optimal use of ultrasound examinations may result in underperformance of Vietnamese maternity care - A qualitative study of midwives' experiences and views. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100508. [PMID: 32278314 DOI: 10.1016/j.srhc.2020.100508] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 02/25/2020] [Accepted: 03/16/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To explore Vietnamese midwives' experiences and views on the role of obstetric ultrasound in relation to clinical management, including ethical aspects. METHODS Using a qualitative design, content analysis of focus group discussions with midwives (N = 25) working at Departments of Obstetrics and Gynecology at three hospitals in urban, semi-urban and rural parts of Hanoi were performed. RESULTS Obstetric ultrasound was reported as being a highly valuable tool, although replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication was perceived as troubling. Participants generally viewed the fetus as a human being already at an early stage of pregnancy. However, when complications occurred, the pregnant woman's health was mostly prioritised. CONCLUSION Although the use of ultrasound has many benefits during pregnancy, replacing ordinary antenatal care surveillance with ultrasound examinations and misuse of ultrasound without medical indication is concerning and needs to be addressed. There is also a need to communicate the benefits of adequate antenatal care to pregnant women and caution about the non-beneficial use of repeated ultrasound examinations without medical indication. Additionally, non-medical ultrasounds consume limited healthcare resources and its use needs to be better regulated in Vietnam.
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Bohren MA, Opiyo N, Kingdon C, Downe S, Betrán AP. Optimising the use of caesarean section: a generic formative research protocol for implementation preparation. Reprod Health 2019; 16:170. [PMID: 31744493 PMCID: PMC6862737 DOI: 10.1186/s12978-019-0827-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 10/18/2019] [Indexed: 01/21/2023] Open
Abstract
Background Caesarean section rates are rising across all geographical regions. Very high rates for some groups of women co-occur with very low rates for others. Both extremes are associated with short and longer term harms. This is a major public health concern. Making the most effective use of caesarean section is a critical component of good quality, sustainable maternity care. In 2018, the World Health Organization published evidence-based recommendations on non-clinical interventions to reduce unnecessary caesarean section. The guideline identified critical research gaps and called for formative research to be conducted ahead of any interventional research to define locally relevant determinants of caesarean birth and factors that may affect implementation of multifaceted optimisation strategies. This generic formative research protocol is designed as a guide for contextual assessment and understanding for anyone planning to take action to optimise the use of caesarean section. Methods This formative protocol has three main components: (1) document review; (2) readiness assessment; and (3) primary qualitative research with women, healthcare providers and administrators. The document review and readiness assessment include tools for local mapping of policies, protocols, practices and organisation of care to describe and assess the service context ahead of implementation. The qualitative research is organized according to twelve identified interventions that may optimise use of caesarean section. Each intervention is designed as a “module” and includes a description of the intervention, supporting evidence, theory of change, and in-depth interview/focus group discussion guides. All study instruments are included in this protocol. Discussion This generic protocol is designed to underpin the formative stage of implementation research relating to optimal use of caesarean section. We encourage researchers, policy-makers and ministries of health to adapt and adopt this design to their context, and share their findings as a catalyst for rapid uptake of what works.
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Affiliation(s)
- Meghan A Bohren
- Gender and Women's Health Unit, Centre for Health Equity, University of Melbourne School of Population and Global Health, 207 Bouverie St, Carlton, VIC, Australia. .,UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Genève, Switzerland.
| | - Newton Opiyo
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Genève, Switzerland
| | - Carol Kingdon
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Soo Downe
- School of Community Health and Midwifery, Faculty of Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Ana Pilar Betrán
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, 20 Avenue Appia, Genève, Switzerland
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12
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Prosen M, Krajnc MT. Perspectives and experiences of healthcare professionals regarding the medicalisation of pregnancy and childbirth. Women Birth 2019; 32:e173-e181. [DOI: 10.1016/j.wombi.2018.06.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2017] [Revised: 06/06/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
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13
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Stevens J, Schmied V, Burns E, Dahlen HG. Skin-to-skin contact and what women want in the first hours after a caesarean section. Midwifery 2019; 74:140-146. [PMID: 30954633 DOI: 10.1016/j.midw.2019.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2018] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To explore women's experience of skin-to-skin contact and what women want in the first two hours after a caesarean. DESIGN Audio recorded interviews were conducted with women as a part of a larger video ethnographic research study where video recordings, observations, field notes, focus groups and further in-depth interviews were conducted. SETTING A metropolitan hospital in Sydney, Australia. PARTICIPANTS Twenty-one women who had a caesarean section were involved in interviews around six weeks postpartum. ANALYSIS The transcribed interviews were thematically analysed. FINDINGS Women wanted their baby to stay with them and have skin-to-skin contact, even if they felt apprehensive about providing this care. An overarching theme was, 'I want our baby'. Several subthemes also emerged: 'I felt disconnected when I was separated from my baby', 'I want to explore my naked baby', 'I want my partner involved', and 'It felt right'. KEY CONCLUSIONS Despite the challenges of providing skin-to-skin contact in the operating theatre and recovery, health professionals and institutions should recognise the importance of advocating for what women want including keeping women, their partners and babies together and encouraging continuous maternal and infant contact and skin-to-skin contact.
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Affiliation(s)
- Jeni Stevens
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751 Australia.
| | - Virginia Schmied
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751 Australia.
| | - Elaine Burns
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751 Australia.
| | - Hannah G Dahlen
- Western Sydney University, School of Nursing and Midwifery, Locked Bag 1797, Penrith, NSW 2751 Australia; Ingham Institute, Liverpool Hospital, Liverpool, NSW Australia.
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Woman-centered care: Women's experiences and perceptions of induction of labor for uncomplicated post-term pregnancy: A systematic review of qualitative evidence. Midwifery 2018; 67:46-56. [DOI: 10.1016/j.midw.2018.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 05/30/2018] [Accepted: 08/15/2018] [Indexed: 11/16/2022]
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15
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Roberts J, Walsh D. “Babies come when they are ready”: Women’s experiences of resisting the medicalisation of prolonged pregnancy. FEMINISM & PSYCHOLOGY 2018. [DOI: 10.1177/0959353518799386] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Being pregnant beyond one’s estimated due date is a relatively common experience and requires complex decisions about whether to induce labour or wait for spontaneous onset. We report a qualitative study undertaken in the UK in 2016. We interviewed fifteen women and eleven more took part in an online focus group. Using thematic analysis, resistance to the medicalisation of prolonged pregnancy was identified as a strong theme. Drawing on the work of Armstrong and Murphy, we identify both conceptual and behavioural resistance in the accounts of women who accepted, delayed or declined induction of labour. Experiential knowledge played a key role in resistance, but women found this was devalued. Some healthcare staff used risk discourse to pressure women to comply with induction protocols but were unwilling to engage in discussion. The social context provided further pressure to produce a baby ‘on time’, with induction normalised as the way to manage prolonged pregnancy. Online spaces provided additional information and support for women to question the medicalisation of prolonged pregnancy. We end by considering the implications for policies of choice and agency in maternity care as well as the need for additional social support for women who are ‘overdue’.
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16
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Stoll K, Edmonds J, Sadler M, Thomson G, McAra-Couper J, Swift EM, Malott A, Streffing J, Gross MM, Downe S. A cross-country survey of attitudes toward childbirth technologies and interventions among university students. Women Birth 2018; 32:231-239. [PMID: 30150150 DOI: 10.1016/j.wombi.2018.07.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 07/25/2018] [Accepted: 07/31/2018] [Indexed: 10/28/2022]
Abstract
PROBLEM & AIM Cultural beliefs that equate birth technology with progress, safety and convenience contribute to widespread acceptance of childbirth technology and interventions. Little is known about attitudes towards childbirth technology and interventions among the next generation of maternity care users and whether attitudes vary by country, age, gender, childbirth fear, and other factors. METHODS Data were collected via online survey in eight countries. Students who had never had children, and who planned to have at least one child were eligible to participate. FINDINGS The majority of participants (n=4569) were women (79.3%), and the median age was 22 years. More than half of students agreed that birth technology makes birth easier (55.8%), protects babies from harm (49.1%) and that women have a right to choose a medically non-indicated cesarean (50.8%). Respondents who had greater acceptance of childbirth technology and interventions were from countries with higher national caesarean birth rates, reported higher levels of childbirth fear, and were more likely to report that visual media or school-based education shaped their attitudes toward birth. Positive attitudes toward childbirth technology and interventions were also associated with less confidence in knowledge of birth, and more common among younger and male respondents. DISCUSSION/CONCLUSION Educational strategies to teach university students about pregnancy and birth in ways that does not frighten them and promotes critical reflection about childbirth technology are needed. This is especially true in countries with high rates of interventions that reciprocally shape culture norms, attitudes, and expectations.
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Affiliation(s)
- Kathrin Stoll
- Birth Place Lab, University of British Columbia, BC Women's Hospital Shaughnessy Building E418 4500 Oak Street, Vancouver, BC V6H 3N1, Canada.
| | - Joyce Edmonds
- Connell School of Nursing, Boston College, Maloney Hall, 140 Commonwealth Avenue, Chestnut Hill, MA 02467, USA.
| | - Michelle Sadler
- Department of History and Social Sciences, Faculty of Liberal Arts, Adolfo Ibáñez University, Diagonal Las Torres 2640, Peñalolén, Santiago, Chile.
| | - Gill Thomson
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
| | - Judith McAra-Couper
- Centre for Midwifery & Women's Health Research, Faculty of Health & Environmental Sciences, Auckland University of Technology, Private Bag 92006, Auckland 1142, New Zealand.
| | - Emma M Swift
- Department of Midwifery, Faculty of Nursing-University of Iceland, Iceland.
| | - Anne Malott
- Midwifery Education Program, McMaster University, 1280 Main St. West, MDCL 2nd Floor, Hamilton, Ontario, Canada.
| | - Joana Streffing
- Midwifery Research and Education Unit, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School Carl-Neuberg-Str. 1, 30625 Hannover, Germany.
| | - Soo Downe
- School of Community Health and Midwifery, University of Central Lancashire, Preston, Lancashire PR1 2HE, UK.
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17
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Preference for cesarean section in young nulligravid women in eight OECD countries and implications for reproductive health education. Reprod Health 2017; 14:116. [PMID: 28893291 PMCID: PMC5594573 DOI: 10.1186/s12978-017-0354-x] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 07/26/2017] [Indexed: 01/22/2023] Open
Abstract
Background Efforts to reduce unnecessary Cesarean sections (CS) in high and middle income countries have focused on changing hospital cultures and policies, care provider attitudes and behaviors, and increasing women’s knowledge about the benefits of vaginal birth. These strategies have been largely ineffective. Despite evidence that women have well-developed preferences for mode of delivery prior to conceiving their first child, few studies and no interventions have targeted the next generation of maternity care consumers. The objectives of the study were to identify how many women prefer Cesarean section in a hypothetical healthy pregnancy, why they prefer CS and whether women report knowledge gaps about pregnancy and childbirth that can inform educational interventions. Methods Data was collected via an online survey at colleges and universities in 8 OECD countries (Australia, Canada, Chile, England, Germany, Iceland, New Zealand, United States) in 2014/2015. Childless young men and women between 18 and 40 years of age who planned to have at least one child in the future were eligible to participate. The current analysis is focused on the attitudes of women (n = 3616); rates of CS preference across countries are compared, using a standardized cohort of women aged 18–25 years, who were born in the survey country and did not study health sciences (n = 1390). Results One in ten young women in our study preferred CS, ranging from 7.6% in Iceland to 18.4% in Australia. Fear of uncontrollable labor pain and fear of physical damage were primary reasons for preferring a CS. Both fear of childbirth and preferences for CS declined as the level of confidence in women’s knowledge of pregnancy and birth increased. Conclusion Education sessions delivered online, through social media, and face-to-face using drama and stories told by peers (young women who have recently had babies) or celebrities could be designed to maximize young women’s capacity to understand the physiology of labor and birth, and the range of methods available to support them in coping with labor pain and to minimize invasive procedures, therefore reducing fear of pain, bodily damage, and loss of control. The most efficacious designs and content for such education for young women and girls remains to be tested in future studies.
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18
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Kay L, Downe S, Thomson G, Finlayson K. "Engaging with birth stories in pregnancy: a hermeneutic phenomenological study of women's experiences across two generations". BMC Pregnancy Childbirth 2017; 17:283. [PMID: 28870181 PMCID: PMC5582406 DOI: 10.1186/s12884-017-1476-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 08/29/2017] [Indexed: 12/04/2022] Open
Abstract
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.
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Affiliation(s)
- Lesley Kay
- Kingston and St. George's Joint Faculty, Health, Social Care and Education, St. George's Campus, Cranmer Terrace, Tooting, London, SW170RE, UK.
| | - Soo Downe
- Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, PR12HE, Preston, Lancashire, UK
| | - Gill Thomson
- Maternal and Infant Nutrition and Nurture Unit, University of Central Lancashire, PR12HE, Preston, Lancashire, UK
| | - Kenny Finlayson
- Research in Childbirth and Health (ReaCH) Group, University of Central Lancashire, PR12HE, Preston, Lancashire, UK
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19
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O'Brien D, Butler MM, Casey M. A participatory action research study exploring women's understandings of the concept of informed choice during pregnancy and childbirth in Ireland. Midwifery 2017; 46:1-7. [DOI: 10.1016/j.midw.2017.01.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/21/2016] [Accepted: 01/03/2017] [Indexed: 10/20/2022]
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20
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Roberts J, Griffiths FE, Verran A, Ayre C. Why do women seek ultrasound scans from commercial providers during pregnancy? SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:594-609. [PMID: 26094706 DOI: 10.1111/1467-9566.12218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The commercial availability of ultrasound scans for pregnant women has been controversial yet little is known about why women make use of such services. This article reports on semi-structured interviews with women in the UK who have booked a commercial scan, focusing on the reasons women gave for booking commercially provided ultrasound during a low-risk pregnancy. Participants' reasons for booking a scan are presented in five categories: finding out the sex of the foetus; reassurance; seeing the baby; acquiring keepsakes and facilitating bonding. Our analysis demonstrates that women's reasons for booking commercial scans are often multiple and are shaped by experiences of antenatal care as well as powerful cultural discourses related to 'good' parenting and the use of technology in pregnancy. Sociological and public debate about the availability of commercial ultrasound and its social and personal impacts should consider the wider sociocultural context that structures women's choices to make use of such services.
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Affiliation(s)
- Julie Roberts
- School of Health Sciences, Nottingham, UK
- Warwick Medical School, Coventry, UK
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21
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Grigg CP, Tracy SK, Schmied V, Daellenbach R, Kensington M. Women׳s birthplace decision-making, the role of confidence: Part of the Evaluating Maternity Units study, New Zealand. Midwifery 2015; 31:597-605. [PMID: 25765744 DOI: 10.1016/j.midw.2015.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2014] [Revised: 01/28/2015] [Accepted: 02/16/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE to explore women׳s birthplace decision-making and identify the factors which enable women to plan to give birth in a freestanding midwifery-led primary level maternity unit rather than in an obstetric-led tertiary level maternity hospital in New Zealand. DESIGN a mixed methods prospective cohort design. METHODS data from eight focus groups (37 women) and a six week postpartum survey (571 women, 82%) were analysed using thematic analysis and descriptive statistics. The qualitative data from the focus groups and survey were the primary data sources and were integrated at the analysis stage; and the secondary qualitative and quantitative data were integrated at the interpretation stage. SETTING Christchurch, New Zealand, with one tertiary maternity hospital and four primary level maternity units (2010-2012). PARTICIPANTS well (at 'low risk' of developing complications), pregnant women booked to give birth in one of the primary units or the tertiary hospital. All women received midwifery continuity of care, regardless of their intended or actual birthplace. FINDINGS five core themes were identified: the birth process, women׳s self-belief in their ability to give birth, midwives, the health system and birth place. 'Confidence' was identified as the overarching concept influencing the themes. Women who chose to give birth in a primary maternity unit appeared to differ markedly in their beliefs regarding their optimal birthplace compared to women who chose to give birth in a tertiary maternity hospital. The women who planned a primary maternity unit birth expressed confidence in the birth process, their ability to give birth, their midwife, the maternity system and/or the primary unit itself. The women planning to give birth in a tertiary hospital did not express confidence in the birth process, their ability to give birth, the system for transfers and/or the primary unit as a birthplace, although they did express confidence in their midwife. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE birthplace is a profoundly important aspect of women׳s experience of childbirth. Birthplace decision-making is complex, in common with many other aspects of childbirth. A multiplicity of factors needs converge in order for all those involved to gain the confidence required to plan what, in this context, might be considered a 'countercultural' decision to give birth at a midwife-led primary maternity unit.
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Affiliation(s)
- Celia P Grigg
- Midwifery and Women׳s Health Research Unit, Faculty of Nursing and Midwifery, 88 Mallett St., The University of Sydney, Sydney 2050, NSW, Australia; University of Sydney, NSW, Australia.
| | - Sally K Tracy
- Centre for Midwifery & Women's Health Research Unit, The Royal Hospital for Women, Sydney, NSW, Australia; University of Sydney, NSW, Australia.
| | - Virginia Schmied
- School of nursing and midwifery, Family and Community Health Research Group, University of Western Sydney, NSW, Australia.
| | - Rea Daellenbach
- School of Midwifery, Christchurch Polytechnic Institute of Technology, New Zealand.
| | - Mary Kensington
- School of Midwifery, Christchurch Polytechnic Institute of Technology, New Zealand.
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Malacrida C, Boulton T. The best laid plans? Women's choices, expectations and experiences in childbirth. Health (London) 2013; 18:41-59. [PMID: 23426792 DOI: 10.1177/1363459313476964] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The past decades have seen a drastic increase in the medicalization of childbirth, evidenced by increasing Caesarean section rates in many Western countries. In a rare moment of congruence, alternative health-care providers, feminist advocates for women's health and, most recently, mainstream medical service providers have all expressed serious concerns about the rise in Caesarean section rates and women's roles in medicalization. These concerns stem from divergent philosophical positions as well as differing assumptions about the causes for increasing medicalization. Drawing on this debate, and using a feminist and governmentality framing of the problem, we interviewed 22 women who have recently had children about their birthing choices, their expectations and their birth experiences. The women's narratives revealed a disjuncture between their expectations of choosing, planning and achieving as natural a birth as possible, and their lived experiences of births that did not typically go to plan. They also reveal the disciplining qualities of both natural and medical discourses about birth and choice. Furthermore, their narratives counter assumptions that women, as ideal patient consumers, are driving medicalization.
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23
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Williams K, Kurz T, Summers M, Crabb S. Discursive constructions of infant feeding: The dilemma of mothers’ ‘guilt’. FEMINISM & PSYCHOLOGY 2012. [DOI: 10.1177/0959353512444426] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Recent feminist and sociological scholarship has problematised the underlying medical assumptions in the established literature on infant feeding by attending to the social and discursive construction of breastfeeding practice. Such work has suggested that the pervasive cultural discourse around breastfeeding as the ‘morally correct’ choice has implications for actual decisions and practices as well as subjective judgements and feelings, particularly those of guilt and inadequacy. The present study employs a discursive approach to analyse the ways in which childcare materials published since 2000 construct the issue of infant feeding. In particular, we focus upon the ways in which these materials attend to the possible implications of pro-breastfeeding discourses for mothers’ subjective experience of guilt. We highlight a focus within the materials on not ‘ feeling’ guilty, as opposed to affirmations that formula feeding mothers are not guilty. The complex and potentially problematic nature of such public health messages in terms of gendered subjectivities is considered.
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Affiliation(s)
- Kate Williams
- Murdoch University, Australia
- University of Adelaide, Australia
| | - Tim Kurz
- Murdoch University, Australia; University of Exeter, UK
- University of Adelaide, Australia
| | - Mark Summers
- Murdoch University, Australia
- University of Adelaide, Australia
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Chadwick RJ, Foster D. Technologies of gender and childbirth choices: Home birth, elective caesarean and white femininities in South Africa. FEMINISM & PSYCHOLOGY 2012. [DOI: 10.1177/0959353512443112] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Since the 1970s, feminist research has provided a powerful critique of biomedical models of childbirth. While this critique has been extremely important, it has to some extent led to the neglect of other forms of power. For example, there has been little research which has explored childbirth as a way of ‘doing gender’ in which normative or resistant forms of gender and femininity are (re)performed. Drawing on the Foucauldian notion of ‘technologies of power’, we argue that gender is a form of disciplinary power which shapes the choices that women make in relation to childbirth. Drawing on pre-birth interviews with 21 white, middle-class pregnant South African women who were planning on either a home birth (n = 12) or an elective caesarean section (n = 9), we show how three central technologies of white femininity shaped and regulated women’s childbirth choices. These included: a patriarchal optics of childbirth, the ‘natural childbirth’ ideal and the ‘good mother’ imperative. The article concludes that women’s childbirth choices are heavily shaped by gendered technologies of power and that the decision to have a home birth or an elective caesarean section intersects with scripts of ‘doing white femininity’ in South Africa.
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