Ways of Relating During Childbirth: An ethical responsibility and challenge for midwives

Supporting birth companions for women in labor, the views and experiences of birth companions, women and midwives: A mixed methods systematic review

BACKGROUND

Birth companions can have a positive effect on women's experiences in labor. However, companions can feel unprepared and need professional guidance to help them feel involved and provide effective support.

METHODS

A convergent segregated mixed-methods systematic review was conducted to explore women's, companions', and midwives' experiences of birth companion support and identify ways to improve the experience for women and companions. A thematic synthesis of qualitative data and a narrative summary of quantitative data were conducted followed by integration of the findings.

RESULTS

Companions who cope well in labor reported feeling involved, able to preserve women's internal focus and have a defined role, providing physical or emotional support. LBGTQ+ partners faced barriers to inclusion due to "forefronting" of their sexuality by staff and a lack of recognition in the language and processes used. The experience of birth companions can be enhanced by promoting their role as co-parent, guardian, and coach, provision of timely information and developing a trusting relationship with care providers. Only two papers reported midwives' views on birth companions in labor.

CONCLUSIONS

Women's and companions' satisfaction with birth is increased when companions can support the mother, feel supported themselves, and valued as a co-parent. The midwives' role in information provision and guidance can maximize birth companions' experience and ability to provide positive support. LBGTQ+ families need more support to feel included and recognized.

Reimagining relationality for reproductive care: Understanding obstetric violence as “separation”

Nursing Ethics has published several pleas for care ethics and/or relationality as the most promising ethical foundation for midwifery philosophy and practice. In this article, we stand by these calls, contributing to them with the identification of the structural form of violence that a care ethical relational approach to reproductive care is up against: that of “maternal separation”. Confronted with reproductive and obstetric violence globally, we show that a hegemonic racialized, instrumentalized, and individualized conception of pregnancy is responsible for a severance of relationalities that are essential to safe reproductive care: (1) the relation between the person and their child or reproductive capabilities; and (2) the relation between the pregnant person and their community of care. We pinpoint a separation of the maternal relation in at least two discursive domains, namely, the juridical-political and the ethical-existential. Consequently, we plea for a radical re-imagination of maternal relationality, envisioning what care ethical midwifery, including abortion care, could be.

Participation in Care Encounters in Heart Failure Home-Care

The purpose of this qualitative study was to observe care encounters during home visits in Heart failure (HF) home-care to identify and describe participation in care. Seventeen patients diagnosed with HF, and 10 registered nurses participated. Data from 19 video-recorded home visits were analyzed using qualitative content analysis. Two themes were identified: (a) Participation in the care encounter is made possible by interaction, including exchanging care-related information, care-related reasoning, collaboration; and (b) participation in the care encounter is made possible by an enabling approach, including the patients expressing their own wishes, showing an active interest, while the nurse is committed and invites to having a dialogue. The HF home-care context showed good potential for patient participation. Room for discussions and collaboration facilitated for the patients to be active partners in their care, which in turn may have positive effects on outcomes.

Negative childbirth experiences and future reproductive decisions: a systematic review protocol

REVIEW QUESTION/OBJECTIVE

The objective of this review is to identify, appraise and synthesize quantitative evidence on the effect of negative childbirth experiences on future reproductive decisions of women aged 18 years and above. More specifically, the review question is: what is the impact of negative childbirth experience on future reproductive decisions, including.

Ethics of infant relinquishment, cultural considerations, and obstetric conveniences

Ethical issues relating to infant relinquishment, caring for culturally diverse women, the importance of shared power between women and their caregivers, and the provision of evidence-based practice versus reliance on obstetric conveniences are addressed in this article. Respectful care of women relinquishing their infants including use of appropriate language demonstrates moral and ethical nursing practice; providing cultural competent care of multilinguistic, multicultural, and multiethnic childbearing women and their families is an ethical imperative. Nurses practicing ethically will foster adoption of best practices on perinatal and neonatal units, and generate a clearly articulated vision of woman and family centered organizational culture. In ethical terms, this demonstrates respect for others as well as beneficence. Promoting the use of ethical nursing practice and evidence-based practice requires that nurses identify change agents, those who are champions and facilitators of evidence-based practice, and then reward such innovators and make sure that clinical guidelines be developed based on best practices.

A narrative review of fathers' involvement during labour and birth and their influence on decision making

OBJECTIVE

to identify and critically review the research literature that has examined fathers׳ involvement during labour and birth and their influence on decision making.

DESIGN

the review follows the approach of a narrative review. Systematic searches of electronic databases Social Services Abstract, Sociological Abstracts, ASSIA, CINAHL Medline, Cochrane library, AMED, BNI, PsycINFO, Embase, Maternity and Infant care, DH-Data and the Kings Fund Database were combined with manual searches of key journals and reference lists. Studies published between 1992 and 2013 examining fathers׳ involvement during intrapartum care were included in the review.

FINDINGS

the findings of this review suggest that fathers׳ level of involvement during labour ranges from being a witness or passive observer of labour and birth to having an active supporting and coaching role. The findings also suggest that there are a number of facilitators and barriers to fathers׳ involvement during labour and birth. There are a limited number of studies that have examined fathers׳ involvement in decision making and specifically how fathers׳ influence decision making during labour and birth.

KEY CONCLUSIONS

future research needs to address the gap in the literature regarding fathers׳ involvement and influence on decision making to help midwives and obstetricians understand the process in order enhance the transition to parenthood for women and men.

Immigrant New Mothers in Finnish Maternity Care: An Ethnographic Study of Caring

PURPOSE: To illuminate experiences and perceptions of caring in the maternity care culture of immigrant new mothers in Finland.

DESIGN: This is a descriptive interpretive ethnography.

PARTICIPANTS AND SETTING: Seventeen new mothers from different cultures on a maternity ward in a medium-sized hospital in Finland.

METHODS: Focused ethnographic analysis and interpretation of interviews, observations, and field notes were used.

FINDINGS: Caring was part of the positive experience of childbearing and beneficial for the health and well-being of the immigrant new mothers. Negative experiences of health care impaired their well-being. The resources of Finnish maternity care and cultural knowledge of the nurses facilitated the caring. The policy and attitude of Finnish society encouraged childbearing. The immigration regulations affected support during childbearing negatively and tended to caused loneliness. The Finnish maternity care was not fully adapted to the mothers’ wishes to understand the organization of Finnish maternity care, to communicate, to breastfeed, and to have family-centered care, a flexible length of stay in the hospital, and extended support after childbirth.

CONCLUSION: Caring improves the childbearing experience and the well-being and health of new immigrant mothers; therefore, caring needs to be emphasized in maternity care, health care administration, and nursing education.

Understanding the moral nature of intrapartum nursing

OBJECTIVE

To explore how intrapartum nurses understand and negotiate their moral responsibilities toward women during childbirth.

DESIGN

Qualitative critical narrative.

SETTING

Labor and birth unit in an urban Canadian hospital.

PARTICIPANTS

Fourteen intrapartum registered nurses.

METHODS

Critical narrative analysis using a feminist ethics perspective.

RESULTS

Nurses understood their moral responsibilities to laboring women in a variety of ways depending on the nurses' personal and professional experiences, the people involved, and the context of care. Four themes were identified: organizing and coordinating care, responding to the unpredictable, recognizing limits of responsibilities to others, and negotiating care with women and families. A key factor influencing responses to women was the degree to which expectations related to birth were deemed to be reasonable and mutually agreed upon among nurses, physicians, women, and their families. Although nurses were able to identify contextual influences that constrained their ability to maintain effective relationships with women, the influence of their own values on the care they provided was less apparent. Nurses also described limits of their responsibilities for others, which departed from the idealized expectations often reflected in professional guidelines

CONCLUSION

These findings suggest a need to challenge assumptions related to the provision of choice and family centered care to create environments that can support and sustain understanding and trust between nurses and women giving birth. In addition, given the lack of shared understandings of what constitutes best care, there is a need to develop collaborative models of care that include the voices of women as a central component.

Women's experiences of outpatient induction of labour with remote continuous monitoring

OBJECTIVE

to gain insight into women's experiences and preferences for induction in the home as part of a trial investigating the feasibility and acceptability of outpatient induction of labour with remote monitoring.

DESIGN

a qualitative study using semi-structured individual interviews. Interview transcripts were subjected to thematic analysis to identify the dominant themes regarding women's experiences of outpatient induction.

SETTING

a large maternity hospital in the North West of England.

PARTICIPANTS

fifteen women who participated in the main trial of outpatient induction of labour with remote continuous monitoring.

FINDINGS

three main themes were identified; the need for women to 'labour within their comfort zone'; their desire to achieve 'the next best thing to a normal labour' and the importance of a 'virtual presence' to offer remote reassurance.

CONCLUSIONS

women's preference for the outpatient setting of induction of labour is dominated by their need to labour within their comfort zone. Outpatient induction offered women the familiarity and freedom of the home environment, and the resulting physical and emotional comforts helped women cope better with their labour and improved their birth experiences. While remote monitoring offered some reassurance, women still depended on effective communication from hospital staff to provide the virtual presence of a health professional in the home.

IMPLICATIONS

the combination of slow-release prostaglandin and a remote monitoring device may provide low risk women with an improved induction and labour experience. While ongoing studies continue to explore further the safety of interventions at home, this study has importantly considered women's views and confirmed that induction at home is not only acceptable to women but also that the outpatient experience is preferable to long inpatient inductions.

Fear of childbirth: mothers' experiences of team-midwifery care - a follow-up study

AIM

The aim of this study was to illuminate mothers' fear of childbirth and their experiences of the team-midwifery care model during pregnancy, childbirth and the postnatal period.

BACKGROUND

Maternal anxiety and fear of childbirth lead to emotional suffering and affected women's well-being. A previous negative experience of childbirth may result in postnatal depression or avoidance of future pregnancies.

METHODS

This hermeneutic study comprised interviews with 13 women, which were audio-taped and transcribed verbatim, after which interpretative content analysis was performed. Ethical approval was granted.

RESULTS

The findings revealed one main theme: The woman's right to ownership of the pregnancy, childbirth and postnatal care as a means of maintaining dignity and three themes; Being aware of barriers and reasons for fear; Being prepared for childbirth and Being confirmed and treated with dignity by the midwife. Each theme contained several sub-themes.

CONCLUSION

The findings contribute insights into how midwives can be educated to reduce fear of childbirth and promote positive birth experiences, despite the existence of negative memories of previous births.

IMPLICATION FOR NURSING MANAGEMENT

In order to achieve continuity and a trusting relationship it is necessary to organise leadership and to adopt models that are flexible and support women's health.

Therapeutic alliance: a concept for the childbearing season

This analysis was conducted to describe the concept of therapeutic alliance and its appropriateness for health-care provider-client interactions during the childbearing season. The concept has been defined in other disciplines. A universal definition suggested a merging of efforts directed toward health. A simple and concise definition evolved, which is applicable to the childbearing season as well as to health-care encounters across the life span. This definition states: Therapeutic alliance is a process within a health-care provider-client interaction that is initiated by an identified need for positive client health-care behaviors, whereby both parties work together toward this goal with consideration of the client's current health status and developmental stage within the life span.

Postpartum experiences of first-time fathers in a Tanzanian suburb: a qualitative interview study

OBJECTIVES

to explore postpartum experiences of first-time fathers in a multicultural, low-income, suburban Tanzanian setting.

DESIGN, SETTING AND PARTICIPANTS

individual qualitative interviews with ten first-time fathers, four to ten weeks post partum in Ilala suburb, Dar es Salaam, Tanzania.

FINDINGS

these first-time fathers enjoyed fatherhood and revealed a sincere concern for the well-being of the mother and infant during the postpartum period. They described themselves as active in mother and infant care and household chores; however, they were limited by breadwinning responsibilities. The families were supported by relatives or laypersons. The mothers' and infants' nutrition had high priority but poverty was an obstacle. Timing of resumption of sex after childbirth was problematic as traditions prescribed abstinence while the woman is breast feeding. The risk of contracting HIV to the family was a concern. Reproductive and child health care often excluded fathers and gave unclear information.

CONCLUSION

these new fathers struggled to gain confidence and experience while engaging in family matters during post partum. Changing gender roles in the suburban Tanzanian society in general and their personal experiences of transition to fatherhood both facilitated and made the postpartum period problematic. The health sector does not respond with respect to fathers' concerns for family health and needs for support.

RECOMMENDATIONS

these findings call for programmes on gender relations, which are supporting constructive masculinities and facilitate new fathers' active participation and responsibilities in parenting, family health and their relations with their partners. Such programmes should not only target people in childbearing age but also their potential support persons. Health workers should welcome fathers and discuss strategies for good family health during post partum. Counselling couples together could facilitate their support for each other in optimising health post partum.

Midwives' experience of encountering women with posttraumatic stress symptoms after childbirth

OBJECTIVE

To describe midwives' experience of encountering women with posttraumatic stress symptoms after childbirth.

STUDY DESIGN

Semi-structured interviews with eight midwives with experiences of encountering women with posttraumatic stress symptoms after childbirth. Data were analyzed using thematic content analysis.

RESULT

The midwives encountered women with severe experiences after a childbirth, which had affected their lives. The midwives thought that they had to reflect on their own attitude and use their gentleness as they responded to the women's stories. By listening to and enabling the women to express their feelings and tell their stories, the midwives thought that they could confirm the women's experience. The midwives thought that they could support women who had lost confidence to give birth but also thought that cesarean section did not solve the women's problems.

CONCLUSION

Training of midwives is necessary to increase awareness of the cause of women's posttraumatic stress symptoms. It is urgent to optimize the implementation of new research into practical reality to raise the quality of care of women with fear of childbirth. Childbirth is an important experience that can influence a woman's well-being and her connection to the child. Posttraumatic stress symptoms should be identified in an early stage/pregnancy to allow early treatment on the right level of care.

Uncaring Midwives

The aim of this study was to understand how mothers experienced midwives' uncaring behaviour and actions during birth. Sixty-seven first-time mothers took part in the study, in which data were collected through interview. The interview text was analysed using hermeneutic text analysis. Nearly half of the mothers interviewed ( n = 32) said that midwives did not care for them. The findings show that midwives' behaviour was humiliating when they ignored mothers and held them in contempt. The mothers felt further humiliated when the midwives did not believe them, treated their bodies in a careless manner and tended to put blame on them. Through their behaviour and actions, some midwives have shown that they no longer have a caring attitude as an element of their professional practice and that they have ignored ethics by offending mothers' sense of dignity.