Do not disturb: the importance of privacy in labor

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.

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 Many outdated childbirth practices are still widely used by healthcare providers.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.

Not Just Mechanical Birthing Bodies: Birthing Consciousness and Birth Reflexes

There are two concepts of neuroendocrine reflexes associated with the expulsion of the fetus through the birth canal during the second stage of birth: the Ferguson reflex and the fetus ejection reflex. These concepts are often confused with one another and treated synonymously, thus interchangeable. However, the two not only refer to different phenomena, but they also represent the birthing woman differently. The Ferguson reflex treats the birthing woman as simply a biomechanical body. In contrast, the fetus ejection reflex does not ignore women's conscious states during birth and recognizes what is currently a well-known empirical fact: The event of birth is a complex biophysical process affected by many mental, social, and environmental factors. In that, it has a connection to the phenomenon of birthing consciousness, which is the positive altered state sometimes experienced during a physiological and undisturbed childbirth. We argue that birthing consciousness and the fetus ejection reflex, made possible by reduced cortical control, are extremely helpful in promoting physiological human childbirth. Therefore, treating a woman giving birth as a biomechanical body is not only erroneous but can also lead to medical mismanagement of the second stage of physiological childbirth with associated mental and physiological consequences.

Navigating intensive altered states of consciousness: How can the set and setting key parameters promote the science of human birth?

The subjective childbirth experience is crucial from a public health standpoint. There is a correlation between a negative childbirth experience and a poor mental state after birth, with effects that go far beyond the postpartum (PP) period. This paper offers a new approach as to how birthing experiences, and birth in general, can be navigated. The theory of set and setting proves that psychedelic experiences are shaped, first and foremost, by the mindset of an individual entering a psychedelic experience (set) and by the surroundings in which the experience happens (setting). In research on altered states of consciousness during psychedelic experiences, this theory explains how the same substance can lead to a positive and life-changing experience or to a traumatic and frightening experience. Because recent studies suggest that birthing women enter an altered state of consciousness during physiological birth ("birthing consciousness"), I suggest analyzing the typical modern birthing experience in terms of set and setting theory. I argue that the set and setting key parameters can help design, navigate, and explain many psychological and physiological elements of the human birth process. Thus, an operative conclusion that emerges from the theoretical analysis presented in this paper is that framing and characterizing the birth environment and birth preparations in terms of set and setting is a central tool that could be used to promote physiological births as well as subjective positive birthing experiences, which is currently a primary, yet unreached goal, in modern obstetrics and public health.

Öğrenci Hemşirelerin Gözüyle Perinatal Kliniklerde Hasta Mahremiyeti: Nitel Bir Çalışma

Giriş: Hemşirelik öğrencilerinin hasta mahremiyetine duyarlı olması, onların meslek yaşamında profesyonel bir duruş sergilemesi açısından oldukça önemlidir. Amaç: Bu araştırmanın amacı, dördüncü sınıf hemşirelik öğrencilerinin perinatal kliniklerde hasta mahremiyetine yönelik görüşlerini belirlemektir. Yöntem: Bu araştırmada, fenomenolojik nitel yöntem uygulanmıştır. Araştırmanın örneklemini, 2019-2020 Eğitim-Öğretim Yılı Güz Döneminde dördüncü sınıfta öğrenim gören 25 öğrenci oluşturmuştur. Veriler, Aralık 2019- Mart 2020 tarihleri arasında yarı yapılandırılmış derinlemesine bireysel görüşme yöntemi ile toplanmıştır. Görüşmede elde edilen veriler, içerik analizi yoluyla çözümlenmiştir. Bulgular: Elde edilen veriler mahremiyetin tanımı, personelin hasta mahremiyetine yönelik tutumu mahremiyet ihlalinin hastaya yansıması hasta mahremiyetini korumada karşılaşılan güçlükler ve hasta mahremiyetini korumaya yönelik yapılması gerekenler şeklinde beş tema altında gruplandırılmıştır. Öğrencilerin çoğunluğu perinatal kliniklerde görev yapan personelin hasta mahremiyetini koruma konusunda özensiz davrandıklarını belirtmişlerdir. Öğrenciler, personelin hasta mahremiyeti konusunda eğitilmesi ve hastane ortamının fiziki koşullarında düzenleme yapılmasının mahremiyeti koruma konusunda faydalı olacağını söylemişlerdir. Sonuç: Perinatal sağlık hizmetlerinde mahremiyet üzerinde yeterince durulmayan oldukça önemli bir konudur. Bu araştırmada; öğrenci hemşirelerin hasta mahremiyeti konusunda farkındalıklarının yüksek olduğu, konuyla ilgili yeni çalışmalara gereksinim duyulduğu belirlenmiştir.

A Broad Study to Develop Maternity Units Design Knowledge Combining Spatial Analysis and Mothers' and Midwives' Perception of the Birth Environment

OBJECTIVES

This article investigates how the physical birth environment is perceived by the users (women and midwives) in different settings, a midwife-led unit and an obstetric-led unit, placed in Italy.

BACKGROUND

In the field of birth architecture research, there is a gap in the description of the spatial and physical characteristics of birth environments that impact users' health, specifically for what concerns the perception by women.

METHODS

The study focuses on multi-centered mixed methods design, employing both quantitative and qualitative research methods (questionnaire, spatial analysis) and covering different disciplines (architecture, environmental psychology, and midwifery).

RESULTS

The results revealed significant differences between the two settings and some associations between perceived and spatial data concerning: calm atmosphere, greater intimacy, spacious birth room, clarity of service points, clarity in finding midwives, sufficient space for labor, noise, privacy, and the birth room adaptability.

CONCLUSIONS

The findings confirm the importance of the spatial layout and indicate documented knowledge as an input to consider when designing birth spaces in order to promote user well-being.

Inequities in quality perinatal care in the United States during pregnancy and birth after cesarean

OBJECTIVE

High-quality, respectful maternity care has been identified as an important birth process and outcome. However, there are very few studies about experiences of care during a pregnancy and birth after a prior cesarean in the U.S. We describe quantitative findings related to quality of maternity care from a mixed methods study examining the experience of considering or seeking a vaginal birth after cesarean (VBAC) in the U.S.

METHODS

Individuals with a history of cesarean and recent (≤ 5 years) subsequent birth were recruited through social media groups to complete an online questionnaire that included sociodemographic information, birth history, and validated measures of respectful maternity care (Mothers on Respect Index; MORi) and autonomy in maternity care (Mother's Autonomy in Decision Making Scale; MADM).

RESULTS

Participants (N = 1711) representing all 50 states completed the questionnaire; 87% planned a vaginal birth after cesarean. The most socially-disadvantaged participants (those less educated, living in a low-income household, with Medicaid insurance, and those participants who identified as a racial or ethnic minority) and participants who had an obstetrician as their primary provider, a male provider, and those who did not have a doula were significantly overrepresented in the group who reported lower quality maternity care. In regression analyses, individuals identified as Black, Indigenous, and People of Color (BIPOC) were less likely to experience autonomy and respect compared to white participants. Participants with a midwife provider were more than 3.5 times more likely to experience high quality maternity care compared to those with an obstetrician.

CONCLUSION

Findings highlight inequities in the quality of maternal and newborn care received by birthing people with marginalized identities in the U.S. They also indicate the importance of increasing access to midwifery care as a strategy for reducing inequalities in care and associated poor outcomes.

The Case for Animal Privacy in the Design of Technologically Supported Environments

Privacy is an essential consideration when designing interactive systems for humans. However, at a time when interactive technologies are increasingly targeted at non-human animals and deployed within multispecies contexts, the question arises as to whether we should extend privacy considerations to other animals. To address this question, we revisited early scholarly work on privacy, which examines privacy dynamics in non-human animals (henceforth “animals”). Then, we analysed animal behaviour literature describing privacy-related behaviours in different species. We found that animals use a variety of separation and information management mechanisms, whose function is to secure their own and their assets' safety, as well as negotiate social interactions. In light of our findings, we question tacit assumptions and ordinary practises that involve human technology and that affect animal privacy. Finally, we draw implications for the design of interactive systems informed by animals' privacy requirements and, more broadly, for the development of privacy-aware multispecies interaction design.

Barriers to Quality Midwifery Care: A Systematic Review and Meta-Synthesis of Qualitative Data

BACKGROUND

Skilled attendance at birth by well-educated and regulated midwives has been identified to reduce maternal and neonatal deaths, however, it has been established that midwives experience barriers that can affect their ability to provide quality care to women and neonates.

AIM

This systematic review and meta-synthesis of qualitative data was conducted to investigate the barriers to midwives' ability to provide quality care focusing on African and developed countries.

METHODS

The Joanna Briggs Institute process for conducting systematic reviews was followed for this review. Qualitative studies that reported on barriers to midwives' ability to provide quality care were identified by searching the following databases: CINAHL, PubMed, Web of Science, and PsychINFO. Studies reported in English in the last 10 years, within which most participants were midwives and the data reported on barriers to quality care provision by midwives were included in this review.

RESULTS

813 published research studies were screened, and 11 research papers were included in this review. The meta-synthesis of the findings resulted in six categories: the lack of equipment; inadequate skills and training, lack of space and infrastructure, staff shortages and high workloads, emotional barriers, and workplace culture. Using the Donabedian model of quality care, the barriers were grouped into structure, process, and outcome factors.

CONCLUSION

Currently efforts to improve quality care in African countries focus on structural factors. Efforts to improve quality care in developed countries focus on process factors. In order to improve quality care for women and neonates, efforts need to be focused on all the factors that promotequality care.

Development and psychometric properties of Iranian women childbirth experience questionnaire

Aim

This study aimed to develop and psychometrics a questionnaire for assessing childbirth experience in Iranian women.

Design

Cross‐sectional study.

Methods

This cross‐sectional study was done in women who experienced childbirth within the last 12 hr to 2 months from May to December 2018. Questionnaire items were extracted from a comprehensive review of the available studies and questionnaires on childbirth experiences and definitions implied by qualitative interviews. The designed questionnaire was validated in three stages: face, content and construct. Cronbach's alpha was used to determine the reliability of the instrument.

Result

Iranian women childbirth experience questionnaire contained seven factors with 52 items which were called professional support, husband's and other important support, baby, preparation, fear, positive perception and control were extracted. The Cronbach's alpha coefficient after factor analysis was 0.62–0.92 and for the whole instrument was 0.91. The findings showed that Iranian women childbirth experience questionnaire was valid and reliable.

Australian massage therapists' views and practices related to preconception, pregnancy and the early postpartum period

BACKGROUND AND PURPOSE

Massage is commonly used by the Australian public and is often sought by expectant mothers. Despite its popularity there is no regulatory body to enforce minimum educational standards, guidelines or evidence-based best practice for massage therapists. The aim of this paper is to critically examine the views and practices of massage therapists who offer preconception, antenatal or postnatal massage.

MATERIALS AND METHODS

An online survey was administered to Australian massage therapists who provide massage in the preconception, antenatal or postnatal periods.

RESULTS

Ninety-nine therapists completed the survey. The majority of respondents had received training in pregnancy massage (n = 72; 72.7%) only. The most confident respondents were those that had both training and experience.

CONCLUSION

There are potential gaps in training for massage therapists including up-to-date curriculum and a fragmentation around industry training requirements for pregnancy massage, which may impact on the safety and benefits of pregnancy massage.

Birthing Consciousness as a Case of Adaptive Altered State of Consciousness Associated With Transient Hypofrontality

In this article, I present the concept of “birthing consciousness,” a psychophysical altered state of women that can occur during natural and undisturbed birth. I demonstrate that this altered state of consciousness (ASC) has phenomenological and cognitive features of hypofrontality; thus, birthing consciousness probably shares a similar brain mechanism to that postulated by the transient-hypofrontality theory (THT). I argue that until recently (with the advent of modern medical intervention), in evolutionary terms, women lacking the proclivity for this specific brain mechanism had a lower chance of reproducing successfully. Hence, I suggest a general and preliminary hypothesis concerning THT: Birthing consciousness is one example of an adaptive pain-induced ASC associated with transient hypofrontality.

Influence of dog-appeasing pheromone on canine maternal behaviour during the peripartum and neonatal periods

Background

Parturition and the initial postpartum period are important moments in the reproductive cycle of dogs.

Methods

A study assessed the effect of ADAPTIL, a dog-appeasing pheromone, on maternal behaviour during peripartum. Bitches were continuously exposed to ADAPTIL (n=20) or placebo (n=21) in double-blinded conditions from an average of about seven days before parturition up to 21 days postpartum. Differences in maternal behaviour in relation to the treatment were evaluated by the observation of specific activities through video recordings, such as the time spent by the bitch in close contact with the puppies, oronasal interaction and nursing duration and position. Videos were recorded at four time points (W0: within the first 48 hours of whelping; W1: one week after parturition; W2: two weeks after parturition; and W3: three weeks after parturition). In addition, the perception of breeders in relation to the quality of maternal care, puppies’ wellbeing and overall relationship between the bitches and the puppies was evaluated using Visual Analogue Scale at the same time points. Moreover, the daily activity of the bitches was measured by using an electronic device (FitBark dog activity trackers, Kansas City, Missouri).

Results

For all observed maternal behaviours, there was a steady decrease in levels as the puppies developed, independently of treatment. However, bitches exposed to ADAPTIL tended to nurse significantly more in lying position, while those exposed to the placebo nursed more in a seated position, especially at W1 (P=0.06) and W3 (P=0.005). According to the breeders, the attention scores of bitches towards puppies were significantly higher in ADAPTIL than in the placebo group at each time point (P=0.01). Moreover, a difference according to parity was observed (P=0.004), with greater attention score displayed by primiparous bitches exposed to ADAPTIL compared with placebo on W0 (P=0.02), W1 and W3 (P<0.001). The global mother–puppies relationship was also perceived as significantly better (P=0.0002) by breeders of bitches exposed to ADAPTIL, with significant differences at W2 (P=0.01) and W3 (P=0.001). The bitches’ daily activity increased starting two days before the whelp, peaked during parturition and then gradually declined up until four days postpartum. There was a trend towards a difference in the activity level according to the treatment during the full study period (P=0.09) and at two days before parturition (P=0.07). Bitches exposed to ADAPTIL were more active compared with placebo in relation to the FitBark data.

Conclusion

The use of ADAPTIL in maternity modulated maternal behaviours. Concerning the caregiver’s view, bitches under the influence of ADAPTIL had greater and extended attention towards the puppies and they were eager to stay with the puppies for a longer time.

Uncovered and disrespected. A qualitative study of Jordanian women's experience of privacy in birth

BACKGROUND

Privacy is related to a person's sense of self and the need to be respected and it is a key factor that contributes to women's satisfaction with their birth experiences.

AIM

To examine the meaning of privacy for Jordanian women during labour and birth.

METHOD

A qualitative interpretive design was used. Data were collected through face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan while seven were living in Australia (with birthing experience in both Jordan and Australia). Thematic analysis was used to analyse the data.

RESULTS

The phrase 'there is no privacy' captured women's experience of birth in Jordanian public hospitals and in some private hospital settings. Women in public hospitals in Jordan had to share a room during their labour with no screening. This experience meant that they were, "lying there for everyone to see", "not even covered by a sheet" and with doctors and others coming in and out of their room. This experience contrasted with birth experienced in Australia.

CONCLUSIONS

This study explicates the meaning of privacy to Jordanian women and demonstrates the impact of the lack of privacy during labour and birth. Seeking a birth in a private hospital in Jordan was one of the strategies that women used to gain privacy, although this was not always achieved. Some strategies were identified to facilitate privacy, such as being covered by a sheet; however, even simple practices are difficult to change in a patriarchal, medically dominated maternity system.

Anxiety or Nervousness Disturbs the Progress of Birth Based on Human Behavioral Evolutionary Biology

In general, anxiety or nervousness in pregnant women increases the risk of dystocia. Pregnant women are easily susceptible to anxiousness or nervousness. To support a safe and healthy birthing process, childbirth educators, other health-care professionals, and pregnant women require an in-depth understanding about the disruptive effects of anxiety or nervousness on birth progress. Anxiety and nervousness are difficult to quantify and may be influenced by culture. Therefore, reports comparing anxiety or nervousness with dystocia must include various biases. It is difficult to find this issue by medical research. Here, we discuss links between anxiety or nervousness and disturbance in the progress of birth based on the adaptive standpoint of human behavioral evolutionary biology.

Stress caused by environmental effects on the birth process and some of the labor hormones at rats: ideal birth environment and hormones

OBJECTIVE

The aim of this study was to compare the effect of environmental conditions on the birth hormones and the labor of rats.

MATERIALS AND METHODS

This Study is animal experiment. A total of of 18 pregnant Sprague Dawley rats were divided into control, stress and enriched groups. Animals in the stress group were exposed to unexpected variable stress paradigm three times a day during the third trimester of their pregnancies. Whereas animals raised in the enriched environment were kept in larger cages equipped with various toys. They were subjected to open field test for 5 minutes in the last trimester. Blood samples were taken from the tail vein at the beginning of birth, and 10 parameters (including corticotropin-releasing hormone, oxytocin, endorphin, epinephrine, norepinephrine, prolactin, estrogen, progesterone, vasopressin, and brain-derived neurotrophic factor) involved in labor were assessed. Kruskal Wallis, Mann Whitney U, and Spearman's rho correlation analysis were used to compare data.

RESULTS

Interactions of hormones were significantly different among the groups. While hormonal interactions in the control group were similar to the physiological parameters, other groups displayed various results. There were significant (p < .05) differences in the values of corticotropin-releasing hormone (CRH) and vasopressin hormone levels. In the open Field test, standing distribution scores of animals displayed differences among control, stress and enriched environment groups (p < .05).

CONCLUSION

These results showed that labor environment diversely affects physiology aspects of birth. It is known that many factors such as procedures in a hospital environment, birth environment, noise, and birth position affect the hormones at birth. Therefore, the birth environment, either at home or at the hospital, needs to be well-organized accordingly.

The Impact of the Physical Environment on Intrapartum Maternity Care: Identification of Eight Crucial Building Spaces

Objectives, Purpose, or Aim:

This article investigates whether the physical environment in which childbirth occurs impacts the intrapartum intervention rates and how this might happen. The study explores the spatial physical characteristics that can support the design of spaces to promote the health and well-being of women, their supporters, and maternity care professionals.

Background:

Medical interventions during childbirth have consequences for the health of women and babies in the immediate and long term. The increase in interventions is multifactorial and may be influenced by the model of care adopted, the relationships between caregivers and the organizational culture, which is made up of many factors, including the built environment. In the field of birth architecture research, there is a gap in the description of the physical characteristics of birth environments that impact users’ health.

Method:

A scoping review on the topic was performed to understand the direct and indirect impacts of the physical environment on birth intervention rates.

Results and Discussion:

The findings are organized into three tables reporting the influence that the physical characteristics of a space might have on people’s behaviors, experiences, practices and birth health outcomes. Eight building spaces that require further investigation and research were highlighted: unit layout configuration, midwives’ hub/desk, social room, birth philosophy vectors, configuration of the birth room, size and shape of the birth room, filter, and sensory elements.

Conclusions:

The findings show the importance of considering the physical environment in maternity care and that further interdisciplinary studies focused on architectural design are needed to enrich the knowledge and evidence on this topic and to develop accurate recommendations for designers.

Are health facilities well equipped to provide basic quality childbirth services under the free maternal health policy? Findings from rural Northern Ghana

BACKGROUND

Basic inputs and infrastructure including drugs, supplies, equipment, water and electricity are required for the provision of quality care. In the era of the free maternal health policy in Ghana, it is unclear if such basic inputs are readily accessible in health facilities. The study aimed to assess the availability of basic inputs including drugs, supplies, equipment and emergency transport in health facilities. Women and health providers' views on privacy and satisfaction with quality of care were also assessed.

METHODS

The study used a convergent parallel mixed methods in one rural municipality in Ghana, Kassena-Nankana. A survey among facilities (n = 14) was done. Another survey was carried out among women who gave birth in health facilities only (n = 353). A qualitative component involved focus group discussions (FGDs) with women (n = 10) and in-depth interviews (IDIs) with midwives and nurses (n = 25). Data were analysed using descriptive statistics for the quantitative study, while the qualitative data were recorded, transcribed, read and coded using themes.

RESULTS

The survey showed that only two (14%) out of fourteen facilities had clean water, and five (36%) had electricity. Emergency transport for referrals was available in only one (7%) facility. Basic drugs, supplies, equipment and infrastructure especially physical space were inadequate. Rooms used for childbirth in some facilities were small and used for multiple purposes. Eighty-nine percent (n = 314) of women reported lack of privacy during childbirth and this was confirmed in the IDIs. Despite this, 77% of women (n = 272) were very satisfied or satisfied with quality of care for childbirth which was supported in the FGDs. Reasons for women's satisfaction included the availability of midwives to provide childbirth services and to have follow-up homes visits. Some midwives were seen to be patient and empathetic. Providers were not satisfied due to health system challenges.

CONCLUSION

Government should dedicate more resources to the provision of essential inputs for CHPS compounds providing maternal health services. Health management committees should also endeavour to play an active role in the management of health facilities to ensure efficiency and accountability. These would improve quality service provision and usage, helping to achieve universal health coverage.

Optimal settings for childbirth

Many studies highlight how health is influenced by the settings in which people live, work, and receive health care. In particular, the setting in which childbirth takes place is highly influential. The physiological processes of women's labor and birth are enhanced in optimal ("salutogenic," or health promoting) environments. Settings can also make a difference in the way maternity staff practice. This paper focuses on how positive examples of Italian birth places incorporate principles of healthy settings. The "Margherita" Birth Center in Florence and the Maternity Home "Il Nido" in Bologna were purposively selected as cases where the physical-environmental setting seemed to reflect an embedded model of care that promotes health in the context of childbirth. Narrative accounts of the project design were collected from lead professional and direct inspections performed to elicit the key salutogenic components of the physical layout. Comparisons between cases with a standard hospital labor ward layout were performed. Cross-case similarities emerged. The physical characteristics mostly related to optimal settings were a result of collaborative design decisions with stakeholders and users, and the resulting local intention to maximize safe physiological birth, psychosocial wellbeing, facilitate movement and relaxation, prioritize space for privacy, intimacy, and favor human contact and relationships. The key elements identified in this paper have the potential to inform further investigations for the design or renovation of all birth places (including hospitals) in order to optimize the salutogenic component of any setting in any country.

Is the Birthing Unit Design Spatial Evaluation Tool valid for diverse groups?

BACKGROUND

Awareness of the impact of the built environment on health care outcomes and experiences has led to efforts to redesign birthing environments. The Birth Unit Design Spatial Evaluation Tool was developed to inform such improvements, but it has only been validated with caseload midwives and women birthing in caseload models of care.

AIM

To assess the content validity of the tool with four new participant groups: Birth unit midwives, Aboriginal or Torres Strait Islander women; women who had anticipated a vaginal birth after a caesarean; and women from refugee or culturally and linguistically diverse backgrounds.

METHODS

Participants completed a Likert-scale survey to rate the relevance of The Birth Unit Design Spatial Evaluation Tool's 69 items. Item-level content validity and Survey-level validity indices were calculated, with the achievement of validity set at >0.78 and >0.9 respectively.

RESULTS

Item-level content validity was achieved on 37 items for birth unit midwives (n=10); 35 items for Aboriginal or Torres Strait Islander women (n=6); 33 items for women who had anticipated a vaginal birth after a caesarean (n=6); and 28 items for women from refugee or culturally and linguistically diverse backgrounds (n=20). Survey-level content validity was not demonstrated in any group.

CONCLUSION

Birth environment design remains significant to women and midwives, but the Birth Unit Design Spatial Evaluation Tool was not validated for these participant groups. Further research is needed, using innovative methodologies to address the subconscious level on which environment may influence experience and to disentangle the influence of confounding factors.

Women's experiences of continuous support during childbirth: a meta-synthesis

Background

Despite the known benefits of continuous support during childbirth, the practice is still not routinely implemented in all maternity settings and women’s views and experiences might not be considered.

The purpose of the study was to integrate individual studies’ findings related to women’s experiences of continuous support during childbirth in order to expand the understanding of the phenomenon. The review question was: What were the views and experiences of women regarding continuous support during childbirth as reported in studies that adopted qualitative or mixed research methods (with a qualitative component) using semi-structured, in-depth or focus group interviews or case studies?

Methods

A detailed search was executed on electronic data bases: EBSCOhost: Medline, CINAHL, PsychINFO, SocINDEX, OAlster, Scopus, SciELO, Science Direct, PubMED and Google Scholar, using a predetermined search strategy. Reference lists of included studies were analysed to identify possible studies that were missing from electronic data bases.

Pre-determined inclusion and exclusion criteria were applied during the selection of eligible sources. After critical appraisal, a total of 12 studies were included for data-extraction and meta-synthesis.

Results

Two themes were identified, namely the roles and attributes of the support persons and the type of support provided. Women’s perceptions about continuous support during childbirth were influenced by the characteristics and attributes of the support person as well as the types of supportive care rendered. Women preferred someone with whom they were familiar and comfortable.

Conclusion

Continuous support during childbirth was valued by most women. Their perceptions were influenced by the type of support person: a health professional or a lay support person. Health care institutions should include continuous support during childbirth in their policies and guidelines.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1755-8) contains supplementary material, which is available to authorized users.

Challenges in implementing continuous support during childbirth in selected public hospitals in the North West Province of South Africa

Background

According to a Cochrane review, continuous support during childbirth increases the mother’s chances of a vaginal birth without identified adverse effects. However, this evidence-based practice is not universally implemented. The objective of the study was to identify challenges encountered in implementing continuous support during childbirth in public hospitals in the North West Province of South Africa.

Method

An explorative, descriptive and contextual qualitative approach was used. The data were collected during 2013 by conducting focus group interviews with 33 registered midwives who had worked in maternity units in three selected public hospitals in the North West Province for at least two years.

Results

Midwives identified challenges that negatively impacted the implementation of continuous support during childbirth at organisational and interpersonal levels. At the organisational level, challenges included human resources, policies and guidelines as well as the architectural outlay of the maternity units. The personal challenges related to communication and attitudes of nurses, patients and their families.

Conclusions

Organisational and personal challenges had a negative impact on the provision of continuous care during childbirth.

Experiences of Austrian mothers with mobility or sensory impairments during pregnancy, childbirth and the puerperium: a qualitative study

BACKGROUND

Approximately 8% of all women of childbearing age in Austria live with permanent impairments. In everyday life, women with disabilities face various challenges and discrimination, among which the issue of pregnancy and motherhood, in particular, is often considered taboo, and their parenting abilities are doubted. Knowledge in the medical field about the experiences of women with disabilities during pregnancy, childbirth and the puerperium is limited.

METHODS

To investigate the personal meanings and experiences of women with disabilities in regard to pregnancy, childbirth and the puerperium, in-depth individual, semi-structured interviews were conducted with ten mothers with various mobility or sensory impairments who reside in Austria. The qualitative interview data were analyzed using the qualitative content analysis proposed by Mayring.

RESULTS

Three main themes or categories emerged from the inductive content analysis, namely, (i) the social network, (ii) self-efficacy and self-awareness and (iii) communication, transparency and information. Participants reported limited acceptance of their life decisions and experienced an environment of discriminatory attitudes. They experienced a lack of support and lack of confidence in their parenting abilities, which negatively influenced their self-efficacy and self-awareness. Violations of personal borders and a feeling of being watched and controlled were reported. Communication with health care professionals was often characterized by mutual aspects of fear, uncertainty and awkwardness, as perceived by women with disabilities. Adequate information about pregnancy, childbirth and the puerperium, particularly about measures taken and interventions applied, was frequently missing.

CONCLUSION

Heath care facilities need to be structured to ensure ease of access for women with disabilities. Education should be offered to health care professionals to improve knowledge about care for women with disabilities and to strengthen communication skills. All necessary information needs to be prepared and provided in an adequate manner. The establishment of a health-promoting environment for mothers, their children and their families requires a sensitive, respectful and non-judgmental attitude of society toward women with disabilities during pregnancy, childbirth and the puerperium.

Women’s Experience of Birth: Childbirth as a Rite of Passage

BACKGROUND: Within midwifery, there is a move toward reclaiming and promoting physiological birth. Because midwifery is woman-centered in nature, it is essential that the experience of birth is understood from the woman’s perspective. To date, there has been little research focusing exclusively on women’s experience of physiological birth.

AIM: The aim of this study was to explore women’s experiences of physiological birth.

METHOD: A narrative approach was taken, and in-depth face-to-face interviews were used to gather birth stories. The participants were 10 women who had recently experienced a physiological birth. Data were analyzed to identify themes occurring across the narratives.

FINDINGS: The findings are presented within the explanatory framework of childbirth as a rite of passage composing of three phases: separation, liminal, and incorporation. During birth, women separated from the external world and sought to minimize external and internal distractions. In the liminal phase, they entered “their own world” and experienced an altered state of consciousness. After their baby was born, they reintegrated with the external world and incorporated their birth experience into their sense of self.

CONCLUSION: The findings of this study suggest that women’s experiences during physiological birth are multidimensional and not aligned with biomedical descriptions of physically defined stages of labor. Birth was an empowering and transformative experience for the women in the study. The rites of passage framework may assist with developing a discourse about birth that resonates with women’s experiences.

[Advantages and disadvantages of water birth. A systematic review of the literature]

CONTEXT

Water birth is under debate among professionals. For the proponents of this approach, immersion in water during labour and birth may increase maternal relaxation, reduce analgesia requirements and promote a model of obstetric care more focused on the needs of mothers, particularly the empowerment of women to realize their full potential. In contrast, major critics cite a risk of inhalation of water for the newborn and a risk of infection for the mother and the newborn.

OBJECTIVE

This review tracks the state of scientific knowledge about water birth in order to determine if it can be generalized in hospitals.

METHOD

A systematic review of the literature was conducted in PubMed, Embase and Cochrane Database. The period covered is from January 1989 to May 2013. The level of evidence of the studies was assessed with the analysis guide of the Haute Autorité de santé.

RESULTS

The level of evidence of the studies identified goes from moderate to low, particularly as regard to studies analysing the expulsion phase.

CONCLUSION

It is possible to recommend immersion in water during the labour phase. No recommendation can be made as regard to the foetal expulsion phase.

Exploring women's personal experiences of giving birth in Gonabad city: a qualitative study

BACKGROUND

Women's health is an important task in society. The aim of this qualitative study that used a phenomenological approach was to explain women's personal experiences of giving birth in Gonabad city that had positive experiences of giving birth in order to establish quality cares and the related factors of midwifery cares for this physiological phenomenon.

METHODS

The participants were 21 primiparae women who gave a normal and or uncomplicated giving birth in the hospital of Gonabad University of medical sciences. Based on a purposeful approach in-depth interviews were continued to reach data saturation. The data were collected through open and semi-structured interactional in-depth interviews with all the participants. All the interviews were taped, transcribed and then analyzed through a qualitative content analysis method to identify the concepts and themes.

FINDINGS

Some categories were emerged. A quiet and safe environment was the most urgent need of the most women giving birth. Unnecessary routine interventions that are performed on all women regardless of their needs and should be avoided were considered such as: "absolute rest, establishing vein, frequent vaginal examinations, fasting and early Amniotomy". All the women wanted to take part actively in their giving birth, because they believed it could affect their giving birth.

CONCLUSION

We hope that the women's experiences of giving birth will be a pleasant and enjoyable experience for all the mothers giving birth.

Development and psychometric testing of the scales for measuring maternal satisfaction in normal and caesarean birth

OBJECTIVE

to develop a scale to measure maternal satisfaction with birth to evaluate women's experiences in labour and the early postpartum period.

DESIGN

development and psychometric assessment of a multidimensional maternal satisfaction questionnaire.

SETTING

maternity unit of a university hospital in Istanbul.

PARTICIPANTS

500 healthy postpartum women.

METHODS

five steps were taken in development of the scale: literature review, generating item pool, content validity testing, administration of draft scale and psychometric testing. Two versions of the scale were developed: the Scale for Measuring Maternal Satisfaction-normal birth and the Scale for Measuring Maternal Satisfaction-caesarean birth. Content validity was evaluated by experts. The appropriate draft scale and the Newcastle Satisfaction with Nursing Scale were administered to postpartum women before hospital discharge.

FINDINGS

content validity index scores for the vaginal and caesarean birth scales were 0.91 and 0.89, respectively. Item-total and subscale-total scores correlated significantly for each scale. Evaluation of construct validity through factor analysis yielded 10 subscales: 'perception of health professionals', 'nursing/midwifery care in labour (in caesarean version: preparation for caesarean)', 'comforting', 'information and involvement in decision making', 'meeting baby', 'postpartum care', 'hospital room', 'hospital facilities', 'respect for privacy' and 'meeting expectations'. Both scales had good internal reliability, with Cronbach's α coefficients of 0.91. The scales established their convergent validity with significant correlations with the Newcastle Satisfaction with Nursing Scale.

CONCLUSION

the scales are valid and reliable tools for evaluating Turkish women's experiences in labour and the early postpartum period.

IMPLICATIONS FOR PRACTICE

the scales can contribute to the assessment of women's satisfaction with different aspects of care, the quality of care and developments in maternity services.

Perceived environmental stressors and pain perception during labor among primiparous and multiparous women

INTRODUCTION

Pain experienced during labor is probably the most painful event in the lives of women. Environment itself influences a mother's experience of pain. Tension and stress resulting from pregnancy crisis and labor increase when the mother is hospitalized, which is concomitant with stressful situations and factors that affect pain perception during labor. The purpose of this study was to explore selected aspects of labor stress and specifically study the relationship between environmental factors and pain perception among parturient women.

MATERIALS AND METHODS

This descriptive-comparative study was carried out in Tabriz Alzahra Hospital during 2005-2006. In this study, 300 primiparous and 300 multiparous women who were candidates for vaginal delivery, were randomly selected and interviewed. The data were collected by a questionnaire and the intensity of pain was determined by Visual Analogue Scale (VAS).

RESULTS

Significant positive correlations were found between pain and tension from environmental factors in primiparous (r=0.16, p<0.01) and in multiparous (r=0.22, p<0.05) women. Furthermore, primiparous women believed that a crowded delivery room (70%) and restriction of movement and mobility (67%) contributed to their environmental stresses. Multiparas women believed that noise in the delivery ward (84%) and restrict of fluid intake (78%) increased their stresses.

CONCLUSION

Performance of routine diagnostic tests in hospitalized pregnant woman, provision of invasive medical care during labor process and a noisy and crowded environment all influence the mother's experience and perception of pain. Therefore, the medical staffs seem to play a great role in alleviating labor pain by reducing stressors, especially the objective ones that are more stressful.