The experience of perinatal care at a birthing center: a qualitative pilot study

Prenatal care in US birth centers: Midwives' perceptions of contributors to birthing People's confidence in physiologic birth

OBJECTIVE

The purpose of this study was to describe US freestanding birth center models of prenatal care and to examine how the components of this care contribute to birthing people's confidence in their ability to have a physiologic birth.

DESIGN

This was a qualitative descriptive study utilizing semi-structured interviews with birth center midwives. Data were analyzed using thematic analysis, constant comparative method and consensus coding to ensure rigor.

SETTING AND PARTICIPANTS

Midwives from six urban and rural freestanding birth centers in a Midwestern US state were interviewed. Twelve birth center midwives participated.

FINDINGS

Six themes emerged: the birth center physical space and organization of care, dimensions of midwifery care within the birth center, continuity of care and seamless service, the empowered birthing person, physiologic birth as normative, and the hospital paradigm and US cultures of birth.

KEY CONCLUSIONS

We identified significant components of birth center models of prenatal care that midwives believe enhance birthing people's confidence for physiologic childbirth. These components may be considered for application to other settings and may improve perinatal care and outcomes.

A Qualitative Study of US Women's Perspectives on Confidence for Physiologic Birth in the Birth Center Model of Prenatal Care

INTRODUCTION

The purpose of this study was to increase understanding of the components of the US birth center model of prenatal care and how the birth center prenatal care model contributes to birthing people's confidence for physiologic childbirth.

METHODS

This was a qualitative descriptive study using semistructured interviews with individuals who gave birth in freestanding birth centers. Birthing people were recruited from freestanding birth centers in a Midwestern US state and were between the ages of 18 and 42, were English-speaking, and had experienced a birth center birth within the previous 6 months. Interviews were transcribed and analyzed using Glaser's constant comparative method.

RESULTS

Twelve women who gave birth in birth centers, representing urban and rural settings, participated. Four core categories were identified encompassing the components of birth center prenatal care and how the birth center model contributes to women's confidence for physiologic birth: birth center culture and processes, midwifery model of care within the birth center, internal influences, and outside influences.

DISCUSSION

Women who gave birth in birth centers believed that the birth center culture and environment, the midwifery model of care in the birth center, internal influences including the belief that birth is a normal physiologic process, and outside influences including family support and positive birth stories contributed to their confidence for physiologic birth.

Client satisfaction with existing labor and delivery care and associated factors among mothers who gave birth in university of Gondar teaching hospital; Northwest Ethiopia: Institution based cross-sectional study

BACKGROUND

There are many reasons for mothers not receiving modern obstetric care, being dissatisfied by health care deliveries is one of the major factors. There are limited studies about maternal satisfaction with labor and delivery care services in Ethiopia and particularly in the study area. Therefore, the aim of this study was to better understand client satisfaction on existing labor and delivery care service and associated factors among mothers who gave birth in the University of Gondar Teaching Hospital, Ethiopia.

METHODS

This institution based cross-sectional study was conducted at the University of Gondar Referral Hospital. 593 mothers who gave birth between July and September 2016 were enrolled. Study participants were selected by systematic random sampling. A standardized, interviewer-administered questionnaire was used to collect data. Descriptive and summary statistics were performed. A linear regression model was fitted and variables having a P value of ≤0.05 in the multivariable model were considered statistically significant.

RESULT

Overall, 31.3% of mothers were satisfied by the existing labor and delivery care. Living in rural areas (-2.9%; 95% CI: -5.75,-0.12) and the presence of a co-morbidity (-3.2%; 95%CI:-5.70, -0.72) were the factor which have a negative influence on maternal satisfaction. On the other hand, travel time to reach to the hospital (hours) (0.79%; 95% CI: 0.07, 1.52), birth by episiotomy or assisted vaginal delivery (6.3%; 95%CI: 1.56, 11.04), and receiving cost-free maternal health services (6.66%; 95%CI: 3.31, 10.01) were the factors that had positive influence.

CONCLUSION

The level of satisfaction of laboring mothers with the labor and delivery care services was poor. Rural residency and chronic medical co-morbidity were negatively associated with level of satisfaction while travel time, mode of delivery, and payment free delivery service had a statistically significant positive influence on satisfaction.

Exploring the Experiences and Perceptions of Women About Childbirth at Birthing Centers in Karachi, Pakistan

Objective:

The purpose of this study was to explore the perceptions of women about childbirth experiences at the birthing centers (BCs) in Karachi, Pakistan.

Design:

A qualitative descriptive exploratory approach was employed using semistructured interviews.

Participants:

A purposive sample of eight women who had used BCs was enrolled from each site.

Findings:

Five themes emerged from content analysis including: (a) satisfaction with BC, (b) provision of homely environment, (c) promotion of normalcy, (d) facilitation of family support, and (e) protection of privacy.

Key Conclusions:

Overall, the findings of the study revealed that women who used BCs were satisfied with the services and the environment provided to them by the midwives during the antenatal, intranatal, and postnatal periods. Most of the women appreciated the privacy offered at the BCs. They considered BCs as a safe, accessible, and affordable option for childbirth and encouraged others in the community to opt for it.

Implications for Practice:

The findings of this study may help to advocate for births at BCs and provide women-friendly maternity care, by giving choice and control to women during childbirth, providing comfort to women by using fewer medical interventions, and promoting normalcy by attending spontaneous vaginal delivery.

Respectful care during childbirth in health facilities globally: a qualitative evidence synthesis

Background

What constitutes respectful maternity care (RMC) operationally in research and programme implementation is often variable.

Objectives

To develop a conceptualisation of RMC.

Search strategy

Key databases, including PubMed, CINAHL, EMBASE, Global Health Library, grey literature, and reference lists of relevant studies.

Selection criteria

Primary qualitative studies focusing on care occurring during labour, childbirth, and/or immediately postpartum in health facilities, without any restrictions on locations or publication date.

Data collection and analysis

A combined inductive and deductive approach was used to synthesise the data; the GRADE CERQual approach was used to assess the level of confidence in review findings.

Main results

Sixty‐seven studies from 32 countries met our inclusion criteria. Twelve domains of RMC were synthesised: being free from harm and mistreatment; maintaining privacy and confidentiality; preserving women's dignity; prospective provision of information and seeking of informed consent; ensuring continuous access to family and community support; enhancing quality of physical environment and resources; providing equitable maternity care; engaging with effective communication; respecting women's choices that strengthen their capabilities to give birth; availability of competent and motivated human resources; provision of efficient and effective care; and continuity of care. Globally, women's perspectives of what constitutes RMC are quite consistent.

Conclusions

This review presents an evidence‐based typology of RMC in health facilities globally, and demonstrates that the concept is broader than a reduction of disrespectful care or mistreatment of women during childbirth. Innovative approaches should be developed and tested to integrate RMC as a routine component of quality maternal and newborn care programmes.

Tweetable abstract

Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies.

Understanding respectful maternity care – synthesis of evidence from 67 qualitative studies.

A metasynthesis of midwife-led care

The purpose of this metasynthesis is to describe and interpret qualitative research relating to midwife-led care to see if it sheds light on why low-risk women experience fewer birth interventions within this model of care. Eleven articles were included in the review. Three themes emerged: (a) relationally mediated benefits for women that resulted in increased agency and empathic care; (b) the problematic interface of midwife-led units with host maternity units, stemming from a clash of models and culture; and (c) greater agency for midwives within midwife-led models of care though bounded by the relationship with the host maternity unit. This metasynthesis suggests that lower rates of interventions could be linked to the greater agency experienced by women and midwives within midwife-led models, and that these effects are mediated, in part, by the smallness of scale in these settings.