"Make it better for the women and babies who come after me": Findings from women in Australia completing the international Babies Born Better survey

BACKGROUND

Woman-centered maternity service delivery is endorsed by Australian federal health policy. Despite this, little evaluation of maternity care is conducted through the lens of women. We examined the responses of women birthing in Australia to the international Babies Born Better 2018 (Version 2) open-response survey.

METHODS

An online international survey was distributed primarily by means of social media for women who had given birth in the last 5 years. In addition to closed-ended questions to describe the sample, a series of open-ended questions recorded women's experiences and satisfaction with their maternity care and place of birth.

RESULTS

Of 1249 women who reported birthing their most recent baby in Australia and speaking English, 84% responded to at least one open-ended evaluation question. We thematically analyzed the data to identify three related themes of safety, choice, and respect for women. Women's experiences of these were closely tied to their model of care; those birthing at home with a private midwife more so reported positive experiences than those discussing obstetric care or, to a lesser extent, midwifery-led care in a hospital. There was a strong preference and need for (1) access to affordable care with a known practitioner from early pregnancy to postpartum, and (2) individualized care with the removal of restrictive hospital policies not aligned with woman-centered practice.

DISCUSSION

This is the first Australian national study of women's maternity experiences and evaluations. Consistent with previous state-based research, women birthing in Australia continue to report maternity "care" that is physically and emotionally harmful. They also stated a need to address the psychosocial aspects of becoming a mother, in addition to the biological ones. Women and other birthing people must be at the center of defining quality maternity health service delivery, and services must be accountable for preventing and addressing harm, as defined by all birthing people.

What influences women's experiences of childbirth in Flanders? - A quantitative cross-sectional analysis of the Babies Born Better survey

OBJECTIVE

Labour and birth experiences are of great importance since these can have positive, but also negative effects on women's health and wellbeing. This is the first study, which investigated the factors that influence women's experiences of childbirth in Flanders, Belgium.

DESIGN

A cross-sectional quantitative analysis was used to examine primary data obtained by the Babies Born Better project. Data collection took place via an online survey from April 2018 until August 2018 in Flanders.

PARTICIPANTS

1414 women that gave birth across all birth settings between 2013 and 2018, who speak Flemish/Dutch were included. Participants were self-selected by filling out the Babies Born Better survey in 2018.

FINDINGS

The majority of the Flemish women included in this study reported a positive labour and birth experience. Analysis of the demographic variables showed that women who were single or not co-habiting reported a worse experience of labour and birth (P = 0.012). All obstetric factors included showed significant differences (P<0.01). Lastly, women were more likely to report a better experience when birth took place at home or in a midwifery unit and when the main care provider was a midwife (P<0.01). When controlled for significant variables from the univariate analysis, an impact on the birth experience was only found with the obstetric factors. A preterm (OR 0.544, 95%CI 0.362-0.817) and post term birth (OR 0.664, 95% CI 0.462-0.953) were found to reduce the chance of a good experience compared to a birth at term. In case of complications during pregnancy, women were less likely to report having had a good experience (OR 0.632, 95% CI 0.470 - 0.849). Medical interventions such as induction- (OR 0.346, 95% CI 0.241 - 0.497) and augmentation of labour (OR 0.318, 95% CI 0.218-0.463), an instrumental birth (OR 0.318, 95% CI 0.218-0.463) or a planned- (OR 0.349, 95% CI 0.205-0.596) or emergency caesarean section (OR 0.190, 95% CI 0.109-0.329) reduced the chances of women reporting to have had a good experience with care around labour and birth.

KEY CONCLUSIONS

The majority of women included in this study reported a good experience of care during labour and at birth. Certain obstetric factors such as having a straightforward pregnancy without complications, a physiological onset of labour at term without the need for augmentation and to give birth vaginally (without instrument) have shown a positive impact on women's reported birth experiences.

IMPLICATIONS FOR PRACTICE

Women's involvement in decision-making, especially when medical interventions are wanted or needed can improve positive birth experiences. More research is needed on how to support women and empower them, even more so in case of complications to ensure a sense of control and achievement.

'To be Informed and Involved': Women's insights on optimising childbirth care in Lithuania

INTRODUCTION

The user expectations and experiences of healthcare services are acknowledged as components of the quality of healthcare evaluations. The aim of the study is to analyse women's experiences and views on childbirth care in Lithuania.

METHODS

The study used the Babies Born Better (B3) online survey as the data collection instrument. The B3 is an ongoing longitudinal international project, examining the experiences of intrapartum care and developed as part of EU-funded COST Actions (IS0907 and IS1405). Responses to open-ended questions about (1) the best things about the care and (2) things in childbirth care worth changing are included in the current analysis. The participants are 373 women who had given birth within 5 years in Lithuania. A deductive coding framework established by the literature review was used to analyse the qualitative data. The framework involves three main categories: (1) the service, (2) the emotional experience and (3) the individually experienced care, each further divided into subcategories.

RESULTS

Reflecting the experience and views regarding the service at birthplace women wished empowerment, support for their autonomy and to be actively involved in decisions, the need for privacy, information and counselling, especially about breastfeeding. In terms of emotional experience, women highlighted the importance of comprehensibility/feeling of safety, positive manageability of various situations and possibilities for bonding with the newborn. Individually experienced care was described by feedback on specific characteristics of care providers, such as competence, personality traits, time/availability and encouragement of esteem in women in childbirth. The possibilities of homebirth were also discussed. The findings reflected salutogenic principles.

KEY CONCLUSIONS

The findings suggest that the Lithuanian healthcare system is in a transition from paternalistic attitude-based practices to a shift towards patient-oriented care. Implementation of the improvements suggested for women in childbirth care in Lithuania would require some additional services, improved emotional and intrapersonal aspects of care and a more active role for women.

PATIENT/PUBLIC CONTRIBUTION

Patients and the public contributed to this study by spreading information about surveys and research findings through their involvement in service user groups that have an interest in maternity care. Members of the patients' groups and the public were involved in the discussion of the results.

Analysis of the Concept of Obstetric Violence: Scoping Review Protocol

(1) Background: Obstetric violence has been highlighted in the political and social agenda of several countries. Efforts have been made to create policies to humanize obstetric care, guarantee the rights of pregnant women and respond to this form of violence. The lack of consensus on the appropriate terminology to name and define the behaviours that constitute obstetric violence, hinders this process. (2) Objective: To analyse the concept of obstetric violence related to assistance to women during labor. (3) Methodology: Scoping review protocol, according to the Joanna Briggs Institute method. The search will be performed on EBSCOhost Research Platform, PubMed, Virtual Health Library and SciVerse Scopus databases. The Open Scientific Repository of Portugal will also be considered. All types of studies, published in the last 10 years, in English, Spanish and Portuguese languages, constitute inclusion criteria. Studies of women experiencing labor, in a hospital setting, that address the dimensions of the concept of obstetric violence will be reviewed. (4) Discussion: The results will serve as a basis for identifying the appropriate terminology of the concept of obstetric violence, in order to direct future research with interest in the problem.