Mediating expectations and experiences that influence birth experiences in Canada's first Alongside Midwifery Unit

BACKGROUND

Globally, midwifery-led birthing units are associated with excellent maternal and neonatal outcomes, and positive childbirth experiences. However, little is known about what aspects of midwife-led units contribute to favorable experiences and overall satisfaction. Our aim was to explore and describe midwifery service user experiences at Canada's first Alongside Midwifery Unit (AMU).

METHODS

We used a qualitative, grounded theory approach using semi-structured interviews with recipients of midwifery care at the AMU.

FINDINGS

Data were collected from twenty-eight participants between September 2018 and March 2020. Our generated theory explains how birth experiences and satisfaction were influenced by how well the AMU aligned with expectations or desired experiences related to the following four themes: (1) maintaining the midwifery model of care, (2) emphasizing control and choice, (3) facilitating interprofessional relationships, and (4) appreciating the unique AMU birthing environment.

CONCLUSION

Canada's first AMU met or exceeded service-user expectations, resulting in high levels of satisfaction with their birth experience. Maintaining core elements of the midwifery model of care, promoting high levels of autonomy, and facilitating positive interprofessional interactions are crucial elements contributing to childbirth satisfaction in the AMU environment.

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.

The Effect of Doulas on Maternal and Birth Outcomes: A Scoping Review

A source of support during birth could be the solution to negative outcomes for the mother and her baby. To improve the birthing experience and increase positive birthing outcomes, sources of support during pregnancy should be evaluated and understood. The goal of this review was to synthesize the existing literature on how doulas might improve birth outcomes. This scoping review also aimed to shed light on the positive impact emotional support during childbirth can have on the health and well-being of mother and child. PubMed and EBSCOhost were used to identify articles using the search words with Boolean operators "doulas" AND "labor support" AND "birth outcomes" AND "pregnancy" AND "effects during labor." The eligibility criteria for article selection included primary studies investigating how doulas contributed to birth outcomes. The studies in this review indicated that doula guidance in perinatal care was associated with positive delivery outcomes including reduced cesarean sections, premature deliveries, and length of labor. Moreover, the emotional support provided by doulas was seen to reduce anxiety and stress. Doula support, specifically in low-income women, was shown to improve breastfeeding success, with quicker lactogenesis and continued breastfeeding weeks after childbirth. Doulas can be a great resource for birthing mothers, and consideration should be given to using them more, as they may have a positive impact on the well-being of the mother and child. This study raised questions about the accessibility of doulas and how they may help mitigate health disparities among women from different socioeconomic levels.

My Story: The Transforming Power of Birth

In this column Henci Goer shares the stories of her two births and how those births shaped her life's work. With her first birth she believed that her caregivers knew better than she what was right for her. During the birth she was ignored. She was left feeling distressed and diminished. Her second birth was dramatically different. She was an active participant, listened to, respected and part of decision-making. She highlights that no matter how difficult the birth, whether things go as planned or not, the joy, the pride, the satisfaction with birth comes with being listened to, respected, and part of decision-making. This birth story is an excerpt from Henci Goer's recent publication, Labor Pain: What's Your Best Strategy? (2022).

My Drug-Free VBAC During Covid

In 2016, I had a complicated cesarean. My daughter was breech and I ended up with a crash cesarean resulting in internal organ damage; furthermore, she was born with a complete cleft lip and palate, so breastfeeding was not possible. In spring 2020, as the world was locking down for Covid, I found out I was having a baby boy, due in September. I wanted to try for a VBAC (vaginal birth after cesarean) to reduce my risk of complications and to heal emotionally from the complicated cesarean. My OB-GYN advised me to stay home as long as possible, as my designated hospital was not known for encouraging VBACs. I woke up on August 29 at 4:30am, 2 weeks before my due date, having mild contractions. I ate, read a book, and timed my contractions and tried to be quiet so as not to wake anyone up. By 6:30am, the contractions were strong so I woke up my husband and we dropped our two girls off with a family friend. We dropped them off at 7:20 and raced to the hospital. Luckily the hospital was only 2 miles away. I showed up fully dilated and ready to push. I would have had my son in the parking lot if a bystander hadn't brought a wheelchair. I had to sign a consent paper and do the rapid Covid test after delivering my son. It was an incredibly healing birth.

Freestanding Birth Centers: An Evidence-Based Option for Birth

Every childbearing person has the right to learn about all options for perinatal care provider and birth setting. To ensure an informed decision about their preferred birth plan, information should be provided either preconceptionally or in early pregnancy. Personal preferences and risk status should be considered in decision-making. Numbers of births in birth centers have doubled over past decade to almost 20,000 births per year. The evidence shows that childbearing people who participate in birth center care, even if they have only birth center prenatal care, experience better outcomes including lower rates of preterm birth, low birth weight births, and cesarean birth, and higher rates of breastfeeding when compared to people with similar risk profiles who receive typical perinatal care.

Evaluation of the effect of Birth Preparation Program on birth satisfaction with "Salmon's Item List" scale

OBJECTIVES

The aim of this study is to investigate the effects of a birth preparation program on birth satisfaction.

MATERIAL AND METHODS

This cross-sectional study was conducted with patients who applied to our hospital between January 2018 and January 2019. A total of 164 pregnant women (Study Group) who applied for the birth preparation program and completed all training in our hospital and 152 pregnant women who did not apply for the birth preparation program and who did not know about such training (Control Group) were included in the study. Demographical data and obstetric parameters of the groups were recorded. All patients were evaluated with the Visual Analog Scale and Salmon's Item List scale 48 hours after the delivery. The scores of both groups were compared.

RESULTS

There were no significant differences between the groups in terms of age, gravida, parity, gestational week of birth, the birth weight of infants, and 5th-minute APGAR scores. It was found that the Visual Analog Scale scores of the Control Group were significantly higher than in the Study Group. The Salmon's Item List scores of the Study Group were significantly higher than those of the patients in the Control Group (< 0.01).

CONCLUSIONS

The birth preparation program increases satisfaction during labor and decreases the traumas that may occur in the following births and increase comfort in the postpartum period. For this reason, such programs must be applied commonly to ensure that women can face both the birth and postpartum processes comfortably.

This Birth (Story) Was a Long Time Coming

The story of Joyce's birth describes a long, hard labor and the determined commitment and hard work of her mother to have a natural birth. This birth story presents a deeply moving, personal reflection on when cesarean surgery is the right choice even if not the preferred outcome.

Giving birth with epidural analgesia: the experience of first-time mothers

The purpose of our qualitative descriptive study was to describe the birth experiences of women using epidural analgesia for pain management. We interviewed nine primiparas who experienced vaginal births. Five themes emerged: (a) coping with pain, (b) finding epidural administration uneventful, (c) feeling relief having an epidural, (d) experiencing joy, and (e) having unsettled feelings of ambivalence. Although epidural analgesia was found to be effective for pain relief and may contribute to some women's satisfaction with the birth experience, it does not guarantee a quality birth experience. In order to support and promote childbearing women's decision making, we recommend improved education on the variety of available pain management options, including their risks and benefits. Fostering a sense of caring, connection, and control in women is a key factor to ensure positive birth experiences, regardless of pain management method.

Participant experiences of mindfulness-based childbirth education: a qualitative study

BACKGROUND

Childbirth is an important transitional life event, but one in which many women are dissatisfied stemming in part from a sense that labour is something that happens to them rather than with them. Promoting maternal satisfaction with childbirth means equipping women with communication and decision making skills that will enhance their ability to feel involved in their labour. Additionally, traditional antenatal education does not necessarily prepare expectant mothers and their birth support partner adequately for birth. Mindfulness-based interventions appear to hold promise in addressing these issues. Mindfulness-based Child Birth Education (MBCE) was a pilot intervention combining skills-based antenatal education and Mindfulness Based Stress Reduction. Participant experiences of MBCE, both of expectant mothers and their birth support partners are the focus of this article.

METHODS

A generic qualitative approach was utilised for this study. Pregnant women between 18 and 28 weeks gestation, over 18 years of age, nulliparous with singleton pregnancies and not taking medication for a diagnosed mental illness or taking illicit drugs were eligible to undertake the MBCE program which was run in a metropolitan city in Australia. Focus groups with 12 mothers and seven birth support partners were undertaken approximately four months after the completion of MBCE. Audio recordings of the groups were transcribed verbatim and analysed thematically using the method of constant comparison by all four authors independently and consensus on analysis and interpretation arrived at through team meetings.

RESULTS

A sense of both 'empowerment' and 'community' were the essences of the experiences of MBCE both for mothers and their birth support partner and permeated the themes of 'awakening my existing potential' and 'being in a community of like-minded parents'. Participants suggested that mindfulness techniques learned during MBCE facilitated their sense of control during birth, and the content and pedagogical approach of MBCE enabled them to be involved in decision making during the birth. The pedagogical approach also fostered a sense of community among participants which extended into the postnatal period.

CONCLUSIONS

MBCE has the potential to empower women to become active participants in the birthing process, thus addressing common concerns regarding lack of control and satisfaction with labour and facilitate peer support into the postnatal period. Further education of health professionals may be needed to ensure that they respond positively to those women and birth support partners who remain active in decision making during birth.

Step 1: offers all birthing mothers unrestricted access to birth companions, labor support, professional midwifery care: the coalition for improving maternity services:

The first step of the Ten Steps of Mother-Friendly Care insures that women have access to a wide variety of support in labor and during the pregnancy and postpartum periods: unrestricted access to birth companions of their choice, including family and friends; unrestricted access to continuous emotional and physical support from a skilled woman such as a doula; and access to midwifery care. The rationales for the importance of each factor and the evidence to support those rationales are presented.

Construct validity of the childbirth trauma index for adolescents

The potentially traumatic nature of childbirth for adult mothers has been confirmed in research; however, adolescent childbirth trauma is unexplored. This article presents research on the construct validity of the Childbirth Trauma Index by providing a conceptual analysis of psychological childbirth trauma, factor validity of the Childbirth Trauma Index, and discussion of testing the Childbirth Trauma Index via contrasted-groups approach. Childbirth trauma can result in an acute stress reaction or actual posttraumatic stress disorder. Using subjective reports, the Impact of Event Scale, and the Childbirth Trauma Index, an appraisal of birth trauma, trauma impact, and indicators associated with childbirth trauma were revealed among 112 adolescents. Clinical implications and research recommendations are offered.