Translation and validation of the Hungarian version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

Evidence relating maternal birth experience to a range of maternal and neonatal outcomes is increasingly compelling. Consequently valid and reliable self-report of birth experience from the mothers perspective is critical.

AIM

The current study sought to translate and validate a Hungarian-language version of the Birth Satisfaction Scale-Revised (BSS-R).

METHOD

Following forward and backwards translation into Hungarian, the Hungarian BSS-R (HU-BSS-R) was administered to women in a major Transylvanian hospital maternity unit within 72 h postpartum. Key psychometric characteristics were then examined in relation to factor structure, divergent and convergent validity, internal consistency, and known-groups discriminant validity.

RESULTS

Two-hundred and thirty-two women completed the HU-BSS-R. Confirmatory factor analysis revealed the HU-BSS-R to offer an excellent fit to data for the established tri-dimensional measurement model. The HU-BSS-R was also found to offer excellent convergent and divergent validity and known-groups discriminant validity. No significant differences were observed between internal consistency observations between the current study and the original UK validation study.

CONCLUSIONS

The HU-BSS-R is a valid and reliable translation of the original BSS-R, it has proved itself to have excellent psychometric properties and is suitable for use in the Hungarian maternity context.

Factors related to a positive childbirth experience - a cross-sectional study

BACKGROUND/AIMS

Giving birth is a life-changing experience for women. Most previous studies have focused on risk factors for a negative childbirth experience. The primary aim of this study was to assess childbirth experience in a sample of postnatal Swedish women. The secondary aim was to analyse demographic and clinical determinants associated with a positive birth experience.

DESIGN/METHODS

A digital survey including the instrument Childbirth Experience Questionnaire 2 (CEQ2) was answered by 619 women six to 16 weeks postpartum. Regression analyses were made assessing the impact that different factors had on the overall childbirth experience and the four subscales of CEQ2: Own Capacity, Perceived Safety, Professional Support and Participation.

RESULTS

Overall, women were satisified with their birthing experience. Several factors contributed to a positive childbirth experience. Having a vaginal mode of birth (without vacuum extraction) together with not having ongoing mental health problems were the factors with the most influence on the total childbirth experience. Not having maternal complications postpartum and receiving much support from a trusted birth companion were two other important factors.

CONCLUSION

Although Swedish women tend to express satisfaction with their childbirth experiences, there is a necessity to advocate for a childbirth approach that optimises the chance of giving birth vaginally rather than with vacuum extraction or acute caesarean section, and reduces the risk for complications whenever possible. During pregnancy, mental health problems should be appropriately addressed. Healthcare professionals could also more actively involve the birth companion in the birthing process and equip them with the necessary tools to effectively support birthing women.

"I need to make sense of my birth experience": A descriptive qualitative study of postnatal women's opinions, and expectations about postnatal debriefing

BACKGROUND

Evidence shows that women feel valued and satisfied after discussing their birth experiences. However, uncertainties persist surrounding the concept of postnatal debriefing practice.

AIM

To explore the opinions and expectations of women relating to postnatal debriefing and their experiences when the postnatal debriefing is not presented.

METHOD

A descriptive qualitative study of 20 postnatal women was conducted using in-depth semi-structured interviews from April-May 2023. Thematic analysis was applied to the data collected in interviews.

RESULTS

Analysis of interview data generated three main themes and nine sub-themes. Women wanted to make sense of their birth experience They expressed their opinions on the components of postnatal debriefing They advocated for all women to be offered this practice by known healthcare professionals who interact with them They do not want to only talk about their birth experience but also meet their needs Women agree that expectations related to birth determine the need for the practice. They hoped for psychological adaptation by relieving their distress and gaining a sense of closure. The discussion process was expected to prevent reflection of trauma to the future and provide transition to the postnatal period.

CONCLUSION

The present study explored women perceptions and expectations of postnatal debriefing. Healthcare professionals should behave sensitively to women's expectations and needs in relation to their birth experience. Further research is warranted to clarify the components and effects of postnatal debriefing practice to develop consolidated guidance.

Maternal performance after childbirth and its predictors: a cross sectional study

BACKGROUND AND OBJECTIVES

Birthing parents need to use specialized skills as the first caregiver of the newborn. Several factors may affect performance. Yet there is a paucity of research in this area, and evidence remains inconsistent. Consequently, this study aimed to determine maternal performance after childbirth and its predictors.

METHODS

This cross-sectional study was conducted with those (n = 450) who had given birth (< two months) and been referred for the vaccination of their newborn. The multi-stage sampling method was carried out from April 2022 to February 2023. Participants who met the inclusion criteria completed a demographic and obstetric information questionnaire, along with the childbirth experience 2 (CEQ2), Barkin maternal performance and maternal self-efficacy scales. Multiple linear regression was used to investigate the predictive effect of the independent variables of childbirth experience, maternal self-efficacy, demographic and obstetric variables on the dependent variable of maternal performance.

RESULTS

The mean age of the participants was 26.78 and the mean total score of maternal performance was 91.04 (0-120). The highest and lowest scores related to the 'maternal competence' and the 'maternal needs' domains, with mean score calculated at 77.51 and 72.81 respectively. 'Childbirth experience' and 'maternal self-efficacy' domains had a statistically significant relationship with maternal performance (P < 0.05). Among the predictive factors of maternal performance, the results of our linear regression demonstrated the variables of birth experience (B = 0.63), maternal self-efficacy (B = 1.53), spouse's employment status (B = 5.78 for worker level, B = 3.99 for employee level), the number of previous childbirth experiences (B = -8.46), frequency of receiving antenatal care (B = -6.68), length of stay in the birth suite (B = -2.22) and length of stay in the hospital (B = 2.84) remained in the model. 53.2% of changes in maternal performance can be explained by these independent variables.

CONCLUSION

The promotion of evidence-based, person-centered, and respectful perinatal care during pregnancy and childbirth are of paramount importance. Strategies to improve the experience of childbirth and self-efficacy are especially required to improve maternal performance in the postpartum period. Prenatal care aimed at improving maternal function after childbirth will be important in achieving this overall.

Going through it together: Dyadic associations between parents' birth experience, relationship satisfaction, and mental health

BACKGROUND

Previous research suggests that a negative birth experience is associated with symptoms of postpartum depression and anxiety in mothers and partners. However, this has mostly been investigated within the first year postpartum and research on the long-term effects is lacking. Additionally, the role of relationship satisfaction and the interdependence between parents have not been considered so far.

METHODS

Couples (N = 1992) completed questionnaires on their birth experience, relationship satisfaction, and symptoms of depression and anxiety at two months, 14 months, and two years after birth, respectively.

RESULTS

Actor-Partner Interdependence Mediation Models indicated no partner effects, but several significant actor and indirect effects. A more positive birth experience was associated with higher relationship satisfaction and less depression and anxiety symptoms for both parents. Higher relationship satisfaction was in turn associated with less depression (mothers and partners) and anxiety symptoms (mothers). The association between birth experience and depression symptoms was partially mediated by relationship satisfaction for mothers and partners, while the association between birth experience and anxiety symptoms was partially mediated by relationship satisfaction only for mothers.

LIMITATIONS

Due to the highly educated, very healthy sample with low levels of depression and anxiety as well as high relationship satisfaction, results cannot be generalized to less privileged parents. Moreover, all effects were very small.

CONCLUSIONS

Results highlight the importance of a positive birth experience for parents' relationship satisfaction and mental health. Negative birth experiences need to be avoided to prevent a negative impact on the whole family.

Experienced disrespect & abuse during childbirth and associated birth characteristics: a cross-sectional survey in the Netherlands

BACKGROUND

Experiencing upsetting disrespect and abuse (D&A) during labour and birth negatively affects women's birth experiences. Knowing in what circumstances of birth women experience upsetting situations of D&A can create general awareness and help healthcare providers judge the need for extra attention in their care to help reduce these experiences. However, little is known about how different birth characteristics relate to the experience of D&A. Previous studies showed differences in birth experiences and experienced D&A between primiparous and multiparous women. This study explores, stratified for parity, (1) how often D&A are experienced in the Netherlands and are considered upsetting, and (2) which birth characteristics are associated with these upsetting experiences of D&A.

METHODS

For this cross-sectional study, an online questionnaire was set up and disseminated among women over 16 years of age who gave birth in the Netherlands between 2015 and 2020. D&A was divided into seven categories: emotional pressure, unfriendly behaviour/verbal abuse, use of force/physical violence, communication issues, lack of support, lack of consent and discrimination. Stratified for parity, univariable and multivariable logistic regression analyses were performed to examine which birth characteristics were associated with the upsetting experiences of different categories of D&A.

RESULTS

Of all 11,520 women included in this study, 45.1% of primiparous and 27.0% of multiparous women reported at least one upsetting experience of D&A. Lack of consent was reported most frequently, followed by communication issues. For both primiparous and multiparous women, especially transfer from midwife-led to obstetrician-led care, giving birth in a hospital, assisted vaginal birth, and unplanned cesarean section were important factors that increased the odds of experiencing upsetting situations of D&A. Among primiparous women, the use of medical pain relief was also associated with upsetting experiences of D&A.

CONCLUSION

A significant number of women experience upsetting disrespectful and abusive care during birth, particularly when medical interventions are needed after the onset of labour, when care is transferred during birth, and when birth takes place in a hospital. This study emphasizes the need for improving quality of verbal and non-verbal communication, support and adequate decision-making and consent procedures, especially before, during, and after the situations of birth that are associated with D&A.

Experiences of success and failure in childbirth

AIMS

To determine what kinds of birth-related experiences of success and failure are described by the participants, and whether there are differences according to fear of childbirth and parity. Studying these experiences is important for understanding the psychological mechanisms behind different childbirth experiences and their impact on maternal mental well-being.

METHODS

This was a longitudinal mixed methods study. Descriptions of the birth experiences of 113 Finnish participants were gathered in a survey at 4-8 weeks postpartum and analysed with content analysis. Fear of childbirth was determined antenatally with the Wijma Delivery Expectations scale (W-DEQ A).The number of success and failure expressions were compared between people with FOC and others and between primiparous and multiparous people.

RESULTS

The contents of the childbirth-related experiences of success and failure were categorised into 12 subcategories, organised under three higher-order categories that were named personal factors, course of childbirth, and support. The most typical expressions of success were in the categories of mode of birth, staff, and mental factors, and the most typical expressions of failure in the categories of staff and mental factors. Experiences of failure were more often expressed by primiparous than multiparous people, but there were no statistically significant differences by FOC. Expressions of success were equally common regardless of parity or FOC.

CONCLUSION

Postpartum people categorise aspects of their birth experiences in terms of success and failure. Primiparous people are more susceptible to experiencing failure at childbirth, but possible differences between people with FOC and other people warrant further investigation.

"I was able to take it back": Seeking VBAC after experiencing dehumanizing maternity care in a primary cesarean

In this article, we present findings from a qualitative narrative analysis that examined the pregnancy, primary cesarean, and subsequent birth experiences of women in the United States. Using a maximal variation sampling strategy, we recruited participants via social media and networking to participate in semistructured interviews. Twenty-five women from diverse backgrounds and geographic locations across the U.S. participated, eight self-identified as racialized and seventeen as non-Hispanic, White. Data were analyzed iteratively using Clandinin and Connelly's approach to Narrative Inquiry. Across their narratives, participants described their experiences of maternity care that were either generally negative (dehumanizing care) or positive (humanized care). They further described how their experiences of dehumanizing or humanized care impacted their decision-making for subsequent births, mental health, relationships with the healthcare system, early parenting birth satisfaction, and family planning. Findings suggest that regardless of ultimate mode of birth, what was most important to women was how they are treated by their maternity care team. We suggest practice changes that may improve the experience of maternity care for primary cesarean and subsequent births, especially among those made marginal by systems of oppression.

Seeking a connection: Women's lived experience of the woman-midwife relationship in mainstream maternity services in Japan

PROBLEM

In Japan, women continue to suffer from mental health and other postpartum issues despite good clinical outcomes of maternity care.

BACKGROUND

As key care providers, midwives potentially affect women's overall birth experience. Most women in Japan give birth in hospitals or obstetric clinics where different midwives and nurses provide one woman with fragmented care. Women's lived experiences of the woman-midwife in these birth facilities are not well known in Japan.

AIM

To understand women's birth experience and relationship with midwives in the mainstream maternity care system in Japan to improve maternity care and women's birth experience.

METHODS

Face-to-face individual interviews with 14 mothers were conducted. The data were analysed using van Manen's hermeneutic phenomenological approach, which reveals the meaning of human experience in the everyday world.

FINDINGS

Four themes were derived from the hermeneutic phenomenological analysis; 1) Closed hearts and bodies in insecure relationships, 2) Alienation, 3) Hopelessness and helplessness, and 4) Women's vulnerability and desire for positive relationships.

DISCUSSION

In institutionalised and fragmented maternity care settings, it is difficult for women and midwives to develop a relationship. In such a care environment, women's birth experience with midwives is negative or even traumatic; yet, women still need and seek the midwife relationship. Respectful care-necessary for women's positive birth experience-requires positive relationship between women and midwives.

CONCLUSION

Women's negative birth experience may affect their mental health and parenting. Maternity and midwifery care in Japan needs to develop relationship-based care to improve women's birth experience.

Measuring disrespect and abuse during childbirth in a high-resource country: Development and validation of a German self-report tool

INTRODUCTION

Increasing evidence on disrespect and abuse during childbirth has led to growing concern about the quality of care childbearing women are experiencing. To provide quantitative evidence of disrespect and abuse during childbirth services in Germany a validated measurement tool is needed.

RESEARCH AIM

The aim of this research project was the development and psychometric validation of a survey tool in the German language that measures disrespect and abuse of women during childbirth.

METHODS

A survey tool was created including the following measures: German adaptations of the short and long form of the "Mothers on Respect" (MOR) index (MOR-7 and MOR-G); the "Mothers' Autonomy in Decision Making" (MADM) scale; a mistreatment-index (MIST-I) comprising indicators of mistreatment during childbirth; and a set of items that measure experiences of discrimination during maternity care. Internal consistency reliability and construct validity of the scales were assessed using Cronbach's alpha, unweighted least squares factor analysis and non-parametric correlation analysis with a scale that measures a related construct, the Posttraumatic Symptom Scale - Self Report (PSS-SR) scale. We distributed the survey online, recruiting through snowball sampling via social media. A selection bias towards women who had experienced disrespect and abuse during their birth was intended and expedient for tool validation. The final sample of participants (n = 2045) had given birth in Germany between 2009 and 2018.

FINDINGS

More than 77% of the study participants reported at least one form of mistreatment with non-consented care being the most commonly reported type of mistreatment, followed by physical violence, violation of physical privacy, verbal abuse and neglect. All included scales showed good psychometric properties with high Cronbach's alphas (0.95 for both MOR versions and 0.96 for MADM). Factor analysis generated one factor scales with high factor loadings (0.75 to 0.92 for MOR-7; 0.37 to 0.90 for MOR-G and 0.83 to 0.92 for MADM). MOR-7, MOR-G, MADM and MIST-I scores were significantly (p<0.001) correlated with PSS-SR scores (Spearman's rho -0.70, -0.61 and 0.68 for MOR-G, MADM and the MIST-I, respectively).

CONCLUSIONS

This study presents a valid and reliable instrument for the quantitative assessment of disrespect and abuse during childbirth in Germany. Childbearing women's experiences of disrespect and abuse are a relevant phenomenon in German hospital based maternity care. Disrespect and abuse during childbirth appear to contribute to post-traumatic symptoms and may be associated with severe mental health problems postpartum.

Maternal postpartum depressive symptoms: The predictive role of objective and subjective birth experience and hair glucocorticoids

BACKGROUND

Having a negative childbirth experience is a known risk-factor for developing postpartum depression (PPD). Alterations of the hypothalamus-pituitary-adrenal (HPA)-axis have been discussed as a potential underlying mechanism. However, research on the association between negative birth experiences and long-term integrated glucocorticoids (GCs) is lacking. This study aimed to examine whether objective and subjective birth experience predicted long-term GCs and PPD symptoms.

METHODS

Measures of objective and subjective birth experience, PPD symptoms, and hair strands for the assessment of hair cortisol concentrations (HairF), hair cortisone concentrations (HairE), and HairF/HairE ratio, were provided eight weeks after childbirth by 235 mothers participating in the study DREAMHAIR.

RESULTS

A negative objective birth experience predicted a higher HairF/HairE ratio but was not associated with HairF or HairE. The subjective birth experience did not explain additional variance in hair GCs but was a significant predictor for PPD symptoms. A higher HairF/HairE ratio predicted PPD symptoms when controlling for prepartum depressive symptoms and number of lifetime traumatic events.

LIMITATIONS

Analyses were based on a relatively homogeneous sample and women reported in general positive birth experiences and low levels of depressive symptoms. Therefore, results should be applied to the broader population with caution.

CONCLUSIONS

Our results suggest that negative objective birth experience is associated with an altered HairF/HairE ratio, which in turn, seems to be a promising biomarker to identify women at risk for developing PPD. A negative subjective birth experience may be less critical for alterations of the HPA-axis but remains an essential risk factor for PPD.

Implementation of the Practice Programme for Upright Positions in the Second Stage of Labour and the birth experience of Chinese women: A qualitative study

OBJECTIVE

Upright positions in the second stage of labour are recommended by many international organizations. However, they have not been widely used worldwide, especially in China. One of the important factors is the absence of a practice programme based on the best available evidence. We thus developed a Practice Programme for Upright Positions in the Second Stage of Labour following the UK Medical Research Council framework. Under the guidance of the programme, whether the use of upright positions can improve the maternal birth experience is a question of great concern. This study aimed to explore the birth experience of Chinese women who adopted upright positions in the second stage of labour.

DESIGN

This qualitative descriptive study was conducted as part of an implementation study that developed an evidence-based intervention and used strategies to integrate the evidence-based intervention into routine obstetric clinical practice.

SETTING

The maternity department of a tertiary comprehensive hospital in Hebei Province, China.

PARTICIPANTS

Semi-structured interviews with twelve eligible women who adopted upright positions in the second stage of labour were conducted between March and April 2022. Qualitative data were analyzed by using conventional content analysis.

FINDINGS

The average age of included women was 26.5 ± 3.5 years, and ten of them were primiparous women. Eight women adopted epidural analgesia during labour to relieve labour pain. All women gave birth in at least one type of upright position in the passive second stage of labour and adopted the semi-recumbent position in the active second stage of labour. Through conventional content analysis, we found that the use of upright positions in the second stage of labour could possibly promote an overall positive birth experience. Women giving birth in upright positions generally perceived they were more involved in their birthing process, and had greater physical and mental capacity to cope with childbirth.

KEY CONCLUSIONS

Women have a positive birth experience when using upright positions in the second stage of labour.

IMPLICATIONS FOR PRACTICE

This study suggests upright positions could improve women's birth experience and have the potential to be widely applied in clinical practice.

Freebirth, the only option for women who do not fit into common practice- A Swedish national interview study

OBJECTIVE

To explore women's experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife.

METHODS

Online semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis.

RESULTS

The five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated.

CONCLUSIONS

The women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.

Traumatic childbirth experiences, effects and coping: A qualitative study

OBJECTIVE

Childbirth experience and perception of birth are personal. It is important to understand how the traumatic childbirth experiences affected women and for the nursing care that would be given to them. The aim of the research was to determine the childbirth experiences perceived by women as traumatic, how they were affected by these experiences, and how they coped.

METHODS

The study was a descriptive phenomenological approach study. The data were obtained through semi-structured, in-depth individual interviews. Content analysis was used in the analysis of the data. The mothers were contacted by using the social media platforms. Sixteen women were included in the research who expressed that they had traumatic childbirth experiences.

RESULTS

It was determined that women experienced severe fear and pain during childbirth, that they were in unsuitable maternity hospital environments, and that care was not taken for their privacy. At the same time, it was determined that they experienced disorders in the postpartum period connected to their traumatic birth experiences, that they postponed their pregnancy plans due to their fear of childbirth that developed connected to traumatic childbirth or that they did not want to become pregnant, and that they did not receive sufficient support from health personnel.

CONCLUSION

It is necessary to provide privacy during childbirth, to take into consideration the decisions of women, and to provide for their continuous support by midwives.

Translation and validation of the Swedish version of the Birth Satisfaction Scale-Revised (BSS-R)

BACKGROUND

Optimizing women's childbirth experience is essential for development of quality mother infant relationships. The Birth Satisfaction Scale-Revised (BSS-R) can be used to measure birth satisfaction.

AIM

The current investigation sought to translate and validate a Swedish version of the BSS-R.

METHOD

Following translation, a comprehensive psychometric validation of the Swedish-BSS-R (SW-BSS-R) was carried out using a multi-model, cross-sectional, between- and within-subjects design.

PARTICIPANTS

A total of 619 Swedish-speaking women participated, from which 591 completed SW-BSS-R and were eligible for analysis.

DATA ANALYSIS

Discriminant, convergent, divergent and predictive validity, internal consistency, test-retest reliability, and factor structure were evaluated.

RESULTS

The SW-BSS-R was found to have excellent psychometric properties and hence is a valid translation of the original UK(English)-BSS-R. Important insights into relationships between mode of birth, post-traumatic stress disorder (PTSD), and postnatal depression (PND) were observed.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The SW-BSS-R is a psychometrically valid translation of the original BSS-R and is suitable for use in a Swedish-speaking population of women. The study has also highlighted important dynamics between birth satisfaction and areas of significant clinical concern (i.e., mode of birth, PTSD and PND) in Sweden.

Dyadic analyses on the prospective association between birth experience and parent-child-bonding: The role of postpartum depression, anxiety, and childbirth-related posttraumatic stress disorder

OBJECTIVE

Negative birth experiences are associated with postpartum mental health difficulties in parents. However, research considering the long-term impact of a negative birth experience on parent-child-bonding and the interdependence between parents is rare. This study aimed to investigate actor as well as partner effects for the association between parents' birth experience and parent-child-bonding and whether this association is mediated by postpartum psychiatric symptoms.

METHOD

A community sample of couples (N = 743) completed questionnaires during pregnancy, 2, and 14 months after birth.

RESULTS

Applying Actor-Partner Interdependence Mediation Models, structural equation modeling showed that parents' own negative birth experience predicted a poorer bond to their child 14 months postpartum. Compared to mothers, this association was twice as strong for partners and was mediated by symptoms of postpartum depression (mothers and partners), anxiety (partners), and childbirth-related posttraumatic stress disorder (mothers). Negative birth experiences of one parent were not related to the other parent's bonding with the child.

CONCLUSION

Results underline the importance of parents' positive birth experience for their postpartum mental health and secure bond to their child. The other parent's birth experience or postpartum mental health does not seem to affect one's own bond to the child in the long term.

Do antenatal preparation and obstetric complications and procedures interact to affect birth experience and postnatal mental health?

BACKGROUND

Antenatal preparation is commonly offered to women in pregnancy in the United Kingdom, but the content is highly variable, with some programmes orientated towards 'normal birth', whilst others may incorporate information about complications and procedures (broader focus). However, the impact of this variability on birth experience has not been explored. We examined the relationship between the content of antenatal preparation received and birth experience, taking into account obstetric complications and procedures. As birth experience can have a profound impact on a mother's postnatal well-being, we also investigated associations with mothers' postnatal mood and anxiety.

METHODS

N = 253 first-time mothers completed a cross-sectional survey measuring demographic and clinical factors, antenatal preparation content (categorised as normality-focused or broader-focused), obstetric complications and procedures experienced, birth experience (measured using three separate indices; the Childbirth Experience Questionnaire, emotional experiences, and presence/absence of birth trauma), postnatal depression and anxiety, and qualitative information on how the COVID-19 pandemic had affected birth experience.

RESULTS

Regarding birth experience, receiving more broader-focused preparation was associated with a more positive birth experience irrespective of complications/procedures experienced, while receiving only normality-focused preparation was beneficial in the context of fewer complications/procedures. Regarding birth trauma, receiving more broader-focused preparation was associated with lower likelihood of reporting birth as traumatic only in the context of more complications/procedures. Degree of normality-focused preparation was unrelated to experience of birth trauma. Lastly, while more complications/procedures were associated with greater anxiety and low mood, only greater normality-focused preparation was linked with better postnatal mental health.

CONCLUSIONS

Antenatal preparation including both normality- and broader-focused information is positively related to women's birth experience. While normality-focused preparation seems most beneficial if fewer complications/procedures are experienced, broader-focused preparation may be most beneficial in the context of a greater number of complications/procedures. As complications/procedures are often unpredictable, offering broader-focused preparation routinely is likely to benefit women's birth experience. This antenatal preparation should be freely available and easily accessible.

Partner support and relationship quality as potential resources for childbirth and the transition to parenthood

BACKGROUND

The aim of the present paper was to explore the role of partners for the stressful life events of birth and the transition to parenthood.

METHODS

In a first prospective longitudinal study (N = 304 dyads) we tested whether relationship quality positively predicted fewer interventions during labor and birth, a more positive birth experience, and better well-being during the first six weeks after birth. In a second study we surveyed mothers (N = 980; retrospective quasi-experimental design) who had given birth during the first lockdown of the COVID-19 pandemic in spring 2020 - some in the absence of their partners - to test the assumption that regardless of relationship quality, the presence of the partner was positively related to low-intervention births and the birth experience.

RESULTS

The results of the longitudinal study (Study 1) could be integrated into a Single Indicator model. They revealed that a high relationship quality assessed between week 5 and week 25 of pregnancy had a positive effect on birth experience for the mother and on psychological well-being during the transition to parenthood for both mothers and fathers. Results of the retrospective quasi-experimental field study (Study 2) revealed that the continuous presence of the partner was associated with a higher probability of a low-intervention birth and a more positive birth experience. Presence of a partner for only part of the birth did not positively predict labor and birth, but did positively predict the birth experience. The effects were independent of relationship quality.

CONCLUSION

The results of both studies highlight the importance of partners for psychological well-being during labor and birth and the transition to parenthood.

The impact of mode of delivery on parent-infant-bonding and the mediating role of birth experience: a comparison of mothers and fathers within the longitudinal cohort study DREAM

BACKGROUND

The association between mode of delivery (MOD) and parent-infant-bonding has only been studied in mothers and findings have been inconclusive. The aim of this study was to prospectively investigate how MOD relates to postpartum parent-infant-bonding in both mothers and fathers and whether these associations are mediated by birth experience.

METHODS

This study is part of the prospective cohort study "Dresden Study on Parenting, Work, and Mental Health" (DREAM). Our sample comprised N = 1,780 participants who completed quantitative questionnaires during pregnancy as well as 8 weeks and 14 months postpartum. MOD was dummy coded, contrasting spontaneous vaginal delivery against vaginal delivery induced by drugs, operative vaginal delivery, planned, and unplanned cesarean section. Parent-infant bonding and birth experience were assessed using validated scales. A moderated mediation analysis based on ordinary least square (OLS) regression and bootstrapped estimates was conducted, considering relevant confounding variables.

RESULTS

Compared to spontaneous vaginal delivery, all categories of MOD predicted more negative birth experiences in both parents. A more positive birth experience predicted stronger parent-infant-bonding at 8 weeks, but not at 14 months postpartum. Mothers who delivered via cesarean section (planned or unplanned) reported stronger parent-infant-bonding at 8 weeks and 14 months postpartum. In fathers, only unplanned cesarean section was associated with stronger parent-infant-bonding at 8 weeks postpartum. At 8 weeks postpartum, birth experience mediated the association between a vaginal delivery induced by drugs and a planned cesarean section and mother-infant-bonding and between a vaginal delivery induced by drugs, an operative vaginal delivery, and planned cesarean section and father-infant-bonding. At 14 months postpartum, birth experience mediated the association between a vaginal delivery induced by drugs, operative vaginal delivery, and planned cesarean section and parent-infant-bonding in both parents.

CONCLUSIONS

The results emphasize the importance of the birth experience for parent-infant-bonding in both mothers and fathers. Further research should address the mechanisms by which parents with an unplanned cesarean section establish stronger parent-infant-bonding compared to parents whose baby was delivered via spontaneous vaginal delivery, despite their overall more negative birth experiences.

[Violated birth integrity during the COVID-19 pandemic in Germany: experiences of women with maternity care]

INTRODUCTION

The COVID-19 pandemic may increase women's vulnerability through violations of their integrity during birth. In a cross-sectional study (March 2020 to March 2022), we investigated how women giving birth experienced maternity care during the pandemic in Germany and which factors were associated with their birth integrity.

METHODS

In a survey (validated questionnaire and two open-ended questions), women ≥ 18 years described their experiences of maternity care. We conducted quantitative analyses using descriptive statistics and logistic regressions to investigate factors associated with dignified care and emotional support, which are understood as proxies of birth integrity. We analysed the open-ended questions through inductive content analysis.

RESULTS

We included data from 1271 participants and 214 comments. The majority of respondents felt emotionally supported (71%) and treated with dignity (76%). One third reported not always being involved in decision-making, while 14% felt they were subjected to physical, verbal or emotional abuse. For 57% of women, their companion of choice was absent or their presence limited. Those factors were all associated with the chances of feeling treated with dignity and emotionally supported. The qualitative comments provided an insight into what specifically women perceive as violating their integrity.

DISCUSSION

During the COVID-19 pandemic, the vulnerability of parturients lies in the violation of their birth integrity. Measures to promote respectful maternity care of women who give birth include comprehensive structural and political solutions as well as further research on the determinants of birth integrity.

The extended gentle caesarean section protocol-expanding the scope and adding value for the family: a cross-sectional study

PURPOSE

In Switzerland, about one in three children is born by caesarean section (CS). For many women, this means a restricted birth experience, limited observation of the birth process and a restricted involvement. We evaluated an extended gentle CS protocol, which offered early intraoperative skin-to-skin contact and the possibility of observing the delivery of the baby from the abdomen through a transparent drape.

METHODS

This is a cross-sectional study incorporating data from a purposely tailored questionnaire and clinical routine data. The extended gentle CS protocol was compared with the gentle CS, which does not allow the possibility of observing the delivery. Data were collected online and analysed by multivariable regression for quantitative data and content analysis for all text responses to open questions, respectively.

RESULTS

193 women completed the questionnaire. Of these, 154 had a gentle CS and 39 had an extended gentle CS. Multivariable regression did not reveal a statistically significant difference for extended gentle CS with regard to satisfaction with childbirth, mother-to-child bonding, or breastfeeding duration. Nevertheless, early intraoperative skin-to-skin contact was associated with the fulfilment of birth expectations. Furthermore, most women who experienced an extended gentle CS would prefer the same procedure for any potential future CS.

CONCLUSIONS

Although our study showed no statistically significant difference in satisfaction from using a transparent drape, most women expressed a preference for this technique. We recommend that the option of an extended gentle CS should be offered to all women for whom CS is indicated.

Women's views and experiences of augmentation of labour with synthetic oxytocin infusion: A qualitative evidence synthesis

OBJECTIVE

To explore and synthesise women's views and experiences of augmentation of labour with synthetic oxytocin infusion.

DESIGN

A qualitative evidence synthesis was conducted. The SPIDER acronym was used to develop the search terms and determine the inclusion criteria. Six bibliographic databases: MEDLINE, CINAHL, EMBASE, PsycINFO, Maternity and Infant Care and Web of Science Core Collection were searched in October 2021. Grey literature sources, EThOS, DART-Europe, and the World Health Organization's Clinical Trials Registry were searched, and reference lists of included studies were reviewed. Methodological quality of included studies was assessed using the Evidence for Policy and Practice Information and Co-ordinating (EPPI) Centre assessment tool. Data were synthesised thematically. The confidence of each review finding was assessed using the Grading of Recommendations Assessment, Development and Evaluation-Confidence in the Evidence from Reviews of Qualitative research (GRADE-CERQual). Research ethical approval was not required.

SETTING AND PARTICIPANTS

Women of any age, parity, and cultural background who underwent augmentation of labour with synthetic oxytocin infusion were included.

FINDINGS

A total of 9306 citations were retrieved. Twenty-five studies conducted across 14 countries met the inclusion criteria and contributed data. Three principal analytical themes emerged: feeling stuck; past and present shaping the future; and cause and effect of augmentation of labour. The decision to augment women's labour was often performed without their informed consent. Women's views and experiences of augmentation of labour were shaped according to their knowledge, beliefs and support received during labour. Irrespective of the context, women consistently associated augmentation of labour with pain.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Clinical guidelines on augmentation of labour need to be informed by research that includes women's views and experiences as a main outcome. Future research exploring the experience of augmentation of labour rather than the experience of labour dystocia would be beneficial. Increasing women's awareness and knowledge of augmentation of labour may help to ensure that their informed consent is obtained. Healthcare providers should discuss the effects, side effects and implications of augmentation of labour with women, ideally before labour.

Quality improvement of childbirth care (Adequate Birth Project) and the assessment of women's birth experience in Brazil: a structural equation modelling of a cross-sectional research

BACKGROUND

Brazil's maternity care is highly medicalized, and obstetric interventions in labour and birth are high, mainly in private health system. The Adequate Birth Project (PPA-Projeto Parto Adequado) is quality improvement project designed to reduce unnecessary caesarian section rates in private hospitals in Brazil. This study evaluated the association between the participation of the PPA and the birth experience assessed by the women.

METHODS

It was carried out in 2017/2018 a hospital-based research with a convenience sample of 12 private hospitals among the 23 participants of the project. In this article, a sub-sample of 2348 mothers of 4878 postpartum women, including only women who desired vaginal birth at the ending of pregnancy was analyzed. Multigroup structural equation modelling was used for data analysis to compare vaginal birth and caesarean section. The latent variable was constructed from four items: participation in decisions, respectful treatment during labour and birth, satisfaction with the care during childbirth, satisfaction with care of the baby.

RESULTS

In the vaginal birth group, women who participated in PPA rated the birth experience better than women who did not participate (standardized coefficient: 0.388, p-value: 0.028). On the other hand, this effect was not observed (standardized coefficient: - 0.271, p-value: 0.085) in the caesarean section. Besides, the explicative models for a good birth experience varied to the type of childbirth. Among women with vaginal birth, complication during pregnancy and younger age were associated with a more positive birth experience. In contrast, for women with a caesarean section, access to information and participation in the pregnant group was associated with a better evaluation of the birth experience.

CONCLUSIONS

The childbirth care model that encourages vaginal delivery and reduces unnecessary caesarean modulates the birth experience according to the type of birth. This study also highlights the importance of perceived control, support, and relationship with the health team shaping women's experience with labour and delivery. These factors may affect policy, practice, and research on childbirth care.

The role of women's emotional profiles in birth outcome and birth experience

OBJECTIVE

The aim was to investigate birth outcome and birth experience in relation to women's emotional health. An additional aim was to explore the relationship between emotional health, continuity with a known midwife, and the birth experience.

METHODS

A prospective longitudinal cohort study of 243 women enrolled in a continuity of care project in a rural area in Sweden. Profiles were constructed from instruments measuring depressive symptoms, worries, fear of birth, and sense of coherence. Antenatal and birth records and questionnaires were used to collect data.

RESULT

Women were categorized into two cluster profiles: "emotionally healthy" vs. "emotionally unhealthy". Women in the "emotionally unhealthy" cluster had a less positive birth experience (p = 0.006). The total score of the Childbirth Experience Questionnaire was highest in women who had had a known midwife assisting at birth. Babies born to women in the "emotionally unhealthy" cluster were more likely to have a severe neonatal diagnosis.

CONCLUSION

There were few differences in birth outcome between the clusters, while there were explicit differences in the childbirth experience. Having a known midwife is important to warrant women a more positive childbirth experience. Screening with validated instruments during antenatal care could be a first step to further investigate women's emotional well-being and provide targeted psychosocial support.

The impact of effective communication-based care on the childbirth experience and satisfaction among primiparous women: an experimental study

Background

There is insufficient scientific evidence on the effect of communication skills of childbirth care providers on maternal childbirth experience and satisfaction. The present study aimed to determine the effect of communication-based care on the childbirth experience and satisfaction among primiparous women.

Methods

A total of 80 primiparous women participated in this experimental study who were randomly assigned into the intervention and control groups. According to the World Health Organization (WHO) care model, the intervention group received effective communication-based care, and the control group received the routine care. Data were collected using demographic and obstetric questionnaires, Labor Agentry Scale (LAS) and Birth Satisfaction Scale-Revised (BSS-R), and Support and Control in Birth (SCIB) scale applied 12 to 24 h after the intervention.

Results

After controlling the effect of confounding variables, the mean scores of childbirth experience (51.23(1.54) and satisfaction (26.03(0.81) in the intervention group were significantly higher than that in the control group (45.33 (1.54) and 22.66 (0.81) respectively; [adjusted mean difference (AMD) = 5.90, CI = 95%: 1.17 to 10.62, P = 0.01] versus AMD =3.37, CI: 95%: 0.87 to 5.87, P = 0.001].

Conclusion

Eeffective communication-based care improved childbirth experience and satisfaction of primiparous women. Therefore, it is recommended that health-care providers should be trained on the communication skills in the delivery room especially during a vital threatened crises such as the Covid pandemic.

The effect on the birth experience of women and partners of giving birth in a "birth environment room": A secondary analysis of a randomised controlled trial

OBJECTIVE

To evaluate women and partners' experience of birth in a "birth environment room" compared to a standard birth room.

DESIGN

A single centre parallel randomised controlled trial. Women and partners were enrolled during a 3-year period (May 2015 to March 2018).

SETTING

The Department of Obstetrics and Gynaecology at Herning Hospital, Denmark.

PARTICIPANTS AND INTERVENTION

A total of 680 Danish speaking nulliparous women, more than 18 years old, with a singleton pregnancy in cephalic presentation, and a spontaneous onset of labour, and their partners were randomly assigned to give birth in a "birth environment room" (n = 340) or in a standard birth room (n = 340) on arrival at the birth unit.

MEASUREMENTS AND FINDINGS

Outcomes were the overall birth experience and overall satisfaction with care, measured on a Likert scale, obtained in the postpartum questionnaire sent to the women 6 weeks after birth and to their partners 1/2 weeks after birth. Other outcomes were "staff support for partner", "undisturbed contact with new-born", "feeling of being listened to", "level of information", "attention to psychological needs", "suggestions for pain-relief", "participation in decision-making", "midwife present when wanted", "support from midwife", "birth wishes were met", "loss of internal control" (only women), "loss of external control", "support from partner" (partners: "being supportive for partner"), "importance of physical environment for birth" and "importance of physical environment for staff´s ability to involve the women" (only women). All outcomes were prespecified. We applied Mann Whitney U test for comparing the two groups. Data were collected from 326 women and 236 partners in the intervention group and from 315 women and 209 partners in the control group. The intention-to-treat analysis revealed no difference in the overall experience of birth for women or partners (p 0.81 and p 0.17, respectively). Partners in the intervention group reported more overall satisfaction with care compared to partners in the control group (p 0.048). In the intervention group, fewer women and partners responded they had not had the opportunity for undisturbed contact with their new-born in the first hours after birth (RR 0.19 (95% CI 0.04-0.87) and OR 0.00 CI (0.00-0.83), respectively). Otherwise, there were no differences between groups. The thematic analysis revealed that many women and partners felt they were not able to benefit from the features in "the birth environment room" in the most intense hours of birth.

KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE

"The birth environment room" did not improve the overall experience of birth for women and partners. Partners in the intervention group were overall more satisfied with care. These findings are of importance in the developing of physical birth environments that support the mental/emotional process of labour.

Fulfilment of expectations on birth and the postpartum period - A Swedish cohort study

BACKGROUND

The fulfilment of birth expectations is important to women and strongly related to birth satisfaction.

OBJECTIVE

The aim of this study was to investigate women's expectations and experiences of birth and the postnatal period and associated factors. An additional aim was to explore if women's expectations were fulfilled.

METHODS

A longitudinal cohort study of 280 women where 226 were followed up two months after birth. Data were collected using questionnaires. Odds ratios with a 95% confidence interval were calculated between the explanatory background variables and expectations/experiences.

RESULTS

The majority (79%) rated continuity as important, but few (32%) actually had a known midwife assisting during birth. Positive birth expectations were found in 37% and a positive birth experience in 66%. Many women (56%) preferred a short postnatal stay, and 63% went home within 24 h. Thirty-six percent preferred postnatal home visits, but only eight women (3.5%) received this. Breastfeeding expectations were high with 86% rating it as important but after birth 63% reported exclusively breastfeeding. Only a few background factors were associated with women's expectations and experiences. Most likely to be fulfilled were women's expectations for a vaginal birth (83%), a positive birth experience (71%) and short length of postnatal stay (67%). Postnatal home visits (96%) and continuity of care (73%) were not fulfilled.

CONCLUSIONS

Pregnant women's expectations about continuity are fulfilled only to a minor degree. The fulfilment of postnatal expectations varied and the preference for a short postnatal stay was fulfilled whereas home visits were not.

The effects of perineal trauma on immediate self-reported birth experience in first-time mothers

INTRODUCTION

Childbirth can sometimes be stressful or traumatic, and previous research has considered how birth complications and interventions may contribute to a negative birth experience. One of the most frequent complications during birth is trauma to the perineum. The aim of this study was to investigate whether different levels of perineal trauma were associated with differences in women's evaluation of their birth experience.

MATERIALS AND METHODS

As part of a longitudinal cohort study, the self-reported birth experiences of 202 primiparous women were compared based on the degree of perineal trauma they had experienced. Women who had given birth for the first time, vaginally and within the last 48 h in a large tertiary maternity unit in England were invited to take part. Data were collected from their hospital records with their consent and using the Childbirth Experience Questionnaire (CEQ), Experience of Birth Scale (EBS) and a perineal pain Visual Analogue Scale (VAS).

RESULTS

Women with an obstetric anal sphincter injury (OASI) or episiotomy reported a more negative overall birth experience and perceived themselves as having less ability to give birth compared to those with a 1st/2nd degree sutured tear. Those with an episiotomy also reported feeling less involved in decision making processes during their birth. Significant differences remained between the OASI and 1st/2nd degree tear groups when controlling for factors known to affect birth experience, highlighting severe perineal trauma as a potential contributor to more negative birth experience.

CONCLUSIONS

Perineal trauma may affect a woman's birth experience. Experiencing an episiotomy should not be overlooked as a potential contributor, especially during instrumental birth and in the absence of involved decision making. Further research is needed to disentangle the effects of episiotomy on birth experience, to explore the care needs of women with different degrees of perineal trauma and to explore how a negative birth experience may contribute to poor psychological health in the longer term.

Labor dystocia and oxytocin augmentation before or after six centimeters cervical dilatation, in nulliparous women with spontaneous labor, in relation to mode of birth

BACKGROUND

The effects of diagnosing and treating labor dystocia with oxytocin infusion at different cervical dilatations have not been fully evaluated. Therefore, we aimed to examine whether cervical dilatation at diagnosis of dystocia and initiation of oxytocin infusion at different stages of cervical dilatation were associated with mode of birth, obstetric complications and women's birthing experience.

METHODS

A retrospective cohort study, including 588 nulliparous term women with spontaneous onset of labor and dystocia requiring oxytocin augmentation. The study population was divided into three groups according to cervical dilatation at diagnosis of dystocia and initiation of oxytocin-infusion (≤ 5 cm, 6-10 cm, fully dilated) with mode of birth as the primary outcome. Secondary outcomes were obstetrical and neonatal complications and women´s experience of childbirth. Statistical comparison between groups using Chi-square and ANOVA was performed. The risk of operative birth (cesarean section and instrumental birth) was assessed using binary logistic regression with suitable adjustments (maternal age, body mass index and risk assessment on admission to the labor ward).

RESULTS

The cesarean section rate differed between the groups (p < 0.001); 12% in the ≤ 5 cm group, 6% in the 6-10 cm group and 0% in the fully dilated group. There was no increased risk for operative birth in the ≤ 5 cm group compared to the 6-10 cm group, adjusted OR 1.28 95%CI (0.78-2.08). The fully dilated group had a decreased risk of operative birth (adjusted OR 0.48 95%CI (0.27-0.85). The rate of a negative birthing experience was high in all groups (28.5%, 19% and 18%) but was only increased among women in the ≤ 5 cm group compared with the 6-10 cm group, adjusted OR 1.76 95%CI (1.05-2.95).

CONCLUSIONS

Although no difference in the risk of operative birth was found between the ≤ 5 cm and 6-10 cm cervical dilatation-groups, the cesarean section rate was highest in women with dystocia requiring oxytocin augmentation at ≤ 5 cm cervical dilatation. This might indicate that oxytocin augmentation before 6 cm cervical dilatation could be contra-productive in preventing cesarean sections. Further, the increased risk of negative birth experience in the ≤ 5 cm group should be kept in mind to improve labor care.

Giving birth in a pandemic: women's birth experiences in England during COVID-19

BACKGROUND

Expectant parents worldwide have experienced changes in the way they give birth as a result of COVID-19, including restrictions relating to access to birthing units and the presence of birthing partners during the birth, and changes to birth plans. This paper reports the experiences of women in England.

METHODS

Data were obtained from both closed- and open-ended responses collected as part of the national COVID in Context of Pregnancy, Infancy and Parenting (CoCoPIP) Study online survey (n = 477 families) between 15th July 2020 - 29th March 2021. Frequency data are presented alongside the results of a sentiment analysis; the open-ended data was analysed thematically.

RESULTS

Two-thirds of expectant women reported giving birth via spontaneous vaginal delivery (SVD) (66.1%) and a third via caesarean section (CS) (32.6%) or 'other' (1.3%). Just under half (49.7%) of the CS were reported to have been elective/planned, with 47.7% being emergencies. A third (37.4%) of participants reported having no changes to their birth (as set out in their birthing plan), with a further 25% reporting COVID-related changes, and 37.4% reporting non-COVID related changes (e.g., changes as a result of birthing complications). One quarter of the sample reported COVID-related changes to their birth plan, including limited birthing options and reduced feelings of control; difficulties accessing pain-relief and assistance, and feelings of distress and anxiety. Under half of the respondents reported not knowing whether there could be someone present at the birth (44.8%), with 2.3% of respondents reporting no birthing partner being present due to COVID-related restrictions. Parental experiences of communication and advice provided by the hospital prior to delivery were mixed, with significant stress and anxiety being reported in relation to both the fluctuating guidance and lack of certainty regarding the presence of birthing partners at the birth. The sentiment analysis revealed that participant experiences of giving birth during the pandemic were predominately negative (46.9%) particularly in relation to the first national lockdown, with a smaller proportion of positive (33.2%) and neutral responses (19.9%).

CONCLUSION

The proportion of parents reporting birthing interventions (i.e., emergency CS) was higher than previously reported, as were uncertainties related to the birth, and poor communication, leading to increased feelings of anxiety and high levels of negative emotions. The implications of these findings are discussed.

Birthing Experiences of Spanish Speakers During the COVID-19 Pandemic in NYC

Patient-provider language discordance is known to negatively affect patient experiences. This study describes the birth experience during COVID-19 among monolingual Spanish and bilingual Spanish/English speakers. Qualitative videoconference interviews with 15 monolingual Spanish and 15 bilingual Spanish/English patients that gave birth during the COVID-19 pandemic at a NYC tertiary-care hospital. 93% of participants had a positive birthing experience. Common themes were quality of care, birth outcome, and supportive staff. 80% of patients lacked a support person postpartum. 27% of Spanish-only speakers felt that an interpreter should have been provided but was not, and 47% felt the experience would have been different if they spoke English. The patient birth experience is tied to birth outcomes and quality of care and remained positive during the beginning of the COVID-19 pandemic. Restrictions on support people during the intra- or postpartum impacted the birthing experience more than provider language discordance.

The Postpartum Specific Anxiety Scale: Confirmatory factor analyses and relationships with birth experience

The Postpartum Specific Anxiety Scale [PSAS] was developed and validated as a research tool with a four-factor structure; with predictive validity corroborated in studies examining infant-feeding and maternal bonding outcomes. The PSAS has not been examined in relation to birth experiences. We aimed to confirm the PSAS four-factor structure and examine these domains of anxiety in relation to subjective and objective birth experiences. Postpartum mothers (≤ 12-months; N = 500) completed the PSAS alongside measures of subjective birth satisfaction and objective obstetric interventions/complications. Confirmatory factor analyses [CFA] tested eight models, theoretically derived from the preceding exploratory work. Structural equation modelling [SEM] tested associations between each PSAS factor and birth experience variables in the best-fitting model. An identical 51-item four-factor model fits the data well. SEM analyses revealed associations between lower perceptions of quality of intrapartum care and increased maternal competence and attachment anxieties, practical infant care anxieties, and infant safety and welfare anxieties. High subjective stress and negative emotional response to labour were associated with increased psychosocial adjustment to motherhood anxieties. Specific associations were found between neonatal care unit admission and practical infant care anxieties; and infant asphyxia and infant safety and welfare anxieties. Findings confirm construct and convergent validity of the four-factor PSAS and its use in measuring postpartum anxiety. Unique associations were also identified, indicating specific subjective and objective experiences occurring during birth may elicit a differential anxiety response, in that they are related to specific forms of postpartum anxiety which occur during the first postpartum year.

Two are better than one? The impact of lay birth companions on childbirth experiences and PTSD

Although continuous support during childbirth is recommended by the World Health Organization (WHO) and has well-established benefits, the practice is still not routinely implemented in all maternity settings. We studied the possible effect of an additional lay companion (other than the partner) on childbirth experience and postpartum post-traumatic stress disorder (PTSD). Two hundred and forty-six women, who gave birth in maternity wards of a large tertiary health center in Israel, responded to questionnaires in person at 1-4 days (Demographic questions and the childbirth experience questionnaire) and on-line at 8-10 weeks postpartum (City Birth Trauma Scale). Obstetric data were taken from the medical files. Women who were accompanied by their partners and an additional companion were lower in birth-related PTSD symptoms (M = 1.17, SD = 2.61) than women accompanied by only their partner (M = 1.53, SD = 2.79) (F(2, 240) = 4.0, p < 0.05). Women who had a single companion (M = 1.44, SD = 2.61) showed more birth-related PTSD symptoms than women who had two or more companions (M = 1.17, SD = 2.52) (F(1, 241) = 6.4, p < 0.05). In addition, women who had a single companion were higher in general PTSD symptoms (M = 3.91, SD = 4.73) than women who had two or more companions (M = 2.31, SD = 4.29) (F(1, 241) = 4.2, p < 0.05). No differences were found in childbirth experiences of women with single or multiple companions. Allowing more than one lay companion (other than the partner) may be a simple cost-effective way of providing beneficial support in all birth settings, promoting respectful maternity care and reducing childbirth-related PTSD levels and by that future psychopathology sequela.

Birth Stories, Support, and Perinatal Emotional Health among Minority Adolescent Mothers: A Mixed Methods Study

STUDY OBJECTIVE

To explore minority, adolescent birth and perinatal experiences to inform and improve quality of care for this unique group.

DESIGN

Mixed quantitative and qualitative study guided by Bourdieu's Social Fields framework.

SETTING

Clinic dedicated to parenting adolescents, and a local charter school founded to serve pregnant and parenting young adults.

PARTICIPANTS

Sample size for quantitative data: n = 27; qualitative data: n = 14. Average age was 16.39 years (SD = 1.29); most self-identified as Latina/Hispanic or African American/Black/Afro-Caribbean/African.

INTERVENTIONS AND MAIN OUTCOME MEASURES

We used 2 validated surveys: Birth Satisfaction Scale-Revised (BSS-R), and the Postpartum Worry Scale-Revised (PWS-R). The BSS-R has 10 items, and quantifies labor and delivery experiences. The PWS-R has 20 items, and quantifies maternal, infant, and social-emotional worries. The qualitative, semistructured 30-minute interviews with a subset of survey respondents further explored perinatal mental health, labor experiences, and support networks.

RESULTS

BSS-R data resulted in an average score of 25.14 (SD = 5.35), which correlated to moderate satisfaction with birth experience (range, 0-40 with 0 = most negative). The PWS-R average score of 55.79 (SD = 21.06) indicated elevated postpartum worry (range, 20-100 with 20 = most worry). Qualitative interviewees worried about relationships and newborn well-being; support networks fluctuated; distinct events, pain, and fear during labor dominated birth stories. Advice for peers included: tending to social support, stress, and self-care. Nonjudgmental communication, empathy, and emotional connection were desired attributes of their health care team. Participants had anxiety related to social networks and newborn care. Although birth experiences were moderately positive, they were also described as stressful. However, participants were resourceful, insightful, and took advantage of social supports.

CONCLUSION

Birth experiences, patterns of stress, and support networks are uniquely identified and utilized by adolescent mothers. Being heard and feeling connected to providers empowered this group of young, minority adolescents. Participant advice could inform future educational courses, programs, and hospital innovations for perinatal adolescents.

The impacts of the COVID-19 pandemic on birth satisfaction in a prospective cohort of 2,341 U.S. women

PROBLEM

Birth satisfaction is an important health outcome that is related to postpartum mood, infant caretaking, and future pregnancy intention.

BACKGROUND

The COVID-19 pandemic profoundly affected antenatal care and intrapartum practices that may reduce birth satisfaction.

AIM

To investigate the extent to which pandemic-related factors predicted lower birth satisfaction.

METHODS

2341 women who were recruited prenatally in April-May 2020 and reported a live birth between April-October 2020 were included in the current analysis. Hierarchical linear regression to predict birth satisfaction from well-established predictors of birth satisfaction (step 1) and from pandemic-related factors (step 2) was conducted. Additionally, the indirect associations of pandemic-related stress with birth satisfaction were investigated.

FINDINGS

The first step of the regression explained 35% of variance in birth satisfaction. In the second step, pandemic-related factors explained an additional 3% of variance in birth satisfaction. Maternal stress about feeling unprepared for birth due to the pandemic and restrictions on companions during birth independently predicted lower birth satisfaction beyond the non-pandemic variables. Pandemic-related unpreparedness stress was associated with more medicalized birth and greater incongruence with birth preference, thus also indirectly influencing birth satisfaction through a mediation process.

DISCUSSION

Well-established contributors to birth satisfaction remained potent during the pandemic. In addition, maternal stress and restriction on accompaniment to birth were associated with a small but significant reduction in birth satisfaction.

CONCLUSION

Study findings suggest that helping women set flexible and reasonable expectations for birth and allowing at least one intrapartum support person can improve birth satisfaction.

"Going through it together": Being accompanied by loved ones during birth and abortion

We sought to understand the meaning people who have given birth and have had an abortion ascribe to being accompanied by partners, family members and friends during these reproductive experiences. Incorporating this knowledge into clinical practice may contribute to improving the quality of these services, especially in abortion care, in which loved ones are often excluded. The study took place in Northern California in 2014. We conducted semi-structured, intensive interviews with twenty cis-women about their birth and abortion experiences and analyzed their narratives with respect to accompaniment using grounded theory. The roles of loved ones were complementary yet distinct to those of medical personnel. They were also multifaceted. Participants needed familiar individuals to bear witness, share the emotional experience and provide protection from perceived or possible harm associated with medical care. In some cases, more often in the context of abortion than childbirth, participants shielded their loved ones from emotional burdens of the reproductive process. Some pregnant people of color faced gendered racism, which also influenced their accompaniment needs. Male partners played a distinct role of upholding dominant social ideals related to pregnancy. As is commonplace in birth-related care, abortion services could be formally structured to include partners, family members and friends when desired by pregnant people to improve their experiences. Such integration should be balanced with considerations for privacy, safety and institutional resources. Working toward this goal may reduce structural abortion stigma and help alleviate pregnant people's burdens associated with reproduction.

Birth Experience in Syrian Refugee Women in Turkey: A Descriptive Phenomenological Qualitative Study

A negative birth experience affects the woman's subsequent pregnancy, and delivery processes negatively, decreases patient satisfaction, and the high anxiety/stress experienced during pregnancy/delivery is transferred to the next generations by epigenetic transmission. In this study, women's birth experiences of Syrian refugees in Turkey aimed to describe in-depth. It was designed as a descriptive phenomenological qualitative study. Fifteen refugee women included in the sample gave birth in Turkey, living in Turkey's southern city. In-depth interviews were conducted with women. Six themes were formed in the results: "quantitatively enough but unsatisfactory service," "not providing autonomy," "think that she was neglected," "no respect to privacy," "feeling loneliness/fear in the delivery room," and "prejudice." The factors that negatively affect the pregnancy and birth experiences of Syrian refugee women are language/communication barriers, the provision of care services that are incompatible with their religious and cultural values, and their prejudice regarding discrimination.

A prospective cohort study of post-traumatic stress disorder and maternal-infant bonding after first childbirth

OBJECTIVE

To investigate risk factors for childbirth-related post-traumatic stress disorder (CR-PTSD) measured 1-month after first childbirth, and the association between CR-PTSD and maternal-infant bonding.

METHODS

In this prospective cohort study 3006 nulliparous women living in Pennsylvania, USA, were asked about CR-PTSD at 1-month postpartum, and maternal-infant bonding at 1, 6 and 12-months postpartum. Multivariable logistic regression models identified risk factors for CR-PTSD and associations between CR-PTSD and maternal-infant bonding at 1, 6 and 12-months postpartum, controlling for confounding variables - including postpartum depression, stress and social support.

RESULTS

Nearly half (47.5%) of the women reported that during labor and delivery they were afraid that they or their baby might be hurt or die, and 225 women (7.5%) reported experiencing one or more CR-PTSD symptoms at 1-month postpartum. Depression, stress and low social support during pregnancy were associated with CR-PTSD, as well as labor induction, delivery complications, poor pain control, and unplanned cesarean delivery. Women with CR-PTSD reported a less positive childbirth experience, less shared decision-making, and were more likely to score in the bottom third on maternal-infant bonding at 1-month postpartum (adjusted odds ratio [aOR] 2.5, 95% CI 1.8-3.3, p < 0.001); at 6-months postpartum (aOR 2.1, 95% CI 1.5-2.8, p < 0.001); and at 12-months postpartum (aOR 2.2, 95% CI 1.6-3.0, p < 0.001).

CONCLUSION

In this large-scale prospective cohort study we found that CR-PTSD was consistently associated with lower levels of maternal-infant bonding over the course of the first year after first childbirth.

Pandemic Birthing: Childbirth Satisfaction, Perceived Health Care Bias, and Postpartum Health During the COVID-19 Pandemic

Objective

To examine the impact of the COVID-19 pandemic on birth satisfaction and perceived health care discrimination during childbirth, and in turn, the influence of these birth experiences on postpartum health.

Study Design

We conducted a cross-sectional, bilingual web survey of 237 women who gave birth at two hospitals in New York City and assessed patient-reported experience and outcomes following the first wave of SARS-CoV-2 infections in the New York region. We ascertained SARS-CoV-2 status at delivery from the electronic medical record using participant-reported name and date of birth. We compared birth experience during the COVID-19 pandemic (March 15, 2020–May 11, 2020) to a pre-pandemic response period (January 1, 2020–March 14, 2020). We estimated risk ratios for associations between birth experience and anxiety, depressive symptoms, stress, birth-related PTSD, emergency department visits, timely postpartum visit, and exclusive breastfeeding. Multivariable models adjusted for age, race-ethnicity, insurance, education, parity, BMI, previous experience of maltreatment/abuse and cesarean delivery.

Results

Women who gave birth during the peak of the pandemic response, and those that were SARS-CoV-2 positive, Black, and Latina, had lower birth satisfaction and higher perceived health care discrimination. Women with lower birth satisfaction were more likely to report higher postpartum anxiety, stress, depressive symptoms, and lower exclusive breastfeeding. Experiencing one or more incident of health care discrimination was associated with higher levels of postpartum stress and birth-related PTSD.

Conclusion

Hospitals and policy-makers should institute measures to safeguard against a negative birth experience during the ongoing COVID-19 pandemic, particularly among birthing people of color.

Reproducing normative femininity: Women's evaluations of their birth experiences analysed by means of word frequency and thematic analysis

BACKGROUND

Given the significance of the birth experience on women's and babies' well-being, assessing and understanding maternal satisfaction is important for providing optimal care. While previous research has thoroughly reviewed women's levels of satisfaction with the childbirth experience from a multitude of different angles, there is a dearth of papers that use a gender lens in this area. The aim of this study is to explore through a gender perspective the circumstances attributed to both women's assessment of a positive birth experience and those which contribute to a lack of satisfaction with their birth experience.

METHODS

Through the use of a local birth evaluation form at a Swedish labour ward, 190 women gave written evaluations of their birth experiences. The evaluations were divided into groups of positive, ambiguous, and negative evaluations. By means of a latent and constructionist thematic analysis based on word count, women's evaluations are discussed as reflections of the underlying sociocultural ideas, assumptions, and ideologies that shape women's realities.

RESULTS

Three themes were identified: Grateful women and nurturing midwives doing gender together demonstrates how a gender-normative behaviour may influence a positive birth experience when based on a reciprocal relationship. Managing ambiguous feelings by sympathising with the midwife shows how women's internalised sense of gender can make women belittle their negative experiences and refrain from delivering criticism. The midwifery model of relational care impeded by the labour care organisation describes how the care women receive during labour and birth is regulated by an organisation not always adapted to the benefit of birthing women.

CONCLUSIONS

Most women were very satisfied, predominantly with emotional support they received from the midwives. The latent constructionist thematic analysis also elicited women's mixed feelings towards the birth experience, with the majority of negative experiences directed towards the labour care organisation. Recognising the impact of institutional and medical discourses on childbirth, women's birth evaluations demonstrate the benefits and challenges of gender-normative behaviour, where women's internalised sense of gender was found to affect their experiences. A gender perspective may provide a useful tool in unveiling gender-normative complexities surrounding the childbirth experience.

Childbirth experience, maternal functioning and mental health: how are they related?

Introduction: Childbirth experience is shaped by the labor and delivery process. The aim of this study was to investigate the relationship between childbirth experience, subsequent postpartum maternal functioning and mental health.Methods: A total of 483 mothers in the first 4-16 weeks postpartum participated in this cross-sectional study. The cluster random sampling method was used to select the participants. The Questionnaire for Assessing the Childbirth Experience, Mental Health Inventory, and the Barkin Index of Maternal Functioning were completed through interviews.Results: The mean childbirth experience, mental health, and maternal functioning scores were 1.6 (0.4), 79.1 (15.0), and 97.4 (13.0), respectively. There was a significant correlation between the total mental health and maternal functioning scores and all its subscales with childbirth experience scores (P<0.001). Results from the general linear model pointed to a significant correlation between maternal functioning and childbirth experience (P<0.001), as well as between receiving support for infant care (P<0.001) and family income adequacy (P=0.006). Mental health was also significantly correlated with childbirth experience (P<0.001), complete life satisfaction (P<0.001), and receiving support for infant care (P=0.025).Conclusion: Supportive care provision services may improve mothers' birth experiences, which leads to enhanced postpartum maternal functioning and mental health.

Does giving birth in a "birth environment room" versus a standard birth room lower augmentation of labor? - Results from a randomized controlled trial

Objective

In the last decade, there has been an increased interest in exploring the impact of the physical birth environment on midwifery practice and women's birth experiences. This study is based on the hypothesis that the environment for birth needs greater attention to improve some of the existing challenges in modern obstetric practice, for example the increasing use of augmentation and number of interventions during delivery.

Study design

A randomized controlled trial was carried out to study the effect of giving birth in a specially designed "birth environment room" on the use of augmentation during labor. The study took place at the Department of Obstetrics and Gynecology, Herning Hospital, Denmark and included 680 nulliparous women in spontaneous labor at term with a fetus in cephalic presentation. Women were randomly allocated to either the "birth environment room" or a standard birth room. The primary outcome was augmentation of labor by use of oxytocin. Secondary outcomes were duration of labor, use of pharmacological pain relief, and mode of birth. Differences were estimated as relative risks (RR) and presented with 95% confidence intervals.

Results

No difference was found on the primary outcome, augmentation of labor (29.1% in the "birth environment room" versus 30.6% in the standard room, RR 0.97; 0.89-1.08). More women in the "birth environment room" used the bathtub (60.6% versus 52.4%, RR 1.18; 1.02-1.37), whereas a tendency to lower use of epidural analgesia (22.6% versus 28.2%) did not reach statistical significance (RR 0.87; 0.74-1.02). The chance of an uncomplicated birth was almost similar in the two groups (70.6% in the "birth environment room" versus 72.6% in the standard room, RR 0.97; 0.88-1.07) as were duration of labor (mean 7.9 hours in both groups).

Conclusions

Birthing in a specially designed physical birth environment did not lower use of oxytocin for augmentation of labor. Neither did it have any effect on duration of labor, use of pharmacological pain relief, and chance of birthing without complications. We recommend that future trials are conducted in birth units with greater improvement potentials.

"It's like a bus, going downhill, without a driver": A qualitative study of how postpartum haemorrhage is experienced by women, their birth partners, and healthcare professionals

PROBLEM

Postpartum haemorrhage [PPH] remains a major cause of maternal morbidity and mortality. Whilst low-resource settings bear the greatest burden of deaths, women live with associated morbidities in all healthcare settings. Limited data exists regarding the experience for women, their partners, or healthcare professionals [HCPs], affected by PPH.

AIM

To qualitatively investigate the experience of PPH, for women (n=9), birth partners (n=4), and HCPs (n=9) in an inner-city tertiary referral centre. To provide multi-faceted insight into PPH and improve understanding and future care practices.

METHODS

Participants were interviewed about their experiences within two weeks of a PPH. Data were analysed using thematic analysis.

FINDINGS

Four distinct, but related, themes were identified: 'Knowledge specific to PPH'; 'Effective and appropriate responses to PPH'; 'Communication of risk factors'; and 'Quantifying blood loss'; which collected around a central organising concept of 'Explaining the indescribable'.

DISCUSSION

PPH was viewed as a 'crisis-style emergency', generating respectful fear in HCPs, whilst women and partners had little-to-no prior knowledge. Specific PPH knowledge dictated HCPs' response and risk communication. PPH risks were typically linked to quantification of blood loss, assessment of which varied with acknowledged questionable accuracy. Women's and partners' confidence in HCPs' ability to deal with PPH was unquestionable. Non-verbal communication was highlighted, with HCP body language betraying professional confidence.

CONCLUSION

Information about blood loss during childbirth must be imparted in a sensitive, timely manner. Whilst training for HCPs results in effective PPH management, consideration should be given to their non-verbal cues and the impact of dealing with this stressful, 'everyday emergency'.

Reducing neonatal morbidity by discontinuing oxytocin during the active phase of first stage of labor: a multicenter randomized controlled trial STOPOXY

BACKGROUND

Oxytocin is effective in reducing labor duration, but can be associated with fetal and maternal complications such as neonatal acidosis and post-partum hemorrhage. When comparing discontinuing oxytocin in the active phase with continuing oxytocin infusion, previous studies were underpowered to show a reduction in neonatal morbidity. Thus, we aim at evaluating the impact of discontinuing oxytocin during the active phase of the first stage of labor on the neonatal morbidity rate.

METHODS

STOPOXY is a multicenter, randomized, open-label, controlled trial conducted in 20 maternity units in France. The first participant was recruited January 17th 2020. The trial includes women with a live term (≥37 weeks) singleton, in cephalic presentation, receiving oxytocin before 4 cm, after an induced or spontaneous labor. Women aged < 18 years, with a lack of social security coverage, a scarred uterus, a multiple pregnancy, a fetal congenital malformation, a growth retardation <3rd percentile or an abnormal fetal heart rate at randomization are excluded. Women are randomized before 6 cm when oxytocin is either continued or discontinued. Randomization is stratified by center and parity. The primary outcome, neonatal morbidity is assessed using a composite variable defined by an umbilical arterial pH at birth < 7.10 and/or a base excess > 10 mmol/L and/or umbilical arterial lactates> 7 mmol/L and/or a 5 min Apgar score < 7 and/or admission in neonatal intensive care unit. The primary outcome will be compared between the two groups using a chi-square test with a p-value of 0.05. Secondary outcomes include neonatal complications, duration of active phase, mode of delivery, fetal and maternal complications during labor and delivery, including cesarean delivery rate and postpartum hemorrhage, and birth experience. We aim at including 2475 women based on a reduction in neonatal morbidity from 8% in the control group to 5% in the experimental group, with a power of 80% and an alpha risk of 5%.

DISCUSSION

Discontinuing oxytocin during the active phase of labor could improve both child health, by reducing moderate to severe neonatal morbidity, and maternal health by reducing cesarean delivery and postpartum hemorrhage rates.

TRIAL REGISTRATION

Clinical trials NCT03991091 , registered June 19th, 2019.

Does prolonged labor affect the birth experience and subsequent wish for cesarean section among first-time mothers? A quantitative and qualitative analysis of a survey from Norway

Background

Prolonged labor might contribute to a negative birth experience and influence first-time mothers’ attitudes towards future pregnancies. Previous studies have not adjusted for possible confounding factors, such as operative delivery, induction and postpartum hemorrhage. We aimed to determine the impact of prolonged labor on birth experience and a wish for cesarean section in subsequent pregnancies.

Methods

A survey including the validated “Childbirth Experience Questionnaire”. First-time mothers giving birth between 2012 and 2014 at a Norwegian university hospital participated. Data from deliveries were collected. Regression analysis and thematic content analysis were performed.

Results

459 (71%) women responded. Women with labor duration > 12 h had significantly lower scores on two out of four sub-items of the questionnaire: own capacity (p = 0.040) and perceived safety (p = 0.023).

Other factors contributing to a negative experience were:

Cesarean section vs vaginal birth: own capacity (p = 0.001) and perceived safety (p = 0.007). Operative vaginal vs spontaneous birth: own capacity (p = 0.001), perceived safety (p < 0.001) and participation (p = 0.047).

Induced vs spontaneous start: own capacity (p = 0.039) and participation (p = 0.050). Postpartum hemorrhage ≥500 ml vs < 500 ml: perceived safety (p = 0.002) and participation (p = 0.031).

In the unadjusted analysis, prolonged labor more than doubled the risk (odds ratio (OR) 2.66, 95%CI 1.42–4.99) of a subsequent wish for cesarean delivery. However, when adjustments were made for mode of delivery and induction, emergency cesarean section (OR 8.86,95%CI 3.85–20.41) and operative vaginal delivery (OR 3.05, 95%CI 1.46–6.38) remained the only factors significantly increasing the probability of wanting a cesarean section in subsequent pregnancies.

The written comments on prolonged labor (n = 46) indicated four main themes:

Difficulties gaining access to the labor ward.

Being left alone during the unexpectedly long, painful early stage of labor.

Stressful operative deliveries and worse pain than imagined.

Lack of support and too little or contradictory information from the staff.

Conclusions

Women with prolonged labors are at risk of a negative birth experience. Prolonged labor per se did not predict a wish for a cesarean section in a subsequent pregnancy. However, women with long labors more often experience operative delivery, which is a risk factor of a later wish for a cesarean section.

Evaluation of the birth plan implementation: a parallel convergent mixed study

BACKGROUND

Pregnancy, birth, and motherhood are among the most important events of every woman's life. Training and participation of mothers in the decision-making process of delivery play an essential role in physical as well as psychosocial preparation of the mother. The healthcare system can improve and enhance the level of care by involving the patient in their self-care process. The aim of the present study is to assess the implementation of the birth plan for the first time in Iran in Tabriz city.

METHODS/DESIGN

The present study uses a mixed-method with a parallel convergence approach, including both quantitative and qualitative phases. The quantitative phase is a randomized controlled clinical trial performed on 106 pregnant women, 32-36 weeks of pregnancy, referring to Taleghani educational hospital in Tabriz city. The participants will be assigned into intervention and control groups using a randomized block method. A training session will be held about the items of the birth plan checklist at weeks 32-36 of gestation for the participants in the intervention group, whereby a mother-requested birth plan will be developed. It will then be implemented by the researcher after admitting them to the delivery ward. Also, those in the control group will receive routine care. During and after the delivery, the questionnaire of delivery information, neonatal information, and Delivery Fear Scale (DFS) will be completed. Also, a partogram will be completed for all participants by the researcher. The participants in both groups will be followed up until six weeks post-delivery, whereby the instruments of Childbirth Experience Questionnaire (CEQ2.0), Edinburgh's Postpartum Depression Scale and PTSD Symptom Scale 1 (PSS-I) will be completed six weeks 4-6 weeks postpartum by the researcher through an interview with participants in Taleghani educational hospital. The general linear model and multivariate logistic regression model will be used while controlling the possible confounding variables. The qualitative phase will be performed to explore the women's perception of the effect of the birth plan on childbirth experience within 4-6 weeks postpartum. The sampling will be of a purposeful type on the women who would receive the birth plan and will continue until data saturation. In-depth, semi-structured individual interviews would be used for data collection. The data analysis will be done through content analysis with a conventional approach. The results of the quantitative and qualitative phases will be analyzed separately, and then combined in the interpretation stage.

DISCUSSION

By investigating the effect of implementing the birth plan on the childbirth experience of women as well as other maternal and neonatal outcomes, an evidence-based insight can be offered using a culturally sensitive approach. The presentation of the results obtained from this study using the mixed method may be effective in improving the quality of care provided for women during labor.

TRIAL REGISTRATION

Iranian Registry of Clinical Trials (IRCT): IRCT20120718010324N58. Date of registration: July 7, 2020. URL: https://en.irct.ir/user/trial/47007/view.

Respectful maternity care and its relationship with childbirth experience in Iranian women: a prospective cohort study

Background

Intrapartum respectful maternity care is defined as a fundamental human right that can affect the mother’s experiences. This study aimed to determine the status of respectful maternity care and its relationship with childbirth experience among Iranian women.

Methods

This prospective cohort study recruited 334 postpartum women in postpartum wards of two public and four private hospitals in Tabriz, Iran. Quota sampling was used based on the number of births in each hospital. Data were collected through interviews with the use of the following tools: sociodemographic and obstetrics characteristics questionnaire, respectful maternity care scale (6 to 18 h postpartum), and childbirth experience questionnaire (30 to 45 days postpartum). The General Linear Model was used to determine the relationship between respectful maternity care and childbirth experience.

Results

The mean respectful maternity care score was 62.58 with a range of 15 to 75, and the total childbirth experience score was 3.29 with a range of 1 to 4. After adjusting for sociodemographic and obstetrics characteristics, a statistically significant direct correlation was found between respectful maternity care and a positive childbirth experience (P < 0.001).

Conclusions

The findings reveals a direct relationship between respectful maternity care and positive childbirth experience. Therefore, it is recommended that mangers and policy makers in childbirth facilities reinforce facilitating a respectful maternity care to improve women’s child birth experience and prevent potential adverse effects of negative childbirth experiences.

The Influence of Personality and Anxiety Traits on Birth Experience and Epidural Use in Vaginal Deliveries - A Cohort Study

A positive birth experience for the mother is an important goal in obstetric health care and is influenced by several factors. For this study, 186 women filled in questionnaires between 24 and 72 hours after giving birth vaginally. We evaluated the Big-Five personality traits (extraversion, neuroticism, openness, conscientiousness and agreeableness), trait anxiety, different dimensions of childbirth experience and pain management. Correlation analysis revealed that trait anxiety and neuroticism were negatively associated with several dimensions of the birth experience. Furthermore, conscientiousness and extraversion were positively correlated with the dimension Participation. Regression analysis for the individual dimensions and overall score respectively, confirmed the independent impact of anxiety trait on Perceived Safety, Participation and Professional Support and the overall score as well as of neuroticism on Perceived Safety and conscientiousness on Participation. The significant regression models showed small R2-scores (.084-.154). The birth experience did not differ whether the women received an epidural or not. Women who did not receive an epidural displayed higher scores on the personality trait conscientiousness. The study highlights small but important associations between personality traits and birth experience in vaginal births which should sensitize the medical staff when supporting women during labor.

Childbirth experience in women participating in a continuity of midwifery care project

BACKGROUND

Continuity models of care are rare in Sweden, despite the evidence of their benefit to women and babies. Previous studies have shown certain factors are associated with a positive birth experience, including continuity of midwifery care.

AIM

The aim was to investigate women's childbirth experiences in relation to background data, birth outcome and continuity with a known midwife, in a rural area of Sweden.

METHODS

An experimental cohort study. Participating women were offered continuity of midwifery care in pregnancy and birth, during selected time periods. Data were collected in mid-pregnancy and two months after birth. The Childbirth Experience Questionnaire was used to determine women's birth experiences.

RESULT

A total of 226 women responded to the follow-up questionnaire. Not living with a partner, fear of giving birth, and a birth preference other than vaginal were associated with a less positive birth experience. Having had a vaginal birth with no epidural, no augmentation and no birth complication all yield a better birth experience. Women who had had a known midwife were more likely to have had a positive birth experience overall, predominantly in the domain Professional support.

CONCLUSIONS

The results of this study showed that women who received care from a known midwife in labour were more likely to have a positive birth experience. The results also pointed out the benefits of a less medicalized birth as important for a good birth experience, and that some women may need extra support to avoid a less positive birth experience.