Essays on pregnancy and childbirth
Of the 39 full text papers, four were excluded after quality appraisal [ 14 — 17 ]. Two were relatively small Brazilian studies with little or no methodological information [ 14 , 15 ], one was a mixed methods review with limited qualitative data [ 16 ] and one had limited methodological information[ 17 ]. Thirty five papers were included in the final analysis.
Post-hoc examination of the four papers excluded on quality grounds indicated that inclusion of the data within them would not have changed the final themes, line of argument, or Summary of Findings statement.
The updated search generated 26 hits after screening by title and a further 2 studies were identified [ 18 , 19 ]. The characteristics and quality of the 35 included studies were tabulated, and are summarized in Table 1. The date range of publication for the results of the primary search was — All regions of the world were represented. The papers incorporated a range of methodological approaches from relatively small phenomenological studies, to qualitative analysis of free text survey responses.
They represented the views of more than women, from a wide range of ethnic backgrounds, ages 14—49 and socio-demographic groups. The quality was mostly moderate to high B or above. The eligible papers from the updated search were scrutinised to assess similarities or differences between the results generated from the primary review, and the themes and findings in the more recent studies.
The numbers used in this table are indexed to the appropriate study in superscript in the reference list below. The findings suggest that, with high or moderate confidence, most women around the world hope for a labour and birth experience that enables them to use their inherent physical and psychosocial capacities to labor and give birth to a healthy baby in a clinically, culturally, and psychologically safe environment with continuity of practical and emotional support from a birth companion s , and with kind, sensitive clinical staff, who provide reassurance and technical competency.
Even where intervention is needed or wanted, women usually wish to retain a sense of personal achievement and control by being involved in decision making. This is summarized in three overarching themes: Hoping for a positive birth experience : anticipating triumph and delight , fearing pain and abandonment ; the enduring influence of familial and socio- childbirth norms; and Enacting what matters in the context of what is available.
Labor Pains and Birth Stories: Essays on Pregnancy, Childbirth, and Becoming a Parent
Beliefs about what matters to women are influenced by familial experiences, and local cultural norms and values. The themes and findings in the papers included in the updated search confirmed the review findings, suggesting that the analysis is robust, and theoretically transferable to a range of women and settings around the world. For a small minority, childbirth was simply a physical process that should be conducted as quickly and painlessly as possible. As with other life-transition experiences, many women were fearful in anticipation of the hard work, pain, and uncertainty of labour, but most of them accepted these potentially extreme difficulties as part of the necessary process of achieving a positive, or even transformatory, birth experience for themselves and for their baby.
Whatever they thought about the nature of birth, women interpreted their expectations of what could and should happen through the lens of family birth stories, and cultural and social norms. Whether women wanted birth over as quickly and painlessly as possible, or whether they understood it as fundamental to their transition to motherhood, they recognized the potential vulnerability of themselves and their baby through the process, and the essential uncertainty about what might happen.
This was associated with a strong desire for safe, supportive, kind, respectful and responsive care during labor and birth. These characteristics applied to birth companions, professional and lay care givers, and to the processes and environment of care. The extent to which women could experience what mattered to them was mediated by the nature of the local maternity care provision that was available to them, including the attitudes and behaviours of staff, the quality of the relationship between women and care providers, and the resources and atmosphere of the local facility.
Systematic reviews are inevitably dependent on the nature and quality of data that have already been collected and reported. In reviews of qualitative studies, these data have already been interpreted through the lens of what is seen to be important by the primary authors. Too few studies, from too narrow a cultural context, can limit the external transferability of the findings. However, the findings are strengthened by the inclusion of a large number of studies, covering every region of the world, and by the confirmatory analysis carried out as a result of the updated search.
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The use of translation software at the inclusion stage of the review could theoretically have led to the exclusion of some relevant papers. In the event, 4 studies from the primary search that were included as a consequence of software translation were in languages other than English 3 in Portuguese and 1 in Japanese. The findings of all of these papers were translated by fluent speakers of the relevant language, and they were consistent with the papers written in English. The final analysis was consistent for women in all regions of the world. GRADE-CERQual assessments indicated that confidence in most of the findings was moderate or high, reflecting the quantity and quality of the included studies, and the wide range of settings, viewpoints, and study types included.
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The findings largely reinforce the prior beliefs of the authors, which could suggest that different reviewers might have come to different conclusions. However, this risk was limited by the conscious search for disconfirming data to test the emerging codes, subthemes, and main themes. The findings apply directly to healthy women of a range of parity, and in a range of cultural and economic settings, who are receiving routine intrapartum care.
The review did not include studies that were only focused on women with specific health conditions, such as HIV or diabetes, or women from particular marginalised groups, such as those seen as ethnic or cultural outsiders, or very young or very poor women. However, women from some of these groups were part of the respondent sample in some of the included studies, and individual studies of the views of women who are marginalised suggest that the review findings are highly likely to be transferable [ 56 — 59 ].
The Effects Of Prenatal Pregnancy On Pregnancy
Facility birth is generally accepted as a solution to persistently high rates of maternal and neonatal mortality and morbidity. Recent WHO antenatal guidelines incorporate evidence from qualitative systematic reviews, indicating that women value the psychological, cultural and emotional experience of pregnancy as well as the health of themselves and their growing baby [ 61 , 62 ]. These reviews have also revealed that women experience pregnancy, birth, and the postnatal period as a psychological and physical continuum, and not as three distinct and un-related states.
The current review adds to this body of evidence, by linking what women perceive as a positive labour and birth to local familial and cultural norms that shape the way that childbirth is framed, and by expressing the limitations on how far women believe they can actually enact a positive experience of labour and birth, depending on the available maternity care provision locally.
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The former takes a human rights perspective, and incorporates a systematic review of what women want and need. The framework recognizes the importance of safe, accessible, evidence based, respectful care provision, and is based on a philosophy of care that optimizes physiological, psychological and cultural norms and values. The latter links the experience of care with provision of care, evidence based practices for routine care and management of complications, actionable information systems and functional referral systems, as well as competent and motivated human resources and essential physical resources.
The findings of this review also complement the Cochrane effectiveness reviews on midwife-led continuity of care [ 63 ] and continuous support in labour [ 64 ]. This review demonstrates that what matters to women in relation to childbirth is underpinned by three phenomena; the physical and psychosocial narture of birth as an embodied experience; local familial and socio-cultural norms that legitimate or reframe expectations about labour and birth; and how maternity care provision enables or restricts what matters.
Whether women perceive childbirth to be a transformatory process that has meaning for them and their baby in the short and longer term, or whether they see it as a necessary process that should be completed as quickly and painlessly as possible, maternity services need to be responsive to their values, beliefs, and needs. What matters to women is also what is likely to generate the safest and most humanized maternity care provision, for mother, baby, and the family.
There is now sufficient evidence from a wide range of sources to suggest that it is imperative that maternity services recognize the benefits of providing what matters to women and the risks of not doing so.
How Has Childbirth Changed in This Century?
Crucially, these factors should become a central component of care provision as a matter of urgency to ensure the optimum uptake of effective and respectful maternity care, and, as a consequence, the health of childbearing women and their babies and families, in both the short and longer-term. Browse Subject Areas? Click through the PLOS taxonomy to find articles in your field. Abstract Introduction Design and provision of good quality maternity care should incorporate what matters to childbearing women.
Results 35 studies 19 countries were included in the primary search, and 2 in the update. Conclusions Most healthy childbearing women want a positive birth experience. Introduction Optimum outcomes for pregnant women and their babies depend on acceptable, affordable, accessible, high quality provision of maternity care during pregnancy, childbirth, and the postnatal period [ 1 ]. Reflexive note In keeping with quality standards for rigor in qualitative research [ 7 ] the review authors considered their views and opinions on intrapartum care as possible influences on the decisions made in the design and conduct of the study, and, in turn, on how the emerging results of the study influenced those views and opinions.
Search strategy An example of the search terms used is given in Fig 1. Download: PPT. Quality assessment The included studies were subject to quality appraisal using the instrument developed by Walsh and Downe [ 7 ] and modified by Downe et al [ 10 ]. Analytic strategy The analytic process followed the method of Noblitt and Hare [ 8 ], which is derived from the constant comparison method [ 11 ].
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Results Included studies The primary search strategy generated a total of hits, including 10 already known to the authors. Characteristics and quality of included studies primary search. Table 1. Included studies: Characteristics and quality rating primary search. Conclusions This review demonstrates that what matters to women in relation to childbirth is underpinned by three phenomena; the physical and psychosocial narture of birth as an embodied experience; local familial and socio-cultural norms that legitimate or reframe expectations about labour and birth; and how maternity care provision enables or restricts what matters.
Supporting information. S1 Appendix. Quality assessment, data extraction and CERQual grading. S1 Table. References 1. Quality of care for pregnant women and newborns—the WHO vision. BJOG ; — Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide. PLoS Med ;e Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas. Midwifery and quality care: findings from a new evidence-informed framework for maternal and newborn care.
Introduction to Pregnancy
Walsh D, Downe S. Appraising the quality of qualitative research.
Midwifery ; — Meta-Ethnography: Synthesizing Qualitative Studies. Newbury Park, CA: Sage; PLoS Med 12 10 : e Expert intrapartum maternity care: a meta-synthesis. J Adv Nursing ; — View Article Google Scholar Strauss A, Corbin J. Grounded Theory in Practice. Thousand Oaks, CA: Sage; Fenwick J. The childbirth expectations of a self-selected cohort of Western Australian women.