Women's experiences of interventions for fear of childbirth in the perinatal period: A meta-synthesis of qualitative research evidence

IssueFear of childbirth (FOC) can be debilitating, impacting women's lives in pregnancy, the puerperium and beyond. Research investigated various interventions for FOC in the perinatal period, but there been no synthesis of the experiences of women who engaged with these interventions, which would inform clinical practice guidance and the development of future interventions.AimTo conduct a review and synthesis of qualitative studies of interventions for fear of childbirth in the perinatal period and women's experiences of them.MethodsA meta-synthesis was performed to examine all relevant qualitative studies describing women's experiences of interventions for FOC, in all languages. A comprehensive search of relevant databases from 1978 to 2019 was conducted. In total, following appraisal, seven qualitative studies were eligible for inclusion. The findings were integrated using thematic synthesis for the final stages in the thematic analysis.FindingsOne overarching theme “Ownership of Childbirth” and three analytical themes “Facing the fear”, “Feeling empowered”, “Managing the fear with a sense of security” were generated through the synthesis. There were no studies outside of Scandinavia located.DiscussionThis meta-synthesis provides a new way to describe the process of moving from fear to “Ownership of childbirth”. The first step in the process appears to be acknowledging and identifying the individual's fears. Women can be empowered to self-manage FOC but may be influenced by external factors such as the support of partners and staff.ConclusionThese findings provide evidence to inform the development of future interventions for FOC and highlight the need for further qualitative research globally.     

“It’s my body,my future”: Older women’s views of their interactions with physicians

ABSTRACT

Based on data obtained from in-depth, qualitative interviews conducted with 30 older Canadian women, this article examines older women’s experiences with, and views of, physicians. The research participants report a very high level of satisfaction with the patient–physician relationship; however, they also report physician shortcomings. Findings indicate that participants’ satisfaction with the patient–physician relationship was influenced by “stories about other doctors,” rationalizations and justifications, and a high level of patient assertiveness.     

The paradoxes of communication and collaboration in maternity care: A video-reflexivity study with professionals and parents

BackgroundResearch on maternity care often focuses on factors that prevent good communication and collaboration and rarely includes important stakeholders – parents – as co-researchers. To understand how professionals and parents in Dutch maternity care accomplish constructive communication and collaboration, we examined their interactions in the clinic, looking for “good practice”.MethodsWe used the video-reflexive ethnographic method in 9 midwifery practices and 2 obstetric units.FindingsWe conducted 16 meetings where participants reflected on video recordings of their clinical interactions. We found that informal strategies facilitate communication and collaboration: “talk work” – small talk and humour – and “work beyond words” – familiarity, use of sight, touch, sound, and non-verbal gestures. When using these strategies, participants noted that it is important to be sensitive to context, to the values and feelings of others, and to the timing of care. Our analysis of their ways of being sensitive shows that good communication and collaboration involves “paradoxical care”, e.g., concurrent acts of “regulated spontaneity” and “informal formalities”.DiscussionAcknowledging and reinforcing paradoxical care skills will help caregivers develop the competencies needed to address the changing demands of health care. The video-reflexive ethnographic method offers an innovative approach to studying everyday work, focusing on informal and implicit aspects of practice and providing a bottom up approach, integrating researchers, professionals and parents.ConclusionGood communication and collaboration in maternity care involves “paradoxical care” requiring social sensitivity and self-reflection, skills that should be included as part of professional training.     

Iranian obstetricians’ views about the factors that influence pregnant women's choice of delivery method: A qualitative study

BackgroundCaesarean section is a commonly performed childbirth procedure. While caesarean section is undeniably a lifesaving procedure for some mothers and babies, it can also be an unnecessary procedure for others. Different factors may be involved in the rate of birth by caesarean section.QuestionThis qualitative study was conducted in Kashan city, Iran, to explore obstetrician's views of what might influence pregnant women's choice of delivery method.MethodsObstetricians’ views and experiences were collected using semi-structured interviews. Interviews were conducted in a clinic or hospital, based on the preference of the 18 physicians who agreed to participate in the study. All interviews were recorded and transcribed. Participants were asked key questions, including: “Why do some women prefer caesarean section?”; “What kind of delivery did you have and why?”; “What kind of delivery would you recommend to pregnant women and why?” Inductive qualitative content analysis was undertaken using the method described by Morreti with 120 initial codes categorized into six categories.FindingsThe six categories developed from the initial codes were: factors relating to women, obstetricians, delivery conditions, complications, society's beliefs and the health system.ConclusionA qualitative study conducted in Iran showed that most of the factors identified by participants facilitated the choice of caesarean section. Vaginal birth was anticipated as a painful and lengthy process, with low cultural acceptance and resulting in less income for obstetricians.     

Undocuqueer Stress: How Safe are “Safe” Spaces,and for Whom?

ABSTRACT

Exploring the intersection of race/ethnicity, gender, sexuality, and immigration status, this study explored the concept of minority stress among 31 Latinx undocuqueer immigrants within the context of LGBTQ “safe” spaces. For participants, LGBTQ nightclubs and relationships represented important physical and symbolic spaces where they were able to understand what it meant to be undocuqueer. Participants described experiences of fear, anxiety, and rejection as they attempted to enter and exist within spaces presumably “safe” for LGBTQ people. The cumulative effect of feeling unsafe led participants to avoid certain spaces and inhibited their capacity to engage in relationships authentically. This study raises implications for research and policy related to serving LGBTQ and immigrant communities.     

Epidurals during normal labour and birth — Midwives’ attitudes and experiences

BackgroundMidwives have their own beliefs and values regarding pain during childbirth. Their preferences concerning labour pain management may influence women’s choices.AimTo gain a deeper understanding of midwives’ attitudes and experiences regarding the use of an epidural during normal labour.MethodsA qualitative approach was chosen for data collection. Ten in-depth interviews were conducted with midwives working in three different obstetric units in Norway. The transcribed interviews were analysed using Malterud’s systematic text condensation.FindingsThe analysis provided two main themes: “Normal childbirth as the goal” and “Challenges to the practice, knowledge, philosophy and experience of midwives”. Distinctive differences in experiences and attitudes were found. The workplace culture in the obstetric units affected the midwives’ attitudes and their midwifery practice. How they attended to women with epidural also differed. An epidural was often used as a substitute for continuous support when the obstetric unit was busy.DiscussionMidwives estimate labour pain differently, and this might impact the midwifery care. However, midwives’ interests and preferences concerning labour pain management should not influence women’s choices. Midwives are affected by the setting where they work, and research highlights that an epidural might lead to a focus on medical procedures instead of the normality of labour.ConclusionMidwives should be aware of how powerful their position is and how the workplace culture might influence their attitudes. The focus should be on “working with” women to promote a normal birth process, even with an epidural.     

Destroying False Images of God: The Experiences of LGBT Catholics

This article is about how lesbian, gay, bisexual, and trans (LGBT) Catholics imagine God and how images of God change in parallel with their self-image. The study is based on qualitative research with LGBT Catholics, most of whom are members of Drachma LGBTI in Malta or Ali d’Aquila in Palermo, Sicily. LGBT Catholics’ image of God changes as they struggle to reconcile their religious and sexual identities and as they go through a process of “conversion” from deviants and sinners to loved children of God. One study participant compares his faith in God to peeling an onion: “With every layer one peels off, one destroys false images of God.” Most study participants have moved away from the image of God as a bearded old man and father of creation and moved more toward a conception of God as love once identity conflicts are resolved.     

Midwife readiness to provide woman-centred weight gain support: Exploring perspectives across models of care

ProblemMore than half of women start pregnancy above a healthy weight and two-thirds gain excess weight during pregnancy, increasing the risk of complications.BackgroundLittle research has examined the influence model of care has on weight-related outcomes in pregnancy.AimTo explore how continuity vs non-continuity models of midwifery care influence perceived readiness to provide woman-centred interventions with women supporting pregnancy weight gain, healthy eating and physical activity.MethodsFocus groups were conducted with midwives working in either continuity or non-continuity models of care at a tertiary hospital in Queensland, Australia. Focus group questions elicited elements around practices, the healthcare environment and woman-centred care skills. Findings were analysed using the Framework Approach to qualitative research.FindingsFour focus groups, involving 15 participants from the continuity of care model and 53 from the non-continuity model, were conducted. Continuity of care participants reported greater readiness to provide woman-centred interventions than those from non-continuity models. Barriers faced by both groups included gaps in communication training, education resources and multidisciplinary support.DiscussionMidwives across models of care require greater support in this area, in particular training in communication and better multidisciplinary service integration to support women.ConclusionThe care model appears to influence capacity to deliver person/woman-centred interventions, highlighting the need for tailored training for the healthcare setting. The roles of other health professionals in delivering weight management interventions during pregnancy also need to be examined.     

Exploring Homophobia in Tbilisi,Georgia

The purpose of this study is to determine statistical predictors of homophobic attitudes among the residents of Tbilisi, Georgia. We analyze 2013 survey data from a representative sample of the Tbilisi adult population. Residents were asked about their attitudes, beliefs, and political and social values in the context of the May 17, 2013 attack on LGBT activists on the International Day Against Homophobia and Transphobia (IDAHOT). Findings show that homophobia is significantly predicted by male gender, lower levels of education, acceptance of social inequality, nonliberal attitudes, and perceiving homosexuals as a “threat to national security.” However, psychological perceptions and personal experiences also indirectly influence homophobic attitudes: the findings suggest that males report homophobic attitudes more often than females do and tend to be even more homophobic when they believe that homosexuality is inborn rather than acquired. The study also found that people without liberal attitudes tend to be more homophobic when they have personal contacts with homosexuals. This article highlights the need for a more comprehensive approach to education and the promotion of liberal values as well as legal equality for LGBTQ individuals to decrease the level of homophobia in Georgian society and, specifically, in Tbilisi.     

The Social Context of Depression Symptomology in Sexual Minority Male Youth: Determinants of Depression in a Sample of Grindr Users

ABSTRACT

The purpose of this study was to understand which social context factors most influence depression symptomology among sexual minority male youth (SMMY). In 2011, 195 SMMY who use Grindr were recruited to complete an online survey in Los Angeles, California. Items focused on social context variables and depression symptomology. Hierarchical multiple regressions were conducted using an ecological framework. The best fitting model accounted for 29.5% of the variance in depression. Experiences of homophobia, gay community connection, presence of an objecting network member, and emotional support were found to be significant predictors. Past experiences of homophobia continuing to affect youth indicates the need for intervention to reduction of homophobia in youths’ social contexts. Interventions that teach youth skills to manage objecting viewpoints or help youth to reorganize their social networks may help to reduce the impact of an objecting network alter.     

Implicit Association Task and Perception of Homosexuality: Differences between African American and Non-Hispanic Caucasian Homosexual Males

ABSTRACT

This study investigated the relationship between sexual orientation and minority group membership in a sample of African American and non-Hispanic Caucasian (NHC) homosexual men. Participants competed measures of pathology, sexual orientation, and ethnic identity. They completed two IATs, one using homosexual symbols and the other ethnically diverse homosexual images. Results indicated that African American participants reported more ethnic and sexual orientation discriminatory experiences than NHC. It was also found that both groups exhibited a positive association toward gay symbols. Both groups also demonstrated a bias toward NHC homosexual images, although the bias was stronger for NHC participants. Moderation analyses indicated that as internalized homophobia increased, preference for gay NHC images decreased, and that high ethnically discriminatory experiences resulted in stronger associations between NHC images and “good” attributes. Overall, the results partially support the minority stress theory and highlight some important differences between African American and NHC homosexual men.     

Empowerment-Oriented Social Work Practice: Impact on Late Life Relationships of Women

SUMMARY

Empowerment interventions promote egalitarian, strengths-based relationships through education, self-help, mutual support, consciousness raising, and social action activities. In this paper we describe the influence of empowerment-oriented group intervention on the relationships of older women. We conducted qualitative interviews with the women who participated in the group and the social workers who staffed the intervention activities. The findings suggest that, in addition to other empowerment outcomes, the older women participants developed sustaining relationships with each other and often seriously considered the nature of their other late life relationships. Thus, empowerment-oriented interventions can enhance the quality of life for older women, including the development and support of meaningful interpersonal relationships.     

Rural Men,Sexual Identity and Community

The relationship between rurality and men's sexuality remain relatively unexplored. This study addresses the knowledge gap in the research literature by focusing on men who have sex with men in rural areas across Ontario, Canada. Employing a constructivist grounded theory methodology, interviews were conducted with 32 men across 28 geographic locales consisting of populations of less than 10,000 people. Men identified as gay, bisexual, queer/bisexual, or refused labels. These self-selected identifiers were then explored to determine how participants conceptualized and organized their sexual identities in relation to context. Participants held divergent management strategies that resulted in two general identity grouping: “natives” and “transplanters.”     

Experiencing menopause in the UK: The interrelated narratives of normality,distress, and transformation

ABSTRACT

We investigated the experience and perspectives of menopause among 48 UK mothers through qualitative in-depth interviews. Interviews were analyzed thematically then explored using social science theories. Three interdependent narratives emerged: menopause as a normal, biological process, distinct from self and social transitions; menopause as struggle, an “idiom of distress” expressing upset, identity loss, shame, and social upheaval; and menopause as transformative and liberating, arising from biopsychic and relational changes. Some women followed a predictable “rite of passage” trajectory with transformation emerging from distress, but not all: Menopause arises from a complex interplay of personal predicament, somatic change, and sociocultural context.     

“You Look Like a Dude,Dude”: Masculine Females Undoing Gender in the Workplace

ABSTRACT

Interviews with 49 masculine females from diverse identities and occupations suggest that their workplace interactions undo gender, that is, breach rather than revise gender parameters. In this study, participants reveal that, although they were acknowledged as women in the workplace, their treatment was often more similar to men. Their classification as “like men” sometimes accrued advantage such as male camaraderie, access to information and opportunities, and greater assumed competence relative to gender-conforming women. Participants’ interactions with coworkers, supervisors, and customers suggest that, rather than a pariah femininity, masculine females may more accurately be described as a subordinate masculinity. Interactions that classify masculine females as predominantly masculine or “like men” denaturalize gender. By visibly countering gender’s anatomical basis and the notion of coherent gendered selves, masculine females might, in one small way, undo gender.     

Women who experience feelings of aversion while breastfeeding: A meta-ethnographic review

ProblemLimited literature is available about women who wish to breastfeed but experience unexpected feelings of aversion in reaction to their infant suckling at the breast while breastfeeding.BackgroundBreastfeeding benefits mothers, infants and society yet breastfeeding rates continue to fall below recommendations in part due to inadequate tailored support after hospital discharge. Influences on breastfeeding are complex and include many physiological, psychosocial and cultural factors.AimTo better understand the experience of women who have feelings of aversion during breastfeeding by synthesising the existing literature.MethodsMEDLINE, CINAHL, PsycINFO, Maternity and Infant Care databases were searched for relevant literature published between 2000 to 2019. Using Covidence software, five qualitative research studies were identified. Studies were then analysed using meta-ethnographic qualitative synthesis.FindingsFeelings of aversion during breastfeeding were described as visceral and overwhelming; leading to feelings of shame and inadequacy. This synthesis identified five findings; a central conceptual category of “it’s such a strong feeling of get away from me” with four key metaphors translated from this central conceptual category: “I do it because I feel it is best for my baby”, “I can’t control those feelings”, “I should be able to breastfeed my son and enjoy it”, and “I’m glad I did it”. This phenomenon may negatively affect a women’s sense of self and impact on the mother-infant relationship.ConclusionSome women who want to breastfeed can experience feelings of aversion while breastfeeding. The feelings of ‘aversion’ while breastfeeding can inhibit women from achieving their personal breastfeeding goals.     

Getting Out in the “Real World”: Young Men,Queer and Theories of Gay Community

ABSTRACT

A recent opinion piece published in the Sydney Morning Herald expresses a widely held perception that, among young same-sex attracted men in Australia, “queer” has well and truly supplanted “gay” as the language and lens through which self and practice is generated. In this article, I discuss findings from a qualitative research project that studied notions of community among young gay men, and argue that this assumption should not be taken for granted. The article explores participants' understandings of the concept of “gay community,” arguing that the young men studied share a common definition of community: one based on a conventional liberal model which prioritizes sameness and the cooperation of individuals to achieve common goals. This is of particular importance in that problems around “fitting in” with these understandings are also raised. In examining the potential place for queer alternatives to these formulations, however, the article finds that queer attracts little support among participants, raising questions about the bind young men may find themselves in if they prioritize sameness as fundamental to community, yet feel themselves to be excluded from community by their own or others' perceived difference.     

A complex and demanding situation – Midwifery preceptors and midwifery students’ experiences of teaching and learning prevention of severe perineal trauma

BackgroundMany high-income countries have seen an increase in severe perineal trauma. Teaching strategies and conditions for learning during the active second stage of labour are scarcely described.AimTo describe midwifery preceptors and midwifery students’ experiences’ of teaching and learning how to manage the second stage of labour, with the specific aim of preventing severe perineal trauma.MethodsA qualitative study with focus group discussions and individual in depth-interviews with preceptor midwives (n = 23) and student midwives (n = 10). Data were analysed by qualitative content analysis.Results“A complex and demanding situation with mutual need for feedback, reflection and safety” was the overall theme describing the conditions. Three sub-themes were identified. “Adapting to a unique situation” refers to the difficulty of teaching and learning the aspects needed to prevent severe perineal trauma, and to provide care during this stage. “Hindering and limiting circumstances” describes teaching strategies that were perceived negatively, and how midwifery students tried to adapt to the preceptors rather than the birthing women. “A trustful and communicative relationship” describes the importance of the relationship between the student and the preceptor, where communication was a central, but not obvious part.ConclusionAn increased awareness among preceptors is needed to optimize teaching strategies, enabling the students to focus on learning the art of the second stage of labour; supporting the woman, preventing severe perineal trauma and ensuring the safety of the unborn baby. Future research should address how existing prevention models can include training to increase preceptors’ confidence in teaching.     

Minimizing heterosexism and homophobia: constructing meaning of out campus LGB life

This work investigates how American college students make meaning of the heterosexism and homophobia they encounter in their daily lives. Through interviews and a focus group with 23 out lesbian, gay, and bisexual (LGB) college students, analysis yielded four themes: the overwhelming majority of students minimized incidences of heterosexism and homophobia; there was a desire on the part of many respondents to develop an identity apart from, rather than integrated with, sexual identity; the campus climate was generally portrayed as positive; and some participants expressed resistance, suggesting that heterosexism and homophobia can be countered.     

Minimizing Heterosexism and Homophobia: Constructing Meaning of Out Campus LGB Life

This work investigates how American college students make meaning of the heterosexism and homophobia they encounter in their daily lives. Through interviews and a focus group with 23 out lesbian, gay, and bisexual (LGB) college students, analysis yielded four themes: the overwhelming majority of students minimized incidences of heterosexism and homophobia; there was a desire on the part of many respondents to develop an identity apart from, rather than integrated with, sexual identity; the campus climate was generally portrayed as positive; and some participants expressed resistance, suggesting that heterosexism and homophobia can be countered.