Women’s experiences of intrapartum care and recovery in relation to planned caesarean sections: An interview study

Problem and backgroundApproximately one third of women in high-income countries give birth by caesarean section (CS). Better understanding of women’s CS experiences is vital in identifying opportunities to improve women’s experience of care.AimTo identify opportunities for service improvement by investigating Australian women’s experiences of care and recovery when undergoing a planned CS.MethodsQualitative telephone interview study with 33 women who had a planned CS at one of eight Australian hospitals. Semi-structured interviews were conducted to elicit women’s perspectives, experiences and beliefs surrounding their planned CS. Interviews were transcribed verbatim and analysed inductively using NVivo-12.ResultsWomen’s experiences of CS care were mixed. Regarding intrapartum care, many women stated their planned CS was a positive experience compared to a previous emergency CS, but was scarier and more medicalised compared to vaginal birth. CS recovery was viewed more negatively, with women feeling unprepared. They reported disliking how CS recovery restricted their role as a mother, wanting more time in hospital, and greater support and continuity of care.DiscussionWomen reported largely positive intrapartum experiences of planned CS but relatively negative experiences of CS recovery. They wished for time in hospital and support from staff during recovery, and continuity of care.ConclusionBy incorporating shared decision-making antenatally, clinicians can discuss women’s birth expectations with them and better prepare them for their planned CS and recovery.     

Indicators of ‘good’ feeding,breastfeeding latch,and feeding experiences among healthy women with healthy infants: A qualitative pathway analysis using Grounded Theory

BackgroundBreastfeeding behaviour remains a public health priority worldwide. Despite evidence-based guidelines, healthy women who give birth to healthy, term infants continue to face barriers to breastfeeding. Understanding women’s experiences of feeding in the early postnatal period is crucial to identify how support may be better tailored to improve breastfeeding outcomes, including women’s experiences.QuestionTo understand women’s experiences of infant feeding amongst healthy women who give birth to healthy, average-weight, term infants.MethodsGrounded Theory methodology was used to analyse data from a nested qualitative interview study. Twelve women between four and twelve months postpartum were recruited from a longitudinal cohort study and public advertisements. Semi-structured face-to-face interviews were audio-recorded and transcribed for analysis.FindingsThree distinct themes were found, subsuming identified super-categories: Perceived indicators of ‘good’ feeding (infant ‘output’; infant crying; weight gain; feeding frequency and duration); Women’s experiences of breastfeeding latch (‘good’ latch; ‘bad’ latch with pain and discomfort); and Overall breastfeeding experience (positive; negative; and uncertain). Data suggest women give precedence to their latch experiences over indicators of ‘good’ feeding, highlighting breastfeeding latch as a possible mediating factor to the overall breastfeeding experience. Feeding experience can be achieved through four distinct pathways.DiscussionThe physical and psychological impacts of latch pain were pronounced. Even amongst healthy women with healthy infants, a positive breastfeeding experience overall was uncommon, highlighting the difficulties women continue to encounter. Understanding women’s perceptions of ‘good’ feeding, and ensuring a pain-free latch, may better support women to have a positive breastfeeding experience.     

Explaining age differences in women’s emotional well-being: The role of subjective experiences of aging

ABSTRACT

Our study examines explanations for the “paradox” of older women’s better emotional well-being compared with younger women. We consider the role of subjective experiences of aging in a society that devalues older women. Using a sample of women (n = 872) from the National Survey of Midlife Development in the United States (1995–1996 and 2004–2006), we examine the role of five components of the subjective experience of aging in explaining older women’s better emotional well-being compared with younger women: age identity, conceptions of the timing of middle age, aging attitudes, aging anxieties, and self-assessed physiological changes. We find that, compared with women 50–54 years old, those 35–39 years old report lower positive affect, and those 25–49 report higher negative affect. These patterns are partially explained by younger women’s greater anxiety about declines in health and attractiveness and older women’s more youthful identities. Our study underscores the value of considering the implications of our ageist and sexist society for women’s emotional well-being across adulthood.     

Women’s experiences of health care utilization in cases of early pregnancy loss: A scoping review

BackgroundApproximately 25% of pregnancies end in miscarriage, most occurring within the first trimester (<13 weeks). For many women early pregnancy loss has implications for short- and long- term mental health, and women’s well-being following early pregnancy loss is impacted by their experiences within the healthcare setting. To improve quality of care, it is crucial to understand women’s’ experiences within the healthcare system in cases of early pregnancy loss.QuestionsWhat does the research literature tell us about the experiences of early pregnancy loss within healthcare settings? Are these experiences positive or negative? ‘How can care improve for those experiencing early pregnancy loss?’MethodsA scoping review of the research literature was undertaken. Three research databases were searched for relevant articles published in English since 2009, with key words related to ‘Experience’, ‘Healthcare’ and ‘Early Pregnancy Loss’. A thematic analysis was undertaken to identify and summarize key findings emerging from the research literature.FindingsTwenty-seven (27) articles met our inclusion criteria. Three main themes were identified: (1) issues related to communication, (2) challenges within care environments, and (3) inadequacies in aftercare.DiscussionThe literature suggests that women’s experiences related to healthcare for early pregnancy loss are largely negative, particularly within emergency departments. Recommendations to improve women’s experiences should extend beyond attempts to improve existing care structures, to include emerging environments and providers.ConclusionWomen’s experiences identified within the literature provide further insights on what women are seeking from their care, and how care models can be improved.     

Breastfeeding experiences and perspectives among women with postnatal depression: A qualitative evidence synthesis

BackgroundStudies show that postnatal depression affects around 10–16% of women globally. It is associated with earlier cessation of breast feeding, which can negatively impact infants’ long-term development. Mechanisms underpinning associations between mental health and women’s decision to commence and continue to breastfeed are complex and poorly understood.AimThe aim of this review was to investigate breastfeeding experiences, perspectives, and support needs of women with postnatal depression. No previous reviews were identified which had addressed this aim.MethodA systematic search was conducted of six databases to identify relevant qualitative studies. Six included studies were critically appraised and synthesised using thematic synthesis.FindingsFive themes were identified: (1) desire to breastfeed and be a ‘good mother’, (2) struggles with breastfeeding, (3) mixed experiences of support from healthcare professionals, (4) importance of practical and social support, (5) support for mental health and breastfeeding. Most women with postnatal depression expressed strong intentions to breastfeed, although some perceived ‘failure’ to breastfeed triggered their mental health problems. Practical and non-judgemental support for their mental health needs and for successful breastfeeding from healthcare professionals, family and friends are needed.ConclusionMost women with postnatal depression desired to breastfeed but experienced breastfeeding difficulties that could impact on their mental health. By offering women with postnatal depression tailored and timely support, healthcare professionals could help women minimize breastfeeding problems which could consequently impact on their mental well-being and ensure they and their infants have opportunity to benefit from the advantages that breastfeeding offers.     

Subjective Realities of Rural Older Women's Lives: A Case Study

SUMMARY

This paper presents and analyzes the subjective reality of a single older rural woman through her telling of her life story and open-ended interviews. This case study is used to demonstrate how a rural woman experiences a positive life experience while living with poverty, poor health, and numerous challenges and losses. The case was selected from the multiphase Rural Older Women's Project completed in rural Minnesota in 1986 and 1987. This representation shows the respondent living her later life and adjusting to old age in the same ways she has always faced life's challenges–with stoicism and tenacity, as well as patience and good humor. In the telling of her life story we recognize key values of rural older women including independence and privacy, balanced with a clear sense of the importance of relationships with others, and a closeness to the land. The views of informal and formal systems of service delivery arc discussed and implications explored for the development of formal services which will more effectively meet the needs of rural older women.     

Wanting to be ‘with woman’, not with machine: Midwives’ experiences of caring for women being continuously monitored in labour

ProblemSome continuous electronic fetal monitoring (CEFM) devices restrict women’s bodily autonomy by limiting their mobility in labour and birth.BackgroundLittle is known about how midwives perceive the impact of CEFM technologies on their practice.AimThis paper explores the way different fetal monitoring technologies influence the work of midwives.MethodsWireless and beltless ‘non-invasive fetal electrocardiogram’ (NIFECG) was trialled on 110 labouring women in an Australian maternity hospital. A focus group pertaining to midwives’ experiences of using CTG was conducted prior to the trial. After the trial, midwives were asked about their experiences of using NIFECG. All data were analysed using thematic analysis.FindingsMidwives felt that wired CTG creates barriers to physiological processes. Whilst wireless CTG enables greater freedom of movement for women, it requires constant ‘fiddling’ from midwives, drawing their attention away from the woman. Midwives felt the NIFECG better enabled them to be ‘with woman’.DiscussionMidwives play a pivotal role in mediating the influence of CEFM on women’s experiences in labour. Exploring the way in which different forms of CEFM impact on midwives’ practice may assist us to better understand how to prioritise the woman in order to facilitate safe and satisfying birth experiences.ConclusionThe presence of CEFM technology in the birth space impacts midwives’ ways of working and their capacity to be woman-centred. Current CTG technology may impede midwives’ capacity to be ‘with woman’. Compared to the CTG, the NIFECG has the potential to enable midwives to provide more woman-centred care for those experiencing complex pregnancies.     

Improving women’s experiences of perineal suturing: A pragmatic qualitative analysis of what is helpful and harmful

BackgroundPerineal trauma requiring suturing is increasing, along with the associated physiological and psychological morbidities for women. Provider training appears to focus more on technical aspects rather than respectful, relational care for women. Studies exploring women’s experiences have identified that how women are cared for can significantly impact upon overall experiences.AimTo identify areas of improvement to the perineal suturing process and provide robust recommendations for urgent change by investigating what aspects are most traumatic to women and which are most supportive.MethodsA pragmatic qualitative analysis of data generated from 15 in-depth interviews with women who were sutured following birth.FindingsRegardless of tear severity, what was identified as helpful included anything that made the process better by increasing feelings of trust and reassurance, and providing women with a sense of being seen and heard. Harmful experiences were identified as those that worsened the experience, by increasing feelings of fear and vulnerability and leaving women with a sense of being disregarded or disrespected.ConclusionThe study confirmed that how the suturing process is conducted can have a significant detrimental impact upon women’s short- and longer-term physical and psychological well-being.Implications for practiceAn improved experience for women is most likely with kind professionals who explain the process as it goes along, check-in regularly and validate how the women feel. Women prefer to be sutured by a known professional, only if this provider is also kind and respectful.     

“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.     

Predictors of postpartum depression service use: A theory-informed,integrative systematic review

ProblemPostpartum depression affects many women globally, yet rates of treatment use are low. A comprehensive view of factors associated with treatment use, from women’s and providers’ perspectives, based on a theoretical model is lacking.BackgroundSeveral studies examined various factors associated with postpartum depression service use; however, each study focused on a small number of factors.AimThis study describes a systematic literature review based on the Behavioral Model of Health Service Use. The purpose of this article is to review and synthesize the available literature regarding factors associated with women’s mental health service use for postpartum depression from women’s and healthcare providers’ perspectives, and provide a comprehensive integrative view of the subject.MethodsThree electronic databases were searched, and 35 studies published up to 2018 in English language journals met inclusion criteria for review. Factors associated with postpartum depression service use were classified according to the Behavioral Model of Health Service Use’s constructs.FindingsService use for postpartum depression is a function of a woman’s predisposition to use mental health services; individual, familial, and communal factors which enable or pose barriers to use of mental health services; and the woman’s perceived or evaluated need for treatment. In addition, societal determinants impact the woman’s decision to seek help directly or through impacting the health and mental health care service system’s resources and organization.ConclusionThis review illustrates key factors for researchers and practitioners to consider when treating postpartum women and developing interventions to enhance postpartum depression treatment use.     

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.     

Women’s experiences of birth trauma: A scoping review

BackgroundA high number of Australian women report experiencing traumatic birth events. Despite high incidence and potential wide spread and long-lasting effects, birth trauma is poorly recognised and insufficiently treated. Birth trauma can trigger ongoing psychosocial symptoms for women, including anxiety, tokophobia, bonding difficulties, relationship issues and PTSD. Additionally, women’s future fertility choices can be inhibited by birth trauma.AimTo summarize the existing literature to provide insight into women’s experiences of birth trauma unrelated to a specific pre-existing obstetric or contextual factor.MethodsThe review follows 5 stages of Arksey and O’Malley’s framework. 7 databases were searched using indexed terms and boolen operators. Data searching identified 1354 records, 5 studies met inclusion criteria.FindingsThree key themes emerged; (1) health care providers and the maternity care system. (2) Women’s sense of knowing and control. (3) Support.DiscussionContinuity of carer creates the foundations for facilitative interactions between care provider and woman which increases the likelihood of a positive birth experience. Women are able to gain a sense of feeling informed and being in control when empowering and individualized care is offered. Functional social supports and forms of debriefing promotes psychological processing and can enable post traumatic growth.ConclusionExisting literature highlights how birth trauma is strongly influenced by negative health care provider interactions and dysfunctional operation of the maternity care system. A lack of education and support limited informed decision-making, resulting in feelings of losing control and powerlessness which contributes to women’s trauma. Insufficient support further compounds women’s experiences.     

Aging Happens: Experiences of Swiss Women Living Alone

ABSTRACT

The purpose of this study was to give beginning insights into how aging is experienced by women living alone in Switzerland. A feminist methodology was used to gather and interpret 17 interviews conducted with a selected group of 9 older women living alone. Interviews were taped and transcribed for hermeneutic analysis; major themes were developed. Aging happens, Independence, Being vulnerable, Memory and aging, and If I had been a boy were the themes discovered. These experiences represent how aging is shaped by individual life courses, sociocultural conditions along with gender and class.     

Older Women's Body Image and Embodied Experience: An Exploration

ABSTRACT

This paper presents and analyzes findings from unstructured interviews with women aged 61 to 92 regarding their perceptions and feelings about their aging bodies. The data are discussed in light of the existing literature on women's body image which has largely ignored the experiences of women in later life and which has tended to focus on adolescent and middle-aged women. Given the fact that beauty is equated with youthfulness and thinness in our society, older women face unique challenges as they strive to construct and maintain positive evaluations of self. The women in the study exhibit the internalization of ageist beauty norms even as they assert that health is more important to them than physical attractiveness and comment on the ‘naturalness’ of the aging process.     

The transition to motherhood: Towards a broader understanding of perinatal distress

BackgroundA substantial body of research has focused on maternal perinatal mood and wellbeing, with the focus predominantly being on depression, and to a lesser extent, anxiety. Perinatal maternal stress has also been investigated recently, but to a far lesser extent. The present paper questions whether the term ‘perinatal distress’ accurately captures the range of challenges experienced by women during the perinatal period, when the scope of ‘distress’ is limited to the experience of depression and anxiety alone.MethodA review of the perinatal literature was conducted using several databases, to identify studies that have focused on the experience of stress as a distinct affective state in the perinatal period.FindingsThe findings of two recent studies which have employed a broader conceptualisation of perinatal distress to encompass the experience of stress as well as depression and anxiety are outlined. These recent studies have identified the experience of stress both in conjunction with and independent of depression and anxiety.ConclusionIt is argued that future studies should investigate the concept of stress as a separate affective state throughout the perinatal period, in order to further assess how it differs from depression and/or anxiety. A more comprehensive understanding of women's experiences during their transition to motherhood, and whether ‘stress’ plays a critical role in the development and maintenance of perinatal anxiety and/or depression is needed.