Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study

BackgroundObstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women’s autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence.AimTo explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students.MethodsA constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data.ResultsTwenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants’ experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans.DiscussionDespite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term ‘obstetric violence’ offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers.ConclusionsObstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.     

Women's access needs in maternity care in rural Tasmania,Australia: A mixed methods study

ObjectivesThis study investigates (i) maternity care access issues in rural Tasmania, (ii) rural women's challenges in accessing maternity services and (iii) rural women's access needs in maternity services.MethodsA mixed-method approach using a survey and semi-structured interviews was conducted. The survey explored women's views of rural maternity services from antenatal to postnatal care, while interviews reinforced the survey results and provided insights into the access issues and needs of women in maternity care.FindingsThe survey was completed by n = 210 women, with a response rate of 35%, with n = 22 follow-up interviews being conducted. The survey indicated the majority of rural women believed antenatal education and check-ups and postnatal check-ups should be provided locally. The majority of women surveyed also believed in the importance of having a maternity unit in the local hospital, which was further iterated and clarified within the interviews. Three main themes emerged from the interview data, namely (i) lack of access to maternity services, (ii) difficulties in accessing maternity services, and (iii) rural women's access needs.ConclusionThe study suggested that women's access needs are not fully met in some rural areas of Tasmania. Rural women face many challenges when accessing maternity services, including financial burden and risk of labouring en route. The study supports the claim that the closure of rural maternity units shifts cost and risk from the health care system to rural women and their families.     

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.     

The needs of women and their partners regarding professional smoking cessation support during pregnancy: A qualitative study

BackgroundDespite the health risks of smoking, some women continue during pregnancy. Professional smoking cessation support has shown to be effective in increasing the proportion of pregnant women who quit smoking. However, few women actually make use of professional support.AimTo investigate the needs of women and their partners for professional smoking cessation support during pregnancy.MethodsSemi-structured interviews were held with pregnant women and women who recently gave birth who smoked or quit smoking during pregnancy, and their partners, living in the north of the Netherlands. Recruitment was done via Facebook, LinkedIn, food banks, baby stores and healthcare professionals. The interviews were recorded, transcribed and thematically analysed.Results28 interviews were conducted, 23 with pregnant women and women who recently gave birth, and five with partners of the women. The following themes were identified: 1) understanding women’s needs, 2) responsibility without criticism, and 3) women and their social network. These themes reflect that women need support from an involved and understanding healthcare professional, who holds women responsible for smoking cessation but refrains from criticism. Women also prefer involvement of their social network in the professional support.ConclusionFor tailored support, the Dutch guideline for professional smoking cessation support may need some adaptations. The adaptations and recommendations, e.g. to involve women and their partners in the development of guidelines, might also be valuable for other countries. Women prefer healthcare professionals to address smoking cessation in a neutral way and to respect their autonomy in the decision to stop smoking.     

The magnitude of the problem of obstetric violence and its associated factors: A cross-sectional study

BackgroundIn recent years, the concept of obstetric violence has become visible among women and professionals, but its prevalence and the factors with which it is related in our healthcare environment are unknown.AimTo determine the prevalence of obstetric violence in the Spanish healthcare system and identify the associated factors.MethodsA cross-sectional observational study was conducted during 2019 and included 899 women who had given birth in the last 12 months. An online questionnaire was distributed through midwives and women associations in Spain. The questionnaire included sociodemographic, clinical, and assistance practices variables. The primary outcome variable was obstetric violence and its verbal, physical, and psycho-affective types. Crude odds ratios (OR) and adjusted OR (ORa) were estimated using binary logistic regression.ResultsObstetric violence was reported by 67.4% (606) of the women; 25.1% (226) verbal, 54.5% (490) physical, and 36.7% (330) psycho-affective. Overall obstetric violence was observed more frequently in women who attended maternal education programme (ORa 1.56, 95% CI 1.05–2.32), those who presented a birth plan but it was not respected (ORa 2.82, 95% CI 1.27–6.29), those who received regional analgesia (ORa 1.61, 95% CI 1.13–2.30), those who required an urgent caesarean section (ORa 3.46, 95% CI 1.79–6.69), underwent an episiotomy (ORa 3.34, 95% CI 2.21–5.38), and whose newborn was admitted to an intensive care unit (ORa 2.73, 95% CI: 1.21–6.15). The presentation of a birth plan was observed as protective factors, and the possibility of skin-to-skin (ORa 0.34, 95% CI 0.18–0.62) and felt respected (ORa 0.61, 95% CI 0.43–0.85).ConclusionsTwo out of three women perceive having suffered obstetric violence during childbirth. Practices such as skin-to-skin contact, and the use of respected birth plans, were protective factors against obstetric violence.     

Obstetric fistula and sociocultural practices in Hausa community of Northern Nigeria

Background

Obstetric Fistula is a childbirth injury that disproportionately affects women in sub-Saharan Africa. Although poverty plays an important role in perpetuating obstetric fistula, sociocultural practices has a significant influence on susceptibility to the condition.

Birth environments for women with complex pregnancies: A mixed-methods systematic review

BackgroundBirth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies.AimTo investigate the impact of the birth environment for women with complex pregnancies.MethodsThis was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently.Findings30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues.DiscussionWomen and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies.ConclusionFurther research is needed investigating different users’ needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.     

Aboriginal women in rural Australia; a small study of infant feeding behaviour

BackgroundAboriginal women in rural areas have lower rates of breastfeeding than Australian averages. The reasons for this are poorly understood. Aboriginal people experience higher morbidity and increased rates of chronic disease throughout the life cycle. The protective effects of sustained breastfeeding could benefit rural Aboriginal communities.ObjectiveTo explore the factors impacting upon infant feeding choices in a rural Aboriginal Community.MethodsSemi-structured interviews were conducted with eight Aboriginal rural dwelling first time mothers. These women received a continuity of midwife and Aboriginal Health Worker model of care. Interviews were also undertaken with five Aboriginal Health Workers and two Aboriginal community breastfeeding champions. The analysis was integrated with a conventional literature review and was further developed and illustrated with historical literature. Indigenist methodology guided the study design, analysis and the dissemination of results.ResultsThree key themes were identified. These were “I’m doing the best thing for…” which encompasses the motivations underpinning infant feeding decisions; “this is what I know…” which explores individual and community knowledge regarding infant feeding; and “a safe place to feed” identifying the barriers that negative societal messages pose for women as they make infant feeding decisions. It appears loss of family and community breastfeeding knowledge resulting from colonisation still influences the Aboriginal women of today.DiscussionAboriginal women value and trust knowledge which is passed to them from extended family members and women within their Community. Cultural, historical and socioeconomic factors all strongly influence the infant feeding decisions of individuals in this study.ConclusionsEfforts to normalise breastfeeding in the culture of rural dwelling Aboriginal women and their supporting community appear to be necessary and may promote breastfeeding more effectively than optimal professional care of individuals can do.     

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.     

Nature as nurture: Rural older women’s perspectives on the natural environment

ABSTRACT

Rural older women are surrounded by nature, a dynamic context for human development. Informed by place attachment and attention restoration theory, and guided by a life course perspective, this qualitative study focused on the perceived influence of nature in the lives of 34 rural older women. Using grounded theory techniques to analyze in-depth interviews, two primary findings emerged: (a) nature was integral to the women’s identity; and (b) interactions with nature were motivated by prior positive spiritual and psychological outcomes. Findings revealed the power of the natural environment as a resource for coping with the challenges associated with aging.     

Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence

BackgroundUnderstanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted.ObjectivesTo synthesise the best available evidence on the experiences of women's needs in maternity care and existing service models in rural areas.MethodsLiterature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis.Findings12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6).ConclusionThe systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address women's maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy.     

An ethnographic study of the interaction between philosophy of childbirth and place of birth

BackgroundOrganisational culture and place of birth have an impact on the variation in birth outcomes seen in different settings.AimTo explore how childbirth is constructed and influenced by context in three birth settings in Australia.MethodThis ethnographic study included observations of 25 healthy women giving birth in three settings: home (9), two birth centres (10), two obstetric units (9). Individual interviews were undertaken with these women at 6–8 weeks after birth and focus groups were conducted with 37 midwives working in the three settings: homebirth (11), birth centres (10) and obstetric units (16).ResultsAll home birth participants adopted a forward leaning position for birth and no vaginal examinations occurred. In contrast, all women in the obstetric unit gave birth on a bed with at least one vaginal examination. One summary concept emerged, Philosophy of childbirth and place of birth as synergistic mechanisms of effect. This was enacted in practice through ‘running the gauntlet’, based on the following synthesis: For women and midwives, depending on their childbirth philosophy, place of birth is a stimulus for, or a protection from, running the gauntlet of the technocratic approach to birth. The birth centres provided an intermediate space where the complex interplay of factors influencing acceptance of, or resistance to the gauntlet were most evident.ConclusionsA complex interaction exists between prevailing childbirth philosophies of women and midwives and the birth environment. Behaviours that optimise physiological birth were associated with increasing philosophical, and physical, distance from technocratic childbirth norms.     

The needs and experiences of women with gestational diabetes mellitus from minority ethnic backgrounds in high-income nations: A systematic integrative review

BackgroundGestational diabetes mellitus (GDM) represents a growing challenge worldwide, with significant risks to both the mother and baby that extend beyond the duration of the pregnancy and immediate post-partum period. Women from ethnic minority groups who access GDM care in high-income settings face particular challenges. The aim of this systematic integrative review is to explore the experiences and needs of women with GDM from select ethnic groups in high-income healthcare settings.MethodsFor the purposes of this systematic integrative review, a comprehensive search strategy explored the electronic databases CINAHL, Medline, Web of Science, and Scopus were searched for primary studies that explored the needs and experiences of women with gestational diabetes from select ethnic minority groups living in high-income nations. The ethnicity of the women in the study included: East, South and Southeast Asian, Indian subcontinent, Aboriginal/First Nations, Torres Strait Islander, Pacific Islander, Māori, Middle Eastern, African, or South/Latina American. Studies were assessed with the Crowe Critical Appraisal Tool and findings were synthesised with thematic analysis.ResultsThis review included 15 qualitative studies, one mixed method, and one cross-sectional study. Six high-income nations were represented. The voices and experiences of 843 women who originated from at least one ethnic minority group are represented. Four major themes were constructed: psychological impact of GDM, GDM care and education, GDM and sociocultural impact, and GDM and lifestyle changes.Discussion and conclusionLimitations exist in the provision of culturally appropriate care to support the management of GDM in women from select ethnic groups in high-income healthcare settings. Women require care that is culturally appropriate, considering the individual needs and cultural practices of the woman. Engaging a woman’s partner and family ensures good support is provided. Culturally appropriate care needs to be co-designed with communities so that women are at the centre of their care, avoiding a one-size-fits-all approach.     

Strengthening resources for midlife and older rural women who experience intimate partner violence

ABSTRACT

Little is known about midlife and older women who experience intimate partner violence living in rural places and their resource needs. Guided by a strengths perspective, we provided insights into resources that midlife and older women use, or would like to use, in their journey in leaving an abusive partner. Eight women who had left an abusive partner participated in a face-to-face interview. They drew on a wide variety of paid and unpaid resources, while each woman had a unique set of resources that contributed to her being able to make such a significant life transition. It is clear that we need to have a variety of formal and informal resources available to older women experiencing intimate partner violence (IPV) in rural places, and new forms of resources need to be developed. Our results also indicate that increased efforts are needed in improving both public and professional education regarding older rural women and IPV.     

Informal Support Networks of Low-Income Senior Women Living Alone: Evidence from Fort St. John,BC

Within the context of an aging Canadian rural and small-town landscape, there is a growing trend of low-income senior women living alone. While there is a perception that rural seniors have well-developed social networks to meet their daily needs, some research suggests that economic and social restructuring processes have impacted the stability of seniors' support networks in small places. While much of the research on seniors' informal networks focuses upon small towns in decline, booming resource economies can also produce challenges for low-income senior women living alone due to both a higher cost of living and the retrenchment of government and service supports. Under such circumstances, an absence of informal supports can impact seniors' health and quality of life and may lead to premature institutionalization. Drawing upon a household survey in Fort St. John, British Columbia, we explore informal supports used by low-income senior women living alone in this different context of the Canadian landscape. Our findings indicate that these women not only have a support network that is comparable to other groups, but that they are also more likely to draw upon such supports to meet their independent-living needs. These women rely heavily on family support, however, and greater efforts are needed to diversify both their formal and informal sources of support as small family networks can quickly become overwhelmed.     

Older Women with Cardiovascular Disease: Perceptions of Initial Experiences and Long-Term Influences on Daily Life

ABSTRACT

In 2004, we conducted qualitative interviews with 29 White women diagnosed with cardiovascular disease (CVD) living in Southwest Virginia, aged 69 to 92 years (M age = 79.2 years; SD = 6.8); time since diagnosis ranged from 1 to 50 years (M = 14.3; SD = 11.2). We explored the women's initial illness episode and the influence of CVD on their current daily functioning, family activities and relationships, and social engagement. The women were slow to seek help for CVD symptoms. Postrecovery, 62% of women perceived their heart disease as influencing change in their daily lives. The influence of CVD varied depending on how congruent behavior changes were with their sense of self.     

Caesarean section by country of birth in New South Wales,Australia

ObjectiveTo determine rates of caesarean section by country of birth and by obstetric risks.MethodsWe analysed the New South Wales Perinatal Data Collection data of women giving birth between January 2013 and December 2015. Obstetric risk was classified using the Robson’s 10-group classification. Multilevel logistic regression with a random intercept was used to measure the variation in caesarean section rate between immigrants from different countries and between regional immigrant groups.ResultsWe analysed data from 283,256 women, of whom 90,750 had a caesarean section (32.0%). A total of 100,120 women were born overseas (35.3%), and 33,028 (33.0%) had a caesarean section. The caesarean section rate among women from South and Central Asia ranged from 32.6% for women from Pakistan to 47.3% for women from Bangladesh. For South East Asia, women from Cambodia had the lowest caesarean section rate (19.5%) and women from Indonesia had the highest rate (37.3%). The caesarean section rate for North Africa and the Middle East ranged from 28.0% for women from Syria to 50.1% for women from Iran. Robson groups that accounted for most of the caesarean sections were women who had previous caesarean section (36.5%); nulliparous women, induced or caesarean section before labour (26.2%); and nulliparous women, spontaneous labour (8.9%).ConclusionsThe caesarean section rate varied significantly between women from different countries of birth within the same region. Women from some countries of birth had the higher caesarean section rates in some Robson groups.