Negotiating who gives birth and the influence of fear of childbirth: Lesbians,bisexual women and transgender people in parenting relationships

BackgroundFear of childbirth (FOC) may affect family planning in lesbian, bisexual and transgender (LBT) couples with two potential carriers of a pregnancy. FOC has previously been researched in heterosexual women, while experiences of LBT people have remained unattended. The choice of birth-giving partner in same-sex couples has gained some attention in previous research, but the potential complexities of the decision have not been studied.AimThe aim is to explore how LBT people negotiate the question of who gives birth, in couples with two potential birth parents, and where one or both partners have a pronounced FOC.MethodsSeventeen self-identified LBT people were interviewed about their expectancies and experiences of pregnancy and childbirth. Data were analysed following a six-step thematic analysis.ResultsFOC was negotiated as one of many aspects that contributed to the decision of who would be the birth-giving partner. Several participants decided to become pregnant despite their fears, due to a desire to be the genetic parent. Others negotiated with their partner about who was least vulnerable, which led some of them to become pregnant despite FOC. Still other participants decided to refrain from pregnancy, due to FOC, and were delighted that their partner would give birth. Several participants described their partner's birth-giving as a traumatic experience for them, sometimes also when the birth did not require any obstetric interventions. The partner's experience was in some cases not addressed in postnatal care.ConclusionsIt is important that healthcare staff address both partners’ prenatal expectancies and postnatal experiences.     

A cross-sectional study to determine utility of childbirth fear screening in maternity practice – An Australian perspective

BackgroundLow intensity anxiety in pregnancy is normal however high levels of fear affect between 20% and 25% of women, with around 10% suffering severe levels. Research from Scandinavian countries includes women with severe levels of fear, with little work undertaken in Australia. This paper explores predictors of fear and the relative benefits of screening women for childbirth fear at high or severe levels.MethodA secondary analysis of data collected for the BELIEF study was conducted to determine differences for demographic, psycho-social and obstetric factors in women with severe fear (W-DEQ ≥85, n = 68) compared to women with less or no fear (n = 1318). Women with severe fear (W-DEQ ≥85, n = 68) were also compared to those with high fear scores (W-DEQ ≥66–84, n = 265). Logistic regression modelling was used to ascertain if screening for high or severe levels of fear is most optimal.Results1386 women completed the W-DEQ. There were no differences on demographic variables between women with severe or high fear. Depression symptoms, decisional conflict and low self-efficacy predicted high and severe fear levels. Nulliparity was a predictor of high fear. A previous operative birth and having an unsupportive partner were predictors of high fear in multiparous women.ConclusionPsychosocial factors were associated with both high and severe fear levels. Screening for severe fear may detect women with pre-existing mental health problems that are exacerbated by fear of birth. Australian women with high childbirth fear levels (W-DEQ ≥66) should be identified and provided appropriate support.     

Causes and outcomes in studies of fear of childbirth: A systematic review

Problem

Fear of childbirth negatively affects women during pregnancy and after birth.

Analysis of the caesarean section rate using the 10-Group Robson classification at Benha University Hospital,Egypt

BackgroundEgypt has the third highest caesarean section rate (54%) in the world and lacks a standard classification system to analyse caesarean section rates. The World Health Organization (WHO) recommends the Robson classification as an effective caesarean section analysis and monitoring tool.AimTo analyse the caesarean section rate of Benha University Hospital, Egypt using the standard 10-Group Robson classification system.MethodA prospective, cross-sectional study was conducted at the Benha University Hospital from 1 April to 30 June 2018. All women admitted for childbirth were categorised into Robson groups to determine the absolute and relative contribution made by each group to the overall caesarean section rate. Epi Data V.3.1 software programme was used to analyse the data.Findings850 women gave birth during the study period, 466 (55%) by caesarean section (CS). Robson Group 5 (multiparous, term, cephalic presentation and previous caesarean section) contributed the most (36%) to the overall CS rate. 175/308 (56%) women in this group had previously undergone one caesarean section. Group 6 (all nulliparous women with single breech pregnancy) and Group10 (cephalic preterm pregnancies) were the second and the third greatest contributors toward the overall CS rate, with 4.6% and 2.8% respectively.ConclusionsIn keeping with other studies, Groups 5, 6, and 10 were the main contributors to the overall caesarean section rate. We found Robson classification to be clinically relevant and an effective tool to analyse the caesarean section rate even in settings with limited resources.     

Women’s and men’s negative experience of child birth—A cross-sectional survey

Background

A negative birth experience may influence both women and men and can limit their process of becoming a parent.

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.     

Fear of birth: Prevalence,counselling and method of birth at five obstetrical units in Norway

BackgroundThere is increasing evidence that fear of birth can have long-term effects on the childbearing woman and the method of birth.AimTo examine differences between five hospitals in Norway in the occurrence of fear of birth, counselling received and method of birth.MethodSource data was from the Norwegian cohort of the Bidens study and retrieved through a questionnaire and electronic patient records from five different hospitals in Oslo, Drammen, Tromsø, Ålesund and Trondheim, which included 2145 women. The Wijma Delivery Expectancy Questionnaire measured fear of birth, and a cut-off of ≥85 was used to define fear of birth.ResultsIn total, 12% of the women reported fear of birth, with no significant differences between the different units. A total of 8.7% received counselling according to hospital obstetrical records, varying significantly from 5.7% in Drammen to 12.7% in Oslo. Only 24.9% of the women with fear of birth had counselling at their hospital. All the units provided counselling for women with fear, but the content varied. Overarching aims included helping women develop coping strategies like writing a birth plan and clearing up issues regarding prior births. A secondary objective was to prevent unnecessary caesarean section. Both primi- and multiparous women who reported fear of birth had a twofold increased risk of a planned caesarean section.ConclusionThere were no differences between five Norwegian hospitals regarding the occurrence of fear of birth. Counselling methods, resources, level of commitment and the number of women who received counselling varied; thus, hospital practices differed.     

Women’s experience of midwife-led counselling and its influence on childbirth fear: A qualitative study

Background

Women with childbirth fear have been offered counseling by experienced midwives in Sweden for decades without evidence for its effectiveness, in terms of decrease in childbirth fear. Women are usually satisfied with the counselling. However, there is a lack of qualitative data regarding women’s views about counselling for childbirth fear.

Birth preference in women undergoing treatment for childbirth fear: A randomised controlled trial

Background

Childbirth fear is the most common underlying reason for requesting a caesarean section without medical reason. The aim of this randomised controlled study was to investigate birth preferences in women undergoing treatment for childbirth fear, and to investigate birth experience and satisfaction with the allocated treatment.

Preference for caesarean and attitudes toward birth in a Chilean sample of young adults

BackgroundLittle empirical research exists about what motivates birth mode preferences, and even less about this topic in Latin America, where obstetric interventions and caesareans are some of the highest worldwide.AimTo identify factors associated with caesarean preference among Chilean men and women who plan to have children and to inform childbirth education and informed consent procedures.MethodsAn online cross-sectional survey measuring attitudes toward birth was administered to graduate students at a large public university in Chile. Eligible students were under the age of 40 and had no children but intended to have children. Logistic regression modelling was used to determine which sociodemographic factors, knowledge and beliefs were associated with caesarean preference.FindingsAmong eligible students, 730 responded and 664 provided complete answers to the variables of interest. Respondents had a mean age of 28.8; 38% were male and 62% female. Positive attitude toward technological intervention (Odds Ratio 7.4, 95% Confidence Interval 3.9–14.0), high risk perception of vaginal birth (Odds Ratio 1.8, 95% Confidence Interval 1.1–2.8), family history of caesarean (Odds Ratio 1.9, 95% Confidence Interval 1.0–3.8) and high fear of birth (Odds Ratio 3.7, 95% Confidence Interval 2.0–6.8) were associated with caesarean preference.DiscussionPreference for caesarean birth was highly associated with positive attitudes toward technological intervention and may be related to a lack of knowledge about the realities of caesarean and vaginal birth.ConclusionsPatient-centered education on the relative benefits and risks of birth modes has the potential to influence preferences toward vaginal birth.     

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.     

Perspectives on antenatal education associated with pregnancy outcomes: Systematic review and meta-analysis

BackgroundMany studies on the relation between maternal health and infant health, including the effect of structured antenatal education, have been published and expanded over the years.AimInvestigate the impact of various antenatal education programmes on pregnancy outcomes to aid the development of future guidelines related to maternal and foetal health.MethodsBibliographic databases (Cochrane, PubMed, EMBASE, CINAHL, Korean Studies Information Service System) were searched up to November 2018, following the PICO criteria: population (pregnant women), intervention (antenatal education), comparison (not specified), and outcome (maternal and foetal outcome including physical or mental health components).FindingsWe included 23 eligible studies consisting of 14 controlled trials and 9 observational studies. The maternal physical outcomes depending on participation in antenatal education were not significantly different; however, the caesarean birth rate was lower in the antenatal education group (relative risk, RR, 0.90; 95% confidence interval, CI, 0.82–0.99), as was the use of epidural anaesthesia (RR, 0.84; 95% CI, 0.74–0.96). The maternal mental health outcomes of stress and self-efficacy significantly improved in the antenatal education group, although there was no difference in anxiety and depression. The foetal outcomes of birth weight or gestational age at birth were also not different between the groups.ConclusionAntenatal education can reduce maternal stress, improve self-efficacy, lower the caesarean birth rate, and decrease the use of epidural anaesthesia; however, there is limited evidence of its effects on maternal or foetal physical outcomes. Therefore, antenatal education should be standardised to elucidate its actual mental and physical health effects.     

Fear of childbirth in nulliparous women: A cross-sectional multicentre study in China

ObjectiveFew studies have focused on the fear of childbirth (FOC) in China. This study aimed to explore the status of FOC and its associated factors among nulliparous women in China.MethodsUsing a cross-sectional study design, 1039 nulliparous women with singleton pregnancies were recruited from four public hospitals in four cities of China. FOC was evaluated using the Chinese version of the Childbirth Attitude Questionnaire scale. Associations of demographic, obstetric and social–psychological factors with the levels of FOC among nulliparous women were investigated.ResultsThe average score on the Childbirth Attitude Questionnaire scale was 31.30 (standard deviation = 8.43). Generalized linear regression analysis revealed that low self-rated health status (β = 2.26, P = 0.003), higher educational levels (β = 2.06, P = 0.010), lower levels of self-efficacy (β = −0.79, P < 0.001), and use of pregnancy-related smartphone applications (β = 2.42, P < 0.001) were associated with higher levels of FOC.ConclusionThe Childbirth Attitude Questionnaire scale is an appropriate tool to measure FOC. Education levels, self-rated health status, self-efficacy levels, and use of pregnancy-related smartphone applications were predictors of FOC among pregnant women in China. Healthcare professionals should identify the Chinese pregnant women with FOC and implement targeted interventions focused on the above factors.     

Exploring outcomes for women and neonates having skin-to-skin contact during caesarean birth: A quasi-experimental design and qualitative study

ProblemWomen having an elective caesarean birth are often separated from their babies at birth with newborns transferred to a postnatal ward with the significant other.BackgroundTwo midwives were employed in 2019 to provide skin-to-skin contact for women who planned for elective caesarean births in a public hospital in metropolitan New South Wales with 4000 births per year and a 39% CB rate (57.8% of these births being elective).AimTo compare the outcomes for women and their newborns on the effects of skin-to-skin contact at elective caesarean births within the first five minutes of birth to those who did not have skin-to-skin contact and to explore the lived experiences of women having skin-to-skin contact during their elective caesarean births.MethodsA quasi-experimental design study with a qualitative component of in-depth interviews. Quantitative analyses included independent t-tests, chi square and logistic regression. Thematic analysis was used for the qualitative data.FindingsIn the quantitative results, there was a reduction in the time to the first feed (t(100) = ?11.32, p < 0.001) (M = 38.9, SE = 20.7) (M = 124.9, SE = 50.1) and the first breastfeed (t(100) = ?5.2, p < 0.001) (M = 53.2, SE = 82.5) (M = 277, SE = 295.8) with increased breastfeeding on discharge for women that had skin-to-skin contact at caesarean birth in comparison to those who did not receive skin-to-skin contact χ2(1) = 10.22, p < 0.05. In the qualitative results, women who had skin-to-skin contact during their caesarean birth had a positive experience with improved bonding and reported less anxiety and depression than their previous caesarean birth.ConclusionThis study provides evidence of the benefits of skin-to-skin contact during a caesarean birth.     

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

BackgroundContinuity 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.AimThe 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.MethodsAn 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.ResultA 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.ConclusionsThe 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.     

Women's knowledge of options for birth after Caesarean Section

ObjectiveIn Australia, the Caesarean Section rate has risen from 21.8% to 31.1% (2010) in a decade; in South Australia the rate was 32.2% in 2009. Caesarean Section is a life saving intervention in certain circumstances, but also a major surgical procedure with potential adverse effects on both mother and baby. The aim of this study was to ascertain the determinants of knowledge regarding options for subsequent birth in women who have experienced a previous Caesarean Section with a live baby.MethodA sample of 33 women in South Australia who had a previous Caesarean Section were surveyed to assess their awareness of birth options and their advantages versus disadvantages as well as the possible factors influencing their information gathering and decision-making on birth options for their subsequent pregnancy.FindingsMost women perceived Caesarean Section to be major surgery but 69.6% were not aware that babies might have problems with breastfeeding, 60.6% did not know the rarity of uterine rupture during labour and/or birth and 48.5% were not aware that a caesarean may involve any complications for the baby at or after birth.ConclusionWomen's knowledge deficits relating to risks and benefits of birth options after previous caesarean can constrain them as most women chose caesarean rather than normal birth in their subsequent pregnancy.