What matters to women during childbirth: A systematic qualitative review

Abstract

IntroductionDesign and provision of good quality maternity care should incorporate what matters to childbearing women. This qualitative systematic review was undertaken to inform WHO intrapartum guidelines.MethodsUsing a pre-determined search strategy, we searched Medline, CINAHL, PsycINFO, AMED, EMBASE, LILACS, AJOL, and reference lists of eligible studies published 1996-August 2016 (updated to January 2018), reporting qualitative data on womens’ childbirth beliefs, expectations, and values. Studies including specific interventions or health conditions were excluded. PRISMA guidelines were followed.Data collection and analysisAuthors’ findings were extracted, logged on a study-specific data form, and synthesised using meta-ethnographic techniques. Confidence in the quality, coherence, relevance and adequacy of data underpinning the resulting themes was assessed using GRADE-CERQual. A line of argument synthesis was developed.Results35 studies (19 countries) were included in the primary search, and 2 in the update. Confidence in most results was moderate to high. What mattered to most women was a positive experience that fulfilled or exceeded their prior personal and socio-cultural beliefs and expectations. This included giving birth to a healthy baby in a clinically and psychologically safe environment with practical and emotional support from birth companions, and competent, reassuring, kind clinical staff. Most wanted a physiological labour and birth, while acknowledging that birth can be unpredictable and frightening, and that they may need to ‘go with the flow’. If intervention was needed or wanted, women wanted to retain a sense of personal achievement and control through active decision-making. These values and expectations were mediated through womens’ embodied (physical and psychosocial) experience of pregnancy and birth; local familial and sociocultural norms; and encounters with local maternity services and staff.ConclusionsMost healthy childbearing women want a positive birth experience. Safety and psychosocial wellbeing are equally valued. Maternity care should be designed to fulfil or exceed womens’ personal and socio-cultural beliefs and expectations.

WHO model of intrapartum care for a positive childbirth experience: transforming care of women and babies for improved health and wellbeing

“…The synthesis of evidence supporting the development of the 2018 WHO recommendations on intrapartum care showed that women want a ‘positive childbirth experience’ that fulfils or exceeds their prior personal and sociocultural beliefs and expectations 5, 15. This includes giving birth to a healthy baby in a clinically and psychologically safe environment, with continuous emotional support from a birth companion and technically competent clinical staff.…”

“…The synthesis of evidence supporting the development of the 2018 WHO recommendations on intrapartum care showed that women want a 'positive childbirth experience' that fulfils or exceeds their prior personal and sociocultural beliefs and expectations. 5,15 This includes giving birth to a healthy baby in a clinically and psychologically safe environment, with continuous emotional support from a birth companion and technically competent clinical staff. The concept was informed by the evidence that most women want a physiological labour and birth, and to have a sense of personal achievement and control through their involvement in decision making, even when medical interventions are needed or wanted.…”

Can an integrated obstetric emergency simulation training improve respectful maternity care? Results from a pilot study in Ghana

“…The training content was based on evidence-based practices on the management of the complications and recommended practices known to have positive effects on birth outcomes and women's experiences such as support and mobility during labor and nonsupine position at delivery. 3,[20][21][22][23][24][25] In addition, simulation scripts had prompts for certain behaviors from the patient actress: For example, if providers did not introduce themselves, the patient actress asked "who are you? ", and if providers did not explain what they were doing or found from examinations, she asked "what are you doing to me?"…”

Creating Guardians of Physiologic Birth: The Development of an Educational Initiative for Student Midwives in the Netherlands

“…In high‐income countries, research confirms the effectiveness of midwifery care, and in low‐ and middle‐income countries, midwives have played a critical role in reducing maternal and perinatal mortality and morbidity . Investigators have documented women's desire for a positive birth experience that includes birthing a healthy newborn in an environment that is both clinically and psychologically safe, supported by competent and kind professionals . These findings are in line with recent guidance from the World Health Organization, which notes that, for many women, birth is about more than mere survival …”

“…Midwifery education can, and should, provide expertise and leadership to meet these challenges. Essentially, midwifery education is responsible for molding students into professionals who meet the needs of women for positive birth

✦Increasing student midwife agency as advocates of physiologic birth is an important component of midwifery education. ✦Specific educational initiatives can be designed using rapid prototyping methodology, which includes the views and feedback of important stakeholders. ✦A focus on communication skills such as discussion and debate may increase student midwife agency as guardians of physiologic birth. ✦The Optimality Index is a useful tool that can be used to structure evidence‐based reflection by student midwives on their own care processes.

experiences that are as physiologic as possible while navigating the challenges presented by medicalization. This requires the development and internalization of an attitude that reflects the midwifery ethos of physiologic birth .…”