Isis Midwife, Forced to Deliver Babies, Shares Moments Tender and Cruel

J Perinat Educ. 2012 Summer; 21(3): 158–168.

The Impact of Pick and Control on Women's Childbirth Experiences

Abstract

Women'southward selection and command impact birthing experiences. This study used a qualitative, descriptive arroyo to explore how women develop their initial birth plan and how changes made to the program bear upon overall nascency experiences. Narrative, semistructured interviews were conducted with 15 women who had given nascence in Waterloo Region, Ontario, Canada, and data were analyzed using a phenomenological approach. Findings showed that women relied on many resource when planning a nativity and that changes fabricated to a woman's initial birth plan affected her recollection of the birth experience. Conclusions are that women'south positive and negative recollections of their nascency experiences are related more to feelings and exertion of choice and control than to specific details of the birth experience.

Keywords: childbirth, choice in childbirth, control in childbirth, birth narrative

The nascence of a child is a pivotal time in the life of a female parent and her family. The wellness and well-being of a mother and kid at birth largely determines the future health and wellness of the entire family (World Health Organization [WHO], 2005). The consequence of childbirth, however, is not the only cistron of importance in a mother's well-beingness. Some research suggests that the manner in which a woman experiences pregnancy and childbirth is also vitally important for a mother's relationship with her child and her future childbearing experiences (Fox & Worts, 1999; Hauck, Fenwick, Downie, & Butt, 2007). The electric current report explored how women develop a birth plan and the ways in which changes to the initial program touch a adult female's description of the birth experience.

In preparing to give nativity, women, knowingly or unknowingly, develop a nascence plan. The apply of formal birth plans adult in the 1980s equally a way for women to engage in word with their care providers and to articulate their desired nascence feel (Kuo et al., 2010). Nativity plans generally include information such every bit where a woman wishes to give birth, who will nourish a birth, and what forms of medical intervention and pain relief volition be used. The nascency plan is a tool that outlines a woman'due south expectations for her birth and tin can open communication between a woman and her care providers, providing the woman with cognition prior to giving birth (Doherty, 2010; Kuo et al., 2010; Pennell, Salo-Coombs, Herring, Spielman, & Fecho, 2011). At that place may also be negative outcomes of developing a nascency program; for example, feelings of failure if the birth plan is not followed and disappointment with the birth experience if expectations are not met (Berg, Lundgren, & Lindmark, 2003; Lundgren, Berg, & Lindmark, 2003).

The birth plan is a tool that outlines a woman's expectations for her birth and tin open advice between a woman and her care providers, providing the woman with knowledge prior to giving birth.

When negotiating birth plan decisions, women tend to modify their expectations to avoid disappointment (Hauck et al., 2007). When expectations are altered, the care providers and support team become vitally of import in helping to negotiate changes and foster a positive birth experience (Hauck et al., 2007). For the purposes of this report, we defined a woman'southward "care team" or "support squad" as all individuals who help with planning and giving birth, including obstetricians, midwives, nurses, doulas, friends, family members, and the adult female's partner, all of whom may shape a adult female's thinking virtually planning a nascency. The literature suggests that at that place is a abiding negotiation of expectations and desires for the birth betwixt a woman and her support team (Doherty, 2010). During both the evolution and implementation of the birth plan, women must negotiate their expectations and brand health decisions with their intendance providers. The role of the care provider is primal in the ways in which women brand decisions. One report suggests that nurses can take an bear upon on women'due south feelings of confidence and the birth-related decisions they make (Carlton, Callister, & Stoneman, 2005). Furthermore, a recent written report by Klein et al. (2011) revealed that younger obstetricians were significantly more likely to favor the routine use of epidurals and were more likely to view cesarean surgery as a viable solution to many bug that can arise during childbirth. The means in which an obstetrician views birth impacts the options that are presented to women (by their obstetrician, their nurse, or other care provider) and the decisions that a woman makes before and during childbirth.

The ways in which women make general wellness-related choices inform decisions they make apropos childbirth. One conceptualization of women's health conclusion making is the Wittmann-Toll (2004, 2006) model of "emancipated decision making." This model has five dimensions: reflection, empowerment, personal knowledge, social norms, and a flexible environment (Kovach, Becker, & Worley, 2004; Noone, 2002; Wittmann-Toll, 2004). Reflection is the procedure of questioning common practices that are based solely on authority or tradition (Wittmann-Price, 2004). This questioning is important for the private to critically analyze both personal and professional information. Empowerment that is derived from cognition promotes autonomy and independence and is also an important attribute of emancipated determination making (Wittmann-Price, 2004). Personal knowledge, social norms, and flexible surroundings are described equally most closely linked to a woman'due south satisfaction with her decisions (Wittmann-Price, 2006). This model is used as a template in the current report for understanding women'southward decisions related to the chosen birth method and subsequent birth experience. Given the broad nature of the Wittmann-Toll model of health-related decisions, it is helpful for understanding the negotiation that takes place during labor and birth.

Several factors contribute to women's retrospective attitudes toward their nascence experience. The well-nigh prominent factors include control, selection in decision making, social support, and efficacy of pain command (Fob & Worts, 1999; Gibbins & Thomson, 2001; Hardin & Buckner, 2004; Howell-White, 1997; McCrea & Wright, 1999; Waldenström, Hildingsson, Rubertsson, & Rådestad, 2004). Women define command every bit consisting of internal and external processes, both of which impact their feelings about the overall birth feel. Internal command refers to a adult female'due south ability to command her feelings and expressions of pain and to make bodily decisions (e.yard., changing position freely) during labor (Hardin & Buckner, 2004; McCrea & Wright, 1999). External control, on the other hand, refers to a woman's ability to take part in decision making concerning her nascence, including medical interventions, sources and types of support, and where and how to requite nascence (Hardin & Buckner, 2004; McCrea & Wright, 1999). A lack of control is more likely to be associated with a negative childbirth feel, whereas feelings of both internal and external control are associated with a positive experience (Hardin & Buckner, 2004). During birth, the development and negotiation of control are function of a dialectical process between a woman and her care team.

The purpose of this study was to better understand the overall office of option and control in women'south childbirth experiences. This study explored how women develop and negotiate their initial birth plan and how subsequent changes fabricated to the plan affect overall nascency experiences.

During birth, the evolution and negotiation of control are office of a dialectical process between a woman and her intendance team.

METHOD

This report implemented a one-group qualitative, descriptive design using narrative method of data collection. A narrative approach allows women to tell their stories, emphasizing parts they deem nearly of import. This study was approved by the inquiry ethics board at Wilfrid Laurier University in Waterloo Region, Ontario, Canada. Participants were recruited using convenience and snowball sampling strategies; individuals in the written report were asked to talk about this study with like others and invite them to participate. The inclusion benchmark was that women must accept given birth in the geographical bounds of the study during the previous ii years. The rationale for this time frame was to speak with women who were still processing their birth or having most recent insights and reflections. The study was advertised at a local system through a program called the Breastfeeding Buddies Support Group. This organization was chosen based on existing professional relationships rather than sample characteristics. A nurse practitioner assisted with recruitment and snowball sampling.

The sample comprised xv women: 47% had one pregnancy and nascence (primiparous), 13% were significant with their second child, and 40% were multiparous (those who have experienced more than one pregnancy and birth). All participants initiated breastfeeding with their baby(southward) and all had a partner involved in the nascency of their kid(ren). In terms of intendance providers for the nativity, 87% of participants (n = 13) used a midwife, one participant pursued the care of a general practitioner, and some other employed the care of an obstetrician. Five of the 15 participants hired a labor doula for their birth(s). Demographic information pertaining to participants' births was collected during the interview; yet, no further demographic information was nerveless.

Data were nerveless through in-depth, unstructured, individual interviews using a guide with sections that inquired most the nascence plan development, birth story (stories)/experiences, and reflections about how what happened (the reality) differed from the program. All interviews began with a general description of the project, followed past an elaboration of 2 specific interview topics about their birth plan(s)—or lack of a nascency plan—and their birthing experience(s). And so, participants were asked to begin telling their story, choosing whichever topic they felt most comfortable with beginning the interview. Later, the interviewer probed for the other topic. The duration of interviews ranged from 45 min to ii 60 minutes, varying in length because of the diversity and complexity of birth stories and the conditions of the interviews. Interviews were conducted at a convenient fourth dimension and place for the participants, frequently in their homes and sometimes with children present, as expected.

All interviews were audio recorded and transcribed verbatim solely by the principal researcher/first author. Data were analyzed and coded using a phenomenological approach and managed using NVivo software. Codes were developed using the diverse parts of the birth story as a guide; for instance, planning, changes to birth plan, conclusion making during birth, back up during nascency, and breastfeeding support. In the adjacent footstep, these codes were analyzed further to gain a better understanding of how women constructed their experiences and which aspects of these experiences were emphasized by participants. In the "Findings" section of this article, pseudonyms are used to refer to participants individually to protect their anonymity and refer to them using names, rather than the impersonal nature of participant numbers.

Several measures were taken to ensure the trustworthiness of the data. To bolster the credibility of the data, the principal researcher kept an inspect trail throughout the course of the report. This was accomplished past keeping a journal of the inquiry process. The journal served to certificate the process of the research as well as the main researcher's developing thoughts and reflections with regards to the process. During data analysis, attention was paid to cases that negated the developing understanding of women'due south experiences of childbirth. The principal researcher remained cognizant of possible negative cases to ensure that all possibilities were considered throughout the process of analyzing the data. Because the information are descriptions of each participant'south experiences with such a unique and complex nature, attention to negative cases was extremely pertinent to this study's trustworthiness.

FINDINGS

Our report of the findings from this study are organized into two sections in subsequent paragraphs. The first section describes the ways in which women planned their nativity experience and how they negotiated these health-related decisions with their support teams. The second department describes changes to the nascence plan and how these changes afflicted the women'south nascency experience. Changes to the nascence plan took three main forms: (a) transfers of care, in terms of care provider and/or place of labor and birth; (b) the level and type of medical intervention used; and (c) stays in the hospital. Table one presents a summary of the nativity choices that women made and the bodily birth experiences women had in terms of their attention care providers and place of birth. The purpose of this table is to provide the reader with a improve understanding of the choices that the women made prior to giving birth and how their plans changed for individual participants. Figure 1 provides a visual depiction of our study's chief findings.

TABLE 1

Participant Summary Table

Participant	Number of Births	Midwife	OB	GP	Doula	Home Birth	Hospital Birth
1. Katrina	1	X →	X				Ten
2. Marlene	i	X				X
3. Thelma	i	X			Ten	Ten
4. Melody	1	10					X
v. Selah	ii (twins)	X →	10				X
half dozen. Marcy	three	X →	X		X	X →	Ten
7. Carla a	2	X	X		X		X
8. Joni	2	X →	Ten			10 →	X
ix. Regina	1	X →	10		Ten	10 →	10
10. Tessa	1	X →	10				X
11. Ella b	1 (significant)	X				X
12. Jenna	4			X			X
xiii. Paige b	1 (pregnant)	X			X		Ten
14. Shelly	1		X				X
15. Lara	3	10
Total		13	8	1	5	5 (actual)	11

Visual model depicting the study's main findings.

Planning and Negotiation

When planning a nascence, the women in our written report noted ii types of resources that influenced their controlling process: people and information. Individuals involved were based on social relations (due east.thousand., a woman's partner or mother) or professional roles such as care providers (e.g., midwife, medico). Overall, women wanted to share the planning and birthing experience with their partners and to contain their partner's wishes into the nativity plan. Some partners directly influenced decisions fabricated, whereas others did not contribute to the plan per se but played the office of supporting a woman'due south decisions. For example, Lara recalled her conclusion to accept a dwelling birth: "My hubby is not a big fan of hospitals either, and so it was, so he had a bit of a say in information technology also and I thought we'd try to make it equally comfortable every bit possible." Another participant described a like partner role:

With my hubby . . . I mean, he was very good at reading up on stuff, he even asked well-nigh the midwife thing the beginning fourth dimension around and he was really more into it than I was, he was thinking that nosotros maybe wanted a doula the first fourth dimension around as well considering his sis had a doula and said it helped a lot. (Carla)

In dissimilarity, i woman made plans without her partner's input:

In my ideal world, my husband would have been more involved in planning, he would have had more than of an interest in information technology, but he didn't, he doesn't, and I'grand used to that in our relationship. . . . It was more often than not me and I knew what I wanted and I had a articulate sense that this was my birth, and if my husband had wanted to be more involved, then certainly I would take been open to that, but he didn't and and then information technology was essentially my birth and information technology was going to happen the way I wanted it. (Marlene)

Intendance providers also influenced women's birthing decisions past providing data or supporting a woman'due south preexisting philosophy of childbirth. Women in this study viewed care providers not only as sources of information, but besides as sources of experienced cognition in making informed decisions. Ane participant recalled the post-obit discussion with her midwife:

We talked well-nigh pain direction and dissimilar options, that kind of thing. Nosotros talked almost the bodily delivery and she pulled out, like, you lot know the pelvis bones in a little pocketbook and showed me how information technology all would happen and, um, she just always answered questions I had. (Tessa)

For two women, the philosophy held past a care provider was important. Lara noted that she and her midwife shared a similar philosophy of childbirth and that this helped her in making nativity-related decisions. Lara explained, "I recollect that it helped that the midwives have a similar philosophy that I do. . . . I think that a lot of who you are using, having the aforementioned philosophy helps." Some other participant felt similarly: "I went to encounter with the midwife and really connected well with her, really liked her philosophies on birthing being a very natural procedure and I really like the time that midwives spend with their clients" (Joni). Care providers' knowledge, whether based on experience or a philosophical basis, influenced women's planning and what happened when, during the nascency, changes were made to the initial plan.

Changes to the Birth Plan

In comparing initial plans to bodily nascence experiences, we observed varying levels of specificity in participants' initial nascence plans. Examples of low level of specificity are illustrated in the following comments from participants:

I pretty much had my mental idea in my head. That was, I wasn't very picky, similar, I wanted [the baby] delivered and condom and didn't want an epidural. (Katrina).

I knew I wanted to practise information technology in the hospital and I wanted to try without an epidural and other than that I was like, whatever happens, happens and just, I'll proceed an open listen so that the birth can be healthy. (Tune)

[The] birth plan for us was, I think, intentionally vague with a lot of holes in information technology . . . at the end of the feel I wanted to be equally healthy equally I could mayhap be and I wanted to have a healthy infant. (Lara)

These iii women recognized that they could not predict how their birth would unfold. Other participants had highly specified birth plans concerning their intendance providers, identify of birth, and medical intervention, as reflected in the following comments:

I wanted as little intervention equally possible and that was throughout the whole pregnancy, so that was probably at the top of the list, which actually informed the rest of it. (Marlene)

I've worked in health-care community services for a number of years, so I was pretty determined that I wanted it to exist as nonmedical as possible, so my intention in the very offset was to have a natural childbirth with no pain medication whatsoever. (Thelma)

The level of specificity, to a large extent, determined the amount of flexibility women had in terms of changes to their nascence plan.

Drastic changes to a woman's nativity programme that immune footling or no control for the women were the most devastating. Three factors caused significant changes to occur in the women's birth plans: (a) the individual who attended the nascency (midwife vs. obstetrician) and where the nativity took identify (home vs. hospital); (b) the type of pain control and amount of medical intervention used; and (c) the length of hospital stay and the adequacy of intendance.

Transfers of care and its bear on on women'due south experiences.

In total, 87% (xiii of 15 women) of participants initially planned to have a midwife as their primary care provider. Of these, xvi% (six women) had their intendance transferred to an obstetrician at some point during pregnancy, labor, or postpartum. In addition, three participants who planned to give nascence at domicile were transferred to the infirmary at some signal during their labor. Both of these types of changes to the initial nascency program impacted the women'south views of their nascency experience. Every bit reflected in the post-obit comments, some participants recalled positive experiences:

I got skillful care from everyone at the hospital, especially at the birth . . . even though it wasn't my ideal state of affairs like home, I cannot mutter about the care. (Regina)

[I felt] so supported by the hospital. The nurses were awesome, like I could accept gotten a crummy nurse and I got a nurse who was completely into that . . . and helped me nurse him. (Marcy)

The nurses on the floor were amazing, similar you would push the push and they would be at that place in a second because there's only and then much my husband could practise and experience comfy doing. (Selah)

Several participants too had negative experiences with transferring care and/or transferring from birthing at home to the infirmary, particularly for those who transferred from a midwife to an obstetrician.

When I was readmitted for my blood clot, because I was officially nether care of an obstetrician, they, the midwives, weren't given access to meet what my blood tests were and things that they would go in a normal case. (Regina)

Information technology was scary and sad. . . . I was merely starting to have this relationship with her [midwife] . . . it was all so fast. . . . I was having twins and it was but all crazy. . . . I'm losing the woman who was going to protect me. (Selah)

For these participants, having a change in care provider during pregnancy or nativity was frustrating and disappointing. Three participants discussed giving nativity in the hospital after planning for a habitation birth:

Only being there, I hated it and then I just, I had a bad attitude about the whole thing right from the moment we had to leave this business firm. . . . I couldn't command it, it was like this visceral response, like I just was not comfy there. (Joni)

I had monitors now strapped on to me and I was express to only lying on my back and I couldn't exist in any other position. . . . It was all of a sudden a iii-ring circus . . . nosotros no longer seemed the focus and we were not. I was not talked to really, it was just, "Let'due south read the machines . . . " it actually felt that way. (Regina)

I have the experience of having a baby in the way that I know what my rights are and I know that if I become to a hospital I don't have to do everything that they tell me I have to exercise, and that irritates me that other women don't know . . . what their choices are. (Paige)

Changes to a birth plan impacted overall birth experiences. Some of the participants reported positive furnishings; however, if the change was drastic, the experience was negative.

Pain control plan and medical intervention.

Approaches for pain management and full general medical intervention varied profoundly. Some participants desired to keep their plan open, whereas other participants were adamantly opposed to medical pain management. Circumstances for changes in pain management and medical intervention emerged in three themes that are not discrete: (a) from without pain management medication to having some form of hurting medication; (b) from home nascence to a hospital nascence (one participant); and (c) from a vaginal hospital nativity with a midwife to cesarean surgery (one participant). The following statements are these particpants' descriptions of their experiences in shifts in pain management:

I wanted to have a drugless birth and . . . I did not want to give birth on my dorsum. The first affair they did when I got into the hospital was put me on my dorsum and I looked at the surgeon and was similar . . . I don't know how people sit like this, it was the well-nigh pain I had been in the entire time and I was like I can't handle this and she's like, "That'southward why we're giving you drugs," and I was similar, "No, just let me stand up!" (Tessa)

I felt like I almost gave up at that point and I just said, "I can't, I demand to have some medication." I really didn't want to beforehand, but at that moment it was like I needed it . . . it was all I could do to wait until that person came in to do the epidural. (Joni)

I all the same wanted to have a vaginal birth, natural if I could. Going through my prenatal classes I found out that at [the hospital], they actually don't allow you to have a natural childbirth with multiples, it's pretty much mandatory you have to accept an epidural right from the beginning of labor. (Selah)

It was merely enough to kind of make me feel off . . . had someone said to me before, like, "Nubain's not available anymore, these are your options" . . . before I was right in the thick of things, I call up information technology would have just affected me differently. (Jenna)

For two women, although the determination to have an epidural was non function of their initial nascency plan, they expressed control over making this alter.

I recall, similar with the epidural, where I really didn't want it, the way it was presented at to the lowest degree wasn't . . . I guess I didn't experience similar I had given up on not having it considering of the way it was presented. (Katrina)

This is one of those things that's control and selection. If you get too stuck on something, y'all feel guilty afterwards. (Marcy)

A 2nd theme in hurting direction is seen in the experiences of women who planned to give nascence naturally and had to take their labor induced, which led to the use of epidurals and other medical hurting management. Joni experienced a neat loss of control.

I really wanted to give it more time to see if labor would come, however belongings on to my home nativity idea . . . then the midwife said, "It's at present 24 hours so we've gotta head to the hospital," so she was born in the hospital past induction equally opposed to a more natural childbirth . . . so our plans changed a lot . . . I retrieve emotionally, too, I just felt like this is so non happening the mode information technology's supposed to exist happening and at that place's this force per unit area for this to happen fast and making information technology happen fast that it is so unbearably painful, similar, I just, if this is how information technology's going to happen so I need some relief because I can't go along like this. (Joni)

Finally, the third theme in hurting management reflected one participant who initially planned for a natural birth with a midwife and was transferred to an obstetrician because she was pregnant with twins. Upon discovering that her babies were not in the correct position for a vaginal birth, Selah was informed that she would demand to have cesarean surgery. For her, finding out that her planned method of giving nascency was not a possibility had a severe impact on her decision and left her feeling "defeated." She said, "I just felt defeated, like I have no choices now, like none. I don't have whatsoever choice in my birthing, nada, these babies are coming and I have to take an performance. I have to have stomach surgery." Generally, participants who experienced a keen bargain of change to their nascence plan in terms of pain management and medical intervention had a hard time dealing with these changes and, overall, had a more negative view of the birth.

Stays in hospital. Many women (87%, northward = 13) had some feel with staying in the hospital for a period of time after the birth of their child. Of these, 31% (n = four) had planned a home birth. Three of these women (23%, northward = 3) transferred to the hospital while birthing, and 1 participant'due south child was transferred to a neonatal intensive intendance unit of measurement shortly afterward existence born at home. Women who had not initially planned on existence admitted to and staying in the hospital said the experience was not positive, as reflected in the following statements:

Information technology was definitely a very different feel and it wasn't what I wanted. I wanted to be dwelling and only skin-on-skin with my baby and that'south not what I had. . . . I merely pretty much kept my mouth shut because I knew that I had a very clear sense that the nurses were not very supportive of anyone who had had a habitation birth. (Marlene)

I was in a lot of hurting and they wouldn't allow [the baby] to stay with me unless I didn't take any hurting killers, and then information technology really felt like people were going confronting me in a weird way because . . . after a c-department, y'all get a ton of pain killers, but your baby yet stays with yous, right? (Regina)

I didn't even, at that point, really get a chance to bail with them [the twins] because I was and so sick. I didn't want anything to practise with them. . . . I notwithstanding felt actually horrible and then the lactation nurse was coming in and harassing me and trying then difficult to strength my kids on me. (Selah)

The primary factor that all of these participants had in common was the drastic modify in their birth plans. For them, information technology was not necessarily simply a transfer to the hospital that led to negative experiences, simply rather an extended stay in the hospital. Negative experiences were related to the degree of change and amount of control over the changes.

DISCUSSION

The findings of this report show that women rely on the expertise of trusted care providers, such as midwives and obstetricians, in society to make nascency-related decisions during the planning phase. The findings too suggest that the existence of a birth plan, although helpful, was not essential for participants. Women who had a flexible birth plan felt that they had more room for negotiation during labor and birth. The Wittmann-Price (2004, 2006) model of women's wellness decision making suggests that women seek personal noesis about their birth choices and that one of the avenues for this data is the woman'southward intendance provider(due south). This model also emphasizes the importance of a flexible environment. In this report, women who needed to renegotiate their nascence program while in labor benefitted from a flexible environment. Women who felt a loss of control during the nascence process were not well supported in renegotiating their birth plan due in role to structured wellness-intendance protocol that was not in the woman'due south command.

Previous research has suggested that when changes to a woman's birth plan are necessary, information technology is the amount of control that the woman maintains over these changes that is important to sustaining a positive nativity experience (Hardin & Buckner, 2004; Hauck et al., 2007). In the current study, ii central factors were related to the touch on of changes to the birth plan on the women's childbirth experiences: (a) the degree of modify that took identify and (b) the amount of control the birthing adult female had over the changes equally they occured.

The virtually drastic changes to women's nativity plans include transfers of care from home to infirmary and/or from midwife to obstetrician, the apply of medical pain command techniques and other medical interventions, and unexpected stays in the hospital subsequently the nativity of the child. Women who experience all of these changes and who have piffling to no command over the controlling procedure every bit changes are happening tend to utilise negative adjectives when describing their overall birth feel; for example, "defeated," "frustrated," and "traumatizing." When women experience a smaller caste of modify and maintain some level of control over the decision making effectually these changes to their plan, the changes do non have a negative impact on their overall birth experience. This is connected to positive reflections on the overall birth experiences, including words like "fantastic," "empowering," and "supported." From this, we can conclude that it is not only the fact that the nascency program changed that leads to positive or negative feelings, it is the caste to which the initial program is modified and, importantly, the degree of control that women accept over the changes every bit they are happening.

When women are well supported in making decisions and take a bully deal of trust in their intendance providers to make decisions on their behalf, women accept a more positive recollection of their birth experiences. This finding of a connexion betwixt control over birth plan changes and overall view of the birth process is consequent with the findings of a previous study that concluded that control over the concrete, emotional, and mental aspects of childbirth are important to women (Hardin & Buckner, 2004). When women'southward care transfers from a midwife to an obstetrician, they tend to consult with their midwives earlier making birth-related decisions. Women who were supported by this type of consultation did not experience a severe loss of control. Women who do not have an opportunity to consult with their midwives on changes to their birth programme, or women whose midwives are no longer in command of the changes, experience a greater loss of control and, therefore, describe a more negative overall experience.

Women who had a flexible birth plan felt that they had more room for negotiation during labor and birth.

Limitations

I of the limitations of this report is the nature of the sample. The sample comprised 15 self-selected women who contacted us. Consequently, the diversity (due east.1000., indigenous, racial, sexual orientation, socioeconomic) of Waterloo Region was non proportionately represented in the sample. Additionally, the sample of this study did not equally stand for the diverse ways in which women choose to give birth, including a variety of intendance providers and places of nascence. Specifically, only 1 participant chose an obstetrician as her primary intendance provider from the starting time of her pregnancy, and only one participant chose a general practitioner equally her chief care provider. Although several women had their care transferred from a midwife to an obstetrician, this situation represents a very different set of choices and circumstances than those of women who chose to work with an obstetrician from the beginning of their pregnancy.

Finally, this study is very specific to the Waterloo Region in Ontario, Canada, and the options that are offered to women in this area. The back up and data bachelor to women varies depending on location. The specific context in which this written report was conducted must be considered when determining the transferability of these findings to other contexts.

Implications and Conclusions

The current written report provides a snapshot of childbirth experiences in Waterloo Region, Ontario, Canada, during the end of 2009 and the offset of 2010. The findings from this written report have the potential to impact the level and type of intendance that is offered to women in this region of Ontario. Information technology is clear from this study that the detail type of care a woman chooses is non necessarily the nigh important concept related to her ability to maintain control over the birth process. In this study, women'south positive and negative recollections of their nascency experience were more related to experiences of choice and control than they were to the individuals who were present in the birthing room or the particular interventions that were chosen or necessary during a woman'southward nascence experience.

Recommendations for Wellness-Care Professionals and Birthing Women

The clearest recommendation that results from this study is that all members of the labor and birthing care team, including family unit, partners, nurses, doulas, midwives, and obstetricians, demand to support women in making informed choices and negotiating these decisions during the birth process. This can be accomplished through consultation and information sharing that begins during pregnancy and continues through the postpartum period. It is important for the birthing adult female to remain at the center of her birth feel and to be well supported in making necessary decisions. Boosted research is needed to improve understand the ways in which intendance providers incorporate these concepts into their practices.

The blazon of intendance that women in the current study received from midwives tended to incorporate the concepts of informed choice, flexibility, and support. This finding suggests that an increased availability in midwifery intendance is an of import approach to ensuring that women have non just a healthy birth experience but besides one that is positive. Additionally, although midwifery care is covered under the Ontario Health Insurance Plan, this is not the example in other provinces (eastward.m., Prince Edward Isle and Newfoundland). A starting time pace in providing a pick over type of care provider to a wider number of women is to make midwifery care gratis and accessible for all women in Canada.

On its website, The Lodge of Obstetricians and Gynaecologists of Canada (SOGC) states the following in describing the organization's beliefs:

Women should take equitable admission to optimal, comprehensive health intendance . . . women should have the information they demand to make choices well-nigh their wellness . . . the Society has a responsibleness to facilitate modify in relation to health system issues affecting the practise of obstetrics and gynecology. (SOGC, 2008, para. 1)

This statement by the SOGC suggests that the order's goals for practitioners are consistent with the recommendations of this report. Futurity research with practitioners could shed light on ways in which individual practitioners implement these values. Incorporating the stated mission of the SOGC into obstetrical pedagogy is likewise an important step in ensuring that all practitioners carry out these behavior.

Furthermore, the Public Health Agency of Canada (2000) publication "Family-Centered Maternity and Newborn Care: National Guidelines" is meant for all care providers, including midwives and obstetricians. These guidelines incorporate informed choice in a woman-centered model of intendance that focuses on the physical, psychological, and social needs of the woman and her baby. The findings of our study suggest that these guidelines need to be further incorporated into obstetric practice and educational activity.

This study provides a stepping stone for future research studies aimed at amend understanding the part of option and control in women's childbirth experiences. In addition, this study gives service providers a framework on which to base of operations the service that they provide to significant and birthing women. Finally, this study provides relevant and useful information for expectant parents in choosing the blazon of care they admission during pregnancy, labor, nascence, and the postpartum period.

Biography

•

KATIE COOK is a community psychologist and independent researcher in Kitchener, Ontario, Canada. COLLEEN LOOMIS is an associate professor of psychology at Wilfrid Laurier University in Waterloo, Ontario, Canada.

REFERENCES

• Berg Thousand., Lundgren I., Lindmark G. (2003). Childbirth feel in women at high risk: Is it improved past employ of a nascency plan? The Periodical of Perinatal Teaching, 12(2), ane–15 10.1624/105812403X106784 [PMC free article] [PubMed] [Google Scholar]
• Carlton T., Callister L. C., Stoneman Due east. (2005). Decision making in laboring women: Upstanding issues for perinatal nurses. The Journal of Perinatal & Neonatal Nursing, xix(2), 145–154 [PubMed] [Google Scholar]
• Doherty M. E. (2010). Midwifery care: Reflections of midwifery clients. The Journal of Perinatal Teaching, nineteen(4), 41–51 10.1624/105812410X530929 [PMC free article] [PubMed] [Google Scholar]
• Fox B., Worts D. (1999). Revisiting the critique of medicalized childbirth: A contribution to the folklore of birth. Gender & Lodge, thirteen, 326–346 10.1177/089124399013003004 [Google Scholar]
• Gibbins J., Thomson A. M. (2001). Women's expectations and experiences of childbirth. Midwifery, 17(4), 302–313 [PubMed] [Google Scholar]
• Hardin A. M., Buckner E. B. (2004). Characteristics of a positive experience for women who have unmedicated childbirth. The Journal of Perinatal Instruction, 13(iv), 10–16 10.1624/105812404X6180 [PMC free article] [PubMed] [Google Scholar]
• Hauck Y., Fenwick J., Downie J., Butt J. (2007). The influence of childbirth expectations of Western Australian women's perceptions of their birth experience. Midwifery, 23(iii), 235–247 x.1016/j.midw.2006.02.002 [PubMed] [Google Scholar]
• Howell-White S. (1997). Choosing a nativity attendant: The influence of a woman'southward childbirth definition. Social Scientific discipline & Medicine, 45(6), 925–936 ten.1016/S0277-9536(97)00003-8 [PubMed] [Google Scholar]
• Klein Thou. C., Liston R., Fraser Westward. D., Baradaran N., Hearps South. J., Tomkinson J., Maternity Care Research Group (2011). Attitudes of the new generation of Canadian obstetricians: How practice they differ from their predecessors? Nascency, 38(2), 129–139 10.1111/j.1523-536X.2010.00462.10 [PubMed] [Google Scholar]
• Kovach A. C., Becker J., Worley H. (2004). The impact of community health workers on the self-determination, self-sufficiency, and decision-making power of low-income women and mothers of young children. Journal of Community Psychology, 32, 343–356 ten.1002/jcop.20006 [Google Scholar]
• Kuo S. C., Lin Thousand. C., Hsu C. H., Yang C. C., Chang K. Y., Tsao C. M., Lin 50. C. (2010). Evaluation of the effects of a birth program on Taiwanese women's childbirth experiences, command and expectations fulfillment: A randomised controlled trial. International Journal of Nursing Studies, 47(7), 806–814 10.1016/j.ijnurstu.2009.11.012 [PubMed] [Google Scholar]
• Lundgren I., Berg M., Lindmark G. (2003). Is the childbirth experience improved by a birth plan? Periodical of Midwifery & Women's Health, 48(5), 322–328 10.1016/S1526-9523(03)00278-2 [PubMed] [Google Scholar]
• McCrea B. H., Wright G. (1999). Satisfaction in childbirth and perceptions of personal control in pain relief during labour. Journal of Advanced Nursing, 29(4), 877–884 [PubMed] [Google Scholar]
• Noone J. (2002). Concept analysis of conclusion making. Nursing Forum, 37(3), 21–32 10.1111/j.1744-6198.2002.tb01007.10 [PubMed] [Google Scholar]
• Pennell A., Salo-Coombs 5., Herring A., Spielman F., Fecho Grand. (2011). Anesthesia and analgesia-related preferences and outcomes of women who accept birth plans. Journal of Midwifery & Women'south Health, 56(4), 376–381 ten.1111/j.1542-2011.2011.00032.x [PubMed] [Google Scholar]
• Public Wellness Agency of Canada (2000). Family-centered maternity and newborn care: National guidelines. Retrieved from http://www.phac-aspc.gc.ca/hp-ps/dca-dea/publications/fcm-smp/index-eng.php
• Society of Obstetricans and Gynaecologists of Canada (2008, . October 17). Most SOGC: Mission/history. Retrieved from http://sogc.org/nigh/about_e.asp
• Waldenström U., Hildingsson I., Rubertsson C., Rådestad I. (2004). A negative nativity experience: Prevalence and gamble factors in a national sample. Nascence, 31(one), 17–27 10.1111/j.0730-7659.2004.0270.ten [PubMed] [Google Scholar]
• Wittmann-Price R. A. (2004). Emancipation in controlling in women's health intendance. Journal of Advanced Nursing, 47(iv), 437–445 x.1111/j.1365-2648.2004.03121.x [PubMed] [Google Scholar]
• Wittmann-Cost R. A. (2006). Exploring the subconcepts of the Wittman-Cost theory of emancipated conclusion-making in women's health intendance. Journal of Nursing Scholarship, 38(iv), 377–382 10.1111/j.1547-5069.2006.00130.x [PubMed] [Google Scholar]
• Globe Wellness Organization (2005). Earth health report 2005: Make every female parent and child count. Geneva, Switzerland: Author [Google Scholar]

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3392605/

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