A Qualitative Approach to Examine Women's Experience of Planned Cesarean.
ABSTRACT OBJECTIVE: To investigate women's expectations regarding cesarean and to assess the subjective experience of birth of these women. Because the birth experience is a multidimensional phenomenon, qualitative as well as quantitative approaches were used to investigate women's expectations and experiences with cesarean. DESIGN: Descriptive cohort study. SETTING: The Division of Obstetrics and Feto-Maternal Medicine of the Department of Obstetrics and Gynecology of an Austrian medical university. PARTICIPANTS: Forty-eight women with a planned cesarean birth. METHODS: Semistructured interviews were conducted with the 48 women before (36(th) week of gestation) the planned cesarean and shortly thereafter. Data were analyzed by means of a qualitative content analysis. Anxiety, depression, and psychological distress were assessed using standardized questionnaires. RESULTS: More than three fourths (81.3%) of the women were satisfied with the cesarean. Nevertheless, 83.3% of the women expressed anxiety about cesarean, including fears about the health of the infant, the epidural anesthesia, and possible complications. Before the cesarean, only one half of the women (54.2%) felt that they had been sufficiently informed about the planned cesarean, and only 25% had detailed knowledge about the specific course of events of the cesarean. Quantitative assessment showed low depression levels and overall psychological distress before and after the cesarean. State anxiety levels were high before the cesarean and moderate afterwards. CONCLUSION: Although the overall satisfaction and psychological tolerability of a planned cesarean is high, improvement is possible by providing more detailed information to the prospective mothers and by specifically addressing prevalent anxieties.
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ABSTRACT: Objective To add to knowledge around women's perceptions of their preparation for and actual experience of a recent scheduled caesarean birth. Design, participants and setting A mixed method study incorporating a postal survey and one-on-one interviews was used. The survey provided feedback on resources to prepare women for their caesarean birth such as a positive birth class, DVD and birth plan. Women were also invited to participate in an interview to share perceptions of their preparation and actual birth experience. Participants attended the only public obstetric tertiary hospital in Western Australia and experienced their caesarean birth between August and December 2012 (n=256). Frequency distributions and univariate comparisons were employed for categorical data, whereas thematic analysis was undertaken with transcripts to extract common themes. Results Data reflect 46% (117 out of 256) of women returned a postal survey. The interview option was removed after three months of data collection, when 38 women were interviewed and data saturation was reached. Of the 61% (71 of 117) who completed a birth plan, 59% (42 of 71) felt it was used to guide their care. Only 38% (44 of 117) were able to stay together with their (baby and partner) in recovery. Thematic analysis revealed a positive theme suggesting their experience "couldn't have been better" with sub-themes: 'involved in care'; 'informed the whole way through'; 'magical for him to be near me' and 'everything was done brilliantly'. Negative reflections centred around "we were just a number" and included four sub-themes: 'no option'; 'still had questions'; 'separated from him and her' and 'none of it happened'. Conclusion Acknowledgement that a scheduled caesarean section is more than a surgical procedure, but a birth is paramount. For women to have a positive birth experience we must respect their wishes within their birth plan and embrace a family friendly model, where mothers, partners and babies can stay together. Key words Scheduled caesarean, caesarean birth, qualitative, women's experiences Funding The study was funded by King Edward Memorial Hospital, Perth, Western Australia.Midwifery 01/2013; · 1.12 Impact Factor
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ABSTRACT: Research on maternity care quality in the US often focuses on avoiding adverse events. Positive birth experiences receive less attention. This analysis used a mixed methods approach to identify factors associated with confidence and positive experiences during birth among a national sample of US mothers. Data are from a nationally representative survey of women who delivered a singleton baby in a US hospital in 2005 (N = 1,573). We explored the relationship between confidence, positive birth experiences and socio-demographic characteristics as well as factors related to the clinical encounter and health systems, including common obstetric procedures and interventions. Self-reported confidence during birth was the outcome in quantitative analyses. We used logistic regression analysis and qualitative analysis of open-ended survey responses. Approximately 42 % of mothers reported feeling confident during birth. Confidence going into labor was the strongest predictor of confidence during birth (adjusted odds ratio 12.88 for nulliparous women, 8.54 for parous women). Black and Hispanic race/ethnicity (compared to white) and having partner support were positively associated with confidence during birth for nulliparous women. Qualitative analyses revealed that positive experiences were related to previous birth experiences, communication between women and their clinicians, perceptions of shared decision-making, and communication among clinicians related to the timing and logistics of managing complications and coordinating care. For clinicians who care for women during pregnancy and childbirth, thoughtful, deliberate attention to factors promoting positive birth experiences may help create circumstances amenable to enhancing the quality of obstetric care and improving outcomes for mothers and infants.Maternal and Child Health Journal 09/2013; · 2.24 Impact Factor