Article About Female Obstetrician Who Delivered a Baby Immediately Before Having Her Own

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

The Touch of Choice and Command on Women's Childbirth Experiences

Abstruse

Women'south option and control 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 plan bear on overall birth experiences. Narrative, semistructured interviews were conducted with 15 women who had given birth in Waterloo Region, Ontario, Canada, and information were analyzed using a phenomenological approach. Findings showed that women relied on many resources when planning a birth and that changes made to a adult female's initial birth plan afflicted her recollection of the birth experience. Conclusions are that women'south positive and negative recollections of their birth experiences are related more to feelings and exertion of option and control than to specific details of the birth feel.

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

The nativity of a child is a pivotal time in the life of a mother and her family. The health and well-being of a female parent and child at nascence largely determines the future health and wellness of the entire family (Earth Health Organization [WHO], 2005). The outcome of childbirth, even so, is non the only factor of importance in a female parent's well-beingness. Some research suggests that the fashion 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 (Trick & Worts, 1999; Hauck, Fenwick, Downie, & Butt, 2007). The current report explored how women develop a birth programme and the ways in which changes to the initial programme affect a adult female'due south description of the nativity experience.

In preparing to requite birth, women, knowingly or unknowingly, develop a nascency program. The use of formal birth plans developed in the 1980s as a way for women to engage in give-and-take with their intendance providers and to articulate their desired nascence feel (Kuo et al., 2010). Nativity plans generally include data such as where a woman wishes to give nativity, who will nourish a nativity, and what forms of medical intervention and pain relief will be used. The nascency plan is a tool that outlines a woman'southward expectations for her birth and can open communication between a woman and her care providers, providing the woman with knowledge prior to giving nascence (Doherty, 2010; Kuo et al., 2010; Pennell, Salo-Coombs, Herring, Spielman, & Fecho, 2011). There may also be negative outcomes of developing a nativity plan; for example, feelings of failure if the nascency 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 programme is a tool that outlines a woman'south expectations for her nascency and can open advice between a adult female and her intendance providers, providing the woman with knowledge prior to giving birth.

When negotiating birth programme decisions, women tend to alter their expectations to avoid disappointment (Hauck et al., 2007). When expectations are contradistinct, the care providers and support squad become vitally important in helping to negotiate changes and foster a positive birth experience (Hauck et al., 2007). For the purposes of this report, nosotros defined a woman's "intendance team" or "support squad" as all individuals who assist with planning and giving birth, including obstetricians, midwives, nurses, doulas, friends, family unit members, and the adult female's partner, all of whom may shape a adult female's thinking about planning a nascency. The literature suggests that there is a abiding negotiation of expectations and desires for the birth between a adult female and her support team (Doherty, 2010). During both the development and implementation of the nascency program, women must negotiate their expectations and make health decisions with their care providers. The role of the care provider is central in the ways in which women make decisions. 1 study suggests that nurses tin can have an impact on women's feelings of confidence and the birth-related decisions they make (Carlton, Callister, & Stoneman, 2005). Furthermore, a recent study by Klein et al. (2011) revealed that younger obstetricians were significantly more probable to favor the routine use of epidurals and were more probable to view cesarean surgery as a viable solution to many problems that tin can ascend during childbirth. The ways in which an obstetrician views birth impacts the options that are presented to women (by their obstetrician, their nurse, or other intendance provider) and the decisions that a adult female makes before and during childbirth.

The ways in which women make general health-related choices inform decisions they make concerning childbirth. One conceptualization of women's health determination making is the Wittmann-Cost (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-Price, 2004). Reflection is the process of questioning common practices that are based solely on authority or tradition (Wittmann-Cost, 2004). This questioning is important for the individual to critically analyze both personal and professional data. Empowerment that is derived from noesis promotes autonomy and independence and is also an of import aspect of emancipated decision making (Wittmann-Price, 2004). Personal noesis, social norms, and flexible environment are described as most closely linked to a adult female's satisfaction with her decisions (Wittmann-Price, 2006). This model is used as a template in the current study 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 most prominent factors include control, choice in determination making, social support, and efficacy of hurting command (Fox & Worts, 1999; Gibbins & Thomson, 2001; Hardin & Buckner, 2004; Howell-White, 1997; McCrea & Wright, 1999; Waldenström, Hildingsson, Rubertsson, & Rådestad, 2004). Women define control as consisting of internal and external processes, both of which impact their feelings about the overall nascency feel. Internal control refers to a woman's power to control her feelings and expressions of pain and to make bodily decisions (e.thousand., changing position freely) during labor (Hardin & Buckner, 2004; McCrea & Wright, 1999). External control, on the other manus, refers to a woman's ability to accept part in decision making concerning her nascence, including medical interventions, sources and types of support, and where and how to give nascence (Hardin & Buckner, 2004; McCrea & Wright, 1999). A lack of control is more than probable 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 nativity, the development and negotiation of control are function of a dialectical procedure between a adult female and her care team.

The purpose of this written report was to meliorate understand the overall role of option and control in women's childbirth experiences. This report explored how women develop and negotiate their initial nascence program and how subsequent changes made to the plan affect overall birth experiences.

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

METHOD

This study implemented a one-group qualitative, descriptive pattern using narrative method of data collection. A narrative approach allows women to tell their stories, emphasizing parts they deem most important. This study was approved by the research ideals lath at Wilfrid Laurier Academy in Waterloo Region, Ontario, Canada. Participants were recruited using convenience and snowball sampling strategies; individuals in the study were asked to talk about this study with similar others and invite them to participate. The inclusion criterion was that women must have given birth in the geographical premises of the study during the previous two years. The rationale for this time frame was to speak with women who were still processing their birth or having near recent insights and reflections. The study was advertised at a local system through a programme 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 fifteen women: 47% had one pregnancy and birth (primiparous), 13% were pregnant with their second child, and xl% were multiparous (those who take experienced more than one pregnancy and birth). All participants initiated breastfeeding with their infant(south) and all had a partner involved in the nascence of their child(ren). In terms of care providers for the birth, 87% of participants (n = 13) used a midwife, one participant pursued the care of a general practitioner, and another employed the care of an obstetrician. V of the xv participants hired a labor doula for their nascency(south). Demographic information pertaining to participants' births was collected during the interview; even so, no further demographic information was collected.

Data were nerveless through in-depth, unstructured, private interviews using a guide with sections that inquired about the birth plan development, nascency story (stories)/experiences, and reflections about how what happened (the reality) differed from the plan. All interviews began with a general description of the project, followed by an elaboration of two specific interview topics virtually their birth plan(s)—or lack of a birth plan—and their birthing experience(southward). Then, participants were asked to begin telling their story, choosing whichever topic they felt most comfortable with beginning the interview. Subsequently, the interviewer probed for the other topic. The duration of interviews ranged from 45 min to ii hr, varying in length because of the diversity and complexity of birth stories and the conditions of the interviews. Interviews were conducted at a user-friendly time and place for the participants, ofttimes 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 adult using the diverse parts of the birth story as a guide; for example, planning, changes to birth program, decision making during nascence, support during birth, and breastfeeding support. In the next step, these codes were analyzed further to gain a meliorate understanding of how women synthetic 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 study. This was achieved by keeping a journal of the enquiry process. The journal served to document the process of the inquiry besides as the master researcher's developing thoughts and reflections with regards to the procedure. During data analysis, attention was paid to cases that negated the developing understanding of women'south experiences of childbirth. The chief researcher remained cognizant of possible negative cases to ensure that all possibilities were considered throughout the process of analyzing the information. Because the data are descriptions of each participant'due south experiences with such a unique and circuitous nature, attention to negative cases was extremely pertinent to this report's trustworthiness.

FINDINGS

Our report of the findings from this written report are organized into two sections in subsequent paragraphs. The beginning department describes the ways in which women planned their birth experience and how they negotiated these health-related decisions with their back up teams. The 2d section describes changes to the birth program and how these changes affected the women's birth experience. Changes to the birth plan took three main forms: (a) transfers of care, in terms of care provider and/or identify of labor and birth; (b) the level and type of medical intervention used; and (c) stays in the hospital. Table 1 presents a summary of the nativity choices that women made and the actual birth experiences women had in terms of their attending care providers and identify of birth. The purpose of this table is to provide the reader with a ameliorate agreement of the choices that the women made prior to giving birth and how their plans changed for private participants. Figure 1 provides a visual depiction of our written report'southward master findings.

TABLE 1

Participant Summary Tabular array

Participant	Number of Births	Midwife	OB	GP	Doula	Dwelling house Birth	Infirmary Nativity
1. Katrina	ane	X →	X				X
ii. Marlene	i	10				X
three. Thelma	1	X			Ten	X
iv. Tune	1	X					X
5. Selah	2 (twins)	X →	X				X
half-dozen. Marcy	3	X →	Ten		X	X →	X
7. Carla a	2	X	Ten		X		X
8. Joni	2	X →	Ten			10 →	10
9. Regina	i	10 →	X		Ten	X →	X
ten. Tessa	1	Ten →	X				X
11. Ella b	ane (significant)	X				Ten
12. Jenna	4			X			X
13. Paige b	1 (pregnant)	X			X		X
xiv. Shelly	one		10				10
xv. Lara	3	Ten
Full		13	8	1	5	five (actual)	11

Visual model depicting the study's main findings.

Planning and Negotiation

When planning a nascency, the women in our study noted ii types of resources that influenced their determination-making 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 (due east.g., midwife, medico). Overall, women wanted to share the planning and birthing experience with their partners and to incorporate their partner'southward wishes into the birth plan. Some partners directly influenced decisions made, whereas others did not contribute to the programme per se but played the part of supporting a woman'due south decisions. For example, Lara recalled her decision to take a home nascence: "My husband is not a big fan of hospitals either, and then it was, then he had a fleck of a say in it as well and I thought nosotros'd try to make it as comfortable every bit possible." Another participant described a similar partner office:

With my husband . . . I mean, he was very practiced at reading up on stuff, he even asked about the midwife thing the first time effectually and he was actually more than into information technology than I was, he was thinking that nosotros mayhap wanted a doula the get-go time around also because his sister had a doula and said it helped a lot. (Carla)

In contrast, one woman made plans without her partner'southward input:

In my ideal globe, my hubby would take been more than involved in planning, he would have had more than of an interest in it, but he didn't, he doesn't, and I'm used to that in our relationship. . . . Information technology was mostly me and I knew what I wanted and I had a clear sense that this was my nativity, and if my husband had wanted to be more involved, then certainly I would have been open up to that, but he didn't and so it was essentially my nascence and information technology was going to happen the way I wanted information technology. (Marlene)

Care providers also influenced women's birthing decisions past providing information or supporting a woman'due south preexisting philosophy of childbirth. Women in this report viewed care providers not just every bit sources of information, but also as sources of experienced noesis in making informed decisions. One participant recalled the following word with her midwife:

Nosotros talked about hurting direction and different options, that kind of thing. Nosotros talked most the actual commitment and she pulled out, like, you know the pelvis bones in a fiddling handbag and showed me how it all would happen and, um, she only e'er answered questions I had. (Tessa)

For ii women, the philosophy held by 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 birth-related decisions. Lara explained, "I think that information technology helped that the midwives have a similar philosophy that I do. . . . I think that a lot of who yous are using, having the aforementioned philosophy helps." Another participant felt similarly: "I went to meet with the midwife and really connected well with her, actually liked her philosophies on birthing beingness a very natural process and I actually like the time that midwives spend with their clients" (Joni). Intendance providers' noesis, whether based on experience or a philosophical footing, influenced women's planning and what happened when, during the birth, changes were made to the initial plan.

Changes to the Birth Program

In comparing initial plans to actual nascence experiences, nosotros observed varying levels of specificity in participants' initial nascency 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 babe] delivered and condom and didn't want an epidural. (Katrina).

I knew I wanted to do it in the infirmary and I wanted to effort without an epidural and other than that I was like, whatever happens, happens and just, I'll continue an open mind and so that the birth can be healthy. (Melody)

[The] nativity plan for us was, I think, intentionally vague with a lot of holes in information technology . . . at the cease of the experience I wanted to exist as salubrious as I could possibly be and I wanted to have a healthy baby. (Lara)

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

I wanted equally piddling intervention as possible and that was throughout the whole pregnancy, so that was probably at the top of the list, which really 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 be as nonmedical as possible, so my intention in the very beginning was to have a natural childbirth with no pain medication whatever. (Thelma)

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

Desperate changes to a woman'southward nascence plan that allowed little or no control for the women were the most devastating. Three factors caused significant changes to occur in the women's nascency plans: (a) the individual who attended the birth (midwife vs. obstetrician) and where the nascency 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 intendance and its impact on women'due south experiences.

In total, 87% (13 of fifteen women) of participants initially planned to take 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 requite birth at domicile were transferred to the hospital at some signal during their labor. Both of these types of changes to the initial birth plan impacted the women's views of their nascency experience. As reflected in the post-obit comments, some participants recalled positive experiences:

I got adept care from everyone at the infirmary, especially at the nascency . . . even though it wasn't my platonic state of affairs like abode, I cannot complain about the care. (Regina)

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

The nurses on the flooring were amazing, similar y'all would push the button and they would exist there in a second considering there'southward only so much my married man could practice and feel comfortable doing. (Selah)

Several participants as well had negative experiences with transferring intendance and/or transferring from birthing at home to the hospital, peculiarly for those who transferred from a midwife to an obstetrician.

When I was readmitted for my blood clot, considering I was officially under care of an obstetrician, they, the midwives, weren't given access to see what my claret tests were and things that they would make it a normal case. (Regina)

It was scary and sad. . . . I was just starting to have this relationship with her [midwife] . . . it was all so fast. . . . I was having twins and it was just 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 nascency was frustrating and disappointing. Three participants discussed giving nascence in the hospital after planning for a habitation birth:

Only being there, I hated information technology and and then I just, I had a bad attitude about the whole thing right from the moment nosotros had to leave this business firm. . . . I couldn't control information technology, it was like this visceral response, like I simply was non comfortable at that place. (Joni)

I had monitors now strapped on to me and I was limited to only lying on my back and I couldn't be in whatsoever other position. . . . Information technology was suddenly a three-ring circus . . . nosotros no longer seemed the focus and we were not. I was not talked to really, it was just, "Permit'southward read the machines . . . " it really felt that way. (Regina)

I have the feel of having a infant 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 programme impacted overall birth experiences. Some of the participants reported positive effects; notwithstanding, if the modify was drastic, the experience was negative.

Hurting control plan and medical intervention.

Approaches for pain direction and general medical intervention varied greatly. Some participants desired to keep their program open, whereas other participants were adamantly opposed to medical pain management. Circumstances for changes in hurting management and medical intervention emerged in three themes that are non discrete: (a) from without pain management medication to having some form of hurting medication; (b) from home nascence to a hospital nascence (i participant); and (c) from a vaginal hospital nativity with a midwife to cesarean surgery (ane participant). The following statements are these particpants' descriptions of their experiences in shifts in pain management:

I wanted to take a drugless nativity and . . . I did not desire to give nascence on my back. The starting time thing they did when I got into the hospital was put me on my back and I looked at the surgeon and was similar . . . I don't know how people sit down similar this, it was the most pain I had been in the entire time and I was like I can't handle this and she's like, "That's why we're giving you drugs," and I was similar, "No, just let me stand!" (Tessa)

I felt like I virtually gave up at that point and I merely said, "I can't, I need 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 still wanted to have a vaginal nascency, natural if I could. Going through my prenatal classes I plant out that at [the hospital], they actually don't allow you to have a natural childbirth with multiples, it'due south pretty much mandatory y'all have to have an epidural right from the beginning of labor. (Selah)

It was just enough to kind of make me experience off . . . had someone said to me before, like, "Nubain's not available anymore, these are your options" . . . before I was correct in the thick of things, I think it would accept merely affected me differently. (Jenna)

For ii women, although the decision to accept an epidural was not office of their initial birth plan, they expressed control over making this change.

I call up, like with the epidural, where I really didn't want information technology, the way it was presented at least wasn't . . . I guess I didn't feel like I had given upwards on not having information technology because of the way it was presented. (Katrina)

This is one of those things that's control and choice. If you get as well stuck on something, you feel guilty afterwards. (Marcy)

A second theme in pain management is seen in the experiences of women who planned to give birth naturally and had to have their labor induced, which led to the utilize of epidurals and other medical pain management. Joni experienced a great loss of command.

I really wanted to give it more time to see if labor would come, still holding on to my home nativity idea . . . then the midwife said, "It's now 24 hours and then nosotros've gotta head to the infirmary," then she was born in the hospital by induction as opposed to a more natural childbirth . . . and so our plans changed a lot . . . I call back emotionally, too, I just felt similar this is so not happening the way it'due south supposed to be happening and there'southward this pressure for this to happen fast and making it happen fast that information technology is so unbearably painful, like, I but, if this is how information technology's going to happen so I need some relief because I tin can't become on like this. (Joni)

Finally, the third theme in pain direction reflected one participant who initially planned for a natural nascency with a midwife and was transferred to an obstetrician because she was pregnant with twins. Upon discovering that her babies were not in the right position for a vaginal nascency, Selah was informed that she would need to have cesarean surgery. For her, finding out that her planned method of giving nascence 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 whatever choice in my birthing, nothing, these babies are coming and I have to have an operation. I take to have breadbasket surgery." Generally, participants who experienced a peachy deal of change to their birth programme in terms of hurting management and medical intervention had a hard time dealing with these changes and, overall, had a more negative view of the nativity.

Stays in hospital. Many women (87%, n = thirteen) had some experience with staying in the hospital for a period of time afterwards the nativity of their kid. Of these, 31% (due north = 4) had planned a home nascency. Three of these women (23%, due north = 3) transferred to the hospital while birthing, and one participant's kid was transferred to a neonatal intensive care unit before long afterward being born at home. Women who had not initially planned on being admitted to and staying in the hospital said the experience was not positive, as reflected in the following statements:

It was definitely a very different experience and information technology wasn't what I wanted. I wanted to be domicile and just peel-on-pare with my baby and that's not what I had. . . . I only 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 home birth. (Marlene)

I was in a lot of pain and they wouldn't allow [the baby] to stay with me unless I didn't take whatsoever hurting killers, so it actually felt like people were going confronting me in a weird mode because . . . afterwards a c-section, you get a ton of hurting killers, but your baby notwithstanding stays with you, right? (Regina)

I didn't even, at that indicate, actually go a run a risk to bond with them [the twins] because I was so sick. I didn't want annihilation to do with them. . . . I still felt really horrible so the lactation nurse was coming in and harassing me and trying so hard to forcefulness my kids on me. (Selah)

The main factor that all of these participants had in mutual was the desperate change in their nativity plans. For them, it was non necessarily simply a transfer to the infirmary that led to negative experiences, just rather an extended stay in the hospital. Negative experiences were related to the degree of change and amount of command over the changes.

Word

The findings of this study prove that women rely on the expertise of trusted care providers, such as midwives and obstetricians, in social club to make nativity-related decisions during the planning stage. The findings besides propose that the existence of a birth plan, although helpful, was not essential for participants. Women who had a flexible nascency plan felt that they had more than room for negotiation during labor and nascency. The Wittmann-Price (2004, 2006) model of women'southward health conclusion making suggests that women seek personal knowledge near their nascency choices and that 1 of the avenues for this data is the woman'due south care provider(s). This model likewise emphasizes the importance of a flexible environment. In this study, women who needed to renegotiate their birth plan while in labor benefitted from a flexible environment. Women who felt a loss of control during the birth process were not well supported in renegotiating their birth plan due in part to structured wellness-care protocol that was not in the woman'due south command.

Previous research has suggested that when changes to a woman's nativity program are necessary, it is the corporeality of control that the woman maintains over these changes that is important to sustaining a positive nascency experience (Hardin & Buckner, 2004; Hauck et al., 2007). In the electric current study, 2 key factors were related to the impact of changes to the birth programme on the women's childbirth experiences: (a) the degree of change that took place and (b) the corporeality of command the birthing woman had over the changes every bit they occured.

The virtually drastic changes to women's birth plans include transfers of care from dwelling house to hospital and/or from midwife to obstetrician, the use of medical pain control techniques and other medical interventions, and unexpected stays in the hospital later on the nascency of the kid. Women who feel all of these changes and who take little to no command over the decision-making process as changes are happening tend to use negative adjectives when describing their overall birth experience; for example, "defeated," "frustrated," and "traumatizing." When women experience a smaller degree of change and maintain some level of command over the decision making around these changes to their plan, the changes do not take a negative bear upon on their overall birth feel. This is connected to positive reflections on the overall birth experiences, including words like "fantastic," "empowering," and "supported." From this, we tin conclude that it is not simply the fact that the birth plan changed that leads to positive or negative feelings, it is the caste to which the initial programme is modified and, importantly, the degree of control that women have over the changes as they are happening.

When women are well supported in making decisions and have a swell bargain of trust in their care providers to make decisions on their behalf, women accept a more positive recollection of their nascency experiences. This finding of a connection between command over nascency program changes and overall view of the birth process is consistent with the findings of a previous report that ended that control over the physical, emotional, and mental aspects of childbirth are important to women (Hardin & Buckner, 2004). When women's care transfers from a midwife to an obstetrician, they tend to consult with their midwives before making birth-related decisions. Women who were supported by this type of consultation did not experience a severe loss of control. Women who do non have an opportunity to consult with their midwives on changes to their birth program, or women whose midwives are no longer in control of the changes, feel a greater loss of control and, therefore, describe a more negative overall experience.

Women who had a flexible nascency programme felt that they had more than room for negotiation during labor and nascency.

Limitations

I of the limitations of this study is the nature of the sample. The sample comprised fifteen self-selected women who contacted us. Consequently, the diversity (e.one thousand., ethnic, racial, sexual orientation, socioeconomic) of Waterloo Region was non proportionately represented in the sample. Additionally, the sample of this study did not as represent the various ways in which women choose to give nativity, including a variety of care providers and places of birth. Specifically, but one participant chose an obstetrician as her main care provider from the beginning of her pregnancy, and only one participant chose a full general practitioner as her primary intendance provider. Although several women had their care transferred from a midwife to an obstetrician, this situation represents a very different prepare of choices and circumstances than those of women who chose to work with an obstetrician from the start 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 support and data available to women varies depending on location. The specific context in which this study was conducted must exist considered when determining the transferability of these findings to other contexts.

Implications and Conclusions

The current study 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 study have the potential to impact the level and type of care that is offered to women in this region of Ontario. It is clear from this study that the particular type of care a woman chooses is non necessarily the nigh important concept related to her ability to maintain control over the nascency process. In this report, women's positive and negative recollections of their birth 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 item interventions that were called or necessary during a woman'southward nascency experience.

Recommendations for Health-Care Professionals and Birthing Women

The clearest recommendation that results from this report is that all members of the labor and birthing care team, including family, partners, nurses, doulas, midwives, and obstetricians, need to support women in making informed choices and negotiating these decisions during the birth process. This tin can be accomplished through consultation and information sharing that begins during pregnancy and continues through the postpartum period. It is important for the birthing woman to remain at the center of her birth experience and to be well supported in making necessary decisions. Additional enquiry is needed to better empathise the ways in which care providers incorporate these concepts into their practices.

The type of care that women in the current study received from midwives tended to comprise the concepts of informed choice, flexibility, and back up. This finding suggests that an increased availability in midwifery care is an important approach to ensuring that women have non only a healthy birth feel but likewise one that is positive. Additionally, although midwifery care is covered under the Ontario Wellness Insurance Plan, this is non the instance in other provinces (e.yard., Prince Edward Isle and Newfoundland). A first pace in providing a pick over type of care provider to a wider number of women is to brand midwifery intendance gratuitous and accessible for all women in Canada.

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

Women should have equitable access to optimal, comprehensive wellness care . . . women should have the information they need to make choices virtually their health . . . the Society has a responsibility to facilitate modify in relation to health organisation bug affecting the practise of obstetrics and gynecology. (SOGC, 2008, para. 1)

This argument by the SOGC suggests that the society'due south goals for practitioners are consistent with the recommendations of this written report. Future inquiry with practitioners could shed light on ways in which individual practitioners implement these values. Incorporating the stated mission of the SOGC into obstetrical education is also an important stride in ensuring that all practitioners carry out these beliefs.

Furthermore, the Public Health Agency of Canada (2000) publication "Family unit-Centered Motherhood and Newborn Care: National Guidelines" is meant for all intendance providers, including midwives and obstetricians. These guidelines contain informed pick in a woman-centered model of care that focuses on the physical, psychological, and social needs of the woman and her babe. The findings of our report suggest that these guidelines demand to exist farther incorporated into obstetric practise and teaching.

This study provides a stepping rock for future research studies aimed at meliorate understanding the role of pick and control in women's childbirth experiences. In addition, this report gives service providers a framework on which to base of operations the service that they provide to meaning and birthing women. Finally, this study provides relevant and useful information for expectant parents in choosing the blazon of care they access during pregnancy, labor, birth, and the postpartum menses.

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.

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

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