Women's experiences of coping with pain during childbirth: A critical review of qualitative research

Objective To identify and analyse qualitative literature exploring women׳s experiences of coping with pain during childbirth. Design Critical review of qualitative research. Findings Ten studies were included, conducted in Australia, England, Finland, Iceland, Indonesia, Iran and Sweden. Eight of the studies employed a phenomenological perspective with the remaining two without a specific qualitative methodological perspective. Thematic analysis was used as the approach for synthesising the data in this review. Two main themes emerged as the most significant influences upon a woman׳s ability to cope with pain: (i) the importance of individualised, continuous support and (ii) an acceptance of pain during childbirth. This review found that women felt vulnerable during childbirth and valued the relationships they had with health professionals. Many of the women perceived childbirth pain as challenging, however, they described the inherent paradox for the need for pain to birth their child. This allowed them to embrace the pain subsequently enhancing their coping ability. Key conclusions Women׳s experience of coping with pain during childbirth is complex and multifaceted. Many women felt the need for effective support throughout childbirth and described the potential implications where this support failed to be provided. Feeling safe through the concept of continuous support was a key element of care to enhance the coping ability and avoid feelings of loneliness and fear. A positive outlook and acceptance of pain was acknowledged by many of the women, demonstrating the beneficial implications for coping ability. These findings were consistent despite the socio-economic, cultural and contextual differences observed within the studies suggesting that experiences of coping with pain during childbirth are universal. Implications for practice The findings suggest there is a dissonance between what women want in order to enhance their ability to cope with pain and the reality of clinical practice. This review found women would like health professionals to maintain a continuous presence throughout childbirth and support a social model of care that promotes continuity of care and an increasing acceptance of pain as part of normal childbirth. It is suggested future research regarding the role of antenatal provision for instilling such a viewpoint in preparation of birth be undertaken to inform policy makers. The need for a shift in societal norms is also suggested to disseminate expectations and positive or negative views of what the role of pain during childbirth should be to empower women to cope with childbirth and embrace this transition to motherhood as part of a normal process

Coping styles associated with post-traumatic stress and depression symptoms following childbirth in croatian women

Childbirth is a normative event in a woman's life and is considered as a positive event. However, one in three women perceive childbirth as a physical threat to themselves or their new-born and 3% of women develop posttraumatic stress disorder (PTSD) following childbirth. Poor coping strategies have been associated with PTSD following childbirth. However, previous studies mainly utilised unidimensional measures of coping strategies, therefore, it remains to be investigated which specific dimensions of coping are more predictive of PTSD after childbirth. The aims of this study were to explore whether women in Croatia report PTSD symptoms following childbirth, and how different coping styles were related to PTSD and depression symptoms. Women (N = 160) who gave birth in the last two years, completed an online questionnaire measuring PTSD symptoms (Impact of Event Scale – IES), postnatal depression symptoms (Edinburgh Postnatal Depression Scale – EPDS) and coping styles (Brief Cope). In this sample, 1.9% reported severe PTSD symptoms following childbirth and 21.9% reported depression symptoms. Many women (66.7%) with PTSD symptoms reported depression symptoms. On the other hand, 28.6% of women with depression symptoms also reported PTSD symptoms, showing that there is a higher co-morbidity of PTSD and depression than vice versa. Avoidant coping styles, specifically, denial and self-blame were positively correlated with both PTSD and depression symptoms. Moreover, of avoidant coping styles, behavioural disengagement was positively correlated with PTSD symptoms only, while self-distraction was positively correlated with depression symptoms only. Also, lower levels of planning and higher levels of emotional support were related to higher levels of depression. However, after controlling for postnatal psychopathology symptoms, coping styles were not significant predictors of PTSD symptoms, but self-blame was a significant predictor of depression symptoms. Psychopathological symptoms following childbirth are reported by Croatian women and are related to coping styles. The avoidant coping style, self-blame, is particularly associated with depression symptoms. Future studies should explore predictors of postpartum PTSD in Croatian women in more representative samples during pregnancy and with the follow-up after childbirth. Also, screening for postnatal psychopathological symptoms should be performed both for depression and PTSD symptoms

Feeling cooped up after childbirth – the need to go out and about.

It is well known that recovering from childbirth can be a real challenge for many women. New mothers are, mostly, left to self care and manage their own recovery process. In seeking to feel like their old selves again mothers in this ethnographic study took longer than the traditional six weeks and needed to manage their feelings around being cooped up after childbirth. This article highlights an aspect of self care such as getting out and about, with or without the baby – a process that is pivotal to good recuperation and a sense of wellbeing after childbirth

The effects of childbirth-related post-traumatic stress disorder on women and their relationships: a qualitative study

There is converging evidence that 1%-2% of women develop post-traumatic stress disorder (PTSD) as a result of childbirth. The current study aimed to explore the long-term effects of childbirth-related PTSD on women, their relationship with their partner and their relationship with their child. Semi-structured interviews were carried out with six women who reported clinically significant PTSD after birth, ranging from 7 months to 18 years beforehand. Interviews were transcribed and analysed using thematic analysis. Childbirth-related PTSD was found to have wide-ranging effects on women and their relationships. Women reported changes in physical well-being, mood and behaviour, social interaction, and fear of childbirth. Women reported negative effects on their relationship with their partner, including sexual dysfunction, disagreements and blame for events of birth. The mother-baby bond was also seriously affected. Nearly all women reported initial feelings of rejection towards the baby but this changed over time. Long-term, women seemed to have either avoidant or anxious attachments with their child. It is concluded that childbirth-related PTSD can have severe and lasting effects on women and their relationships with their partner and children. Further research is needed to compare this to normal difficulties experienced by women after having children

Maternal movements to part time employment: what is the penalty?

In Britain, part time employment is typically used to combine work and motherhood: 60% of employed mothers in Britain work part time, and this usually involves a transition from full time employment around the first childbirth. Part time jobs are often situated in lower level occupational groups and so a transition from full to part time employment may reduce the wage. Using the British Household Panel Survey this study investigates the wage impact of switching from full to part time employment. Furthermore, mother-specific wage impacts of re-entering employment after childbirth via part time employment are analysed. A mother of one child receives a pay penalty of 7%, switching to part time employment increases this to 15%. Mothers who move from full to part time employment over childbirth receive lower wages than mothers who remained in full or part time employment over childbirth for 10 years after the birth

Holistic obstetrics: the origins of "natural childbirth" in Britain.

The term "natural childbirth" denotes an approach to childbirth characterised by a bias towards physical and mental hygiene in the management of pregnancy and labour. It emerged in Britain in the interwar period, partly as a response to the growing interventionism of mainstream obstetrics. Its appeal since then has rested on the belief that it could provide a holistic approach to maternity care, capable of addressing the needs of the "whole" patient. At the same time, "natural childbirth" has provided a means of expressing anxieties about the social, economic and political upheavals of the 20th century. This paper explores this complex set of beliefs and practices by examining the ideas of some British pioneers

The Effect of Antenatal Class Plus Coping Skill Training on the Level of Stress and Childbirth Self-Efficacy

Background: Pregnancy puts mothers in vulnerable conditions that lead to stress. Consequently, a negative impact over the stress influences mother’s and baby’s health. Antenatal class (AC) was aimed to increase knowledge and prepare for childbirth. However, AC focuses on delivering knowledge, whereas the content is lack of psychological preparation such as developing self-efficacy and coping skill in facing childbirth. This study aimed to find the effect of antenatal class plus coping skills training towards a level of stress, and a childbirth self-efficacy. Method: This study was a randomized pre-test post-test control group design over primigravida women in their 24–34 weeks of Deliveredpregnancy. DatabyIngentacollectionto:wasDianconductedSawitriin 4 weeks. Data were analyzed using paired T-test and independentIP:36.80.134T-test,.221andOn:alsoTue,repeated08 AugANOVA2017with16:17:43Benferroni post hoc test. Results: The mean age of participantsCopyright:was24yearsAmerican.TheinterventionScientificof antenatalPublishersclass plus coping skills training had significant influence to decrease the stress level (p = 0 014) between groups. In one hand, it was also enhancing the childbirth self-efficacy but in the other hand it was statistically insignificant with the mean and standard deviation of 2.484 and 12.727 respectively, with a p value of 0.579 between the groups. Conclusion: It is essential for pregnant women to have antenatal classes plus coping skills training. It is also important to screen the pregnant women for stress and the screen protocol could be included in the maternal handbook. Keywords: Coping Skill Training, Childbirth Self-Efficacy, Antenatal Class, Stress Levels

Failures in childbirth care

The study, first published in 2003, looks at the root causes of adverse events and near misses in obstetrics at seven hospital maternity units by interviewing 93 members of staff, identifying the areas of mismanagement in each case and thematically analysing them

Health System Support for Childbirth care in Southern Tanzania: Results from a Health Facility Census.

Progress towards reaching Millennium Development Goals four (child health) and five (maternal health) is lagging behind, particularly in sub-Saharan Africa, despite increasing efforts to scale up high impact interventions. Increasing the proportion of birth attended by a skilled attendant is a main indicator of progress, but not much is known about the quality of childbirth care delivered by these skilled attendants. With a view to reducing maternal mortality through health systems improvement we describe the care routinely offered in childbirth offered at dispensaries, health centres and hospitals in five districts in rural Southern Tanzania. We use data from a health facility census assessing 159 facilities in five districts in early 2009. A structural and operational assessment was undertaken based on staff reports using a modular questionnaire assessing staffing, work load, equipment and supplies as well as interventions routinely implemented during childbirth. Health centres and dispensaries attended a median of eight and four deliveries every month respectively. Dispensaries had a median of 2.5 (IQR 2--3) health workers including auxiliary staff instead of the recommended four clinical officer and certified nurses. Only 28% of first-line facilities (dispensaries and health centres) reported offering active management in the third stage of labour (AMTSL). Essential childbirth care comprising eight interventions including AMTSL, infection prevention, partograph use including foetal monitoring and newborn care including early breastfeeding, thermal care at birth and prevention of ophthalmia neonatorum was offered by 5% of dispensaries, 38% of health centres and 50% of hospitals consistently. No first-line facility had provided all signal functions for emergency obstetric complications in the previous six months. Essential interventions for childbirth care are not routinely implemented in first-line facilities or hospitals. Dispensaries have both low staffing and low caseload which constraints the ability to provide high-quality childbirth care. Improvements in quality of care are essential so that women delivering in facility receive "skilled attendance" and adequate care for common obstetric complications such as post-partum haemorrhage

The Impact of Child and Maternal Health Indicators on Female Labor Force Participation after Childbirth: Evidence from Germany

This paper analyzes the influence of children's health and mothers' physical and mental wellbeing on female labor force participation after childbirth in Germany. Our analysis uses data from the German Socio-Economic Panel (SOEP) study, which enables us to measure children's health based on the occurrence of severe health problems including mental and physical disabilities, hospitalizations, and preterm births. Since child health is measured at a very young age, we can rule out any of the reverse effects of maternal employment on child health identified in US studies. Within a two-year time period, we investigate the influence of these indicators on various aspects of female labor force participation after childbirth, including continuous labor force participation in the year of childbirth and the transition to employment in the year following childbirth. Since the majority of women in Germany do not go back to work within a year after childbirth, we also investigate their intention to return to work, and the preferred number of working hours. We find that the child's severe health problems have a significant negative effect on the mothers' labor force participation and a significant positive effect on her preferred number of working hours, but that hospitalizations or preterm births have no significant effect. For the mothers' own health, we find a significant negative effect of poor mental and physical wellbeing on female labor force participation within a year of childbirth. To our knowledge, this is the first empirical study of this kind on data outside the US.Female labour supply, Childhealth, Well-being