Delivery method and women’s experiences

289161249_39c8dceeb7A study looking at women’s experiences of different types of birth has again reinforced the idea that we should be doing all we can to promote physiological birth and reduce interventions. (Yes, we also definitely need to work on making birth better for those women who truly need intervention and operative delivery, but so many more women experience unnecessary intervention and surgery so that’s what I’m going to focus on here).

The authors of this paper begin by noting what we already know. Many interrelated factors contribute to the construction of the delivery experience – including perceived control, support, and the relationship with the caregiver (Larkin et al., 2009) – and there has been lots of debate about the mode of delivery and the extent to which this affects a woman’s experience. (I suspect that some of the variation in the results of studies looking at this factor may be due to differences in the belief systems of those carrying out the research, but that’s another blog post).

In this study, women who gave birth in two university hospitals were asked to fill out a questionnaire, and 291 completed questionnaires were received. (This constitutes a 61% response rate, which is actually really good for this kind of research. We can’t read too much into that, but I can’t help but wonder if it might be because this is an area that women feel passionate about).

One thing that shocked me (though I should probably know better by now) and that I cannot let pass without commenting upon, is that 43% of the women had induction of labour. This is a really high number, and I surely cannot be the ony person who is dismayed by the finding that only 3 in 5 women experience their labour starting spontaneously?

The findings are complex, and key features include that:

  • The delivery method significantly affected item 2 ‘I felt secure’ (p <0.001), with a progressive worsening of women reported to be ‘totally’ secure from VDs (74.7%) to VDi [instrumental birth] (67.3%), elective CS (50%) and emergency CS (41.8%) groups.
  • The ‘feeling of could express myself and give opinion about medical decisions’ (item 8) was significantly different between groups (p <0.02) with a higher proportion among elective CS group, in comparison to the VDi group (75% and 45.4%, respectively).
  • During delivery, responses related to items regarding ‘management to successfully move or choose posture freely’ (item 11) and feeling of ‘losing control’ (item 12b) differed significantly with delivery method (p = 0.03 and p = 0.003, respectively). We noted that the best responses expected were in VDs group with 34.7% of women who have ‘totally’ ‘manage to successfully move or choose posture freely’ and 47.2% who have not expressed a feeling of ‘losing control’.
  • ‘First moments with the newborn’ was more negatively experienced by women from the caesarean section group compared to those who delivered vaginally (p < 0.001). Similar results regarding the dimension of ‘emotional status’ were also observed, as women who delivered by caesarean section felt more worried, less secure, and less confident (p = 0.001).
  • The mean scores of the four questionnaire dimensions varied significantly by delivery method.  ‘Relationship with staff’ significantly differed between groups (p = 0.047) as more negative results were shown in the ‘unexpected medical intervention groups’ (i.e. emergency caesarean section and instrumental delivered vaginally).
  • Women’s ‘feelings at one-month postpartum’ in the emergency caesarean section group were less satisfactory than the other groups.

(Carquillat et al 2016).

There is an interesting point to be explored from this and similar research about elective caesarean section, in that women in this study appeared to be more satisfied with that in some dimensions than with an unplanned instrumental birth. However, while proponents of the technocratic approach and/or surgical childbirth might seek to use such findings to justify more planned surgery, this can also be seen as a further warning about the failings of the services that are currently available and perhaps also a consequence of the way our culture teaches us to view birth. We need to be acutely aware that, for a few people, the certainty of a planned caesarean – even with the risks that this carries – is seen as preferable to uncertainty of a hospital labour and birth experience. Recommending elective caesarean is only one possible response to that. Another (and arguably better in terms of health outcomes) response would be to improve services for healthy women and give them decent continuity of midwifery care (which will entail treating midwives better as well) which will help them better manage the journey of birth in all of its dimensions.

 

Carquillat P, Boulvain M, Guitter M-J (2016).How does delivery method influence factors that contribute to women’s childbirth experiences? Midwifery, Online ahead. DOI: http://dx.doi.org/10.1016/j.midw.2016.10.002

photo credit: sean dreilinger dark haired baby via photopin (license)

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