Background: Overwhelmingly, women in Middle Eastern countries experience birth as dehumanising and disrespectful. Women's stories can be a very powerful way of informing health services about the impact of the care they receive and can promote practice change. The aim of this study is to examine Jordanian women's experiences and constructions of labour and birth in different settings (home, public and private hospitals in Jordan, and Australian public hospitals), over time and across generations. Method: A qualitative interpretive design was used. Data were collected by face-to-face semi-structured interviews with 27 Jordanian women. Of these women, 20 were living in Jordan (12 had given birth in the last five years and eight had birthed over 15 years ago) while seven were living in Australia (with birthing experience in both Jordan and Australia). Interview data were transcribed verbatim and analysed thematically. Results: Women's birth experiences differed across settings and generations and were represented in the four themes: 'Birth at home: a place of comfort and control'; 'Public Hospital: you should not have to suffer'; 'Private Hospital: buying control' and 'Australian maternity care: a mixed experience'. In each theme, the concepts: Pain, Privacy, the Personal and to a lesser extent, Purity (cleanliness), were present but experienced in different ways depending on the setting (home, public or private hospital) and the country. Conclusions: The findings demonstrate how meanings attributed to labour and birth, particularly the experience of pain, are produced in different settings, providing insights into the institutional management and social context of birth in Jordan and other Middle Eastern countries. In the public hospital environment in Jordan, women had no support and were treated disrespectfully. This was in stark contrast to women birthing at home only one generation before. Change is urgently needed to offer humanised birth in the Jordanian maternity system,
BACKGROUND:Episiotomy is still a commonly used surgical intervention during birth in some parts of the world, such as the Middle East and Eastern Europe. Evidence supports the restrictive use of episiotomy, and this is reflected in policy statements and clinical practice recommendations. Internationally, various strategies have been used to change and reduce the incidence of episiotomy.AIM:To identify and describe the strategies and practices that have been used internationally to effectively reduce the rate of episiotomy.METHOD:We searched CINAHL, Medline, Scopus, PubMed and Nursing Consultant from 1980 to 2010 by using the keywords episiotomy, change, practice, midwife, routine use and evidence-based. A review of the literature was undertaken, which examined factors that facilitate the reduction in episiotomy rates.RESULTS:Two hundred articles were found, and after examination, only nine provided relevant data and are included in this review. The findings of this review are discussed under the following headings: impact of practice change on episiotomy rates, continuous quality improvement, implementing clinical guidelines, practice change (system change), and the impact of health beliefs and organizational culture. Strategies for changing practice that were identified focused on challenging rationales for current practice and on creating a social and organizational environments that encourage motivation and, therefore, are more effective in reducing episiotomy rates. The literature identified the importance of clarifying critical success factors before trying to implement change with regards to episiotomy usage.CONCLUSION:Greater efforts to reduce episiotomy rates are currently needed, particularly in countries with high rates. Researchers need to continue to examine the barriers to change and investigate approaches that promote clinician behavior change.
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