Humanized birth in high risk pregnancy: barriers and facilitating factors

Abstract

The medical model of childbearing assumes that a pregnancy always has the potential to turn into a risky procedure. In order to advocate humanized birth in high risk pregnancy, an important step involves the enlightenment of the professional's preconceptions on humanized birth in such a situation. The goal of this paper is to identify the professionals' perception of the potential obstacles and facilitating factors for the implementation of humanized care in high risk pregnancies. Twenty-one midwives, obstetricians, and health administrator professionals from the clinical and academic fields were interviewed in nine different sites in Japan from June through August 2008. The interviews were audio taped, and transcribed with the participants' consent. Data was subsequently analyzed using content analysis qualitative methods. Professionals concurred with the concept that humanized birth is a changing and promising process, and can often bring normality to the midst of a high obstetric risk situation. No practice guidelines can be theoretically defined for humanized birth in a high risk pregnancy, as there is no conflict between humanized birth and medical intervention in such a situation. Barriers encountered in providing humanized birth in a high risk pregnancy include factors such as: the pressure of being responsible for the safety of the mother and the fetus, lack of the women's active involvement in the decision making process and the heavy burden of responsibility on the physician's shoulders, potential legal issues, and finally, the lack of midwifery authority in providing care at high risk pregnancy. The factors that facilitate humanized birth in a high risk include: the sharing of decision making and other various responsibilities between the physicians and the women; being caring; stress management, and the fact that the evolution of a better relationship and communication between the health professional and the patient will lead to a stress-free environment for both. Humanized birth in a high risk pregnancy is something that goes beyond just curing women of their illnesses. It can be considered as a token of caring, and continued support, which positively consolidates the doctor-patient relationship. As yet, it has not been described as a practiced guideline, due to its ever-changing complexities.

Nurses’ Perspectives on the Intersection of Safety and Informed Decision Making in Maternity Care

“…Providers can hinder or facilitate a woman's sense of control and can humanize high-risk births even in the presence of multiple interventions (Kjaergaard, Foldgast, Dykes, 2007; Behruzi et al, 2010). Thus treatment decisions and interactions during labor and birth can influence the long-term health and quality of life of the mother, child, and family.…”

Maternity care providers’ perceptions of women’s autonomy and the law

“…The barriers and enablers to women’s involvement in decision making as part of a suite of outcomes have also been examined [10-12], but these studies do not appear to extend to specific consideration of autonomy or the experiences or beliefs of women or care providers when requested care is at variance to professional advice.…”

How women with high risk pregnancies perceive interactions with healthcare professionals when discussing place of birth: A qualitative study

“…It is important to provide women with evidence based information but attempts to coerce women into certain decisions should be avoided. Behruzi et al (2010) believe it is possible for high risk birth to be humanised, that is for the feelings, values and autonomy of women to be recognised, within a medicalised setting. If women are given high quality, unbiased advice, they can make robust decisions which suit their circumstances even if these do not agree with professionals' advice or available evidence (Say et al 2011).…”