Positive Childbirth Experiences in US Hospitals: A Mixed Methods Analysis

Abstract

Objective Research on maternity care quality in the U.S. often focuses on avoiding adverse events. Positive birth experiences receive less attention. This analysis used a mixed methods approach to identify factors associated with confidence and positive experiences during birth among a national sample of U.S. mothers. Methods Data are from a nationally representative survey of women who delivered a singleton baby in a U.S. hospital in 2005 (N=1,573). We explored the relationship between confidence, positive birth experiences and socio-demographic characteristics as well as factors related to the clinical encounter and health systems, including common obstetric procedures and interventions. Self-reported confidence during birth was the outcome in quantitative analyses. We used logistic regression analysis and qualitative analysis of open-ended survey responses. Results Approximately 42% of mothers reported feeling confident during birth. Confidence going into labor was the strongest predictor of confidence during birth (Adjusted Odds Ratio (AOR) 12.88 for nulliparous women, 8.54 for parous women). Black and Hispanic race/ethnicity (compared to white) and having partner support were positively associated with confidence during birth for nulliparous women. Qualitative analyses revealed that positive experiences were related to previous birth experiences, communication between women and their clinicians, perceptions of shared decision-making, and communication among clinicians related to the timing and logistics of managing complications and coordinating care. Conclusion For clinicians who care for women during pregnancy and childbirth, thoughtful, deliberate attention to factors promoting positive birth experiences may help create circumstances amenable to enhancing the quality of obstetric care and improving outcomes for mothers and infants.

Women's Perceptions of Prenatal Influences on Maternal Confidence for Physiologic Birth

“…A recent integrative review also concluded that maternal self‐efficacy is related to childbirth outcomes and is likely modifiable through specific interventions . Finally, women who responded affirmatively about being confident in labor were more likely to have responded to open‐ended questions with comments about previous pregnancy experiences, positive communication with their maternity care providers, and opportunity for shared decision making . Our findings complement and extend these studies through more detailed discussions with women focusing on the client‐provider relationship and external supports.…”

Mothers' Perceptions of Labor Support

“…Emotional, informational and tangible support have positive effects on a woman's mental and physical well-being during labor, according to a recent review (Iliadou, 2012), and labor support reportedly enhances the birth process and increases satisfaction with childbirth (Attanasio, McPherson, & Kozhimannil, 2014;Aune et al, 2014). In this study we also found that all three kinds of support correlated significantly with a positive birth experience.…”

Maternal Confidence for Physiologic Childbirth: A Concept Analysis

“…Another key attribute of a woman's confidence for physiologic birth was her belief in her innate ability to birth . In numerous instances, women described confidence in their body's ability or a confidence in their innate ability to give birth (Table ).…”

“…Women's past experiences with labor and birth were also a prominent attribute of confidence for physiologic birth . Previous experience giving birth reassured women that they were capable, both physically and psychologically, of giving birth again.…”

“…Maternal confidence for birth may be seen as one solution to ameliorate the fear‐tension‐pain cycle and prevent the cascade of intervention. Studies of confidence for labor and birth have demonstrated an inverse relationship between confidence and pain, in which women who articulate greater confidence about coping with labor experience less pain during labor and may experience decreased anxiety and enhanced birth experiences and satisfaction …”