When birth is not as expected: a systematic review of the impact of a mismatch between expectations and experiences

Abstract

Background Pregnancy and childbirth are significant events in women’s lives and most women have expectations or plans for how they hope their labour and birth will go. It is possible that strong expectations about labour and birth lead to dissatisfaction or other negative outcomes if these expectations are not met, but it is not clear if this is the case. The aim was therefore to synthesise prospective studies in order to understand whether unmet birth expectations are associated with adverse outcomes for women, their partners and their infants. Method Searches were carried out in Academic Search Complete; CINAHL; Medline; PsycINFO, PsychArticles, PubMed, SCOPUS and Web of Science. Forward and backward searches were also completed. Studies were included if they reported prospective empirical research that examined the association between a mismatch in birth expectations/experience and postnatal outcomes in women, their children and/or their partners. Data were synthesised qualitatively using a narrative approach where study characteristics, context and methodological quality were extracted and summarised and then the differences and similarities among studies were used to draw conclusions. Results Eleven quantitative studies were identified for inclusion from nine countries. A mismatch between birth expectations and experiences was associated with reduced birth satisfaction. Three studies found a link between a mismatch and the development of postnatal post-traumatic stress disorder (PTSD). The evidence was inconsistent for postnatal depression, and fear of childbirth. Only one study looked at physical outcomes in the form of health-related quality of life. Conclusions A mismatch between birth expectations and experiences is associated with birth satisfaction and it may increase the risk of developing postnatal PTSD. However, it is not clear whether a mismatch is associated with other postnatal mental health conditions. Further prospective research is needed to examine gaps in knowledge and provide standardised methods of measuring childbirth expectations-experiences mismatch. To ensure women’s expectations are met, and therefore experience a satisfying birth experience, maternity providers should provide sensitive care, which acknowledges women’s needs and preferences, is based on open and clear communication, is delivered as early in pregnancy as possible, and enables women to make their own decisions about care. Trial registration Protocol registration: PROSPERO CRD42020191081.

How and when doula support increases confidence in women experiencing socioeconomic adversity: Findings from a realist evaluation of an Australian volunteer doula program

“…This judgment could then shape a woman’s memory of how she felt at the time of birth. However, it is important to acknowledge that there is a wide range of other contextual factors, such as type of birth and medical intervention, known to impact a woman’s retrospective feelings about her birth experience, including confidence [ 52 , 53 ].…”

Systematic Reviews to Inform Practice, September/October 2022

“…Note that this study uses the term clinically led when referring to health system–designed templates, which is the term that will be used in this review. This particular systematic review focused on the question “Does the purpose and process of the birth plan influence the outcomes?” 2 (p2) Because of its focus on purpose and process, it is not a comprehensive review of outcomes and birth plans, such as the systematic review evaluating longer‐term postpartum outcomes and birth plans 3 …”

Women’s Expectations About Birth, Requests for Pain Relief in Labor and the Subsequent Development of Birth Dissonance and Trauma

“…The discrepancy between expectation and reality of birth has not previously been distilled into a single term, but rather described as a 'mismatch between expectation and reality' (34,(43)(44)(45)51). To address this, we have developed the term 'birth dissonance'.…”

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