When choice becomes limited: Women’s experiences of delay in labour

Armstrong, Natalie; Kenyon, Sara

doi:10.1177/1363459315617311

Cited by 7 publications

(4 citation statements)

References 41 publications

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“…Women generally preferred not to have or 'don't mind' continuous fetal monitoring, drugs to speed labour, induction and episiotomy, bearing out previous research that women tend to choose MLUs because they prefer physiological over managed birth. 20,186,187 Although around half of women 'don't mind' having their waters broken, most of the rest preferred not to have or definitely did not want this to happen. For attribution the title, original author(s), the publication source -NIHR Journals Library, and the DOI of the publication must be cited.…”

Section: Antenatal Wants and Expectationsmentioning

confidence: 99%

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Annandale

Baston

Beynon-Jones

et al. 2022

Health Soc Care Deliv Res

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Background NHS policy emphasises shared decision-making during labour and birth. There is, however, limited evidence concerning how decision-making happens in real time. Objectives Our objectives were as follows – create a data set of video- and audio-recordings of labour and birth in midwife-led units; use conversation analysis to explore how talk is used in shared decision-making; assess whether or not women’s antenatal expectations are reflected in experiences and whether or not the interactional strategies used (particularly the extent to which decisions are shared) are associated with women’s postnatal satisfaction; and disseminate findings to health-care practitioners and service users to inform policy on communication in clinical practice. Design This was a mixed-methods study. The principal method was conversation analysis to explore the fine detail of interaction during decision-making. Derived from the conversation analysis, a coding frame was developed to quantify interactions, which were explored alongside questionnaire data concerning women’s antenatal expectations and preferences, and women’s experiences of, and postnatal satisfaction with, decision-making. Semistructured interviews with health-care practitioners explored factors shaping decision-making. Setting and participants The study took place in midwife-led units at two English NHS trusts. A total of 154 women (aged ≥ 16 years with low-risk pregnancies), 158 birth partners and 121 health-care practitioners consented to be recorded. Of these participants, 37 women, 43 birth partners and 74 health-care practitioners were recorded. Key findings Midwives initiate the majority of decisions in formats that do not invite women’s participation (i.e. beyond consenting). The extent of optionality that midwives provide varies with the decision. Women have most involvement in decisions pertaining to pain relief and the third stage of labour. High levels of satisfaction are reported. There is no statistically significant relationship between midwives’ use of different formats of decision-making and any measures of satisfaction. However, women’s initiation of decisions, particularly relating to pain relief (e.g. making lots of requests), is associated with lower satisfaction. Limitations Our data set is explored with a focus on decision initiation and responses, leaving other important aspects of care (e.g. midwives’ and birth partners’ interactional techniques to facilitate working with pain) underexplored, which might be implicated in decision-making. Despite efforts to recruit a diverse sample, ethnic minority women are under-represented. Conclusions Policy initiatives emphasising patient involvement in decision-making are challenging to enact in practice. Our findings illustrate that women are afforded limited optionality in decision-making, and that midwives orient to guidelines/standard clinical practice in pursuing particular decisional outcomes. Nonetheless, the majority of women were satisfied with their experiences. However, when women needed to pursue decisions, particularly concerning pain relief, satisfaction is lower. Conversation analysis demonstrates that such ‘women-initiated’ decision-making occurs in the context of midwives’ avoiding pharmacological methods of pain relief at particular stages of labour. Future research We suggest that future research address the following – the barriers to inclusion of ethnic minority research participants, decision-making in obstetric units, systematic understanding of how pain relief decisions are pursued/resolved, conversation analysis of interactional elements beyond the specific decision-making context, interactional ‘markers’ of the emotional labour and inclusion of antenatal encounters. Trial registration This trial is registered as ISRCTN16227678 and National Institute for Health and Care Research (NIHR) CRN Portfolio (CMPS):32505 and IRAS:211358. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme and will be published in full in Health and Social Care Delivery Research; Vol. 10, No. 36. See the NIHR Journals Library website for further project information.

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Section: Antenatal Wants and Expectationsmentioning

confidence: 99%

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Annandale

Baston

Beynon-Jones

et al. 2022

Health Soc Care Deliv Res

View full text Add to dashboard Cite

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“…Studies show that women in prolonged labour agree that their ideals might no longer be feasible and that their choices are restricted. However, open and respectful communication between women and care professionals is essential when making decisions 14 15. Therefore, support and the involvement of the woman in care is of importance for reducing the risk of prolonged labour and FOC.…”

Section: Introductionmentioning

confidence: 99%

“…To address the themes: lack of involvement; lack of communication and information; and lack of care plan, the model was designed to identify supporting factors and prevent the issues that the women had described. This information together with current research1 3 4 8 12 14 15 and professional knowledge from midwives and obstetricians formed the basis for the model.…”

Section: Introductionmentioning

confidence: 99%

Time-out in prolonged labour: development of a care model to prevent secondary fear of childbirth

et al. 2022

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BackgroundDuring qualitative improvement work, the statistics at the hospital reveal prolonged labour as one of the major causes of secondary fear of childbirth (FOC). The aim of this improvement work was to develop and implement a care process for prolonged labour to prevent secondary FOC.Materials and methodsTo explore the factors behind secondary FOC among multiparous women, a follow-up of referral reasons for 600 women with severe FOC was made between 2015 and 2017 at a Swedish University Hospital. In the group with the most common factor, namely prolonged labour, 41 women were interviewed. From their answers, further research and existing professional knowledge, a care process to prevent secondary FOC was designed, ‘Time-out in prolonged labour’ (the Time-out). To improve the quality of the care process, the functional resonance analysis method was used. The findings from the interviews were categorised into three themes: lack of involvement; lack of communication and information; and lack of care plan. The women explained that if these areas had been fulfilled, it may have reduced their FOC.ResultTo prevent the above-mentioned themes, ‘Time-out in prolonged labour’ was developed with supporting factors such as gathering the interprofessional team, collecting information, dialogue within the team and the involvement of the women when deciding the care plan. Result after implementation shows a reduction of referral reason due to prolonged labour for women with severe FOC from 28% in 2016 to 8.5% in 2020.ConclusionsThe Time-out is a good model to prevent secondary FOC. Central aspects of the model are to ensure women’s involvement, good communication and a documented care plan for women in prolonged labour. The supporting factor of interprofessional teamwork is of importance when using the Time-out in practice.

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“…By integrating psychological experiences, a wider picture of birth can be revealed. A few qualitative studies have explored women's lived experiences of prolonged labour, but these have focused on the overall birth experience (143)(144)(145). Swedish women experiencing prolonged labour have described an experience of suddenly falling ill or finding themselves in a life-threatening condition associated with intractable pain, overwhelming fear of losing oneself (139) and loss of control (144).…”

Section: Birth Experiencementioning

confidence: 99%

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

Bjelke

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Aim: This study aimed to describe the prolonged passive second stage of labour in nulliparous women in relation to its prevalence, risk factors, birth outcomes, midwives’ intrapartum management, and women's birth experiences. Methods: Study I was a qualitative study in which 36 midwives participated in seven focus group discussions. Data were analysed using qualitative content analysis. Studies II and III were retrospective observational cohort studies where medical records from 1131 nulliparous women in Sweden were reviewed. Analyses were performed using descriptive statistics and multivariable logistic regression. Study IV included 15 individual interviews with nulliparous women who had a passive second stage lasting three hours or more. Data were analysed using thematic analysis based on descriptive phenomenology. Results: Midwives’ management of the passive phase is complex, especially if progress is slow. Guidelines were considered, but women were preferably managed individually. The prevalence of prolonged passive second stage (≥2h) was 38%. Epidural analgesia, malpresentation, maternal age ≥30 years, and birth weight of ≥4 kg were identified as risk factors for prolonged passive second stage. Longer duration of the passive second stage was associated with an increased risk of operative delivery. There were no associations with adverse maternal outcomes. Associations with adverse neonatal outcomes were found, although the rate of adverse neonatal outcomes were low in the study population. Women’s experiences of prolonged passive second stage were described in four themes: “An unknown phase”, “Trust and mistrust in the body’s ability”, ”Loss of control“, and “Support through presence and involvement”. Conclusion: This thesis describes the prolonged passive second stage from multiple perspectives, including midwives, epidemiological data, and women’s experiences. The midwives’ management of the passive second stage included a complex continuous process of assessment and balancing options for the next step. A prolonged passive second stage was common and did not result in increased risks of adverse maternal outcomes, although further fetal surveillance can be called for. Nulliparous women experienced the passive second stage as an unknown phase and expected a different path for birth, and the experience could include loss of control and increased need for emotional and physical support.

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When choice becomes limited: Women’s experiences of delay in labour

Cited by 7 publications

References 41 publications

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Shared decision-making during childbirth in maternity units: the VIP mixed-methods study

Time-out in prolonged labour: development of a care model to prevent secondary fear of childbirth

Prolonged passive second stage of labour in nulliparous women: A multi perspective study

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