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

Abstract

Introduction A physiologic approach to labor and birth is preferred for most women. The United States spends more on birth than any other country. Cesarean rates are currently 32%, and approximately 23% of women with a singleton pregnancy experience induction or augmentation of labor. Most physiologic birth research has focused on care during labor and birth. The purpose of this study was to describe women's perceptions of the care processes, support, and information received during pregnancy that helped them feel confident for physiologic labor and birth. Methods Using a qualitative descriptive design with 2 phases, women were recruited from an urban area and a smaller city in Minnesota. Phase 1 included focus groups with women who had given birth within the previous 6 months. They participated in a discussion about experiences that helped them feel confident for labor and birth. In Phase 2, women who had a physiologic birth, which was defined as term pregnancy, spontaneous labor, no epidural analgesia, and vaginal birth, participated in individual interviews. Focus group and individual interview recordings were transcribed and analyzed using Glaser's constant comparative approach. Results Thirty‐eight women participated in 9 focus groups. Seventeen women had a physiologic birth; 14 participated in individual interviews. Themes derived from the analysis included confidence in the face of uncertainty, belief in the normalcy of birth and the body's ability to birth, research on my own, supportive care partnership, on the same page, and sources of information and support. Discussion Women who experienced physiologic birth believed that this was possible and expected. They sought information, including searching on their own, from maternity care providers and a broader support system. Relationships with their maternity care providers were important. Prenatal care focused on women's strengths and abilities, while also monitoring pregnancy health and safety, may help reduce unnecessary interventions, improve outcomes, and reduce costs.

A Qualitative Study of US Women's Perspectives on Confidence for Physiologic Birth in the Birth Center Model of Prenatal Care

“…The environment was important to their experiences of labor and birth and supported physiologic labor processes. This finding is noteworthy because it differs from qualitative study findings of confidence for physiologic birth when women gave birth in a hospital setting (N = 38) in which environment was not identified as a theme 19 . An environment where a birthing person feels safe, however, was found to be an antecedent for confidence for birth in a concept analysis by Neerland 13 .…”

“…Similarly, birth center midwives (N = 12) and women who intended hospital birth (N = 38) also identified time as important to relationship building and confidence. 19,23 Inadequate time for prenatal visits was identified by maternity care providers (N = 31) as a barrier to the development of confidence for physiologic birth. 26 Inadequate time and rushed visits may lead to decreased satisfaction with care and potentially to subpar care or poorer outcomes.…”

“…This finding is noteworthy because it differs from qualitative study findings of confidence for physiologic birth when women gave birth in a hospital setting (N = 38) in which environment was not identified as a theme. 19 An environment where a birthing person feels safe, however, was found to be an antecedent for confidence for birth in a concept analysis by Neerland. 13 In several qualitative studies, which included women identified as marginalized or at risk, the welcoming and comfortable environment of birth centers and the relationship between environment and confidence or satisfaction was identified.…”

Coping With the Unexpected in Childbirth: A Thematic Analysis

“…Additionally, there is a growing body of evidence that supports physiologic birth or "one that is powered by the innate human capacity of the woman and fetus" (American College of Nurse-Midwives et al, 2013, p. 15) as a pathway to a higher quality, better value maternity care system (Avery et al, 2018). Interruptions to normal hormonal physiology can make labor more difficult, increase the chance of fetal distress requiring more interventions, interrupt maternal-newborn bonding, and increase the risk of multiple cesarean surgeries and their associated risk for complications (Avery et al, 2019). Support of physiologic birth through educational preparation and evidence-based care practices during labor and birth will likely have a positive effect on birth satisfaction and maternal-newborn health outcomes overall.…”

Induction of labor or expectant management? Birth outcomes for nulliparous individuals choosing midwifery care

“…9 People may choose midwifery care because they value limiting intervention in otherwise healthy pregnancy and labor. [10][11][12][13][14] In a midwifery care model, IOL is generally performed for medical indications or in the setting of prolonged pregnancy (41 weeks or greater weeks of gestation); thus, data on elective IOL in midwifery care are less available. 15 Researchers have demonstrated that low-risk individuals receiving midwifery care (compared with physician care) experience lower rates of CB and other obstetric interventions, including fewer IOLs, less augmentation with oxytocin, and less neuraxial analgesia.…”