Promoting a normal birth and a positive birth experience — Norwegian women׳s perspectives

doi:10.1016/j.midw.2015.03.016

Midwifery

Volume 31, Issue 7, July 2015, Pages 721-727

https://doi.org/10.1016/j.midw.2015.03.016 Get rights and content

Highlights

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A safe environment promoted a normal birth and a positive birth experience.
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A safe environment included stability in everyday life and close relationships.
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Close and trustful relationships influenced the birth process and birth experience.
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The women felt confident when remaining at home as long as possible.
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Their positive attitude to childbirth was essential for feeling emotional strength.
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The women used learned coping strategies to deal with childbirth.

Abstract

Objective

the aim of this study is to gain a deeper understanding of a woman׳s internal factors and factors in her environment that are important for a normal birth and a positive birth experience.

Design/setting

a qualitative approach was selected for data collection, and the data presented are derived from in-depth interviews. Twelve healthy first time Norwegian mothers, aged 22–34, with a normal childbirth and a positive birth experience were interviewed five to six weeks after giving birth. All participants had given birth at a maternity unit, where 4000 births take place per year. The transcribed interviews were analysed through systematic text condensation.

Findings

the findings included two main themes: safe environment and emotional strength. Stability in everyday life and close relationships provided the women with the safe environment they needed. The women had a positive attitude to childbirth and they had all previously developed coping strategies. They highlighted that these acquired coping strategies contributed to higher emotional strength and a positive birth experience.

Conclusions

the women experienced that a safe environment and network contributed to a sense of trust and emotional strength, which were positive factors promoting a normal birth and a positive birth experience. The women had a positive attitude towards the birth and used acquired coping strategies to deal with it, which in turn led to a positive birth experience. The natural vision the women had in connection with childbirth was part of their antenatal preparation, which also contributed to a positive experience of childbirth.

Introduction

Over the last decade in Norway and in other Western countries, maternity care has focused on risk factors for the mother and child. This is associated with an increased use of scheduled inductions, epidural analgesia, augmentation of labour and caesarean sections (Walker et al., 2009, Shaw, 2013, Lothian, 2014). The World Health Organization (WHO, 1996) emphasises that there should be a valid reason for interfering with the natural process of childbirth. The care for normal pregnancy and birth should be de-medicalized, which means changing maternity care and ensuring that inappropriate interventions are not used (WHO, 1998). Unnecessary medical interventions during labour and birth may compromise the safety and emotional well-being of both the mother and baby (Shaw, 2013).

The care provided by the midwife includes the promotion of normal physiological stages of labour and birth (ICM, 2005). WHO (1996:4) defines normal birth as: ‘Spontaneous in onset, low-risk at the start of labour and remaining so throughout labour and delivery. The infant is born spontaneously in the vertex position between 37 and 42 completed weeks of pregnancy. After birth mother and infant are in good condition’. Normal birth is associated with maternal satisfaction (Leap et al., 2010) and several other advantages for the mother and new born child, like prolonged breastfeeding duration (Brown and Jordan, 2013), improved mother–infant bonding (Moore et al., 2012) and reduced risk of postpartum haemorrhage (Davis et al., 2012). A normal childbirth has been associated with a positive birth experience (Hildingsson et al., 2013). It has also proved to enhance a woman’s psychological postnatal well-being (Michels et al., 2013), and her self-esteem and confidence as a new mother (Kringeland et al., 2010).

Childbirth is a major life event for women. It is a psychological transition, with important changes in life (Blåka, 2002). This powerful event may affect the woman positively or negatively, depending on her experiences (Halldorsdottir and Karlsdottir, 1996). Downe (2008) points out that there is a lot of research describing what could go wrong during labour, and the factors that may cause a negative birth experience. This is despite the fact that the World Health Organization declares health to be ‘a state of well-being’ (WHO, 1948). Downe (2008) emphasises that health care in the future should have a more salutogenic focus, where health becomes a contrast to disease and risk thinking. Antonovsky (1987) describes health as a continuous movement on an axis between poor health and good health. His salutogenic question ‘what is it that keeps individuals healthy despite stress and critical events in life’ underlines the fact that stress management may be decisive for whether the outcome will be pathological, neutral or improved health. Antonovsky also described ‘Generalized Resistance Resources’ (GRR) that can support well-being in the context of major life events (Antonovsky, 1979). These include both internal resources, such as knowledge and attitudes, and external resources like social support and easy access to services. The capacity to use these resources to improve and maintain health is described by Antonovsky as the Sense of Coherence (SOC). SOC includes the three components: meaningfulness, comprehensibility and manageability (Antonovsky, 1987, Lindström and Eriksson, 2005). According to Antonovsky׳s theory, a pregnant woman with a strong SOC will be more likely to define stimuli as non-stressful (comprehensible), assuming that she is capable of adjusting to the actual demands of pregnancy and childbirth (manageable) and that these are challenges worthy of investment and engagement (meaningful). On the basis of Antonovsky’s salutogenic theory, one can focus on the woman׳s internal and external resources that promote good health during the childbearing process. Oz et al. (2009) conclude that higher SOC scores represent an independent protective factor when predicting an uncomplicated childbirth. There is minimal evidence around a woman׳s internal and external resources based upon Antonovsky׳s salutogenic theory applicable to the promotion of health during childbirth. This study will attempt to address this gap in knowledge.

Section snippets

Aim

The purpose of this study is to gain a deeper understanding of the woman׳s internal factors and factors in her environment that are important for promoting a normal birth and a positive birth experience.

Data collection

A qualitative approach was chosen for data collection, and the data presented are derived from in-depth interviews. The inclusion criteria were a healthy first time mother with a normal childbirth and a positive birth experience. The women had to master the Norwegian language. The women were requested to participate in the study during the postpartum consultation with the midwife at the post-natal ward. During the consultation, the midwife and the women discussed how the women had experienced

Findings

Twelve women aged 22–34 volunteered to take part in the study. They were all ethnic Norwegians, they lived with their partners and had both lower and higher educational backgrounds. All participants had given birth at a maternity unit, which is responsible for about 4000 births a year.

The findings of the analysis are presented below. They cover the two main themes: ‘To be in a safe environment’ and ‘Emotional strength’. From these main themes, several sub-themes emerged. Under the main theme

To be in a safe environment

According to the women, being in a safe environment included stability in everyday life and experiencing a close relationship with family and friends.

Emotional strength

The women highlighted their positive attitude to childbirth and learned coping strategies as essential for their feeling of emotional strength.

Discussion

One key finding in this study is that the women’s experience of a safe environment is essential in promoting a normal birth and a positive birth experience. The women highlighted caring relationships and stability in everyday life as fundamental factors. This is supported by several other studies where close relationships in the childbearing process are portrayed as crucial for women (Gibbins and Thomson, 2001, Howarth et al., 2011, Aune et al., 2012, Haga et al., 2012, Dahlberg and Aune, 2013

Conclusions

We have considered several factors that the women stress as important for promoting a normal birth and a positive birth experience. The women pointed out that a safe environment and a stable network contributed to a sense of trust and emotional strength that they considered essential. The women had a positive attitude towards childbirth and used learned coping strategies to deal with it, which in turn led to a positive birth experience. The natural vision on giving birth was part of the women’s

Conflict of interest

There are no conflict of interest.

Acknowledgements

We would like to thank the 12 women who participated in this study.

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