Pregnancy and childbirth are important life experiences in a woman’s psychosocial and psychological development. For many women, vaginal birth is still considered an integral part of being a woman and becoming a mother. Furthermore, it is thought to promote maternal well-being through helping women to match their expectations to experiences. For these women, a failed natural birth can be a psychological, psychosocial, and existential challenge that can result in significant and far-reaching consequences for their psychological wellbeing. Research, especially recent research, on the experiences of women who most wanted to, but were unable to deliver their babies naturally is relatively rare. This is surprising given the potential implications of these experiences on a mother’s emotional well-being, as well as for her feelings towards her new baby. Nevertheless, literature on the topic presents a coherent perspective on the problem and indicates that these women experience difficulties in adapting to not being able to fulfill their dream of delivering their baby naturally. There is no existing research on the subjective experiences of South African women who delivered their babies by unplanned Caesarean section. This study therefore aimed to contribute to knowledge that may fill this gap to some extent. Through purposeful sampling, ten mothers who had wanted to deliver their babies naturally, but had not been able to for whatever reason, were selected as the study sample. Various aspects of their birth experiences were explored in indepth phenomenological interviews. This allowed the researcher to probe certain aspects offered by participants in order to understand and explore their contributions in as much depth as possible. A semi-structured, open-ended approach allowed for the exploration of relevant opinions, perceptions, feelings, and comments in relation to the women’s unplanned Caesarean experiences. The transcribed data was synthesized within a framework of phenomenological theory, where women’s experiences were analyzed and explored in an attempt to understand how participants made sense of their experiences. The different aspects of women’s experiences were explored in three substudies. The results are reported in three manuscripts/articles. Research suggests that post-partum adjustment difficulties are influenced by the potentially virulent stress reactions generated in response to a perceived birth trauma. The objective of the first article was to explore women’s labour and birthing accounts with specific regard to the subsequent stress responses experienced. The stress responses experienced by the women in this study both prior to, and during the Caesarean section were predominantly anxiety-based. This was distinguished from the post-partum period, where women described having experienced more depressive symptoms. Post-traumatic stress responses are associated with negative perceptions of the birth, self and infant. The experience of adverse emotional consequences during the post-partum period can undermine a woman’s ability to successfully adapt to her role as a mother, meet the needs of her infant, and cope with post-partum challenges. The second article highlighted the possible impact of women’s unexpected and potentially traumatic childbirth experiences on initial mother-infant bonding. The unplanned Caesarean sections left mothers feeling detached from the birthing process and disconnected from their infants. Passivity, initial separation, and delayed physical contact further compromised mother-infant interaction. Postpartum physical complications and emotional disturbances have important implications for a woman’s perceptions of herself as a mother and her ability to provide for her infant, her self-esteem, and feelings of relatedness with her baby. Adverse responses to a traumatic birth experience could therefore influence the establishment of a maternal role identity, the formation of balanced maternal attachment representations, the caregiving system, and ultimately initial motherinfant bonding. In the third article, women’s experiences were contextualized in relevant coping resources and strategies. The processes occurring during a traumatic birth experience, such as during an unplanned Caesarean section, could be influenced by perceived strengths when coping with the stress related to the incident. The mothers in this study described several factors and coping strategies that they perceived to have been effective in reducing the impact of their traumatic birth experiences. These included active coping strategies, problem-focused coping strategies, and emotion-focused coping strategies. Coping strategies could result in reassessment of the birth process, and be associated with a more positive, acceptable and memorable experience. This study contributes to nursing, midwifery and psychological literature, by adding to the professional understanding of the emotional consequences of surgical delivery on South African childbearing women. This exploration therefore has important implications for preventative measures, therapeutic intervention, and professional guidance. However, the restricted sample may limit the generalizability of results. Further investigation of the experiences of a larger, more biographically and culturally diverse population could be instrumental in the development of knowledge and understanding in this field of study. / Thesis (PhD (Psychology))--North-West University, Potchefstroom Campus, 2013

Pregnancy and childbirth are important life experiences in a woman’s psychosocial and psychological development. For many women, vaginal birth is still considered an integral part of being a woman and becoming a mother. Furthermore, it is thought to promote maternal well-being through helping women to match their expectations to experiences. For these women, a failed natural birth can be a psychological, psychosocial, and existential challenge that can result in significant and far-reaching consequences for their psychological wellbeing. Research, especially recent research, on the experiences of women who most wanted to, but were unable to deliver their babies naturally is relatively rare. This is surprising given the potential implications of these experiences on a mother’s emotional well-being, as well as for her feelings towards her new baby. Nevertheless, literature on the topic presents a coherent perspective on the problem and indicates that these women experience difficulties in adapting to not being able to fulfill their dream of delivering their baby naturally. There is no existing research on the subjective experiences of South African women who delivered their babies by unplanned Caesarean section. This study therefore aimed to contribute to knowledge that may fill this gap to some extent. Through purposeful sampling, ten mothers who had wanted to deliver their babies naturally, but had not been able to for whatever reason, were selected as the study sample. Various aspects of their birth experiences were explored in indepth phenomenological interviews. This allowed the researcher to probe certain aspects offered by participants in order to understand and explore their contributions in as much depth as possible. A semi-structured, open-ended approach allowed for the exploration of relevant opinions, perceptions, feelings, and comments in relation to the women’s unplanned Caesarean experiences. The transcribed data was synthesized within a framework of phenomenological theory, where women’s experiences were analyzed and explored in an attempt to understand how participants made sense of their experiences. The different aspects of women’s experiences were explored in three substudies. The results are reported in three manuscripts/articles. Research suggests that post-partum adjustment difficulties are influenced by the potentially virulent stress reactions generated in response to a perceived birth trauma. The objective of the first article was to explore women’s labour and birthing accounts with specific regard to the subsequent stress responses experienced. The stress responses experienced by the women in this study both prior to, and during the Caesarean section were predominantly anxiety-based. This was distinguished from the post-partum period, where women described having experienced more depressive symptoms. Post-traumatic stress responses are associated with negative perceptions of the birth, self and infant. The experience of adverse emotional consequences during the post-partum period can undermine a woman’s ability to successfully adapt to her role as a mother, meet the needs of her infant, and cope with post-partum challenges. The second article highlighted the possible impact of women’s unexpected and potentially traumatic childbirth experiences on initial mother-infant bonding. The unplanned Caesarean sections left mothers feeling detached from the birthing process and disconnected from their infants. Passivity, initial separation, and delayed physical contact further compromised mother-infant interaction. Postpartum physical complications and emotional disturbances have important implications for a woman’s perceptions of herself as a mother and her ability to provide for her infant, her self-esteem, and feelings of relatedness with her baby. Adverse responses to a traumatic birth experience could therefore influence the establishment of a maternal role identity, the formation of balanced maternal attachment representations, the caregiving system, and ultimately initial motherinfant bonding. In the third article, women’s experiences were contextualized in relevant coping resources and strategies. The processes occurring during a traumatic birth experience, such as during an unplanned Caesarean section, could be influenced by perceived strengths when coping with the stress related to the incident. The mothers in this study described several factors and coping strategies that they perceived to have been effective in reducing the impact of their traumatic birth experiences. These included active coping strategies, problem-focused coping strategies, and emotion-focused coping strategies. Coping strategies could result in reassessment of the birth process, and be associated with a more positive, acceptable and memorable experience. This study contributes to nursing, midwifery and psychological literature, by adding to the professional understanding of the emotional consequences of surgical delivery on South African childbearing women. This exploration therefore has important implications for preventative measures, therapeutic intervention, and professional guidance. However, the restricted sample may limit the generalizability of results. Further investigation of the experiences of a larger, more biographically and culturally diverse population could be instrumental in the development of knowledge and understanding in this field of study. / Thesis (PhD (Psychology))--North-West University, Potchefstroom Campus, 2013