Yes / Positive birth (PB) experiences assist with successful transition into parenthood and psychological growth. Identifying contributing factors, which assist in the achievement of such experiences, could inform birth workers and maternity service providers and improve experiences for future parents. To undertake a systematic review of factors which the birthing person perceived as contributing to their PB experience. Search strategy: Six databases were searched with English language restriction. Grey literature sources and relevant journal content were searched. Main results: Sixty-eight participants were included from studies conducted in Norway, Sweden, the United States (US) and the United Kingdom (UK). The major themes of the thematic synthesis were: strength through preparation; a positive mental attitude; feeling safe and connected through autonomy; the presence of others; and fond memories that were formulated. Findings informed birth workers that their authentic presence is valued by birthing people, and that a person’s or provider’s birthing culture impacts on a person’s perception of their birth experiences. In order to experience PB, maternity services should support individualised care. Conclusions: A PB experience matters to families, and enables self-esteem and confidence to be felt as a new parent. The unique individualised care and authentic presence of the birth workers provided strength, reassurance and encouragement during the birth process. / The author’s master’s was supported by funding from the Yorkshire and Humberside Strategic Health Authority.

The period of pregnancy and childbirth is an important and sensitive time for men’s upcoming parenthood. Research into fathers’ experiences of childbearing has received less attention compared to maternal experiences. The purpose of this thesis was to study the sources fathers use to obtain information about pregnancy and childbirth, fathers’ preference for the mode of birth of their baby, and fathers’ childbirth experience and their perception of postnatal care quality.In 2007, 1105 expectant fathers were enrolled in the study when their partner had reached the middle of pregnancy. The fathers were followed until one year after the birth of their baby. The fathers were living in the county of Västernorrland in Sweden and their babies were born in one of the three hospitals in the county. Data was analysed using descriptive and inferential statistics, and content analysis. An index was created from a combination of fathers’ experiences of postnatal care quality.iiiCommon sources of information about pregnancy and childbirth used by prospective fathers were the Internet, their partners and the midwife. Fathers who were expecting their first baby (OR 1.4; 1.2-1.7), had a high level of education (OR 1.3; 1.2-1.5) and fathers with previous experience of caesarean section (OR 1.3; 1.1-1.6) were the greatest users of the Internet. Of the prospective fathers 71 (6.4%) desired caesarean section for the birth of their baby. Previous negative birth experience (PR 8.6; 2.6-28.3) and the experience of caesarean section (PR 5.7; 2.8-11.9) were factors associated with the wish that the baby would be born by caesarean section. A desire to plan the day of the baby’s birth (PR 6.0; 1.5-24.1) was associated with a preference for caesarean section for the men who were expecting their first baby. Two months after the birth of the baby 604 (74%) of the fathers in this group had had a positive birth experience. A correlation with a less-positive birth experience was with emergency caesarean section (OR 7.5; 4.1-13.6), instrumental vaginal birth (OR 4.2; 2.3-8.0) and if the man was unhappy with the medical care which the partner received (OR; 4.6; 2.7-7.8). Positive experience of healthcare professionals’ knowledge and attitudes was related to a satisfactory birth experience. The deficiencies in the postnatal care were mainly related to deficiencies in the information on the baby’s care and needs, and fathers’ experiences of their partners’ inadequate check-ups and medical care. A year after the birth 488 (79%) of the fathers were satisfied with the overall postnatal care, although they had pointed to deficiencies in the provision. Deficiencies in the attitude of the staff (OR 5.01; 2.80-8.98) and the medical care and check-ups their partner received were associated with fathers’ dissatisfaction with the overall postnatal care (OR 2.13; 1.25-3.62).ivMost fathers in this study had a positive birth experience and were happy with the postnatal care. The thesis highlights, however, opportunities for improvements in intrapartum and postnatal care. Healthcare professionals should be informed regarding the information provided via the web and to discuss the information that expectant fathers receive about pregnancy and childbirth. Prospective fathers should be given the opportunity to discuss their preferences and attitudes to the mode of birth. In addition, professionals should provide supportive information and be present in the delivery room. The information about the newborn baby’s care and needs can be strengthened, both before and after birth.

Hensikt: Å belyse hvilke aspekter kvinner selv trekker fram når de beskriver sin fødselsopplevelse som negativ. Metode: Kvalitativ tematisk analyse er anvendt for å analysere fritekstkommentarer fra 103 kvinner som har vurdert sin fødselsopplevelse som negativ, i den norske kohorten av Bidens-studien. Hovedresultater: Tre hovedtemaer trer fram i resultatene: ”Komplikasjoner hos mor, barn eller begge”, ”Å ikke føle seg sett og hørt” og ”Opplevelse av smerte og tap av kontroll”. Funnene viser at majoritetenav kvinnene hadde opplevd uventede og dramatiske komplikasjoner. Mange hadde følt seg ignorert, dårlig behandlet og ikke inkludert i avgjørelser. Et mindretall opplevde at den negative fødselsopplevelsen hovedsaklig skyldtes smerte og/eller tap av kontroll. Konklusjon: Kvinnenes beskrivelser viser at de ikke forventet å oppleve det de gjorde i fødsel, det være seg komplikasjoner eller mangelfull ivaretakelse. Enkelte opplevde situasjoner som må betraktes som overgrep i form av forsømmelse, verbale overtrampog uhøflig opptredenfra omsorgsgivernes side. I denne studien kommer det fram at omsorgsgiveres holdninger og væremåte er vesentlig for en positiv fødselsopplevelse. Den informasjonen som komfram gjennom funnene kan brukes av jordmødre for på best mulig måte å forebygge negative fødselsopplevelser. / Aim: This study aimed to explore the aspects women describe as contributing to their negative experience of childbirth. Methods: We used qualitative thematic analysis to analyze 103 free-text comments in a questionnaire from the Norwegian cohort of the Bidens study. The comments were provided by women who had a negative childbirth experience. Main findings: The majority of respondents reported experiencing unexpected and dramatic complications during childbirth. We identified three major themes: “(i) complications in mother, baby or both”, “(ii) not being seen or heard”; and (iii) “experience of pain and loss of control”. Further, the majority of respondents had felt ignored, had not been treated with respect, and did not feel included in decisions about their childbirth. A minority described pain and loss of control as the main reason for their negative birth experience. Conclusions: The women’s comments show that they did not expect to experience negative things during childbirth. Further, they were unprepared for complications and improper care. Alarmingly, many respondents experienced what must be characterized as abuse in the health-care system (i.e. neglect, verbal abuse or rudeness). The present study shows that caregivers’ attitudes and presentation contribute importantly to a positive childbirth experience. Midwives can use the information gained from this study to prevent negative birth experiences. / <p>ISBN 978-91-86739-95-9</p>

Objective: We aimed to analyze the birth experience of women with caesarean section (CS) and the influence of clarification. Furthermore weaknesses of care from women’s view should be determined. Method: Online survey of women who had at least one CS Results: We analyzed data of 383 women. 47,8% women had a primary, 52,2% a secondary CS . The birth experience ranged from wonderful (13,3%) to gruesome (25,1%). There were significant more women with secondary CS whose birth experience was associated with negative emotions. Regarded in hindsight for 29,0% the CS was better than expected and 39,6% stated it had been worse than assumed. Almost half of participants stated having coped (rather) bad with the CS and its concomitants. The opportunity of psychological consultation in hospital or at least addresses to contact when needed were repeatedly required. In this survey the birth experience as well as the meeting of expectations toward CS depended on the satisfaction with the antenatal discussion by obstetricians and the clarification by medical staff while for antenatal classes no significant influence could be proved. Conclusions: A substantial amount of women had a negative birth experience. More effort concerning clarification and patient-centered care is required.

Sammanfattning Bakgrund: Under de senaste decennierna har förlossningar som startats via induktion ökat. Anledningen till att en förlossning behöver induceras kan vara flera. Vid induktion när cervix är omogen kan det ta flera dagar innan aktiv förlossning startar. Induktion och en långdragen förlossning är två enskilda riskfaktorer för en negativ förlossningsupplevelse.  Syfte: Syftet var att belysa kvinnors upplevelser av induktion av förlossning som varat längre än 48 timmar.  Metod: En kvalitativ design med tio semistrukturerade intervjuer ligger till grund för studiens resultat. En kvalitativ innehållsanalys med en induktiv ansats har tillämpats.  Resultat: Empirin frambringade fyra kategorier: Tidens betydelse för upplevelsen, Känslan av att vara lågt prioriterad, Känslan av att kroppen inte var redo samt Stöd och information, med totalt åtta underkategorier. Resultatet visade att kvinnor som genomgått lång induktion upplevde att tiden gick ut på att vänta, flera kände sig lågt prioriterade, och att de var i vägen. De kände en frustration till kroppen när progress uteblev eller tog lång tid. Tydlig och saklig information bidrog till en känsla av delaktighet i processen. Stödet som barnmorskan förmedlade påverkade kvinnornas upplevelse av den långa induktionen.  Slutsats: Kvinnor som genomgått en lång induktion tenderar att känna sig nedprioriterade. Upplevelsen av lång induktion som varat längre än 48 timmar påverkas av den erhållna informationen. Genom tydlig och saklig information samt närvaro och individanpassat stöd möjliggör barnmorskan en ökad känsla av trygghet och en bättre upplevelse av den långa induktionen. / Abstrakt Background: In recent decades, the rates of induced labours have increased. Reasons to why a birth needs to be induced can be several. In the case of induction when the cervix is not ripe, it may take several days before active labour starts. Induction and prolonged labour are two individual risk factors for a negative birth experience.  Purpose: The aim was to shed light to women´s experiences of induction of labour lasting longer than 48 hours.  Method: A qualitative design with ten semi-structured interviews from the basis if the study´s results. A qualitative content analysis with an inductive approach has been applied.  Result: Four categories emerged: The importance of time for the experience, The feeling of being low proritiy, The feeling that the body was not ready and Support and information, with eight subcategories. The results showed that women who undergo a long induction experience time spent waiting, having low priority, and being “in the way.” They feel frustration with the body when labor is not progressing or takes a long time. Clear and concise information contributed to the women feeling involved in the process. The support provided by the midwife influenced the experiences of the long induction.  Conclusion: Women who have undergone a long induction tend to feel de-prioritized. The experiences of a long induction are affected by the information given. With clear and concise information, presence and individualized support, the midwife enables an increased feeling of security and a better experience for the women.

Aim: The overall aim of this study is to describe experiences of, and the association between, fear of childbirth and birth experiences of women with fear ofchildbirth. Methods: In studies I, II, and IV, a reflective lifeworld approach based on phenomenological philosophy was used to describe women’s experiences of fear of childbirth (I), previous birth experiences (II), and fear of childbirth and of birth experience in a long-term perspective (IV). In study III, differences between women who reported fear of childbirth and those who did not were calculated using risk ratios with a 95 % confidence interval and multivariate logistic regression analysis. Data were collected from interviews with eight (I) and nine (II) pregnant women with intense fear of childbirth, and with six women who had sought care for intense fear of childbirth 7 to 11 years prior to the interview (IV), and via questionnaire from a sample of 763 women during pregnancy and again one year following birth (III). Findings: Fear of childbirth was described as “to lose oneself as a woman into loneliness” (I). Previous birth experience was described as “a sense of not being present in the delivery room and an incomplete childbirth experience” (II). Fear of childbirth was associated with a previous negative birth experience and a previous emergency caesarean section (III). From a long-term perspective, fear of childbirth and birth experience was described as “an effort to make all the pieces come together” (IV). Conclusions: This thesis generates evidence on the importance of previous birth experience for women with fear of childbirth, from both qualitative and quantitative perspectives. These perspectives illustrate the complexity where women´s experiences in the delivery room are central. To avoid creating fear of childbirth, it is important that maternity care services focus on women’s birth experiences and critically evaluate care in relation to childbirth.

Background: The birth experience has long-term implications on women’s health. Previous research mainly focuses on risk factors and traumatic birth. The lack of a salutogenic perspective on the birth experience is troublesome since childbirth generally is a healthy life event with the capability of empowering women and their families.  Objectives: The aim of this study was to describe what contributes to women’s sense of security during childbirth and what the meaning of a sense of security during childbirth is. Method: The study had a qualitative design. Semi-structured interviews were conducted with 13 informants who had given birth at home or in hospital, the last 3-20 months. Both vaginal and cesarean births among primiparous and multiparous women were represented in the material. Data was analyzed with qualitative content analysis. Results: Aspects that contributed to a sense of security were presented in the two themes “Support and assistance from a respecting team” and “The strengthening of women’s own ability in childbirth”. The third theme, “Sense of security enables emotional growth”, described the informants’ view of the meaning of a sense of security.  Conclusion:The results contribute to the knowledge of how midwives can model their support to women in order to empower them and increase their sense of security during childbirth. It provides a deepened understanding for the concept of sense of security, seen as a continuum, and as an inseparable part of women’s birth experiences.  Keywords: birth experience, control, sense of security, support, qualitative content analysis / Bakgrund:Förlossningsupplevelsen påverkar hälsa och välbefinnande hos kvinnor och deras familjer. Tidigare forskning har främst fokuserat på riskfaktorer och följderna av en traumatisk förlossningsupplevelse. Avsaknaden av ett salutogent perspektiv på förlossningsupplevelsen inom barnmorskans forskningsfält är problematiskt eftersom de flesta förlossningar är friska, normal livshändelse som kan stärka kvinnor och deras familjer.  Syfte:Studiens syfte var att beskriva vilken betydelse som känslan av trygghet har under en förlossning och hur en känsla av trygghet kan uppnås och stärkas. Metod:Studien hade en kvalitativ design. Semistrukturerade intervjuer genomfördes med 13 informanter som fött barn de senaste 3 - 20 månaderna, hemma eller på förlossningsavdelning. Bland informanterna fanns både förstföderskor och omföderskor som fött barn vaginalt eller med kejsarsnitt. Data analyserades med kvalitativ innehållsanalys.  Resultat:Självtillit, valmöjlighet gällande förlossningsplats, fokus och kontroll bidrar till kvinnors känsla av trygghet under förlossningen. Stöd från en känd barnmorska ökade kvinnors känsla av trygghet och bidrog till en positiv förlossningsupplevelse. Aspekter som förstärkte känslan av trygghet presenterade i två teman, “Stöd och bistående” och “Egen förmåga och inre styrka”. Det tredje temat, “Känslan av trygghet möjliggör emotionell utveckling”, beskrev betydelsen av en känsla av trygghet. Slutsats:Studiens resultat bidrar med kunskap om hur barnmorskor kan anpassa sitt stöd under förlossning så att det stärker kvinnors egenförmåga och känsla av trygghet. Studien bidrar till att förbjuda förståelsen för känslan av trygghet, sedd som ett kontinuum och en oskiljaktig del av kvinnors förlossningsupplevelser.  Nyckelord:förlossningsupplevelse, kontroll, kvalitativ innehållsanalys, stöd, trygghet

Objective: We aimed to analyze the birth experience of women with caesarean section (CS) and the influence of clarification. Furthermore weaknesses of care from women’s view should be determined. Method: Online survey of women who had at least one CS Results: We analyzed data of 383 women. 47,8% women had a primary, 52,2% a secondary CS . The birth experience ranged from wonderful (13,3%) to gruesome (25,1%). There were significant more women with secondary CS whose birth experience was associated with negative emotions. Regarded in hindsight for 29,0% the CS was better than expected and 39,6% stated it had been worse than assumed. Almost half of participants stated having coped (rather) bad with the CS and its concomitants. The opportunity of psychological consultation in hospital or at least addresses to contact when needed were repeatedly required. In this survey the birth experience as well as the meeting of expectations toward CS depended on the satisfaction with the antenatal discussion by obstetricians and the clarification by medical staff while for antenatal classes no significant influence could be proved. Conclusions: A substantial amount of women had a negative birth experience. More effort concerning clarification and patient-centered care is required.

Background: Many women experience childbirth fear to such an extent that it seriously interferes with the woman’s daily life and affects her mental well-being. Aim: The overall aim was to conduct an overview of the midwife-led counselling for childbirth fear in Sweden, to investigate women’s birth preferences and to describe their experiences of treatment on childbirth fear, with focus on midwife-led counselling. Methods: Study I is a cross-sectional study where 43 out of 45 maternity clinics responded to a questionnaire regarding midwife-led counselling. Study II is a longitudinal survey where 889 women participated of whom 70 received counselling. Data were collected by questionnaires in mid-pregnancy, two months and finally, one year after birth. Study III is a randomised controlled study with 258 participating women assessed with childbirth fear. It compares Internet-based cognitive behaviour therapy (ICBT) with midwife-led counselling. Data were collected by questionnaires twice during pregnancy and two months after birth. Study IV is a qualitative interview study using thematic analysis, including 27 women who received midwife-led counselling during pregnancy. Results: Overall, midwife-led counselling was perceived as empowering by the women and increased their confidence when facing birth. The preference for a caesarean section decreased during pregnancy and the majority had a normal vaginal birth but an increase in preference for caesarean section appeared after birth. Half of the women who received treatment for childbirth fear experienced a less than positive birth. Women who had a positive birth experience voiced that the contributing factors were the self-confidence received from counselling and the support from the midwife during birth. Decreased or manageable fear was expressed by the women after counselling and birth, which in turn brought a strengthened confidence for a future pregnancy and birth. Furthermore, major differences exist in counselling for childbirth fear throughout the clinics in Sweden. Conclusion: Midwife-led counselling improved women’s confidence toward giving birth and fear was perceived as manageable. Continuous support is crucial to experience birth as positive. Although women’s preferences for caesarean section did not change over time, few women gave birth with a caesarean section without medial reason.

Background: The subjective experience of giving birth to a child varies considerably depending on psychological, medical, situational, relational, and other individual characteristics. In turn, it may have an impact on postpartum maternal mental health and family relationships, such as mother–infant bonding. The objective of the study was to evaluate the relevance of the subjective birth experience (SBE) for mother–infant bonding difficulties (BD) in women with mental disorders. - Methods: This study used data from N = 141 mothers who were treated for postpartum mental disorders in the mother–baby day unit of the Psychosomatic University Clinic in Dresden, Germany. Patients' mental status at admission and discharge was routinely examined using a diagnostic interview (SCID I) and standard psychometric questionnaires (e.g., EPDS, BSI, PBQ). Both, the SBE (assessed by Salmon's Item List, SIL) as well as medical complications (MC) were assessed retrospectively by self-report. The predictive value of SBE, MC, as well as psychopathological symptoms for mother–infant BD were evaluated using logistic regression analyses. - Results: About half of this clinical sample (47.2%) reported a negative SBE; 56.8% of all mothers presented with severe mother–infant BD toward the baby. Mothers with BD showed not only significantly more depressiveness (EPDS: M = 16.6 ± 5.6 vs. 14.4 ± 6.2*), anxiety (STAI: M = 57.2 ± 10.6 vs. 51.4 ± 10.6***), and general psychopathology (BSI-GSI: M = 1.4 ± 0.7 vs. 1.1 ± 0.6**) compared to women without BD, but also a significantly more negative SBE (SIL: M = 79.3 ± 16.2 vs. 61.3 ± 22.9***). Moreover, the SBE was the most powerful predictor for BD in univariate and multiple logistic regression analyses [OR = 0.96*** (95% CI 0.94–0.98) vs. OR = 0.96** (95% CI 0.93–0.98)], even when univariate significant predictors (e.g., current psychopathology and MC during birth) were controlled. - Conclusions: A negative SBE is strongly associated with mother–infant bonding in patients with postpartum mental disorders. It needs to get targeted within postpartum treatment, preferably in settings including both mother and child, to improve distorted mother–infant bonding processes and prevent long-term risks for the newborn. Furthermore, the results highlight the importance of focusing on the specific needs of vulnerable women prior to and during birth (e.g., emotional safety, good communication, and support) as well as individual factors that might be predictive for a negative SBE.