The health care around childbirth has recently been concentrating on complications and risks for mother and child. The obstetric outcome has been focused on more than women’s experience [
A qualitative design content analysis was chosen for this study. Written narratives were found to be the most suitable data collection method for the present study in order to catch the women’s freely described experiences of their first-time giving birth. Content analysis is a stepwise process of categorization based on the expression of thoughts, feelings, and actions described throughout the text. The intention of the analytical process is to remain close to the words of the text and to elicit the contextual meanings. Content analysis can either be manifest or latent, depending on the depth and level of abstraction. Manifest content is about the actual text, while latent content describes what the text is talking about [
This study was undertaken during February to April 2008 in a hospital labor ward in a southwestern county of Sweden. The county holds 280,000 inhabitants. In 2006, there were 2204 births to 914 first-time mothers. The inclusions criteria for taking part in the present study were Swedish speaking first-time mothers with a normal birth and not cared for by the authors of this study and had healthy infants at discharge from hospital. The midwives at the maternity ward asked women that fit the inclusion criteria to participate in the study. The first-time mothers were provided information about the study, its objectives, and the rights of the research participants orally by the midwives at the maternity ward, and also by a leaflet. The first-time mothers were asked to freely describe their experiences of their first-time of giving birth in at least one page.
Written narratives were obtained from fourteen first-time mothers, one to two weeks after childbirth. The written narratives were two to seven pages. Data collection and part of the analysis were carried out simultaneously to follow up on the issues that were emerging and to decide when they were reaching saturation [
The written narratives were transcribed and analyzed separately using content analysis [
The ethical principles of the Helsinki declaration [
The written narratives of the first-time mothers experiences and reflections of their first birth are presented as one main theme
Categories with subcategories and theme identified from narratives with first-time mothers.
Categories and subcategories | Theme |
---|---|
|
To be empowered increases first-time mother’s chances for a positive birth experience |
Each category and its subcategories are presented using direct quotations in a conversational format. A code number for each respondent is included after the quotation (W1–W14).
The first-time mothers described that the body’s strength was affected by the order to go into themselves, knowing that nothing else matters and to allow the body to work all by itself. First-time mothers’ experiences to trust the body was positive and gave a sense of power. The body had command and there was no turning back. The body was like a big muscle, while it was a body working at the same time. Contractions were handled differently by crying or shouting out while others felt completely focused on breathing through the contractions to give birth.
The first-time mothers described that the body’s strength was affected by how they could manage and deal with the pain. It was a new painful experience that they had not been through before. At the beginning of labor, first-time mothers experienced alternative pain relief as relaxing and comfortable. First-time mothers who decided not to have medical pain relief, such as Epidural Anesthesia (EDA), before birth, but did so because of severe pain, could experience it as a defeat. Despite of this, these mothers experienced good effect of EDA. The first-time mothers described a feeling of weakness. The strength declined during the first stage in labor because it lasted long and was painful and difficult.
The first-time mothers described a feeling of strength to have control during childbirth, such as concentrating on taking one contraction at a time. Loss of control was described by some first-time mothers as worse than the pain. First-time mothers also describe that the pain relief could affect the feeling of control in a positive way.
Feelings of satisfaction were expressed when the birth was an experience that the first-time mothers did not want to be without, and when they were proud of their own effort. A rapid labor progress and professional support gave feelings of satisfaction.
First-time mothers described the varying degrees of patience during childbirth. Little patience was experienced when giving birth did not go ahead, waiting for the staff to come or waiting for pain relief. Patience was needed when having to wait to have the vaginal rupture stitched after the birth.
First-time mothers described a sense of strength to bear children, an experience without equal. A feeling of indescribable happiness occurred when the baby slipped out and the pain disappeared. They also described a sense of unreality that they had given birth, to have managed it as they never thought they could do and this gave them a feeling of power.
The first-time mothers described that the feeling of trust is influenced by the environment in the maternity ward, tolerant, and peaceful atmosphere and the personal chemistry between the first time mothers and the midwives. To feel safe at home was important if the first-time mothers could stay quietly at home in the beginning of the labor. If the first-time mothers felt nervousness and concern about being at home, she perceived insecurity. The first-time mothers described lower support from both the partner and the professionals when the birth was complicated.
The first-time mothers described the presence of a midwife and the partner during childbirth as a positive feeling of support, it helped the first-time mothers to cope with the childbirth as well as they did
The first-time mothers described that there was a sense of responsiveness to be seen and heard of the professionals and in an opposite way a decreased sense of responsiveness occurred in some unexpected situations.
The first-time mothers wanted to be confirmed and seen as unique individuals by the professionals at their first childbirth. If professionals responded to the individual woman’s needs of emotional support, the woman more often had a positive birth experience, even if the birth was protracted or with medical complications. Inadequate support from the midwives could lead to negative birth experience. The first-time mothers could have a negative experience, although well supported by midwives, because of very severe pain or risk of medical complications.
The results showed that individualized emotional support empowers the first-time mothers during their first birth and increases their chances for a positive birth experience, even if the birth was protracted or with medical complications. Inadequate support from the midwives could lead to a negative birth experience. The women could have a negative experience, although well supported by midwives, because of very severe pain or the risk of medical complications. An empowerment approach means that the health care professionals should provide mothers with the information, expertise, support, and skills they need to enable an interactive participation [
The mothers described that the body’s strength was affected by how they could manage and deal with the pain; a feeling of losing control could be worse than pain, but pain relief could affect the feeling of control in a positive way. If the mothers not planned to have medical pain relief, but did so because of severe pain, they experienced a defeat, whether the pain was relieved or if they experienced remained control. If the women in this study felt empowered, it affected their experience positively, unless medical interventions or not, which is in line with earlier research [
The results showed that the first-time mothers who either had a fast delivery process or received a request support of midwives and the partners had a positive childbirth experience. This result is confirmed by previous research [
Using content analysis, this study investigated first time mother’s experiences of birth and reflections of receiving support during the first time of giving birth. Individual written narratives were chosen as the data collection method, which was able to catch the first-time mother’s narratives. According to Willman et al., words are often the best way to describe people’s experiences, both spoken or written [
A positive childbirth experience is an important goal of obstetric care where childbirth is defined as a normal life event, with outcomes defined as “A live, healthy mother and baby and satisfaction of individual needs” [
Evidence-based knowledge around childbirth shows the importance of seeing childbirth as a normal life event; however, the focus in recent years has been on medical interventions, which is not in conformity with the evidence. The goal of obstetric care should be a healthy mother and a healthy baby including a positive birth experience for the women, regardless of normality or complication. It is of importance that healthcare organization promotes an evidence-based approach around childbirth where health professionals have ability and skills to evidence base the care around childbirth. It is essential that these goals are met in order to individualize support to women during labor which increases her chances for a positive birth experience
Women’s feeling of being empowered was due to a presence and trustful relationship with the professionals and the partners. If the women felt empowered, it resulted in an increased ability to feel control, strength of the body, satisfaction and reassurance, and as a result of this a better ability to manage the pain which occurred. Inadequate support from the professionals could lead to a negative birth experience where women felt abandoned, immobilized, and not prioritized by the professionals.
The authors wish to express their gratitude to the mothers whose narratives were analyzed for this study. In addition, the authors wish to thank the Departments of Obstetrics and Gynaecology at the Central Hospital in Skövde, the School of Life Sciences of the University of Skövde, and the Skaraborg Institute for Research and Development, Sweden.