Get started
Work

Pain in Childbirth: Women's Expectations and Experience

Year: 2016
Type: dissertation
Study design: Observational Study
Abstract: Background: Few studies have focused on women’s expectations and experience of childbirth pain and what predicts a positive childbirth pain experience. Moreover, few studies have explored childbirth pain from a salutogenic perspective and from the perspective of childbearing women, how they prepare for and manage the pain. \nAim: The aim of this doctoral thesis was to increase knowledge about women’s expectations and experiences of childbirth pain and to identify predictors of pregnant women’s expected intensity of childbirth pain and what factors predict a positive childbirth pain experience. Moreover, the aim was to study childbirth pain from a salutogenic perspective and how women prepare for and manage childbirth pain. \nMethods: The thesis comprise three different studies. In the first study, which was a qualitative study (Paper I) the Vancouver School of doing Phenomenology was used as a research approach. Data were collected with open interviews with 14 women, selected through purposeful sampling, who had been healthy and had undergone normal labour and produced healthy babies not less than 8 hours to four days before the interview took place. In the second study (Paper II), a cross-sectional survey and self-reported questionnaires were used to collect data from pregnant women (n=1111) in Iceland early in the pregnancy, at 26 of the largest primary healthcare centres in Iceland. This consecutive national sample was stratified by residency, the questionnaires were posted to women that had agreed to take part in the study, and the response rate was 63%. The third study (Paper III) was a population-based cross-sectional cohort study, where the participants in Study II were sent a questionnaire five to six months after childbirth. Data from 726 women were used after removing data for women who had pre-planned C-sections. The response rate was 68%. \nIn all the studies, the focus was on salutogenic outcomes and their connection to other factors in women’s own expectations and experience of childbirth pain. \nResults: The main results of the three studies are that women do prepare themselves during pregnancy for managing the pain of childbirth and use their own strategies to manage childbirth pain. They generally have a positive attitude to pain during childbirth and many different factors predict positive childbirth pain experience. By studying pain first from the perspective of women with a qualitative approach (Paper I), and from those results investigating the object using quantitative methods (Paper II and III) a holistic view of pain in childbirth from the perspective of women was gained. Paper I: The overriding theme constructed was: childbirth pain was demanding and difficult but could be managed with different strategies and with support from encouraging and empowering midwives. The participating women used different means to prepare themselves for the birth, including obtaining information, increasing their own strength, taking into account their own attitudes and developing a positive attitude toward the pain. During the birth they tried to let their bodies lead the way and trusted their bodies, despite the pain. The women emphasized that the time between contractions was important in order to develop strength to manage the pain. The results showed also that the women found it useful to be, mentally, in their own world without outside interference, gaining strength from an empowering midwife and a supportive relative. Some thought it necessary to use an epidural when the pain was overwhelming, others felt it helpful to make a noise and to remember that the pain would end and they would be rewarded with a baby in their arms. The women felt the pain of childbirth was unlike any other pain. In the aftermath of the birth they felt it was important to be at peace with the pain and that the effort had strengthened their self-image. Paper II: The mean score for the expected intensity of childbirth pain was 5.58 (SD=1.38) measured on a seven-point scale. Most women (77%) had a positive attitude towards pain management without medication and 35% had a positive attitude to pain management with medication. The strongest predictors of a high expected intensity of childbirth pain score were: a negative attitude to the impending birth, low manifestation of a sense of security, and a positive attitude to pain management with medication. Women living outside the capital area were less likely to have a high expected intensity of childbirth pain. Paper III: A large group of women experienced childbirth pain as positive, as the mean score was 4.21 (SD = 1.73) on a seven-point scale ranging from ‘very negative’ (1) to ‘very positive’ (7). The strongest predictors for women’s positive childbirth pain experience were: a positive attitude to childbirth during pregnancy, support from the midwife during birth, use of epidural analgesia, high level of education and low intensity of pain in childbirth. \nConclusions: The results of these studies highlight women’s expectations and experiences of childbirth pain, which has been named the third paradigm, the first and second being the midwifery and the medical paradigm. The results emphasize the importance of taking the women’s perspective into account when planning childbirth services and health-promoting factors contributing to a positive childbirth pain experience. \nThis highlights a holistic approach and individualized care, which is in accordance with the theory of salutogenesis that focuses on the strength of each and every individual rather than on risk and diseases. These factors need to be highlighted when planning childbearing services. Further research is needed in this important area, for example, studying the most effective way to enhance positive attitude towards childbirth pain.
Language: English
Field: Medicine
Open Access status: green
OpenAlex ID: W2911076579
Cites: 24
Cited by: 1
Related to: 10