The leading purpose of this article is to understand why cesarean deliveries are overused, considering the increased risk of complications that affect mother and fetus. The author makes it a point to focus on the larger scale of cultural factors that are associated with a key clinical measure of quality care for the maternal population. In this study, they recruited obstetricians, family physicians, midwives, anesthesiologists, and labor nurses from 79 hospitals in California. The Labor Culture Survey (LCS) consisted of 29 items with 6 subscales: “Best Practices to Reduce Cesarean Overuse”, “Fear of Vaginal Birth”, ”Unit Microculture”, “Physician Oversight”, ”Maternal Agency”, and “Cesarean Safety”. These factors were included on a large scale validation study that suggested the LCS was a valid, reliable instrument to use. The authors of this study believe that the quality of care has been compromised because of lack of clear quality metrics, a strong history of the individualistic approach to caring for pregnant mothers, and undervaluing maternal outcomes in birth. Why is a low-risk female delivering her newborn by a cesarean delivery? A cesarean delivery is an invasive procedure specifically indicated for fetal intolerance of labor, failure to progress, or other complications that hinder the fetus or mother. Furthermore, the factors analyzed were closely observed and measured, creating the LCS to focus on constructs unique to birth. This being the value of vaginal birth, reducing unnecessary intervention, and empowering women. The article concludes that the LCS is beneficial because it targets the process of implementation towards specific attitudes, unit norms, knowledge deficits, communication gaps, and behaviors. After all, future work should look at testing individuals among a diverse population in states other than California. This being said, the attitudes about birthing practices show a positive correlation when it comes to mothers experience. The birthing process is a time in a woman’s life that is surreal. A woman giving birth vaginally, unless contraindicated, is an empowering moment for her because her body made this human being and she was able to bring it into this world. Ultimately, if a female is able to have a normal birth, then her healthcare staff should respect her decision and properly educate her (Van Gompel et.al, 2019).
Holten and Miranda (2016) draws a close study analyzing literature that explores women’s motivations to ‘birth outside the system’. She outlines research of women who choose to have an unassisted birth, home-birth in countries where home-birth was not integrated into the maternity care system, or a midwife attended high-risk home birth, from Sweden, USA, Australia, Canada, and Finland. The focal point is understanding women’s freedom of choice in maternity care and how to respectively deal with if a woman chooses to birth ‘outside the system’. The author emphasizes five main themes as significant factors: 1) resisting the biomedical model of birth by trusting intuition, 2) challenging the dominant discourse on risk by considering the hospital as a dangerous place, 3) feeling that true autonomous choice is only possible at home, 4) perceiving birth as an intimate or religious experience, and 5) taking responsibility as a reflection of true control over decision-making. The authors of this study conclude that there is a lack of fit between the health needs of pregnant women and the current system of maternity care. Why do women feel the need to have unassisted child births? Perhaps, many women feel a sense of empowerment in themselves or lack of faith in the healthcare system.There is approximately 200 planned unassisted child births yearly. This is a direct result of the data the article identified that influences women to deliver outside the system. Discussed throughout the article, women’s motivation to deliver at home is due to wanting to have more involvement with the birth, as well as, avoiding unnecessary medical interventions. There will always be a patient that does not want to adhere to medical advice. The women in this study are set on their beliefs and want to experience the birth of their child in a natural/holistic environment. A hospital does not offer this for them, which drives them to unassisted childbirth or high-risk home-birth. Future research is needed to understand the motivations and actions among women and to explore the scope of women birthing outside the system with the experiences of healthcare professionals. It’s not an easy and quick process no matter where you are, so it’s important to understand that at home child-birth can result in an increase in complications. This article provides us with a concise overview of attitudes that are presented around the different approaches of ‘birthing outside the system’ and women's autonomy over their bodies (Holten & Miranda, 2016).
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According to the 2018 article (Leyva-Moral et. al, 2018), Reproductive decision-making in women living with human immunodeficiency virus, the information in this review can lead to establishing high quality care to women living with HIV, who would like to conceive. The authors make it a point to understand the reproductive decisions made by women living with human immunodeficiency virus. In this study, there are many factors that contributed to the rising pregnancy rates among women living with HIV. This includes the increased life span of HIV-infected women in childbearing age, improved clinical status, and awareness of low risk mother-to-child transmission. On the other hand, there are still social issues that have occurred such as stigma and discrimination against women living with HIV, and the thought of them conceiving a child. This being said, women are not receiving accurate, family centered, culturally competent, and evidence-based care to inform their decision-making process regarding reproduction. If women are not receiving quality, accurate care from their providers, what would make them want to stay with that specific practitioner? These authors concluded that this evidence could be related to the lack of health care provider cultural competence, as well as, the knowledge deficiency about the current evidence-based practices. This discourages women who have this disease and drives them have little trust in the healthcare system. However, this study revealed that multiple women found satisfaction with their care from specialized teams. These specialized teams offer high activity anti-retroviral therapy during pregnancy, neonatal prophylaxis, avoidance of breastfeeding, in addition to scheduled cesarean birth, are effective in preventing HIV mother-to-child transmission. Overall, this study presents evidence-based practice guidelines that indicate women can reproduce and have a family with a healthy future (Leyva-Moral et. al, 2018).
Many women have concerns about the safety and risk of birth, which are fundamental to the decisions women make about pregnancy and delivery. Midwives are a safety net for most women, in terms of traditional birth choices. This is because they can choose the place for birth, move freely during labor, and have family present for the birth, none of which is allowed in medical facilities. Cultural practices, economic and logistic realities, and education are the main influence on women’s preferences for childbirth. Healthcare professionals should inform these women about the pros and cons pertaining to an at home birth vs. hospital birth. However, childbirth may cause adverse outcomes, such as postpartum hemorrhaging. How is one medical professional going to ensure the mother’s safety if she decides to deliver at home? This statement is not meant to be biased, but it is important to consider all the facts before deciding on a birth plan. Some of the women interviewed stated, “they do not feel that they are being controlled by medicine or forced into decisions through their doctor’s expertise of authority; instead, they experience agency and a sense of control in the choices they make to trust the medical establishment.” With this being said, it is important to have the required medical technology, constant observation to minimize risks, and rely on the competence of medical professionals that they will do everything in their power to ensure the mother and baby are safe. Furthermore, historical attitudes can change a woman's mind in regards to her birth plan. They consider if women were able to deliver children before new scientific technology, then why can’t they have an at home delivery. This may work for some women, but childbirth is not always as straightforward as one may think. There are several complications that can have fatal outcomes. Ultimately, it will be a mother’s preference in how she wants to deliver her child. It is critical for healthcare professionals to communicate with these women about the complications that exist if they experience adverse effects with at home deliveries and do not have the proper medical equipment or staff (Miller & Shriver, 2012).
Maternal bonding is a key factor for the development of a newborn. The first hour of birth is essential because this is a critical time for the mother and newborn to become acquainted. Bonding is a pivotal role for the newborn to develop important, healthy relationships and offers them security and self-esteem for their future selves. Women who gave birth to children in the past often had wet nurses care and feed their newborns. This made the maternal bonding difficult for those children because they were confused about who they should be connected towards. This most likely caused developmental issues later in life because of the confusion growing older. The main factors that influence the emotional-involvement between the mother and her newborn consist of several components. These include socio-demographics, previous life events, types of delivery, pain at childbirth, support from partner, infant characteristics, early experiences with the newborn, and mother’s mood. The outcomes of this study indicated that maternal attachment is an interactive process between the mother and the child, seeing that some infants qualities interfered in the excitement the mother had toward the child. The results concluded that mothers with depressive symptoms, unemployment history, and mothers without a partner contributed to a negative bonding experience with their newborn. With this being said, early postpartum mood should be a priority after delivery to help the bonding experience for the newborn. The mother’s experience during pregnancy and delivery should be one that is filled with joy and excitement. The bonding process is involved with this experience. If a mother does not develop this maternal attachment to her newborn, the child will feel insufficient and withdrawal from emotional connectedness. The bonding experience also consists of breastfeeding the newborn. This not only helps promote the mother-infant bonding, but it helps the mother heal from delivery. This is because breastfeeding helps the uterus contract and keep the fundus firm postpartum. In conclusion, this article illustrates the importance of promoting a mother-child bonding experience. Regardless of birthing practices, early attachment after delivery helps enhance the psychological development of the child. This is often related to the mother’s involvement and feelings during and after birth (Figueiredo et.al, 2008).
As a cultural phenomenon, childbirth is an empowering personal event in a woman’s life. This can be recognized as a social experience that differs within each culture and society. It’s important to originate knowledge about the basic understanding of diversity. That being said, health care professionals need to effectively learn about an individual's heritage, so they can provide effective care to their patients. The focal factors that contribute to childbirth within women of African descent consist of multiple aspects. These include a sense of responsibility, childbirth as a positive life event, the uniqueness of childbirth as a life experience, childbirth as a bitter-sweet paradox, and childbirth as a spiritual event (Etowa, 2012). Childbirth is a journey a woman takes control of in order to gain self-worth and hope. This journey consists of socio-economic, cultural and historical factors.
References:
- White Van Gompel, E., Perez, S., Wang, C., Datta, A., Cape, V., & Main, E. (2019). Measuring labor and delivery unit culture and clinicians’ attitudes toward birth: Revision and validation of the Labor Culture Survey. Birth: Issues in Perinatal Care, 46(2), 300–310. https://doi-org.libdb.dc.edu/10.1111/birt.12406
- Holten, L., & Miranda, E. D. (2016). Women׳s motivations for having unassisted childbirth or high-risk homebirth: An exploration of the literature on ‘birthing outside the system.’ Midwifery, 38, 55–62. doi: 10.1016/j.midw.2016.03.010
- Leyva-Moral, J. M., Palmieri, P. A., Feijoo-Cid, M., Cesario, S. K., Membrillo-Pillpe, N. J., Piscoya-Angeles, P. N., … Edwards, J. E. (2018). Reproductive decision-making in women living with human immunodeficiency virus: A systematic review. International Journal of Nursing Studies, 77, 207–221. doi: 10.1016/j.ijnurstu.2017.10.012
- Miller, A. C., & Shriver, T. E. (2012). Women’s childbirth preferences and practices in the United States. Social Science & Medicine, 75(4), 709–716. doi: 10.1016/j.socscimed.2012.03.051
- Figueiredo, B., Costa, R., Pacheco, A., & Pais, Á. (2008). Mother-to-Infant Emotional Involvement at Birth. Maternal and Child Health Journal, 13(4), 539–549. doi: 10.1007/s10995-008-0312-x
- Etowa, J. B. (2012). Becoming a mother: The meaning of childbirth for African–Canadian women. Contemporary Nurse, 41(1), 28–40. doi: 10.5172/conu.2012.41.1.28
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