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Maintaining power: Women's experiences from labour onset before admittance to maternity ward
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.ORCID iD: 0000-0001-8354-3382
Halmstad University, School of Health and Welfare, Centre of Research on Welfare, Health and Sport (CVHI), Health promotion and disease prevention.
Hälsoakademin, Örebro University, Örebro, Sweden.
Karolinska Institutet, Stockholm, Sweden.
2011 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 28, no 1, p. 86-92Article in journal (Refereed) Published
Abstract [en]

Background: in Sweden pregnant women are encouraged to remain at home until the active phase of labour. Recommendation is based on evidence, that women who seek care and are admitted in the latent phase of labour are subjected to more obstetric interventions and suffer more complications than women who remain at home until the active phase of labour. The aim of this study was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset until admission to labour ward. Method: interviews were conducted with 19 women after they had given birth to their first child. A Constructivist Grounded theory method was used. Findings: 'Maintaining power' was identified as the core category, explaining the women's experience of having enough power, when the labour started. Four related categories: to share the experience with another', to listen to the rhythm of the body', to distract oneself and to be encased in a glass vessel', explained how the women coped and thereby maintained power. Conclusions: the first time mothers in this study, who managed to stay at home during the latent phase of labour, had a sense of power that was expressed as a driving force towards the birth, a bodily and mental strength and the right to decide over their own bodies. This implies that women who maintain power have the ability to make choices during the birth process. The professionals need to be sensitive, supportive and respectful to women's own preferences in the health-care encounter, to promote the existing power throughout the birthing process. © 2010 Elsevier Ltd.

Place, publisher, year, edition, pages
Kidlington, UK: Churchill Livingstone , 2011. Vol. 28, no 1, p. 86-92
Keywords [en]
Experiences, Grounded theory, labour onset, Maintaining power
National Category
Obstetrics, Gynecology and Reproductive Medicine Nursing
Identifiers
URN: urn:nbn:se:hh:diva-14337DOI: 10.1016/j.midw.2010.11.011ISI: 000299324500013Scopus ID: 2-s2.0-84855931014OAI: oai:DiVA.org:hh-14337DiVA, id: diva2:394411
Available from: 2011-02-02 Created: 2011-02-02 Last updated: 2018-03-23Bibliographically approved
In thesis
1. The movement towards birth: A study of women's childbirth self-efficacy and early labour
Open this publication in new window or tab >>The movement towards birth: A study of women's childbirth self-efficacy and early labour
2014 (Swedish)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aim: The overall aim of this thesis was to increase the understanding of early labour, the latency phase of labour, based on women’s experiences and ability to handle the situation. Furthermore, the aim was to perform a psychometric testing of an instrument measuring childbirth self-efficacy and to explore the relationships to women´s well-being and number of obstetric interventions and birth outcomes.

Methods: In study I, a grounded theory method was used to obtain a deeper understanding of how women who seek care at an early stage experience the latent phase of labour. The same method, grounded theory was used in study II, but in this study, the aim was to obtain a deeper understanding of how women, who remain at home until the active phase of labour, experience the period from labour onset before admission to maternity ward. In both these studies (I & II) interviews were used to collect data. Study III and IV were cross sectional studies with a  consecutive data collection. In study III, a forward-backward translation was used to translate the childbirth self-efficacy inventory (CBSEI) into a Swedish version. An explorative factor analysis with principal component analysis was used to test the psychometric properties of the inventory and reliability tests with Cronbach's alpha and inter item total correlation was performed. In study IV, chi-2 test, Fisher's exact test and student's t-test for independent samples was performed between women´s estimated childbirth self-efficacy and demographics, obstetric interventions and birth outcomes. Correlations were also performed between different scales measuring well-being during pregnancy and childbirth self-efficacy. Finally a logistic regression analysis was performed to predict the probability for low or high childbirth self-efficacy.

Findings: Being in a safe place is essential for the women in the early labour process. But a safe place has different meanings for different women, depending on how they assess their own ability to handle their impending labour. For some women, the hospital is a secure place, a place where somebody else can take over the responsibility for themselves, the labour process or their child’s well-being. Some women choose to remain in their homes, which they consider as a kind of base camp which they can leave and go back to whenever they please. There is also a difference in how women ascribe ability to their own bodies and women´s belief in their own ability to cope and deal with the impending birth, their self-efficacy. These differences together with the women´s choice of seeking care or not, during the early labour process, affect the women´s experience of the labour process. The women's experience during the early labour process varies from feeling powerful and strong, to perceiving themselves as victims and feeling totally powerless. Women with high self-efficacy as measured by CBSEI had less previous mental illness and had more often been told their sister´s birth story. During the labour process, women with a higher childbirth self-efficacy have a lower frequency of epidural analgesia than women with low childbirth self-efficacy.

Conclusion: Women´s belief in their childbirth self-efficacy affects their choice of place to be, during the early labour process. The place in turn, affects the women´s experiences and the way they handle the early labour process. The early labour process is a sensitive period that requires attention and should not be neglected. Through increased knowledge and understanding of the problematic issues related to the early labour process, the birth preparation and antenatal obstetric care, as well as the care during labour can be improved.

Place, publisher, year, edition, pages
Stockholm: Karolinska institutet, 2014. p. 65
Keywords
Childbirth self-efficacy, early labour, factor analysis, grounded theory, logistics regression, pregnancy, well-being
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:hh:diva-25949 (URN)978-91-7549-498-2 (ISBN)
Public defence
2014-06-05, Samuelssonsalen, Schelelaboratoriet, Tomtebodavägen 6, Solna, Stockholm, 13:00 (Swedish)
Opponent
Supervisors
Note

Examen: Medicine doktorsexamen

Available from: 2016-01-22 Created: 2014-06-27 Last updated: 2018-03-22Bibliographically approved

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Carlsson, Ing-MarieZiegert, Kristina

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