Immigrant Women's Views About Care During Labor and Birth: An Australian Study of Vietnamese, Turkish, and Filipino Women

The association between women's overall experience of labor and birth and a range of possible explanatory variables were studied in a group of 1111 women who participated in a birth center trial. Data were collected by a questionnaire in early pregnancy (demographic background, parity, personality traits, and expectations), hospital records (pharmacological pain relief, induction, augmentation of labor, duration of labor, operative delivery, and infant outcome), and a follow-up questionnaire 2 months after the birth (the principal outcome "overall experience of labor and birth," pain, anxiety, freedom in expression, involvement, midwife, and partner support). Logistic regression was conducted by including all variables that were associated with the birth experience when analyzed one by one. In a second regression analysis, only explanatory variables measured independently of the principal outcome were included; that is, only data collected from the pregnancy questionnaire and the hospital records. The first regression analysis identified five explanatory variables: involvement in the birth process (perceived control) and midwife support were associated with a positive experience; anxiety, pain, and having a first baby with a negative experience. Parity remained a significant predictor in the second regression analysis, but the others were replaced by augmentation of labor, cesarean section, instrumental vaginal delivery, and nitrous oxide (Entonox), which were all associated with a negative birth experience.

This study is a first attempt to describe Lebanese women's responses to the medical management of their pregnancy and delivery. A qualitative approach in data collection and analysis was adopted to gain an in-depth view of women's perceptions. Women of any parity undergoing a normal vaginal delivery during the three months preceding the interview were interviewed in different areas in Lebanon: one urban, one semi-rural and two remote rural. Childbirth for all the women interviewed was managed within the medical system. Findings show that women accord total trust to their physicians, and very rarely question the usefulness of many routinely applied procedures, even those which the literature shows are unnecessary. When probed, women report that many aspects of the technical care are intimidating and that they experience discomfort with these procedures. Women are more vocal about patient-provider communication and value good interaction with their provider. The extent of passivity and feelings of discontent women have varies according to their social class and the amount of psychosocial support they receive throughout the process of childbirth.

To investigate the views and experiences of care in labour and birth of a representative sample of women who gave birth in Victoria, Australia in 1993. Cross-sectional survey mailed to women 6-7 months after giving birth. All women who gave birth in a two week period in Victoria, Australia in September 1993, except those who had a stillbirth or neonatal death. After adjusting for parity, the risk status of the pregnancy, and social and obstetric factors, specific aspects of care with the greatest negative impact on the overall rating of intrapartum care were: caregivers perceived as unhelpful (midwives: adjusted OR 12.03 [95% CI 7.8-18.6], doctors: adjusted OR 6.76 [95% CI 4.4-10.3]); and having an active say in decisions only sometimes, rarely or not at all (adjusted OR 8.90 [95% CI 4.9-16.1]). In a separate regression analysis including parity, risk status, obstetric and social factors, but not specific aspects of care, factors associated with dissatisfaction with intrapartum care included: participation in shared antenatal care programme (adjusted OR 1.89 [95% CI 1.2-3.0]) and being of nonEnglish speaking background (adjusted OR 1.70 [95% CI 1.1-2.6]). The following factors lowered the odds of dissatisfaction: attending a birth centre (adjusted OR 0.34 [95% CI 0.1-1.0]) and knowing the midwives before going into labour (adjusted OR 0.68 [95% CI 0.5-0.9]). The survey demonstrates the potential for 'new' models of care to have either positive or negative effects on women's experiences of care. Evaluation of innovations in perinatal care taking into account women's views is a prerequisite for improvements in maternity care.