NURSING DEPARTMENT, MEDICINE AND HEALTH COLLEGE
Lishui University, China
FACULTY OF HEALTH AND OCCUPATIONAL STUDIES
Department of Caring Sciences
Women’s experiences before- and after
giving birth for the first time
A descriptive review
Jin Yihan (Alice)
Hong Bingqian (Ruth)
2020
Student thesis, Bachelor degree, 15 credits Nursing
Degree Thesis in Nursing Supervisor: Wang Mengyu (Lily)
Abstract
Background: Nowadays, with the development of economy and improvement of our
society, women have a better life, so they put forward higher requirements for childbirth. Some women and their family members refuse to cooperate with nurses, which creates a great number of problems for nurses. The role of nurses includes being familiar with signs of childbirth, improving patients' safety , enhancing the quality of care with supported delivery, fostering an environment of respect and promoting a career in health care. Therefore, it is important and necessary to explore women’s first childbirth experiences.
Aim: To describe women’s experiences before- and after giving birth for the first time. Design: A descriptive review of qualitative and quantitative studies was conducted. Method: Scientific literature were searched from the database PubMed including
articles with qualitative and quantitative approach. Similarities and differences between the studies were compared before induction.
Results: The result are based on 10 articles related to women’s experiences of giving
birth for the first time. Four themes were found: “Hard decision making”, “Psychological aspects of and after giving birth”, “Physical aspects of before-and after giving birth” before-and “Support from family members before-and medical workers”.
Conclusions: Women’s experiences before- and after giving birth for the first time
were described in both physical and psychological discomfort in childbirth. In spite of this, they experienced a childbirth successfully through responding and adapting to these discomforts actively and harvested the meaning of birth with the help of various support groups (mainly from nurses).Women described the role of nurses during childbirth that provided active or passive psychological and physical support.
Table of content
1. Introduction... 1
1.1 Definition...1
1.1.1 Definition of Giving Birth... 1
1.1.2 Definition of primiparous and multiparous... 2
1.1.3 Definition of Experience... 2 1.2 Epidemiology...2 1.3 Nurses’ role...2 1.4 Theoretical Framework...3 1.5 Previous review... 4 1.6 Problem description...4
1.7 Aim and research questions... 5
2. Method...5
2.1 Design...5
2.2 Search strategy...5
2.3 Selection criteria...6
2.4 Selection process and outcome of potential articles...6
2.5 Data analysis...8
2.6 Ethical considerations...9
3.Results... 9
3.1 Hard decision making...10
3.1.1 A decision about natural birth...10
3.1.2 A decision about vaginal delivery with epidural anesthesia... 10
3.1.3 A decision about Caesarean birth...11
3.2 Psychological aspects of before- and after giving birth... 12
3.2.1 Negative emotions... 12
3.2.2 Positive emotions...15
3.3 Physical aspects of before- and after giving birth... 16
3.3.1 Pain... 16
3.3.2 Physical discomfort from anesthesia... 16
3.3.3 Physical recovery...17
3.4 Active support from family members and medical workers...17
3.4.1 Family and friends support...17
3.4.2 Professional support... 18
4. Discussion...19
4.1. Main results... 19
4.2 Results discussion...20
4.2.1 Hard decision making...20
4.2.2 Psychological aspects of before- and after giving birth... 22
4.2.3 Physical aspects of before- and after giving birth... 24
4.2.4 Active support...27
4.3. Method discussion... 29
4.4. Suggestions for future research... 30
4.5. Clinical implication for nursing...30
5.Conclusions... 31
6. Reference...32
Table 2. Overview of selected articles.
Table 3. Overview of selected articles’ aims and main results.
1. Introduction
For most women, childbirth is a positive and significant event in life, and it means their lives come to a new stage ( Kay, Downe, Thomson, & Finlayson, 2017; Namujju, Muhindo, Mselle, Waiswa, & Muwanguzi, 2018). However, some women consider delivery as a negative process, especially for those who have experienced complications during the last production (Hege, Garthus-Niegel, Vangen, & Eberhard-Gran, 2012). There are mainly two reasons that studying the women’s childbirth experiences is worthwhile. On one hand, due to the development of economy, improvement of quality life and social class, women put forward higher requirements for delivery and pursue a comfortable and painless process (Lally, Murtagh, Macphail, & Thomson, 2008). On the other hand, some nurses complain that some women and their family members refuse to cooperate with them, which brings many troubles to their work (Bhattacharyya, Srivastava, Saxena, Gogoi, Dwivedi, & Giessler, 2018). Therefore, it is important and necessary to explore the childbirth experiences of women who give birth for the first time, especially for both women and nurses (Bhattacharyya et al., 2018; Hege et al., 2012; Kay et al., 2017; Namujju et al., 2018).
1.1 Definition
1.1.1 Definition of Giving Birth
experience during her entire life (Carquillat, Vendittelli, Perneger, & Guittier, 2017). Similarly, giving birth for the first time means first delivery. Women’s experiences of giving birth for the first time means the first delivery experiences of women, which involve physical and psychological aspects (Nilsson et al., 2018).
1.1.2 Definition of primiparous and multiparous
Primiparous women means that women who recently gave birth to the first child and multiparous means that women who having borne more than one child for several times(Lally, Murtagh, Macphail & Thomson, 2008).
1.1.3 Definition of Experience
Experience is an occurrence or event through practicing, which leaves an impression on someone’s mind (Oxford English Dictionary, 2018).
1.2 Epidemiology
The percentage of natural vaginal delivery in 2013 and 2014 were 35.3% and 41.4% respectively in Iran (Rooeintan, Borzabad, & Yazdanpanah, 2016). In the past few decades, the rate of cesarean section has been steadily increasing globally and it has exceeded 20% of all deliveries in many places (Olieman, Siemonsma, Bartens, Garthus-Niegel, Scheele, & Honig, 2017). In addition, women in 27 states of the northeastern United States undergoing vaginal delivery used epidural or spinal anesthesia and researchers predicted that the proportion of epidural anesthesia may increase in the next decade (Man, Qing, Jun, Zheng, Yingying, Arier, & Qi, 2018).
1.3 Nurses’ role
competent, fostering an environment of respect, dispelling myths and stereotypes, ensuring research ethically, and promoting a career in health care (Wright, 2015).
According to what women expect, nurses give them comfort, emotional support as well as information support. Meeting women's expectations of childbirth can increase women's satisfactions with childbirth experiences. Knowing women’s childbirth experiences can help nurses understand more about women's expectations (Tumblin & Simkin, 2001).
Nurses’ attitudes and beliefs can affect nursing care decisions and patients (Levine & Lowe, 2015). Nurses who have personal birth experiences will provide more professional support because they have a positive attitude and intention, and nurses who will give birth can also benefit from their work experience. Novice nurses or nursing students will strengthen training and enrich nursing experience of labor and childbirth to improve attitudes and expected behaviors for PLS (Professional Labor Support). Further research on the factors that influence the integration of PLS and care is important for promoting healthy delivery outcomes (Larkin et al., 2009).
1.4 Theoretical Framework
1.5 Previous review
For most women, childbirth is an important part that they must experience in their lives. Many researchers have studied on childbirth in different dimensions. Researches focused on the differences of women in different countries was very common, for example, Heidi, Yael, Malin & Susan (2018) pointed out that Norwegians had a preference in cesarean sections, while Israeli women were more likely to use epidural in the delivery. And Cheung & Pan (2012) also found that the local midwife model was not suitable for migrant women’s childbirth. Apart from that, there are some articles discussed specific psychological features and intervenes of woman who had a childbirth. Some articles tried to find out the mechanism of fear and related effective measures. The psychological features of women in the childbirth were analyzed for finding out the fundamental principle (Rondung, Johanna Thomtén, & Örjan Sundin, 2016). Moghaddamhosseini, Nazarzadeh & Jahanfar (2017) pointed out that the educational intervene was the most effective one to reduce women’s fear. In contrast, some researches were mainly focus on women’s physical aspects and related interventions, such as trauma and medications (Michaels & Paula,2018; Mirko, & Tavčar, 2018). Meanwhile, there were some articles about others’ support. Petronellah, Susanna & Benadé Petronella (2018) supported that there was a clear-cut distinctions between professional support and lay health support.
To sum up, although a lot of researches have discussed and explored the women’s experience, their research area was very specific and limited. It was hard to find out some articles about the complete experience of women in childbirth.
1.6 Problem description
unique position to support physiologic birth because they attend almost all births(Adams et al., 2018). In order to improve the quality of care during childbirth, nurses must understand the experiences of the first delivery so as to provide better guidance for those women (Nilsson et al., 2018). Therefore, it is important to explore women’s experiences of first delivery.
1.7 Aim and research questions
The aim of the literature review is to describe women’s experiences before- and after giving birth for the first time with the following question:
-How do women describe their experiences before- and after giving birth for the first time?
2. Method
2.1 Design
The authors conducted a descriptive literature review (Polit & Beck, 2012).
2.2 Search strategy
Databases
All the articles were searched from the database of PubMed (Polit et al., 2012).
Search terms
The search phrases were including Women (free text), First-time mothers (free text), Primiparous (free text), First delivery (free text), Child birth (free text), and Experiences (free text). The authors didn’t use MeSH to search more articles. The authors also used different combinations of search words to narrow the search scope with the Boolean term AND and OR (Polit et al., 2012).
Search limits
2.3 Selection criteria
Inclusion criteria: (1) relevant to the aim of the review study (that is, women’s
experiences before- and after first delivery) for articles in the degree project, empirical scientific articles using a qualitative and a quantitative approach, (2) articles about first-time mothers’ experiences of delivery .
Exclusion criteria: (1) literature reviews, (2) articles that are only referred to
fathers’, multiparas’, professionals or the general public’s experiences of giving birth.
2.4 Selection process and outcome of potential articles
In order to make a summary of useful information and answer the descriptive review’s aim and research question, the titles and abstracts of the articles were skim-read. Next, the whole article were read and selected if the article was judged to answer the aim and research question. Both authors were involved in all stages of the selection process (see table 1). As a result, 30 were selected as potential articles after Selection criteria. The figure shows that 6 articles coulldn’t be downloaded; 2 articles were literature reviews; 5 articles were in-relevant to the topic; 7 articles were experiences of multiparae and professionals. Finally, only 10 articles were used.
Table 1. Search strategies for the study
Database Limits and search date
Search terms Number
of hits Possiblearticles (excluding doubles) Medline via PubMed 10 years, English, 2019-06-20
“Women” (free text ) 296,622
Medline via PubMed 10 years, English, 2019-06-20
“Primiparous” (free text) 9,103 4
Medline via
2019-06-20 Medline via
PubMed 10 years,English, 2019-06-20
“First delivery” (free text) 19256
Medline via PubMed 10 years, English, 2019-06-20
“Child birth”(free text) 29,608
Medline via PubMed 10 years, English, 2019-06-20
“Experiences” (free text) 156154
Medline via
PubMed 10 years,English, 2019-06-20
“Women” AND “First delivery”
(free text) 131 Medline via PubMed 10 years, English, 2019-06-20
“First-time mothers” AND “Child birth” (free text)
254 10 Medline via PubMed 10 years, English, 2019-06-20
“First-time mothers” AND “experiences” OR “Child birth”
327 9
Medline via
PubMed 10 years,English, 2019-06-20
“Primiparous” AND
“experiences” OR “Child birth”(free text from the University of Gävle) 330 3 Medline via PubMed 10 years, English, 2019-06-20
“Women” AND “experiences” AND “First delivery”
98 4
Figure 1: The process of article screening and selection
2.5 Data analysis
article, the authors classified and organized them by the form of themes and sub-themes in Table 4 of the Appendix (Polit et al., 2012).
2.6 Ethical considerations
Authors objectively read and reviewed all these articles. The results, which were fully presented, but they didn’t include the authors’ own opinions and attitudes (Polit et al., 2012). The authors did not modify the results as they wish. Authors’ degree project program did not plagiarize others.
3.Results
3.1 Characteristics of included articles
The result refers to ten articles including in total 30929 participants, which are divided into seven qualitative articles (116 participants) and three quantitative articles (30811 participants). The age of the included participants varied between 18-37 years. Among the seven qualitative articles, which were based on interviews. All of the three quantitative articles used questionnaires to collect data. These ten articles were published in six different countries, Iran (n=1), Spain (n=1), UK (n=1), Norway (n=1), Sweden (n=2) and Germany (n=4).
3.2 Main result
Figure 2. The themes and sub-themes of the result. 3.1 Hard decision making
Most pregnant women described that they wanted to have a natural labor and they thought it was the only way to give birth to a baby (Guittier, Cedraschi, Jamei, Boulvain & Guillemin, 2014; Puia, 2018). However, several of the women chose a vaginal delivery with epidural anesthesia, and other women chose a cesarean delivery for many reasons, such as a cesarean decision in their plan, a cesarean decision with professional advice and an emergency cesarean decision without options (Guittier et al, 2014; Lupton & Schmied, 2012; Puia, 2018; Aasheim, Waldenström, Rasmussen & Schytt, 2013; Ulfsdottir, Nissen, Ryding, Egloff & Itzel, 2014).
3.1.1 A decision about natural birth
For many of the women, natural birth was the best choice instead of the epidural anesthesia ones because they wanted to fully participate in the delivery process (Hidaka & Callister, 2012). Therefore, they accepted and were satisfied with their decisions for the reason that they had the initiative and plenty of time to consider which mode of delivery was suitable for them (Puia, 2018).
3.1.2 A decision about vaginal delivery with epidural anesthesia
(Hidaka et al., 2012). One reason was that media report news about the the epidural anesthesia, which can largely reduces the feeling of pain and it can be applied in the vaginal delivery, and many women were satisfied with it in many cases (Guittier et al, 2014; Hidaka et al., 2012). Therefore, the media greatly affected women’s traditional opinions, and then they made a decision of vaginal delivery with epidural anesthesia instead of natural birth (Guittier et al, 2014).
Another reason was that most of the first-delivering women chose it after trying many non-pharmacological pain strategies such as walking, hydrotherapy and massage (Hidaka et al., 2012). They were worried, afraid, and nervous during the process of making the decision because they thought it was an unknown experience and some of their friends had experienced complications after epidural administration (Hidaka et al., 2012).
3.1.3 A decision about Caesarean birth
Women chose the mode of cesarean birth actively or passively, which could be mainly divided into three parts: a Caesarean decision in one’s plan, a Caesarean decision with professional advice, and an emergency Caesarean decision without options.
A Caesarean decision in one’s plan
A Caesarean decision with professional advice
There was also a group who chose a Caesarean birth by themselves, though some of them hesitate whether it was an ideal delivery mode (Puia, 2018). The main reason was that they do not think it was the natural way to give birth to a baby (Puia, 2018). But with the help, faith and support from partner and God as well as people’s comments, they finally accepted it on account of they considered it is a good way to get a healthy baby (Puia, 2018).
An emergency Caesarean decision without options
There’s a special group that women who had an emergency Caesarean and lost their rights to control and make a decision (Puia, 2018). In another word, they were in a very passive status, just like puppets to be played by others (Puia, 2018). Puia (2018) also mentioned that at this time, women were alone and nobody else care about their feelings and opinions.
3.2 Psychological aspects of before- and after giving birth
Women who chose different modes of delivery may have different negative emotions (Guittier et al., 2014). However, according to the research, there is no big difference in women’s satisfaction of delivery who chose different modes of giving birth (Ulfsdottir et al., 2014).
3.2.1 Negative emotions
Negative feelings before delivery
2013). Also, many women complained that too many tests increase their discomfort and anxiety before delivery (Askari et al., 2014).
Negative feelings during delivery
Women experienced different modes of delivery may had different negative emotions (Guittier et al., 2014).
Lack of patience
Women who had vaginal delivery announce the importance of the need of being patient in childbirth (Nilsson, Thorsell, Wahn & Ekström, 2013). Once delivery failed, they were waiting for medical staff to come for pain relief, and there was almost no patience for them at this time (Nilsson et al, 2013).
Out of control
In terms of control, women in three modes of delivery all described that they were out of control during childbirth because of uterine contractions, which made them very anxious (Nilsson et al, 2013). They also experienced a kind of potential distressing and a sense of lost and confused, for instance, physically stupid, dull and insensible senses force women experienced an emergency and let them upset and weird (Guittier et al, 2014). Specifically, women expressed that their spirits are splitting from their bodies during the delivery (Guittier et al, 2014).
Lose privacy
few women who gave childbirth in the natural delivery room believed that their privacy was well protected because there were just a small number of participants (Guittier et al., 2014).
Psychological challenge of epidural anesthesia
The psychological challenges of epidural anesthesia appeared only among women who were undergoing a vaginal delivery with epidural anesthesia or a cesarean delivery, and this epidural anesthesia were the same in spite of these two delivery modes were quite different.Women who chose epidural anesthesia also faced such challenges are the same in spite of although these two modes of delivery were quite different in the other parts of the delivery, so women met the same psychological challenge of epidural anesthesia no matter what kind of delivery mode they had (Hidaka et al., 2012; Puia, 2018). Women who gave birth for the first time were being left with unsettled or restlessness feelings during epidural anesthesia as they were confined to the bed (Hidaka et al., 2012). What’s more, fear of anesthesia was also a very common feeling among women who were giving a childbirth (Puia, 2018). Firstly, in most cases, there was no familiar support person (their husbands or other relatives) to accompany them, therefore, and women felt fear and helpless because nurses and the anesthesiologists were all the strangers (Puia, 2018). In spite of this, fears also derived from the needle (Puia, 2018). Some women said that although they were anesthetized, they were very clear in mind and they even have a felt of skin burning during the operation (Puia, 2018).
Negative feelings after delivery
for the latter, there were a great number of people who feel that it’s hard for them to get an emotional recovery after delivery (Guittier et al., 2014; Puia, 2018). They felt more and more anxious and depressed because they believed their lives are totally changed (Guittier et al., 2014; Puia, 2018; Lupton et al, 2012). Women who experienced an emergency caesarean can hardly imagine whether they can accept a new pregnancy in the future (Guittier et al., 2014).
3.2.2 Positive emotions
A sense of satisfaction and well-being
Almost all women are quite satisfied with the delivery experience and feel happy (Ulfsdottir et al., 2014). This indescribable sense of well-being and unrealistic feeling is always mentioned by a lot of women when their babies are born and held in their arms (Puia, 2018; Nilsson et al, 2013; Scarton et al., 2015; Hidaka et al., 2012). Although many women express negative feelings in their caesarean delivery experiences, there are still some women who think that they have had a perfect surgery experience (Puia, 2018). For instance, some women are calm and well prepared before the surgery, and they are satisfied with the professionals’ behaviors because everything goes fluently and successfully (Puia, 2018).
Psychologically recovery and Psychologically growth
After delivery, for the Caesarean group, some women can have a quick emotional recovery and come back to the normal life space with the help and support from others (Puia, 2018; Guittier et al., 2014).
they experienced during the natural delivery is worthwhile (Guittier et al., 2014). They also express that they are more patient and feel stronger because they have been given respect and positive emotions during childbirth (Hidaka et al., 2012).
3.3 Physical aspects of before- and after giving birth
3.3.1 Pain
In the mode of natural delivery, first-delivery women have different sensitivities to pain and the level of pain is related to personal physical strength and medical staff’s abilities of pain management (Scarton et al., 2015; Nilsson et al., 2013). All mothers feel sleepy and fatigue, and all their strength has nearly burned out when the pain is produced by regular uterine contractions (Nilsson et al., 2013; Hidaka et al., 2012; Lupton et al, 2012). Some women couldn’t tolerant the pain, screaming and saying that they cannot bear it (Scarton et al., 2015; Nilsson et al., 2013). While some women attempt to affect the work for medical staff as less as possible by relieving their pain through breathing regularly during childbirth (Scarton et al., 2015; Nilsson et al., 2013).
First-born women who choose vaginal delivery with epidural anesthesia also need to deal with pain before epidural anesthesia (Hidaka et al., 2012; Lupton et al, 2012). However, they will soon be relieved from pain with the effect of anesthetics (Hidaka et al., 2012). Once the pain is reduced, they will feel much better and relaxed. Although they can feel the pressure of contractions, there is no continuous pain throughout their bodies (Hidaka et al., 2012; Lupton et al, 2012).
3.3.2 Physical discomfort from anesthesia
Women who gave birth by Caesarean delivery and vaginal delivery with epidural anesthesia both expressed a numbness sensation (Puia, 2018; Guittier et al., 2014).
body control, they still have conscious at the moment when babies are coming out from their bodies (Hidaka et al., 2012; Lupton et al, 2012). What they can do is interpreting the behavior and words from observations, such as partners, the attending nurses and doctors (Hidaka et al., 2012). Similarly, women who have vaginal delivery epidural anesthesia have the same feeling (Puia, 2018). The use of epidural analgesia in vaginal childbirth raises an unexpected sensory experience for women after they experience a bit pain of needle for a short time (Guittier et al., 2014).
3.3.3 Physical recovery
After delivery, women who have a natural delivery show no evident discomfort (Scarton et al., 2015). While Puia (2018) said the situation is quite different for women who have a Caesarean delivery. Some of them only take two weeks for physical recovery and then do anything as normal, but it’s quite difficult and challenging for the others and they need nearly one year to adjust their body changes (Puia, 2018; Lupton et al, 2012). Women who are troubled with physical recovery think that it’s painful after the Caesarean surgery and they even couldn’t lift things, which deeply influence their lives, but some of them ascribe this to difficulties in breastfeeding (Puia, 2018).
3.4 Active support from family members and medical workers
3.4.1 Family and friends support
delivery (Aasheim et al., 2013).
Similarly, in the process of physical recovery, Puia (2018) described that women always get help from families and friends who share and take responsibilities of household chores and baby care. This can lower women’s burden of breastfeeding and give them a break to adjust their weak and tired bodies (Puia, 2018).
3.4.2 Professional support
Most women were quite satisfied with professional support from medical staff, which was embodied in communication and professional skills as well as attitude of medical staffs (Nilsson et al., 2013).
Humanistic concern
First-time mothers thought that professionals played important roles in the delivery process, especially midwives who took part in the vaginal delivery (Guittier et al., 2014). They also described the role of caregivers during childbirth that provided active or passive psychological support (Guittier et al., 2014).
Professionals listened and care about women’s needs and then built a bond of trust to facilitate the delivery process which improved the quality of delivery (Scarton et al., 2015; Nilsson et al., 2013). Specifically, medical staff talked and listened to their fear and emotional insecurity of childbirth, providing support and strength to make women feel secure and peaceful (Scarton et al., 2015; Nilsson et al., 2013). Besides, they created an atmosphere of trust and peace in the delivery room, which can also improved women’s delivery experiences (Askari et al., 2014; Nilsson et al., 2013).
Professional skills
Many women thought the quality of care and the competence of the caregivers were very essential (Fakhraei et al., 2017). Good professional skills could speed up the process of childbirth and relieve them from maternal nervousness (Askari et al., 2014; Scarton et al., 2015). For example, medical staff encouraged women to calm down and alleviate their pain, which could strength the cooperation and help women to get a better experience of delivery (Askari et al., 2014; Scarton et al., 2015).
Attitudes of professionals
The attitudes of nursing professionals towards women were also important for women’s experience of delivery (Askari et al., 2014; Nilsson et al., 2013; Puia, 2018). A lot of women who gave birth for the first time said that their delivery experience was good when the health care providers helped them with their challenges of maternal discomfort and overcome anxiety (Askari et al., 2014; Nilsson et al., 2013).
Some women who had Caesarean delivery argue that the staff who were too confident may let them feel that they were unprepared and useless (Puia, 2018). Fakhraei & Terrion (2017) described some women in the vaginal delivery group also complain that health care workers neglect their health and safety precautions and they want to be more involved in the decision-making process and be respected in their personal decisions. Similarly, a part of women expected to be treated carefully as a distinctive individual (Puia, 2018).
4. Discussion
4.1. Main results
about natural birth, A decision about vaginal delivery with epidural anesthesia, A decision about Caesarean birth), Psychological aspects of before- and after giving birth (Negative emotions, Positive emotions), Physical aspects of before- and after giving birth (Pain, Physical discomfort from anesthesia, Physical recovery), Support from family members and medical workers (Family and friends support, Professional support).
4.2 Results discussion
4.2.1 Hard decision making
The result shows that women choose a natural birth, but few women choose vaginal delivery with epidural anesthesia or Caesarean birth.
Internet and the public opinion might have a significant influence on women’s decision of childbirth (Kay, Downe, Thomson & Finlayson, 2017). During the pregnancy process, women try their best to find as much valuable information as they can, such as searching on the internet. They are quite eager for details about the process of childbirth, the duration of uterine contraction, the severity of pain as well as its interventions (Namujju, Muhindo, Mselle, Waiswa, Nankumbi, & Muwanguzi, 2018). This deeply affects their choice of delivery mode. Some women in the present study (ref, ref) don’t think they could tolerate the pain of uterine contraction, and then choose the Caesarean birth or vaginal birth with epidural anesthesia instead. Similar results are found in Namujju et al (2018), where some women think that it’s necessary to reduce the pain of childbirth through medicine if possible, because they’ve heard that a great number of women who didn’t receive medical painkillers experienced severe pain during childbirth. Thus, they say that they could not imagine the pain of imminent delivery. Nevertheless, there’s a big difference in the prevalence and acceptance of vaginal birth with epidural anaesthesia among Europe and other developing countries (Capogna, Alahuhtat, Celleno, Vlieger & Vertommen, 1996).
messages are quite negative and some of them are even fake, which may mislead them and let them feel scared. But in the research of Kay et al (2017), a participant showed her opinion that the information from the Internet was the easiest one to access, though some messages were not authoritative. Another participant supported with it and said that it was a good way to get suggestions from others and express worries of childbirth. Besides the Internet, it’s also an access to get information by communicating with their mothers and acquaintances. In the present study, most of women get the delivery information mainly from professionals, such as nurses. In contrast, most women’s mothers were born between 1970s to 1980s who are always unwilling to share their experience with their daughters for cultural and generational reasons (Kay et al., 2017). There is also a number of women who monitor and evaluate the health of fetus and children by advanced techniques, such as household fetal heart detectors. If they detect something abnormal, they will fell anxious and nervous (Cronin, & Mccarthy, 2003). To sum up, woman’s degree of anxious, worry, frighten and nervous depend on how much negative information they have absorbed. If women can’t estimate the pain of delivery properly, they can't prepare to give a childbirth well (Lally, Murtagh, Macphail & Thomson, 2008).
According to Roy’s adapting theory, preparing delivery and adjusting mental status are the essential processes to adapt the stimuli from the external environment (Raile Alligod et al, 2014). Women who are going to give a childbirth always need to find a balance between negative and positive messages. If the negative ones exceed the positive ones, they will get a passive emotion easily.
part of women haven’t choose the epidural anesthesia and feel extremely pain in childbirth, in this case, nurses can help them to make decisions of using anesthetic drugs, which can greatly improve their satisfaction of childbirth experiences. There is also a need to respect women’s decisions of childbirth and actively involve them into the delivery process (Wright, 2015). What’s more, nurses can give them a reference of other similar birth cases, which can help these women not only avoid being misled by fake information, but also save their time and energy to find the effective one.
4.2.2 Psychological aspects of before- and after giving birth
The present study shows that childbirth experience gives women happiness, including satisfaction, maturity and integrity, which come from their trust to God, environmental safety and a mother’s strength. A point that should be recognized is that a mother’s strength is related to the need of caring babies other than delivery itself. This has a positive impact on women’s mental health and affects women’s relationship with their babies (Balaam, Akerjordet, Lyberg, Kaiser, Schoening, Fredriksen, Ensel, Gouni, & Severinsson,2013).
The result reveals why some women expressed that they were unsatisfied with their childbirth can be divided into three parts: different delivery modes, influence of professionals and partners, occurrence of “complications”.
The result and the other study show that some women have experienced a vaginal birth with epidural anaesthesia or a Caesarean instead of a natural childbirth as they expected (Wiklund, Edman, Ryding & Andolf, 2008). Although they have various negative feelings during delivery, their mood after delivery is the most sophisticate and depressed one throughout the whole process. They may have spent a lot of time and energy in preparing natural birth or they don't even have time for preparation (Kay et al., 2017). In addition to this, they are disappointed to the childbirth because they have to adapt to pain, environment and other related factors in a short time (Wiklund et al., 2008).
and partners deeply influence a lot of women. Although most women in our study are quite satisfied with the nurses’ work, the research of Kay et al (2017) indicates that some professionals may are not care about women’s feelings and demands, which makes them feel that they are not concerned. It reflects on many details, for instance, professionals give them few personal care and explanation, the mechanical process make them fear and confused (Fakhraei & Terrion, 2017). What’s more, Fakhraei et al (2017) also reflects that the words from professionals are often imperative, which makes women under pressure and feel anxious. Some women complain that medical staff’s words are always like an order that you must be a good patient and a good mother. The present study shows that the influence of partner is mainly reflected on loosing privacy. Being exposed in front of either many medical staffs or their husbands, they feel quite uncomfortable and embarrassed, which might be related to their traditional culture (Hodgkinson, Smith & Wittkowski, 2014).
The last factor that should be considered is the “complications” of the delivery, which is a must but hard physical recovery process. In Dahlberg, Persen, Skog, Selboe, Torvik & Aune’s (2015) research, some participants feel fear and worry about postpartum hemorrhage because they don't know whether it is a normal phenomenon. Similarly, according to Wiklund et al (2008), women who have a complicated caesarean section are more likely to generate negative emotions.
The present study reveals that the negative emotions come from both women themselves, nurses as well as the delivery process. According to Roy’s theory, women should adjust and find a balance between clam and these negative emotions in a short time, such as trying to shift their attention to other things, which can prevent them from struggling with bad emotions (Raile Alligod et al, 2014).
some interesting things, like listening to soft music and reading novels (Taheri, Takian, Taghizadeh, Jafari, & Sarafraz,2018). Also, giving them a big hug can make them feel warm and safe. When the delivery begins, nurses should comfort women’s tense mood by frequent and timely communication with soft words, holding their hands to give them strength, which is extremely important for those who are experiencing an emergency Caesarean (Wiklund et al., 2008). Taking advantage of empathy to understand their annoyance, nervous and sadness, which is the foundation of giving physical suggestions. After that, nurses can give them comfort with words and behaviors, like telling them that they are not alone and there’s a great number of women have also met similar problems, everything well be okay and it’s just a stage that will be ended soon (Dahlberg, Persen, SkogS, Selboe, Torvik & Aune, 2015). Protecting women’s privacy is also essential in childbirth. Allowing husbands to company with their wives through assessment of women’s expectations and personal situations as far as possible. If there is enough time, nurses should make an instruction of the medical staff for the women, which can speed up the process of being familiar and adapting to the new environment (Nilsson et al., 2018). Also, the chief nurse should manage and reduce unnecessary medical staffs in the delivery room (Wright, 2015). After delivery, women meet a new challenge that they should accept and adapt to the new role: a mother. Nurses can provide women advice according to others’ experience to help them to adapt to the new role as quickly as possible, such as reading books about how to care a baby and how to be a good first-time mother (Kay et al., 2017). Setting up discussion groups is beneficial for first-time mothers to learn skills of caring a baby, solve problems and communicate to relieve pressure with multipara and professionals.
4.2.3 Physical aspects of before- and after giving birth
during anesthesia. The other uncomfortable senses are dulled, losing of physical control and conscious, which are also unavoidable. However, some pain is avoidable, like women who are being given epidural anesthesia after three centimeters opening of the uterus.
Due to uncontrolled uterine contraction or the effect of anesthetics, women always couldn’t control the pain and other physical discomforts. First of all, the pain comes from their back is hard to tolerate for its unique location rather than its severity (Gibbins & Thomson, 2001). No matter women have a natural childbirth or a vaginal birth with epidural anesthesia, they both think that it is so hard to tolerate the pain that they even can’t control their behaviors. The main difference is that women who have a vaginal birth with epidural anesthesia are relieved from pain after the treatment of epidural anesthesia (Lally, Murtagh, Macphail & Thomson, 2008). Similarly, some women express that they can’t manage the pain well by their own strength unless it is dealt properly by medical staff (Dahlberg et al., 2015). A research pointed out that antenatal education plays an important role in controlling the pain in childbirth (Kay et al., 2017). However, another research shows that if women have too high expectations about pain in childbirth, they will feel worse; otherwise, they will feel better (Gibbins et al., 2001). Therefore, whether women are open minded and have a good state of mind plays an important role in making right decisions for the pain relief.
protection.
The present study and Downe et al both find that women under any mode of delivery feel happy and contented during physical recovery process because they meet no accidents during delivery, and nurses share their joy and express their congratulations verbally and physically (Downe, Finlayson, Oladapo, Bonet, & Gulmezoglu,2018). This belongs to nursing measures, which effectively reduces the incidence of postpartum hemorrhage and infection. However, some “physical complications” still happened on some women for the reason that their body changes affect their couple’s life. Women always care about their husbands’ comments on their postpartum bodies and they think their bodies are no longer attractive to their partners (Hodgkinson et al., 2014). This is because in their opinions, there’s a big difference between social ideal figure and a mother’s real figure. An article also points out that women are more likely to be satisfied with their appearance and feel secure when their partner respect their body changes (Chang, Chao & Kenney, 2006). Apart from changes of appearance, a part of women complain about the uncomfortable sexual live caused by a reluctant vaginal delivery, and they were refused by the professionals when they asked to have a Caesarean delivery (Petrucka, Bassendowski, Marie Dietrich- leurer, Cara Spence- gress & Buza, 2015). This illustrates that women are unsatisfied with the medical institution by the adverse consequences caused by their unwanted decisions.
Raile Alligod et al (2014) announce that it is important to adapt the stimuli and keep mental and physical stability. Thus, women need to adapt to those physical discomforts with nurses’ help, which help them to have a better childbirth experience, for instance, relaxing by taking a deep breath.
understand and know what will happen and what they should do in every stage, for example, instructing women on some small tips about delivery process, like using abdominal pressure during intermittent periods rather than the uterus contracts. Thus, their pain will be relieved once they find comfortable positions with nurses help (Green et al., 2003). When nurses care women who had experienced a delivery, they should pay more attention to their physical and mental recovery. For physical care, nurses should help women keep their wounds and vaginas clean to prevent complications. Nurses should also give women guidance on healthy diet and exercise which can help them get back in shape quickly (Fakhraei et al., 2017). What’s more, encouraging women’s partner to understand their wives’ pain and uncomfortable can also improve their experiences of childbirth.
4.2.4 Active support
The result shows that the first-time mothers are always lack of information about childbirth, so they have a great demand for obtaining effective messages. Luckily, their families, friends and professionals support them with various messages, which influences their experiences of childbirth in many ways (Kay et al., 2017; Dahlberg et al., 2015).
The quality of medical institutions affects women’s experiences of childbirth in the present research. A research shows that private clinic and hospitals provide services according to the medical fees instead of women's private needs, and there are more employees with poor quality working in the worse organizations (Petrucka et al., 2015). The medical level can also be reflected on many details, such as the environment, hospital legislation and even food. A clean and quiet room provides women with a good surrounding to rest and sleep. But some women complain that the visiting system of hospital is inappropriate, they are always interrupted by visitors and have poor sleep. Apart from that, some women always worry about parking fees, which is also a reason of their dissatisfaction of childbirth (Petrucka et al., 2015).
largely influence women especially at the beginning and the end of childbirth (Kay et al., 2017). Kay et al (2017) reveal that those people not only provide advice according to their experiences to women who are going to give a birth, but also take care of them and their infants after the delivery. This can largely release the women’s physical and mental burden. Another role that must be considered is their husbands. Different women have different opinions. Some women think their husbands’ company can help them relax during the delivery, while other women don’t think so. This might be related to culture differences in privacy and attitude towards sex (Petrucka et al., 2015).
The result also shows that the qualities of professionals directly affects women’s childbirth experiences. In general, the main problem is the communication between professionals and women. A medical staff’s attitude and respect for women largely influences childbirth experiences (Dahlberg et al., 2015). For instance, a positive attitude always make women feel calm and warm. On the contrary, ignoring women’s demands and lacking conscious in providing professional information can let women feel afraid and helpless. A research shows that some women are worried about the way of health examination of their children, but they couldn’t get any medical messages from professionals (Fakhraei et al., 2017). However, mixed and incomprehensible messages as well as poor empathy can also make women feel puzzled. Fakhraei et al (2017) points out a common phenomenon that nurses don’t provide guidance and demonstration of breastfeeding after the delivery.
should provide a relaxing environment for them, such as playing soft music in the delivery room (Dahlberg et al., 2015).
4.3. Method discussion
According to Polit & Beck (2012), a review should be performed using the following steps: proposing the research topic, formulating processes and plans, searching relevant literature, discussing, analyzing and summarizing the effective information. This is also the way present study had been made. The authors used a descriptive design to describe women’s experiences before- and after giving birth for the first time in this descriptive review. According to Polit and Beck (2012), most qualitative articles are more suitable than quantitative articles to describe one’s experiences. Therefore, the authors selected seven qualitative articles and three quantitative articles.
In this review, the authors used PubMed as a database and used the Boolean operators "AND" and "OR" in different combinations to collect articles which are related to the theme. According to Polit and Beck (2012), the study of inclusion and exclusion criteria should be specific.
In order to ensure the objectivity and completeness of the article, the authors read these articles without any subjective judgment or communication. After that, the authors discussed the selected articles and then listed and combined all the effective ideas.
4.4. Suggestions for future research
The aim of the study is the women’s experiences before- and after giving birth for the first time, so the authors tried to find as many articles as possible about different delivery ways in the database. However, few qualitative studies about vaginal delivery with epidural anesthesia could be found on the database. So, there is a need for further studies to describe women’s experiences of giving birth by vaginal with epidural anesthesia. The authors also encourage more scholars to conduct a research on a wider range of physical and psychological aspects and women in different countries or of different ages. Another interesting area of research might be to explore if there is any difference in the woman’s experiences when giving birth for the first time or second time etc. To sum up, these will make meaningful contributions to women’s experiences of childbirth.
4.5. Clinical implication for nursing
their mental conditions and communicate with them frequently because they may have a postpartum depression. Partners gave women a positive sense of support during the delivery, which helped women responding to childbirth positively.
5.Conclusions
6. Reference
* Articles included in the result of the study
*Aasheim, V., Waldenström, U., Rasmussen, S., & Schytt, E. (2013). Experience of childbirth in first-time mothers of advanced age – a Norwegian population-based
study. BMC Pregnancy and Childbirth,
http://www.biomedcentral.com/1471-2393/13/53, 1-8.
Adams, E. D., Stark, M. A., & Low, L. K. (2016). A nurse’s guide to supporting physiologic birth. Nursing for Womens Health, 20(1), 76-86.
Aschenbrenner, A. P., Hanson, L., Johnson, T. S., & Kelber, S. T . (2016). Nurses" own birth experiences influence labor support attitudes and behaviors. Journal of Obstetric, Gynecologic & Neonatal Nursing, 45(4), 491-501.
*Askari, F., Atarodi, A., Torabi, S. & Moshki, M. (2014). Exploring Women's Personal Experiences of Giving Birth in Gonabad City: A Qualitative Study. Global Journal of Health Science, 6(5), 46-54.
Balaam, M. C., Akerjordet, K., Lyberg, A., Kaiser, B., Schoening, E., Fredriksen, A. M., Ensel, A., Gouni, O. & Severinsson, E. (2013). A qualitative review of migrant women’s perceptions of their needs and experiences related to pregnancy and childbirth. JOURNAL OF ADVANCED NURSING, 69(9), 1919–1930.
Capogna, G. , Alahuhtat, S. , Celleno, D. , Vlieger, H. D. , & Vertommen, J. D. . (1996). Maternal expectations and experiences of labour pain and analgesia: a
multicentre study of nulliparous women. International Journal of Obstetric Anesthesia, 5(4), 229-235.
Carquillat, P., Vendittelli, F., Perneger, T., & Guittier, M. J. (2017). Development of a questionnaire for assessing the childbirth experience (QACE). BMC Pregnancy and Childbirth, 17(1), 279.
Chang, S. R. , Chao, Y. M. Y. , & Kenney, N. J. . (2006). I am a woman and I’m pregnant: body image of women in taiwan during the third trimester of pregnancy. Birth, 33(2), 147-153.
Cheung, N. F. , & Pan, A. . (2012). Childbirth experience of migrants in china: a systematic review. Nursing & Health Sciences, 14(3), 362-371.
Cronin, C. & Mccarthy, G. (2003). First-time mothers - Identifying their needs, perceptions and experiences. Journal of Clinical Nursing, 12(10), 260–267.
Dahlberg, U. , Persen, J. , Skog?S, A. K. , Selboe, S. T. , Torvik, H. M. , & Aune, I. . (2015). How can midwives promote a normal birth and a positive birth experience? the experience of first-time norwegian mothers. Sexual & Reproductive Healthcare, S1877575615000609.
*Fakhraei, R. & Terrion, J. L. (2017). Identifying and Exploring the Informational and Emotional Support Needs of Primipara Women: A Focus on Supportive Communication. The Journal of Perinatal Education, 26(4), 195-207.
Gibbins, J. , & Thomson, A. M. . (2001). Women"s expectations and experiences of childbirth. Midwifery, 17(4), 0-313.
Green, J. M. , & Baston, H. A. . (2003). Feeling in control during labor: concepts, correlates, and consequences. Birth, 30.
*Guittier, M. J., Cedraschi, C., Jamei, N., Boulvain, M. & Guillemin, F. (2014). Impact of mode of delivery on the birth experience in first-time mothers: a qualitative study. BMC Pregnancy and Childbirth, 14:254, 1-9.
Hege, T. S., Garthus-Niegel, S. , Vangen, S. , & Eberhard-Gran, M. . (2012). The impact of previous birth experience on maternal fear of childbirth. Acta Obstetricia Et Gynecologica Scandinavica, 92(3), 318-324.
Heidi, P. , Yael, B. , Malin, E. G. , & Susan, G. N. . (2018). Childbirth preferences and related fears - comparison between norway and israel. Bmc Pregnancy & Childbirth, 18(1), 362-.
Hodgkinson, E.L., Smith, D.M., & Wittkowski,A. . (2014). Women’s experiences of their pregnancy and postpartum body image: a systematic review and meta-synthesis. BMC Pregnancy and Childbirth, 14(330), 1-11.
Kay, L. , Downe, S. , Thomson, G. , & Finlayson, K. . (2017). “engaging with birth stories in pregnancy: a hermeneutic phenomenological study of women’s experiences across two generations”. BMC Pregnancy and Childbirth, 17(1), 283.
Kinney, M. V., Boldosser-Boesch, A., & Mccallon, B. (2016). Quality, equity, and dignity for women and babies. The Lancet, 388(10056), 2066-2068.
Lally, J. E. , Murtagh, M. J. , Macphail, S. , & Thomson, R. . (2008). More in hope than expectation: a systematic review of women"s expectations and experience of pain relief in labour. Bmc Medicine, 6(1).
Larkin, P., Begley, C. M., & Devane, D. (2009). Women's experiences of labour and birth: an evolutionary concept analysis. Midwifery, 25(2), 49-59.
Levine, M. S. , & Lowe, N. K. . (2015). Measuring nurse attitudes about childbirth: revision and pilot testing of the nurse attitudes and beliefs questionnaire. Journal of Nursing Measurement, 23(2), 287-301.
Lewis, L., Hauck, Y. L., Ronchi, F., Crichton, C. & Waller, L. (2016). Gaining insight into how women conceptualize satisfaction: Western Australian women’s perception of their maternity care experiences. BMC Pregnancy and Childbirth, 16(29), 1-9.
*Lupton, D. & Schmied, V. (2012). Splitting bodies selves: women’s concepts of embodiment at the moment of birth. Sociology of Health & Illness, 35(6), 828-841.
Man, W., Qing, S., Jun, X., Zheng, H., Yingying, G., Arier, C. L., & Qi, C.(2018). Continuous support during labour in childbirth: a Cross-Sectional study in a university teaching hospital in Shanghai,China. BMC Pregnancy and Childbirth, 18(480), 1-7.
Michaels, & Paula, A. . (2018). Childbirth and trauma, 1940s–1980s. Journal of the History of Medicine & Allied Sciences, 73(1), 52-72.
Mirko, P. , & Tavčar, K. M. . (2018). Perspectives and experiences of healthcare professionals regarding the medicalisation of pregnancy and childbirth. Women & Birth, S187151921730505X-.
Moghaddamhosseini, V. , Nazarzadeh, M. , & Jahanfar, S. . (2017). Interventions for reducing fear of childbirth: A systematic review and meta-analysis of clinical trials. European Congress of Psychiatry. Women Birth.
*Nilsson, L., Thorsell, T., Wahn, E. H. & Ekström, A. (2013). Factors Influencing Positive Birth Experiences of First-Time Mothers. Nursing Research and Practice, http://dx.doi.org/10.1155/2013/349124, 1-6.
Olieman, R. M., Siemonsma, F., Bartens, M. A., Garthus-Niegel, S., Scheele, F. & Honig, A. (2017). The effect of an elective cesarean section on maternal request on peripartum anxiety and depression in women with childbirth fear: a systematic review. BMC Pregnancy and Childbirth, 17(197), 1-8.
Organization, W. H. (2015). WHO | Prevention and elimination of disrespect and abuse during childbirth.
Organization, W. H. (2016). Standards for improving quality of maternal and newborn care in health facilities. Geneva Switzerland WHO.
Petronellah, L. , Susanna, M. C. , & Benadé Petronella. (2018). Women’s experiences of continuous support during childbirth: a meta-synthesis. Bmc Pregnancy &
Childbirth, 18(1), 167.
Petrucka, P. , Bassendowski, S. , Marie Dietrich- leurer, Cara Spence- gress, & Buza, J. . (2015). Maternal, newborn and child health needs, opportunities and preferred futures in arusha and ngorongoro: hearing women's voices. BMC Research Notes, 8(1), 1-10.
*Puia, D. (2018). First-Time Mothers’ Experiences of a Planned Cesarean Birth. The Journal of Perinatal Education, 27(1), 50-60.
Raile Alligod, M., & Marriney Tomey, A(current edition). (2014). Nursing Theorists and Their Work, Elsevier Mosby, 281-302.
Rondung, E. , Johanna Thomtén, & Örjan Sundin. (2016). Psychological perspectives on fear of childbirth. Journal of Anxiety Disorders, 44, 80-91.
Rooeintan, F., Borzabad, P. A. & Yazdanpanah, A. (2016). The Impact of Healthcare Reform Plan on the Rate of Vaginal Delivery and Cesarean Section in Shiraz (Iran) in 2015. Electronic Physician, 8(10), 3076-3080.
*Scarton, J., Prates, L.A., Wilhelm, A. L., Silva, S. C., Possati, A. B., Ilha, C. B. & Ressel, L. B. (2015). “It was worth it when I saw his face”: experiences of primiparous women during natural childbirth. Rev Gaúcha Enferm, 36(spe), 143-151.
Taheri, M., Takian, A., Taghizadeh, Z., Jafari, N. & Sarafraz, N. (2018). Creating a positive perception of childbirth experience: systematic review and metaanalysis of prenatal and intrapartum interventions. Reproductive Health, 15(73), 1-13.
Tumblin A, Simkin P. (2001)Pregnant women's perceptions of their nurse's role during labor and delivery. Birth issues in perinatal care.28(1):52-6.
childbirth; a prospective cohort study. BMC Pregnancy and Childbirth, http://www.biomedcentral.com/1471-2393/14/208, 1-7.
Wiklund, I. , Edman, G. , Ryding, E. L. , & Andolf, E. . (2008). Expectation and experiences of childbirth in primiparae with cesarean section. Bjog An International Journal of Obstetrics & Gynaecology, 115(3), 324-331.
Appendix
Table2. Overview of selected articles.
Authors and year/country of publication Title Design (possible approach)
participants Data collection method(s) Data analysis Method(s) Study code Aasheim , V., Waldenström , U., Rasmussen , S., & Schytt , E. Year of publication: 2013 Country:Norwegi an Experience of childbirth in first-time mothers of advanced age – a Norwegian population-base d study A quantitative approach with questionnaires . Number: 30065 participants. Age: ≥32 years
The patients who around gestational week 17 and 30, and at 6 months postpartum.
Based on the National Norwegian Mother and Child Cohort Study (MoBa) conducted by
the Norwegian Institute of Public Health. Data on 30065 nulliparous women recruited in the second trimester 1999–2008 were used.Three questionnaires. Medical data were retrieved from the national Medical Birth Register. Descriptive and multiple logistic regression analyses were conducted. Statistical analyses. Student’s t-test and chi-square
tests.Bivariate analyses.
Askari, F., Atarodi, A., Torabi, S. & Moshki, M. Year of publication: 2014 Country: Iran Exploring Women's Personal Experiences of Giving Birth in Gonabad City: A Qualitative Study A qualitative approach./The Husserlian phenomenolog ical approach. Number: 21 participants. Age: age of 19-29 years. The patients who gave a normal and or
uncomplicated giving birth in the hospital of Gonabad University of medical sciences.
The open and
semi-structured interactional in-depth interviews took place 2 to 3 weeks.The interviews were conducted in a calm and silent room that was a special place in their own choice. The inteview time was 45-60 minutes. All interviews started with an open-ended and narrative questions. A qualitative content analysis method followed the descriptions based on Colaizzi procedural steps. B Fakhraei, R. & Terrion, J. L. Year of publication： 2017 Country: Germany Identifying and Exploring the Informational and Emotional Support Needs of Primipara Women: A Focus on Supportive Communication A quantitative approach. Number:300 participants. Participants who are first-time mothers and wrote a comment on their survey in answer to the last question.
Participants were asked to completed the questionnaire at The Ottawa Hospital and The Ottawa Hospital, General Campus Civic Campus during December 2014 to December 2015.
Guittier, M. J., Cedraschi, C., Jamei, N., Boulvain, M. & Guillemin, F. Year of publication: 2014 Country:Germany Impact of mode of delivery on the birth experience in first-time mothers: a qualitative study A qualitative approach with in-depth interviews. Number: 24 participants. Age: over 18
All primiparous women delivered at term following pregnancies without major
complications were eligible for study inclusion. All modes of delivery were equally represented, irrespective of the analgesic methods used.
Face-to-face semi-structured interviews were conducted between 4 and 6 weeks' postpartum from January to July 2012. Open-ended questions.interviews lasted approximately 45 minutes. Interviews were tape-recorded and transcribed. The "MAXQDA 07" software was used to manage and analyse the qualitative data collected and conducted a thematic content analysis. D Hidaka, R. & Callister, L. C. Year of publication： 2012 Country: Germany Giving Birth With Epidural Analgesia: The Experience of First-Time Mothers A descriptive study/A qualitative approach. Number:11 participants. Age: 19 to 37 years Participants are first-time mothers who got epidural anesthesia and Healthy full-term babies through vagina.
Participants were interviewed in their homes after they had given birth for 4–6 weeks. And the interviews last for 60- to 90-minute and were recorded after getting informed consent of the participants. Collaborative analysis. E Lupton, D. & Schmied, V. Splitting bodies selves: women’ s concepts of A exploratory study /A qualitative Number: 25 participants. Age: 23 to 35 years The semistructured interviews took place 3 years. The interview place
A foucauldian with critical discourse
Year of publication：2012 Country:UK embodiment at the moment of birth
approach. Participants who were expecting their first child .
are participants’ homes. Participants were interviewed by two authors separately.
analysis approach. Nilsson, L., Thorsell, T., Wahn, E. H. & Ekström, A. Year of publication： 2013 Country: Sweden Factors Influencing Positive Birth Experiences of First-Time Mothers A qualitative design content analysis with written narratives. Number:14 participants. Participants are first-time mothers who can speak Swedish and have a healthy baby. They also not cared by the authors of the study.
This study was taken place during February to April 2008 in a hospital labor ward in a southwestern county of Sweden. Participants were asked to write at least one page about experiences of their first-time of giving birth.
Puia, D. Year of publication： 2018 Country: Germany First-Time Mothers’ Experiences of a Planned Cesarean Birth A qualitative method with in-depth interviews. Number:11 participants. Age: 28 to 50 years Participants must have had a birth of a live infant, must be able to read and write English and be a minimum of 18 years of age.
Participants tell their stories and provided demographic information by email or interview. The content of the interview were recorded and translated with the consent of the participants. Riessman's (1993, 2008) method of thematic narrative analysis. H Scarton, J., Prates, L.A., Wilhelm, A. L., Silva, S. C., Possati, A. B., Ilha, C. B. & Ressel, L. B. Year of publication: 2015 Country: Spain
“It was worth it when I saw his face”: experiences of primiparous women during natural childbirth A descriptive study/A qualitative approach. Number: 10 participants. Age: over 18.
Primiparous women with intact psycho-cognitive conditions, hospitalised in the scenario of the investigation in the data collection period and women who had given birth to
viable ,healthy ,full-term babies by vaginal delivery .
The data were collected through semi-structured interviews containing closed questions that sought to characterise the participants and the care provided during the parturitive process .The interviews were conducted in February ,March and April 2014 ,respecting the 24-hour postpartum period for data collection .
The data were subjected to thematic content analysis, according to the operative proposal.
Table3. Overview of selected articles’ aims and main results.
Authors and
year/country of publication Aim Result
Aasheim , V., Waldenström , U., Rasmussen , S., & Schytt , E.
To further, investigate the association between advanced maternal age in primiparous women and the postnatal
A1 Background characteristics
A2 Nulliparous women's feelings about the upcoming birth in relation to maternal age Ulfsdottir , H., Nissen , E., Ryding, E. L., Egloff, D. L., & Itzel, E. W. Year of publication: 2014 Country:Sweden The association between labour variables and primiparous women’s experience of childbirth; a prospective cohort study A quantitative approach with questionnaires . Number: 446 participants. Age: a gestational age between 37–42 weeks. Healthy,Swedish-speakin g, nulliparous women, with singleton
pregnancy . Labour should have started spontaneously, the foetus should be in a cephalic presentation, the cervical dilation should be at least 3 cm and regular, painful contractions should be present.
The Wijma Delivery Experience Questionnaire (W-DEQ B) .
Socio-demographic and obstetric background data were collected from the antenatal and delivery records.
Year of publication: 2013 Country:Norwegian
assessment of the birth experience.
Askari, F.,
Atarodi, A., Torabi, S., & Moshki, M. Year of publication: 2014
Country: Iran
To explore women's personal
experiences of giving birth for the first time in Gonabad city.
B1 Feeling Relaxation in Giving Birth Environment B2 Giving Confidence to Laborer
B3 Reduction of Stress from Unnecessary Practices (Routines) Fakhraei, R. & Terrion, J. L.
Year of publication： 2017 Country: Germany
To explore and understand women’s experiences of labor and giving birth for the first time in relation to supportive communication, including both emotional support and informational support.
C1 Information support C2 Emotional support C3 Instrumental support
Guittier, M. J., Cedraschi, C., Jamei, N., Boulvain, M. & Guillemin, F.
Year of publication: 2014 Country:Germany
To determine important elements associated with women’s first delivery experience according to the mode of delivery: vaginal or caesarean section.
D1 Representations and expectations
D2 Role of the relationship with caregivers and the father during delivery
D3 Privacy
D6 Perceived control D7 Emotions
D8 First moments with the baby D9 Imagining a second pregnancy Hidaka, R. & Callister, L. C.
Year of publication： 2012 Country: Germany
To understand the birth experiences for the first time of women using epidural analgesia for pain management.
E1 Characteristics of participants and their births E2 Giving birth using epidurals
E3 Coping the pain before opting for an epidural E4 Finding epidural administration uneventful E5 Feeling relief using an epidural
E6 Experiencing joy
E7 Being left with unsettled feelings Lupton, D. & Schmied, V.
Year of publication：2012 Country:UK
To explore the ways in which women who had very recently given birth for the first time described both their own embodiment and that of their infants at this highly significant time and how the mode of delivery may have an impact on women’s experiences.
F1 Loss of control and the painful opening of the maternal body F2 Ambiguity and the unknown
F5 The absent maternal body F6 The absent infant body Nilsson, L., Thorsell, T., Wahn, E. H.
& Ekström, A.
Year of publication： 2013 Country: Sweden
To describe first-time mothers’
experiences and reflections of their first birth.
G1 To Trust the Body and to Face the Pain (Body strength, Manage pain)
G2 Interaction between Body and Mind in Giving Birth (Control, Satisfaction, Patience, Happiness)
G3 Consistency of Emotional Support (Create trust, Presence, Responsiveness) G4 Individualized support to women during labor increases
their chances for a positive birth experience Puia, D.
Year of publication： 2018 Country: Germany
To explore the overall experience of a planned cesarean birth (either for medical or social reasons) including the entire birthing process; beginning with the preceding factors that influenced first-time mothers to have a planned cesarean birth, including the physical and emotional experience of the birth itself, and concluding with the postpartum period and complete recovery.
H1 The decision, not much of a choice H2 Acceptance of birth method H3 Emotional roller coaster of birth H4 Physical recovery (Feeling like myself)
H5 Emotional recovery (A kaleidoscope of feelings) H6 Expectations (Apicture in mind)
Scarton, J.,
Prates, L.A., Wilhelm, A. L., Silva, S. C., Possati, A. B., Ilha, C. B., & Ressel, L. B.
Year of publication: 2015 Country: Spain
To know the experiences of
primiparous women in relation to the care provided by nursing professionals during natural childbirth.
I1 The fear of not being able to give birth naturally and the encouragement of the nursing staff
I2 The experience of pain in natural childbirth I3 Support versus distance
I4 Good or bad childbirth experience? “It was worth it in the end!” Ulfsdottir , H., Nissen , E., Ryding, E.
L., Egloff, D. L., & Itzel, E. W. Year of publication: 2014 Country:Sweden
To explore the association between labour variables and primiparous women’s experience of childbirth.
J1 Background characteristics for the 446 women J2 Labour outcome of the 446 women
J3 Outcome at delivery of the 446 newborns delivered in the study J4 Result of additional questions from the included women
Table 4. Synthesized finding, categories and findings from the included studies.
Synthesized finding Categories Study finding
“Changes”(H7)
“Personality characteristics of others and their childbirth experience”(E1)
A decision about vaginal delivery with epidural anesthesia “Representations and expectations”(D1)
“Personality characteristics of others and their childbirth experience”(E1)
“Finding epidural administration uneventful” (E2,E4)
A decision about Caesarean “The sensory of unprepared”(D8,H6) “Loss power of decision”(D6)
“Good childbirth experience and worth”(J2) “Emergency”(H1)
Psychological aspects of before- and after giving birth
Negative emotions “Fear, Inspired and Confident”(B2,I1) “Reduction of Stress”(B3)
“Disappointed”(A2) “Negative feeling” (D7, J2)
