Women's Birth Beliefs During Pregnancy and Postpartum in the Netherlands: A Quantitative Cross-Sectional Study.

INTRODUCTION: Women and care providers increasingly regard childbirth as a medical process, resulting in high use of medical interventions, which could negatively affect a woman's childbirth experience. Women's birth beliefs may be key to understanding the decisions they make and the acceptance of medical interventions in childbirth. In this study we explore women's beliefs about birth as a natural and medical process and the factors that are associated with women's birth beliefs. METHODS: Data were obtained from a cross-sectional survey of women living in the Netherlands asking them about their experiences during pregnancy and childbirth, including their beliefs about birth as a natural and medical process. RESULTS: A total of 3494 women were included in this study. Mean scores of natural birth beliefs ranged between 3.73 and 4.01 points, and medical birth belief scores ranged between 2.92 and 3.12 points. There were significant but very small changes between prenatal and postnatal birth beliefs. Regression analyses showed that (previous) childbirth experiences were the most consistent predictor of women's birth beliefs. DISCUSSION: Women's high scores on natural birth beliefs and lower scores on medical birth beliefs correspond with the philosophy of Dutch perinatal care that considers pregnancy and childbirth to be natural processes. Perinatal care providers must be aware of women's birth beliefs and recognize that they as professionals influence women's birth beliefs. They make an important contribution to women's perinatal experiences, which affects both women's natural and medical birth beliefs.

Women's decision-making autonomy in Dutch maternity care.

BACKGROUND: A positive childbirth experience is an important outcome of maternity care. A significant component of a positive birth experience is the ability to exercise autonomy in decision-making. In this study, we explore women's reports of their autonomy during conversations about their care with maternity care practitioners during pregnancy and childbirth. METHOD: Data were obtained from a cross-sectional survey of women living in The Netherlands that asked about their experiences during pregnancy and childbirth, including their role in conversations concerning decisions about their care. RESULTS: A total of 3494 women were included in this study. Most women scored high on autonomy in decision-making conversations. During the latter stage of pregnancy (32+ weeks) and in childbirth, women reported significantly lower levels of autonomy in their care conversations with obstetricians as compared with midwives. Linear regression analyses showed that women's perception of personal treatment increased women's reported autonomy in their conversations with both midwives and obstetricians. Almost half (49.1%) of the women who had at least one intervention during birth reported pressure to accept or submit to that intervention. This was indicated by 48.3% of women with induced labor, 47.3% who had an instrumental vaginal birth, 45.2% whose labor was augmented, and 41.9% of women who had a cesarean birth. CONCLUSIONS: In general, women's sense of autonomy in decision-making conversations during prenatal care and birth is high, but there is room for improvement, and this appeared most notably in conversations with obstetricians. Women's sense of autonomy can be enhanced with personal treatment, including shared decision-making and the avoidance of pressuring women to accept interventions.

Integrating women's voices in quality improvement for maternity care: A qualitative study.

INTRODUCTION: Improving the quality of maternity care is high on the national agenda in the Netherlands. One aspect gaining significant attention is integrating women's experiences - as users of maternity care - in this quality improvement. The aim of this study was to gain deeper insights into how maternity care professionals in Dutch Maternity Care Collaborations integrate women's voices into quality improvement as part of integrated maternity care and what role midwives can have in this. METHODS: This was a descriptive qualitative study, using semi-structured individual interviews and content analysis for an in-depth exploration of maternity care professionals' experiences and opinions on integrating women's voices in quality improvement. Participants were twelve maternity care professionals involved in quality improvement activities from eight Dutch Maternity Care Collaborations. RESULTS: Four themes emerged: 'Quality improvement based on women's voices is still in its infancy' and was experienced as an important but challenging topic; 'Collecting women's voices' was conducted, but needed more facilitation; Using women's voices' was hindered by a lack of expertise and a structured feedback and feedforward system; and 'Ensuring listening to women's voices' and integrating them in quality improvement required further facilitation. CONCLUSIONS: Care professionals emphasized that listening to women's voices for quality improvement is important but challenging due to the lack of expertise, organizational structure, time, and financial resources. A feasible implementation strategy including concrete support is recommended by maternity care professionals to boost action.

Sources of information used by women during pregnancy and the perceived quality.

BACKGROUND: Access to reliable information is critical to women's experience and wellbeing during pregnancy and childbirth. In our information-rich society, women are exposed to a wide range of information sources. The primary objective of this study was to explore women's use of information sources during pregnancy and to examine the perceived usefulness and trustworthiness of these sources. METHOD: A quantitative cross-sectional study of Dutch women's experiences with various information sources during pregnancy, including professional (e.g. healthcare system), and informal sources, divided into conventional (e.g. family or peers) and digital sources (e.g. websites or apps). Exploratory backward stepwise multiple regression was performed to identify associations between the perceived quality of information sources and personal characteristics. RESULTS: A total of 1922 pregnant women were included in this study. The most commonly used information sources were midwives (91.5%), family or friends (79.3%), websites (77.9%), and apps (61%). More than 80% of women found professional information sources trustworthy and useful, while digital sources were perceived as less trustworthy and useful. Personal factors explain only a small part of the variation in the perceived quality of information sources. CONCLUSION: Even though digital sources are perceived as less trustworthy and useful than professional and conventional sources, they are among the most commonly used sources of information for pregnant women. To meet the information needs of the contemporary generation of pregnant women it is essential that professionals help in the development of digital information sources.

Validating a framework of women's experience of the perinatal period; a scoping review.

OBJECTIVE: The aim of this paper is to identify and explain the factors that make up a woman's experience of the perinatal period. We accomplish this by validating a framework, described in an earlier study, that identifies the distinct dimensions of the perinatal experience. DESIGN: We conducted a scoping review, using five online databases, to identify and categorize studies that investigate women's experience of the perinatal period. FINDINGS: We found 251 publications that focused on the experience of the perinatal period. Our review confirmed the seven dimensions of our framework describing women's experiences of the perinatal period - the woman as unique individual, the woman as active participant in care, the responsiveness of maternity care and health services, the lived experience of being pregnant, giving birth and the postpartum period, communication and relationships with care providers, information and childbirth education, and support from social environment. One new dimension emerged from the studies we identified: societal influence. The resulting eight dimensions provide a comprehensive overview of the important aspects of women's experience of the perinatal period. While each dimension is distinct, there are significant overlaps and close relationships between them. CONCLUSION: The framework is a useful guide for healthcare providers, researchers, and policy makers who wish to improve the experience of the perinatal period. It is important to remember, however, that the current framework is dynamic, open to new insights and further development and refinement.

Dimensions in women's experience of the perinatal period.

A positive experience of the perinatal period is significant for women in midwifery care. The literature on women's experiences of the care in this period is extensive. However, a clear overview of the dimensions important for women's experiences is lacking. Consequently, care providers and researchers may ignore aspects significant to women's experience. In this short communication, we present a framework identifying the dimensions relevant for women's experiences of the perinatal period.