The Subjective Experience of Pregnancy and the Expectations of Childbirth on a Medicalized World: a Qualitative Study
Abstract
Background: To become a mother represents, for many women, a challenging existential process. Women have to deal with countless changes and adaptations, which can be experienced as sources of imbalance but also as moments of personal enrichment. Currently, this process is influenced by the medicalization of pregnancy and childbirth, which may have positive or negative consequences to the individual experiences of pregnancy and childbirth.
Goals: This study aimed to deepen the understanding of the experience of pregnancy and expectations regarding childbirth in a group of women, in a context where pregnancy and childbirth are increasingly medicalized processes.
Methods: In this qualitative study, we used semi-structured interviews to collect data regarding the experience of pregnancy and regarding expectations about childbirth in a sample of women (n = 37), recruited in health care centres or obstetric clinics by research assistants. The individual interviews took place at their homes. Data resulting from these interviews, focusing on the relationship with the health team, the partner and the unborn baby, and on the moment of childbirth, were analysed using ALCESTE software. Two senior researchers, psychologists, conducted the content analysis. Investigator triangulation was achieved through independent content analysis by each researcher and subsequent discussion and consensual interpretation.
Results: Thirty-seven pregnant women were interviewed. Four classes emerged from the analysis: "Expectations about childbirth and baby health", “Significant relational experiences of the pastâ€, "Mother-baby relationship process" and “Health care in pregnancy". Results emphasize the desire of future mothers to have a quick childbirth, without stress and with minimal suffering and anxiety. Despite these worries, women described a positive subjective experience of pregnancy and a feeling of security related to the knowledge they attribute to health professionals.Â
Discussion: “Medicalization†seems to be perceived as positive and securing, with no mention to a sense of disempowerment or loss of control. Therefore, the existence of spaces for sharing disturbing experiences and expectations of childbirth is prophylactic,
contributing to the creation of conditions that foster positive expectations and mitigate fears related to childbirth.
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Adams, S., Eberhard-Gran, & M., Eskild, A. (2012). Fear of childbirth and duration of labour: a study of 2206 women with intended vaginal delivery. BJOG: An International Journal of Obstetrics and Gynaecology, 119. doi: 10.1111/j.1471-0528.2012.03433.x.
Bäckström, C., Thorstensson, S., Mårtensson, L.B.,Grimming, R., Nyblin, Y., & Golsäter, M. (2017). ‘To be able to support her, I must feel calm and safe’: Pregnant women’s partners’ perceptions of professional support during pregnancy. BMC Pregnancy and Childbirth, 17, 234-245. doi: https:// doi.org/10.1186/s12884-017-1411-8.
Betrán, A.P., Ye, J., Moller, A-B., Zhang, J., Gülmezoglu, A. M. & Torloni, M. R. (2016). The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLoS ONE, 11(2). doi:10.1371/journal.pone.0148343
Biggerstaff, D. (2012). Qualitative Research Methods in Psy-chology. In G. Rossi (Ed.). Psychology - Selected papers. Croatia: InTech. (pp. 175-206). http://www.intechopen.com/ books/psychology-selected-papers/qualitative-research-methods-in-psychology
Bunting, L., & McAuley, C. (2004). Research review: Teenage pregnancy and motherhood – The contribution of social support. Child and Family Social Work, 9(2), 207-216. doi: 10.1111/jj.1365-2206.2004.00335.x.
Camargo, B. V. (2005). Alceste: um programa informático de análise quantitativa de dados textuais. In M. A. S. Paredes, B. V. Camargo, J. C. JesuÃno, & S. M. Nóbrega (Eds.). Perspe-tivas Teórico-Metodológicas em Representações Sociais (pp. 511-539). João Pessoa, ParaÃba: Editora Universitária – UFPB.
Canavarro, M. C. (2001). Psicologia da Gravidez e da Mater-nidade. Coimbra: Quarteto.
Cheng, E., Rifas-Shiman, S. L., Perkins, M. E., Rich-Edwards, J. W., M. W. Gillman, Wright, R., & Taveras, E. M. (2016). The Influence of Antenatal Partner Support on Pregnancy Out-comes. Journal of Women’s Health, 25(7). 672-679. doi: 10.1089/jwh.2015.5462
Clay, E. C., & Seehusen, D. A. (2004). A review of postpartum depression for the primary care physician. Southern Medi-cal Journal, 97(2), 157-161. doi:10.1097/01.SMJ.0000091029. 34773.33
Correia, M. (1998). Sobre a maternidade. Análise Psicológica, 3(XVI), 365 – 371.
Denis, A., Parant, O., & Callahan, S. (2011). Post-traumatic stress disorder related to childbirth: a prospective longitu-dinal study in a French population. Journal of Reproductive and Infant Psychology, 29. doi: 10.1080/02646838.2010.513048.
Eriksson, C. Westman, G. R., & Hamberg, K. (2005). Experien-tial factors associated with childbirth-related fear in Swe-dish women and men: A population based study. Journal of Psychosomatic Obstetrics and Gynecology, 26. doi: 10.1080/01674820400023275.
Evans, K., Walters, K. A., Liechty, T., & LeFevour, K. M. (2016). Women's experiences of physically active leisure during pregnancy. Annals of Leisure Research, 19(4), 386-404. doi: 10.1080/11745398.2015.1135068.
Epifanio, M. S., Genna, V., De Luca, C., Roccella, M., & La Grutta, S. (2015). Paternal and Maternal Transition to Parenthood: The Risk of Postpartum Depression and Par-enting Stress. Pediatric reports, 7(2), 5872. doi:10.4081/pr.2015.5872.
Fenwick, J., Toohill, J., Creedy, D. K., Smith, J., & Gamble, J. (2015). Sources, responses and moderators of childbirth fear in Australian women: A qualitative investigation. Midwifery, 31. doi: 10.1016/j.midw.2014.09.003.
Ferrari, A. G., Piccinini, C. A., & Lopes, R. S. (2007). O bebê imaginado na gestação: aspectos teóricos e empÃricos. Psi-cologia em Estudo, 12(2), 305- 313. doi: 10.1590/S1413-73722007000200011.
Figueiredo, B., Costa, R., & Pacheco, A. (2002). Experiência de parto: Alguns factores e consequências associadas. Análise Psicológica, 2(XX), 203-217.
Figueiredo, B. (2001). Perturbações psicopatológicas da ma-ternidade. In C. Canavarro (Ed.). Psicologia da Gravidez e da Maternidade. Coimbra: Quarteto: (pp. 161-188).
Gibson, E. (2014). Women’s expectations and experiences with labour pain in medical and midwifery models of birth in the United States. Women and Birth, 27. doi: 10.1016/j.wombi.2014.05.002.
Glazier, R. H., Elgar, F. J., Goel, V., & Holzapfel, S. (2004). Stress, social support, and emotional distress in a commu-nity sample of pregnant women. Journal of Psychosomatic Obstetrics and Gynecology, 25(3-4), 247-255. doi: 10.1080/016748204000 24406.
Helman, C. (2007). Culture, Health and Illness (5ª Ed.). Lon-dres: Hodder-Arnold.
Hildingsson, I., Tingvall, M., & Rubertsson, C. (2008). Partner support in the childbearing period – A follow up study. Women & Birth, 21(4), 141-149. doi: 10.1016/j.wombi. 2008.07.003
Hill, C. L., Baird, W. O., & Walters, S. J. (2014). Quality of life in children and adolescents with osteogenesis imperfecta: a qualitative interview based study. Health Quality of Life Outcomes, 12(54). doi: 10.1186/1477-7525-12-54.
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(1), 330-340. doi: 10.1186/1471-2393-14-330.
Hung, C., & Chung, H. (2001). The effects of postpartum stress and social support on postpartum women’s health status. Journal of Advanced Nursing, 36(5), 676-684. doi: 10.1046/j.1365-2648.2001.02032.x
Image (2018). Alceste 2018 version Education: Un logiciel d’Analyse de Données Textuelles. Retrieved from www.image-zafar.com.
Justo, J. (2005). Trabalho de Parto, parto e nascimento: a influência dos factores psicológicos. Arquivos de Psiquia-tria, 2(1/2), 17-143.
Kitzinger, S. (1987). A experiência de dar à luz. São Paulo: Martins Fontes.
Lanes, A., Kuk, J.L., & Tamin, H. (2011). Prevalence and char-acteristics of postpartum depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health, 11, 302. doi: 10.1186/1471-2458-11-302.
Larsson, A., Wärna-Furu, C., & Näsman, Y. (2016). Expecting a child: pregnancy in light of an ontological health model. Scandinavian Journal of Caring Sciences, 30, 757–765. doi: 10.1111/scs.12302.
Lee, C. (2000). Psychology of women’s health: A Critique. In J. M. Ussher (Ed.). Women’s health: Contemporary interna-tional perspectives. London: The British Psychological Soci-ety (pp. 26¬40).
Lou, S., Frumer, M., Schlütter, M. M., Petersen, O.B., Vogel, I., & Nielsen, C.P. (2017). Experiences and expectations in the first trimester of pregnancy: a qualitative study. Health Expectations, 20(6), 1320-1329. doi: 10.1111/hex.12572.
Lydon, J., Dunkel-Schetter, C., Cohan, C. L., & Pierce, T. (1996). Pregnancy decision making as a significant life event: a commitment approach. Journal of Personality and Social Psychology, 71(1), 141-151. doi: 10.1037/0022-3514.71.1.141.
Malacrida, C., & Boulton, T. (2014). The best laid plans? Women’s choices, expectations and experiences in child-birth. Health, 18. doi: 10.1177/1363459313476964.
McKee, M. D., Cunningham, M., Jankowski, K. B., & Zayas, L. (2001). Health-related functional status in pregnancy: Re-lationship to depression and social support in a multi-ethnic population. Obstetrics and Gynecology, 97(6), 988-993. doi: 10.1016/s0029-7844(01)01377-1.
McKenzie-McHarg, K., Crockett, M., Olander, E., & Ayers, S. (2014). Think pink! A sticker alert system for psychological distress or vulnerability during pregnancy. British Journal of Midwifery, 22(8), 590-595. doi: 10.12968/bjom.2014.22.8. 590.
Moore, M. (2016). Multicultural Differences in women’s expectations of birth. ABNF Journal, 27(2), 39-43
Nagy, E., Molnar, P., Pal, A., & Orvos, H. (2011). Prevalence rates and socioeconomic characteristics of post-partum depression in Hungary. Psychiatry Research, 185, 113-20. doi: 10.1016/j.psychres.2010.05.005.
Pedreira, M., & Leal, I. (2015). Terceiro trimestre de gravidez: expectativas e emoções sobre o parto. Psicologia, Saúde & Doenças, 16. doi: 10.15309/15psd160210
Peñacoba-Puente, C., Carmona-Monge, F. J., MarÃn-Morales, D., & Gallardo, C. (2016). Evolution of childbirth expecta-tions in Spanish pregnant women. Applied Nursing Re-search, 29. doi: 10.1016/j.apnr.2015.05.017 0897-1897
Raphael-Leff, J. (1997). Gravidez: A história interior. Porto Alegre: Artes Médicas.
Reinert, M. (1990). Alceste - une méthodologie d'analyse des données textuelles et une application: Aurelia de Ge-rard de Nerval. Bulletin de Méthodologie Sociologique, 26(24), 24-54. doi: 10.1177/075910639002600103.
Rocha, T. S. G. (2012). As Cesarianas em Portugal Continen-tal – Fatores Explicativos. Dissertação de Mestrado em Economia. Universidade de Aveiro.
Rudolfsdottir, A. (2000). “I Am Not a Patient, and I Am Not a Childâ€: The Institutionalization and Experience of Pregnan-cy. Feminism & Psychology, 10(3), 337–350. doi: 10.1177/0959353500010003004
Salomonsson, B., Gullberg, M., Alehagen, S., & Wijma, K. (2013). Self-efficacy beliefs and fear of childbirth in nullip-arous women. Journal of Psychosomatics Obstetrics and Gynecology, 34. doi: 10.3109/0167482X.2013.824418
Saunders, B., Sim, J., Kingstone, T., Baker, S., Waterfield, J., Bartlam, B., Burroughs, H., & Jinks, C. (2018). Saturation in qualitative research: exploring its conceptualization and operationalization. Quality & Quantity, 52(4), 1893–1907. doi: 10.1007/s11135-017-0574-8.
Simkin, P. (1991). Just another day in a woman’s life? Part I: Women’s long-term perceptions of their first birth experi-ence. Birth, 18, 203-210. doi: 10.1111/j.1523-536x.1991.tb00103.x.
Simkin, P. (1992). Just another day in a woman’s life? Part II: Nature and consistency of women’s long term memories of their first birth experiences. Birth, 19, 64- 81. doi: 10.1111/j.1523-536x.1992.tb00382.x.
Simões, J. (2016). Cesariana – um indicador de qualidade de cuidados obstétricos – mito ou realidade. Dissertação de Mestrado. Instituto Ciências Biomédicas Abel Salazar.
Staneva, A., & Wittkowski, A. (2013). Exploring beliefs and expectations about motherhood in Bulgarian mothers: A qualitative study. Midwifery. doi: 29, 10.1016/j.midw.2012.01.008.
World Health Organization (2015). WHO Statement on Cae-sarean Section Rates. Retrieved from https://www.who.int/ reproduc-tivehealth/publications/maternal_perinatal_health /cs-statement/en/
Zar, M., Wijma, K., & Wijma, B. (2001). Pre- and Postpartum Fear of Childbirth in Nulliparous and Parous Women. Scan-dinavian Journal of Behaviour Therapy, 30. doi: 10.1080/02845710152507418.
DOI: https://doi.org/10.33525/pprj.v3i1.65
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