Psychological effects of physical childbirth on women: a meta-analysis

Roars Skewt

doi:10.37532/jlcb.2023.6(2).013-019

Editorial - Journal of Labor and Childbirth (2023) Volume 6, Issue 1

Psychological effects of physical childbirth on women: a meta-analysis

Roars Skewt^{^*}

Department of Psychology, University of Michigan

*Corresponding Author:

Roars Skewt
Department of Psychology, University of Michigan
E-mail: roars3@um.ac.us

Received: 09-Feb-2023, Manuscript No. jlcb-23-93070; Editor assigned: 10-Feb-2023, PreQC No. jlcb-23- 93070 (PQ); Reviewed: 24-Feb-2023, QC No. jlcb-23-93070; Revised: 27- Feb-2023, Manuscript No. jlcb-23- 93070(R); Published: 28-Feb-2023, DOI: 10.37532/jlcb.2023.6(2).013-019

Abstract

Methods: Qualitative studies of women’s psychological experiences with physiological birth were eligible. The following databases were searched by the research team: PsycARTICLES, SocINDEX, MEDLINE, CINAHL, PsycINFO, and the Psychology and Behavioural Sciences Collection. We contacted important authors and looked through the reference lists of the collected articles. Using the checklist from the Critical Appraisal Skills Programme (CASP), independent quality assessment was carried out. Meta-ethnographic methods were used to synthesize the studies. Results included were eight studies with 94 women in them. There are three possible third-order interpretations: ”maintaining selfconfidence in early labor,” “withdrawing within as labor intensifies,” and “the uniqueness of the birth experience” are just a few of the topics covered. Utilizing the first, second and third request understandings, a line of contention fostered that illustrated ‘the engaging excursion of conceiving an offspring’enveloping the different feelings, contemplations and ways of behaving that ladies experience during birth. End conceiving an offspring physiologically is an extraordinary and extraordinary mental experience that produces a feeling of strengthening. Physical, emotional, and social support for women can maximize the benefits of this process by strengthening their belief in their ability to give birth and not interfering with their physiology unless absolutely necessary. The psychological experience of physiological childbirth can have empowering effects on healthcare providers. It is necessary to conduct additional research to verify the findings of this study. Conclusion: The physiological birthing process is an intense, life changing, and empowering psychological experience. Physical, emotional, and social support for women can maximize the benefits of this process by strengthening their belief in their ability to give birth and not interfering with their physiology unless absolutely necessary. The psychological experience of physiological childbirth can have empowering effects on healthcare providers. It is necessary to conduct additional research to verify the findings of this study.

Keywords

Psychology • Behavioural science • Labor • Birth experience • Offspring • Critical appraisal skills programme

Introduction

Birth is a profound psychological experience that has a short and long term physical, psychological, social, and existential impact. Women remember it vividly for the rest of their lives. The experience of giving birth can have positive and empowering effects or negative and traumatizing effects. Regardless of their cultural background, women must share their birth experiences in order to fully comprehend an emotionally and physically taxing experience. Neurobiological, hormones produced by the maternal and fetal brains control childbirth. Both the mother’s and the father’s brains are immersed in an extremely unique neuro hormonal scenario that cannot be artificially reproduced. These neuro hormones, in addition to particular cultural and personal issues, are likely to play a role in regulating the psychological aspects of childbirth.

The altered state of consciousness that midwives and mothers easily recognize or describe as “labor land” is likely caused by the peaks of endogenous oxytocin during labor and the progressive release of endorphins in the maternal brain. However, this phenomenon has received little attention from neuropsychology. In order to meet the emotional and psychosocial needs of laboring women, obstetricians and midwives need a thorough understanding of the emotional aspects of childbirth. Having a sense of control over the birth experience, the opportunity to actively participate in care and support, and being responsive are all factors that contribute to a positive birth experience. Mismanagement of the birthing process can result from this ignorance of the psychological aspect of childbirth. Even when the immediate outcome is a physically healthy mother and newborn, a lack of understanding of the psychology of childbirth can contribute to a traumatizing birth that can be devastating to women. Disrespect, mistreatment, or in some cases, obstetric violence can be experienced by women in labor when caregivers fail to address their emotional needs. The issue of disrespect for women in labor is becoming a global concern, as is the excessive application of medicalized care practices for healthy women. Rates for these mediations fluctuate significantly. Macfarlane et al.(2016), for instance, used Euro-Peristat data from 2010 to report a range of spontaneous vaginal births from 45.3% to 78.5%.

This meta-synthesis aims to locate and synthesize published qualitative studies that focus on the immediate psychological responses that women experience during labor and birth and describe the psychological process of women during physiological childbirth. We hypothesized that physiological labor is accompanied by a common psychological experience. We focus on the thoughts and feelings of laboring women as well as the meanings they assign to their perceptions of the childbirth process and the environment, as the reactions to both the childbirth and the environment are parts of the same psychological process.

Methods

We carried out a meta-analysis. According to Thomas and Harden (2008), this is the process of reviewing and consolidating qualitative research in order to produce a summary of qualitative findings and permit the creation of new interpretations. A number of qualitative studies can be qualitatively synthesized to produce solid evidence that can be used to guide healthcare procedures. In order to develop a conceptual model that transcends the findings of individual study accounts, the qualitative synthesis approach deemed most appropriate for this analysis was meta-ethnography. This synthesis method has the potential to provide a higher level of analysis and generate new conceptual understandings. The seven step process described by Noblit and Hare, which employs line of argument synthesis in addition to reciprocal and refutational metaethnographic techniques, served as the basis for this meta-synthesis thesis. The meta-synthesis was informed by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statements. The examination convention was enrolled and distributed in the International Imminent Register of Orderly Reviews. Patients and public were not associated with the plan, origination or direct of this review.

Data Sources

In March 2016, a comprehensive search was carried out, which was updated in October 2017. Included were the following databases: MEDLINE, CINAHL, PsycINFO, PsycARTICLES, SocINDEX, and the Psychology and Behavioural Sciences Collection are all available on EBSCOhost. Online supplementary appendix 1 lists the search terms. We didn’t use MeSH terms because we used EBSCOhost for the entire search. The English, Spanish, and Portuguese versions of the eligible papers were used. Five gatherings of two writers freely read the edited compositions and chosen the articles. The choice to incorporate an article was accomplished by agreement. A third author provided assistance and input when disagreements arose. We looked through reference arrangements of the included articles to distinguish extra articles that were pertinent to the review question. We looked for articles and suggestions from experts in the field.

Required Criteria for Study

Physiological childbirth was defined as a continuous process without major interventions like induction, augmentation, instrumental assistance, caesarean section, or the use of epidural anesthesia or other painkillers for the purposes of our study. The inclusion rules were (1) unique examination of (2) ladies who had physiological labor and (3) depicted their encounters and ways of behaving during (4) the entire interaction of labor. Studies were ruled out if the birth experience was (1) described by someone other than the woman who gave birth (2) only described a single stage of the process, or (3) described births that required major medical and surgical interventions or pain management.

Data Collection

The following steps were included in data analysis: All of the studies were read and reread for the first order interpretation. The findings of each of the included studies were coded line by line by the first author (IO). In the initial studies, quotes, interpretations, and explanations were considered data. The categories of coding included: feelings, behaviors (or actions), signs (like pain or contractions), relationships (like the midwife, partner, baby, and relatives), perceptions of time, and cognitions (like thoughts and knowledge) include home, water, places, and transferring. These coding categories were sorted into early labor, intense labor, pushing, baby out (immediately), placenta, and evaluation of the entire birth experience based on the emerging data.

The research team considered the first order interpretations to identify the themes and subthemes that describe the emerging constructs based in the primary studies in order to achieve the second and third order interpretations. Reciprocal (similarity) and contradictory analysis were used in this process to identify differences, divergences, and dissonance between the studies and then to synthesize these translations. The research team used a line of argument to create a model that best explains the psychological process of physiological childbirth as described in the included studies following this reflection process.

Quality Control

All of the included papers were evaluated using the consolidated criteria for reporting qualitative research to ensure that they had reported all of the relevant details of their methodological and analytical approach. This was done to ensure the quality of the study’s findings.

Reflexibility

The authors investigated and identified their own perspectives as potential influences on the decisions made throughout the research process. This was done to maintain the study’s methodological rigor due to the subjective nature of qualitative research. This paper’s authors are all part of a COST Action funded by the EU that focuses on physiological birth. The group of researchers decided to participate in the COST Action IS1405 Building Intrapartum Research Through Health (BIRTH) due to their strong interest in the importance of understanding the physiological and psychological processes of childbirth in order to improve women’s abilities to labor and give birth normally wherever it is possible for them to do so. The majority of women and babies, according to the authors, experience a profound physiological, psychological, and social cultural birth.

Results

The search recognized 1520 articles in EBSCOhost. The sample contained 1144 unique articles after 376 duplicates were removed. The criteria for quality screening and evaluation were met by all of the selected studies. Because only a few participants did not have a physiological birth as defined by this study, some papers had to be excluded. The online supplement files provide detailed information about the CASP and COREQ assessments. There were 94 women in the eight included studies, including 28 primiparous and 22 multiparous women. However, four of the studies did not include a parity sample. Two of these studies included a mixture of primiparous and multiparous women (half each) and two of these studies did not even consider parity for the sample.

Meta Synthesis Analysis

There were three main themes: maintaining self-confidence during the early stages of labor, withdrawing internally as the labor progresses, and the individuality of the birth experience each of the three main themes contained a number of subthemes.

Enhancement of Self Confidence in Early Labor The events that women went through when they realized they were pregnant are depicted in this theme. According to the accounts, the majority of women preferred to wait calmly for progress while maintaining confidence by maintaining a familiar routine and environment.

Starting of Labor

When women realized they were having an early labor, they shared their emotions. Others described a lovely feeling and expressed excitement. At this point, the data emitted a variety of emotions, including excitement, happiness, calm, and occasionally apprehension and anxiety. Women valued conserving emotional strength and maintaining a positive outlook.

Beginning of the Labor

Women shared the beginning of labor with other women when they recognized it. Before calling the hospital or the midwife, they typically called their mother or sister. Very few people at this point asked their midwife to be with them.

Accepting the Normal Life

Continuing with one’s usual routine appeared to be the most common behavior during labor. There were numerous descriptions of wanting to remain at home, taking a shower, being mindful of the requirements of others and happily waiting.

Escaping Inside as Labor Increases

Women retreated into an inner world where time seemed to be suspended as the labor got harder. Women described how this inner space helped them feel like they could manage by allowing them to focus on the labor process. The feeling of being in control was nuanced and complex; for some, it meant being able to make all of the decisions, while for others, it meant feeling safe enough to hand over control or guardianship to the midwife so they could retreat into their inner laboring world.

Accepting the Intensity of Labor

When contractions became stronger and pain intensified, women felt the need to be fully focused on the physical task. At this point women really needed to be with safe companions in a protected place. This was the moment to contact the midwife and/or move to the hospital. Accepting pain as a natural part of childbirth was important for women because it framed the pain experience. Trusting in the body and dealing with pain were two important aspects of the response. During this time, women needed to be able to move around or else they would drown. Women said they wanted to be in charge, but this was different for each woman. Some people saw control as maintaining control and deciding what they required, while others saw control as the decision to delegate management to the midwives.

Proceeding to Inner World

Women talked about how they went inside themselves and focused on the importance of living in the present moment. Nothing else matters, and the universe kind of shrinks to this particular, you know this particular job that you have to do, which is you know about giving birth. Other words used include “narrowed,” “zone,” “faraway place,” “another planet,” and “private.”I withdrew myself, just like I did with my previous jobs. I don’t need people to look at me. Women talked about how they felt like time had changed or stopped. As if I had forgotten it in a drawer at home, my sense of time was completely gone. It was a strange sensation. You’re surrounded by a lot of people, but you’re in your own world. We were not in the same world even if we were in the same room. After some time as the force of the compressions and the torment expanded, ladies depicted sensations of dread and desperation. Some felt depleted and denied of energy. The possibility that they couldn’t go on any more, communicating fears of death. I was so hopeful in the start of the last option birth...I had conceived an offspring previously and I survived...so that you accept you will get by. However, during both births, I had the impression for a while that I would never make it.

Pushing Phase

Time was no longer suspended when women started pushing, and they became more active.

Self Empowering

Women said they felt different after processing their emotions. They incorporated this new knowledge and understanding of themselves into their sense of self. They described their birth as an experience of empowerment.

The Way of Giving Birth

The next step in a meta-synthesis that is based on interpretations of the first, second, and third orders is to build an argument. The line of argument for this study was “the empowering journey of giving birth,” which encompassed the various feelings, thoughts, and actions that women go through during labor. While cocooned in a familiar setting, women began their psychological journey by telling other women in their social network that labor had begun. At the beginning of labor, the majority of women tended to withdraw into their own world and focus on maintaining self-control. Women’s states of consciousness changed as the birth process went on, including a shift in how they saw time and intense emotions like the fear of dying. Women talked about a variety of ways to deal with the pain and keep control, which paradoxically included giving control to the midwife when it was needed. Women felt like they were becoming more alert and active once more when they felt the need to push. The predominant emotions following the birth of the baby were pride and joy. Personal strength grew as a result of the birth experience.

Discussion

As a meta-synthesis on this topic, our study provides novel insights into women’s psychological experience of physiologic childbirth. We developed a behavioral and emotional based model of the emerging psychological pattern of this journey. Women described giving birth as a difficult but mostly positive experience that they were able to overcome with the assistance of others and their own coping mechanisms. This gave them the confidence they needed to face a new challenge with their family. Our results back up our main hypothesis: The psychological experience of physiological labor is common. This has not previously been reported using women’s accounts as primary data, as far as we are aware. According to our findings, giving birth is both a physical and a mental experience. Overall, according to our meta-analysis, women expressed confidence in their ability to give birth and trust in themselves and the process, despite some apprehension when labor began and some concerns, such as death phobia, during the most intense stages. Women’s positive birth experiences were linked to positive perceptions of their own coping strategies and confidence in their ability to give birth. Women’s psychological experience of physiological childbirth is strongly influenced by the people present at their birth. Women said that their partners and mothers, as well as caregivers, and close relatives were very important to how they felt about giving birth. Women confirmed that human birth is a social event by stating that their partner was the person with whom they most closely shared their experience and relied for support. This is in line with other studies that emphasized the significant contribution partners can make to feelings of trust and the woman’s desire for a physiological birth. Women rated the presence of the midwife as critically important. Women tended to want to be alone and away from the midwife at the beginning of the labor, but as the labor progressed, they wanted the midwife to be more visible and present while supporting the woman’s control or taking control if the woman wanted to. Our study relied heavily on control.

Women’s internal control includes a sense of self control, including thoughts, emotions, behaviors, and coping with labor pain. Over the years, various researchers have identified various internal and external dimensions of control. The term “external control” refers to a woman’s participation in the birth process, understanding what medical professionals are doing, and having an impact on decisions. What appears to be essential to ladies isn’t really ‘having control’, but instead the emotional part of control, which is the ‘feeling’ of having influence, having the option to have something to do with what occurs and having guardians who are receptive to communicated wishes. Women’s external control also seemed to come from the belief that they were well informed and could, if necessary, challenge decisions.

This meta-synthesis demonstrates how crucial it is to have compassionate maternity care providers, such as midwives, present at the birth to support women in maintaining a sense of control that is tailored to their specific requirements and preferences. By providing women with emotional support, encouraging trust and confidence, and encouraging meaningful others to be present during the birthing process, care providers can help women feel more coherent. Women who are giving birth need to be able to form a trusting relationship with the midwives and obstetricians who are attending to them. This relationship should provide them with reassurance and enable them to feel in control. Women may be more likely to have a psychologically positive physical birth if they feel like they are being cared for by a companion or healthcare provider who is sympathetic and sensitive to their cues, such as a midwife in the included studies. This includes helpful responses for the woman when she needs them, as well as straightforward support, information, or encouragement to reassure the woman that what is happening to her is normal. Women may be able to trust that they are safe to focus inward, which makes it easier for hormones to be released and allows the maternal behaviors necessary for a physiological labor and birth to progress. By supporting a woman’s belief in her own ability to give birth, midwives and other caregivers, including obstetricians, can facilitate this process. These are essential skills and abilities that have been identified in midwifery led care and are recommended for worldwide implementation. Further examination is required in ladies from various social foundations. In addition, gaining insight into the psychological experience of giving birth in women who experience complications during pregnancy or childbirth is crucial. As labor is a neuro biological occasion coordinated by neuro hormones created both by the maternal and fetal brain, further exploration needs to address the interrelationship between neuro hormones, mental experience and physiological work and birth. From a mental health and physical wellbeing perspective, a positive, physiological labor and birth can be beneficial. The findings will raise awareness of the significance of optimizing physical birth as much as possible to improve maternal mental health and challenge the biomedical “stages of labor” discourse. Physical, emotional, and social support for women can maximize the process’s benefits by strengthening their belief in their ability to give birth and not disrupting their physiology unless absolutely necessary.

Conclusion

Psychologically, giving birth physiologically in the presence of caregivers who are sympathetic and supportive seems to produce a sense of empowerment during the transition to motherhood. Physical, emotional, and social support for women can maximize the benefits of this process, boosting their confidence in their ability to give birth without disrupting their physiology unless absolutely necessary. The psychological experience of physiological childbirth has empowering effects, and healthcare professionals must be aware of these. It is necessary to conduct additional research to verify the findings of this study.

References

Consistency of women's long-term memories of their first birth experiences. Birth. 19, 64- 81 (1992).

Journal of Labor and Childbirth

Psychological effects of physical childbirth on women: a meta-analysis

Abstract

Keywords

Introduction

Methods

Results

Discussion

Conclusion

References

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