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Utdragen förlossning: kvinnors upplevelser och erfarenheter
Umeå University, Faculty of Medicine, Nursing. Umeå University, Faculty of Medicine, Clinical Sciences, Obstetrics and Gynaecology.
2005 (Swedish)Doctoral thesis, comprehensive summary (Other academic)Alternative title
Prolonged labour : women's experiences (English)
Abstract [en]

Aim: The overall aim of this thesis was to illuminate, describe, and promote understanding of women’s experiences of prolonged labour. The thesis compromises four studies.

Methods: Paper I describes a case-referent study that recruited women (n = 255) giving singleton live birth to their first child by spontaneous labour after more than 37 completed weeks’ pregnancy. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships, and childhood experiences. Paper II presented a cross-sectional study of 644 women who had been expecting their first child. Participants were asked to complete a questionnaire measuring psychosocial resources (social network and support), work-related psychosocial factors, control of daily life, and health characteristics. Papers III and IV presented interviews performed with 10 women, who, following prolonged labour, had given singleton live birth to their first children.

Results: The risk of a negative birth experience was increased for women following prolonged labour. Both women experiencing prolonged and normal labours perceived the support given by their partners and midwives during labour to be very important, and felt pain relief to be a key issue. The suffering experienced during labour was more likely to mark the women for life if the labour was prolonged than if the experience of giving birth was positive and labour was normal. Both women, including those who had and those who had not experienced prolonged labour reported a high level of psychosocial resources, support, and sense of wellbeing in early pregnancy.

The difficulties of prolonged labour were interpreted as an experience of being caught up in pain and fear: the women described how they had felt exhausted, powerless, and out of control. They described their dependency on others, and said that the caregiver’s decision to assist with the delivery was experienced as being relieved from pain. Prolonged labour could be understood as an experience of suddenly falling ill or of finding oneself in a life-threatening condition associated with an overwhelming fear of losing oneself and the child.

The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like “fumbling in the dark”. Women had experienced bodily fatigue accompanied by feelings of illness and detachment from the child. Meeting the child when in this condition entailed a struggle to become a mother. The negativity connected with prolonged labour and a struggle for motherhood may be comparable to the experience of illness and recovery. In spite of these experiences, reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged their interaction and relationship with the child, and contributed to their adaptation to motherhood.

Conclusion: Women experiencing prolonged labour require advanced medical and obstetric care, which may limit their ability to participate in making decisions about their care. They have a special need for extra support and encouragement, as well as increased nursing and midwifery care during delivery.

Place, publisher, year, edition, pages
Umeå: Omvårdnad , 2005. , 69 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 978
Keyword [en]
Caring sciences, Childbirth experience, dystocia, illness, normal labour, prolonged labour, psychosocial resources, social network, social support, thematic content analysis, wellbeing
Keyword [sv]
Vårdvetenskap
National Category
Nursing
Research subject
Caring Sciences
Identifiers
URN: urn:nbn:se:umu:diva-579ISBN: 91-7305-917-X (print)OAI: oai:DiVA.org:umu-579DiVA: diva2:143850
Public defence
2005-09-16, Aulan, Vårdvetarhuset, Umeå Universitet, Umeå, 13:00 (English)
Opponent
Supervisors
Available from: 2005-08-31 Created: 2005-08-31 Last updated: 2009-11-26Bibliographically approved
List of papers
1. The negative birth experience of prolonged labour: a case-referent study.
Open this publication in new window or tab >>The negative birth experience of prolonged labour: a case-referent study.
2005 (English)In: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 14, no 5, 579-586 p.Article in journal (Refereed) Published
Abstract [en]

AIMS: This study aimed to analyse and describe women's different perceptions and experiences of childbirth following prolonged or normal labour. BACKGROUND: In clinical practice prolonged labour, or dystocia, is a common delivery complication often causing a negative birth experience. METHOD: Women giving singleton live birth to their first child with spontaneous labour after more than 37 completed weeks' pregnancy at three hospitals in northern Sweden were recruited to a case-referent study. Cases (n = 84) were women following a prolonged labour with assisted vaginal or abdominal delivery, and referents (n = 171) delivered following a normal labour. Participants completed a questionnaire that investigated childbirth experiences, previous family relationships and childhood experiences. RESULTS: Women with prolonged labour had a negative childbirth experience more often (34%) than did women who had a normal labour (4%) (P < 0.05). Cases agreed significantly more than the referents with the statement, 'Pain relief during the delivery saved me' (OR 4.5, 95% CI: 1.9-11.1) and 'My difficulties during the delivery will mark me for life' (OR 12.4, 95% CI: 4.4-35.9). There were no differences between the cases and referents regarding perceived experience of professional or social support. RELEVANCE TO CLINICAL PRACTICE: To improve care, midwives and doctors can alleviate pain and relieve the negativity and difficulty associated with the experience of prolonged labour from the perspective of the woman giving birth.

Identifiers
urn:nbn:se:umu:diva-22232 (URN)10.1111/j.1365-2702.2004.01105.x (DOI)15840072 (PubMedID)
Available from: 2009-04-29 Created: 2009-04-29 Last updated: 2017-12-13
2. Low psychosocial resources during early pregnancy are not associated with prolonged labour.
Open this publication in new window or tab >>Low psychosocial resources during early pregnancy are not associated with prolonged labour.
2006 (English)In: European Journal of Obstetrics, Gynecology, and Reproductive Biology, ISSN 0301-2115, E-ISSN 1872-7654, Vol. 125, no 1, 29-33 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVES: To examine if a low level of psychosocial resources in early pregnancy is associated with the occurrence of prolonged labour. STUDY DESIGN: A cross sectional study of 644 women expecting their first child. Participants were asked to complete a questionnaire at their first antenatal visit, measuring psychosocial resources defined as social network and support, work-related psychosocial factors, control of daily life and health characteristics. Outcome was prolonged labour at the end of the pregnancy. RESULTS: A low level of psychosocial resources was not associated with prolonged labour. The majority of women reported that the degree of support was high in early pregnancy. CONCLUSIONS: A perceived low level of psychosocial resources in early pregnancy did not increase the risk of prolonged labour at the subsequent delivery.

Keyword
Adult, Body Height, Female, Humans, Obstetric Labor Complications/etiology/*psychology, Pregnancy, Pregnancy Outcome, Pregnancy Trimester; First, Prospective Studies, Psychosocial Deprivation, Social Support
Identifiers
urn:nbn:se:umu:diva-6678 (URN)10.1016/j.ejogrb.2005.02.028 (DOI)16026919 (PubMedID)
Available from: 2008-04-09 Created: 2008-04-09 Last updated: 2011-04-08Bibliographically approved
3. Some Swedish women's experiences of prolonged labour.
Open this publication in new window or tab >>Some Swedish women's experiences of prolonged labour.
2006 (English)In: Midwifery, ISSN 0266-6138, E-ISSN 1532-3099, Vol. 22, no 1, 56-65 p.Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: to elucidate women's experiences of prolonged labour. DESIGN: qualitative research interviews were conducted and thematic content analysis was applied. PARTICIPANTS: 10 primiparae who, 1-3 months previously, had a prolonged labour with assisted vaginal or caesarean delivery. FINDINGS: the narratives about giving birth were interpreted and formulated into three themes and six sub-themes. The first theme, 'being caught up in labour', described the sense of not making progress during labour. The second theme was 'being out of control', and was related to the women's insufficient control of their own bodily processes, and consisted of descriptions of exhaustion and powerlessness. The third theme was 'being dependent on others', and described the women's dependence on care and on the support of the caregivers, and included descriptions of caregivers' assistance with birth as an experience of being relieved from pain and distress. KEY CONCLUSIONS: the experience of giving birth was not the experience of a healthy woman in labour, but one of severe labour pains that seemed to go on forever. The experience of prolonged labour could be understood as an experience of suddenly falling ill or finding oneself in a life-threatening condition associated with intractable pain, dependence on others and an overwhelming fear of losing oneself. IMPLICATIONS FOR PRACTICE: women with prolonged labour are more dependent on their caregivers than are women without prolonged labour. They have a special need for extra support and encouragement during the delivery as well as increased nursing and midwifery care.

Keyword
Adult, Anxiety/psychology, Continuity of Patient Care, Dystocia/*psychology, Female, Humans, Infant; Newborn, Labor Stage; Second/*psychology, Midwifery/*methods, Mothers/*psychology, Narration, Pregnancy, Questionnaires, Social Support, Sweden
Identifiers
urn:nbn:se:umu:diva-6685 (URN)10.1016/j.midw.2005.05.003 (DOI)16488810 (PubMedID)
Available from: 2008-04-09 Created: 2008-04-09 Last updated: 2011-04-08Bibliographically approved
4. Women's experiences of becoming a mother after prolonged labour.
Open this publication in new window or tab >>Women's experiences of becoming a mother after prolonged labour.
2008 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 63, no 3, 250-258 p.Article in journal (Refereed) Published
Abstract [en]

AIM: This paper is a report of a study to explore women's experiences of becoming a mother after prolonged labour. BACKGROUND: The negativity associated with a complicated labour such as prolonged labour can lead to a struggle to become a healthy mother and could restrict the process of becoming a mother. METHODS: Interviews were conducted in 2004 with 10 mothers who had been through a prolonged labour with assisted vaginal or caesarean delivery 1-3 months previously. Thematic content analysis was used. FINDINGS: Three themes were formulated, describing women's experiences as fumbling in the dark, struggling for motherhood and achieving confidence in being a mother. The difficulties and suffering involved in becoming a mother after a prolonged labour were interpreted to be like 'fumbling in the dark'. Women experienced bodily fatigue, accompanied by feelings of illness and detachment from the child. Having the child when in this condition entailed a struggle to become a mother. In spite of these experiences and the desire to achieve confidence in being a mother, the reassurance of these women regarding their capacity for motherhood was crucial: it was central to their happiness as mothers, encouraged interaction and relationship with the child, and contributed to their adaptation to motherhood. CONCLUSION: Women experiencing prolonged labour may be comparable with the experience of and recovery from illness, which could contribute to difficulties transitioning to motherhood and limit a woman's ability to be emotionally available for the child.

Identifiers
urn:nbn:se:umu:diva-21808 (URN)10.1111/j.1365-2648.2008.04636.x (DOI)18518904 (PubMedID)
Available from: 2009-04-20 Created: 2009-04-20 Last updated: 2017-12-13

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