Background
The sense of security concept
Safety and risk concepts in the obstetric context
Formulation of the problem
Methods
Aim
Methodology
Literature search
Evaluation of data
Qualitative studies (Qualitative Checklist) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Author(s) | Was there a clear statement of the aims of the research? | Was a qualitative methodology appropriate? | Was the research design appropriate to address the aims of the research? | Was the recruitment strategy appropriate to address the aims of the research? | Was the data collected in a way that addressed the research issue? | Was the relationship between the researcher and participants adequately considered? | Were ethical issues taken into consideration? | Was the data analysis sufficiently rigorous? | Was there a clear statement of findings? | Is the research valuable? | |
Côté-Arsenault and Donato [76] | Y | Y | Y | Y | N | N | N | Y | Y | Y | |
Ekström et al. [85] | Y | Y | Y | N | Y | N | Y | Y | Y | Y | |
Halldorsdottir and Karlsdottir [77] | Y | Y | Y | N | Y | N | Y | Y | Y | Y | |
Karlström et al. [78] | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | |
Melender and Lauri [79] | Y | Y | Y | N | Y | N | Y | Y | Y | Y | |
Namey and Lyerly [81] | Y | Y | Y | N | Y | N | Y | Y | Y | Y | |
Persson and Dykes [83] | Y | Y | Y | N | Y | Y | Y | Y | Y | Y | |
Persson et al. [82] | Y | Y | Y | Y | Y | N | Y | Y | Y | Y | |
Persson et al. [87] | Y | Y | Y | Y | Y | Y | Y | Y | Y | Y | |
Quantitative studies (Cohort Study Checklist) | |||||||||||
Did the study address a clearly focused issue? | Was the cohort recruited in an acceptable way? | Was the exposure accurately measured to minimise bias? | Was the outcome accurately measured to minimise bias? | Did the authors identify all important confounding factors? Did they consider the factors in the design and/or analysis? | Was the follow-up of subjects sufficiently complete/long enough? | Were the results presented transparently and precisely? | Are the results plausible? | Can the results be applied to the local population? | Do the results of this study fit with other available evidence? | Does the study have implications for practice? | |
Melender and Lauri [80] | Y | Y | Y | Y | NA | Y | Y | Y | Y | Y | Y |
Persson and Dykes [84] | Y | Y | Y | Y | NA | Y | Y | Y | Y | Y | Y |
Data analysis
Qualitative studies | ||||||
---|---|---|---|---|---|---|
Authors and country | Objective | Study sample and inclusion criteria | Research design and data collection method(s), instrument(s) | Method(s) of analysis | Key findings | Limitations |
Côté-Arsenault and Donato [76], USA | To describe women’s late pregnancy after loss experiences | Purposive sampling; n = 69 pregnant women | Qualitative, longitudinal study Pregnancy calendar entries and field notes provided from 10 to 17 weeks gestation to birth | Thematic analysis | Previous experiences influenced the sense of security in the subsequent pregnancy. Assessing foetal movements and regular feedback from a care provider contributed to a sense of security. | Relatively unstructured and extensive data collection |
Ekström et al. [85], Sweden | To explore fathers’ feelings and experiences during pregnancy and childbirth | Purposive sampling; n = 8 first-time and experienced fathers | Qualitative, inductive approach Written interviews (data collection after birth) | Content analysis | Being prepared to welcome the baby gave first-time fathers a sense of security. The confidence in healthcare professionals contributed to paternal sense of security. The lack of control over the beginning of the childbirth created insecurity. | Recruitment by midwives at two maternity wards Small sample size Only five of twenty fathers returned their written interviews Data from the pilot study was included in the analysis |
Halldorsdottir and Karlsdottir [77], Iceland | To explore the essential structure of the experience of childbearing from the perspective of women | Purposive sampling; n = 14 mothers | Qualitative, phenomenological approach Interactive interviews | Thematic analysis | Feeling safe was perceived as a need while in labour and delivery. Fulfilment through the support and presence of a midwife and the partner reduced fear and encouraged admittance to the birth. | Small sample No statement about the period of data collection The results refer to a limited geographic area, and thus, a cultural and social group of participants was represented in this study |
Karlström et al. [78], Sweden | To describe women’s experiences of a very positive birth experience | Purposive sampling; n = 26 first-time and experienced mothers | Qualitative (part of a prospective longitudinal cohort study) Focus group discussions (6–7 years after giving birth) | Thematic analysis | Feeling safe was an essential part of positive birth experiences and was confirmed by the presence of the child’s father, a trustful relationship with the midwife, and a positive atmosphere in the birthing suite. Feeling safe was essential to gaining control during birth. | The timing of recruitment: 6–7 years after the index birth Relatively homogenous sample group |
Melender and Lauri [79], Finland | To describe security associated with pregnancy and childbirth | Convenience sampling; n = 20 Finnish women (primiparous and multiparous) during pregnancy | Qualitative Semi-structured interviews (23–36 weeks of gestation) | Content analysis | The elements creating security associated with pregnancy and childbirth were maternity healthcare, social support, a sense of control and one’s own attitudes. If the feeling of security was lessened during pregnancy, a search for support was performed through the women’s social network and contact with the midwife or obstetrician. | The sampling strategy is insufficiently described |
Namey and Lyerly [81], USA | To deconstruct the term “control” as used by childbearing women | Purposive sampling; 101 mothers n = 39 (primiparous women) and n = 62 (multiparous women) who had given birth in various birthplaces and experienced different modes of delivery | Qualitative Semi-structured interviews (between April 2006 and July 2009) | Data analysed using NVivo software. Method of key word concept analysis by Quinn | Part of the definition of control relates to personal security, which encompasses feelings of physical safety and emotional and psychological attributes of security, such as comfort and confidence in one’s surroundings. Management of the birth experience and minimisation of anxiety or fear are associated with feelings of personal security. | Sample: Only parous women Recruitment primarily from a defined geographical area The recruitment method was held constant across the predefined sampling characteristics |
Persson and Dykes [83], Sweden | To reveal factors that influence the experiences of mothers and fathers when they choose to return home | Purposive sampling; n = 12 (first-time and experienced) parents | Qualitative. Grounded theory Open interviews (2–3 weeks after giving birth) | Coding by Strauss and Corbin | The most important factors for creating a sense of security for the parents were the midwife’s empowering behaviour, affinity within the family, autonomy and sense of control and physical well-being. | Purposive recruitment from one hospital by using theoretical sampling strategy Restricted variety of experiences by only healthy participants |
Persson et al. [82], Sweden | To describe factors influencing mothers’ sense of security during the first postnatal week | Purposive sampling; n = 14 mothers | Qualitative descriptive design Open interviews and focus group discussions (2–11 weeks after giving birth) | Thematic content analysis by Burnard | Mother’s postnatal sense of security was dependent on support from staff, support from the partner, and the mother’s and baby’s physical health and well-being. | Variation in time span for conducting the interviews Participants with lower educational levels were under-represented |
Persson et al. [86], Sweden | To explore and describe factors that influence fathers’ sense of security during the first postnatal week | Purposive sampling; n = 13 fathers | Qualitative Open interviews and focus group discussions (3–9 weeks after childbirth) | Thematic content analysis by Burnard | Participation in the processes of pregnancy, birth and early parenthood fostered fathers’ postnatal sense of security. Fathers felt secure when they had someone knowledgeable to ask and when they were heard and taken seriously. | Variation in time span for conducting the interviews |
Quantitative studies | ||||||
Authors and country | Objective | Study sample and inclusion criteria | Research design and data collection method(s), instrument(s) | Method(s) of analysis | Key findings | Limitations |
Melender and Lauri [80], Finland | To describe elements creating a sense of security associated with pregnancy and childbirth, the manifestation and the influence of background factors | n = 329 (primiparous and multiparous) women who were 16–40 weeks pregnant; 69% response rate | Quantitative, descriptive design Structured questionnaire Development of the instrument was based on a pilot study and review of the literature | Factor analysis, Kruskal-Wallis test, and Mann-Whitney U-test |
Elements that created a sense of security
1. Support from relatives (REP 12.4%) 2. Knowledge about pregnancy, childbirth and childcare (REP 10.5%) 3. Prenatal healthcare experiences and support from healthcare professionals (REP 8.8%) 4. Support from the partner (REP 8.5%) 5. Livelihood (REP 7.6%) 6. Positive stories heard about pregnancy, childbirth and baby care (REP 7.5%)
Elements creating security in relation to background factors
Knowledge about pregnancy, childbirth and childcare was reported significantly more often by experienced mothers. Prenatal healthcare experiences create security significantly more often in women without pregnancy-related problems compared to those with such problems. Support from the partner was reported significantly more often by women without pregnancy-related problems than those with such problems. | Limitations were not stated |
Persson and Dykes [84], Sweden | To evaluate dimensions of both parents’ postnatal sense of security during the first week after childbirth | n = 113 mothers and n = 99 fathers of every fifth baby born live at term at five hospitals in southern Sweden; 71% response rate (mothers) and 63% response rate (fathers) | Evaluative, cross-sectional design Postal questionnaire consisted of background questions, parents’ postnatal sense of security (PPSS) instrument and State Trait Anxiety Inventory (STAI) trait instrument (8 weeks postpartum) | Mann-Whitney U-test and multiple regression analysis | First-time mothers felt significantly less postnatal security than experienced mothers. A sense of midwives’ empowering behaviour and a sense of personal well-being (for mothers) were significantly associated with security. For mothers, parity was significantly associated with security together with a sense of participation in care, a sense of the partner’s participation during pregnancy, expected positive childbirth and security experienced during birth. For fathers, a sense of participation during pregnancy was significantly associated with security. | There was no analysis of the dropouts due to the study design |
Results
Theme 1. The meaning and manifestation of sense of security
Theme 2. Sense of security in relation to confidence and control
Theme 3. The lack of feeling secure and coping strategies
Theme 4. Factors influencing sense of security
Internal factors | Emotional state, knowledge and experiences |
─ Autonomy [81] | |
─ Comfort [81] | |
─ Feeling of not being alone [79] | |
─ Confidence in one’s surroundings [81] | |
Physical health of mother and child | |
─ Active self-care and care of unborn child [76] | |
External factors | Attributes and acts of supporting persons |
─ Being seen as an individual [82] | |
─ Support from relatives [80] | |
Settings and options of maternity care | |
─ Prenatal visits and ultrasound [76] | |
─ Positive atmosphere in the birthing suite [78] | |
─ Avoiding interventions [81] | |
─ Planned follow-up after birth [82] | |
Personal life situation | |
Internal factors | Own emotional state, knowledge and experiences |
─ Lack of control over the beginning of birth [85] | |
─ Concern about not arriving at the delivery ward in time and having to deliver the baby themselves [85] | |
─ Confidence in healthcare professionals [85] | |
─ Knowing who to ask [86] | |
─ Affinity to mother of the common child [81] | |
External factors | States of health of mother and child |
─ Emotional well-being of the mother [84] | |
Attributes and acts of supporting persons | |
─ Cooperation with the midwife [85] | |
─ Information from friends and midwives [85] | |
─ Being heard and taken seriously [86] | |
─ Being given confirmation about the normality of the situation [86] | |
─ Being given relevant and consistent information and explanations [86] | |
Settings and options of maternity care | |
─ Parental education meetings [85] | |
─ The opportunity to be together with the mother and child at hospital [86] | |
─ Postnatal visits at home [83] | |
Personal live situation | |
─ Returning home after childbirth [86] | |
─ Possibility of being together with the mother and child at home [86] |