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International Journal of Behavioral Medicine

Erschienen in:

28.07.2017

Women’s Experiences of Childbirth in Serbian Public Healthcare Institutions: a Qualitative Study

verfasst von: Biljana Stankovic

Erschienen in: International Journal of Behavioral Medicine | Ausgabe 6/2017

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Abstract

Purpose

The aim of the present study was to explore how women, users of public maternity healthcare services in Serbia, experience birth and what the most problematic relational aspects of institutional context associated with negative or even traumatic aspects of birth experiences are, as described by the women themselves.

Method

An exploratory qualitative study was undertaken using semi-structured interviews with 15 primiparous women aged 26 to 49 who have recently given birth in different public healthcare institutions in Belgrade. The basic framework for the analysis of interview transcripts was the interpretative phenomenological analysis (IPA).

Results

Through the analysis, four relatively broad and partly interrelated themes emerged: (a) feelings of isolation and abandonment, (b) lack of communication, (c) lack of a caring relationship, and (d) lack of control and agency. The aspects of institutional environment that were considered particularly distressing in most of the childbirth experiences are related to distant and cold relationship with healthcare providers which adds to the feelings of isolation and abandonment, in addition to the lack of insight into and control over the process of birth that is managed in the hospital context without relying on women’s subjective involvement in any relevant way.

Conclusion

The present study emphasized a supportive and caring relationship with medical practitioners, as well as allowing women to be more involved into their birthing process, as crucial for positive experience of birth, which might have profound and long-lasting psychosocial consequences. Recommendations for policy makers and future research are offered.

Evidence suggests that between 1 and 6% of women develop post-traumatic stress disorder (PTSD) after childbirth if measured by DSM-IV criteria [12, 16], but around 30% of women are partially symptomatic, e.g., report the presence of at least some of the trauma symptoms [12, 13, 17].

While this aspect is almost universally recognized as crucial, there are some indications that the importance of control might be the subject of class and regional differences [30]. It is also suggested that for marginalized women, control and proper care are even harder to negotiate [8, 18].

Although the first private maternity ward has recently been opened in Belgrade, it is unavailable to the great majority of Serbian women.

Maternal healthcare is publicly financed through mandatory social healthcare insurance and provided through a network of medical institutions organized on three levels—university hospitals and clinical centers, maternity departments in general hospitals, and small unit maternity departments within primary health care institutions [36].

Average satisfaction score was around 4.3 on a 5-point Likert scale and around 80% of women gave mark 5 or 4 [36].

Some authors also report that quantitative measures of birth satisfaction can be biased and skewed towards positive evaluations, so they may differ significantly from what is obtained in qualitative research [8].

Due to time and resource restrictions and a number of methodological difficulties (e.g., I regularly talked to the women in crowded hospital rooms with babies present, which often made either recording or later transcription of the material unfeasible).

A typical strategy in local circumstances is looking for personal connections or choosing a doctor [35], in hope that he will serve as a woman’s advocate within the medical system [30]. However, having a connection (private or paid) is not a guarantee, because attitudes toward women patients and existing communication norms are widely accepted and considered non-problematic by the caregivers, so women can hardly find a way to avoid them.

With one exception—cesarean section is the only intervention for which women’s written consent is regularly asked for.

An additional consequence of this is a complete violation of privacy, since the women giving birth often can see other women across them.

Since it allows the number of staff to be reduced and involves less work for them, because they can oversee the progression of labor of multiple women at the same time.

Previous studies have shown that the presence of a labor companion might serve as a protective factor against the neglect by the medical practitioners [49].

This woman did not feel the urge to push so doctors and midwives pressed her belly (which is a rather common practice in local institutions) and finished the labor using forceps.

No education, incomplete primary education, complete compulsory primary education, and lower secondary education.

The same goes for multiparous mothers when compared to primiparous, and in this study, only primiparous women were interviewed.

Expectations and the discrepancy between the expectations and real experience are shown to be important determinants of childbirth experience and satisfaction [5, 19, 52].

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Titel: Women’s Experiences of Childbirth in Serbian Public Healthcare Institutions: a Qualitative Study
verfasst von: Biljana Stankovic
Publikationsdatum: 28.07.2017
Verlag: Springer US
Erschienen in: International Journal of Behavioral Medicine / Ausgabe 6/2017
Print ISSN: 1070-5503
Elektronische ISSN: 1532-7558
DOI: https://doi.org/10.1007/s12529-017-9672-1

Springer Medizin

Abstract

Purpose

Method

Results

Conclusion

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