Doctors don't. (Woman, IDI, 30‐45 years). A doula is a woman trained and experienced in childbirth. After all, how easy is it to bite your tongue after being abruptly cut off in mid-sentence by your manager? A recent article in the New York Times boiled it down to the domestic tasks that typically fall on wives and mothers—planning the children’s school lunches, reminders to take out the trash, etc.—that must be done to keep a household running smoothly. Create an appropriate emotion for the situation. The statements above exemplify the spiritual needs of a Nigerian woman during childbirth, as most women agreed that they would like health facilities where spiritual support could be provided. But at that moment, I know that if the decision of ‘let's give her blood’ should come up, I know he would decide it on my behalf, yes, he should decide it on my behalf. The strengths of this study include that the research team was warmly accepted by participants who expressed their views on the subject freely with openness and readiness. According to the WHO, quality of care during childbirth in health facilities reflects both how care is provided and how care is experienced, within the available physical infrastructure, supplies, management, and human resources with the knowledge, skills, and capacity to deal with pregnancy and childbirth.8 Research demonstrates that it is necessary to go beyond maximizing coverage of essential interventions to accelerate reductions in maternal and perinatal mortality and severe morbidity.9 Moreover, there is a complex interplay of experiences of mistreatment and lack of support that impact women's childbirth experiences and outcomes.10, 11 Good experiences in the health facilities may encourage the further use of health facilities and bad experiences may discourage the use of health facilities. (Doctor, FGD, 30‐45 years). We conducted 42 IDIs and 10 FGDs between January and May 2015. nurses and visitors will also be in the same room… sleeping on the floor, this is not adequate. However, doctors agreed that most of them “have that kind of communication problem,” and that as a solution to the problem they “as health providers need to learn and train” themselves “more on how to communicate effectively, learn to break information [down] to patients and relatives in very simple terms and clear terms they can understand.” A doctor further explained it this way: It is also believed that communication using simple words is an important way to make the work of healthcare providers easier and ultimately improve the experience of women and their relative during childbirth. Women do not want healthcare providers to “think of what they handle every time” a woman is in labor during their shift. How Many Years of Life Will a Bad Relationship Cost You? Women stated that such a companion could equally serve as a bridge to any communication gaps between the healthcare provider and the woman. It is noted that when a woman is properly counselled in a way that she understands, it will be easier to convince her to follow medical advice if a complication should arise. Most women believe that it is not “right for you to be having like 3, 4, 5 people at the labor room at the same time.” (Woman, FGD, 30–45 years). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. To the Editor. This type of continuous support during labor and childbirth has been identified as a crucial component of sensitive and responsive woman‐centered care, and has demonstrated effectiveness at improving women's and newborn's health outcomes.23, 24. We are concerned with the statistically significant difference in childbirth education afforded these patients. Individuals who met the inclusion criteria in each group were interviewed. J Psychosom Obstet Gynecol 18(4): 286–91. Sometimes they will say what has she done based on my relationship with the husband or sometimes they will come if it is not the sex they prefer, some will leave their wife in the hospital premises, they will abandon them and go, not even minding what they are going to eat…But when they [the men] are there…I think it will have impact on them and they will appreciate their wife more and they will know it is not easy. There were 2616 births during the study period (January to May 2015), and seven maternal deaths were reported. Care providers’ perspectives on disrespect and abuse of women during facility-based childbirth in Africa: a qualitative systematic review protocol. Emotional Labor 1. 3. Guess what the person is feeling. 1997. Prior to data collection, the teams received 2 days of training on the study protocol, interview guides, and research ethics. Why are so many people drawn to conspiracy theories in times of crisis? Findings from this study have directly informed the development of the “Passport to Safer Birth,” as the needs, expectations, and gaps in how care is provided to pregnant women have been identified and prioritized in Nigeria.28 The Passport to Safer Birth is a set of tools designed to help increase demand for quality of care during childbirth in health facilities, and aims to facilitate better communication between women and their providers during pregnancy and childbirth, and provides information to women in a clear, simple, and culturally‐appropriate way. Some women preferred their mother (especially) or mother‐in‐law (occasionally), sister, or friend as labor companion, rather than their husbands or partners. Most of the women agreed that they would like to have a labor companion, with only a few objecting to this idea. Most women agreed that having their husbands beside them during childbirth was desirable, and would like this to be made policy in Nigeria. This manuscript is reported according to the Consolidated Criteria for Reporting Qualitative research (COREQ) checklist.33, The study was conducted in the Mother and Child Hospital (MCH) in Akure, the capital of Ondo State, and in its urban catchment area and two peri‐urban/rural catchment areas of Akure—all in the Southwest of Nigeria. Studies have equally shown that women whose husbands were involved in their pregnancy‐related matters had a higher level of psychological well‐being and lower levels of depressive symptoms compared with women who reported no father involvement during pregnancy.44 A major reason stated by women in this study for preferring their husbands as their labor companion is because they want to be deeply appreciated for what they go through during childbirth. In other studies, women preferred not to be treated only as medical patients during childbirth, but also as human beings with feelings, and as active agents, in charge of the process of childbirth.36-39 In our study setting, we found that women have limited control over their childbirth process, as decisions about their care and consent processes may happen around the woman, but without her direct involvement or final say. Rather than shouting at women, women wanted nurses to show empathy to the pain of labor, demonstrating that they “at least they know what labor … If our family members stay with us there won't be the need to start looking for them in order to get their consent if delivery is going to be by cesarean; the husband can also sign if he is the one around so that the operation can be done on time. In this study, many women referred to these prayers as one of the best experiences they have ever had during childbirth. ... and provide you with the support you need in making this very important decision. Safe Motherhood Strategies: A Review of the Evidence, Countdown to 2015 decade report (2000–2010): Taking stock of maternal, newborn, and child survival, Maternal mortality in northern Nigeria: Findings of a health and demographic surveillance system in Zamfara State, Nigeria, Strategies for reducing maternal mortality: Getting on with what works, Ending preventable maternal and newborn mortality and stillbirths, Strategies toward ending preventable maternal mortality (EPMM), Quality of care for pregnant women and newborns—the WHO vision, Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): A cross‐sectional study, Facilitators and barriers to facility‐based delivery in low‐ and middle‐income countries: A qualitative evidence synthesis, The mistreatment of women during childbirth in health facilities globally: A mixed‐methods systematic review, The childbirth experience: A study of 295 new mothers, The pain of childbirth: Perceptions of culturally diverse women, Feeling in control during labor: Concepts, correlates, and consequences, Expectations and experiences of pain in labor: Findings from a large prospective study, Informed decision making in maternity care, Women's perceptions of in‐ formed choice in maternity care, Why some women fail to give birth at health facilities: A qualitative study of women's perceptions of perinatal care from rural Southern Malawi, ‘They treat you like you are not a human being’: Maltreatment during labour and delivery in rural northern Ghana, Comparison of maternal satisfaction following vaginal delivery after caesarean section and caesarean section after previous vaginal delivery, Mothers’ views of their childbirth experiences 2 years after planned caesarean versus planned vaginal birth for breech presentation at term, in the international randomized term breech trial, Continuous support for women during childbirth, WHO Better Outcomes in Labour Difficulty (BOLD) project: Innovating to improve quality of care around the time of childbirth, Formative research and development of innovative tools for “Better Outcomes in Labour Difficulty” (BOLD): Study protocol, The development of a Simplified, Effective, Labour Monitoring‐to‐Action (SELMA) tool for Better Outcomes in Labour Difficulty (BOLD): Study protocol, Using a service design model to develop the “Passport to Safer Birth” in Nigeria and Uganda, Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study, Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities, Expectations and needs of Ugandan women for improved quality of childbirth care in health facilities: A qualitative study, A service concept and tools to improve maternal and newborn health in Nigeria and Uganda, Consolidated criteria for reporting qualitative research (COREQ): A 32‐item checklist for interviews and focus groups, National Population Commission (NPC) [Nigeria] and ICF International. Yes, women do tend to shoulder more emotional labor in the workplace, and more attention on its health and professional repercussions means more attempts to alleviate it. This article is presented some information’s about nursing interventions during labor and delivery for a pregnant woman. and emotional support. Be understanding, friendly and reassuring A woman explained her challenge communicating with the provider: Despite women's professed need for clear communication and being well received in their interactions with providers, women lamented that healthcare providers often “didn't hear me out” (Woman, IDI, 30–45 years) as they were rushing off to see another patient. We also thank the babies for their cooperation during the interviews with their mothers. Second, this analysis focused on a sample of women and providers from one region of southwestern Nigeria and may not be transferable to other settings. During pregnancy, emotional and tangible support provided by the spouse and others is related to the expectant mother's mental well-being. There is a vast literature in organizational psychology on the topic. In the modern era, emotional labor is a feminist issue. The head of facility who attended the study training workshop acted as an entry point to connect the trained research assistants to the healthcare providers. Some people struggle to put a label on their emotions or may even try to mask their feelings. you start shouting on the person, no, it should not be like that. Their gentle but firm touch and words of encouragement are invaluable. This is what makes me love this set of nurses…I got to the hospital in the morning and delivered at night. The instruments used to guide the discussions with providers were similar, and explored five major domains: (1) the meaning of good quality of care during childbirth in their work environment; (2) expectations and needs to provide good quality care; (3) barriers and facilitators to the provision of quality care during childbirth; (4) potential changes that could be made to enhance the provision of quality childbirth care; and (5) perceived expectations and needs of women during facility‐based childbirth. Midwives’ perspectives of respectful maternity care during childbirth: A qualitative study. In particular, women wanted their family member to stay with them and pray with them especially if their labor becomes difficult. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. …when something negative is happening, you just tell the woman, ‘madam, can you see now that we have been trying for some time to make sure that you are alive and the baby is alive?’…you guide the patient, any procedure you are doing with the patient, you'd relate with the patient and let the patient know. No matter you are a dad, sister, mother or a friend of the pregnant woman, you don’t need to be an expert to provide her some emotional support during early labor. Most facilities are built in a way that more than one woman will be in a labor room at a time. Emotional labor demands—the need to provide comfort and care to the cranky—are likely one of the main culprits. Below is the memorable experience a woman shared about the facility where she delivered: Lack of respect for women is still an issue in Nigeria. The needs and priorities of women differ during childbirth. Using these stratification parameters, the research team recruited participants to achieve a diverse and varied sample. Participants reported such needs as communication in simple words in local language by healthcare staff, having their husbands as birth companions, spiritual support, and prayers from family members and healthcare providers. The childbirth experience is an intensely dynamic, physical and emotional event with lifelong implications. The nurses that came to greet and stay with me, one has [gone] home and returned later to stay with me until I gave birth…they stayed and played with me, they also took care of me, they were not hostile…I like them because they are trying their best and I cannot forget them for this. A woman who senses empathy from her healthcare provider would receive care with more open mindedness, understand the constraints of the facility where she gives birth, and take the instructions of the healthcare provider with less criticism thus improving her perception and experience of care in the facility. You know I don't understand Yoruba that much, so I just have to tell them, see I don't understand what you are saying, you understand, thank God the person attending to me just start breaking it down, break everything down for my own understanding, you get it? How to Provide Emotional Support During Early Labor. To increase, improve, and sustain facility‐based childbirth in Nigeria, health systems should appreciate the uniqueness and importance of each woman's needs during childbirth. Studies from other settings have similarly revealed that issues relating to women's experiences during childbirth are multidimensional and extend beyond medical needs.36-38 Therefore, there is a need to have a holistic approach toward childbirth for women, including in low‐resource countries like Nigeria. To improve women's childbirth experiences in health facilities, their psychosocial and communication needs have to be met. I told you that my blood pressure was low, so at that time when they even checked me, they asked my husband to go for a blood transfer, you understand, so at that moment I wasn't told, maybe they don't want to give me the pressure, I wasn't told, so he had to do it, so when he finished doing it, he came then and then everything was normal, everything was fine. Let's teach them how to communicate with people as if they are the owner of this health facility, because if you are the owner of something you want to make it good. Does the Therapist Have Holes in His or Her Shoes? (Woman, FGD, <30 years). What matters to women during childbirth: A systematic qualitative review. Childbirth is a life-changing experience. Women noted that some parents are to be blamed for “not have anything to use for the baby or themselves. The “Better Outcomes in Labour Difficulty” (BOLD) project was initiated by the WHO to address the quality of facility‐based childbirth care in low‐resource settings.25 The goal of this project is to accelerate the reduction of childbirth‐related maternal, fetal, and newborn mortality and morbidity by addressing the critical impediments in the process of care of women and fetus during labor, and taking advantage of the interactions between the health system and the community to learn what kind of care women want and value. Furthermore, women were recruited from urban, peri‐urban, and rural settings to improve the diversity of the sample and transferability of the results. What is a doula? Based on these perspectives, it is apparent that women may have different needs and opinions regarding labor companionship, and it is important to ensure that the decision to have a companion or not, and who the companion is (husband/sister/mother) should be the woman's. The instruments used to guide the discussions with women explored five major domains: (1) perceptions of care provided at the facility and decision‐making to seek care at the facility; (2) the meaning of good quality of care during childbirth in health facilities; (3) perceived expectations and needs of women during facility‐based childbirth care; (4) potential changes that could be made to enhance the provision of quality childbirth care; and (5) perceived expectations and needs of providers during facility‐based childbirth. Most women agreed that healthcare providers and “especially nurses are rude,” they “shout,” and “talk badly” to the women. Doctors suggested that: When interacting with providers, women desired to be treated in a dignified and respectful manner. . All transcripts were coded using Atlas.ti, version 7.5.6 (ATLAS.ti Scientific Software Development, Berlin, Germany), and a subset of the transcripts was reviewed by an independent researcher for reliability. Turning local knowledge and experience into innovative tools for quality care during labor and childbirth: The BOLD project experience. Companions provided practical support, including encouraging women to move around, providing massage, and holding her hand. They should attend to us well any time we come, as if they are the one that is pregnant, because this is why they are employed and being paid, they should not be cranky, they should do their work with love. Birch E. 1986. Learn more. This includes improving women's birth experiences and both clinical and sociobehavioral outcomes; for example, satisfaction with care provided and adequate provision of emotional support. You can do this using two emotional labor techniques: 1. An interview lasted an average of 1 hour with the range of 45 minutes to 2 hours. The hospital does not provide food for their patients and women reflected that they would like to have a labor companion who could bring them “tea, milk, food, hot water and other things that can give her strength” (Woman, FGD, 30–45 years). In‐depth interviews (IDIs) and focus group discussions (FGDs) were conducted among women of reproductive age, midwives, doctors, and facility administrators. So you explain to them in terms they can understand and I think they do that here, we do here. The project seeks to achieve this goal through a two‐pronged approach26: the development of a Simplified, Effective, Labour Monitoring‐to‐Action tool (SELMA)27 and the Passport to Safer Birth.28 SELMA is a digital tool developed to enhance the expertise of health professionals assisting labor in health facilities. OAO and MT wrote the first draft of the paper. Guidelines and additional tools that will be pointing towards a patient that will need a particular intervention earlier, could make it easier for healthcare providers to decide and to communicate early and more effectively with the relatives and the patient herself. There is little doubt that constant emotional labor is exhausting. A restaurant customer rudely demands more prompt service, while a harried server struggles to cheerfully float between multiple tables. The majority of behaviors considered most helpful were in the emotional support category. However, the women said they would appreciate having a female labor companion on such occasions. (Woman, FGD, 30–45 years). Women in this study stated that they would like the prayers of their healthcare providers and family members irrespective of their religious affiliation as long as the prayers are being offered to “God.” The women further stated that this act of prayer, especially from a healthcare provider, in itself is reassuring to a woman in labor and her family members, and makes the woman connect better with her healthcare provider and also encourages her cooperation with the healthcare provider. Women emphasized that they need detailed information about the health procedures to be carried out on them and the opportunity to consent to or refuse treatments. In particular, the formative research was used to explore the needs and expectations of women and healthcare providers related to improving quality of care during childbirth. Emotional Support and Guidance During Labor. The MMR for Ondo State is lower than the national MMR, the contraceptive prevalence for the state is 31.1%, delivery by skilled provider is 67.2%, and the rate of facility‐based childbirth is 56.2%.34. Get the help you need from a therapist near you–a FREE service from Psychology Today. The research team sought to recruit 10–15 women per catchment area (one urban and one peri‐urban) for IDIs and to hold 2–3 FGDs. Humanised childbirth: the status of emotional support of women in rural Bangladesh. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. We found that labour companions supported women in four different ways. Millennium Development Goal (MDG) 5 targeted a 75% decrease in maternal mortality, but the number of maternal deaths worldwide only dropped by 43% between 1990 and 2015.1 To accelerate this decline, the international community set another target under the Sustainable Development Goals (SDGs) to reduce the global maternal mortality ratio to less than 70 per 100 000 births, with no country having an MMR of more than twice the global average. Women would like to be given opportunities to ask questions and would like their questions to be answered properly; they felt that denial of this opportunity left them in the dark with regard to their own safety and that of their baby during labor and birth. While women did not specifically mention that visual communication and educational tools would help them to understand complex procedures, both the healthcare providers and the women suggested the need to improve on what is currently available for communication between the healthcare providers and the woman. First, some of the IDIs and FGDs conducted with women were conducted in local languages and translated into English, therefore it is possible that some culturally relevant phrases or words were lost in translation. The authors have no conflicts of interest to declare. The research team sought to recruit midwives for 3–5 IDIs and to hold 1–2 FGDs, and to recruit doctors for 3–5 IDIs and to hold 1–2 FGDs. Field, T. et al. BJOG: An International Journal of Obstetrics & Gynaecology, International Journal of Gynecology & Obstetrics, Acta Obstetricia et Gynecologica Scandinavica, Australian and New Zealand Journal of Obstetrics and Gynaecology, Journal of Obstetrics and Gynaecology Research, I have read and accept the Wiley Online Library Terms and Conditions of Use, Trends in Maternal Mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Among providers, two FGDs and five IDIs were conducted with midwives, and two FGDs and five IDIs were conducted with doctors working in the maternity wards. The interviews were conducted in English and Yoruba languages, and were digitally recorded and transcribed verbatim by the data collectors immediately thereafter. On occasion, embarrassing things happen during labor that women do not want others to see: “each woman has a different way of giving birth, some vomit while in labor, some defecate, while some urinate incessantly” (Woman, FGD, <30 years. Ethical approval was obtained from the WHO Ethical Review Committee (protocol ID, A65878), the University of Ibadan/University College Hospital Ethical Review Committee (protocol ID, AD 4693/168; approved October 16, 2014), and the Research and Ethics Committee of Ondo State Ministry of Health (approved September 1, 2014). Communication is very vital…I think that's just what we are lacking in this government facility…the communication channel there is broken already. Observations and assessments during interviews were digitally recorded and field notes were taken and added to the end of the interview transcripts. (Woman, IDI, 30–45 years). Several reasons for the value of companions were given including: (1) decision‐making and consent for hospital procedures; (2) a sense of appreciation; (3) hospital companion and assistant; and (4) provision of food. A woman's perception of how her needs are prioritized and met determines her childbirth experience. In 2001 I came across the English edition of Dr. Lamaze’s biography. Nigeria Demographic and Health Survey, Swedish women's experience of childbirth 2 years after birth, The limitations on choice: Palestinian women's childbirth location, dissatisfaction with the place of birth and determinants, Childbirth and authoritative knowledge: Cross‐cultural perspectives, Male partner's role during pregnancy, labour and delivery: Expectations of pregnant women in Nigeria, Birth in the United States: An overview of trends past and present, Language Barriers Are Hindering Health Care, Effective communication and delivery of culturally competent health care, Father involvement and psychological well‐being of pregnant women. In jobs that rely on tipping, mental health outcomes are exacerbated among women. At its core, emotional labor is the regulation of one’s feelings at one’s job. As stated by one woman: “Communication is very, very important…it is everything” (IDI, 30–45 years). MCH is the referral hospital established in 2010 for the “Abiye” (safe birth) program—a Safe Motherhood project organized by the Ondo State Government that was sponsored by the World Bank. (Nurse, FGD, 30–45 years). A straightforward definition that is crystal clear encourages more meaningful discussion. Sharmin Tunguz, Ph.D., is an Associate Professor of Psychology and Neuroscience at DePauw University where she teaches courses in Psychology to undergraduate students. Remember, it is your right and the doctor’s responsibility to fully inform you prior to the procedures. When it is not feasible to communicate with the woman in a local language, the use of professional translators can be explored as lay translators at times may distort the original message that is being passed across to the woman and may further have a negative effect on the health outcome.41 The women would like to express their concerns freely without fear of any reprimand. When I wanted to give birth, my mother, husband and mother‐in‐law was around, whenever the nurses want something I cannot leave the bed to buy it they are the ones who get everything the nurses wanted. Many women interviewed perceive that many healthcare providers in this facility, “especially nurses,” are offended when asked questions and that asking questions may result in abuse of the women. Women reflected that a companion would also help to support with the logistics of their stay. In a US … Because women and their family members tend to value emotional support and positive experiences of care as important components of health care, it is important for healthcare providers and systems administrators to understand and respond to women's needs and preferences, and to ensure that their own perceptions regarding how women define quality care align with what women say that they value. 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