Heidi Preis

Women’s attitudes towards the medicalization of childbirth and their associations with planned and actual modes of birth

PROBLEM Rates of medical interventions in childbirth have greatly increased in the Western world. BACKGROUND Womens attitudes affect their birth choices. AIM To assess womens attitudes towards the medicalization of childbirth and their associations with womens background as well as their fear of birth and planned and unplanned modes of birth. METHODS This longitudinal observational study included 836 parous woman recruited at womens health centres and natural birth communities in Israel. All women filled in questionnaires about attitudes towards the medicalization of childbirth, fear of birth, and planned birth choices. Women at <28 weeks gestation when filling in the questionnaire were asked to fill in a second one at ∼34 weeks. Phone follow-up was conducted ∼6 weeks postpartum to assess actual mode of birth. FINDINGS Attitudes towards medicalization were more positive among younger and less educated women, those who emigrated from the former Soviet Union, and those with a more complicated obstetric background. Baseline attitudes did not differ by parity yet became less positive throughout pregnancy only for primiparae. More positive attitudes were related to greater fear of birth. The attitudes were significantly associated with planned birth choices and predicted emergency caesareans and instrumental births. DISCUSSION Women form attitudes towards the medicalization of childbirth which may still be open to change during the first pregnancy. More favourable attitudes are related to more medical modes of birth, planned and unplanned. CONCLUSION Understanding womens views of childbirth medicalization may be key to understanding their choices and how they affect labour and birth.

The birth beliefs scale – a new measure to assess basic beliefs about birth

Abstract Introduction: Basic beliefs about birth as a natural and safe or a medical and risky process are central in the decisions on where and how to birth. Despite their importance, they have not been studied separately from other childbirth-related constructs. Our aim was to develop a measure to assess these beliefs. Method: Pregnant Israeli women (N = 850, gestational week ≥14) were recruited in women’s health centers, in online natural birth forums, and through home midwives. Participants filled in questionnaires including sociodemographic and obstetric background, the Birth Beliefs Scale (BBS), dispositional desire for control (DC) and planned mode of delivery. Results: Factor analyses revealed that the BBS is composed of two factors: beliefs about birth as a natural process and beliefs about birth as a medical process. Both subscales showed good internal and test–retest reliability. They had good construct validity, predicted birth choices, and were weakly correlated with DC. Women’s medical obstetric history was associated with the BBS, further supporting the validity of the scale. Discussion: Beliefs about birth may be the building blocks that make up perceptions of birth and drive women’s preferences. The new scale provides an easy way to distinctly assess them so they can be used to further understand planned birth behaviors. Additional studies are needed to comprehend how these beliefs form in different cultural contexts and how they evolve over time.

A quantitative investigation into women's basic beliefs about birth and planned birth choices

OBJECTIVE Perceptions about the nature of the birth process are important in determining womens birth choices regarding labour and delivery but are scarcely the subject of empirical research. The aim of the current study was to assess womens beliefs about birth as a natural and safe or medical and risky process and study the associations of these beliefs with fear of childbirth and planned birth choices. DESIGN An observational study using self-administered questionnaires during pregnancy. SETTING 1. Community womens health centres in a metropolitan area in Israel; 2. Purposeful sampling of women who plan to birth naturally, through home midwives and targeted internet forums. PARTICIPANTS 746 women with a singleton pregnancy in their second and third trimester. MEASUREMENTS Beliefs about birth as a natural and a medical process, fear of childbirth, and a range of natural birth choices. FINDINGS The birth beliefs were associated with womens birth intentions. The more women believed birth to be natural and the less they believed it to be medical, the more likely they were to make more natural birth-related choices. In the presence of the birth beliefs, fear of childbirth no longer had an independent association with birth choices. The beliefs interacted with each other, revealing a stronger association of viewing birth as natural with planning more natural choices among women who did not view birth as very medical. KEY CONCLUSION It is important to recognize womens beliefs about birth and how they may affect their fear of childbirth and birth intentions. Further studies on the origin of such beliefs and their development are needed. IMPLICATIONS FOR PRACTICE Women should be allowed to choose how they would like to birth in accordance with their beliefs. At the same time, strengthening womens belief in the natural birth process and their bodys ability to perform it, could help lower fear of childbirth and medical intervention rates.

Between Expectancy and Experience: Testing a Model of Childbirth Satisfaction

Childbirth is a pivotal event for many women, and evidence suggests that women possess strong expectations regarding this experience. In a longitudinal study of 330 Israeli first-time mothers, we distinguished between physical, emotional, and cognitive factors and used them to assess the underlying mechanism of satisfaction, based on theoretical frameworks of stress and control. Women completed questionnaires during pregnancy and two months postpartum. The negative association between a more medicalized birth and birth satisfaction was partially mediated by perceived control. In turn, specific emotions mediated the association between perceived control and satisfaction: Greater perceived control over the birth environment predicted more positive emotions, less fear, and better perceived care; while greater perceived control over the birth process predicted more positive emotions, less fear, and less guilt. Greater incongruence between the planned and actual birth experience predicted lower satisfaction, mediated by perceived care and feelings of guilt. This investigation unraveled the association between women’s lived birth experience and their birth satisfaction. The findings underscore the value of helping women achieve satisfying births by discussing their expectations with them, providing them with experiences that meet their needs, and supporting those with a gap between their expectations and experience. Respecting individual preferences while lowering blame may improve women’s health and well-being. Additional online materials for this article are available on PWQ’s website at http://journals.sagepub.com/doi/suppl/10.1177/0361684318779537.

First-time mothers’ birth beliefs, preferences, and actual birth: A longitudinal observational study

PROBLEM Birth preferences, such as mode and place of birth and other birth options, have important individual and societal implications, yet few studies have investigated the mechanism which predicts a wide range of childbirth options simultaneously. BACKGROUND Basic beliefs about birth as a natural and as a medical process are both predictive factors for childbirth preferences. Studies investigating birth beliefs, preferences, and actual birth are rare. AIM To test a predictive model of how these beliefs translate into birth preferences and into actual birth related-options. METHODS Longitudinal observational study including 342 first-time expectant mothers recruited at womens health centres and natural birth communities in Israel. All women filled out questionnaires including basic birth beliefs and preferred birth options. Two months postpartum, they filled out a questionnaire including detailed questions regarding actual birth. FINDINGS Stronger beliefs about birth being natural were related to preferring a more natural place and mode of birth and preferring more natural birth-related options. Stronger beliefs about birth being medical were associated with opposite options. The preferences mediated the association between the birth beliefs and actual birth. The beliefs predicted the preferences better than they predicted actual birth. DISCUSSION Birth beliefs are pivotal in the decision-making process regarding preferred and actual birth options. In a medicalized obstetric system, where natural birth is something women need to actively seek out and insist on, the predictive powers of beliefs and of preferences decrease. CONCLUSION Womens beliefs should be recognized and birth preferences respected.

From research on girls to girlhood studies: Exploring Israeli girlhood studies from an international and historical perspective:

This review, based on analysis of the abstracts of 271 academic publications, critically examines the development of girlhood studies within a specific sociocultural context – Israeli society. By examining one particular context the authors hope to contribute to the discourse on the worldwide evolution of girlhood studies. The following research questions were posed: How did the body of literature on Israeli girls develop over time? What is the distribution of disciplines and topics represented? Who are the girls at the focus of the writing? What are the methodological and paradigmatic approaches adopted? The findings point to the tentative development of a girlhood studies perspective that began in the 1980s and expanded over time, revealing the spread and reclaiming of feminist theoretical tenets as embodied in the study of girls. The review both sheds light on the pace and the manner in which Western feminist ideas spread to a specific local arena, and identifies unique local influences impacting this process.