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Background: The high maternal and neonatal mortality rate in sub‐Saharan Africa could be reduced by using navigation by means of mobile devices to increase the number of women who choose to give birth in a health center (HC) with a skilled healthcare practitioner. Methods: A quasi‐experimental design was used to test a midwife‐delivered navigation by means of mobile phone. A total of 208 women were randomized to two groups (intervention and control). Women in the intervention group received up to three navigation calls from midwives. Women in the control group received usual antenatal education during prenatal visits. Data were collected using semistructured questionnaires. Childbirth location was determined through medical records. Results: Overall, 180 (87%) women gave birth in a HC with a 3% advantage for the intervention group. A total of 86% (88/102) of the control group gave birth in a HC versus 89% (92/103) for the intervention group (Χ2 = 0.44, p‐value = 0.51), with an unadjusted odds ratio of 1.33 (95% CI: 0.57, 3.09). Among those with personal phones, 91% (138/152) had a birth in a HC versus 79% (42/53) in those without a personal phone (Χ2 = 4.89, p‐value = 0.03). Conclusions: The results of this study indicate that it is feasible to deliver phone‐based navigation to support birth in a HC; personal phone ownership may be a factor in the success of this strategy. [ABSTRACT FROM AUTHOR]

Background: Research suggests that doula support improves birth outcomes, contributing to lower rates of preterm birth, low birthweight, and nonindicated cesarean delivery. Few studies investigate whether doula support is associated with the quality of patient‐reported birth experiences in hospital settings. Methods: This study uses data from Listening to Mothers in California, a statewide representative survey of women who gave birth in 2016 in Californian hospitals. The analytic sample included 1345 English‐speaking participants. We used multivariable logistic regression to test for associations between doula support and self‐reported unfair treatment, abuse, and rapport with delivery staff. We also examined associations between these experiences and openness to doula support in a future birth. Models adjusted for maternal sociodemographic characteristics and views about medical intervention in birth. Results: Just over 9% of women had doula support during birth. During their hospital stay, 6.3% reported unfair treatment, 11.5% reported abuse by providers, and 5.7% reported no rapport with delivery room staff. There were no statistically significant relationships between doula support and unfair treatment, abuse, or delivery staff rapport in our models. Participants who reported no rapport with hospital staff were more likely to express openness to doula support in a future birth (AOR: 2.59; 95% CI: 1.15, 5.79). Conclusions: Despite their best efforts, doulas may not be able to mitigate all negative interactions between their clients and hospital staff. These experiences may also influence desires for additional support from doulas in future births. Hospital policies and practices should include doulas as valuable members of the care team to help ensure positive experiences during birth. [ABSTRACT FROM AUTHOR]

Background: A positive childbirth experience is an important outcome of maternity care. A significant component of a positive birth experience is the ability to exercise autonomy in decision‐making. In this study, we explore women's reports of their autonomy during conversations about their care with maternity care practitioners during pregnancy and childbirth. Method: Data were obtained from a cross‐sectional survey of women living in The Netherlands that asked about their experiences during pregnancy and childbirth, including their role in conversations concerning decisions about their care. Results: A total of 3494 women were included in this study. Most women scored high on autonomy in decision‐making conversations. During the latter stage of pregnancy (32+ weeks) and in childbirth, women reported significantly lower levels of autonomy in their care conversations with obstetricians as compared with midwives. Linear regression analyses showed that women's perception of personal treatment increased women's reported autonomy in their conversations with both midwives and obstetricians. Almost half (49.1%) of the women who had at least one intervention during birth reported pressure to accept or submit to that intervention. This was indicated by 48.3% of women with induced labor, 47.3% who had an instrumental vaginal birth, 45.2% whose labor was augmented, and 41.9% of women who had a cesarean birth. Conclusions: In general, women's sense of autonomy in decision‐making conversations during prenatal care and birth is high, but there is room for improvement, and this appeared most notably in conversations with obstetricians. Women's sense of autonomy can be enhanced with personal treatment, including shared decision‐making and the avoidance of pressuring women to accept interventions. [ABSTRACT FROM AUTHOR]

Background: This prospective study aims to investigate whether severe fear of childbirth increases pain perceptions during birth and whether co‐occurring maternal health and birth factors as well as length and weight of the child explain the association. Methods: The study sample comprised women with a vaginal delivery and was drawn from the Akershus Birth Cohort. Data from the hospital birth's record and questionnaires at weeks 17‐19 and 32 of pregnancy and 8 weeks postpartum were used (n = 1649). Analysis of variance and analysis of covariance were conducted to examine whether ratings of labor pain differed significantly between women with and without severe fear of childbirth and which factors explained the difference. Results: Women with severe fear of childbirth experienced significantly more labor pain than women without severe fear of childbirth (P < .01). However, when controlling for symptoms of maternal depression and anxiety, use of epidural/spinal anesthetic or nitrous oxide gas, and menstrual pain, this difference was no longer significant (P = .09). Discussion: Although the results show that labor pain is related to multiple physiological and psychological factors in a complex manner, symptoms of maternal depression and anxiety seem to play a central role for the experience of labor pain, and should therefore be focused on by health practitioners. [ABSTRACT FROM AUTHOR]