Adverse Experiences during Childbirth – a mixed-methods study based on birth reports

Abstract Background: The birth of a child is a multifaceted event, and the mother’s perception of this event, whether positive or negative, is primarily influenced by the birthing environment, and above all, by the interaction with the healthcare staff attending the birth. Incidents of adverse experiences (AE) during childbirth can lead to further negative effects (e.g., a disrupted mother-child bond), though there has never been any uniform system of recording this data to date. Studies show that, among other things, the delivery mode can have an influence on the birthing experience. For the Germany health system, esp. in the field of obstetrics, very few qualitative studies have been conducted that use inductive categorization to analyze the women’s adverse experiences and further summarize them into categories of “adverse experiences” during childbirth. Aim: The goal of the present study is: 1) to establish a system of categorizing incidents of AE based on written birth reports; 2) to conduct a frequency analysis of the identified categories; and 3) establish a pattern of frequency related to the birth mode. Methods: The study was conducted as a mixed-methods study with a cross-sectional online survey. Along with the quantitative data, the experiences of the N = 445 women were analyzed by means of an unrestricted text field where participants could freely write their subjectively perceived AE and a qualitative content analysis. The identified, inductively designed categories were subjected to a frequency analysis and a chi-square test to determine the correlation frequency with the birth mode (sub-categorized into vaginal, operative vaginal, and primary and secondary cesarean). Results: Seven categories were identified: 1) adverse experience (AE) concerning autonomy (31.9 %); 2) AE caused by medical interventions or treatments (26.5 %); 3) AE as a result of care and support (19.3 %); 4) difficulty in communicating with the medical staff (16.6 %); 5) problems or AE affecting the exchange of information process between the women and the birth attendants (13.9 %); 6) structural conditions (7 %) and 7) other (unrelated to the medical staff) (26.1 %). The chi-square test showed there to be no significant correlation between the frequency of the individual categories and the birth mode. Conclusions: The study shows that women experience a broad spectrum of AEs during childbirth, with loss of autonomy being the most frequently cited. This underscores the importance of respect and the need to promote it. Nevertheless, it also raises questions about necessary restrictions in cases of fetal compromise. The study highlights the necessity of including women in the decision process, of a sufficient and easily comprehensible explanation of the information, as well as obtaining the patient’s consent in accordance with German law, as unauthorized medical intervention can also be perceived as an adverse experience. These identified categories provide a starting point for improving obstetric and psychological care.