The findings emerged from the data analysis of the face to face and phone interviews with 15 primipara women who participated in this research. The average age of the participants was 24 years old. Women’s booking visit with the midwifery team was earlier than 24 weeks of pregnancy. Table 1, represents the demographic characteristics of the research participants. From the data analysis, two themes, four main categories, and nine subcategories emerged (Table 2). The themes were “Maternal empowerment” and “Women’s satisfaction during the transition from pregnancy to motherhood”.
Table 1 Demographic Characteristics of participants (N = 15)
Variable
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N (%)
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Age group
|
|
15-25
|
9(60)
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26-35
|
6(40)
|
Education level
|
|
High school
|
6(40)
|
University
|
9(60)
|
Employment status
|
|
Housewife
|
11(73.3)
|
Employee
|
4(26.6)
|
Table 2 Themes and subcategories
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Themes
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Sub-categories
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1
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Maternal empowerment
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· Increased knowledge and skills of couples
|
|
|
· The mother's ability to cope with new situations
|
|
|
· Emotional acceptance of natural birth by mother
|
|
|
· Mother’s trust in the midwife
|
|
|
· Mother’s perceived support from the midwife
|
2
|
Mother’s satisfaction during the transition from pregnancy to motherhood
|
· Satisfaction with pregnancy period
|
|
|
· Satisfaction with childbirth and postpartum periods
|
|
|
· A sense of success and pride through passing the difficult path of childbirth
|
|
|
· More motivation for acceptance of getting pregnant again
|
Maternal empowerment
Empowerment is a woman’s ability to take the lead in the decision making process about her maternity care through interaction and information sharing with her chosen midwife (21). This theme consisted of two categories as follows: Improving self-efficacy during antenatal education classes and the effective midwife-mother interaction.
Improving self-efficacy during antenatal education classes
Self-efficacy is women’s belief in their ability to perform a task or behaviour (22). In this current study, participants expressed improvement in their self-efficacy through antenatal education classes which grouped in three subcategories of increased knowledge and skills of couples; the mother's ability to cope with new situations; and emotional acceptance of physiological birth by mother.
Increased knowledge and skills of couples:
Participants frequently mentioned that they were satisfied with the antenatal classes and explained that they did not have any prior knowledge regarding pregnancy and childbirth as a first-time mother. They asserted that these classes improved their knowledge and skills, and then they transferred this knowledge to their partners.
“I was very inexperienced; I didn’t know anything at all. As soon as I came here (antenatal classes), they informed me about the physiological pregnancy and birth process and what may happen” (Woman 5)
“When I came for antenatal classes around 32-34 weeks of my pregnancy, I’m talking about the pain relief classes, you taught me about several pressure points … In case of I may forget those things during the labour and birth, I had written and gave it to my husband. When the pain started, he massaged those points. Especially the one which was on my foot, helped me a lot” (Woman 6)
The mother's ability to cope with new situations:
From the participants’ point of view, antenatal classes empowered them to cope with the new challenges that they faced during the physiological process of pregnancy, birth and postpartum. Additionally, they learned how to manage and deal with labour pain, according to their individual needs and situations.
“I didn't expect that childbirth is a very simple task, but with the educational classes and what you taught us, such as exercises, the process became much easier.” (Woman 5)
“I didn’t know what to do, whenever I had pain. For example, sometimes I had a stomachache, I did not know where to go, I was thinking maybe I should go to hospital. But after participating in these antenatal classes, everything was explained to us. I was doing the same thing that you told us and my pain was really reduced.”(Woman 10)
“I was told in those classes … this (labour pain) pain comes and goes. The moment you are pain-free and between pains and you are Okay ...mobilise and do the things you like. It helped me a lot. I mean, I was at home at 4.30 am, and I had severe pain. When the pain wasn’t there, for example, I was walking, filling the hot water bottle, packing my stuff for the hospital stay (getting ready to go to the hospital) and then, when the pain started, I had to sit again. It was so good.”(Woman 8)
Emotional acceptance of physiological birth by mother:
The majority of women who participated in this research reported that antenatal classes played a remarkable role in reducing their fear and anxiety. Moreover, these classes helped them to enhance their pain tolerance, change their negative attitude towards birth and demystify their misconceptions about childbirth.
“When I was with my midwife ... Her help, her words were very soothing. She guided me before my pain was started. I was fearful, I was very anxious, but she helped me a lot.” (Woman 4)
“I was not tolerant. I could not tolerate this pain at all, could I? Not at all! To bear the pain of having a baby. But I became more patient when I came to these classes.” (Woman 2)
“When I attended those classes, they ( the team midwives) said … the body changes naturally. It changes during natural birth … When I got this information, my mind got ready and accepted it. So, such a thing is possible. When my mind accepts such a thing, the body naturally accepts it” (Woman 7)
The effective midwife-mother interaction
This category brings together two subcategories that emerged from the data: Mother’s trust in the midwife and mother’s perceived support from the midwife.
Mother’s trust in the midwife:
Participants said that they followed the advice given by the midwives because they believed that the team midwives were very knowledgable, skilled and experienced as well as very compassionate midwives who they could trust them.
“Yea! In one of my blood tests, my haemoglobin was a bit low. She (the midwife) gave me some advice. I did the same. My vitamin D also was low. But the next blood test came back normal. It was good. I could trust her ... trust. She (the midwife) is very experienced, she is very sympathetic.” (W 5)
Some participants claimed that the partnership relationship with the midwife was one of the reasons which they felt relaxed and could express their problems and ask their questions. They considered the team midwives as their professional friends who provided women-centred continuity midwifery care for them:
“If I want to get pregnant again, I will choose her again (one of the team midwives). She is very friendly and patient. This relationship has a great effect on you to be comfortable with her. She is like your mother, your sister ... you are not afraid of having a problem. You would tell her.” (W 1)
Mother’s perceived support from midwife:
All research participants mentioned that the team midwives were very approachable, accessible and they were always available for them which gave them a feeling of assurance.
“……Her words, her help, were very effective, for example when I was in pain or I had a question, even in the middle of the night, I sent her a text and she replied immediately. It reassured me that I knew I had a midwife who is always there for me, she could help me, she could answer my questions very well, she could take care of me.” (W 4)
Participants appreciated companionship and support of midwives during the birth process, which led them to feel empowered and safe:
“When I realized that I’m in labour, I was happy. My mum said: “aren't you scared, love?” I said “no, mom”, I’m happy. The reason that I was happy was the guidance of Mrs. ... (midwife), her support. That I knew someone is with me. Nothing terrible will happen because I’m in safe hands.” (W 8)
Mother’s satisfaction during the transition from pregnancy to motherhood
This theme included two categories of satisfaction with the process of pregnancy, childbirth and postpartum as well as satisfaction with motherhood
Satisfaction with the process of pregnancy, childbirth and postpartum
This category involves two subcategories of participants’ satisfaction with pregnancy period and participants’ satisfaction with childbirth and postpartum periods
Satisfaction with pregnancy
This subcategory represents the positive viewpoint of participants about avoiding unnecessary interventions and relying more on experience and knowledge in the process of care by midwives. Some participants appreciated midwives’ efforts to encourage them giving birth normally and avoid caesarian section which is not medically indicated.
“On the other hand, I did not want to go to ultrasound all the time. They (midwives) could understand a series of issues with an examination and according to their experience. They could understand even the rotation of the baby with the examination. Well, this was much better for me. “(Woman 11)
“I even think, I bothered her (midwife) a lot. For example, at the end of the labour, I said: "call my husband and let him sign for me to have a cesarean section." Then, she said: "No, I am not a midwife who let you undergo the surgical blade, I do not allow that, at all.” (Woman 12)
Based on participants’ statements, in addition to midwives’ clinical skills, their accompaniment during pregnancy enhanced their inner strength and made this period memorable for them.
“I nearly experienced a very good year. I mean, nine months. It takes about a year for my baby to be born and somehow grow. My tolerance was enhanced a lot when I was seeing her (midwife) accompanied me (during labour) patiently.” (Woman 4)
Satisfaction with childbirth and postpartum periods
All participants were grateful with giving birth by a known midwife, as they were relaxed and was not anxious. They stated that following a pleasurable physiological birth, they got a new and positive attitude towards labour and recommended it to others because they believed their care providers and their abilities.
“They (midwives) give birth themselves. Women usually do not like to be examined by someone every minute when they go to the hospital. I did not want someone to come every minute, for example, I was embarrassed. They (team midwives) only examined me themselves. It was very good, I was satisfied.” (Woman14)
“I told them, the ladies … (midwives) are angels. With their help, I had no pain at all. You would have neither pain nor stress. Having these people, it is very easy to give birth.” (Woman 12)
Participants were satisfied with their midwives because they were so promising and helped them to relieve their concerns during the postpartum period:
“At early pregnancy, I was not worried. But in the end, it was very difficult. Both birth and becoming a mother made me concerned. It is a tough responsibility. I was worried about my studies, my job … that I could not take care of my baby. Most of these issues were my concerns. Mrs ... (midwife) helped me a lot.” (W11)
Satisfaction with motherhood
This category comprises of two subcategories of a sense of pride through passing the difficult path of childbirth and more motivation for acceptance of getting pregnant again
A sense of pride through passing the difficult path of childbirth
women were pleased with their experience of natural labor, which offered them a great sense of triumph and dignity. Some of them enjoyed having a beautiful feeling of accomplishment, self-confidence and empowerment following giving birth
“... (With the birth of the baby) as if putting the world on your chest. Something very big happened, that you could handle. Yes, I always say it is a miracle. Why do they say now it is not a miracle? ... Every time a baby is born, a miracle happens. “(Woman 1)
“When my baby was born, the moment of his birth was very beautiful. Something that has not experienced before. One feels that has been born again. A sense of pride and confidence. You are complete. This feeling was so beautiful.” (Woman 4)
“(Birth) made me very strong … My self-confidence improved, when I could bear it all night. Birth is a difficult path for every woman.”(Woman 7)
More motivation for acceptance of getting pregnant again:
According to statements of some participants, they did not afraid of getting pregnant again, due to experience of a comfortable birth and even one of the women pointed out that following her natural birth, she decided to get pregnant again, because of her amazing midwife.
“Two months ago, I thought I was pregnant. I mean, I had this stress. But I was not afraid. I said that if I was probably pregnant and wanted to give birth, I would have no problem. I mean, I was not afraid of pregnancy and childbirth. This is because I had a comfortable birth.” (Woman 9)
“When I got pregnant, I told my husband “That’s it, I’m done”. After I gave birth, I told him that I want another girl. He asked me “Do you want to get pregnant again?” I told him that yes I do, because of having Mrs ... (midwife), I want to get pregnant again, I want another girl.” (W2)