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Woman in child birth


Learning from women’s experiences during childbirth to improve quality of care

Learning from women’s experiences during childbirth to improve quality of care
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    • Learning from women’s experiences during childbirth to improve quality of care

    UNICEF/Naftalin
    Midwife in South Sudan

    © Credits

    A special supplement from WHO and HRP, newly published in BMJ Global Health, spotlights how women and their newborn babies are treated during childbirth and offers a path to improved facility-based care.

    More and more evidence shows that women across the world face unacceptable mistreatment during childbirth. Women everywhere face violations of their rights – including rights to privacy, informed consent, and the right have a trusted companion of choice throughout childbirth.  

    Mistreatment can seriously erode trust in the health facility, which can mean that women are less likely to access facility-based care before, during and after birth. This can have grave consequences for the health and well-being of women and their babies and can even put their lives at risk.

    As Özge Tunçalp, Medical Officer at WHO and the Human Reproductive Program (HRP) explains, “Improving the experience of women throughout labour and childbirth is essential to help increase women’s trust in facility-based care – as well as ensuring access to quality postnatal care following birth.”

    More research – and research capacity – is urgently needed to better understand and improve women’s experiences of mistreatment during childbirth but also across the continuum maternity care. This includes research on novel methods of collecting data, understanding how experiences vary depending on context and how these experiences impact overall outcomes.

    In recognition of this gap, the new supplement presents evidence from a WHO multi-country study on the positive impact of labour companions, the need for increased privacy measures and improved ways to measure the experiences and satisfaction women have when giving birth at any given health care facility.

    Within the collection, the analysis on labour companionship showed women without a companion were more likely to report physical abuse, non-consented medical procedures and poor communication compared with women with a labour companion. In contrast, when women had a companion of choice, they experienced lower levels of some forms of mistreatment - although this was dependent on the setting.

    Three of the papers show the importance of understanding the experiences of women to improve care during childbirth through better research and treatment. Measuring both experiences and satisfaction gives insight into what can be improved to increase satisfaction. An increased accountability for mistreatment in childbirth will improve experiences.

    The paper on vaginal examination and mistreatment during childbirth based on labor observations showed the crucial importance of good communication and clear consent processes during childbirth. Additionally, the research offered up a practical way to reduce women’s exposure and increase privacy such as curtains.

    When considering adolescents, mistreatment contributes to dissatisfaction and misses the opportunity for engagement and education with this demographic. 

    The final two papers show that the development of concise, valid and reliable measures for mistreatment applicable across settings would offer facilities the opportunity to instigate initiatives to make quality improvements for lasting change.  

    The WHO and HRP special supplement on understanding mistreatment of women during childbirth to improve quality of care  identifies risk factors and aims to take a step closer toward positive pregnancy, childbirth and postnatal experiences for all.

    “When women and their babies receive respectful, quality, person-centred care, they are more likely to access contacts with health workers and they are more likely to access potentially life-saving care at a health-facility,” comments Dr Özge Tunçalp, “Now that we have this evidence we will be able to take more steps towards reducing mistreatment worldwide.”

     

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    WHO Statement: The prevention and elimination of disrespect and abuse during facility-based childbirth

    Journal article: How women are treated during facility-based childbirth in four countries: a cross-sectional study with labour observations and community-based surveys

    Journal article: Operationalizing a Human Rights-Based Approach to Address Mistreatment against Women during Childbirth

    What happens to your body during childbirth

    What happens to your body during childbirth | Pregnancy Birth and Baby beginning of content

    7-minute read

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    Key facts

    • Female bodies are designed to give birth, and changes during the last weeks of pregnancy help prepare your body for labour and delivery.
    • The shape of the pelvis, hormones, powerful muscles and more all work together to help you bring your baby into the world.
    • Many different types of hormones work together to prepare your body for labour and birth.
    • Your baby’s skull can also change shape to better pass through your birth canal.

    How does my body prepare for labour?

    Here are some of the ways your body will prepare both you and your baby for the birth ahead.

    Braxton Hicks contractions

    In the weeks or days before you start having proper contractions, you may experience Braxton Hicks contractions. This is your uterus tightening then relaxing. These contractions don't usually hurt and are thought to help your uterus and cervix get ready for labour. Braxton Hicks contractions are sometimes referred to as 'false labour'.

    Braxton Hicks contractions may become more regular as you get closer to the time of birth. Unlike labour contractions, they don't change the shape of the cervix. Your midwife can tell you if you're experiencing Braxton Hicks contractions or if you are in labour by doing a vaginal examination.

    Changes to the cervix

    As labour gets closer, your cervix softens and becomes thinner, getting ready to dilate (widen). This will allow your baby to enter your vagina during birth. You may also see a ‘show’, which is a pinkish plug of mucus that may be bloodstained.

    Engagement

    Your baby may move further down your pelvis as the head engages, or sits in place over your cervix, ready for the birth. You may feel that you have more room to breathe after the baby has moved down. This is called ‘lightening’.

    Rupture of the membranes, or ‘waters breaking’

    During labour, the sac of amniotic fluid containing the baby breaks, and the fluid leaks (or gushes) out of the vagina. This is called rupture of the membranes or 'waters breaking'. In some cases, this happens before labour.

    Let your maternity team know when your waters have broken and take notice of the colour of the fluid. It is usually clear or tinged pink. If it is green or red, tell your maternity team since this could mean the baby is having problems.

    If your labour doesn’t start within 24 hours of your waters breaking, there is a risk of infection. If this happens, your doctor or midwife may recommend inducing your labour.

    How will I know when labour has started?

    Movies often show labour starting with sudden, painful contractions and a rush to hospital. In real life, labour usually starts gradually. It’s common not to be sure if your labour has actually started.

    You may feel restless, have back pain or period-like pain, or digestive issues such as diarrhoea.

    Labour officially begins with contractions, which start working to open up (dilate) the cervix. It’s a good idea to phone your midwife when your contractions start. However, you may not be encouraged to come to the hospital or birthing centre until your contractions are closer together.

    In preparation for labour, your baby may move further down your pelvis as the head engages, or sits in place over your cervix.

    You and your baby’s bodies work together during labour and birth.

    Your pelvis is located between your hip bones. Females typically have wider, flatter pelvises than males, as well as a wider pelvic cavity (hole) to allow a baby to pass through.

    During childbirth, the muscles at the top of your uterus contract and push your baby towards your cervix. If your baby is facing head-down, the head will press on your cervix.

    This, along with the release of the hormone oxytocin (see 'How hormones help you give birth', below), brings on contractions. The bones and ligaments of your pelvis also move or stretch as the baby travels into the vagina.

    Your baby’s skull is made up of 5 separate bones, which can cross over each other during labour. This allows your baby's head to fit more easily through your birth canal.

    Which hormones help me give birth?

    Your body produces hormones that trigger changes in your body before, during and after childbirth. Here's how they work to help you deliver your baby.

    • Prostaglandin — Before childbirth, a higher level of prostaglandin will help open the cervix and make your body more receptive to another important hormone, oxytocin.

    • Oxytocin — This hormone causes contractions during labour, as well as the contractions that deliver the placenta after the baby is born, and during breastfeeding.

    • Relaxin — The hormone relaxin helps soften and stretch the cervix for birth. It helps your waters break and allows the ligaments in your pelvis to stretch to allow the baby to come through.

    • Beta-endorphins — During childbirth, this type of endorphin helps with pain relief and may cause you to feel joy or euphoria.

    • Adrenaline and noradrenaline — These ‘fight or flight’ hormones are released just before birth, causing several strong contractions and a surge of energy that help you birth your baby.

    When childbirth doesn’t go to plan

    Despite your best efforts, sometimes, labour and birth do not go to plan. This could be because of complications before the labour, such as your waters breaking early, problems with your placenta, or issues with your baby’s position, health or progress during labour. If this happens, your midwife or doctor may recommend intervening to ensure a safe birth for both you and your baby.

    Some of the more common interventions include:

    • external cephalic version (turning your baby so they are in a better position for birth)
    • induction or augmentation of labour
    • assisted delivery
    • episiotomy
    • caesarean section

    It’s your choice whether to have interventions in your labour. You can ask your doctor or midwife about the benefits and risks of any intervention they recommend.

    Talk to your doctor or midwife if you have questions about your body. They can give you more information and help you understand what you're experiencing.

    You can also call Pregnancy, Birth and Baby for free advice, support and guidance from our maternal child health nurses.

    Speak to a maternal child health nurse

    Call Pregnancy, Birth and Baby to speak to a maternal child health nurse on 1800 882 436 or video call. Available 7am to midnight (AET), 7 days a week.

    Sources:
    Mater Mothers’ Hospital (Labour and birth information), National Childbirth Trust (Hormones in labour: oxytocin and the others – how they work), NSW Government (Having a baby), QLD Health (How your body prepares for labour), Royal Australian and New Zealand College of Obstetricians and Gynecologists (Labour and birth), Stat Pearls (Anatomy, Abdomen and Pelvis), You and Your Hormones from the Society for Endocrinology (Hormones of pregnancy and labour)

    Learn more here about the development and quality assurance of healthdirect content.

    Last reviewed: August 2022


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