The relationship between women-centred care and women's birth experiences: A comparison between birth centres, clinics, and hospitals in Japan
Introduction
A historical perspective reveals that while Japan emerged from the devastation of WWII to become a modern leading industrial nation the ancient Confucian values of harmony (wa), benevolence (jin), and paternalism (amae) guided medical practice. Japan is transitioning from that highly paternalistic health-care system to one that is embracing a more people-centred ethos (Kimura, 1995). Midwifery and nursing, both highly influenced by Western educational curricula, attempt to enhance the care of childbearing women within this mix of values and practices.
A strong national comprehensive maternal–child health policy dramatically reduced the post-war maternal mortality from 180/100,000 to 50/100,000 in one decade (1960–1970), and by 2004 it was 6/100,000, which is one of the lowest in the world. Easy access to professionally trained midwives in hospitals, clinics, and birth centres was a strong component of the initiative (Graham, 2008).
In Japan, women receive about 14 antenatal checkups: once every 4 weeks until 23 weeks; once every 2 weeks from 24 to 35 weeks and once a week from 36 weeks. Therefore, women have many opportunities to meet their health-care providers to discuss their preferences towards labour, birth, and the postpartum period. About 50.8% of women choose to have their antenatal checkups and birth in hospital, 48.0% at clinics and 1.0% at birth centres (Mothers' & Children's Health & Welfare Association, 2009). This ratio has varied little since the 1990s.
A birth centre in Japan is a small home-like place, with nine or fewer beds, and a small number of midwives who can take the lead to manage normal births. Usually a specific midwife takes care of the woman through pregnancy to the postpartum period, providing continuity of care. Gepshtein et al. (2007) described birth centres as an effective combination of Western-scientific and traditional knowledge and they cite research documenting the safety of birthing at birth centres. Throughout pregnancy, women visit obstetric clinics or hospitals at least three times to have their ultrasound examination and blood tests because birth centres do not perform these medical procedures. The midwives work in collaboration with the obstetricians at clinics and hospitals. Clinics have 19 or fewer beds and treat low-risk pregnant women.
Hospitals have more than 20 beds and are considered to be a secondary or tertiary level medical setting. If a complication occurs during pregnancy or delivery at a birth centre or clinic, women are transported to secondary or tertiary level medical settings to receive specialised medical treatment. At clinics and hospitals, obstetricians, predominately male, manage the childbearing process while midwives take an auxiliary role. Because, hospitals are considered a ‘safety first’ setting, the standards of comfort and other amenities are much lower. In a normal birth the average number of hospital days is 5.6 (SD=0.76) and 8.8 (SD=1.75) days for a caesarian section (Ohoga et al., 2009).
Midwives and caregivers have a crucial task in the childbirth experience. Several researchers (Kennedy, 1995, Tinkler and Quinney, 1998, Luyben and Fleming, 2005) have reported that women who received care from midwives had higher self-esteem and self-efficacy and thus empowerment. They were also able to achieve a sense of mastery during pregnancy, labour, and the child-rearing period. Other researchers (Matthews and Callister, 2004, Hauck et al., 2007, Bryanton et al., 2008, Goldbort, 2009) reported that caregivers played an important role to empower women's sense of control during the childbearing period, which was valuable to women's birth experience. Caregivers not only influenced women's sense of control, but also the mother–caregiver relationship helped women to become mothers (Holaday, 2008). The caregiver–mother relationship develops over time allowing trust to evolve.
From the evidence, care provided at birth centres can be called women-centred care (WCC). The four elements of WCC were respect, safety, holism, and partnership and its goal is the general well-being of women, potentially leading to the woman's empowerment (Pope et al., 2001, Horiuchi et al., 2006). Horiuchi et al. (2009) found four basic attitudes to be important in providing WCC: (1) treating women with respect, (2) providing care in a non-threatening manner, (3) working in collaboration as equal partners, and (4) giving priority to the woman's preferences over that of the health-care provider.
Gepshtein et al. (2007) presented core concepts guiding midwifery care in Japanese birth centres as ‘positive communication’ and ‘supporting women's own way’. Takehara et al. (2009) described care provided for pregnant women and relationships between women and midwives at birth centres as: ‘accepting women's feeling’, ‘personalised care and advice’ and ‘respect for women’. From these qualitative studies, WCC can be defined as a woman–caregiver relationship, which influences a woman's birth experiences.
Despite the small number of women who decide to give birth at birth centres, it is known that their satisfaction with care is fairly high (Horiuchi et al., 1997, Misago et al., 2000, Gepshtein et al., 2007, Takehara et al., 2009). While research has demonstrated that women birthing at birth centres receive WCC, little is known about women's perceptions of their WCC maternity care at clinics or hospitals in Japan. A first step in providing WCC to all pregnant women is to describe women's perceptions of WCC during pregnancy and how that correlates with pregnancy and delivery experiences in different health facilities.
Therefore, the objectives of this study were to ask (a) what are the perceptions and comparison of WCC at Japanese birth centres, clinics, and hospitals and (b) what are the relationships between WCC and three dimensions of women's birth experience: (1) satisfaction with care they received during pregnancy and birth, (2) sense of control during labour and birth, and (3) attachment to their new born babies.
Section snippets
Design
In this cross-sectional study using self-completed retrospective questionnaires, women who gave birth in birth centres, clinics, or hospitals were surveyed 1–5 days after birth regarding: WCC, personal control during childbirth, their attachment to their newborn and their satisfaction with care. Correlations among the four variables were examined.
In descriptive studies data are usually presented in the form of descriptive statistics. However, correlations or differences between groups may also
Number of questionnaires distributed and the timing of administration
During the study period, 591 questionnaires were distributed to women eligible for participation. Of these, 500 were returned (response rate 84.6%), and after questionnaires with insufficient data were excluded, 482 were included in the analysis (response rate 96.4%). The average time of questionnaire administration was 2.9 (SD=1.7) days postpartum. Administration time of the questionnaire was mostly the same: hospitals (3.1 days), clinics (2.9 days), and birth centres (2.4 days).
Characteristics of participants and health facilities
Participants'
Discussion
This study explored the question: what are women's experiences and relationships between WCC, sense of control, maternal attachment and satisfaction with care among birth centres, clinics, and hospitals? Results revealed that generally, women felt that they received WCC. Women giving birth at birth centres felt that they perceived receiving a high degree of WCC and were significantly more satisfied with care they received compared to those who gave birth at clinics and hospitals. It is also
Conclusion
Women who gave birth at birth centres perceived women-centred care, sense of control, and were significantly more satisfied with care they received than women attending clinics and hospitals. Future research should take into account the details of the caregivers who provide care and the actual care provided at the settings.
Acknowledgements
We are grateful to each woman who participated in the research, staff who accepted and assisted our research and all the people who supported us to overcome the difficulties. This study was supported by the Aoki Midwifery Scholarship, St. Luke's College of Nursing, Tokyo, Japan.
References (34)
Finnish women's experience of antenatal care
Midwifery
(2002)- et al.
Predictors of women's perceptions of the childbirth experience
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2008) - et al.
The influence of childbirth expectations on Western Australian women's perceptions of their birth experience
Midwifery
(2007) - et al.
Women's perspectives on maternity services in Sweden: processes, problems, and solutions
Journal of Midwifery and Women's Health
(2007) - et al.
Development of an evidence-based domestic violence guideline: supporting perinatal women-centered care in Japan
Midwifery
(2009) Swedish women's experience of childbirth 2 years after birth
Midwifery
(2005)- et al.
Women's needs from antenatal care in three European countries
Midwifery
(2005) - et al.
Childbearing women's perceptions of nursing care that promotes dignity
Journal of Obstetric, Gynecologic, and Neonatal Nursing
(2004) - et al.
Satisfying birth experiences in Japan
Lancet
(2000) - et al.
Women-centered care
International Journal of Nursing Studies
(2001)