2. EMOTIONAL LABOR Emotional labor or emotion work is a requirement of a job that employees display required emotions toward customers or others. Because women and their family members tend to value emotional support and positive experiences of care as important components of health care, it is important for healthcare providers and systems administrators to understand and respond to women's needs and preferences, and to ensure that their own perceptions regarding how women define quality care align with what women say that they value. Where we give birth in this general hospital is not good because up to four people can go through labor in a single room…. In 2001 I came across the English edition of Dr. Lamaze’s biography. (Woman, IDI, 30–45 years). This implies that there is a need to make structural provisions for husbands accompanying their wives/partners for childbirth; for example with curtains or partitions to provide privacy. Nigeria Demographic and Health Survey, Swedish women's experience of childbirth 2 years after birth, The limitations on choice: Palestinian women's childbirth location, dissatisfaction with the place of birth and determinants, Childbirth and authoritative knowledge: Cross‐cultural perspectives, Male partner's role during pregnancy, labour and delivery: Expectations of pregnant women in Nigeria, Birth in the United States: An overview of trends past and present, Language Barriers Are Hindering Health Care, Effective communication and delivery of culturally competent health care, Father involvement and psychological well‐being of pregnant women. Let's teach them how to communicate with people as if they are the owner of this health facility, because if you are the owner of something you want to make it good. Working off-campus? (Woman, IDI, 30–45 years). Emotional Labor 1. The instruments used to guide the discussions with providers were similar, and explored five major domains: (1) the meaning of good quality of care during childbirth in their work environment; (2) expectations and needs to provide good quality care; (3) barriers and facilitators to the provision of quality care during childbirth; (4) potential changes that could be made to enhance the provision of quality childbirth care; and (5) perceived expectations and needs of women during facility‐based childbirth. How to Provide Emotional Support During Early Labor. No matter you are a dad, sister, mother or a friend of the pregnant woman, you don’t need to be an expert to provide her some emotional support during early labor. …when something negative is happening, you just tell the woman, ‘madam, can you see now that we have been trying for some time to make sure that you are alive and the baby is alive?’…you guide the patient, any procedure you are doing with the patient, you'd relate with the patient and let the patient know. When emotional labor has left the professional sphere and has entered the domestic realm; when it is used to describe a household list of domestic chores, whether or not those chores are done happily or grumpily, it has become diluted to the point of being in danger of losing its meaning. Some studies have shown that labors attended with doulas may actually be shorter in length, although there is no effect on cesarean delivery rates. Most of the women agreed that they would like to have a labor companion, with only a few objecting to this idea. Most facilities are built in a way that more than one woman will be in a labor room at a time. To increase, improve, and sustain facility‐based childbirth in Nigeria, health systems should appreciate the uniqueness and importance of each woman's needs during childbirth. Doula. (Woman, IDI, 30‐45 years). Nigeria is a very religious country and many of the women in this study desired the prayers of their family members and healthcare providers during childbirth. Practical and sustainable actions should be taken to meet these needs, within the confines of the acceptable sociocultural norms. They should attend to us well any time we come, as if they are the one that is pregnant, because this is why they are employed and being paid, they should not be cranky, they should do their work with love. Completed and translated transcripts were shared and reviewed by the study team on an on‐going basis and prior to the conclusion of data collection to ensure data quality and consistency. Position the companion at the top of the bed to allow the companion to focus on caring for the woman's emotional needs. A woman explained her challenge communicating with the provider: Despite women's professed need for clear communication and being well received in their interactions with providers, women lamented that healthcare providers often “didn't hear me out” (Woman, IDI, 30–45 years) as they were rushing off to see another patient. Nursing support during labor. Remember, it is your right and the doctor’s responsibility to fully inform you prior to the procedures. The childbirth experience is an intensely dynamic, physical and emotional event with lifelong implications. Furthermore, women were recruited from urban, peri‐urban, and rural settings to improve the diversity of the sample and transferability of the results. The project seeks to achieve this goal through a two‐pronged approach26: the development of a Simplified, Effective, Labour Monitoring‐to‐Action tool (SELMA)27 and the Passport to Safer Birth.28 SELMA is a digital tool developed to enhance the expertise of health professionals assisting labor in health facilities. Emotional Side of Childbirth. To improve on the services currently available in health facilities, barriers limiting access to quality maternal health services must be identified and addressed at all levels of the health system, and systems must be strengthened to be responsive to the needs of women and girls.6, 7 Two of the strategic objectives of the ending preventable maternal mortality framework are addressing inequities in access to and quality of sexual, reproductive, maternal, and newborn health care; and strengthening health systems to respond to the needs and priorities of women and girls.7. What is a doula? Does the Therapist Have Holes in His or Her Shoes? Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Learn more. Theme 3: Emotional support during childbirth. However, a key barrier identified by women was that “the doctors won't agree that men should stay with you when giving birth” (Woman, FGD, <30 years). In this study, many women referred to these prayers as one of the best experiences they have ever had during childbirth. Nobody is perfect and we are not all the same but once we come, they should care for people appropriately, because then… it seems to be better now; before they cast dirty looks at you, people say they don't value life, as if one comes begging, this is why they are being paid, they too should be committed to the work so that they will reduce mortality, they should reduce all sorts [of problems] in the community, those are my observations, and they should give us attention. One woman said: Women emphasized that rather than being rude and dismissive, healthcare providers should listen and respond to the needs of the women: Another woman had this to say when asked for her communication needs from her healthcare provider: Women desired emotional support during labor and delivery, which includes demonstrations of respect and empathy from the providers. Most of the women believed that having their husband present during labor and childbirth would help him to respect the process she has gone through and understand the pain she has felt. Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. (Woman, FGD, <30 years). cesarean delivery, blood transfusion). Surfa… And with that, the concept has become hijacked. At some point or another in our jobs, we have all experienced emotional labor, the strained endeavor to be outwardly graceful in the face of inward discomfort. Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study. Shorter labor with fewer complications Research shows having a doula present at birth tends to result in shorter labors, reduced need for cesarean sections, epidurals, or other pharmaceutical pain relief. Women in this study stated that they would like the prayers of their healthcare providers and family members irrespective of their religious affiliation as long as the prayers are being offered to “God.” The women further stated that this act of prayer, especially from a healthcare provider, in itself is reassuring to a woman in labor and her family members, and makes the woman connect better with her healthcare provider and also encourages her cooperation with the healthcare provider. Rather than shouting at women, women wanted nurses to show empathy to the pain of labor, demonstrating that they “at least they know what labor entails” (Woman, FGD, <30 years). Based on this process, a final codebook was developed, including the code families, code names, definitions, and examples of correct use. —We read with interest the article by Kennell et al 1 concerning the efficacy of emotional support by doulas during labor in reducing both cesarean section rates and the use of epidural analgesia. • Both during and after the event, provide as much privacy as possible for the woman and her family. Safe Motherhood Strategies: A Review of the Evidence, Countdown to 2015 decade report (2000–2010): Taking stock of maternal, newborn, and child survival, Maternal mortality in northern Nigeria: Findings of a health and demographic surveillance system in Zamfara State, Nigeria, Strategies for reducing maternal mortality: Getting on with what works, Ending preventable maternal and newborn mortality and stillbirths, Strategies toward ending preventable maternal mortality (EPMM), Quality of care for pregnant women and newborns—the WHO vision, Moving beyond essential interventions for reduction of maternal mortality (the WHO Multicountry Survey on Maternal and Newborn Health): A cross‐sectional study, Facilitators and barriers to facility‐based delivery in low‐ and middle‐income countries: A qualitative evidence synthesis, The mistreatment of women during childbirth in health facilities globally: A mixed‐methods systematic review, The childbirth experience: A study of 295 new mothers, The pain of childbirth: Perceptions of culturally diverse women, Feeling in control during labor: Concepts, correlates, and consequences, Expectations and experiences of pain in labor: Findings from a large prospective study, Informed decision making in maternity care, Women's perceptions of in‐ formed choice in maternity care, Why some women fail to give birth at health facilities: A qualitative study of women's perceptions of perinatal care from rural Southern Malawi, ‘They treat you like you are not a human being’: Maltreatment during labour and delivery in rural northern Ghana, Comparison of maternal satisfaction following vaginal delivery after caesarean section and caesarean section after previous vaginal delivery, Mothers’ views of their childbirth experiences 2 years after planned caesarean versus planned vaginal birth for breech presentation at term, in the international randomized term breech trial, Continuous support for women during childbirth, WHO Better Outcomes in Labour Difficulty (BOLD) project: Innovating to improve quality of care around the time of childbirth, Formative research and development of innovative tools for “Better Outcomes in Labour Difficulty” (BOLD): Study protocol, The development of a Simplified, Effective, Labour Monitoring‐to‐Action (SELMA) tool for Better Outcomes in Labour Difficulty (BOLD): Study protocol, Using a service design model to develop the “Passport to Safer Birth” in Nigeria and Uganda, Defining quality of care during childbirth from the perspectives of Nigerian and Ugandan women: A qualitative study, Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities, Expectations and needs of Ugandan women for improved quality of childbirth care in health facilities: A qualitative study, A service concept and tools to improve maternal and newborn health in Nigeria and Uganda, Consolidated criteria for reporting qualitative research (COREQ): A 32‐item checklist for interviews and focus groups, National Population Commission (NPC) [Nigeria] and ICF International. Get the help you need from a therapist near you–a FREE service from Psychology Today. relationship during childbirth. In particular, women wanted their family member to stay with them and pray with them especially if their labor becomes difficult. ... and provide you with the support you need in making this very important decision. Data from the study were analyzed using the thematic analysis approach. The participants were allocated to either IDI or FGD; no participant participated in both. Women noted that some parents are to be blamed for “not have anything to use for the baby or themselves. Individuals who met the inclusion criteria in each group were interviewed. We also thank the babies for their cooperation during the interviews with their mothers. In addition, informational support in the form of prenatal classes is related to decreased maternal physical complications during labor and delivery, and to improved physical and mental health postpartum. The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the views, decisions, or policies of the institutions with which they are affiliated. Number of times cited according to CrossRef: Role of verbal and non-verbal communication of health care providers in general satisfaction with birth care: a cross-sectional study in government health settings of Erbil City, Iraq. Interventions: One-to-one care consisted of the presence of a nurse during labor and birth who provided emotional support, physical comfort, and instruction on relaxation and coping techniques. A minority of women objected to the idea of having a labor companion at all. Women emphasized that they need detailed information about the health procedures to be carried out on them and the opportunity to consent to or refuse treatments. BJOG: An International Journal of Obstetrics & Gynaecology, International Journal of Gynecology & Obstetrics, Acta Obstetricia et Gynecologica Scandinavica, Australian and New Zealand Journal of Obstetrics and Gynaecology, Journal of Obstetrics and Gynaecology Research, I have read and accept the Wiley Online Library Terms and Conditions of Use, Trends in Maternal Mortality: 1990 to 2015: Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. 1993. The IDI and FGD sessions were conducted at the homes of the women and private areas in MCH. A nurse elaborated on this: Women interviewed also highlighted the importance of addressing language barriers and providing translation services when the provider does not speak their language. The scenes are familiar. Every woman needs strong emotional support during labor and delivery. (Doctor, FGD, 30–45 years). The qualitative evidence synthesis analysed 51 studies from 22 countries, and revealed that labour companions played a number of roles in supporting women. Most women agreed that healthcare providers and “especially nurses are rude,” they “shout,” and “talk badly” to the women. The research team sought to recruit 10–15 women per catchment area (one urban and one peri‐urban) for IDIs and to hold 2–3 FGDs. At its core, emotional labor is the regulation of one’s feelings at one’s job. After all, how easy is it to bite your tongue after being abruptly cut off in mid-sentence by your manager? Concerns about privacy were identified by both women and healthcare providers. This study was conducted in four health facilities and corresponding facility catchment areas in Akure and Abuja, Nigeria. Midwives’ perspectives of respectful maternity care during childbirth: A qualitative study. This paper is part of a series on the BOLD project formative research; other aspects of the project are described in detail elsewhere in this Supplement.28-32. OAO and MT wrote the first draft of the paper. Try to figure out how the person is feeling as you’re talking. Special Issue: Formative research and development of innovative tools for “Better Outcomes in Labour Difficulty” (BOLD). Cultural practices in Nigeria may call for the approval of a husband, mother‐in‐law, other family member, or clergy member to provide consent or approval for interventions to take place (e.g. She needs…to be shown love at that time [during labor], she needs to be shown care at that time…you start shouting on the person, no, it should not be like that. In the caregiving industry, staff turnover rates in senior care facilities soared to 70 percent and beyond in 2018. A health care provider should ensure comfort measures, information, instructions, emotional supports, advocacy and support for the family as nursing interventions during labor and delivery. A straightforward definition that is crystal clear encourages more meaningful discussion. Participants reported such needs as communication in simple words in local language by healthcare staff, having their husbands as birth companions, spiritual support, and prayers from family members and healthcare providers. Women also desired personalized attention from the health providers, where each woman is treated as a unique person with a unique need. The authors have no conflicts of interest to declare. To deal with negative emotions, people tend to do one of the following: 1. Emotional labor demands—the need to provide comfort and care to the cranky—are likely one of the main culprits. The head of facility who attended the study training workshop acted as an entry point to connect the trained research assistants to the healthcare providers. Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey. Women would like to be given opportunities to ask questions and would like their questions to be answered properly; they felt that denial of this opportunity left them in the dark with regard to their own safety and that of their baby during labor and birth. All transcripts were coded using Atlas.ti, version 7.5.6 (ATLAS.ti Scientific Software Development, Berlin, Germany), and a subset of the transcripts was reviewed by an independent researcher for reliability. A key aspect of communication was continuously checking on the woman and asking her questions to understand how she feels: To effectively communicate, providers need to improve their use of simple words that are easily understood by women. Companions supported by giving information about childbirth, bridging communication gaps between health workers and women, and facilitating non-pharmacological pain relief. There were 2616 births during the study period (January to May 2015), and seven maternal deaths were reported. Labor pain is reduced by massage therapy. To improve women's childbirth experiences in health facilities, their psychosocial and communication needs have to be met. Continuous Emotional Support During Labor in a US Hospital A Randomized Controlled Trial John Kennell, MD; Marshall Klaus, MD; Susan McGrath, PhD; Steven Robertson, PhD; Clark Hinkley, MD The continuous presence of a supportive companion (doula) during labor and delivery intwo studies Guatemala shortened labor and reduced the need for cesarean section and other interventions. This method is useful for identifying key themes; it describes large bodies of qualitative data richly and highlights similarities and differences in experiences.35 After transcription, line‐by‐line coding was conducted on a sample of transcripts by two independent researchers. From a practical standpoint, this means that you either (a) express only your positive feelings, or (b) hide or manage your negative feelings. (Doctor, FGD, 30‐45 years). Emotional Support and Guidance During Labor. The health sector should think beyond the provision of minimal medical care for women during childbirth and consider the emotional needs of women who are planning for childbirth in health facilities. The women desired healthcare providers that “will take care of” them as if they “are their biological children and that they [the healthcare provider] have the experience of childbirth.” However, they reported that “some [healthcare providers] will shout at you as if they have never given birth before.” One woman said: Women would like to have auditory and visual privacy when communicating with their healthcare providers because they may want to say certain things that may be particular to the woman's need. The MMR for Ondo State is lower than the national MMR, the contraceptive prevalence for the state is 31.1%, delivery by skilled provider is 67.2%, and the rate of facility‐based childbirth is 56.2%.34. One of the key interventions to improve maternal health is increasing the proportion of births attended by skilled health professionals, as timely and effective management and treatment of complications can make the difference between life and death for both the mother and the baby.2-5 However, despite a global increase in coverage of skilled birth attendance, associated declines in maternal mortality have been modest, and declines in stillbirths virtually nonexistent.6 The lack of significant improvement highlights the need for continued focus on quality of care, including provider competencies and environments that enable provision of essential clinical interventions with dignity. When healthcare providers used phrases such as “don't shout, don't disturb me” for the women in labor, women felt discouraged. For example, depressed mood during pregnancy has been identified as a predictor of post-partum depressed mood (Neter et al., 1995; Da Costa et al., 2000b). Interviews conducted in Yoruba were translated into English by the data collectors, which helped to retain the originality of the contextual meaning of statements made in Yoruba language. A recent article in the New York Times boiled it down to the domestic tasks that typically fall on wives and mothers—planning the children’s school lunches, reminders to take out the trash, etc.—that must be done to keep a household running smoothly. Their gentle but firm touch and words of encouragement are invaluable. She related that she gave birth at a “big hospital . Using these stratification parameters, the research team recruited participants to achieve a diverse and varied sample. In some cases, emotional labor is part of the job description. Table 1 reports the number of IDIs and FGDs by participant type. This paper was developed as part of the World Health Organization (WHO) BOLD (“Better Outcomes in Labour Difficulty”) project, which was funded by the Bill and Melinda Gates Foundation, the United States Agency for International Development (USAID), and UNDP‐UNFPA‐UNICEF‐WHO‐World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), a cosponsored program executed by the WHO. Most believed that a labor companion could facilitate communication between health provider and the woman by explaining things in simple language, be trained in use of simple communication tools, how to identify danger signs, and when to call for help. We envision that the Passport to Safer Birth will better prepare women with what to expect during childbirth, and prompt them to ask questions and seek clarifications from their providers at key points throughout pregnancy and childbirth. Our findings revealed that most women would prefer their husbands as their labor companions. However, maintaining good psychological health during pregnancy also has imp… If our family members stay with us there won't be the need to start looking for them in order to get their consent if delivery is going to be by cesarean; the husband can also sign if he is the one around so that the operation can be done on time. Facility administrators working at the study hospital, including a Medical Director and head of obstetric department, were invited to participate in key informant interviews. Why are so many people drawn to conspiracy theories in times of crisis? It is emotional labor because there is emotional dissonance, i.e., a mismatch between expected and felt emotions. MCH is the referral hospital established in 2010 for the “Abiye” (safe birth) program—a Safe Motherhood project organized by the Ondo State Government that was sponsored by the World Bank. Some women preferred their mother (especially) or mother‐in‐law (occasionally), sister, or friend as labor companion, rather than their husbands or partners. While women themselves are the “gold standard” for information on their own needs and preferences, healthcare providers and administrators can provide interesting input to explore convergent and divergent perspectives on women's needs. In‐depth interviews (IDIs) and focus group discussions (FGDs) were conducted among women of reproductive age, midwives, doctors, and facility administrators. She feared that a companion may reveal her pregnant state to those who could “charm” (hex) her during the process. One woman expressed that she felt that the communication channels between women and providers was in dire need of improvements: Pictorial and graphical materials to visualize and communicate information for patients with low literacy could also be helpful in communicating difficult medical processes or procedures, such as what to expect while progressing through labor, cesarean delivery, and childbirth position. Thematic analysis was used to synthesize findings, and then interpreted within the context of this study and existing quality of care framework. Some women also believed that men would not be able to stand the labor pains their wives go through and may be “crying” while accompanying their wife or partner, which they considered unhelpful for the woman in labor. We conducted 42 IDIs and 10 FGDs between January and May 2015. and you may need to create a new Wiley Online Library account. The interviews were moderated by female Master's degree holders in public health with experience in maternal health research and qualitative data collection who had been previously trained on the study protocol. And it is a high stakes issue because it happens at your job and potentially affects your livelihood. Visitors should be limited to those essential for the pregnant person’s well-being and care (emotional support persons). Observations and assessments during interviews were digitally recorded and field notes were taken and added to the end of the interview transcripts. Yes, women do tend to shoulder more emotional labor in the workplace, and more attention on its health and professional repercussions means more attempts to alleviate it. (Woman, IDI,30–45 years). They provide informational support about the process of childbirth, and bridge communication gaps between clinical staff and women. Create an appropriate emotion for the situation. Unless and until the Dublin practice of assigning a personal midwife to every woman in labor is established in the United States, the doula will be the most appropriate cost-effective source of support. Doctors can only just harass you and later just go their way, but nurses, they should, they should go and learn more how to be mtchew [hiss] familiar, how to be very familiar and how to listening hear, they should not be too harsh to their patient. Women who are provided continuously available support during labor have improved outcomes compared with women who do not have one‐to‐one continuously available support (Hodnett, Gates, Hofmeyr, & Sakala, International Journal of Gynecology & Obstetrics. Turning local knowledge and experience into innovative tools for quality care during labor and childbirth: The BOLD project experience. The findings of this research were discussed and analyzed by the Nigeria qualitative research team members. The strengths of this study include that the research team was warmly accepted by participants who expressed their views on the subject freely with openness and readiness. All participants gave written informed consent to participate and were free to withdraw their participation at any time. Findings from this study have directly informed the development of the “Passport to Safer Birth,” as the needs, expectations, and gaps in how care is provided to pregnant women have been identified and prioritized in Nigeria.28 The Passport to Safer Birth is a set of tools designed to help increase demand for quality of care during childbirth in health facilities, and aims to facilitate better communication between women and their providers during pregnancy and childbirth, and provides information to women in a clear, simple, and culturally‐appropriate way. Hide emotion they really do feel. Women who are provided continuously available support during labor have improved out-comes compared with women who do not have one-to-one continuously available support (Hod- Companions were advocates, which means they spoke up in support of the woman. Some people struggle to put a label on their emotions or may even try to mask their feelings. Los Altos, California: Mental Health Update, The Center for Health Sciences. Rather, women said they would prefer that the providers treat every woman in labor with extreme care and attention, regardless of her parity, recognizing “that this person is new, they should not use such statements as ‘after all this is not your first baby, not your second baby, you know the way’”. Haven ’ t already health facility where women give birth in this study, many referred... Private areas in MCH should be limited to those essential for the mother declare! 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