Experiences of health and allied health professionals during labour and birth

Women gave birth in different settings and were supported by a range of health or allied health professionals during labour and birth. Most mothers gave birth in hospital (public or private) where they were attended by midwives only or by both midwives and an obstetrician. Some chose midwife-led care in a birthing centres, while a couple of women had their babies at home with a homebirth midwife or doula present. A few women engaged a doula to support them during labour and birth, whether this was in hospital or a birthing centre.

Women who felt positively about their labour and birth often described feeling a sense of 'control' throughout the experience. For some, this was because they had vaginal births with minimal intervention or pharmacological pain relief (and often spent most of their labour at home), while for others it was a result of deciding to have an elective caesarean.

Lara felt 'gratitude' for support from midwives and women friends and minimal intervention in her son's birth. The only time they saw a doctor was on discharge.

In late pregnancy, Melissa was told her IVF-conceived baby was large for its gestational age. Although her obstetrician was happy for her to have a vaginal birth, she opted for an elective caesarean.

For other women who described their births as 'good', feelings of control resulted from respectful support from and 'connection' with the health professionals who were present during their labour and birth. Melanie who had an epidural and had positive memories of her hospital-based labour and birth said: 'all the midwives were really beautiful and I can't fault the hospital in any way' while Beth who had a water birth for her first baby in a birthing centre said: 'all the midwives started crying. And it was lovely. And my doula had been awesome'.

Josie felt very supported by her doula, midwife and obstetrician when giving birth to her first baby in a private hospital.

In contrast, mothers who recalled difficult births involving intervention (see Labour and birth experiences, unwanted or ineffective pharmacological pain relief, assisted instrumental delivery, or emergency caesareans described varied emotional responses.

Some felt that health professionals did not support them or 'believe' what they were trying to communicate to them. Sarah M described what happened when she went into pre-term labour in hospital with her third baby at 30 weeks: 'A student came in and asked what was wrong and I said, "I'm going to have the baby," and she said, "No you're not, you're just contracting because you're bleeding, everything's okay," and I said, "Look, I've had two children, I know how it feels and I'm definitely going to push this baby out tonight, please get an obstetrician"'.

Alice, a young mother, felt her emergency caesarean and haemorrhage could have been avoided if the midwives and doctors had taken her seriously when she tried to tell them she was worried about the size of her baby.

After Sara L's waters broke she went into hospital where she said the obstetric registrar did not perform the required test to confirm this, even though she was Group B Streptococcus positive.

Other women who had 'traumatic' births described feeling unsupported.

Susanne and her partner were very upset when the team midwife care program they had chosen at a public hospital fell through at the birth.

A few women were critical of how consent was dealt with during labour and birth and described feeling powerless or 'violated'. During advanced labour with her second child Nellie recalled being pressured to consent to 'drugs' and augmentation. A new midwife came on shift as she was 'about to cause a big problem by not consenting' and accepted her wishes. Nellie was happy with this but said: 'I just feel that uneven care makes it difficult. And I don't know how many times one has to say in labour, "No I don't want drugs. I will ask if I need drugs. But I don't need them"'.

Cecilia experienced a loss of 'self-agency and control' as a result of intervention during the second ('pushing') stage of labour.

Not everyone who had a difficult birth felt negatively about the health professionals who supported them. A few people said they experienced a variety of midwives, some 'horrible' and some 'lovely'. Michelle had a very difficult birth ending in an emergency caesarean but appreciated her midwife: 'she stayed with us the whole time and constantly said to me, "You're very brave"'.

Others were able to see things from the perspective of the health professionals who attended their labour and birth. Joanne felt quite 'traumatised' by her baby's ventouse (vacuum) delivery and the midwives' failure to give her antibiotics during labour for Group B Streptococcus. This meant antibiotics had to be given to her son, which made him unsettled and breastfeeding hard to establish. However, as Joanne reflected: 'it's a bit conflicting, I did feel the care was good, but then they forgot to give me my antibiotics - but I think I saw that as a genuine mistake because all hell did break loose, it just was a bit crazy at the end'.

When Nellie's first baby was overdue she resisted a caesarean but had to be induced. One midwife who attended her labour was 'officious' while the other was 'lovely'.

Most mothers described feeling better prepared for the birth of their second babies. Several who had had a difficult first birth described taking steps to try to make the second a better experience. Some employed a birth attendant or doula, others described being more assertive with hospital staff, or chose to have either a VBAC or an elective caesarean if they had had an emergency caesarean for their first birth. Elizabeth who found her first emergency caesarean 'quite traumatic' had an elective caesarean for her second baby and said: 'the second much nicer experience with the second baby did help to replace some of the bad memories from the first birth experience'.

Rumer explained why she engaged a doula to support her attempt to have a VBAC (vaginal birth after caesarean) following an emergency caesarean with her first baby.

A few women experienced difficulties with their second or later births. Again, health professionals' approaches made a difference. Deb experienced complications after her second child's birth including surgery for a haemorrhage and her daughter having facial bruising. She said: 'I woke up from surgery and I was really confused. I feel we probably didn't get enough support from the nurses there'.

In contrast, Melissa's second elective caesarean was more stressful than her first because her spinal block didn't work as well and she could feel 'every movement'. However, as she explained: 'the obstetrician was really good because he just kept talking to me while he stitched me up and everything so that I wasn't concentrating on that, which was great'.