CHAPTER ONE

INTRODUCTION

Background to the Study

Pregnancy is a time of excitement, anticipation and planning interspersed with periods of anxiety, fear and stress all of which are quite normal (Tiran, 2010). Generally, expectant mothers spend the early pregnancy coping with various physiological discomforts like early morning sickness and backache while trying to continue with their day to day lives. It is not until later in their pregnancy that they begin to think about the impending birth, perhaps worrying about pain and its relief during labour and the actual delivering of the baby and also planning for how they would want it to be (Tiran, 2010).

Childbirth is a unique experience for any parents and along with it are beliefs and expectations that have cultural variations (Callister, 2009). It is often glamorized as a spiritual journey, but physically it is called labour for a reason because it can be a transcendent experience for many women. Cara, (2014) also posits that childbirth without adding any other stressful or complicating circumstances, has all the necessary ingredients to be bewildering, frightening and emotionally exhausting; and yet because of the subjective nature of the experience, two mothers can have the same event happen during birth and one can emerge merely rattled while the other emerges with great fulfillment (Hunter, 2012). According to Blaaka and Schauer (2009), childbirth is a complex life event characterized by rapid biological, social and emotional transition and it is a great stress to many women especially the first time mothers.

Childbirth expectation as defined by Sarah (2013), is an event a pregnant woman thinks will happen during labour. According to Main, Oshiro & Bingham (2010), it is a wish a pregnant mother has about her labour and delivery. This is why many pregnant women have concerns about the pain they     may encounter and method of pain relief available to them during labour; lack of appropriate knowledge about the various methods of pain relief can heighten anxiety (Carter, 2010). Mothers develop expectations regarding midwives’ care during labour and delivery. The pregnant mothers expect midwives to provide professional and emotional support and in addition they expect their partner and significant others to provide them with support (Gibbin & Thomson, 2008). Pregnant women also expect to participate in decisions about their healthcare, including pregnancy and childbirth (Paink, 2014). Tiran (2010), asserts that many women expect to have a “natural childbirth” which means a labour that starts, progresses and is completed without medical intervention, and one which empowers the mother to make choices about the way her labour is managed. Unfortunately the reality of childbirth is not always in keeping with maternal expectation because labour is a dynamic event where things can change quickly and so things may not work out as the mother expected.

While the healthcare around childbirth has recently been concentrating on complications and risk for mothers and children, little attention has been focused on women’s experiences and expectations. Meeting a pregnant woman’s childbirth expectation is the most valuable part of her satisfaction (Saliday, 2014). A satisfied pregnant mother is one who has her labour and birthing expectations met. Carter (2010) and Tiran (2010) described the resulting grief from an unexpected childbirth as devastating to mothers. This may increase their risk of post natal depression. Thus congruence between maternal childbirth expectations and reality of the actual experience has an important impact on perception of severity of labour pain, subsequent evaluation of pain itself, the childbirth experience and on mother-baby relationship, (Beaton and Gupton, 2000).

Almost every first time pregnant woman has a preset notion of what labour will be like and that is normal. Many of them believe they will go through labour and give birth without medical intervention and more often than not labor often do require interventions; and new mothers who experience unexpected obstetric intervention have reduced feeling of confidence and fulfillment. The multiparous women also entertain many expectations about the experiences and outcome of childbirth as one pregnancy differs from another. It is important to note that individual women have varying capacities to handle challenges, disappointments and sorrow connected with childbirth and if the experience of labour does not respond to expectations, anxiety usually results (Carter, 2010). The challenge in this context is the feeling and fear in approaching subsequent labour by the distress experienced by these women. The potential source of this distress and fear is not limited to pain or pain relief option but to such challenges as emotional, social and economic implications which has great impact on the woman. The disappointment, if the expectations are not met, can be obvious and easily observed by healthcare providers but the psychological (emotional and mental) challenges are subjective (Beaton et al 2000). Paink, (2010) asserted the need for women to develop realistic expectations about pain, pain relief and support from significant others during labour. Bennet and Brown (2009), observed that expectations and emotions expressed during childbirth are greatly influenced by a combination of several factors such as level of mother’s education, values, religion, cultural beliefs and accumulation of past experiences from previous deliveries especially for the multiparous mothers, and fear for the first time pregnant women.

Childbirth in America and United Kingdom is generally considered to be safe or at least a safe enough event, but whilst women and their babies thankfully rarely die, the psychological morbidity for mothers whose labours have been less than satisfying can be long term and in turn create fear in the mind of the mother especially first time ones (Nock, 2009). Most women of African culture see childbirth as a guarantee of continuation of the lineage and clan. They believe also that children provide helping hands for farm work, housework and childcare. Being able to produce many children therefore, adds to their sense of importance and helps them feel a strong sense of belonging within their clan. Children are very highly celebrated in some cultures as some of them believe in reincarnation, (Quincy, 2010)

 In most countries of Africa, 1 in 39 women risk dying from pregnancy or childbirth related causes compared to 1 in 4,300 in developed countries, (Miller, 2009). With this staggering figure, there is still high rate of maternal and infant morbidity and mortality resulting from intractable poor health indices including psychological and emotional feelings arising from failed childbirth expectations (Ayers & Pickering, 2009). The anxiety and emotional feelings in the primiparous are more obvious and intense than in the multiparous mothers (Kitzinger, 2012). This experience plays a major role on how she will develop good self-esteem, positive feeling for the baby and an easier adjustment to motherhood and also future childbirth experiences (Oweis & Abushaikha, 2005). All these emotional and psychological issues can affect a patient’s quality of life.

 In different parts of the world, more especially in developed countries such as UK and Denmark, spousal participation is common practice during labor and delivery with about 95% attendance, (Somers, 2009). Studies conducted in these developed countries show that women who had continuous spousal labor support are reassured, comforted and emotionally encouraged to overcome pain associated with labor and delivery, (Hodnett, Gates, Hofmeyr, Sakala, 2007) but in  low income countries like Nigeria, which is known to be a patriarchal male dominated society where pregnancy and childbirth are regarded as exclusively women’s affairs, spousal participation in labor and delivery remains acutely low (Iliyasu, Abubakar, Galadanci and Aliyu, 2010). Men traditionally do not accompany their wives for antenatal care and are mostly absent in the labor room during delivery, leaving their support roles to relatives and midwives, (Somers, 2009). Umeora, Ukaegbe, Eze and Masekoameng, ( 2011)  posit  that status and acceptability of spousal participation in labor and delivery in Nigeria is quite low due in part to socio-cultural drawbacks.

Consequent upon this, issues surrounding childbirth need to be considered from the mother’s point of view in terms of birthing environment, pain, pain relief, spousal support, support from significant others, medical intervention as well as labour outcome as these are vital in ensuring ideal expectations. However, despite other research works done on childbirth expectations in America, UK and Canada, little  data exist for studies on childbirth expectations in Nigeria and in Enugu specifically hence this study sets to compare the childbirth expectations of primigravidae and multigravidae in selected health facilities in Enugu State.

Statement of Problem