Birth-Issues in Perinatal Care最新文献

{"title":"Assessing patient autonomy in the context of TeamBirth, a quality improvement intervention to improve shared decision-making during labor and birth","authors":"Vanessa L. Neergheen MPH,&nbsp;Lynn El Chaer MPH,&nbsp;Avery Plough MPH,&nbsp;Elizabeth Curtis RN,&nbsp;Victoria J. Paterson MPH,&nbsp;Trisha Short RN,&nbsp;Amani Bright BS,&nbsp;Stuart Lipsitz ScD,&nbsp;Aizpea Murphy BA,&nbsp;Kate Miller PhD,&nbsp;Laura Subramanian MS,&nbsp;Evelyn Radichel MSN,&nbsp;John Ervin MD,&nbsp;Lindsay Castleman RN,&nbsp;Erin Brown DO,&nbsp;Tracy Yeboah BS,&nbsp;Tiffany Moore Simas MD, MPH, MEd,&nbsp;Daniel Terk MD,&nbsp;Saraswathi Vedam CNM, MSN, RM,&nbsp;Neel Shah MD,&nbsp;Amber Weiseth DNP","doi":"10.1111/birt.12857","DOIUrl":"10.1111/birt.12857","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Respectful maternity care includes shared decision-making (SDM). However, research on SDM is lacking from the intrapartum period and instruments to measure it have only recently been developed. TeamBirth is a quality improvement initiative that uses team huddles to improve SDM during labor and birth. Team huddles are structured meetings including the patient and full care team when the patient's preferences, care plans, and expectations for when the next huddle will occur are reviewed.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We used patient survey data (<i>n</i> = 1253) from a prospective observational study at four U.S. hospitals to examine the relationship between TeamBirth huddles and SDM. We measured SDM using the Mother's Autonomy in Decision-Making (MADM) scale. Linear regression models were used to assess the association between any exposure to huddles and the MADM score and between the number of huddles and the MADM score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>In our multivariable model, experiencing a huddle was significantly associated with a 3.13-point higher MADM score. When compared with receiving one huddle, experiencing 6+ huddles yielded a 3.64-point higher MADM score.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Discussion</h3>\u0000 \u0000 <p>Patients reporting at least one TeamBirth huddle experienced significantly higher SDM, as measured by the MADM scale. Our findings align with prior research that found actively involving the patient in their care by creating structured opportunities to discuss preferences and choices enables SDM. We also demonstrated that MADM is sensitive to hospital-based quality improvement, suggesting that future labor and birth interventions might adopt MADM as a patient-reported experience measure.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 4","pages":"855-866"},"PeriodicalIF":2.8,"publicationDate":"2024-08-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141977336","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Toward a semiotics of midwifery: Multimodal communication's effects on accessibility, equity, and power dynamics.","authors":"Jane Celeste","doi":"10.1111/birt.12853","DOIUrl":"https://doi.org/10.1111/birt.12853","url":null,"abstract":"<p><p>According to semiotics, we live in a world of signs, where almost anything can act as a signifier and convey meaning. But what of the semiotic landscape of midwifery? What signs are present within a client's multi-sensory experience of their midwifery care? How are these signs functioning to increase equity and accessibility? Or worse, how might certain aspects of the client's experience communicate unjust power dynamics? Semiotics allows us to examine a wide communicative and educational environment. By paying particular attention to the multivalent meanings of different signs-be they written, visual, oral, or even physical-we can start to see how multimodal communication plays a vital role in a client's perception of equity and power. One way to improve client experience is by approaching education and semiotic experience from the same place as trauma-informed care. A more health-literate sensitive approach viewed through the lens of semiotics assumes all clients have little previous knowledge or comfort within a care setting. This hyperawareness and criticality of the semiotic environment would allow midwives to acknowledge various sensory and communicative biases and intentionally redesign the entire client experience. The semiotic landscape is then curated to meet the needs of the most important audience-those marginalized and discriminated against whether that is because of education, finances, race, gender, or any other intersectional identity. We must acknowledge the fact that all sign systems can either reinforce abusive power relations or work to improve them. For what is at stake here is not just a client's overall comfort, but their full understanding of the care they are receiving, the options they have, and their autonomy within their entire perinatal experience.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of relationship factors on antenatal depression in the context of the COVID-19 pandemic.","authors":"Chloe Pekarsky, Janice Skiffington, Kathleen Chaput, Donna Slater, Lara M Leijser, Amy Metcalfe","doi":"10.1111/birt.12862","DOIUrl":"https://doi.org/10.1111/birt.12862","url":null,"abstract":"<p><strong>Background: </strong>Antenatal depression is the most prevalent pregnancy-associated mental health disorder. Previous studies have identified several risk factors for antenatal depression, including partner support. However, during the COVID-19 pandemic, many relationship dynamics changed. This study examined the extent to which relationship factors had an impact on antenatal depression in comparison with other well-researched factors in the context of the pandemic.</p><p><strong>Methods: </strong>A secondary analysis was conducted using data from the P3 Cohort in Calgary, a longitudinal cohort study based in Alberta, Canada. Pregnant people (n = 872) completed self-report questionnaires and validated scales about sociodemographic, psychological, and relationship characteristics. Antenatal depression was assessed using the Edinburgh Postnatal Depression Scale (EPDS). Logistic regression was used to assess the impact of reported characteristics on antenatal depression. Tests of model fit were used to examine whether the inclusion of variables related to relationship quality improved model fit after accounting for other known risk factors.</p><p><strong>Results: </strong>Overall, 18.23% of participants experienced antenatal depression. Relationship factors including relationship unhappiness (OR = 1.98 [95% CI: 1.06-3.69]), having an upsetting partner (OR = 2.00 [95% CI: 1.17-3.40]), and having a lower quality of relationships with close friends and family (OR = 1.76 [95% CI: 1.14-2.73]) were associated with antenatal depression; however, inclusion of these relationship factors did not improve model fit after accounting for other known predictors.</p><p><strong>Conclusion: </strong>Overall, relationship factors were not associated with antenatal depression during the pandemic after accounting for other known risk factors. Stress and anxiety caused by the pandemic may have overshadowed the impact of relationship factors, or relationship factors may have contributed to higher levels of stress and anxiety more generally within our sample.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-08-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141972364","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A case study analysis of a successful birth center in northern Uganda","authors":"Michelle Telfer DNP, CNM, MPH, FACNM,&nbsp;Rachel Zaslow PhD, RM,&nbsp;Scovia Nalugo Mbalinda PhD, RM,&nbsp;Rachel Blatt MSN, CNM,&nbsp;Diane Kim MSN, CNM,&nbsp;Holly Powell Kennedy PhD, CNM, FACNM, FAAN","doi":"10.1111/birt.12837","DOIUrl":"10.1111/birt.12837","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Mothers and infants continue to die at alarming rates throughout the Global South. Evidence suggests that high-quality midwifery care significantly reduces preventable maternal and neonatal morbidity and mortality. This paper uses a case study approach to describe the social and institutional model at one birth center in Northern Uganda where, in over 20,000 births, there have been no maternal deaths and the neonatal mortality rate is 11/1000—a rate that is lower than many high-resource countries.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This case study combined institutional ethnographic and narrative methods to explore key maternal and neonatal outcomes. The sample included birthing people who intended to or had given birth at the center, as well as the midwives, staff, stakeholders, and community health workers affiliated with the center. Data were collected through individual and small group interviews, participant observation, field notes, data and document reviews. Iterative and systematic analytical steps were followed, and all data were organized and managed with Atlas.ti software.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Findings describe the setting, an overview of the birth center's history, how it is situated within the community, its staffing, administration, clinical outcomes, and model of care. A synthesis of contextual variables and key outcomes as they relate to the components of the evidence-informed Quality Maternal and Newborn Care (QMNC) framework are presented. Three overarching themes were identified: (a) community knowledge and understanding, (b) community integrated care, and (c) quality care that is respectful, accessible, and available.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>This birth center is an example of care that embodies the findings and anticipated outcomes described in the QMNC framework. Replication of this model in other childbearing settings may help alleviate unnecessary perinatal morbidity and mortality.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 4","pages":"783-794"},"PeriodicalIF":2.8,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141460885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Through our eyes: A birth mom and adoptive parent share their perspectives on bias in obstetric care.","authors":"Nadja Wainwright, Keith Reisinger-Kindle","doi":"10.1111/birt.12829","DOIUrl":"https://doi.org/10.1111/birt.12829","url":null,"abstract":"<p><p>Understanding the impacts of bias, and how to mitigate these impacts, on clinical care is critically important for all healthcare team members. However, the concerns and needs in our current system are likely even more fundamental, as we are continuing to hear about the experiences of patients who are struggling to seek care that contains even the most basic tenants of respect and decency. Creating inclusive and diverse environments requires constant proactive evaluation, commitment, and energy. This piece shares the experiences of a Black birth mom and a White adoptive dad (who is also an Ob/Gyn and anti-racism researcher) and the experiences surrounding the birth of their daughter.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Indigenous maternal and infant outcomes and women's experiences of midwifery care: A mixed-methods systematic review.","authors":"Deborah McNeil, Sarah A Elliott, Angie Wong, Seija Kromm, Liza Bialy, Stephanie Montesanti, Adam Purificati-Fuñe, Sonje Juul, Pamela Roach, Jackie Bromely, Esther Tailfeathers, Maddie Amyotte, Richard T Oster","doi":"10.1111/birt.12841","DOIUrl":"10.1111/birt.12841","url":null,"abstract":"<p><strong>Background: </strong>The impact of midwifery, and especially Indigenous midwifery, care for Indigenous women and communities has not been comprehensively reviewed. To address this knowledge gap, we conducted a mixed-methods systematic review to understand Indigenous maternal and infant outcomes and women's' experiences with midwifery care.</p><p><strong>Methods: </strong>We searched nine databases to identify primary studies reporting on midwifery and Indigenous maternal and infant birth outcomes and experiences, published in English since 2000. We synthesized quantitative and qualitative outcome data using a convergent segregated mixed-methods approach and used a mixed-methods appraisal tool (MMAT) to assess the methodological quality of included studies. The Aboriginal and Torres Strait Islander Quality Appraisal Tool (ATSI QAT) was used to appraise the inclusion of Indigenous perspectives in the evidence.</p><p><strong>Results: </strong>Out of 3044 records, we included 35 individual studies with 55% (19 studies) reporting on maternal and infant health outcomes. Comparative studies (n = 13) showed no significant differences in mortality rates but identified reduced preterm births, earlier prenatal care, and an increased number of prenatal visits for Indigenous women receiving midwifery care. Quality of care studies indicated a preference for midwifery care among Indigenous women. Sixteen qualitative studies highlighted three key findings - culturally safe care, holistic care, and improved access to care. The majority of studies were of high methodological quality (91% met ≥80% criteria), while only 14% of studies were considered to have appropriately included Indigenous perspectives.</p><p><strong>Conclusion: </strong>This review demonstrates the value of midwifery care for Indigenous women, providing evidence to support policy recommendations promoting midwifery care as a physically and culturally safe model for Indigenous women and families.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141428319","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Family and Pregnancy Pop-Up Village: Developing a one-stop shop of services to reduce pregnancy care-related inequities in San Francisco.","authors":"Malini A Nijagal, Osamuedeme J Odiase, April J Bell, Alison M El Ayadi, Schyneida Williams, Chloe Nicolaisen, Garrett Jacobs, Brandi Mack, Monique LaSerre, Chelsea Stewart, KaSelah Crockett, Patience A Afulani","doi":"10.1111/birt.12839","DOIUrl":"https://doi.org/10.1111/birt.12839","url":null,"abstract":"<p><strong>Introduction: </strong>Centering affected individuals and forming equitable institutional-community partnerships are necessary to meaningfully transform care delivery systems. We describe our use of the PRECEDE-PROCEED framework to design, plan, and implement a novel care delivery system to address perinatal inequities in San Francisco.</p><p><strong>Methods: </strong>Community engagement (PRECEDE phases 1-2) informed the \"Pregnancy Village\" prototype, which would unite key organizations to deliver valuable services alongside one another, as a recurring \"one-stop-shop\" community-based event, delivered in an uplifting, celebratory, and healing environment. Semi-structured interviews with key partners identified participation facilitators and barriers (PRECEDE phases 3-4) and findings informed our implementation roadmap. We measured feasibility through the number of events successfully produced and attended, and organizational engagement through meeting attendance and surveys.</p><p><strong>Results: </strong>The goals of Pregnancy Village resonated with key partners. Most organizations identified resource constraints and other participation barriers; all committed to the requested 12-month pilot. During its first year, 10 pilot events were held with consistent organizational participation and high provider engagement.</p><p><strong>Conclusion: </strong>Through deep engagement and equitable partnerships between community and institutional stakeholders, novel systems of care delivery can be implemented to better meet comprehensive community needs.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421993","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relative impact of labor induction versus improved labor management: Before and after the ARRIVE (a randomized trial of induction vs. expectant management) trial","authors":"Annette E. Fineberg MD, MPH,&nbsp;Kim Harley PhD,&nbsp;Maureen Lahiff PhD,&nbsp;Elliott K. Main MD","doi":"10.1111/birt.12845","DOIUrl":"10.1111/birt.12845","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To evaluate the association of labor induction on cesarean delivery and other maternal and neonatal outcomes in low-risk, full-term patients in community hospitals during a period of concerted effort to safely prevent cesarean delivery.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We performed a retrospective cohort study using the California Maternal Data Center comprised linked discharge diagnoses and birth certificate data for all low-risk, nulliparous, term, singleton, vertex (NTSV) individuals between 39 and 41 weeks from three Sacramento Valley community hospitals from 2016 to 2022 (<i>N</i> = 10,821) during a period of state-wide efforts to safely reduce cesarean rates. Logistic regression was used to calculate odds ratios (ORs) and adjusted odds ratios (aORs) after labor induction in two time periods before and after the ARRIVE trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During the study period, labor induction increased from 14.7% to 23.1%. Controlling for maternal age, pre-pregnancy BMI, birthweight, maternal race and ethnicity, birthplace, English language, gestational age, Medicaid status, delivery year, and labor induction was associated with an increased aOR of 1.67 (95% CI 1.48–1.89) for cesarean delivery. We found a trend toward increased aOR of chorioamnionitis but no differences in blood transfusion, severe maternal morbidity, unexpected newborn complications, chorioamnionitis, operative vaginal delivery, maternal lacerations, and shoulder dystocia with labor induction. A decrease aOR of cesarean delivery was observed comparing all births in 2019–2021 to 2016–2018.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Labor induction was associated with an increased aOR for cesarean delivery both before and after the ARRIVE trial. A decreased aOR for cesarean delivery was observed during the period of statewide efforts to safely reduce cesarean delivery both with and without labor induction.</p>\u0000 </section>\u0000 </div>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":"51 4","pages":"719-727"},"PeriodicalIF":2.8,"publicationDate":"2024-06-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/birt.12845","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141321966","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Separation at birth due to safeguarding concerns: Using reproductive justice theory to re-think the role of midwives.","authors":"Kaat De Backer, Hannah Rayment-Jones, Elsa Montgomery, Abigail Easter","doi":"10.1111/birt.12842","DOIUrl":"https://doi.org/10.1111/birt.12842","url":null,"abstract":"<p><p>Separation at birth due to safeguarding concerns is a deeply distressing and impactful event, with numbers rising across the world, and has devastating outcomes for birth mothers and their children. It is one of the most challenging aspects of contemporary midwifery practice in high-income countries, although rarely discussed and reflected on during pre- and post-registration midwifery training. Ethnic and racial disparities are prevalent both in child protection and maternity services and can be explained through an intersectional lens, accounting for biases based on race, gender, class, and societal beliefs around motherhood. With this paper, we aim to contribute to the growing body of critical midwifery studies and re-think the role of midwives in this context. Building on principles of reproductive justice theory, Intersectionality, and Standpoint Midwifery, we argue that midwives play a unique role when supporting women who go through child protection processes and should pursue a shift from passive bystander to active upstander to improve care for this group of mothers.</p>","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263583","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"I have to listen to them or they might harm me\" and other narratives of why women endure obstetric violence in Bihar, India.","authors":"Kaveri Mayra, Zoë Matthews, Jane Sandall, Sabu S Padmadas","doi":"10.1111/birt.12828","DOIUrl":"https://doi.org/10.1111/birt.12828","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Evidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;Participatory qualitative visual arts-based method of data collection-body mapping-assisted interviews (adapted as birth mapping)-was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2-4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Findings: &lt;/strong&gt;Women's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) \"I am admitted under your care, so, I will have to do what you say\"-Influence of power on care during childbirth; (2) \"I was blindfolded … because there were men\"-Influence of gender on care during childbirth; (3) \"The more money we give the more convenience we get\"-Influence of structure on care during childbirth; and (4) \"How could I ask him, how it will come out?\"-Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross-cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender-based issue that is part of certain cultures in a patriarchal structure as a result of power-based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Discussion: &lt;/strong&gt;Sensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and em","PeriodicalId":55350,"journal":{"name":"Birth-Issues in Perinatal Care","volume":" ","pages":""},"PeriodicalIF":2.5,"publicationDate":"2024-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141263582","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}