This is what makes me love this set of nurses…I got to the hospital in the morning and delivered at night. (Woman, IDI, 30–45 years). The hospital has three obstetricians/gynecologists, two pediatricians, and seven Medical Officers in the obstetrics department. Suggests the NYT writer, if the emotional labor imbalance becomes too extreme, couples should seek couples therapy. ... and provide you with the support you need in making this very important decision. In this context, many women are not permitted to make decisions independently, including for issues related to their own health, and decisions may be made by others such as their husbands or mother‐in‐laws. Using these stratification parameters, the research team recruited participants to achieve a diverse and varied sample. Thematic analysis was used to synthesize findings, and then interpreted within the context of this study and existing quality of care framework. 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. In jobs that rely on tipping, mental health outcomes are exacerbated among women. 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. Where we give birth in this general hospital is not good because up to four people can go through labor in a single room…. Women stated that such a companion could equally serve as a bridge to any communication gaps between the healthcare provider and the woman. A caregiver must model patience and compassion while navigating the tantrums of small children. nurses and visitors will also be in the same room… sleeping on the floor, this is not adequate. We need to try and bring it back to normal the way it is supposed to be. The thing is that you explain, but you don't explain using medical terms now, you explain using words that the patient can understand… Instead of telling a patient that the cervical dilation is not adequate…So I do the practical thing… I tell patient see you need 10 over 10 to pass this exam, to give birth, and now you just have 2 over 10 so that means you need 8 over 10 more. (Woman, FGD, 30–45 years). 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. Emotional labor demands—the need to provide comfort and care to the cranky—are likely one of the main culprits. The doula is a professional trained in childbirth who provides emotional, physical, and educational support to a mother who is expecting, is experiencing labor, or has recently given birth. Some studies have shown that labors attended with doulas may actually be shorter in length, although there is no effect on cesarean delivery rates. Observations and assessments during interviews were digitally recorded and field notes were taken and added to the end of the interview transcripts. Negotiating quality standards for effective delivery of labor and childbirth care in Nigeria and Uganda, Category 1: Mothers (Rural Area)Mothers (Urban Area). What matters to women during childbirth: A systematic qualitative review. 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. Learn more. To deal with negative emotions, people tend to do one of the following: 1. Table 1 reports the number of IDIs and FGDs by participant type. Background The childbirth experience is an intensely dynamic, physical and emotional event with lifelong impli-cations. Labour companionship and women’s experiences of mistreatment during childbirth: results from a multi-country community-based survey. An interview lasted an average of 1 hour with the range of 45 minutes to 2 hours. However, doctors agreed that most of them “have that kind of communication problem,” and that as a solution to the problem they “as health providers need to learn and train” themselves “more on how to communicate effectively, learn to break information [down] to patients and relatives in very simple terms and clear terms they can understand.” A doctor further explained it this way: It is also believed that communication using simple words is an important way to make the work of healthcare providers easier and ultimately improve the experience of women and their relative during childbirth. Instances were cited where providers would tell a woman who is in labor or who has just given birth to a baby that “if you stain the bed you will wash it yourself before leaving.” Women believed that the rude attitudes of nurses discouraged some women from presenting for childbirth in the health facility. However, this analysis focuses on the data from Akure to provide a deep exploration into communication and emotional needs of women at one of the study sites, which will feed back directly to the local and hospital authorities. 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. Companions supported by giving information about childbirth, bridging communication gaps between health workers and women, and facilitating non-pharmacological pain relief. 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. (Woman, IDI, 30–45 years). 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. There is a vast literature in organizational psychology on the topic. Because we call it labor pain you know, labor plus pain, it is a severe pain, oh, I think that will help those kind of men, it will change their orientation. Advertisement. 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. you start shouting on the person, no, it should not be like that. In the modern era, emotional labor is a feminist issue. 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. Facility administrators working at the study hospital, including a Medical Director and head of obstetric department, were invited to participate in key informant interviews. 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. The minimum number of participants for each FGD session was five while the maximum was seven. I guess I don’t like the blurriness of the thinking.” It struck me that her very response concealed some emotional labor: polite on the surface, but uncomfortable on the inside. Quota sampling was used to achieve a stratified purposive sample without random selection using specified parameters to stratify the sample, including setting (urban or rural), religion, and age for all participants. 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. However, the women said they would appreciate having a female labor companion on such occasions. But when contexts morph, and meanings change, are we still talking about the same thing? Second, this analysis focused on a sample of women and providers from one region of southwestern Nigeria and may not be transferable to other settings. In such situations, women and the healthcare providers in this study agreed that having a companion present would help facilitate the consent and approvals needed for interventions or healthcare decision‐making, as women may be incapacitated by the demands of labor. OAO and MT wrote the first draft of the paper. Their purpose is to help women have a safe, memorable, and empowering birthing experience. 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. Childbirth can be a life-changing experience for women, creating lifelong memories [1, 2].Thus midwives should be familiar with women’s diverse needs during childbirth [], including emotional, physical and informational needs [].Good interpersonal relationships could reduce fear associated with childbirth [] and subsequently contribute to a satisfactory birth experience []. The invisibility of emotional labor renders it thankless and unappreciated, but the vividness and relatable nature of the term has allowed it to permeate into mainstream discourse. Healthcare providers’ perspectives on labor monitoring in Nigeria and Uganda: A qualitative study on challenges and opportunities. Facility structure is a major barrier to this as most facilities in Nigeria are not structured to accommodate male companions during childbirth. The instruments used to guide the discussions with women explored five major domains: (1) perceptions of care provided at the facility and decision‐making to seek care at the facility; (2) the meaning of good quality of care during childbirth in health facilities; (3) perceived expectations and needs of women during facility‐based childbirth care; (4) potential changes that could be made to enhance the provision of quality childbirth care; and (5) perceived expectations and needs of providers during facility‐based childbirth. The research team sought to recruit 1–2 administrators. EMOTIONAL LABOR Emotional labor or emotion work is a requirement of a job that employees display required emotions toward customers or others. Some people struggle to put a label on their emotions or may even try to mask their feelings. Studies from other settings have similarly revealed that issues relating to women's experiences during childbirth are multidimensional and extend beyond medical needs.36-38 Therefore, there is a need to have a holistic approach toward childbirth for women, including in low‐resource countries like Nigeria. One woman said: “At least he would respect me at home that what this woman passed through is not easy” (Woman, IDI, 30–45 years). cesarean delivery, blood transfusion). Corbett CA(1), Callister LC. The statements above exemplify the spiritual needs of a Nigerian woman during childbirth, as most women agreed that they would like health facilities where spiritual support could be provided. (Woman, IDI,30–45 years). A restaurant customer rudely demands more prompt service, while a harried server struggles to cheerfully float between multiple tables. The qualitative evidence synthesis analysed 51 studies from 22 countries, and revealed that labour companions played a number of roles in supporting women. Emotional Support and Guidance During Labor. When you engage in emotional labor, you control your feelings to fulfill the goals and expectations of your organization. According to the WHO, quality of care during childbirth in health facilities reflects both how care is provided and how care is experienced, within the available physical infrastructure, supplies, management, and human resources with the knowledge, skills, and capacity to deal with pregnancy and childbirth.8 Research demonstrates that it is necessary to go beyond maximizing coverage of essential interventions to accelerate reductions in maternal and perinatal mortality and severe morbidity.9 Moreover, there is a complex interplay of experiences of mistreatment and lack of support that impact women's childbirth experiences and outcomes.10, 11 Good experiences in the health facilities may encourage the further use of health facilities and bad experiences may discourage the use of health facilities. A woman who senses empathy from her healthcare provider would receive care with more open mindedness, understand the constraints of the facility where she gives birth, and take the instructions of the healthcare provider with less criticism thus improving her perception and experience of care in the facility. This study has both limitations and strengths. She related that she gave birth at a “big hospital . …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. Below is the memorable experience a woman shared about the facility where she delivered: Lack of respect for women is still an issue in Nigeria. At its core, emotional labor is the regulation of one’s feelings at one’s job. Women's experiences could affect the utilization of facilities in the future, and may, therefore, directly or indirectly influence neonatal and maternal mortality and morbidity. What is a doula? There will be many questions you both have as labor … Women in this study described their need for effective communication with their health providers. Every woman needs strong emotional support during labor and delivery. Try to figure out how the person is feeling as you’re talking. When it is not feasible to communicate with the woman in a local language, the use of professional translators can be explored as lay translators at times may distort the original message that is being passed across to the woman and may further have a negative effect on the health outcome.41 The women would like to express their concerns freely without fear of any reprimand. . and emotional support. Emotional Labor 1. According to Dr. Christine Morton, author of the book Birth Ambassadors, a birth doula is a companion who supports a birthing person during labor and birth. Qualitative research was conducted in a large referral maternity hospital and its catchment communities in Akure, Nigeria. A woman's perception of how her needs are prioritized and met determines her childbirth experience. As part of this larger project, this analysis is focused on the communication and emotional needs of women during facility‐based childbirth in Southwest Nigeria, from the perspectives of women, healthcare providers, and administrators. Depending upon the extent of community-transmission, institutions may consider limiting visitors to one essential support person and having that person be the same individual throughout the hospitalization. Communication is very vital…I think that's just what we are lacking in this government facility…the communication channel there is broken already. 3. Nurses. The transcription and translation processes, which took place in parallel to the data collection, were overseen by the lead social scientist. But at that moment, I know that if the decision of ‘let's give her blood’ should come up, I know he would decide it on my behalf, yes, he should decide it on my behalf. Some women preferred their mother (especially) or mother‐in‐law (occasionally), sister, or friend as labor companion, rather than their husbands or partners. Create an appropriate emotion for the situation. 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. 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. We conducted 42 IDIs and 10 FGDs between January and May 2015. Los Altos, California: Mental Health Update, The Center for Health Sciences. This process yielded a hierarchical codebook to organize codes into meaningful code families and to explore higher level concepts and themes related to quality of care. They reported that providers made unreasonable requests of women, such as asking them to perform tasks that are inappropriate to ask of a woman in labor. Having their husband with them during labor would better engage him in the childbirth experience; one woman suggested that “let him stay by the window then so that he can know what it entails” (Woman, FGD, <30 years); while another suggested that “even if he does not stay by the window let him come in so that he can see the pain involved” (Woman, FGD, <30 years). Most of the women agreed that they would like to have a labor companion, with only a few objecting to this idea. …to have listening ears, they have to listen to complaint of their patients and they should not be too harsh, because during that labor we [women] were something else, but they don't have to pamper us and they don't have to be too harsh and they should stop cursing, they should stop cursing. Special Issue: Formative research and development of innovative tools for “Better Outcomes in Labour Difficulty” (BOLD). The components of labor support that women report finding helpful are emotional support (continuous presence, reassurance, encouragement, and praise); physical support … 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. The needs and priorities of women differ during childbirth. In particular, women wanted their family member to stay with them and pray with them especially if their labor becomes difficult. Explain to patient in a language… in a way they can understand what is happening so that they understand the essence of the intervention you want to render and how promptly you need to do it. The childbirth experience is an intensely dynamic, physical and emotional event with lifelong implications. In other studies, women preferred not to be treated only as medical patients during childbirth, but also as human beings with feelings, and as active agents, in charge of the process of childbirth.36-39 In our study setting, we found that women have limited control over their childbirth process, as decisions about their care and consent processes may happen around the woman, but without her direct involvement or final say. Emotional Support: Now is the time to prepare for your baby’s upcoming birth, which can be exciting and also very stressful. Enter your email address below and we will send you your username, If the address matches an existing account you will receive an email with instructions to retrieve your username. Nursing support during labor. In some cases, emotional labor is part of the job description. During pregnancy, emotional and tangible support provided by the spouse and others is related to the expectant mother's mental well-being. Pregnancy constitutes a time of significant life change requiring major psychological adjustments, often associated with anxiety and stress (Da Costa et al., 1999). 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. In 2001 I came across the English edition of Dr. Lamaze’s biography. They [healthcare providers] also have faith in God, they place their trust in God, they know they are not perfect, but they just say do this, do that, use your faith, they encourage us with God's words, that we should have faith in God, that they are only trying their best but we should put our trust in God, so such things and prayers, they pray for us. 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