BACKGROUND: Studies indicate that complex postsurgical wound healing can significantly alter biopsychological markers responsible for recovery. Yet, there is a lack of research investigating women\'s experience of living with slow-to-heal Caesarean birth wounds. This is an important area of investigation considering the increase of factors associated with surgical births and poor wound healing in the UK and globally.
OBJECTIVE: The aim of this study was to explore women\'s experiences of living with a slow-to-heal Caesarean wound.
METHODS: Semi-structured interviews were conducted with seven women who had lived experience of slow-to-heal Caesarean wounds. Narratives were analysed using Interpretative Phenomenological Analysis (IPA) approach.
RESULTS: Analysis of women\'s narratives revealed three interlinking superordinate themes of 1) \'Tied to that event\': healing physical and emotional wounds, 2) The \'good mother\' and the \'good patient\': negotiating being a carer and being cared for, and 3) \'Adjusting to a new normality\'. Overall, slow-to-heal wounds embodied women\'s perceptions of agency over their Caesarean birth experience and achievement of a new motherhood identity. Wherein, successful healing would encompass a sense of normality defined by subjective notions of regaining expected roles and daily activities, previous bodily functions, and maternal status within their families that became disrupted due to delayed wound healing.
CONCLUSIONS: Women\'s narratives support discourse surrounding Caesarean birth and recovery as a biopsychosocial phenomenon. This has important ramifications regarding research and treatment programmes for postnatal women with complex healing that are largely described as \'invisible\'.

OBJECTIVE: Little is known about the maternity experiences of women who have been trafficked and further investigation is needed to better inform midwifery practice and to ensure that the voices of women are heard when developing guidance.
BACKGROUND: People who have been trafficked experience a range of health problems that could impact on pregnancy.
OBJECTIVE: The aim of this study was to explore the experiences of pregnancy and NHS maternity care for women who have been trafficked, as well as increasing understanding of social and health factors that may impact on pregnancy outcomes.
METHODS: A qualitative interview study was conducted. Participants (professionals and service users) were recruited using purposive sampling. Data were analysed using thematic analysis.
RESULTS: Seventeen interviews were conducted (5 service users and 12 professionals). Five themes were identified: \'One Size Fits All\', \'Loss of Control\', \'Social Complexity\', \'Bridging Gaps\', and \'Emotional Load\'.
CONCLUSIONS: Our findings identify that women are expected to fit into a standardised model of maternity care that does not always recognise their complex individual physical, emotional or social needs, or provide them with control. Support workers play a vital role in helping women navigate and make sense of their maternity care.
CONCLUSIONS: Despite the issues identified, our research highlighted the positive impact of individualised care, particularly when women received continuity of care. A joined-up, trauma-informed approach between midwives and support workers could help improve care for women who have been trafficked.

Background: Owing to its high sensitivity, as concluded in the Breast UltraSound Trial (BUST), targeted ultrasound (US) now seems a promising accurate stand-alone modality for diagnostic evaluation of breast complaints. This approach implies omission of bilateral digital breast tomosynthesis (DBT) in women with clearly benign US findings. Within BUST, radiologists started with US followed by DBT. This side-study investigates women\'s experiences with DBT, their main motivation to undergo diagnostic imaging, and their view on US as a stand-alone modality. Methods: A subset of BUST participants completed a questionnaire on their DBT experiences, reason for undergoing diagnostic assessment, and view on US-only diagnostics. Responses were analyzed with descriptive statistics and logistic regression analyses. Results: In total, 778 of 838 women (response rate 92.8%) were included (M = 47, SD = 11.16). Of them, 16.8% reported no burden of DBT, 33.5% slight burden, 31.0% moderate, and 12.7% severe burden. Furthermore, 13% reported no pain, 35.3% slight pain, 33.2% moderate, and 11.3% severe pain. Moreover, 88.3% indicated that the most important reason for breast assessment was explanation of their complaint and to rule out breast cancer, whereas 3.2% wanted to \"check\" both breasts. And 82.4% reported satisfaction with US only in case of a nonmalignancy. Conclusions: Our study shows that most women in the diagnostic setting experience at least slight-to-moderate DBT-related burden and pain, and that explanation for their symptoms is their main interest. Also, the majority report satisfaction with US only in case of nonmalignant findings. However, exploration of women\'s perspectives outside this study is needed as our participants all underwent both examinations.

UNASSIGNED: One in four women experience urinary incontinence. A woman\'s medical history, a physical examination and certain tests can guide specialists in diagnosing and offering treatment. Despite the high prevalence, little is known about women\'s experience of urinary incontinence assessment.
UNASSIGNED: To explore the experience of a group of women undergoing an assessment for urinary incontinence.
UNASSIGNED: Individual semi-structured interviews were conducted with 10 women who had been assessed for urinary incontinence. A thematic reflective analysis method was used.
UNASSIGNED: The women experienced a lot of shame and worry related to their urinary incontinence and the assessment. Having a safe relationship with the urotherapist was very important, and being given information about treatment options gave hope for a better life.
UNASSIGNED: Urinary incontinence and its assessment are associated with shame and anxiety. A good patient-urotherapist relationship is paramount and learning that treatments are available made women feel more optimistic about the future.

Introduction: Recent high-profile calls have emphasized that women\'s experiences should be considered in maternity care provisioning. We explored women\'s experiences of using closed-loop during type 1 diabetes (T1D) pregnancy to inform decision-making about antenatal rollout and guidance and support given to future users. Methods: We interviewed 23 closed-loop participants in the Automated insulin Delivery Among Pregnant women with T1D (AiDAPT) trial after randomization to closed-loop and ∼20 weeks later. Data were analyzed thematically. Results: Women described how closed-loop lessened the physical and mental demands of diabetes management, enabling them to feel more normal and sleep better. By virtue of spending increased time-in-range, women also worried less about risks to their baby and being judged negatively by health care professionals. Most noted that intensive input and support during early pregnancy had been crucial to adjusting to, and developing confidence in, the technology. Women emphasized that attaining pregnancy glucose targets still required ongoing effort from themselves and the health care team. Women described needing education to help them determine when, and how, to intervene and when to allow the closed-loop to operate without interference. All women reported more enjoyable pregnancy experiences as a result of using closed-loop; some also noted being able to remain longer in paid employment. Conclusions: Study findings endorse closed-loop use in T1D pregnancy by highlighting how the technology can facilitate positive pregnancy experiences. To realize fully the benefits of closed-loop, pregnant women would benefit from initial intensive oversight and support together with closed-loop specific education and training. Clinical Trial Registration number: NCT04938557.

Stillbirth and (obstetric) fistula are traumatic life events, commonly experienced together following an obstructed labour in low- and middle-income countries with limited access to maternity care. Few studies have explored women\'s experiences of the combined trauma of stillbirth and fistula.
To explore the lived experiences of women following stillbirth and fistula.
Qualitative, guided by Heideggerian phenomenology. Twenty women who had experienced a stillbirth were interviewed while attending a specialist Hospital fistula service in urban Kenya. Data were analysed following Van Manen\'s reflexive approach.
Three main themes summarised participants\' experiences: \'Treated like an alien\' reflected the isolation and stigma felt by women. The additive and multiplying impacts of stillbirth and fistula and the ways in which women coped with their situations were summarised in \'Shattered dreams\'. The impact of beliefs and practices of women and those around them were encapsulated in \'It was not written on my forehead\'.
The distress women experienced following the death of a baby was intensified by the development of a fistula. Health professionals lacked an understanding of the pathophysiology and identification of fistula and its association with stillbirth. Women were isolated as they were stigmatised and blamed for both conditions. Difficulty accessing follow-up care meant that women suffered for long periods while living with a constant reminder of their baby\'s death. Cultural beliefs, faith and family support affected women\'s resilience, mental health and recovery. Specialist services, staff training and inclusive policies are needed to improve knowledge and awareness and enhance women\'s experiences.
A Community Engagement and Involvement group of bereaved mothers with lived experience of stillbirth and neonatal death assisted with the review of the study protocol, participant-facing materials and confirmation of findings.

In the Netherlands, antenatal cardiotocography (aCTG), used to assess fetal well-being, is performed in obstetrician-led care. To improve continuity of care, an innovation project was designed wherein primary care midwives perform aCTGs for specific indications. The aim of this study was to examine the satisfaction and experiences of pregnant women who received an aCTG in primary midwife-led care and explore which factors were associated with high satisfaction.
Data were collected through a self-administered questionnaire based on the Consumer Quality Index. The primary outcome was general satisfaction on a 10-point scale, with a score above nine indicating participants were \"highly satisfied\".
In total, 1227 women were included in the analysis. The study showed a mean general satisfaction score of 9.2. Most women were highly satisfied with receiving an aCTG in primary midwife-led care (77.4%). On the Consumer Quality Index, the mean satisfaction level varied from 3.98 (SD ± 0.11) for the subscale \"client satisfaction\" to 3.87 (SD ± 0.32) for the subscale \"information provision\" on a 4-point scale. Women at between 33 and 36 weeks\' gestation were more likely to be highly satisfied (adjusted OR [aOR] = 3.35). Compared with a completely comfortable position during the aCTG, a mostly comfortable or somewhat comfortable level had decreased odds of being associated with a ranking of highly satisfied (aOR 0.24 and 0.19, respectively).
This study shows that pregnant women are satisfied with having an aCTG in midwife-led care. Providing aCTG in midwife-led care can increase access to continuity of care.

OBJECTIVE: To explore aspects of intrapartum care that were importanrt for primiparous women who had given birth in large obstetric units in Norway.
METHODS: We used data from the Babies Born Better (B3) survey, version 1, which is an international, web-based qualitative survey. We performed a reflexive, thematic analysis of the responses to two questions about descriptions of aspects of positive care and areas of care requiring improvement during the intrapartum period. The responders could give up to three responses to each question and there were no word limits.
RESULTS: In all, 677 first time mothers who gave birth at the five largest specialised obstetric units in Norway during 2014-2015 were included in the study. The thematic analysis of the 2 205 responses resulted in three final themes: \'Communication and positive interactions with the caregivers\', \'Autonomy and active involvement in the labour process\', and \'Safety, competence and quality of labour care\'.
CONCLUSIONS: For women who give birth for the first time in specialised obstetric units both relational aspect such as communication and respect, and environmental aspects such as facilities, are of importance. First-time mothers might be particularly vulnerable to absence of positive interactions with caregivers because they lack the resources former birthing experience can give. It is essential to give unexperienced birthing women special attention during childbirth because the first birth may influence decisions in following pregnancies.

BACKGROUND: An obstetric fistula also known as vesico vaginal fistula (VVF), or recto-vaginal fistula (RVF) is an abnormal opening between the urogenital tract and intestinal tract caused by prolonged obstructed labour; when the head of the baby presses on the soft tissues in the pelvis leading to loss of blood flow to the women\'s bladder, vagina, and rectum. This can cause necrosis of the soft tissues resulting in debilitating fistula formations.
OBJECTIVE: This study aimed to uncover North-central Nigerian women\'s experiences of obstetric fistula and their perceived treatment services.
METHODS: Qualitative, interpretive descriptive methodology underpinned by symbolic interactionism involving face-to-face semi-structured interviews was used to explore North-central Nigerian women\'s experiences of obstetric fistula and their perceived treatment services.
METHODS: A purposive sample of 15 women who had experienced obstetric fistula at a repair Centre in North-central Nigeria were eligible.
RESULTS: Four themes emerged from North-central Nigerian women\'s experiences of obstetric fistula and their perceived treatment services i) I was left alone in the room ii) Waiting for the one vehicle in the village iii) I never knew about labour until that very day iv) and We kept following the native doctors and sorcerers.
CONCLUSIONS: The findings from this study highlighted the depth of women\'s experiences from the devastating complication of childbirth injury in North-central Nigeria. Analysis of insights from women\'s voices directly affected by obstetric fistula demonstrated that in their views and experiences the themes identified were majorly responsible for their fistula status. Thus women need to raise their collective voices to resist oppressive harmful traditions and demand empowerment opportunities that will improve their social status. Government should improve primary healthcare facilities, train more midwives and subsidise maternal care for antenatal education and birth services spending for childbirth women may result in improved childbirth experiences for women in rural and urban communities.
CONCLUSIONS: Reproductive women call for increased accessibility to healthcare services and the provision of more midwives to mitigate obstetric fistula in North-central Nigerian communities.

Vaginal birth after caesarean (VBAC) is supported in systematic reviews (Wu et al., 2019) and national guidelines (RCOG, 2015) and women are expected to be involved in the decision-making process for either a repeat caesarean birth or planned VBAC.
OBJECTIVE: To develop a Grounded Theory (GT) of women\'s decision making of their birth choices in pregnancy following a previous caesarean birth (CB) OBJECTIVE: To explore what determines women\'s birth choice and their decision making for birth following a previous CB.
METHODS: Semi structured interviews with pregnant women were undertaken in order to develop a Glasserian Grounded Theory SETTING: Antenatal clinics and wards in a large tertiary level maternity hospital.
RESULTS: The theory of \'Mentalizing Possibilities\' is a substantive theory which explains pregnant women\'s decision making about their birth choices after a previous CB. Women\'s main concern is to achieve a positive experience. The core category of \'Mentalizing Possibilities\' explains how women process their previous experience, adapt to uncertainty and deal with the decisional conflict. There are behavioural and cognitive strategies which women use to go through this process.
CONCLUSIONS: Women want a positive birth experience after a previous CB and require support and continuity in decision making to help them decide the optimal birth choice for their current pregnancy.