The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany
- To what extent does the communication training impact the preparation for childbirth and communication during childbirth from the mothers’ subjective views?
- How was the quality of communication and mutual understanding in the hospital perceived by the mothers-to-be and their partners?
2. Materials and Methods
- Risk perceptions and outcome expectancies: awareness about personal wishes for the birthing process and the role of communication.
- Intention: understanding communication strategies (four sides of communication—communication square) .
- Planning and self-efficacy: expressing personal needs and wishes, inquiring (close-the-loop) and speaking up.
- Support: building empathy for professionals by taking their perspectives (empathy maps) and mobilizing/accepting support.
3.1. Impact of the Training on Preparation for Childbirth and Communication during Childbirth
“So I have dealt with it (senders and receivers) quite intensively during my studies. And even for me, I thought at during this training, ah, yes, that was true. And I don’t think I would have thought about it in advance, without that. So that’s our (partner included) opinion, it would probably be very, very useful for every expectant parent to do such a training”(P_21).
“This exchange with the other pregnant women and the course instructor was important because you could see that other women wanted completely different things for the birth than I did (…). Other mothers have said, I want to be left alone as much as possible. Then the thought came to me, ‘YES; how should the midwife know that? How should she know my wishes if I never express them?’ And then it occurred to me that I might have to communicate more”(P_08).
“For us, this training was actually a start to prepare the birth more intensively. And we just took that as a hanger, okay, we have to know exactly what we want, that we can communicate what we want. And then I started to talk very clearly with my husband. These are my worries, these are my fears”(P_21).
“I was so afraid of the pain (…) I then learned during communication training that I should express my feelings beforehand. That’s why I then said, I’m so afraid of pain, please help me have less pain during birth. Exactly. That was very good”(P_22).
3.2. Perceived Quality of Communication and Understanding in the Hospital
“Before the birth, I may have wanted a doctor, but that was not necessary for us and that was okay, but I think I would have felt even safer with the doctor. I don’t doubt the competence of midwives either. But maybe it is also because in (participant’s country of origin) it is usual that the doctor is present at the birth”(P_16).
“And she was also a bit of a mediator, I suppose, between the doctors and me, in case something had happened. She would probably have said, I don’t think the patient is doing so well or something. Whereas the gynecologist, she didn’t see me at all, I was already covered”(P_05).
“When the water broke at some point during the birth, the amniotic fluid was quite dark green and then the senior physician was immediately called in and she also stayed there the whole time, that was, so nothing against the resident, but the senior physician has even more experience, she also brought more calm into the whole thing, I found that very pleasant”(P_01).
“So as a positive example, a midwife student comes to mind. How patiently she listened to me every time I had questions. And she didn’t make me feel like I was asking stupid questions. (…) Even if she didn’t know something, she said with so much respect: ‘Mrs. (name), I don’t know, but please give me two hours. I will clarify this with the experienced colleague and then I will come back.’ Two hours later she was back and provided me with an answer”(P_06).
“What I found particularly good about the training was that we put ourselves in the shoes of the professionals. (...) Because when you were in the delivery room, you remembered that, ok, they have a lot to do right now and for you it’s such an exceptional situation, but for them it’s everyday life, what they’re doing right now. And that was, especially in terms of communication, that you weren’t too demanding, but rather took into account a little bit, ok, let them do their rounds now and if you have another detailed question, then they will take the time, if they have it. And that has already helped me. Absolutely”(P_10).
3.3. Positive Experiences with Sufficient Communication Competence and Perceived Empathy
“We noticed exactly, all have read this sheet (questionnaire regarding wishes for birth). Even the midwives, they knew exactly what was going on. Things like ‘we want to take our placenta home with us’ or ‘we don’t want an epidural at first’. I wasn’t offered an epidural until I asked for one. And then I realized that the doctors and midwives had read it. Or one of them had read it and told the others”(P_03).
“And then a really great midwife team came. That was actually the most beautiful phase of the birth. That was a trainee and an instructor. And they did a really, really good job. They explained everything in detail. And you also noticed that they had time. They spent quite a lot of time in the room with me. (…) One of them, the student, came two days later to the maternity ward and asked how we were doing. Visited us”(P_17).
“A psychologist was also there one day later. She talked with me for half an hour. This was ordered by the doctor who operated on me. I also thought that was great. And the doctor was there again on the next day. She told me that it was a good decision (C-section). She didn’t want me to go out with a trauma. (...) She really took her time again”(P_30).
“And my midwife took over a lot of this prepartum talk, so I had the wish for a birthing stool. In the end, I didn’t use it. But she had already set everything up. And I had checked fragrance would be nice. Then she asked me which fragrance I would like and then she added it (...)So she was not the midwife with whom I had spoken before. But she knew the file. And I just felt like I was in such good hands. She was also there the whole time, because I had told her, I’m always afraid when no one is there”(P_08).
3.4. Negative Experiences with Insufficient Communication and a Lack of Interpersonal Adaption and Empathy
“What I found problematic was that some nurses still went through their program at night. It’s 11:30 p.m. and you’ve just gone to sleep for the first time, your baby doesn’t want to be breastfed and you’re glad you can close your eyes. Then the nurse comes in, turns on all the lights, cheerfully says “Hello”, wakes everyone up and says “So, we’re going to do the Hessel Screening” or whatever there is. We’re going to prick your child’s heel now or we’re going to do a hearing test or things like that, which I would have expected in the morning”(P_03).
“And then it was so intense that I said, now I need an epidural. Because I can’t stand it for that long again. And then it took an insanely long time. At first no one came. There was no real information about how long it would take. So I would have liked to know a time horizon. ‘You have to hold out for about half an hour’ or something like that. I then sent my husband there several times and said, go and have another look. Let me know, somehow. Because that is now really unbearable”(P_14).
“I had been a mother for 20 h and I have no idea about diseases as far as children are concerned and blood values. I’m not from that area. And the nurse comes in the second morning. And tells me, ‘Mrs. (name), the bili has gone up.’ And I look at her and I say, ‘What?’ ‘Yes, the bili has risen, the child has to go under the lamp’”(P_06).
“So the resident came and listed the factors that are not so optimal and that they also discuss this again with the leading physician. In retrospect, I thought that at that moment I knew what she wanted to tell me. She had already listed the issues that were in favor of a C-section, but she hadn’t made it clear at that moment”(P_04).
“I had these really bad contractions after the induction and in retrospect I think to myself, yes, you have pain, but it doesn’t have to be that bad and I should have gotten help beforehand. I should have simply let them know beforehand. But then I was shy because the midwife said at the beginning, ‘Well, I have to stay on the ward, I couldn’t go down to the delivery room’”(P_37).
“My hands were shaking and I was somehow not really on-top. You need a little sleep after four days. And she (midwife) noticed how I was feeling and she said, it’s no wonder that my child cries so much when I’m in such a bad mood (...) I think if you’re overwhelmed, you should try to communicate differently. Or maybe ask for understanding that she now has to do everything quickly because they are understaffed or whatever. I have understanding for something like that, if someone tells me that, but if someone is simply unfriendly with me, I don’t understand that”(P_06).
4.1. Impact of the Training on Preparedness for Childbirth and Communication during Childbirth
4.2. Perceived Roles of Professionals and Commitments during Childbirth
4.3. Positive and Negative Experiences with the Quality of Communication
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
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|Age of the study participant||range = 27–46 years; |
median 33 years; mean 34 years (SD = 4)
|Migration status||5 (21%), of which:|
3 (12.5%) < 10 years immigrated themselves and 2 (8.5%) second generation
|Parity||18 (75%) first-time mothers|
6 (25%) second and multiple birth
|Birth mode||18 (75%) vaginal |
6 (25%) C-section
|Twin birth||1 (4%)|
|Child with disability||1 (4%)|
|COVID-19 tested positive||2 (8%)|
|Interview duration||21–95 min;|
median 37; mean 36 min (SD = 15)
|Interview format||21 (88%) via TEAMS with camera on;|
3 (12%) by telephone/TEAMS camera off
|Interview period||February to July 2021|
|Period of giving birth||July 2020 to May 2021|
|Interview time after delivery||3.5 to 33 weeks;|
median 11; mean 13 weeks (SD = 8)
|Do you remember getting your first information about births in your life, and if yes from whom?|
Do you recall an emotional association to your recent birth experience—what describes the feeling you associate with your birth the best?
How and with whom did you prepare for your birth—giving process? (doctors, midwives, nurses, friends, relatives)
|You attended an online communication training at (date). If you recall, what impact did the training have on your preparation for the delivery?|
|What kind of thoughts have you given to the delivery process? |
To what extent have you considered how to articulate your needs?
|Now it’s about your recent birth experience: |
Could you please recall the whole process of delivery from the moment you decided you have to go to the hospital to the time of discharge?
|What kind of support did you receive, what was sufficient, what was lacking, how did you feel?|
|How did you perceive the communication with the professionals?|
Were your questions answered?
|How far do you perceive your mental preparation as helpful? |
How would you express your needs?
|Which persons or professions (midwives, doctors, nurses, partners) were most important in providing or lacking support|
|What could have been better? And who should have done something differently?|
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Schmiedhofer, M.; Derksen, C.; Dietl, J.E.; Haeussler, F.; Strametz, R.; Huener, B.; Lippke, S. The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany. Int. J. Environ. Res. Public Health 2022, 19, 11481. https://doi.org/10.3390/ijerph191811481
Schmiedhofer M, Derksen C, Dietl JE, Haeussler F, Strametz R, Huener B, Lippke S. The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany. International Journal of Environmental Research and Public Health. 2022; 19(18):11481. https://doi.org/10.3390/ijerph191811481Chicago/Turabian Style
Schmiedhofer, Martina, Christina Derksen, Johanna Elisa Dietl, Freya Haeussler, Reinhard Strametz, Beate Huener, and Sonia Lippke. 2022. "The Impact of a Communication Training on the Birth Experience: Qualitative Interviews with Mothers after Giving Birth at Obstetric University Departments in Germany" International Journal of Environmental Research and Public Health 19, no. 18: 11481. https://doi.org/10.3390/ijerph191811481