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Article

Major Factors Contributing to Positive and Negative Childbirth Experiences in Pregnant Women Living with HIV

by
Andréa Paula de Azevedo
1,2,*,
Luisa Castro
1,3,
Cristina Barroso Hofer
2,4 and
Francisca Rego
1
1
Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
2
Martagão Gesteira Childhood and Pediatric Institute, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
3
CINTESIS@ RISE, Faculty of Medicine, University of Porto, 4099-002 Porto, Portugal
4
Faculty of Medicine, Federal University of Rio de Janeiro, Rio de Janeiro 21941-853, Brazil
*
Author to whom correspondence should be addressed.
Behav. Sci. 2025, 15(4), 442; https://doi.org/10.3390/bs15040442
Submission received: 12 February 2025 / Revised: 21 March 2025 / Accepted: 25 March 2025 / Published: 31 March 2025
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Abstract

:
Objective: The aim of this study was to assess the opinions of pregnant women living with HIV (PWLWHIV) about their positive childbirth experiences and the most important factors contributing to positive or negative experiences. Methods: A cross-sectional study was conducted with 82 PWLWHIV; semi-structured interviews were conducted in a public hospital in Rio de Janeiro. Results: A total of 65 (79.3%) PWLWHIV experienced a positive childbirth experience. Conversely, 14 (17.1%) PWLWHIV had a negative experience. The main reasons given by the PWLWHIV for positive experiences were the good health of the baby, their partner’s presence at the childbirth, and good healthcare professional support. The main reasons for negative childbirth experiences were poor healthcare professional support, excessive pain or medication, and the absence of a companion during childbirth. Conclusions: Our findings indicate that the health of the baby at birth was the main factor in positive childbirth experiences. On the other hand, poor healthcare professional support was the main cause of negative childbirth experiences. Increasing the incidence of positive childbirth experiences could reduce maternal depression and anxiety, and significantly impact neonatal outcomes (mainly low birth weights and preterm birth). Future studies should target reducing depressive symptoms in perinatal HIV-positive women, increasing partner involvement, and decreasing HIV stigma.

Graphical Abstract

1. Objective

The aim of this study was to determine the most important factors for positive and negative childbirth experiences in pregnant women living with HIV (PWLWHIV).

2. Introduction

The incidence of HIV among pregnant women is influenced by factors such as geographic location, access to healthcare, and sociodemographic characteristics. These findings underscore the importance of targeted HIV prevention and treatment strategies during pregnancy to reduce mother-to-child transmission and improve maternal health outcomes. A systematic review and meta-analysis reported an HIV incidence rate of 3.6 per 100 person-years among pregnant and breastfeeding women in sub-Saharan Africa, with variability between different populations (Graybill et al., 2020).
Experiences of pregnancy and birth are important and have long-term impacts on the well-being of women and their families. Perinatal services should aim for care that promotes a positive childbearing experience, as well as optimizing health outcomes for the woman and newborn (Hall et al., 2023; Leinweber et al., 2023). A positive childbirth experience is influenced by several key factors, which can be broadly categorized into healthcare provider attributes, health system attributes, communication and decision making, and the overall experience of care. These aspects encompass both the emotional and physical aspects of care (Leinweber et al., 2023). A positive childbirth experience is characterized by a combination of emotional support, respectful and competent care, effective communication, and a safe and supportive environment. These factors collectively contribute to a woman’s sense of control, safety, and respect during childbirth, leading to a positive experience (Hall et al., 2023; Hemalatha, 2012; Montgomery, 2003; Powell et al., 2017).
Competent and professional healthcare providers who offer respectful and individualized care are crucial. Providers who facilitate shared decision making and provide continuous support during labor significantly enhance the childbirth experience (Hall et al., 2023; Taheri et al., 2018). Effective communication and the involvement of women in decision-making processes are essential. Pregnant women who feel informed and involved in their care are more likely to report positive childbirth experiences (Baranowska et al., 2020; Hall et al., 2023; Nicoloro-SantaBarbara et al., 2017). Effective communication can alleviate maternal anxiety, which is often heightened in older mothers due to the increased risk of complications. Maternal age influences childbirth outcomes through increased medical risks and the need for specialized, integrated care. Effective communication and a supportive care environment are essential to mitigate these risks and enhance the childbirth experience for older mothers (Vandekerckhove et al., 2021).
A study by Nicoloro-SantaBarbara et al. demonstrated that better communication, collaboration, and empowerment from healthcare providers were associated with more frequent salutary health behavior practices in late pregnancy, mediated by reductions in anxiety (Nicoloro-SantaBarbara et al., 2017). Effective patient–provider communication is essential for older mothers, as it can reduce anxiety, set realistic expectations, and enhance understanding and decision making, thereby improving childbirth outcomes. Moreover, patient-centered communication that includes messages of empowerment, emotional support, and clear explanations can help set realistic and flexible expectations for the birthing experience (Kaimal & Norton, 2021).
The physical and psychological environment of the birth setting plays a significant role in pregnant women’s decision-making process (Chen et al., 2023). Elements such as a “homey” atmosphere, comfort, demedicalization of the birthing environment, and the presence of birth partners can improve outcomes and satisfaction. This description from mothers highlights the importance of provider interactions for facilitating a positive childbirth experience. Feeling supported and having a sense of control, safety, and respect are central tenets (Chen et al., 2023; Downe et al., 2018; Leinweber et al., 2023). The most effective strategies to create a positive birth experience are supporting women during birth, intrapartum care with minimal intervention, and birth preparedness (Taheri et al., 2018; Vandekerckhove et al., 2021).
Emotional support and addressing stigma are also vital. PWLWHIV often face significant psychological and emotional challenges, including stigma and HIV-related shame, which can impact their childbirth experience and postpartum care engagement (Fentie et al., 2022). Providing a supportive environment that includes counseling and peer support can help mitigate these challenges (Fentie et al., 2022). Maternity care should be designed to cater to or meet women’s personal and socio-cultural beliefs and expectations (Baumont et al., 2023).
Maternal stress, including stress, depression, and PTSD (post-traumatic stress disorder), from negative childbirth experiences, particularly in women living with HIV treated with antivirals, is closely associated with adverse cognitive outcomes (Boivin et al., 2019; Magondo et al., 2024; Schoeman et al., 2017). Higher maternal stress and depression scores were linked to lower overall cognitive scores in HIV-exposed infants, affecting domains such as expressive language, fine motor skills, gross motor skills, and visual reception (Mebrahtu et al., 2018; Nöthling et al., 2013). Maternal PTSD and depression are significant risk factors for child behavior problems (Nöthling et al., 2013; Rodriguez et al., 2018b). Moreover, Marr et al. found that increasing maternal stress during late pregnancy was associated with altered neonatal amygdala connectivity to the anterior insula and the ventromedial prefrontal cortex, as well as negative affect in infants, which can lead to poor long-term cognitive development (Marr et al., 2023).
High maternal HIV viremia during pregnancy can contribute to neonatal cognitive impairments, including deficits in global cognitive abilities, short-term memory, delayed memory, attention, and processing speed (Awadu et al., 2022; Benki-Nugent et al., 2017). Additionally, le Roux et al. reported that cumulative maternal viremia predicted lower motor and expressive language scores (le Roux et al., 2019). Young et al. showed that HEU children scored significantly lower on measures of Full-Scale IQ, Performance IQ, visual motor integration, and adaptive functioning during early childhood (Young et al., 2022).
In utero and peripartum exposure to certain antiretroviral therapies (ARTs) has been associated with developmental disorders. For instance, one study found that children exposed to a combination of single-dose nevirapine, zidovudine, and lamivudine (SdNVP + AZT + 3TC) had higher probabilities of attention deficit and hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and functional impairment compared with those not exposed to this therapy (Awadu et al., 2022).

3. Material and Methods

A cross-sectional study was conducted at a public prenatal care center in Rio de Janeiro that cares for PWLWHIV (De Azevedo et al., 2025). At this institution, prenatal care is provided by specialists in obstetrics and gynecology, infectiologists, and nurses. Semi-structured interviews with the PWLWHIV were conducted during the first month of postnatal care. They were asked if they had a positive or negative experience and to give three factors that contributed to this positive or negative experience. All the interviews were conducted by one researcher, and the participants filled out the questionnaire in a quiet environment without any interruptions. The researcher remained available to answer any questions and to clarify any specific aspects of the questionnaire items. The doctors or midwives who assisted in the childbirth were not informed of this study to avoid any bias.
The inclusion criteria were PWLWHIV who were 18 years or older and had a childbirth experience less than one month ago at a public maternity ward in Rio de Janeiro.
The exclusion criteria were preterm birth and PWLWHIV who could not understand the interview and the questions.
Considering the annual number of PWLWHIV in Rio de Janeiro (N), we defined a margin of error of 4 points (resulting in a confidence interval with an amplitude of 8 points), a confidence level of 95%, and a variance of 369 (Lopes et al., 2019, 2021a, 2021b). With these parameters, the calculation indicated a minimum sample of 80 participants. Therefore, we set a minimum sample size of 80 pregnant women for this study. For this study, all PWLWHIV that met the inclusion criteria were included until the minimum size was achieved, with the enrollment period lasting from June 2023 to December 2023.

3.1. Instrument

A semi-structured interview was developed and conducted, which involved a questionnaire (used to collect sociodemographic data and information about the labor, the delivery, and the baby) and a question about whether the childbirth was positive, negative, or neither positive nor negative. The PWLWHIV were also asked to give the three main causes that led to their experience.

3.2. Data Analysis

The variables were maternal age (years); parity (primiparity or multiparity); ethnicity (white, mixed, or black); type of delivery (vaginal or cesarean); newborn sex (male or female); gestational age at birth (weeks); birth weight (grams); 1 min Apgar score (0 = score > 7; 1 = score ≤ 7); length at birth (cm); and complications during birth. Table 1 displays the variables studied: the sociodemographic and birth characteristics of the study population, which is the same as that used in a study using the Mackey questionnaire (De Azevedo et al., 2025).
When asked if their childbirth experience was positive or negative and the factors that contributed to it, the PWLWHIV were allowed to answer freely and could give one, two, or three reasons. Through content analysis, the answers were divided into 7 groups for positive experiences and 7 groups for negative experiences. Table 2 shows the answers given by the PWLWHIV and their groupings.
The factors that contributed to a positive experience were baby health; the presence of a companion; good assistance from healthcare professionals (doctors, nurses, and midwives); everything going well; good physical structure of the maternity ward; an early visit to the maternity ward during prenatal care; and a lack of pain during childbirth.
The factors that contributed to a negative experience were an absence of a companion; poor assistance from the healthcare professionals (doctors, nurses, and midwives); complications for the baby; poor physical structure of the maternity ward; excessive pain or medication during birth; an absence of information during birth; and cesarean delay.
The descriptive statistics are presented as absolute (n) and relative (%) frequencies for categorical variables, the mean and standard deviation (SD) for normally distributed quantitative variables, and the median with interquartile intervals (IQIs), minimum and maximum values, otherwise.

4. Results

This study was conducted on 82 PWLWHIV in public maternity wards in Rio de Janeiro. Table 1 displays the sociodemographic and birth characteristics of the study population, which is the same as that used in a study using the Mackey questionnaire (De Azevedo et al., 2025).
The participants ranged in age from 19 to 49 years, with a median age of 28.5 (IQI = [23.3; 28.6]). In terms of ethnicity, 14 were white (17.1%), 34 were mixed (41.5%), and 34 were black (41.5%). Almost half of the PWLWHIV had not completed high school (40, 48.8%) and only 2 (2.4%) completed university. The majority were married or living unofficially with a partner (58, 70.7%), and an additional 24 (29.2%) were single or divorced.
Their childbirth history ranged from one to six pregnancies, with a mean of one and a half pregnancies. Their parity ranged from zero to five. Forty-two (42, 51.2%) were pregnant with their first child. None of the women who had vaginal deliveries received either analgesia or anesthesia during the labor and birth. Only those who had a cesarean section received anesthesia (25, 30.5%).
There were no differences in the responses based on race, parity, or socio-economic status. Unfortunately, it was not possible to analyze the influence of viral load; companion support; whether it was a planned pregnancy; or smoking, alcohol, or drug use, because most of the PWLWHIV had the same profile.
A positive childbirth experience occurred for 65 PWLWHIV (79.3%) (Figure 1). The main reasons given by the PWLWHIV for positive childbirth experiences were associated with the health of the baby (n = 33, 40.2%), their partner’s presence at childbirth (n = 26, 31.7%), and good support from the healthcare professionals (n = 25, 30.5%) (Figure 1). The main reasons for the negative childbirth experiences were poor healthcare professional support (n = 12, 14.6%), excessive pain or medication (n = 7, 8.5%), and the absence of a companion during childbirth (n = 6, 7.3%) (Figure 1).
Regarding whether it was the first baby or not, there was no statistical difference concerning satisfaction with childbirth. The other tables can be found in the Supplementary Material.

5. Discussion

For pregnant women, practical and emotional support from birth companions and competent healthcare professionals is important (Karlström et al., 2015). The presence of a supportive environment, including a trusting and respectful relationship with healthcare providers, is crucial. Additionally, effective communication and shared decision making are essential components that contribute to a positive experience (Downe et al., 2016; Hall et al., 2023).
The importance of a partner for PWLWHIV is multifaceted and significantly impacts both maternal and infant health outcomes. Male partner involvement in antenatal care has been shown to be critical in reducing the mother-to-child transmission (MTCT) of HIV and improving HIV-free survival among infants. A randomized controlled trial in South Africa demonstrated that active male partner involvement during pregnancy was associated with a significantly lower rate of HIV-infected infants at 12 months postpartum (adjusted odds ratio [aOR] = 4.55) and a lower proportion of dead and HIV-infected infants compared with those without partner involvement (aOR = 1.98) (Sifunda et al., 2019). Emotional and instrumental support from male partners is also crucial for the physical and mental health of pregnant women living with HIV. Qualitative interviews in Zambia highlighted that women prioritized communication, honesty, and respect in their relationships, and considered partner support essential for their well-being during pregnancy (Hampanda et al., 2021). Psychosocial support from partners can mitigate the stress and stigma associated with HIV during the perinatal period. In Uganda, women reported that partner support helped them navigate the challenges of HIV-related stigma and intimate partner violence, which are common stressors during pregnancy (Ashaba et al., 2017). Partner support plays a crucial role in reducing maternal stress and improving mental health for PWLWHIV. Studies have shown that male partner involvement can significantly decrease depressive symptoms in HIV-positive pregnant women.
PWLWHIV also highly valued personal achievement and control through active decision making during labor and birth, even when medical interventions were necessary. The sense of being informed and involved in decisions regarding labor and pain management significantly impacts the overall experience (Downe et al., 2016; Hall et al., 2023) (Medema-Wijnveen et al., 2012). This is in accordance with our study, as the first and third most common reasons for a negative childbirth experience were related to healthcare professionals. PWLWHIV value practical and emotional support from birth companions and competent, reassuring, and kind clinical staff. The presence of a supportive environment, including a trusting and respectful relationship with healthcare providers, is crucial. Additionally, effective communication and shared decision making are essential components that contribute to a positive experience (Kunneman & Montori, 2017; Meyer et al., 2017; Noone, 2002).
The physical environment also plays a role (fourth most common reason), with PWLWHIV emphasizing the importance of a clinically and psychologically safe environment, preserving the individuality of PWLWHIV (Watt et al., 2024).
PWLWHIV without partner support face several common psychological challenges, which can significantly impact their mental health and overall well-being. Depression and anxiety are highly prevalent among PWLWHIV lacking partner support (Tuthill et al., 2021; Waldron et al., 2022). A study in Tanzania found that 25% of such women met the criteria for depression, and 23.5% for anxiety (Ngocho et al., 2019). A lack of partner support for PWLWHIV can lead to increased risks of adverse birth outcomes, impaired infant development (Rodriguez et al., 2018b), nonadherence to ART (Lin et al., 2023), and higher neonatal mortality (Larsen et al., 2023), primarily due to the exacerbation of maternal depression, anxiety, and social isolation. Addressing these psychosocial factors is crucial for improving both maternal and neonatal health outcomes. A study in Tanzania found that antenatal depression was prevalent in 67% of the cohort, and was associated with a higher risk of infant wasting (relative risk [RR]: 2.61) (Saleh et al., 2023). Another study in Kenya highlighted that depressive symptoms were linked to a five-fold increase in pregnancy loss and a higher risk of preterm birth (Larsen et al., 2023).
The promotion of a positive birth experience has been a main goal of the World Health Organization (WHO)’s recent work on improving maternity care (WHO, n.d.). Improving maternal care to exceed maternal expectations leads to positive childbirth experiences and involves several key strategies grounded in evidence-based practices. First, ensuring respectful and dignified care is paramount (Mohamoud et al., 2023; Patel et al., 2024). Training healthcare providers in respectful maternity care (RMC) has been shown to significantly improve maternal satisfaction and birth experiences. This includes fostering a supportive environment where women feel valued and respected throughout their childbirth experience (Singh et al., 2024). Second, shared decision making and patient autonomy are critical. Many PWLWHIV feel excluded from decision-making processes regarding their care. They report that healthcare providers often do not seek their consent before procedures or involve them in care decisions, leading to feelings of disempowerment and a lack of autonomy (Alruwaili et al., 2024; Hughes et al., 2022; Jolly et al., 2019). Women value being active participants in their care, making informed decisions, and having their preferences respected. This can be facilitated through individualized care plans and effective communication from healthcare providers (Baumont et al., 2023; Downe et al., 2016). Third, continuity of care and emotional support are essential. Women benefit from consistent care providers and the presence of birth companions, which contribute to a sense of safety and support. Emotional support from both healthcare providers and companions can significantly enhance the childbirth experience (Downe et al., 2016; Yelland et al., 2009). Fourth, postnatal support is crucial for maternal well-being. Providing comprehensive postnatal care, including domiciliary visits and accessible support services, can address physical and emotional postpartum health needs (Hannon et al., 2022; Yelland et al., 2009). Lastly, addressing systemic healthcare issues such as healthcare provider training, resource availability, and infrastructure improvements can enhance the overall quality of maternal care. Ensuring adequate staffing, improving facilities, and implementing patient feedback mechanisms are important steps (Lazzerini et al., 2020; Mauluka et al., 2023; Valente et al., 2022). These strategies are supported by evidence from multiple studies and align with the World Health Organization’s standards for quality maternal care (Downe et al., 2016; Hannon et al., 2022; Lazzerini et al., 2020; Mauluka et al., 2023; Singh et al., 2024).
Structural and organizational issues such as overcrowding, lack of privacy, and inadequate facilities lead to negative childbirth experiences. PWLWHIV also report long waiting times and insufficient human resources, which can negatively impact the quality of care they receive (Lambert et al., 2018; Oyugi et al., 2024), which was also reported in our study.
Maternal mental health plays a significant role in the neurodevelopment of HIV-exposed uninfected (HEU) children. Maternal depression and stress are associated with adverse neonatal and neurodevelopmental outcomes in these children, mainly low birth weights and preterm birth (Grigoriadis et al., 2018; Portwood et al., 2023; Voit et al., 2022). Higher maternal depression scores are linked to lower overall cognitive scores in specific domains such as expressive language, fine motor skills, gross motor skills, and visual reception in HEU infants (Mebrahtu et al., 2018). Additionally, maternal stress is associated with poorer cognitive outcomes, particularly in expressive language, gross motor skills, and visual reception (Mebrahtu et al., 2018).
Maternal depression, both pre- and postpartum, has been shown to predict cognitive delays and gross motor development issues in HEU infants (Mokhele et al., 2019; Rodriguez et al., 2018a). Furthermore, maternal post-traumatic stress disorder (PTSD) and depression are significant risk factors for child behavior problems, with maternal PTSD having the greatest explanatory power for these issues (Nöthling et al., 2013). Persistent maternal mental health disorders, including depression and anxiety, are associated with lower cognitive and motor scores in infants (Burger et al., 2023). Suicidal ideation is also linked to poorer cognitive outcomes in children (Mebrahtu et al., 2020). Prohibiting having a birth companion during labor and delivery can contribute to feelings of isolation and anxiety (Hughes et al., 2022; Lambert et al., 2018).
Negative childbirth experiences can exacerbate postpartum mental health issues (Akinsolu et al., 2023; Larsen et al., 2023). Akinsolu et al. highlighted that having a partner was significantly associated with lower perceived depression among PWLWHIV as they provide emotional and psychological stability, reducing the risk of postpartum depression and mitigating the effects of previous negative childbirth experiences. This indicates that partner support can buffer the negative impact of adverse childbirth experiences on postpartum mental health (Akinsolu et al., 2023). A negative childbirth experience for PWLWHIV can also significantly influence their reproductive intentions and outcomes in subsequent pregnancies (Fortin-Hughes et al., 2019).
This study had a limitation, which is that almost all PWLWHIV had a low viral load, which could be associated with better neonatal outcomes.

6. Conclusions

6.1. Practical Implications

PWLWHIV had positive childbirth experiences in public maternity wards in Rio de Janeiro. Our findings indicate that complications with baby health at birth was the main factor associated with a negative childbirth experience. Other studies have found that the perinatal period is a time of stress for all pregnant women, especially PWLWHIV (Hickson, 1998). The challenges experienced by PWLWHIV may compromise successful engagement in HIV care and may reduce the quality of life for these women and their children (Ashaba et al., 2017). The health of babies born to HIV-positive mothers is critically dependent on early HIV detection, effective ART, and careful management of the pregnancy and delivery to minimize MTCT and optimize neonatal outcomes.
Partner involvement is crucial for improving maternal and infant health outcomes in PWLWHIV through enhanced support, better ART adherence, and reduced MTCT rates; therefore, new approaches must be implemented involving PWLWHIV partners (Dinh et al., 2018; Sifunda et al., 2019).

6.2. Limitations of the Study

One of the limitations of our study was that we did not study postnatal child development. As we discussed above, prenatal through to postnatal care is important in child development. Another limitation was not assessing maternal mental health using specific scores, such as the Edinburgh Postnatal Depression Scale, a 10-item self-rated scale (Kroska & Stowe, 2020; Miller et al., 2023).
Another limitation is the small sample used, but it is representative of the population of Rio de Janeiro, which was ensured by the sample calculation.

6.3. Recommendations for Future Research

Future research on improving childbirth experiences for PWLWHIV should include approaches targeting emotional, social, and health factors. Maternity service providers should consider a multi-faceted approach to reorient pre- and postnatal services in order to improve PWLWHIV’s experiences of care. Approaches worthy of consideration include ensuring consistency and continuity of care through staffing arrangements; guidelines and protocols based on PWLWHIV’s decision making; an emphasis on planning for postnatal care during pregnancy; the use of evidence to inform both consumer information and advice, and in the practice of providing care; and skill-enhancement opportunities for improving healthcare professional communication with PWLWHIV.
Interventions targeting reductions in depressive symptoms in perinatal HIV-positive women could include increasing partner involvement and decreasing HIV stigma and intimate partner violence (Peltzer et al., 2020).
Addressing antenatal depression and anxiety through cognitive behavioral therapy (CBT) and other psychosocial interventions could also significantly reduce depressive symptoms, which are associated with adverse birth outcomes (Jacobson et al., 2021; Mendelson et al., 2017; Mphonda et al., 2023; Sakyi et al., 2020).

6.4. Ethical Considerations

Human ethics approval was granted from the IPPMG and CONEP (National Commission in Research Ethics). All the PWLWHIV who enrolled in the study met the inclusion criteria, and this study was explained to them. They were informed that their participation was voluntary, and their responses were confidential. Written informed consent was then obtained, and data collection was completed. Before beginning the interviews, we ensured that the women understood the information provided, consented to participate, and allowed the extraction of their data for the specified aims. The data were pseudo-anonymized before the analysis. This study complied with the guidelines for human research in the Declaration of Helsinki.

Supplementary Materials

The following supporting information can be downloaded at: https://www.mdpi.com/article/10.3390/bs15040442/s1, Table S1: Frequency of positive and negative experience of the sample (N = 82). Table S2. Frequency of PWLWHIV reasons to classify their childbirth experience (N = 82). Figure S1. Frequency of positive experience, regarding if it is the first baby or not.

Author Contributions

Conceptualization: A.P.d.A., F.R. and C.B.H. Data analysis: A.P.d.A., L.C. and F.R. Writing: A.P.d.A., L.C., C.B.H. and F.R. All authors have read and agreed to the published version of the manuscript.

Funding

This research received no external funding.

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Human Research Ethics Committee of Federal University of Rio de Janeiro (CAAE; No. 66217722.2.0000.5264—6.130.657; 20 June 2023).

Informed Consent Statement

This study was approved by the Human Research Ethics Committee of the Federal University of Rio de Janeiro (CAAE; No. 66217722.2.0000.5264—6.130.657; 20 June 2023). Written informed consent was obtained from all participants.

Data Availability Statement

Further inquiries about original data can be asked directed to the corresponding author.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Akinsolu, F. T., Abodunrin, O. R., Lawale, A. A., Bankole, S. A., Adegbite, Z. O., Adewole, I. E., Olagunju, M. T., Ola, O. M., Dabar, A. M., Sanni-Adeniyi, R. A., Gambari, A. O., Njuguna, D. W., Salako, A. O., & Ezechi, O. C. (2023). Depression and perceived stress among perinatal women living with HIV in Nigeria. Frontiers in Public Health, 11, 1259830. [Google Scholar] [CrossRef]
  2. Alruwaili, T. A., Crawford, K., & Fooladi, E. (2024). Shared decision-making in maternity care in Saudi Arabia: A cross-sectional study. Midwifery, 138, 104147. [Google Scholar] [CrossRef] [PubMed]
  3. Ashaba, S., Kaida, A., Coleman, J. N., Burns, B. F., Dunkley, E., O’Neil, K., Kastner, J., Sanyu, N., Akatukwasa, C., Bangsberg, D. R., Matthews, L. T., & Psaros, C. (2017). Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda. PLoS ONE, 12(5), e0176256. [Google Scholar] [CrossRef]
  4. Awadu, J. E., Sikorskii, A., Zalwango, S., Coventry, A., Giordani, B., & Ezeamama, A. E. (2022). Developmental disorder probability scores at 6–18 years old in relation to in-utero/peripartum antiretroviral drug exposure among Ugandan children. International Journal of Environmental Research and Public Health, 19(6), 3725. [Google Scholar] [CrossRef]
  5. Baranowska, B., Kajdy, A., Pawlicka, P., Pokropek, E., Rabijewski, M., Sys, D., & Pokropek, A. (2020). What are the critical elements of satisfaction and experience in labor and childbirth—A cross-sectional study. International Journal of Environmental Research and Public Health, 17(24), 9295. [Google Scholar] [CrossRef]
  6. Baumont, M. S., Dekker, C. S., Rabinovitch Blecker, N., Turlington Burns, C., & Strauss, N. E. (2023). Every Mother Counts: Listening to mothers to transform maternity care. American Journal of Obstetrics and Gynecology, 228(5), S954–S964. [Google Scholar] [CrossRef]
  7. Benki-Nugent, S., Wamalwa, D., Langat, A., Tapia, K., Adhiambo, J., Chebet, D., Okinyi, H. M., & John-Stewart, G. (2017). Comparison of developmental milestone attainment in early treated HIV-infected infants versus HIV-unexposed infants: A prospective cohort study. BMC Pediatrics, 17(1), 24. [Google Scholar] [CrossRef]
  8. Boivin, M. J., Maliwichi-Senganimalunje, L., Ogwang, L. W., Kawalazira, R., Sikorskii, A., Familiar-Lopez, I., Kuteesa, A., Nyakato, M., Mutebe, A., Namukooli, J. L., Mallewa, M., Ruiseñor-Escudero, H., Aizire, J., Taha, T. E., & Fowler, M. G. (2019). Neurodevelopmental effects of ante-partum and post-partum antiretroviral exposure in HIV-exposed and uninfected children versus HIV-unexposed and uninfected children in Uganda and Malawi: A prospective cohort study. The Lancet HIV, 6(8), e518–e530. [Google Scholar] [CrossRef]
  9. Burger, M., Einspieler, C., Jordaan, E. R., Unger, M., & Niehaus, D. J. H. (2023). Persistent maternal mental health disorders and toddler neurodevelopment at 18 months: Longitudinal follow-up of a low-income South African cohort. International Journal of Environmental Research and Public Health, 20(12), 6192. [Google Scholar] [CrossRef]
  10. Chen, L., Pan, W., Mu, P., & Gau, M. (2023). Birth environment interventions and outcomes: A scoping review. Birth, 50(4), 735–748. [Google Scholar] [CrossRef]
  11. De Azevedo, A. P., Castro, L., Hofer, C. B., & Rego, F. (2025). The childbirth experience of pregnant women living with HIV virus. Journal of Clinical Medicine, 14(6), 1975. [Google Scholar] [CrossRef] [PubMed]
  12. Dinh, T.-H., Mushavi, A., Shiraishi, R. W., Tippett Barr, B., Balachandra, S., Shambira, G., Nyakura, J., Zinyowera, S., Tshimanga, M., Mugurungi, O., & Kilmarx, P. H. (2018). Impact of timing of antiretroviral treatment and birth weight on mother-to-child human immunodeficiency virus transmission: Findings from an 18-month prospective cohort of a nationally representative sample of mother–infant pairs during the transition from Option A to Option B+ in Zimbabwe. Clinical Infectious Diseases, 66(4), 576–585. [Google Scholar] [CrossRef] [PubMed]
  13. Downe, S., Finlayson, K., Oladapo, O., Bonet, M., & Gülmezoglu, A. M. (2018). What matters to women during childbirth: A systematic qualitative review. PLoS ONE, 13(4), e0194906. [Google Scholar] [CrossRef]
  14. Downe, S., Finlayson, K., Tunçalp, Ö., & Metin Gülmezoglu, A. (2016). What matters to women: A systematic scoping review to identify the processes and outcomes of antenatal care provision that are important to healthy pregnant women. BJOG: An International Journal of Obstetrics & Gynaecology, 123(4), 529–539. [Google Scholar] [CrossRef]
  15. Fentie, E. A., Yeshita, H. Y., Shewarega, E. S., Boke, M. M., Kidie, A. A., & Alemu, T. G. (2022). Adverse birth outcome and associated factors among mothers with HIV who gave birth in northwest Amhara region referral hospitals, northwest Ethiopia, 2020. Scientific Reports, 12(1), 22514. [Google Scholar] [CrossRef]
  16. Fortin-Hughes, M., Proulx-Boucher, K., Rodrigue, C., Otis, J., Kaida, A., Boucoiran, I., Greene, S., Kennedy, L., Webster, K., Conway, T., Ménard, B., Loutfy, M., & de Pokomandy, A. (2019). Previous experiences of pregnancy and early motherhood among women living with HIV: A latent class analysis. AIDS Care, 31(11), 1427–1434. [Google Scholar] [CrossRef]
  17. Graybill, L. A., Kasaro, M., Freeborn, K., Walker, J. S., Poole, C., Powers, K. A., Mollan, K. R., Rosenberg, N. E., Vermund, S. H., Mutale, W., & Chi, B. H. (2020). Incident HIV among pregnant and breast-feeding women in sub-Saharan Africa: A systematic review and meta-analysis. AIDS, 34(5), 761–776. [Google Scholar] [CrossRef]
  18. Grigoriadis, S., Graves, L., Peer, M., Mamisashvili, L., Tomlinson, G., Vigod, S. N., Dennis, C.-L., Steiner, M., Brown, C., Cheung, A., Dawson, H., Rector, N. A., Guenette, M., & Richter, M. (2018). Maternal anxiety during pregnancy and the association with adverse perinatal outcomes. The Journal of Clinical Psychiatry, 79(5), 17r12011. [Google Scholar] [CrossRef]
  19. Hall, H., Fooladi, E., Kloester, J., Ulnang, A., Sinni, S., White, C., McLaren, M., & Yeganeh, L. (2023). Factors that promote a positive childbearing experience: A qualitative study. Journal of Midwifery & Women’s Health, 68(1), 44–51. [Google Scholar] [CrossRef]
  20. Hampanda, K., Matenga, T. F. L., Nkwemu, S., Shankalala, P., Chi, B. H., Darbes, L. A., Turan, J. M., Mutale, W., Bull, S., & Abuogi, L. (2021). Designing a couple-based relationship strengthening and health enhancing intervention for pregnant women living with HIV and their male partners in Zambia: Interview findings from the target community. Social Science & Medicine, 283, 114029. [Google Scholar] [CrossRef]
  21. Hannon, S., Newnham, E., Hannon, K., Wuytack, F., Johnson, L., McEvoy, E., & Daly, D. (2022). Positive postpartum well-being: What works for women. Health Expectations, 25(6), 2971–2981. [Google Scholar] [CrossRef] [PubMed]
  22. Hemalatha, B. S. (2012). Care of mother with HIV/AIDS. The Nursing Journal of India, 103(5), 198–200. [Google Scholar] [PubMed]
  23. Hickson, G. (1998). Satisfaction with obstetric care: Relation to neonatal intensive care. Obstetrics & Gynecology, 91(2), 288–292. [Google Scholar] [CrossRef]
  24. Hughes, C. S., Kamanga, M., Jenny, A., Zieman, B., Warren, C., Walker, D., & Kazembe, A. (2022). Perceptions and predictors of respectful maternity care in Malawi: A quantitative cross-sectional analysis. Midwifery, 112, 103403. [Google Scholar] [CrossRef]
  25. Jacobson, D. L., Neri, D., Gaskins, A., Yee, L., Mendez, A. J., Hendricks, K., Siminski, S., Zash, R., Hyzy, L., & Jao, J. (2021). Maternal anemia and preterm birth among women living with HIV in the United States. The American Journal of Clinical Nutrition, 113(6), 1402–1410. [Google Scholar] [CrossRef]
  26. Jolly, Y., Aminu, M., Mgawadere, F., & van den Broek, N. (2019). “We are the ones who should make the decision”—Knowledge and understanding of the rights-based approach to maternity care among women and healthcare providers. BMC Pregnancy and Childbirth, 19(1), 42. [Google Scholar] [CrossRef]
  27. Kaimal, A., & Norton, M. E. (2021). Society for maternal-fetal medicine consult series #55: Counseling women at increased risk of maternal morbidity and mortality. American Journal of Obstetrics and Gynecology, 224(4), B16–B23. [Google Scholar] [CrossRef]
  28. Karlström, A., Nystedt, A., & Hildingsson, I. (2015). The meaning of a very positive birth experience: Focus groups discussions with women. BMC Pregnancy and Childbirth, 15(1), 251. [Google Scholar] [CrossRef]
  29. Kroska, E. B., & Stowe, Z. N. (2020). Postpartum depression. Obstetrics and Gynecology Clinics of North America, 47(3), 409–419. [Google Scholar] [CrossRef]
  30. Kunneman, M., & Montori, V. M. (2017). When patient-centred care is worth doing well: Informed consent or shared decision-making. BMJ Quality and Safety, 26(7), 522–524. [Google Scholar] [CrossRef]
  31. Lambert, J., Etsane, E., Bergh, A.-M., Pattinson, R., & van den Broek, N. (2018). ‘I thought they were going to handle me like a queen but they didn’t’: A qualitative study exploring the quality of care provided to women at the time of birth. Midwifery, 62, 256–263. [Google Scholar] [CrossRef] [PubMed]
  32. Larsen, A., Pintye, J., Abuna, F., Bhat, A., Dettinger, J. C., Gomez, L., Marwa, M. M., Ngumbau, N., Odhiambo, B., Phipps, A. I., Richardson, B. A., Watoyi, S., Stern, J., Kinuthia, J., & John-Stewart, G. (2023). Risks of adverse perinatal outcomes in relation to maternal depressive symptoms: A prospective cohort study in Kenya. Paediatric and Perinatal Epidemiology, 37(6), 489–504. [Google Scholar] [CrossRef] [PubMed]
  33. Lazzerini, M., Mariani, I., Semenzato, C., & Valente, E. P. (2020). Association between maternal satisfaction and other indicators of quality of care at childbirth: A cross-sectional study based on the WHO standards. BMJ Open, 10(9), e037063. [Google Scholar] [CrossRef] [PubMed]
  34. Leinweber, J., Fontein-Kuipers, Y., Karlsdottir, S. I., Ekström-Bergström, A., Nilsson, C., Stramrood, C., & Thomson, G. (2023). Developing a woman-centered, inclusive definition of positive childbirth experiences: A discussion paper. Birth, 50(2), 362–383. [Google Scholar] [CrossRef]
  35. le Roux, S. M., Donald, K. A., Kroon, M., Phillips, T. K., Lesosky, M., Esterhuyse, L., Zerbe, A., Brittain, K., Abrams, E. J., & Myer, L. (2019). HIV viremia during pregnancy and neurodevelopment of HIV-exposed uninfected children in the context of universal antiretroviral therapy and breastfeeding. Pediatric Infectious Disease Journal, 38(1), 70–75. [Google Scholar] [CrossRef]
  36. Lin, D., Zhang, C., & Shi, H. (2023). Adverse impact of intimate partner violence against HIV-positive women during pregnancy and post-partum: Results from a meta-analysis of observational studies. Trauma, Violence, & Abuse, 24(3), 1624–1639. [Google Scholar] [CrossRef]
  37. Lopes, F., Carvas Júnior, N., Nakamura, M. U., & Nomura, R. M. Y. (2019). Content and Face Validity of the Mackey Childbirth Satisfaction Rating Scale Questionnaire Cross-culturally Adapted to Brazilian Portuguese. Revista Brasileira de Ginecologia e Obstetricia, 41(6), 371–378. [Google Scholar] [CrossRef]
  38. Lopes, F., Júnior, N. C., Nakamura, M. U., & Nomura, R. M. Y. (2021a). Psychometric properties of the Mackey Childbirth Satisfaction Rating Scale cross-culturally adapted to Brazilian Portuguese. The Journal of Maternal-Fetal & Neonatal Medicine, 34(13), 2173–2179. [Google Scholar] [CrossRef]
  39. Lopes, F., Nakamura, M. U., & Nomura, R. M. Y. (2021b). Women’s satisfaction with childbirth in a public hospital in Brazil. Birth, 48(2), 251–256. [Google Scholar] [CrossRef]
  40. Magondo, N., Meintjes, E. M., Warton, F. L., Little, F., van der Kouwe, A. J. W., Laughton, B., Jankiewicz, M., & Holmes, M. J. (2024). Distinct alterations in white matter properties and organization related to maternal treatment initiation in neonates exposed to HIV but uninfected. Scientific Reports, 14(1), 8822. [Google Scholar] [CrossRef]
  41. Marr, M. C., Graham, A. M., Feczko, E., Nolvi, S., Thomas, E., Sturgeon, D., Schifsky, E., Rasmussen, J. M., Gilmore, J. H., Styner, M., Entringer, S., Wadhwa, P. D., Korja, R., Karlsson, H., Karlsson, L., Buss, C., & Fair, D. A. (2023). Maternal perinatal stress trajectories and negative affect and amygdala development in offspring. American Journal of Psychiatry, 180(10), 766–777. [Google Scholar] [CrossRef] [PubMed]
  42. Mauluka, C., Stones, W., Chiumia, I. K., & Maliwichi, L. (2023). Exploring a framework for demandable services from antenatal to postnatal care: A deep-dive dialogue with mothers, health workers and psychologists. BMC Pregnancy and Childbirth, 23(1), 390. [Google Scholar] [CrossRef] [PubMed]
  43. Mebrahtu, H., Sherr, L., Simms, V., Weiss, H. A., Rehman, A. M., Ndlovu, P., & Cowan, F. M. (2020). Effects of maternal suicidal ideation on child cognitive development: A longitudinal analysis. AIDS and Behavior, 24(8), 2421–2429. [Google Scholar] [CrossRef] [PubMed]
  44. Mebrahtu, H., Simms, V., Chingono, R., Mupambireyi, Z., Weiss, H. A., Ndlovu, P., Malaba, R., Cowan, F. M., & Sherr, L. (2018). Postpartum maternal mental health is associated with cognitive development of HIV-exposed infants in Zimbabwe: A cross-sectional study. AIDS Care, 30(Suppl. 2), 74–82. [Google Scholar] [CrossRef]
  45. Medema-Wijnveen, J. S., Onono, M., Bukusi, E. A., Miller, S., Cohen, C. R., & Turan, J. M. (2012). How perceptions of HIV-related stigma affect decision-making regarding childbirth in rural Kenya. PLoS ONE, 7(12), e51492. [Google Scholar] [CrossRef]
  46. Mendelson, T., Cluxton-Keller, F., Vullo, G. C., Tandon, S. D., & Noazin, S. (2017). NICU-based interventions to reduce maternal depressive and anxiety symptoms: A meta-analysis. Pediatrics, 139(3), e20161870. [Google Scholar] [CrossRef]
  47. Meyer, Y., Frank, F., Schläppy Muntwyler, F., Fleming, V., & Pehlke-Milde, J. (2017). Decision-making in Swiss home-like childbirth: A grounded theory study. Women and Birth, 30(6), e272–e280. [Google Scholar] [CrossRef]
  48. Miller, E. S., Metz, T., Simas, T. A. M., Hoffman, M. C., Byatt, N., & Roussos-Ross, K. (2023). Treatment and management of mental health conditions during pregnancy and postpartum. Obstetrics & Gynecology, 141(6), 1262–1288. [Google Scholar] [CrossRef]
  49. Mohamoud, Y. A., Cassidy, E., Fuchs, E., Womack, L. S., Romero, L., Kipling, L., Oza-Frank, R., Baca, K., Galang, R. R., Stewart, A., Carrigan, S., Mullen, J., Busacker, A., Behm, B., Hollier, L. M., Kroelinger, C., Mueller, T., Barfield, W. D., & Cox, S. (2023). Vital Signs: Maternity care experiences—United States, April 2023. MMWR. Morbidity and Mortality Weekly Report, 72(35), 961–967. [Google Scholar] [CrossRef]
  50. Mokhele, I., Nattey, C., Jinga, N., Mongwenyana, C., Fox, M. P., & Onoya, D. (2019). Prevalence and predictors of postpartum depression by HIV status and timing of HIV diagnosis in Gauteng, South Africa. PLoS ONE, 14(4), e0214849. [Google Scholar] [CrossRef]
  51. Montgomery, K. S. (2003). Childbirth education for the HIV-positive woman. The Journal of Perinatal Education, 12(4), 16. [Google Scholar] [CrossRef]
  52. Mphonda, S., Dussault, J., Bengtson, A., Gaynes, B. N., Go, V., Hosseinipour, M. C., Kulisewa, K., Kutengule, A., Meltzer-Brody, S., Udedi, M., & Pence, B. (2023). Preferences for enhanced treatment options to address HIV care engagement among women living with HIV and perinatal depression in Malawi. BMC Public Health, 23(1), 1922. [Google Scholar] [CrossRef]
  53. Ngocho, J. S., Watt, M. H., Minja, L., Knettel, B. A., Mmbaga, B. T., Williams, P. P., & Sorsdahl, K. (2019). Depression and anxiety among pregnant women living with HIV in Kilimanjaro region, Tanzania. PLoS ONE, 14(10), e0224515. [Google Scholar] [CrossRef]
  54. Nicoloro-SantaBarbara, J., Rosenthal, L., Auerbach, M. V., Kocis, C., Busso, C., & Lobel, M. (2017). Patient-provider communication, maternal anxiety, and self-care in pregnancy. Social Science & Medicine, 190, 133–140. [Google Scholar] [CrossRef]
  55. Noone, J. (2002). Concept analysis of decision making. Nursing Forum, 37(3), 21–32. [Google Scholar] [CrossRef]
  56. Nöthling, J., Martin, C. L., Laughton, B., Cotton, M. F., & Seedat, S. (2013). Maternal post-traumatic stress disorder, depression and alcohol dependence and child behaviour outcomes in mother–child dyads infected with HIV: A longitudinal study. BMJ Open, 3(12), e003638. [Google Scholar] [CrossRef]
  57. Oyugi, B., Audi-Poquillon, Z., Kendall, S., & Peckham, S. (2024). Examining the quality of care across the continuum of maternal care (antenatal, perinatal and postnatal care) under the expanded free maternity policy (Linda Mama Policy) in Kenya: A mixed-methods study. BMJ Open, 14(5), e082011. [Google Scholar] [CrossRef]
  58. Patel, S. J., Truong, S., DeAndrade, S., Jacober, J., Medina, M., Diouf, K., Meadows, A., Nour, N., & Schantz-Dunn, J. (2024). Respectful maternity care in the United States—Characterizing inequities experienced by birthing people. Maternal and Child Health Journal, 28(7), 1133–1147. [Google Scholar] [CrossRef]
  59. Peltzer, K., Abbamonte, J. M., Mandell, L. N., Rodriguez, V. J., Lee, T. K., Weiss, S. M., & Jones, D. L. (2020). The effect of male involvement and a prevention of mother-to-child transmission (PMTCT) intervention on depressive symptoms in perinatal HIV-infected rural South African women. Archives of Women’s Mental Health, 23(1), 101–111. [Google Scholar] [CrossRef]
  60. Portwood, C., Sexton, H., Kumarendran, M., Brandon, Z., Kirtley, S., & Hemelaar, J. (2023). Adverse perinatal outcomes associated with antiretroviral therapy in women living with HIV: A systematic review and meta-analysis. Frontiers in Medicine, 9, 924593. [Google Scholar] [CrossRef]
  61. Powell, A. M., DeVita, J. M., Ogburu-Ogbonnaya, A., Peterson, A., & Lazenby, G. B. (2017). The effect of HIV-centered obstetric care on perinatal outcomes among a cohort of women living with HIV. JAIDS Journal of Acquired Immune Deficiency Syndromes, 75(4), 431–438. [Google Scholar] [CrossRef]
  62. Rodriguez, V. J., Mandell, L. N., Babayigit, S., Manohar, R. R., Weiss, S. M., & Jones, D. L. (2018a). Correlates of suicidal ideation during pregnancy and postpartum among women living with HIV in rural South Africa. AIDS and Behavior, 22(10), 3188–3197. [Google Scholar] [CrossRef] [PubMed]
  63. Rodriguez, V. J., Matseke, G., Cook, R., Bellinger, S., Weiss, S. M., Alcaide, M. L., Peltzer, K., Patton, D., Lopez, M., & Jones, D. L. (2018b). Infant development and pre- and post-partum depression in rural South African HIV-infected women. AIDS and Behavior, 22(6), 1766–1774. [Google Scholar] [CrossRef] [PubMed]
  64. Sakyi, K. S., Lartey, M. Y., Kennedy, C. E., Denison, J. A., Sacks, E., Owusu, P. G., Hurley, E. A., Mullany, L. C., & Surkan, P. J. (2020). Stigma toward small babies and their mothers in Ghana: A study of the experiences of postpartum women living with HIV. PLoS ONE, 15(10), e0239310. [Google Scholar] [CrossRef]
  65. Saleh, A., Perumal, N., Muhihi, A., Duggan, C. P., Ulenga, N., Al-Beity, F. M. A., Aboud, S., Fawzi, W. W., Manji, K. P., & Sudfeld, C. R. (2023). Associations between social support and symptoms of antenatal depression with infant growth and development among mothers living with HIV in Tanzania. AIDS and Behavior, 27(11), 3584–3595. [Google Scholar] [CrossRef]
  66. Schoeman, J. C., Moutloatse, G. P., Harms, A. C., Vreeken, R. J., Scherpbier, H. J., Van Leeuwen, L., Kuijpers, T. W., Reinecke, C. J., Berger, R., Hankemeier, T., & Bunders, M. J. (2017). Fetal metabolic stress disrupts immune homeostasis and induces proinflammatory responses in human immunodeficiency virus type 1– and combination antiretroviral therapy–exposed infants. The Journal of Infectious Diseases, 216(4), 436–446. [Google Scholar] [CrossRef]
  67. Sifunda, S., Peltzer, K., Rodriguez, V. J., Mandell, L. N., Lee, T. K., Ramlagan, S., Alcaide, M. L., Weiss, S. M., & Jones, D. L. (2019). Impact of male partner involvement on mother-to-child transmission of HIV and HIV-free survival among HIV-exposed infants in rural South Africa: Results from a two phase randomised controlled trial. PLoS ONE, 14(6), e0217467. [Google Scholar] [CrossRef]
  68. Singh, M., Baruhee, S., & Saxena, P. (2024). Impact of respectful maternal care training of health care providers on satisfaction with birth experience in mothers undergoing normal vaginal birth: A prospective interventional study. International Journal of Gynecology & Obstetrics, 168(2), 673–679. [Google Scholar] [CrossRef]
  69. Taheri, M., Takian, A., Taghizadeh, Z., Jafari, N., & Sarafraz, N. (2018). Creating a positive perception of childbirth experience: Systematic review and meta-analysis of prenatal and intrapartum interventions. Reproductive Health, 15(1), 73. [Google Scholar] [CrossRef]
  70. Tuthill, E. L., Maltby, A. E., Odhiambo, B. C., Akama, E., Pellowski, J. A., Cohen, C. R., Weiser, S. D., & Conroy, A. A. (2021). “I found out I was pregnant, and I started feeling stressed”: A longitudinal qualitative perspective of mental health experiences among perinatal women living with HIV. AIDS and Behavior, 25(12), 4154–4168. [Google Scholar] [CrossRef]
  71. Valente, E. P., Mariani, I., Covi, B., & Lazzerini, M. (2022). Quality of informed consent practices around the time of childbirth: A cross-sectional study in Italy. International Journal of Environmental Research and Public Health, 19(12), 7166. [Google Scholar] [CrossRef] [PubMed]
  72. Vandekerckhove, M., Guignard, M., Civadier, M.-S., Benachi, A., & Bouyer, J. (2021). Impact of maternal age on obstetric and neonatal morbidity: A retrospective cohort study. BMC Pregnancy and Childbirth, 21(1), 732. [Google Scholar] [CrossRef] [PubMed]
  73. Voit, F. A. C., Kajantie, E., Lemola, S., Räikkönen, K., Wolke, D., & Schnitzlein, D. D. (2022). Maternal mental health and adverse birth outcomes. PLoS ONE, 17(8), e0272210. [Google Scholar] [CrossRef] [PubMed]
  74. Waldron, E. M., Miller, E. S., Wee, V., Statton, A., Moskowitz, J. T., & Burnett-Zeigler, I. (2022). Stress, coping and the acceptability of mindfulness skills among pregnant and parenting women living with HIV in the United States: A focus group study. Health & Social Care in the Community, 30(6), e6255–e6266. [Google Scholar] [CrossRef]
  75. Watt, M. H., Marchand, V., Barabara, M. L., Minja, L. M., Stephens, M. J., Hanson, O. R., Mlay, P. S., Olomi, G. A., Kiwia, J. F., Mmbaga, B. T., & Cohen, S. R. (2024). Outcomes of the MAMA training: A simulation and experiential learning intervention for labor and delivery providers to improve respectful maternity care for women living with HIV in Tanzania. AIDS and Behavior, 28(6), 1898–1911. [Google Scholar] [CrossRef]
  76. WHO. (n.d.). Recommendations: Intrapartum care for a positive childbirth experience. Available online: https://www.who.int/publications/i/item/9789241550215 (accessed on 11 February 2025).
  77. Yelland, J., Krastev, A., & Brown, S. (2009). Enhancing early postnatal care: Findings from a major reform of maternity care in three Australian hospitals. Midwifery, 25(4), 392–402. [Google Scholar] [CrossRef]
  78. Young, J. M., Bitnun, A., Read, S. E., & Smith, M. L. (2022). Neurodevelopment of HIV-exposed uninfected children compared with HIV-unexposed uninfected children during early childhood. Developmental Psychology, 58(3), 551–559. [Google Scholar] [CrossRef]
Behavsci 15 00442 g001
Figure 1. Reasons associated by PWLWHIV with positive and negative experiences in the sample (N = 82).
Figure 1. Reasons associated by PWLWHIV with positive and negative experiences in the sample (N = 82).
Behavsci 15 00442 g001
Table 1. Sociodemographic characteristics of the sample (N = 82).
Table 1. Sociodemographic characteristics of the sample (N = 82).
VariableValue
Mother
Maternal age at birth28.5 [23.3; 28.6], 19–49
Ethnicity
 White14 (17.1%)
 Mixed34 (41.5%)
 Black34 (41.5%)
Number of pregnancies1.5 [1; 3], 1–6
Number of previous deliveries0 [0; 2], 0–7
Planned pregnancy
 No69 (84.1%)
 Yes13 (15.9%)
Viral load at 34 weeks
 Detectable1 (1.2%)
 Undetectable79 (96.3%)
 Undetermined2 (2.4%)
Birth type
 Cesarean25 (30.5%)
 Vaginal57 (69.5%)
Baby
Age (weeks)
 3820 (24.4%)
 3932 (39.0%)
 4024 (29.3%)
 416 (7.3%)
Sex
 Female40 (48.8%)
 Male42 (51.2%)
Weight3180 (247), 2580–3820
Apgar score at 1 min9 [8; 9], 1–9
Apgar score at 5 min9 [9; 9], 2–10
Birth complications
 No75 (91.5%)
 Yes7 (8.5%)
Results are described using absolute and relative frequencies (n (%)); median [1st quartile; 3rd quartile]; and mean (SD), min–max.
Table 2. Reasons given by PWLWHIV to explain their childbirth experience (N = 82).
Table 2. Reasons given by PWLWHIV to explain their childbirth experience (N = 82).
GroupAnswersn (%)
Positive reasons
Baby healthBaby was crying33 (40.2)
Healthy baby
Baby’s well-being
Baby’s birth
Saw the baby’s face
Had skin-to-skin contact with baby
Companion presenceHusband was present26 (31.7)
Mother was present
Husband could not enter delivery room
Happiness of husband
Support from husband
Absence of a partner
Good healthcare professional supportSupport from nurses
Wonderful doctors		25 (30.5)
Excellent doctors
Excellent nurses
Attention from doctors
Good support from doctors
Attention from healthcare professionals
Wonderful nurses
Given respect from all healthcare professionals
Excellent anesthetist
Good physical structure of maternity wardGood hygiene in maternity ward8 (9.8)
Good structure of maternity ward
Everything went wellEverything went well4 (4.9)
Everything was perfect
Fully assisted in maternity ward
Did not feel painDid not feel pain during birth1 (1.2)
Prenatal visit to maternity wardVisited maternity ward before the childbirth1 (1.2)
Negative reasons
Poor healthcare professional supportPoor care from doctors 12 (14.6)
Poor care from nurses
Poor care from nurses and doctors
Lack of attention from nurses
Absence of nurses during labor
Companion absenceAbsence of mother 6 (7.3)
No companion
Absence of husband
Excessive pain or medicationTerrible expulsive period7 (8.5)
Large amount of bleeding and pain
Painful birth
Long fast
Excessive pain
Poor physical structure of maternity wardBed was not secure1 (1.2)
Absence of birth informationAbsence of birth information1 (1.2)
Complications for babyBaby was suffering3 (3.7)
Baby went to UTI
No contact with baby
Cesarean delayCesarean delay2 (2.4)
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de Azevedo, A.P.; Castro, L.; Hofer, C.B.; Rego, F. Major Factors Contributing to Positive and Negative Childbirth Experiences in Pregnant Women Living with HIV. Behav. Sci. 2025, 15, 442. https://doi.org/10.3390/bs15040442

AMA Style

de Azevedo AP, Castro L, Hofer CB, Rego F. Major Factors Contributing to Positive and Negative Childbirth Experiences in Pregnant Women Living with HIV. Behavioral Sciences. 2025; 15(4):442. https://doi.org/10.3390/bs15040442

Chicago/Turabian Style

de Azevedo, Andréa Paula, Luisa Castro, Cristina Barroso Hofer, and Francisca Rego. 2025. "Major Factors Contributing to Positive and Negative Childbirth Experiences in Pregnant Women Living with HIV" Behavioral Sciences 15, no. 4: 442. https://doi.org/10.3390/bs15040442

APA Style

de Azevedo, A. P., Castro, L., Hofer, C. B., & Rego, F. (2025). Major Factors Contributing to Positive and Negative Childbirth Experiences in Pregnant Women Living with HIV. Behavioral Sciences, 15(4), 442. https://doi.org/10.3390/bs15040442

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