Humanized birth in high risk pregnancy: barriers and facilitating factors
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The medical model of childbearing assumes that a pregnancy always has the potential to turn into a risky procedure. In order to advocate humanized birth in high risk pregnancy, an important step involves the enlightenment of the professional’s preconceptions on humanized birth in such a situation. The goal of this paper is to identify the professionals’ perception of the potential obstacles and facilitating factors for the implementation of humanized care in high risk pregnancies. Twenty-one midwives, obstetricians, and health administrator professionals from the clinical and academic fields were interviewed in nine different sites in Japan from June through August 2008. The interviews were audio taped, and transcribed with the participants’ consent. Data was subsequently analyzed using content analysis qualitative methods. Professionals concurred with the concept that humanized birth is a changing and promising process, and can often bring normality to the midst of a high obstetric risk situation. No practice guidelines can be theoretically defined for humanized birth in a high risk pregnancy, as there is no conflict between humanized birth and medical intervention in such a situation. Barriers encountered in providing humanized birth in a high risk pregnancy include factors such as: the pressure of being responsible for the safety of the mother and the fetus, lack of the women’s active involvement in the decision making process and the heavy burden of responsibility on the physician’s shoulders, potential legal issues, and finally, the lack of midwifery authority in providing care at high risk pregnancy. The factors that facilitate humanized birth in a high risk include: the sharing of decision making and other various responsibilities between the physicians and the women; being caring; stress management, and the fact that the evolution of a better relationship and communication between the health professional and the patient will lead to a stress-free environment for both. Humanized birth in a high risk pregnancy is something that goes beyond just curing women of their illnesses. It can be considered as a token of caring, and continued support, which positively consolidates the doctor-patient relationship. As yet, it has not been described as a practiced guideline, due to its ever-changing complexities.
KeywordsHumanized birth High risk pregnancy Barriers Facilitators
Our sincere gratitude goes to Dr. Ii, Professor at Hitotsubashi University; Mrs. So, responsible of Matsugaoka Birthing Center; Mrs. Osanai, Midwife at the Bureau of International Medical Center in Japan; Dr. Noguchi Professor at Tokyo Women’s Medical University; Mrs. Uminai, Head Midwife at IMCJ; Dr. Kume, Dine of Faculty of Nursing of Tokyo Women’s Medical University; Dr. Takeuchi, Ob &Gyn and director of Tokyo Humanized Care Center; Dr. Inuoe, Ob&Gyn at Shonan-Kamakura Hospital; Dr. Natori, Director General of Research Center and Professor in Department of Obstetrics & Gynecology at Seiiku-Medical Centre, Dr. Usui, Chief of Department of Surgery and Chief of Division of International Medical Cooperation at Okayama Medical Center; Dr. Tada, Head of Department of Obstetrics & Gynecology at Okayama Medical Center; Mr. Onuki, Professor at Tokai University, and Ms. Watanabe, International graduated student and translator. The main author benefited from financial support of Japan Society for Promotion of Science (JSPS) and Canadian Institute of Health Research (CIHR) for 2 months fellowship in Japan, in summer 2008.
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