Birth stories from South Africa: Voices unheard.

BACKGROUND: The manner that birth events unfold can have a lasting impact on women. Giving voice to women's experiences is key in the creation of care that embodies humanistic, family-centred service.

AIM: The aim of this research was to describe the experiences of women receiving care during childbirth.

METHODS: The design was qualitative and descriptive using thematic analysis to analyse women's birth stories. A purposive sample of women (N=12) who had recently given birth in South Africa was selected. Participants were recruited who had delivered across a variety of settings: public, private, and maternity hospital, as well as at home. Data were collected using in-depth interviews and field notes.

FINDINGS: Four themes were noted: cocoon of compassionate care, personal regard for shared decision-making, beliefs about birth, and protection. Themes demonstrated both caring and non-caring behaviours including feelings of sadness, loneliness and being unwanted, being scared and uncertain, and overall dissatisfaction with the birth experience. Irrespective of setting, patients felt the absence of shared decision-making; the exception was where care was with midwives in an independent maternity hospital or at home.

DISCUSSION: A period of high vulnerability, birth is often met with care perceived as non-caring and lacking in compassion. Many women reported failure to be included as a partner in decision-making where birth occurred in private or public hospital settings. Where a midwifery model of care was in place, experiences were uniformly positive.

CONCLUSIONS: Fundamental change is needed in midwifery education and scope of practice, with overhaul of health system resourcing.