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New research is challenging traditional categorisations of coping strategies in a bid to promote autonomy and create empowering childbirth experiences that are aligned to women鈥檚 individual preferences and values.

A proposed framework by , comes amid growing concerns about birth trauma and maternity care experiences that were highlighted in the final report of the New South Wales Parliamentary Inquiry into Birth Trauma, handed down in late May.

Researchers examined the current pharmacological and non-pharmacological grouping of strategies, with the findings suggesting a shift towards a more holistic approach where medication is viewed as one of several supportive tools for coping during childbirth.

Women鈥檚 perspectives

Dr Laura Whitburn, senior researcher and study lead, with long-term collaborator and senior researcher Dr Lester Jones and lead author Janine Shifman, a physiotherapist and birth doula, have proposed reframing coping strategies as 鈥榠ntrinsic鈥� and 鈥榚xtrinsic鈥� to better reflect women鈥檚 perspectives and shift the focus away from medical interventions.

Intrinsic strategies are those that can be self-generated by women, while extrinsic strategies require the use of equipment or the help of someone else.

鈥淭he current framing immediately assumes that pharmacology is going to be the main solution in helping a woman when she feels she is not coping,鈥� Whitburn said.

鈥淲e know that for some women, pharmacological pain relief is important and effective; however, by introducing the concepts of intrinsic and extrinsic, we鈥檙e turning the focus back to women and their sense of autonomy throughout the process.鈥�

Factors most important to women

The study surveyed 56 women in late pregnancy, between February and May 2021, having their first baby at Mercy 黑料吃瓜群网 for Women: one of Victoria鈥檚 largest tertiary maternity hospitals.

Thinking about labour pain as productive and purposeful pain, feeling safe and supported, and preparing a range of coping strategies to help manage were identified as three factors most important to women.

鈥淧eople may assume that pain relief or having their pain under control during labour is a priority but, in fact, it wasn鈥檛 explicitly listed among the most important factors to women,鈥� Whitburn said.

鈥淲hat mattered was feeling supported and safe, thinking positively about the process and feeling well prepared.鈥�

Intrinsic strategies

The most common intrinsic strategies identified by respondents included breathing techniques, generating a positive mindset, as well as movement and keeping active.

鈥淭hinking positively, reminder that we are not alone in the experience, excitement of meeting my baby,鈥� said a study participant.

鈥淢indset, staying calm. Understanding that it鈥檚 a completely natural and normal process. I just have to let my body do what it knows how to do and get my mind out of the way,鈥� said another study participant.

Extrinsic strategies

Extrinsic strategies, such as using a bath or shower, the use of a TENS machine or having physical contact from support people or a known support person, were recorded as the most common among respondents.

鈥淩elying on my partner and knowing he will be my spokesperson if I can鈥檛 cope well. Trusting that I鈥檓 in a safe space, surrounded by experts who can help if things go wrong,鈥� said a study participant.

All women in the study planned to use a combination of intrinsic and extrinsic strategies, acknowledging that coping with labour would, at various points, involve both self-trust and autonomy, as well as external support.

鈥淭he intention is not to reject or stigmatise the use of pharmacological options, such as an epidural, but to present them as one component of a suite of extrinsic options available,鈥� Shifman said.

鈥淲e recognise a range of extrinsic options may help to re-centre a woman鈥檚 focus and enable her to re-engage with the intrinsic strategies as her labour progresses.鈥�

It is hoped that reframing coping strategies will encourage healthcare providers to prioritise women鈥檚 autonomy and enhance their birthing experience, rather than being framed by medical intervention.

鈥淲e鈥檙e hoping this will change the conversation and mindset from 鈥榶ou鈥檙e not coping anymore, so let me take over鈥� to 鈥榶ou鈥檙e not coping anymore, so let鈥檚 support you with what you need to get you back on track鈥�,鈥� Shifman said.

Image credit: iStock.com/guvendemir