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Birth Trauma: in the Eye of the Beholder Critique

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The phenomenon of interest (birth trauma and what it means to women) was clearly identified in the report. In the introduction the authors stated that women’s perception of birth trauma is quite different from the perception of the same phenomenon by health care providers. She also uses a term “in the eyes of the beholder” to emphasize that for every woman this phenomenon is unique. It is stated that PTSD after childbirth is quite prevalent and several studies support this fact. However, research is regarding the understanding of the birth trauma phenomenon from the woman’s experience lacking. The problem statement was worded clearly and directly and I wasn’t ambivalent about what problem will be discussed in the remainder of the article.
Due to a lack of current literature on the subject and prevalence of PTSD after childbirth one can see the value in conducting such a study and the potential benefit to the profession of nursing. By understanding the perception of birth trauma to women, we as nurses will be able to facilitate better care, improve patients’ experience with childbirth, and prevent PTSD associated with childbirth.
The methods used are not mentioned in the first paragraph but in a separate section following the research question where they are outlined clearly. The method of interviewing participants in focus groups is consistent with the naturalistic paradigm of qualitative research.
The researcher clearly explained the reason behind choosing a qualitative design and the philosophical underpinning of the study. Husserl’s descriptive phenomenology was the philosophical underpinning of this study. Phenomenological research is centered on the investigation of the description of the lived experience (Beck, 2012). It is a process where one learns and constructs meaning of the human experience through the discourse of those that are living the experience. In the current study the goal was to establish the “lived-in” experience of the women that underwent traumatic childbirth and is congruent with design and choice of philosophical underpinning.
Beck clearly described how participants were selected. The aim of the study was for women who had experienced traumatic childbirth. Therefore, all participants were women who experienced this phenomenon. The purposeful sample consisted of 40 mothers who perceived they had experienced birth trauma. In addition, the sample required the mother to be willing to articulate her experiences and ability to read and write English. In this study, Beck (2004) stated that the participants were recruited via Internet primarily from Trauma and Birth Stress, a charitable trust located in New Zealand. This self-help organization supports women who have experienced birth trauma and educates about birth trauma and the resulting PTSD (Beck, 2004).
Although, the researcher does not describe the study’s significance to nursing directly, I believe it is pertinent to nursing practice. This study educates health care providers in birth trauma and because nurses play a crucial role in labor, the results of this study can be used as a foundation for evidence- based practice. In this phenomenological study, it was shown that the mother’s perception of the birth trauma is based not only on the birth event, but also on the unmet expectations of the women during birth. This finding illustrates the need for nurses to play a proactive role in preventing birth trauma by enhancing a woman’s’ sense of control over the birth. It also shows that it’s crucial to establish an empathetic relationship and be with the woman during experience, facilitate interaction between the woman and the members of the team, and provide anticipatory guidance regarding labor experience.
A descriptive phenomenology approach utilized for this is appropriate for its’ purpose. Data analyses in qualitative studies involve examining words obtained throughout the research. The author explicitly explained the procedures for collecting the data. Members of TABS were informed of the study by a pocket with two letter sent to each of them by mail from the chairperson of TABS. One letter informed members of a study. The researchers wrote the second letter explaining the role of the woman in the study and the research program. Several women sent their personal journals chronicling their traumatic birth experiences and the PTSD. Most of the participants chose to participate over the Internet and sent their story as an attachment. In phenomenological studies, in-depth conversations are the main data source. Researchers help informants to describe lived experiences without leading the discussion (Beck, 2012). In my opinion it was fully achieved with the use of personal stories and personal journals.
As was mentioned above, the data collection focused on human experience and I believe the subjects were protected in this study. This study was approved by university’s institutional review board and participants were provided with informed consent.

The author used Colaizzi’s method of data analysis. She did a great job explaining the procedures used to analyze the data. The analysis of the data in this study began with the reading of the stories and journals. The researcher extracted significant statements and formulated the meanings for those statements. The information was then further broken down into cluster of 4 themes. The process of saturation was reached when no further categories could be formed. Then, the findings were integrated into description of phenomenon and validated by nine participants. The rationale for not including all participants for validation was explained in the report and was that some of the women did not want to relive their experiences. All reviewers agreed that the results reflected the essence of their birth trauma experience, which shows the credibility of the study.
After the completion of data analysis and saturation had been reached, a subsequent description of the phenomena was developed. Beck developed a table to aid in the understanding of the research findings. The table also facilitates better understanding of each theme by illustrating each theme with significant statements made by participants. The study supported the findings of numerous prior research studies. However the forth’s theme, the feeling of being raped, has never been mentioned in research before. The research concluded that traumatic birth experience may be caused by poor care, lack of empathy and communication, feeling of powerlessness and loss of control, and feeling raped when physicians disregard woman’s state and concentrate only on the successful outcomes of clinical efficiency and live healthy infant (Beck, 2004).
Many recommendations were made for clinicians to have a proactive role in preventing PTSD after childbirth. In this study, it was revealing some women experienced loss of control. The author recommended that clinicians should strive to enhance a woman’s sense of control by offering her options when possible. This study showed that women often felt that clinicians focused exclusively on a positive outcome for the baby regardless of mother’s emotional and physical experience. The author asserts that obstetric care providers need to discuss with the women the means of delivery, and not just the outcome. Women’s perception of birth trauma can be based not only on the event, but also on their unmet expectation regarding the event. Often times women feel scared and panicky if their anticipated births plan changes. Clinicians need to address the women’s unmet expectations regarding their anticipated labor process. Careful history about particular fears a woman may have about giving birth at the admission. If a woman had a previous delivery, a through history about her previous experience must be taken and questions on whether the previous deliveries were perceived as traumatic. This can help clinicians to identify any possible contributing factors to birth trauma and alert the team to address certain factors with a special care.
Qualitative research studies provide an invaluable perspective that concentrates on participants’ own personal perspectives and experiences. Beck (2004) examined women’s perceptions regarding birth trauma. This critique reviewed the study using several criteria to analyze a qualitative study. Some of the guidelines utilized include assessment of the use of a qualitative approach for the research, the determination of purposive sample, methods used to avoid researcher bias, and the clarity of the study findings. The critique found that all these criteria had been addressed in the study. References
Beck, C. (2004). Birth trauma: in the eye of the beholder. Nursing Research, 53(1), 28-35. Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for nursing practice (9th ed.). Philadelphia: Lippincott Williams.…...

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