International Platform of Registered Systematic Review and Meta-analysis Protocols INPLASY Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 Downloaded from https://inplasy.com/inplasy-2022-4-0123/ Women´s experiences during PROTOCOL childbirth: a systematic review To cite: Gorina et al. Women´s experiences during childbirth: protocol a systematic review protocol. Inplasy protocol 202240123. doi: 10.37766/inplasy2022.4.0123 Gorina, M1; Lorente, S2; Vives, J3; Losilla, JM4. Review question / Objective: General aim of this systematic Received: 20 April 2022 review is to synthesize available evidence on women´s Published: 20 April 2022 experiences during childbirth in health institutions and formal care settings. Speci c objectives are to: 1. Describe women´s experiences during childbirth in Corresponding author: institutional health centers. Sonia Lorente Sánchez 2. Classify women´s experiences according to the Mother and Baby Friendly Birth Facility (MBFBF) criteria. sonia.lorente@uab.cat 3. Describe prevalence of these experiences across di erent countries and cultures. Author A liation: 4. Determine the impact of childbirth experiences on self- Department of Psychobiology perceived women's health on aspects related to physical, and Methodology in Health psychological and social domains. Sciences. Faculty of Condition being studied: This review will be framed within the Psychology. Universitat context of the Mother and Baby Friendly Birth Facility Autònoma de Barcelona. (MBFBF). Women´s experiences during childbirth will be classi ed according to the categories de ned by the MBFBF. Support: MICINN: Other actions or experiences, as interventionism or di erent PGC2018-100675-B-I00. procedures applied during childbirth, will be also analyzed (Mena-Tudela et al., 2020). Review Stage at time of this submission: Preliminary INPLASY registration number: This protocol was registered with searches. the International Platform of Registered Systematic Review and Meta-Analysis Protocols (INPLASY) on 20 April 2022 and was last Con icts of interest: updated on 20 April 2022 (registration number None declared. INPLASY202240123). INTRODUCTION 1. Describe women´s experiences during childbirth in institutional health centers. Review question / Objective: General aim 2. Classify women´s experiences according of this systematic review is to synthesize to the Mother and Baby Friendly Birth available evidence on women´s Facility (MBFBF) criteria. experiences during childbirth in health 3. Describe prevalence of these institutions and formal care settings. experiences across di erent countries and Speci c objectives are to: cultures. INPLASY Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 1 fl fi fi ffi fi ff fi ff ff 4. Determine the impact of childbirth speci c patient attributes; abandonment of experiences on self-perceived women's care and detention in facilities (Mena- health on aspects related to physical, Tudela, Cervera-Gasch, Alemany-Anchel, psychological and social domains. Andreu-Pejó, & González-Chordá, 2020; Miller & Lalonde, 2015). Within this Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 Downloaded from https://inplasy.com/inplasy-2022-4-0123/ Rationale: In the context of reproductive framework, this systematic review aims to health and quality of care, women have the synthesize available evidence on women´s right to have positive birth experiences. experiences during childbirth in health Quality of care involves speci c health institutions and formal care settings to facilities, skilled providers and e ective classify them according to the MBFBF interventions that ensure maternal and criteria when applicable, describe the child safety, but preventing deaths and prevalence of these experiences across disabilities during the pregnancy and di erent countries and culture, and identify delivery should be framed in a human the impact of these experiences on self- rights perspective (Miller & Lalonde, 2015; perceived women’s health on aspects OHCHR, 2010, 2012). Women have the legal related to physical, psychological and right to obtain information, to be treated social domains. Provided information will with dignity and respect, to be protected be helpful to understand women´s from unnecessary, unconsented or not perspectives during childbirth, proposing evidence-based practices, procedures, or strategies for improving women’s protocols interventions, to clari ed consent with the care, and map countries regarding possibility of refusal, receive professional childbirth practices. care and have access to the highest possible level of health with autonomy and Condition being studied: This review will be self-determination (da Silva, Marcelino, framed within the context of the Mother Rodrigues, Toro, & Shimo, 2014; Miller & and Baby Friendly Birth Facility (MBFBF). Lalonde, 2015; OHCHR, 2010, 2012; World Women´s experiences during childbirth will H e a l t h O rg a n i z a t i o n , 2 0 1 4 , 2 0 1 8 a ) . be classi ed according to the categories Moreover, positive women´s experiences de ned by the MBFBF. Other actions or undergoing labor are related to experiences, as interventionism or di erent motherhood adaptation and successful procedures applied during childbirth, will establishment of breastfeeding. Thus, be also analyzed (Mena-Tudela et al., 2020). women’s body integrity and their emotional welfare should be considered as a relevant METHODS quality care outcome for the public health (Al Adib Mendiri, Ibáñez Bernáldez, Casado Search strategy: 1 "Parturition" [Mesh] OR Blanco, & Santos Redondo, 2017; Sadler et "Natural Childbirth" [Mesh] OR "Trial of al., 2016). Aiming at classifying a healthcare L a b o r " [ M e s h ] O R " L a b o r, institution as being apt for attending O b s t e t r i c " [ M e s h ] O R " D e l i v e r y, mothers and newborns, a series of criteria Obstetric" [Mesh] OR obstetric* OR and indicators, i.e. the Mother and Baby childbirth* OR childbearing OR birth* OR Friendly Birth Facility (MBFBF), were parturition OR deliver* proposed by the World Health Organization 2 Perception* OR experience* OR view* OR (World Health Organization, 2014), along preference* OR perspective* OR with the International Federation of expectation* Gynecology and Obstetrics (Miller & 3 "Delivery Rooms" [Mesh] OR "Hospitals, Lalonde, 2015), the International Maternity" [Mesh] OR "Birthing Confederation of Midwives (ICM), the Centers" [Mesh] OR maternit* International Pediatric Association (IPA) 4 "Neoplasms" [Mesh] OR and the White Ribbon Alliance (WRA). This "COVID-19" [Mesh] OR "COVID-19 initiative is based on seven categories Va c c i n e s " [ M e s h ] O R " C O V I D - 1 9 identi ed as: Physical abuse; non- Testing" [Mesh] OR "COVID-19 Serological consented care; non-con dential care; Testing" [Mesh] OR "SARS-CoV-2" [Mesh] non-digni ed care; discrimination based on OR "SARS Virus" [Mesh] OR INPLASY Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 2 ff fi fi fi fi fi fi fi fi ff ff " Va c c i n e s " [ M e s h ] O R " S t u d e n t s , Study designs to be included: Empirical Nursing" [Mesh] OR "Students, Health primary studies as qualitative design Occupations" [Mesh] OR "Education, studies (e.g., phenomenology, grounded Medical, Graduate" [Mesh] OR theory, ethnography, interview studies), and "Contraception"[ Mesh] OR quantitative design studies (e.g., trials, Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 Downloaded from https://inplasy.com/inplasy-2022-4-0123/ "Biopsy" [Mesh] OR "Fertility" [Mesh] OR cross-sectional, cohorts, case-control) " F e r t i l i t y P re s e r v a t i o n " [ M e s h ] O R focus on reporting women's experiences "Abortion, Induced" [Mesh] OR "Abortion, during childbirth will be included.Case- Threatened" [Mesh] OR "Smoking" [Mesh] studies series; single-case studies; OR "Smoking Cessation" [Mesh] OR psychometric studies focus on developing "Alcoholics" [Mesh] OR "Self- or validating an instrument; guidelines; Testing" [Mesh] OR cancer* OR tumor* OR protocols; opinion reports, and letters to malignac* OR carcinom* OR COVID OR the editor will be excluded. SARS OR "SARS-CoV-2" OR "covid-19" OR "COVID-19" OR vaccin* OR breast* OR Eligibility criteria: Participants: Women who stakehold* OR provid* OR student* OR experienced childbirth in health institutions graduat* OR undergraduat* OR educat* OR across di erent countries and cultures will contracepti* OR biops* OR fertilit* OR be included. Providers, stakeholders, abort* OR smok* OR alcoh* OR test* students, health personnel will be 5 "Systematic Review" [Publication Type] excluded. Outcome/s: Experiences and OR "Review Literature as Topic" [Mesh] OR opinions of women´s who have "Meta-Analysis as Topic" [Mesh] OR experienced childbirth. Settings: Di erent "Guideline" [Publication Type] OR "Practice formal healthcare settings will be analyzed. Guideline" [Publication Type] OR "Practice Therefore, delivery rooms, birthing centers Guidelines as Topic" [Mesh] OR "Guidelines and maternity settings will be included. a s To p i c " [ M e s h ] O R " G u i d e l i n e Community services and health promotion Adherence"[Mesh] OR "Clinical and prevention settings will be excluded. Protocols" [Mesh] OR "Organizational Case Additional inclusion or exclusion criteria: Studies"[Mesh] OR "Case Filter 10 years, restricted by language Reports" [Publication Type] OR "Single- (English and Spanish). Case Studies as Topic" [Mesh] OR "Health Policy" [Mesh] OR "review*" OR Information sources: A systematic review "systematic review" OR "metareview" OR will be performed in PubMed, US National "meta-review" OR "metanalysis" OR Library of Medicine, by the National Center "meta-analysis" OR protocol* OR guidelin* for Biotechnology Information (NCBI); OR "case-stud*" OR "case-report" OR CINAHL, Cumulative Index to Nursing and "single-stud*" Allied Health Literature, by EBSCOhost; 6 #1 AND #2 AND #3 PsycINFO, Psychological Information, by 7 #1 AND #2 AND #3 NOT #4 Proquest; WOS (Web of Science CORE) by 8 #7 NOT #5 Thomson Reuters. In addition, ProQuest 9 Filter 10 years Dissertations &Theses Global and Google 10 Filter Language, English, Spanish. (up to 500 results) will be used for searching grey literature. Search will Participant or population: Women who consist of 3 lters composed of search experienced childbirth in health institutions terms for the following: 1) Childbirth (2) across di erent countries and cultures will Women´s experiences (3) Labor-related be included. Providers, stakeholders, settings. Additional group of terms students, health personnel will be preceded by the boolean operator NOT to excluded. improve the speci city of the search strategy will be added. All lters will be Intervention: None. adapted for all databases, and search a l e r t s w i l l b e s e t . To e n s u r e t h e Comparator: None. transparency of the search strategy we will follow the Preferred Reporting Items for INPLASY Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 3 ff ff fi fi fi ff reporting Literature searches in Systematic 2021) developed for extracting data Reviews (PRISMA-S) (Rethlefsen et al., (https://srdrplus.ahrq.gov/) will be used. 2021), and registering the searches in the Extracted information of each selected Open Science Framework (OSF) platform, a study will include: free open source project manager tool that a) General information: author, year, Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 Downloaded from https://inplasy.com/inplasy-2022-4-0123/ allows to manage les and sharing country of origin of papers. information (https://osf.io/). b) Methodological data: design, aim/s of the study; year of data collection; protocol Main outcome(s): Main outcomes will be re g i s t e re d ; s a m p l i n g m e t h o d ; d a t a related to the classi cation of women´s collection method; validated questionnaires experiences during childbirth in labor when applicable, type of intervention when health formal settings according to the applicable. Mother and Baby Friendly Birth Facility c) Sample characteristics: mean/range age (MBFBF) criteria; description of the of participants, gestational age, race/ prevalence of these experiences across ethnicity, education level, marital status, di erent countries and cultures, and employment status, gravidity, parity, type of description of the impact of these birth (eutocic/dystocic); if dystocic, type of experiences on self-perceived women´s intervention professional who attend the health on aspects related to physical, birth; companion during birth. psychological and social domains. d) Healthcare institution characteristics: Provided information will be helpful to number of health institutions involved; propose strategies aiming at improving source of payment (public, private or women’s care protocols, considering their mixed); health care system model; expectations and wishes, with respect for geographic region, income level of the the timing and the natural process of region, and Baby-Friendly accreditation. childbirth. e) Childbirth practices or routines, e.g. food deprivation, restriction of mobility, or Additional outcome(s): None. multiple vaginal examinations (do Nascimento et al., 2016). Data management: References identi ed f) Women´s experiences classi ed into the by the search strategy will be entered into seven categories of MBFBF by using the Mendeley bibliographic software, and Disrespect and Abuse scale proposed by duplicates will be removed automatically. Ghimire et al. (2021). Those experiences Duplicates will be also removed by that would not be able to be classi ed in handsearching when applicable. Titles and these categories will be also reported abstracts will be screened independently establishing a new categorization. by two reviewers (with a third reviewer g) Impact of these experiences on self- where necessary). When decisions are perceived women´s health on physical, unable to be made from title and abstract psychological and social domains, e.g alone, the full paper will be retrieved. Full- physical injured, mood disturbances, or text inclusion criteria will be screened impaired sexuality These experiences may independently by two reviewers. be classi ed as Garcia (2020) proposed. Discrepancies during the process will be Those experiences that would not be able resolved through discussion (with a third to be classi ed will be also reported reviewer where necessary). Reference lists establishing a new categorization. of included articles will be manually screened to identify additional studies and Quality assessment / Risk of bias analysis: authors of eligible studies will be contacted Risk of bias (RoB) of the included studies to provide missing or additional data if will be assessed. Tools proposed by the necessary. Agreement between reviewers Joanna Briggs Institute (JBI) for quasi- during the study selection will be analyzed experimental studies (Tufanaru, Munn, by Cohen´s kappa (Cohen, 1960). Aromataris, Campbell, & Hoop, 2017), Systematic review data repository (SRDR) randomized controlled trials (Tufanaru, (Brown Evidence-based Practice Center, Munn, Aromataris, Campbell, & Hopp, INPLASY Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 4 ff fi fi fi fi fi fi fi 2017), cross-sectional and cohort studies geographic and income level of the (Moola et al., 2017), and qualitative studies regions, because these characteristics may (Lockwood, Munn, & Porrit, 2015) will be determine the available health facilities used. RoB will be assessed by two (Perrotte, Chaudhary, & Goodman, 2020); e) independent reviewers. Agreement during professional that attend the delivery, as Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 Downloaded from https://inplasy.com/inplasy-2022-4-0123/ the RoB assessment process will be depending on the professional category analyzed by Cohen´s kappa (Cohen, 1960). (e.g nurse, midwife, physician) di erent No studies will be excluded due to high procedures and practices are conducted RoB, but this will be considered in (Terán, Castellanos, González Blanco, & conclusions. To maximize quality of Ramos, 2013); f) companion (partner or reporting of this systematic review protocol family), as the emotional support may we will follow the Preferred Reporting provide a more satisfactory experience of Items for Systematic Reviews and Meta- birth (Pereira Rodrigues et al., 2018); g) Analysis Protocols Guidelines (PRISMA-P) Baby Friendly institution accreditation, as (Moher et al., 2015). To maximize the quality this initiative supports the maternity and of reporting of the systematic review we promotes breastfeeding, ensuring that will follow the Preferred Reporting Items quali ed midwifes and professionals have for Systematic Reviews and Meta-Analysis the strong foundation of knowledge Guidelines (PRISMA)(Page et al., 2021). needed to support families (World Health Organization, 2018b). Strategy of data synthesis: Data summaries will be presented in gures and tables. Sensitivity analysis: Sensitivity analyses will Narrative synthesis will be adopted. The be performed using relevant synthetized results will be organized based methodological characteristics, as design, on major aspects including description of sampling, data collection method, or risk of general bibliographic data, methodological bias (RoB). data, sample characteristics, healthcare institution characteristics, childbirth Language: Only documents published in practices or routines, women´s English or Spanish will be considered for experiences during the childbirth and inclusion. classi cation of these experiences within the framework of MBFBF criteria, impact of Country(ies) involved: Spain. childbirth experiences on self-perceived women's health on aspects related to Keywords: Childbirth practices, Obstetric physical, psychological and social violence, Labor-related settings, Women´s domains. The synthesis will address experiences, Systematic review. limitations, strengths and recommendations for further research and Dissemination plans: Results will be clinical practices. disseminated by its publication in a peer- reviewed journal and presented at a Subgroup analysis: Subgroup analysis will relevant conference. compare and women´s experiences according to: a) year of collecting data, Contributions of each author: because of the time-period evolution of the Author 1 - Marta Gorina conceived, violence obstetric concept (Sadler et al., designed and coordinated the review. She 2016; World Health Organization, 2014) b) will manage data collection; data healthcare attention, public, private or management; analysis of data; mixed, as the source of payment may interpretation data; writing the protocol determine di erent insurance plans (Leal et and the review manuscript. al., 2018; Mena-Tudela et al., 2021); c) Email: martagorina@euit.fdsll.cat health care system model according to the Author 2 - Sonia Lorente conceived, geographic region, because health facilities designed and coordinated the review. She may be di erent across cultures (Leal et al., will manage data collection; data 2018; Mena-Tudela et al., 2021) d) management; analysis of data; INPLASY Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 5 fi fi ff ff fi ff interpretation data; writing the protocol (2018). Perception of nurse midwives on and the review manuscript. obstetric violence. Cogitare Enfermagem, 23(2), Email: sonia.lorente@uab.cat e52473. https://doi.org/10.5380/ce.v23i1.52473 Author 3 - Jaume Vives conceived, Lockwood, C., Munn, Z., & Porrit, L. (2015). designed and coordinated the review. He Qualitative research synthesis:methodological Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 Downloaded from https://inplasy.com/inplasy-2022-4-0123/ guidance for systematic reviewers utilizing will manage data collection; data meta-aggregation. International Journal of management; analysis of data; Evidence-Based Healthcare, 13(3), 179–187. interpretation data; writing the protocol Mena-Tudela, D., Cervera-Gasch, A., Alemany- and the review manuscript. Anchel, M. J., Andreu-Pejó, L., & González- Email: jaume.vives@uab.cat Chordá, V. M. (2020). Design and validation of Author 4 - Josep-Maria Losilla conceived, the PercOV-S questionnaire for measuring designed and coordinated the review. He perceived obstetric violence in nursing, will manage data collection; data midwifery and medical students. International management; analysis of data; Journal of Environmental Research and Public interpretation data; writing the protocol Health, 17(21), 1–12. https://doi.org/10.3390/ and the review manuscript. ijerph17218022 Email: josepmaria.losilla@uab.cat Mena-Tudela, D., Iglesias-Casás, S., González- Chordá, V. M., Valero-Chillerón, M. J., Andreu- Pejó, L., & Cervera-Gasch, Á. (2021). Obstetric References: Al Adib Mendiri, M., Ibáñez violence in Spain (Part III): Healthcare Bernáldez, M., Casado Blanco, M., & Santos professionals, times and areas. International Redondo, P. (2017). La violencia osbtétrica: Un Journal of Environmental Research and Public fenómeno vinculado a la violación de los H e a l t h , 1 8 ( 7 ) . h t t p s : / / d o i . o rg / 1 0 . 3 3 9 0 / derechos elementales de la mujer. Medicina ijerph18073359 Legal de Costa Rica, 34(1). Miller, S., & Lalonde, A. 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World Health Organization. (2014). The prevention and elimination of disrespect and abuse during facility-based childbirth. World Health Organization. (2018a). Intrapartum care for a positive childbirth experience. World Health Organization. (2018b). Protecting, promoting and supporting breastfeedin in facilities providing maternity and newborn services: The revised BaBy-Friendly Hospital Initiative. Geneva. https://doi.org/ 10.1002/9780470935576.ch7. INPLASY Gorina et al. Inplasy protocol 202240123. doi:10.37766/inplasy2022.4.0123 7 ff