Pulled in different directions – The experiences of birth partners and care-providers when supporting women to implement what they learn in childbirth education classes

Background: Childbirth education (CBE) is often viewed as a singular intervention separate from the broader maternity system, meaning differences in effectiveness are attributed solely to the program delivered. Understanding the impact support people have on the translation of CBE techniques using Bowen theory as a wider systems-based lens, could offer important insights into the utilisation and effectiveness of CBE techniques. 

Aim: To examine how the functioning of birth partners and care-providers during labour, impacts the use of CBE strategies employed by women. 

Methods: In-depth, semi-structured interviews with 11 birth partners; and two focus groups with 12 care-providers, examined their experiences of supporting CBE techniques. Bowen family systems theory concepts were used as a guide for deductive analysis. 

Findings: Interpersonal and systemic pressures presented a challenge to maintaining CBE strategies, captured in the over-arching theme ‘Pulled in different directions’. Support in using CBE strategies transitioned along two continuums; ‘Positioned with self or other’ and ‘Dominance of thoughts or emotions’, highlighting the challenge of balancing supportive encouragement for CBE with pressure that limits their application. 

Discussion: Birth partners and care-providers are well positioned to help women utilise CBE techniques, but various factors impact their ability to do so. These factors largely relate to systemic pressures that impact inter-personal relations and subsequent individual responses. 

Conclusion: While birth partners and care-providers aim to support the use of CBE techniques, maternity system level factors leave them feeling ‘pulled in different directions’. This impacts their capacity to continue supporting their use throughout labour.