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From antenatal preparedness to enacted agency during labor: integrated findings from a woman-centered intervention on mobility
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INTRODUCTION Freedom of movement and upright positions during labor are recommended in maternity care, yet organizational routines may constrain women’s mobility, autonomy, and shared decision-making. This study examined how a womancentered antenatal intervention on mobility during labor operated and under which conditions its effects were enabled or constrained. METHODS A convergent mixed-methods study was conducted in community-based childbirth preparation programs in Portugal. Quantitative data were collected from low-risk nulliparous women at baseline (n=56), post-intervention (n=38), and postpartum (n=30), assessing emancipated decision-making, decision satisfaction, childbirth self-efficacy, birth beliefs, and childbirth experience. Semi-structured interviews were conducted with eight women and four nurse-midwives. Data were analyzed separately and integrated through joint display analysis and meta-inferences. RESULTS Satisfaction with decision-making improved significantly (3.66 vs 3.70, p<0.001), natural birth beliefs increased (4.14 vs 4.41, p<0.001), and medical birth beliefs decreased (3.74 vs 3.51, p=0.032). No significant antenatal changes were found in emancipated decision-making or childbirth self-efficacy. Women who remained mobile during labor reported higher overall childbirth experience (p=0.005), participation (p=0.011), own performance (p=0.011), and professional support (p=0.015). Qualitative findings showed acceptability and feasibility, highlighting experiential learning, bodily awareness, reflective preparation, and nurse-midwife facilitation as key mechanisms. Integrated findings suggested that antenatal measures primarily captured preparedness for action, whereas agency became more visible when women enacted mobility during labor. CONCLUSIONS The intervention may strengthen women’s preparedness to act regarding mobility during labor, but enacted agency appears to depend on intrapartum relational and organizational conditions.
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Agency Antenatal education Childbirth experience Decision-making Labor mobility
Contexto Educativo
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European Publishing