Our findings showed that the mode of delivery influences the perceived control, the characteristics of the emotional experience, and the first moments with the newborn. These aspects revealed to be central for the construction of the delivery experience and to imagine a second pregnancy notably with detrimental aspects in the case of delivery by emergency caesarean section. The results highlighted also that women’s and health professionals’ representations played a key role in the construction of the delivery experience and sometimes led to a hierarchy based on the mode of delivery and the use of analgesia.
The impact of the mode of delivery remains highly controversial. According to Bryanton et al. , it is the most relevant predictor of birth satisfaction for women. The authors argue that elective caesarean section is less well experienced than the vaginal delivery attempt, emergency caesarean section included . In contrast, exactly the opposite was reported by Blomquist et al. . Wiklund et al.  reported that the scores of the personality variables were different depending on the mode of delivery. Thus, women in the vaginal delivery group increased their scores on anxiety and guilt scales, while those in the caesarean delivery group decreased their scores . Another study of the same authors about maternal request for elective caesarean section reported a better birth experience for these women compared to women planning a vaginal birth (p < 0.001) . For Rijnders et al. , instrumental vaginal delivery and emergency caesarean section can be negatively experienced, while spontaneous vaginal delivery and elective caesarean section have similar satisfaction scores. Other studies suggest a positive experience with spontaneous vaginal delivery because it is associated with a high perceived control level compared to instrumental vaginal delivery or caesarean section, and a higher feeling of accomplishment [9, 13]. These conflicting results highlight the complexity when studying the delivery experience. Most scientific investigations on the subject have been conducted using a quantitative questionnaire method. In this study, a qualitative approach was considered to be the most appropriate methodology to seek a better understanding of women’s representations about the mode of delivery. Face-to-face interviews can provide an environment in which it is easier to gain access to the women’s overall views on delivery and their way of thinking about the experience [21, 31].
Our results pointed to a significant effect of the feeling of being in control that was dependent on the mode of delivery. The concept of perceived control is defined by Wallston et al. as “the belief that one can determine one’s own internal states and behavior, influence one’s environment, and/or bring about desired outcomes. Two important dimensions of perceived control are delineated: (1) whether the object of control is located in the past or the future and (2) whether the object of control is over outcome, behavior, or process” . Perceived control is inevitably highly subjective. In addition, this perceived control was not static during labour and delivery and evolved according to the individual event sequence and response [2, 18, 33]. Indeed, women delivering by emergency caesarean section had the perception that everything was out of control, including the delivery and the first encounter with the baby. In this group, all women had a negative delivery experience, largely explaining their difficulties to imagine a second pregnancy. These women still described a feeling of emotional vulnerability six weeks after delivery including feelings of failure, regret, and disappointment. The mode of delivery clearly impacted on the first discovery moments of the baby. With vaginal delivery, mothers reported the importance of the sensory discovery of their newborn, while with caesarean section, they insisted on the frustration related to the absence of this sensory encounter .
The delivery-related pain experience is a complex phenomenon that can have a negative impact, but can also result in feelings of accomplishment. For some women, pain is an essential component of the delivery experience and provides a meaning to the transition to motherhood . Its absence can be considered as a loss of control . This hypothesis has been supported by Rijnders et al.  and Green  who have shown that women who managed their pain without analgesia have higher perceived control and are more satisfied than others. We observed the same phenomenon in our sample. The prevailing feeling associated with delivery without epidural was pride. The latter is constructed micro-socially. Indeed, the tone of the pain feeling is described by Le Breton as largely dependent on the meaning ascribed to it in response to cultural indications . This is why physical childbirth feelings may be absent for women who have no other choice than to deliver by caesarean section or unplanned epidural analgesia . During vaginal delivery, it appears important to let the woman decide when she needs to use analgesia. In this sense, our study provides some insight into the importance of the mode of delivery and its ability to sustain a form of social desirability through the control of analgesic techniques that it allows or not.
About the influence of the delivery mode, findings of Lilja et al.  allow us a casual hypothesis. They report 22% of women with depressive mood at 10 days post-partum and affirm that depressive mood in women at childbirth predicts their mood and relationship with infant and partner during the first year postpartum. This symptomatology near delivery should be investigated according to the delivery mode and our findings about the perceived control, women’s emotions and first moments with their baby.
Our findings highlight the importance of representations by both women and caregivers in the construction of the delivery experience. Women view the birth experience as a critical time of self-affirmation that is essential to their psychological well-being , and our results emphasize that the representations of primiparous women can be idealized. More or less strong expectations derive from these representations and their (in)consistency with the reality will determine the positive or negative perception of this birth experience . When the perception is negative, the risk of postpartum depression is increased [2, 41].
The women’s narratives suggested also that caregivers’ own representations influenced their attitudes and discourse with women, and therefore potentially affected the delivery experience. For example, although nearly one in three women deliver by caesarean section in Switzerland, similar to most industrialized countries, women reported that prenatal classes prepared them for vaginal delivery, but very little for the eventuality of a caesarean section. In addition, the caregivers’ personal opinion on the parental choice for mode of delivery was often reported as unwelcome, mainly for women who chose to deliver by caesarean section . Taken together, our results highlight the necessity to investigate the women’s representation and expectations before delivery in order to help them to make the best possible informed choice.
Some caregiver gestures or attitudes need to be carefully reconsidered and adapted in an attempt to try to compensate for the shortcomings experienced. In particular, it appears essential to consider women delivering by emergency caesarean section as particularly vulnerable and to provide a better accompaniment during the intervention and early postpartum.
We identified a number of recommendations for clinical practice (see list below “Recommendations for practice”). For example, we recommend to provide all women with an opportunity to talk about the experience of childbirth, and if possible the father. Indeed, sometimes it is the father who is traumatized by seeing things he would rather not see, e.g., forceps or vacuum. Callister  has highlighted the importance for the mother to share the delivery experience with a professional with expertise in technical aid as a preventive and therapeutic action. By virtue of their skills both in obstetrics and psychology, midwives would appear to be the best qualified to do this.
Recommendations for practice
Promote a reflection process on delivery representations among women and midwives
Prepare mother and father for a possible delivery by caesarean
Prepare women for a possible separation with their newborn so that they can implement compensating actions
Inform women about possible changes in sensory perceptions subsequent to epidural and endorphins during delivery
Identify and respond as much as possible to mother and father expectations
Let the woman take the initiative to ask for analgesia
Hide instruments (forceps, suction cups, scissors) from parents
Learn about the parents’ wishes concerning the possible exposure of maternal genital areas
In the case of caesarean section, ensure that parents can see their infant’s face immediately if the newborn clinical status allows it
Encourage the mother-infant sensory encounter as early as possible following caesarean section: lower the sterile towel so that the newborn can be seen entirely by the parents, establish a ‘skin-to-skin’ as soon as possible
In the case of caesarean section, offer fathers the possibility to perform the symbolic gesture of ‘cutting the cord’ during newborn care, and to do a ‘skin-to-skin’ with their infant when the mother is in the operating room
Create a postnatal discussion space with a specialized midwife to discuss delivery progress if necessary
Restore a feeling of being in control to women who did not feel it during the delivery from early postpartum
Pay particular attention to women who deliver by emergency caesarean section
Although our findings offer insight into the understanding of the construction of the delivery experience according to the mode of delivery, the limitations of its design and outcomes should be recognized. But the most notable is the common challenge of generalizing the results to other women or to other settings with qualitative methodology. It would be interesting to further investigate the role of delivery mode for the three identified components, the feeling of control, emotions and first moments with the newborn, in a larger sample with quantitative approach.
Indirectly through mother reporting, we have highlighted different roles that can be endorsed by fathers. They appear to adapt to the requests of their wife and the midwife, but the mode of delivery necessarily impacts on their role. Some women explained that their partner negatively experienced their presence at delivery, especially when it was instrumented. Their experiences should be collected in future qualitative researches for a better understanding of their experience and the possible psychological consequences . The citation of a participant perfectly illustrates this issue: ‘I think that there are not enough things for the dad, to allow him to talk about it. As the mum, we are made a fuss of, the one who gave birth, the one who can talk about it. The dad has just these mental images and it is very rare that somebody asks him “what was your experience?’ That’s also a study subject… » (Tania, instrumental vaginal delivery)